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AIM To better understand the healthcare burden of people with type 2 diabetes (T2D) and estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 in Ontario, Canada. MATERIALS AND METHODS We used administrative data to evaluate the prevalence of T2D, eGFR < 90 mL/min/1.73 m2 and adverse cardiovascular co-morbidities in individuals aged ≥ 30 years living in Ontario, Canada. We also examined incremental healthcare costs and healthcare resource utilization (HCRU) for these patients with specific incident cardiovascular and renal outcomes, in comparison with controls without these outcomes. RESULTS While the prevalence of T2D in the general population aged ≥ 30 years in Ontario increased by 1.8% over a 5-year period (2011-2012 to 2015-2016), the prevalence of eGFR < 90 mL/min/1.73 m2 among people with T2D increased by 35%. In comparison with corresponding controls without these outcomes, the per patient average total costs (Canadian dollars) over a 2-year analysis period were higher for patients with cardiovascular disease/chronic kidney disease related death ($69 827; n = 32 407), doubling of serum creatinine ($52 260; n = 22 825), those who started dialysis ($150 627; n = 3499) or received a kidney transplant ($50 664; n = 651). Similarly, HCRU was significantly greater for patients with these incident outcomes. CONCLUSIONS This real-world retrospective study highlights an increasing prevalence of T2D, eGFR < 90 mL/min/1.73 m2 , and the substantially higher healthcare costs and HCRU when these patients have adverse cardiovascular and renal outcomes. The existence of such a large economic burden underpins the importance of preventing these diabetes-related complications.

Objective: Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004. Using a national data source, we aim t...

Background and Aims The CREDENCE trial with canagliflozin demonstrated definitive evidence of renal benefits to slow the progression of end stage renal disease (ESRD) in type 2 diabetes (T2D) patients with chronic kidney disease (CKD). This real-world study was undertaken to better understand the prevalence of CKD among T2D patients in Ontario using the CREDENCE trial criteria. Ontario is the largest province, accounting for 38.8% of Canada’s population in 20191. Patients were identified in the following cohorts: T2D-CKD, T2D-CKD+cardiovascular disease (CVD), T2D-CKD+stroke, and T2D-CKD+CVD or stroke. Method This population-based retrospective cohort study was conducted in partnership with IQVIA and the Institute for Clinical Evaluative Sciences (ICES). The ICES data repository contains publicly funded administrative health service records for the Ontario population eligible for universal health coverage since 1986. Patients’ eligibility for this study was aligned with enrolment criteria in the CREDENCE trial. Patients were ≥30 years of age at index and were identified as having both T2D and CKD. Diabetes patients were identified using the validated Ontario Diabetes Database (ODD), patients Results The prevalence of T2D patients ≥30 years of age in Ontario has increased from 959,850 in FY2011/12 to 1,169,759 in FY2015/16 (Figure 2). The prevalence of CKD among T2D patients ≥30 years of age in Ontario has increased across all methods from FY2011/12 to FY2015/16: from 21% to 28% based on diagnosis/billing codes, 47% to 63% based on eGFR, 55% to 70% based on diagnosis/billing codes or eGFR, and 76% to 84% based on capture-recapture. Similarly, prevalence of T2D-CKD+CVD, T2D-CKD+stroke, and T2D-CKD+CVD or stroke has increased in most cases (Figure 3). Conclusion CKD is a common comorbidity amongst T2D patients ≥30 years of age. The study provides estimates of the prevalence of CKD in four cohorts of T2D patients with defined co-morbidities and shows that the use of diagnosis/billing codes alone may underestimate the prevalence of CKD in T2D patients. Furthermore, this real-world analysis highlights a significant, increasing prevalence of CKD among T2D patients ≥30 years of age in Ontario with all methods. On-going research aims to assess the burden of illness of patients with both T2D and CKD who are incident to T2D-related outcomes (CKD or CVD related death, kidney transplant, kidney dialysis, doubling of serum creatinine).

How cognitive neural systems process information is largely unknown, in part because of how difficult it is to accurately follow the flow of information from sensors via neurons to actuators. Measuring the flow of information is different from measuring correlations between firing neurons, for which several measures are available, foremost among them the Shannon information, which is an undirected measure. Several information-theoretic notions of &ldquo, directed information&rdquo, have been used to successfully detect the flow of information in some systems, in particular in the neuroscience community. However, recent work has shown that directed information measures such as transfer entropy can sometimes inadequately estimate information flow, or even fail to identify manifest directed influences, especially if neurons contribute in a cryptographic manner to influence the effector neuron. Because it is unclear how often such cryptic influences emerge in cognitive systems, the usefulness of transfer entropy measures to reconstruct information flow is unknown. Here, we test how often cryptographic logic emerges in an evolutionary process that generates artificial neural circuits for two fundamental cognitive tasks (motion detection and sound localization). Besides counting the frequency of problematic logic gates, we also test whether transfer entropy applied to an activity time-series recorded from behaving digital brains can infer information flow, compared to a ground-truth model of direct influence constructed from connectivity and circuit logic. Our results suggest that transfer entropy will sometimes fail to infer directed information when it exists, and sometimes suggest a causal connection when there is none. However, the extent of incorrect inference strongly depends on the cognitive task considered. These results emphasize the importance of understanding the fundamental logic processes that contribute to information flow in cognitive processing, and quantifying their relevance in any given nervous system.

