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Background and Purpose: Health professional programs, including pharmacy, have increased Indigenization efforts through cultural safety learning. The objective of this paper is to describe student and alumni interest, impact, and perceptions for improvement of an undergraduate elective course on Indigenous health., Educational Activity and Setting: A three-credit elective course was developed with an Indigenous advisory committee and a two-phase mixed-methods design incorporating pre- and post-course surveys and interviews for pharmacy students was implemented from 2013 to 2016. In 2019, all previous students enrolled in the course, now alumni and practicing pharmacists were invited to participate in an online survey and follow-up interview., Findings: A total of 87 students and 21 alumni participated. The course appeared to have considerable impact on students' interest in course topics, specifically Canadian history of colonialism and impact on health. The course generated an increased interest in both Indigenous-oriented practicums and future practice setting. Self-perceived efficacy in providing care to Indigenous patients increased post-course and was sustained in alumni. Three major themes emerged: course should be mandatory and/or more widely available to all students, incorporate more experiential learning (such as educational field trips), and understanding of Indigenous history and impact on health care was a key learning outcome., Summary: A lecture-based elective course increased interest in Indigenous health topics, changed current perspectives on Indigenous health needs, and improved self-perceived efficacy in providing care. Students and alumni felt course content should be more widely available and highlighted the importance of increased experiential learning opportunities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Walking patterns can be used as a key parameter in identifying individuals, as it varies visually depending on one's body size as well as their habits, gender, and age group. In this study, we measure the gait characteristics of a large number of subjects using 34 visual parameters to identify significant parameters that can be used to distinguish individual walking features. We recorded 291 subjects' walking on a constructed footpath using four video cameras, and data on parameters was calculated at the points of double support, toe-off, and heel-strike. K-means Clustering Analysis and ANOVA were conducted to determine the difference between age, gender, and BMI. As a result, we confirm that parameters related to the spine, neck, and feet are useful for identifying individuals. In the comparative analysis between age groups, the older the age, the more significant variables appeared in the upper body. The difference between genders showed significant parameters in both the upper and lower bodies of males. Similarly, among the large BMI groups, we also derived significant results in the upper and lower bodies. The key parameters derived from this study can be used more effectively in the real-world visual analysis of gait, as the walking characteristics of a large number of subjects have been measured with a similar view as real-world CCTV. This study will be effectively utilized as a foundation for future research attempting to identify people through their gait by distinguishing major gait characteristic differences.

Objectives: The aim of this study was to discover new potential biomarkers of breast cancer and investigate their cellular functions., Materials and Methods: We analysed the gene expression profiles of matched pairs of breast tumour and normal tissues from 24 breast cancer patients. Tetracycline-inducible MAMDC2 expression system was established and used to evaluate cell proliferation in vitro and in vivo. MAMDC2-mediated signalling was determined using immunoblot analysis., Results: We identified MAMDC2 as a down-regulated gene showing significant prognostic capability. Overexpression of MAMDC2 or treatment with MAMDC2-containing culture medium significantly inhibited the cell proliferation of T-47D cells. Furthermore, MAMDC2 expression reduced in vivo growth of T-47D xenograft tumours. MAMDC2 may exert its growth-inhibitory functions by attenuating the MAPK signalling pathway., Conclusion: We report that MAMDC2 has a tumour-suppressive role and, as a secretory protein, it might be useful as a biomarker for breast cancer treatment., (© 2020 The Authors. Cell Proliferation published by John Wiley & Sons Ltd.)

Objective: 'Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions ., Methods: Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: 'partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or 'default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options., Results: 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95%CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95%CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89)., Interpretation: A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals' behaviours in relation to overuse or underuse of tests or treatments., Objective: The aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services., Methods and Analysis: We will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group., Ethics and Dissemination: No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The present article describes the synthesis and biological activity of various series of novel hydroxamic acids incorporating quinazolin-4(3H)-ones as novel small molecules targeting histone deacetylases. Biological evaluation showed that these hydroxamic acids were potently cytotoxic against three human cancer cell lines (SW620, colon; PC-3, prostate; NCI-H23, lung). Most compounds displayed superior cytotoxicity than SAHA (suberoylanilide hydroxamic acid, Vorinostat) in term of cytotoxicity. Especially, N-hydroxy-7-(7-methyl-4-oxoquinazolin-3(4H)-yl)heptanamide (5b) and N-hydroxy-7-(6-methyl-4-oxoquinazolin-3(4H)-yl)heptanamide (5c) (IC 50 values, 0.10-0.16 μm) were found to be approximately 30-fold more cytotoxic than SAHA (IC 50 values of 3.29-3.67 μm). N-Hydroxy-7-(4-oxoquinazolin-3(4H)-yl)heptanamide (5a; IC 50 values of 0.21-0.38 μm) was approximately 10- to 15-fold more potent than SAHA in cytotoxicity assay. These compounds also showed comparable HDAC inhibition potency with IC 50 values in sub-micromolar ranges. Molecular docking experiments indicated that most compounds, as represented by 5b and 5c, strictly bound to HDAC2 at the active binding site with binding affinities much higher than that of SAHA., (© 2019 Wiley-VHCA AG, Zurich, Switzerland.)

