Integration of Th17- and Lymphotoxin-Derived Signals Initiates Meningeal-Resident Stromal Cell Remodeling to Propagate Neuroinflammation.

Tertiary lymphoid tissues (TLTs) have been observed in the meninges of multiple sclerosis (MS) patients, but the stromal cells and molecular signals that support TLTs remain unclear. Here, we show that T helper 17 (Th17) cells induced robust TLTs within the brain meninges that were associated with local demyelination during experimental autoimmune encephalitis (EAE). Th17-cell-induced TLTs were underpinned by a network of stromal cells producing extracellular matrix proteins and chemokines, enabling leukocytes to reside within, rather than simply transit through, the meninges.

Employment and Income of People Who Experience Mental Illness and Homelessness in a Large Canadian Sample.

Objectives: Research suggests that homeless people with mental illness may have difficulty obtaining employment and disability benefits. Our study provides a comprehensive description of sources of income and employment rates in a large Canadian sample.

Methods: Participants (n = 2085) from the 5 sites of the At Home/Chez Soi study were asked about their income, employment, and desire for work during the pre-baseline period.

Sphingosine-1-Phosphate Signaling Regulates Myogenic Responsiveness in Human Resistance Arteries.

We recently identified sphingosine-1-phosphate (S1P) signaling and the cystic fibrosis transmembrane conductance regulator (CFTR) as prominent regulators of myogenic responsiveness in rodent resistance arteries. However, since rodent models frequently exhibit limitations with respect to human applicability, translation is necessary to validate the relevance of this signaling network for clinical application. We therefore investigated the significance of these regulatory elements in human mesenteric and skeletal muscle resistance arteries.

The association between visiting a primary care provider and uptake of periodic mammograms as women get older.

Objective: To determine whether visits to a primary care provider (PCP) are associated with the uptake of periodic mammograms as women get older.

Methods: The cohort consisted of 2,389,889 women resident in Ontario, Canada, aged 50 to 79 at any point from 2001 to 2010, who were cancer-free and eligible for the Ontario Health Insurance Plan prior to study entry. Non-parametric estimation was used to describe the mean cumulative number of periodic mammograms for women with and without recent exposure to a PCP, as a function of age.

Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study.

Purpose: Increasingly, very old patients are admitted to Intensive Care Units (ICUs). The objective of this study was to describe 12-month outcomes of these patients and determine which characteristics are associated with a return to baseline physical function 1 year later.

Methods: In this prospective cohort study in 22 Canadian hospitals, we recruited 610 patients aged 80 years or older who were admitted to ICU for at least 24 h.

Qualitative Study Exploring the Meaning of Knee Symptoms to Adults Ages 35-65 Years.

Objective: While osteoarthritis (OA) has mainly been viewed as a disease affecting older people, its prevalence in younger adults is substantial. However, there is limited research on how younger adults understand knee symptoms. This article explores the meaning of knee symptoms to adults ages 35-65 years.

Primary Care Practice Reports: Administrative Data Profiles for Identifying and Prioritizing Areas for Quality Improvement.

Information to help guide quality improvement activities in primary care should be readily available, routinely updated and include comparisons across groups, regions and jurisdictions. Primary care practice reports, developed jointly by the Institute for Clinical Evaluative Sciences and Health Quality Ontario, is one such effort. These data include practice demographics, the prevalence of common chronic conditions, the use of health services and measures of chronic disease prevention and management.

Dr. Bernard Langer - inductee into the Canadian Medical Hall of Fame.

Dr. Bernard Langer's induction into the Canadian Medical Hall of Fame acknowledges his profound effect on medicine and surgery in Canada and an impact that has been truly international. In this brief biography, we highlight the major accomplishments that have made Dr.

Admission of the very elderly to the intensive care unit: family members' perspectives on clinical decision-making from a multicenter cohort study.

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit.

Aim: To describe family members' perspectives about care provided to very elderly critically ill patients.

Design: Multicenter, prospective, cohort study.

Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada.