Inspired by the effects of a switching surface on the stability of passive dynamic walking (Safa and Naraghi in Robotica 33(01):195–207, 2015; Safa et al. in Nonlinear Dyn. 81(4):2127–2140, 2015), this paper suggests a new control strategy for stabilization of dynamic bipedal locomotion. It verifies that the stability improvement of a dynamic walking system is feasible while preserving the speed, step-length, period, natural dynamics, and the energy effectiveness of the gait. The proposed control policy goes behind the three primary principles: (i) The system’s switching surface has to be replaced by a new one if an external disturbance is induced. (ii) The new switching surface has to be reshaped back into its old style, together with the disturbance rejection. (iii) The stabilization procedure has to be performed with as small energy consumption as possible. Because of the reversibility effects of the switching surfaces in the above rules, the terminology of “Reversible Switching Surfaces” (RSS) is employed to address the control scheme; so the control objective would be the implementation of RSS for a bipedal robotic system. In this paper, this aim is achieved by a kinematically controlled foot scheme that is implemented on a simple structured biped. The presented idea is validated by a commercial version of MSC Adams software.

Objective: The goal of this study was to characterize the frequency and trends of psychotropic drug prescribing in Canadian children from 2010 to 2016 and to compare these results with a previous study conducted between 2005 and 2009. Methods: Using a national physician panel survey database from IQVIA Canada, aggregated frequencies of written prescriptions and therapeutic indications for antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medications (psychostimulants and nonstimulants), and antidepressants were analyzed in children. Changes in frequency of written prescriptions and therapeutic indications are presented using descriptive statistics. Results: Written prescriptions for antipsychotics decreased by 10% from 2010 to 2016, in contrast to a 114% increase in written prescriptions for antipsychotics observed between 2005 and 2009. Written prescriptions for psychostimulants and antidepressants rose by 35% and 27%, respectively, between 2012 and 2016, comparable with previous results. The most common reasons for recommending an antipsychotic were ADHD and conduct disorder, although there appears to be a downward trend for ADHD compared with other conditions. In contrast, the share of written prescriptions for antipsychotics for autism increased 34% over the study period. Within the second-generation antipsychotics, written prescriptions for aripiprazole increased. An increase in the use of guanfacine extended release for ADHD was also observed. Conclusion: Several factors may be involved in stabilization and small decrease in antipsychotic use in recent years, including physician and patient awareness of adverse effects related to antipsychotic use, knowledge implementation strategies advocating short-term and judicious use of antipsychotics in children, and the approval of guanfacine extended release for use in Canada for ADHD in 2013.

By employing a few simple models of passive dynamic walking mechanism, we have shown the possibility of extending the boundaries of the maximum stable speed of these autonomous robots merely by changing their terrain. The replaced terrain consists of a series of parallel local slopes and is recognized as a general form of a ramp–stair surface. Although here, the mechanism of stabilization of the unstable locomotion patterns is not clearly known, the technique is quite simple and works effectively. The merit to the method over other strategies, could be described in two separate aspects: First, it is still completely passive; so we do not need any external energy to control the robot. Second, the existing passive trajectory is preserved; thus except for the robot's stability, other walking characteristics like speed, step length, period and efficiency, either do not change (if the machine is a point-foot walker) or ultimately minimally vary (if the model possesses other kinds of foot). This theory is validated using MSC Adams commercial software. There is hope that the presented passive strategy contributes to the development of efficient control algorithms, i.e. control methods boosting the gait stability without going against the gait efficiency.

The main focus of this paper is on how the biped robot has a stable passive gait cycle as well as going through a stable journey on a level ground merely with push-off actuation. During recent years humanoids have been in the center of attention due to several reasons some of which are: compactness of the structure, low energy consumption, humanoid behavior and last but not least being of great use in medical field. In this paper, equations of motion regarding the passive phase as well as push-off are simulated in MATLAB software. For the next step, a comparison between these two stable gait cycles is made so as to figure out the difference between energy injected to the system by push-off and the one provided by the gravity. Then it is studied from the robustness point of view and it continues with a touch upon period doubling and bifurcation. Results from MATLAB are followed and validated by MSC ADAMS software in both fields and are compared to one another with the aim of finding a rational relationship between these two gait cycles. In the end, the robot is constructed and tested on a slope successfully. Eventually by having the similarity made between passive gait cycle and the one with push-off, having a stable gait cycle on a level ground with push-off actuation is possible.

This paper presents a novel tactile sensing robot designed to detect breast lesions with minimum invasiveness to the tissue while providing exact documentation to make therapeutic and surgical decisions. The robot named "Robotic Tactile Breast Mass Identifier (Robo-Tac-BMI) consists of an indentation probe controlled by a robotic system and a visualization interface to manipulate the end-effecter. Geometrical maps of the test points with related tension-relaxation curves are provided during clinical examinations. Utilizing the curves, three functional stiffness parameters are extracted locally for each test point. These parameters are employed to provide objective information to facilitate the surgeon's task in the diagnostic procedure. Computational analysis is proposed for a real breast tissue model to study the capability of artificial tactile sensing in the mass detection. Indications of the mass existence are determined and employed as the basis of the Robo-Tac-BMI design and construction. Clinical trials are executed by the Robo-Tac-BMI on 161 cases. The results show that the robot has the potential to provide tissue mechanical properties unlike the conventional screening modalities carried out either by the surgeon or the imaging techniques which are not quantitative and lack documentation. Sonography with and without mammography is chosen as the "gold standard" tests.

Passive dynamic of the simplest walking model is considered for stepping motion. The only variable is the ratio of the stair height to the robot leg length. It exhibits period-one stable limit cycles and then period doubling route to chaos. Since the results are comparable with walking down a shallow incline, we show the similarities and differences between these two kinds of passive walking to specify the role of surface profile in walking stability.

We describe a novel technique to treat anal stenosis by reconstructing the anal canal by the use of a full-thickness skin graft from the abdominal wall. This treatment was successfully applied in our institution and showed positive results.