4-(Trimethylsiloxy)-3-pentene-2-one (TMSPO) is tested as an electrolyte additive to enhance Coulombic efficiency and cycle retention for the Li/LiNi 0.5 Mn 1.5 O 4 (LNMO) half-cell and graphite/LNMO full-cell. TMSPO carries two functional groups, siloxane (-Si-O-) and carbon-carbon (C═C) double bonds. It is found that the siloxane group reacts with hydrogen fluoride (HF), which is generated by hydrolysis of lithium hexafluorophosphate (LiPF 6 ) by impure water in the electrolyte solution, to produce 4-hydroxypent-3-ene-2-one (HPO). The as-generated HPO, as well as TMSPO itself, is electrochemically oxidized to form a protective surface film on the LNMO electrode, in which it is inferred that the carbon-carbon (C═C) double bond initiates radical polymerization. The surface film derived from the TMSPO-added electrolyte shows a superior passivating ability to that generated from the pristine (TMSPO-free) electrolyte. The suppression of electrolyte oxidation enabled by the superior passivating ability offers two beneficial features to the half-cells and full-cells: the suppression of both HF generation and deposition of the resistive surface film on LNMO. As a result, the metal dissolution by HF attack on LNMO appears to be smaller by the addition of TMSPO. The cell polarization is also less significant because of the latter beneficial feature. In short, the bifunctional activity of TMSPO (HF scavenger and protective film former) allows an enhanced Coulombic efficiency and cycle retention to the half-cell and full-cell.

Rationale: Previous studies have suggested that interstitial lung disease (ILD) progresses most rapidly early in the course of systemic sclerosis-associated (SSc)-ILD, and that SSc-ILD is often more stable or even "burned out" after the first 4 years following diagnosis., Objectives: Our objectives were to determine whether an apparent plateau in pulmonary function decline is due to survival bias and to identify distinct prognostic phenotypes of ILD progression., Methods: Consecutive patients with SSc-ILD from a single center were included. Pulmonary function measurements were typically performed every 6 months. Study participants were categorized into long-term survivors (>8 yr survival from diagnosis), and those with medium-term and short-term mortality (4-8 and <4 yr survival, respectively). We excluded those censored with less than 8 years of follow-up. Subject-specific slopes for change in forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (Dl CO ) were calculated using generalized linear models with mixed effects. The rate of decline in FVC was compared across prognostic groups., Results: The cohort included 171 study participants with SSc-ILD. A plateau in the progression of FVC was apparent in the full cohort analysis but disappeared with stratification into prognostic subgroups to account for survival bias. Those with short-term mortality had a higher annual rate of decline in FVC (-4.10 [95% confidence interval (CI), -7.92 to -0.28] vs. -2.14 [95% CI, -3.31 to -0.97] and -0.94 [-1.46 to -0.42]; P = 0.003) and Dl CO (-5.28 [95% CI, -9.58 to -0.99] vs. -3.13 [95% CI, -4.35 to -1.92] and -1.32 [95% CI, -2.01 to -0.63]; P < 0.001) than those with medium-term mortality and long-term survival with adjustment for age, sex, and pack-years. Change in FVC in the previous year did not predict FVC change in the subsequent year., Conclusions: Adults with SSc-ILD have distinct patterns of physiological progression that remain relatively consistent during long-term follow-up; however, recent change in FVC cannot be used to predict future change in FVC within shorter follow-up intervals. The findings of this study provide important information on the course of disease in SSc-ILD and identify specific phenotypes of progression that may improve clinical decision-making and design of future therapeutic trials.