Background: Most Canadian newcomers are admitted in the economic, family, or refugee class, each of which has its own selection criteria and experiences. Evidence has shown various risks for mental health disorders across admission classes, but the respective service-use patterns for people in these classes are unknown. In this study, we compared service use for nonpsychotic mental health disorders by newcomers in various admission classes with that of long-term residents (i.

Two cases of arteriovenous fistula formation between the external iliac vessels following endovenous laser therapy.

Minimally invasive treatment of varicose veins is becoming increasingly popular with both patients and physicians. Endovenous laser therapy has been shown to be safe and effective but the rare complication of iatrogenic creation of arteriovenous fistulas has been described. One case of fistulation between the external iliac artery and vein has been published.

Association between survival and early versus later rhythm analysis in out-of-hospital cardiac arrest: do agency-level factors influence outcomes?

Study Objective: Effectiveness of a resuscitation strategy may vary across communities. We hypothesize that a strategy that prioritizes initial emergency medical services (EMS) rhythm analysis (analyze early) will be associated with survival advantage among EMS systems with lower baseline (pretrial) ventricular fibrillation survival, whereas a strategy that prioritizes initial EMS cardiopulmonary resuscitation (analyze late) will be associated with survival advantage among systems with higher ventricular fibrillation baseline survival.

Methods: We conducted a secondary, post hoc study of a randomized trial of out-of-hospital cardiac arrest.

Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers.

Background And Objectives: Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy.

Trends in HIV prevalence, new HIV diagnoses, and mortality among adults with HIV who entered care in Ontario, 1996/1997 to 2009/2010: a population-based study.

Background: Population-based estimates of HIV prevalence, rates of new HIV diagnoses, and mortality rates among persons with HIV who have entered care are needed to optimize health service delivery and to improve the health outcomes of these individuals. However, these data have been lacking for Ontario.

Methods: Using a validated case-finding algorithm and linked administrative health care databases, we conducted a population-based study to determine the prevalence of HIV and rates of new HIV diagnoses among adults aged 18 years or older in Ontario between fiscal year 1996/1997 and fiscal year 2009/2010, as well as all-cause mortality rates among persons with HIV over the same period.

Serious preeclampsia among different immigrant groups.

Objective: Research conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish between immigrant and non-immigrant women; they also included women with mild PET arising near term, the clinical importance of which is debatable. We created the term "serious PET" to describe a diagnosis of severe PET, eclampsia, or any degree of PET with concomitant preterm delivery, fetal death, or maternal hospitalization of seven days or more, and evaluated its risk in association with world region of origin among recent immigrants to Ontario.

Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia: overlap of clinical features.

Purpose Of Review: Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia all phenotypically present with the same features because they are subject to the operation of similar mechanistic factors. However, the conditions referred to above differ by which mechanism dominates the cause of the clinical condition. This review discusses the overlap and differences, which distinguish as well as unite these different conditions and allow a rationale for treatment.

An exploratory analysis of factors associated with weight change in a 16-week trial of oral vs. orally disintegrating olanzapine: the PLATYPUS study.

Background: We conducted exploratory analyses of the data from a multinational, randomised study to identify factors associated with weight change after 16 weeks of treatment with standard olanzapine tablets (SOT) or sublingual orally disintegrating olanzapine (ODO).

Methods: One hundred and forty nine outpatients who gained weight during prior SOT therapy were enrolled into the study and treated with ODO (N = 84) or SOT (N = 65). Exploratory analyses were conducted with the subset of compliant patients (ODO: n = 60; SOT: n = 47).

The gatekeeper system and disparities in use of psychiatric care by neighbourhood education level: results of a nine-year cohort study in toronto.

Background: In Ontario, psychiatric care is fully covered by provincial health insurance without co-payments or deductibles. The provincial fee schedule supports a "gatekeeper" system for psychiatric care by paying psychiatrists more for consultations with patients who have a physician referral. In this context, we sought to explore socio-economic differences in patterns of mental health service delivery.