Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial

Article evaluating whether advanced prostheses can provide better safety and performance capabilities to maintain and improve quality of life in individuals who are predominantly designated MFCL level K2. This study used a 13 month longitudinal clinical trial to determine the benefits of using a C-Leg and 1M10 foot in individuals at K2 level with transfemoral amputation due to vascular disease

A Protocol for the Secure Linking of Registries for HPV Surveillance

In order to monitor the effectiveness of HPV vaccination in Canada the linkage of multiple data registries may be required. These registries may not always be managed by the same organization and, furthermore, privacy legislation or practices may restrict any data linkages of records that can actually be done among registries. The objective of this study was to develop a secure protocol for linking data from different registries and to allow on-going monitoring of HPV vaccine effectiveness.A secure linking protocol, using commutative hash functions and secure multi-party computation techniques was developed. This protocol allows for the exact matching of records among registries and the computation of statistics on the linked data while meeting five practical requirements to ensure patient confidentiality and privacy. The statistics considered were: odds ratio and its confidence interval, chi-square test, and relative risk and its confidence interval. Additional statistics on contingency tables, such as other measures of association, can be added using the same principles presented. The computation time performance of this protocol was evaluated.The protocol has acceptable computation time and scales linearly with the size of the data set and the size of the contingency table. The worse case computation time for up to 100,000 patients returned by each query and a 16 cell contingency table is less than 4 hours for basic statistics, and the best case is under 3 hours.A computationally practical protocol for the secure linking of data from multiple registries has been demonstrated in the context of HPV vaccine initiative impact assessment. The basic protocol can be generalized to the surveillance of other conditions, diseases, or vaccination programs

Mesurer la santé mentale positive au Canada : validation des concepts du Continuum de santé mentale – Questionnaire abrégé

Introduction : La santé mentale positive est de plus en plus reconnue comme un élément central des politiques et des programmes en matière de santé publique. On a déterminé au Canada que le Continuum de santé mentale - Questionnaire abrégé (CSM-QA) constituait un outil de mesure prometteur qu'il fallait intégrer aux enquêtes d'évaluation de la santé mentale positive de la population. Ce questionnaire vise à évaluer un modèle à trois facteurs de santé mentale positive : le bien-être émotionnel, le bien-être social et le bien-être psychologique. Cette étude a pour but de déterminer si le CSM-QA offre une mesure adéquate de la santé mentale positive des Canadiens adultes. Méthodologie : Nous avons réalisé une analyse factorielle confirmatoire (AFC) à l'aide des données de l'Enquête sur la santé dans les collectivités canadiennes - Santé mentale de 2012 (ESCC-SM). Nous avons également effectué une validation croisée du modèle à l'aide des données de l'Enquête sur la santé dans les collectivités canadiennes - Composante annuelle (ESCC - Composante annuelle) de 2011-2012. Nous avons examiné la validité reliée à un critère dans le cadre d'analyses de corrélation entre les scores des sous-échelles du CSM-QA et les concepts positifs (comme la satisfaction à l'égard de la vie) et négatifs (comme la détresse psychologique) associés. Résultats : Nous avons confirmé la validité du modèle à trois facteurs du bien-être émotionnel, social et psychologique dans le cadre d'une AFC de deux échantillons distincts, et ce, après avoir intégré les quatre erreurs corrélées entre les questions relatives à l'échelle du bien-être social. Nous avons observé, comme prévu, des corrélations significatives entre le bien-être émotionnel, psychologique et social et les concepts associés. Le coefficient alpha de Cronbach était de 0,82 pour les sous-échelles du bien-être émotionnel et du bien-être psychologique et de 0,77 pour le bien-être social. Conclusion : Notre étude suggère que le CSM-QA permet de rendre compte du modèle à trois facteurs de la santé mentale positive de la population canadienne. Toutefois, la prudence est de mise lorsque l'on utilise l'échelle du bien-être social, qui ne s'est pas avérée aussi efficace que les autres facteurs, comme l'ont mis en évidence la nécessité d'ajouter plusieurs termes d'erreur corrélés afin d'obtenir un ajustement adéquat du modèle, le pourcentage plus élevé de données manquantes pour ces questions et les corrélations plus faibles avec les concepts connexes. Comme le bien-être social constitue un élément important d'une évaluation exhaustive de la santé mentale positive, la tenue d'autres recherches est recommandée