Background and Objective: It is unknown whether oesophageal disease is associated with systemic sclerosis-associated interstitial lung disease (SSc-ILD) severity, progression or mortality., Methods: High-resolution computed tomography (HRCT) scans from 145 SSc-ILD patients were scored for fibrosis score, oesophageal diameter and presence of hiatal hernia. Fibrosis asymmetry was calculated as: (most affected side - least affected side)/(most affected side + least affected side). Mixed effects models were used for repeated measures analyses., Results: Mean fibrosis score was 8.6%, and most patients had mild-to-moderate physiological impairment. Every 1 cm increase in oesophageal diameter was associated with 1.8% higher fibrosis score and 5.5% lower forced vital capacity (FVC; P ≤ 0.001 for unadjusted and adjusted analyses). Patients with hiatal hernia had 3.9% higher fibrosis score, with persistent differences on adjusted analysis (P = 0.001). Oesophageal diameter predicted worsening fibrosis score over the subsequent year (P = 0.02), but not when adjusting for baseline fibrosis score (P = 0.16). Oesophageal diameter was independently associated with mortality (P = 0.001). Oesophageal diameter was not associated with asymmetric disease or radiological features of gross aspiration., Conclusion: Oesophageal diameter and hiatal hernia are independently associated with SSc-ILD severity and mortality, but not with ILD progression or asymmetric disease. Oesophageal disease is unlikely to be a significant driver of ILD progression in SSc., (© 2018 Asian Pacific Society of Respirology.)

Background: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices., Aims: To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices., Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016)., Results: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%)., Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned., (© 2017 Royal Australasian College of Physicians.)

Context: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system., Objective: To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing., Data Sources: We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature., Study Selection: Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations; from developed countries; written in the English language; and published between January 1, 1996, and April 29, 2017., Data Extraction: Two researchers independently extracted data and assessed study quality using a Cochrane group risk of bias tool. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine grading system., Results: We found 64 articles including 44 before-after, 14 interrupted time series, and 1 randomized controlled trial. More effective interventions were (1) multifaceted, with 3 components (mean relative reduction = 45.0%; SD = 28.3%) as opposed to 2 components (32.0% [30.3%]); or 1 component (28.6%, [34.9%]); (2) targeted toward families and clinicians compared with clinicians only (61.9% [34.3%] vs 30.0% [32.0%], respectively); and (3) targeted toward imaging (41.8% [38.4%]) or pathology testing only (48.8% [20.9%]), compared with both simultaneously (21.6% [29.2%])., Limitations: The studies we included were limited to the English language., Conclusions: Promising interventions include audit and feedback, system-based changes, and education. Future researchers should move beyond before-after designs to rigorously evaluate interventions. A relatively novel approach will be to include both clinicians and the families they manage in such interventions., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

The complementary modalities of Doppler echocardiography and multidetector computed tomography are most frequently used for the planning and follow-up of transcatheter aortic valve replacement (TAVR). TAVR is now a well-established modality in the treatment of high-risk and inoperable patients with symptomatic severe aortic stenosis. Furthermore, recent studies have shown that TAVR is equivalent or superior to surgical aortic valve replacement in patients at intermediate surgical risk. We review the most commonly used imaging modalities and discuss their respective strengths and contributions to optimal patient selection, procedure planning, implementation, and follow-up in TAVR., (Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Cognitive biases in decision making may make it difficult for clinicians to reconcile evidence of overuse with highly ingrained prior beliefs and intuition. Such biases can predispose clinicians towards low value care and may limit the impact of recently launched campaigns aimed at reducing such care. Commonly encountered biases comprise commission bias, illusion of control, impact bias, availability bias, ambiguity bias, extrapolation bias, endowment effects, sunken cost bias and groupthink. Various strategies may be used to counter such biases, including cognitive huddles, narratives of patient harm, value considerations in clinical assessments, defining acceptable levels of risk of adverse outcomes, substitution, reflective practice and role modelling, normalisation of deviance, nudge techniques and shared decision making. These debiasing strategies have considerable face validity and, for some, effectiveness in reducing low value care has been shown in randomised trials.

