CASE 1: Artificial Intelligence in Primary Care: Implementing New Technology into Existing Systems

The Digital Health Bureau has received funding from the province to develop projects focused on improving telemedicine. The Department of Health Analytics has been instructed by the Digital Health Bureau to use the funding to improve the use of electronic medical records in response to the COVID-19 pandemic. Noor Grewal, a public health liaison officer, has been tasked with determining the best option for electronic medical record integration to address key public health needs in primary care. Currently, the Department of Health Analytics is focused on advocating for the use of artificial intelligence in health care and wants to use this funding opportunity to integrate an artificial intelligence-enabled tool into the province’s certified electronic medical record systems. Noor has narrowed down the top concerns in primary care and searched for artificial intelligence tools that have the potential to solve the identified problems. She has a meeting to provide her recommendations to Damon Miller, the Director of Strategy and Planning, in one week. This case highlights the importance of setting decision making criteria and critically evaluating all evidence before making a decision that has the potential to impact the health of the entire population of the province

Potato Protein Isolate Stimulates Muscle Protein Synthesis at Rest and with Resistance Exercise in Young Women

Skeletal muscle myofibrillar protein synthesis (MPS) increases in response to protein feeding and to resistance exercise (RE), where each stimuli acts synergistically when combined. The efficacy of plant proteins such as potato protein (PP) isolate to stimulate MPS is unknown. We aimed to determine the effects of PP ingestion on daily MPS with and without RE in healthy women. In a single blind, parallel-group design, 24 young women (21 ± 3 years, n = 12/group) consumed a weight-maintaining baseline diet containing 0.8 g/kg/d of protein before being randomized to consume either 25 g of PP twice daily (1.6 g/kg/d total protein) or a control diet (CON) (0.8 g/kg/d total protein) for 2 wks. Unilateral RE (~30% of maximal strength to failure) was performed thrice weekly with the opposite limb serving as a non-exercised control (Rest). MPS was measured by deuterated water ingestion at baseline, following supplementation (Rest), and following supplementation + RE (Exercise). Ingestion of PP stimulated MPS by 0.14 ± 0.09 %/d at Rest, and by 0.32 ± 0.14 %/d in the Exercise limb. MPS was significantly elevated by 0.20 ± 0.11 %/d in the Exercise limb in CON (p = 0.008). Consuming PP to increase protein intake to levels twice the recommended dietary allowance for protein augmented rates of MPS. Performance of RE stimulated MPS regardless of protein intake. PP is a high-quality, plant-based protein supplement that augments MPS at rest and following RE in healthy young women

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

OBJECTIVE: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. METHODS: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives. RESULTS: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits. CONCLUSIONS: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted

Chronic Inflammation as the Mechanistic Link between Type 2 Diabetes Mellitus and Alzheimer's Disease

Recent research has identified type 2 diabetes mellitus (T2DM) as a risk factor for neurodegenerative disorders such as Alzheimer’s disease (AD). However, the mechanisms involved in this interaction still remain unclear. Chronic neuroinflammation caused by activation of glial cells in the brain contributes to neuronal loss and disease progression in AD. This thesis investigated if chronic inflammation could be a mechanistic link responsible for increasing the risk of AD in individuals with T2DM. Specifically, I hypothesized that high levels of glucose and the phenomenon of insulin resistance observed in T2DM could accelerate neuronal loss and eventually lead to AD by increasing glial cell activation and/or enhancing neuronal injury caused by disease-specific agents. Since astrocytes are the most abundant glial cell type in the brain, in vitro experiments were conducted using primary human astrocytes and U-118 MG human astrocytic cells as models of primary astrocytes. I found that supernatants of astrocytic cells incubated in high glucose (30.5 mM) were more toxic to neuronal cells pre-treated with high glucose compared to supernatants of astrocytic cells incubated in low glucose (5.5 mM). High glucose increased mRNA expression of the pro-inflammatory cytokine interleukin (IL)-6 and enhanced secretion of both IL-6 and IL-8 by all astrocytic cells. Data obtained indicated that increased activation of the p38 mitogen activated protein kinase (MAPK) may be mediating the effects of high glucose in astrocytic cells. In addition, high glucose increased the susceptibility of undifferentiated human SH-SY5Y neuronal cells and retinoic-acid differentiated SH-SY5Y cells to injury by hydrogen peroxide and fibrillar amyloid beta-42 protein (Aβ42), respectively. Human primary glial cells and astroglial cell lines expressed the insulin receptor (INSR) and its signaling components. Moreover, insulin was found to modulate secretion of pro-inflammatory cytokines by primary human astrocytes with 1nM insulin concentration causing maximum enhancement of IL-6 and IL-8 secretion. Therefore, high glucose and insulin levels in T2DM could contribute to an early appearance of AD-like symptoms by increasing glial cell-mediated inflammation. This research highlights novel mechanisms responsible for AD progression and could help identify new preventative and treatment strategies for AD.Arts and Sciences, Irving K. Barber School of (Okanagan)Biology, Department of (Okanagan)Graduat