At-a-glance - Traumatic brain injury management in Canada: changing patterns of care

Introduction: With growing awareness about traumatic brain injuries (TBI), there is limited information about population level patterns of TBI care in Canada. Methods: We examined data from the Canadian Community Health Survey (years 2004, 2009, and 2014) among all respondents ages 12 years and older. TBI management characteristics examined included access to care within 48 hours of injury, point of care, hospital admission, and follow-up. Results: We observed that many Canadians sought care within 48 hours of their injury, with no changes over time. We found a significant decline in the proportion of Canadians opting to visit an emergency department (p = 0.03, all ages), and a significant increase in youth opting to visit a doctor’s office (p < 0.01). Conclusion: TBIs are an important and growing health concern in Canada. Care for such injuries appears to have shifted towards the use of health care professionals outside the hospital environment, including primary care doctors

Trends in antimicrobial resistance in neisseria gonorrhoeae isolated in Canada:2000-2009

Background: Canada conducts surveillance of penicillin, tetracycline, erythromycin, spectinomycin, ciprofloxacin, cefixime, and ceftriaxone susceptibilities in Neisseria gonorrhoeae isolates to support development of national treatment guidelines for sexually transmitted infections. Methods: N. gonorrhoeae isolates were collected by Canadian provincial public health laboratories and included isolates from males and females ranging in age from 1 to 86 years. Minimum inhibitory concentrations (MICs) were determined by agar dilution at the National Microbiology Laboratory, Public Health Agency of Canada, and MIC interpretations were based on the criteria of the Clinical Laboratory Standards Institute. RESULTS:: From 2000 to 2009, 40,875 isolates of N. gonorrhoeae were tested by provincial laboratories and 10,993 of these were characterized by the Public Health Agency of Canada. There was an increasing incidence of N. gonorrhoeae isolates that were chromosomally resistant to penicillin, tetracycline, and erythromycin while the plasmid-mediated resistance strains (penicillinase-producing N. gonorrhoeae, tetracycline-resistant N. gonorrhoeae, and PP/tetracycline-resistant N. gonorrhoeae strain all had a declining trend. The percentage of isolates resistant to ciprofloxacin significantly increased from 1.3% in 2000 to 25.5% in 2009. Only 0.17% of isolates tested were azithromycin resistant. Between 2000 and 2009, the modal MICs for ceftriaxone increased from 0.016 μg/mL to 0.063 μg/mL. Conclusions: Ciprofloxacin resistance in N. gonorrhoeae within Canada has increased to a level where quinolones are no longer the preferred drugs for the treatment of gonococcal infections and the modal MICs for the third-generation cephalosporins have increased over time. Close monitoring of antibiotic susceptibilities are required to inform treatment options

Aperçu - Prise en charge des traumatismes crâniens au Canada : évolution des tendances en matière de soins

Introduction : Malgré une plus grande sensibilisation aux traumatismes crâniens, nous disposons de peu de renseignements à l’échelle de la population sur les types de soins prodigués en lien avec les traumatismes crâniens au Canada. Méthodologie : Nous avons examiné les données de l’Enquête sur la santé dans les collectivités canadiennes (années 2005, 2009 et 2014) portant sur les répondants de 12 ans et plus. Les variables sélectionnées en lien avec la prise en charge des traumatismes crâniens ont été l’accès à des soins dans les 48 heures suivant la blessure, le point de service, l’admission à l’hôpital et les soins de suivi. Résultats : Nous avons constaté qu’un grand nombre de Canadiens avaient bénéficié de soins médicaux dans les 48 heures suivant leur blessure, sans changement dans cette proportion au fil du temps. Nous avons aussi observé un déclin significatif de la proportion de Canadiens ayant décidé de se rendre au service des urgences (p = 0,03, tous âges confondus) et une augmentation significative du nombre de jeunes ayant décidé de consulter un médecin (p < 0,01). Conclusion : Les traumatismes crâniens sont un problème de santé important et en augmentation au Canada. Ces blessures semblent de plus en plus être traitées par des professionnels de la santé en dehors des hôpitaux, en particulier par des médecins de première ligne