Introduction: We sought to validate whether low dose CACS CT with hybrid IR (HIR) could replace standard dose filtered back projection (FBP)., Method: We enrolled 100 patients to undergo low dose CACS CT with HIR, in addition to routine full dose FBP., Results: No significant difference between full and low dose CT in Agatston score 138.2±360.6 vs. 137.3±356.4 (p=0.272) or calcium mass score 19±48.3 vs. 18.7±49 (p=0.8), respectively. Bland-Altman analysis showed no systematic bias. Calcium volume difference was statistically significant 57.2±134 vs. 55.1±130.2 (p=0.001)., Conclusion: Low dose CT for calcium scoring with HIR enables stable CACS Agatston score and calcium mass quantification as compared to full dose FBP., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Objectives: The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects., Background: The long-term prognostic value of coronary CTA in patients with DM is not well established., Methods: Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models., Results: A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001)., Conclusions: Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Motion correction (MC) algorithms have been shown to improve image quality, interpretability and diagnostic accuracy in coronary CT angiography. We sought to determine whether MC extended to the whole heart would demonstrate improved image quality and reproducibility of aortic annular measurements in pre-TAVR CT., Materials and Methods: Twenty-two consecutive contrast enhanced CT data sets acquired for pre TAVR evaluation using retrospective ECG synchronization during a single heart beat were retrospectively identified. Image data sets were obtained from raw data acquired at 35% and 75% of the R-R interval using both standard (STD) and motion corrected (MC) reconstruction algorithms. Four data sets (2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers for aortic annular area, short and long axis, perimeter and average diameter. Image quality was graded using a 5 point Likert score (1 and 2 non diagnostic, 5 excellent). Statistical analysis was performed using Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75% MC., Results: Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%, there was a significant improvement in image quality for MC (Likert score 3.3 ± 0.9 STD vs. 3.9 ± 0.7 MC, p < 0.007). While B-A analysis demonstrated narrower interobserver agreement for aortic annular area (bias 0.03 vs 0.02 cm(2), range -0.32 to 0.39 cm(2) vs -0.50 to 0.55 cm(2)), and perimeter (bias 0.3 vs 0.3 mm, range -3.1 to 3.8 mm vs -4.6 to 5.3 mm), this was not statistically significant by concordance correlation coefficient. At 75%, there was no significant difference in image quality (Likert score 3.3 ± 0.9 vs. 3.5 ± 0.76, p = 0.454) or annular measurement agreement intervals., Conclusion: Motion correction algorithms may yield significant improvements of image quality in systolic CT data sets of the heart. Further validation studies are required to determine the effect on annular measurements and translation into clinical practice., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

The prevalence of dementia is increasing, especially in Asia. Caregivers of people with dementia are at greater risk of psychological morbidity; however, most studies on caregiving have been conducted in Western populations. As a caregiver's experience can be influenced by cultural factors, this needs exploring further. This study explored the lived experience of caregivers of dementia patients in Singapore and the impact of caring on their sense of self. Six Chinese female spousal caregivers were interviewed and their experiences were analyzed using interpretative phenomenological analysis (IPA). Four super-ordinate themes were identified: impact of caregiving, acceptance of destiny, taking control, and view of self. The findings reflected the influence of Confucian values. Clinical implications are discussed, including more culturally sensitive services.