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Not AvailablePolyploidization plays an important role in the genesis of cultivated wheat (hexaploid and tetraploid) fromits diploid progenitors. Thus, evolution during polyploidization resulted in present-day hexaploid bread wheat. GS2 and Fd-GOGAT enzymes are core components involved in the assimilation of primary nitrogen (N) in plants. In the present study, we aimed to analyze these two important genes at their molecular level to find the extent of variation that occurred during evolution from the ancient diploid progenitors to the modern-day hexaploid bread wheat. Furthermore, we studied their gene expression pattern and assayed both the enzymes under N stress. We also investigated the degree of resilience among these species in terms of certain important morphophysiological and biochemical parameters under N stress. Comparison of the genomic sequences along with their promoter region revealed that both GS2 and Fd-GOGAT genes were located on chromosome 2 and were comprised of 13 and 33 exons respectively. A limited sequence divergence at cDNA and amino acid levels was observed among the genome species, but the divergence was significantly higher in the promoter region. Both these genes were present in three copies in the bread wheat, two copies in the durum wheat, and a single copy in their diploid progenitors. Differential gene expression among the five genome species under N stress suggested major differences in gene regulation due to the difference in cis-elements. Enzyme activity did not correlatewith the gene expression level probably due to post-transcriptional and post-translationalmodification of the enzymes. There was neither correlation between the GS2 and Fd-GOGAT activity in any species. All growth parameters, except root length, decreased or remain unchanged with different degrees of plasticity in the genotypes under N stress and correlated with reduced Fd-GOGAT activity, which supply the primary assimilate glutamate. GS2/Fd-GOGAT enzyme activity along with total N accumulation, protein, chlorophyll, and carotenoid content in shoot were found responsive to the N stress through combined PCA analysis. Our study confirmed the conserved nature of GS2 and Fd-GOGAT enzymes at the CDS and protein level; however, their expression and subsequent effects were different in cultivated wheat and their progenitors.Not Availabl

Canadian Public Health Laboratory Network Laboratory Guidelines for the Use of Direct Tests to Detect Syphilis in Canada

Treponema pallidum subsp. pallidum and/or its nucleic acid can be detected by various methods such as microscopy, rabbit infectivity test or polymerase chain reaction (PCR) tests. The rabbit infectivity test for T. pallidum, although very sensitive, has been discontinued from most laboratories due to ethical issues related to the need for animal inoculation with live T. pallidum, the technically demanding procedure and long turnaround time for results, thus making it impractical for routine diagnostic use. Dark-field and phase-contrast microscopy are still useful at clinic- or hospital-based laboratories for near-bedside detection of T. pallidum in genital, skin or mucous lesions although their availability is decreasing. The lack of reliable and specific anti-T. pallidum antibodies and its inferior sensitivity to PCR may explain why the direct fluorescent antibody test for T. pallidum is not widely available for clinical use. Immunohistochemical staining for T. pallidum also depends on the availability of specific antibodies, and the method is only applicable for histopathological examination of biopsy and autopsy specimens necessitating an invasive specimen collection approach. With recent advances in molecular diagnostics, PCR is considered to be the most reliable, versatile and practical for laboratories to implement. In addition to being an objective and sensitive test for direct detection of Treponema pallidum subsp. pallidum DNA in skin and mucous membrane lesions, the resulting PCR amplicons from selected gene targets can be further characterized for antimicrobial (macrolide) susceptibility testing, strain typing and identification of T. pallidum subspecies