Objective: This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care., Intended Users: Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services., Target Population: Women with an unintended first trimester pregnancy., Evidence: Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required., Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1)., Benefits, Harms And/or Costs: Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability., Summary Statements: Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care, Recommendations: Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care., (Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Background: Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE)., Objective: Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE., Methods: From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days)., Results: Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend., Conclusions: In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period., (Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Background: Multidetector computed tomographic (MDCT) assessment of the aortoventricular interface has gained increased importance with the advent of minimally invasive treatment modalities for aortic and mitral valve disease. This has included a standardised technique of identifying a plane through the nadir of each coronary cusp, the basal plane, and taking further measurements in relation to this plane. Despite this there is no published data defining normal ranges for these aortoventricular metrics in a healthy cohort. This study seeks to quantify normative ranges for MDCT derived aortoventricular dimensions and evaluate baseline demographic and anthropomorphic associates of these measurements in a normal cohort., Methods: 250 consecutive patients undergoing MDCT coronary angiography were included. Aortoventricular dimensions at multiple levels of the aortoventricular interface were assessed and normative ranges quantified. Multivariate linear regression was performed to identify baseline predictors of each metric., Results: The mean age was 59±12 years. The basal plane was eccentric (EI=0.22±0.06) while the left ventricular outflow tract was more eccentric (EI=0.32±0.06), with no correlation to gender, age or hypertension. Male gender, height and body mass index were consistent independent predictors of larger aortoventricular dimensions at all anatomical levels, while age was predictive of supra-annular measurements., Conclusions: Male gender, height and BMI are independent predictors of all aortoventricular dimensions while age predicts only supra-annular dimensions. Use of defined metrics such as the basal plane and formation of normative ranges for these metrics allows reference for clinical reporting and for future research studies by using a standardised measurement technique., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Contraceptives are underutilized in Canada, and nearly one in three Canadian women will have an abortion in her lifetime. To help delineate a national family planning research agenda, the authors interviewed healthcare providers and organizational stakeholders to explore their perspective on barriers to contraception across regions of Canada., Methods: Semi-structured interviews were conducted based on validated frameworks for assessing family planning access and quality. The authors purposefully selected 14 key stakeholders from government agencies, professional organizations and non-governmental organizations for in-person interviews. Fifty-eight healthcare providers and representatives of stakeholder organizations in reproductive health who self-selected through an online survey were also interviewed. Transcripts were analyzed for repeated and saturated themes., Results: Cost was the most important barrier to contraception. Sexual health education was reported as inconsistent, even within provinces. Regional differences were highlighted, including limited access to family physicians in rural Canada and throughout Quebec. Physician bias and outdated practices were cited as significant barriers to quality. New immigrants, youth, young adults and women in small rural, Northern and Aboriginal communities were all identified as particularly vulnerable. Informants identified multiple opportunities for health policy and system restructuring, including subsidized contraception, and enhancing public and healthcare provider education. Sexual health clinics were viewed as a highly successful model. Task-sharing and expanded scope of practice of nurses, nurse practitioners and pharmacists, alongside telephone and virtual healthcare consultations, were suggested to create multiple points of entry into the system., Conclusion: Results underscore the need for a national strategic approach to family planning health policy and health services delivery in Canada., (Copyright © 2015 Longwoods Publishing.)

Here we show how the electromechanical properties of silicon nanowires (NWs) are modified when they are subjected to extreme mechanical deformations (buckling and buckling mode transitions), such as those appearing in flexible devices. Flexible devices are prone to frequent dynamic stress variations, especially buckling, while the small size of NWs could give them an advantage as ultra-sensitive electromechanical stress sensors embedded in such devices. We evaluated the NWs post-buckling behavior and the effects of buckling mode transition on their piezoresistive gauge factor (GF). Polycrystalline silicon NWs were embedded in SiO(2) microbridges to facilitate concurrent monitoring of their electrical resistance without problematic interference, while an external stylus performed controlled deformations of the microbridges. At points of instability, the abrupt change in the buckling configuration of the microbridge corresponded to a sharp resistance change in the embedded NWs, without altering the NWs' GF. These results also highlight the importance of strategically positioning the NW in the devices, since electrical monitoring of buckling mode transitions is feasible when the deformations impact a region where the NW is placed. The highly flexible NWs also exhibited unusually large fracture strength, sustaining tensile strains up to 5.6%; this will prove valuable in demanding flexible sensors.

The soil-inhabiting, nematode-trapping fungus, Monacrosporium lysipagum, captures mobile stages of nematodes using specialized morphological structures, sticky knobs, that arise from mycelia. A study was conducted to separate the proteome of M. lysipagum mycelia containing knobs on two-dimensional (2D) gels resulting in a partial map of the proteome. The fungus was grown in a liquid soy peptone medium supplemented with the amino acids phenylalanine and valine to produce mycelia with knobs. Proteins extracted from the mycelia were separated by 2D gel electrophoresis and relatively high abundant proteins were identified by peptide mass fingerprinting (PMF). Out of the 250 proteins analysed by PMF, 51 (20%) were identified by cross-species matching due to unavailability of genomic information from M. lysipagum. This is the first published report on a proteomic analysis of a nematode-trapping fungus.

Background: Lipid-lowering therapeutics, particularly HMG Co-A reductase inhibitors, can be beneficial in primary and secondary cardiovascular prevention. The Canadian population frequently uses these medications but the manner in which they are used in community-based practice is unknown., Objectives: To assess the patient characteristics associated with lipid lowering drug use in community-based clinical practice across four geographic regions in Canada. To assess amongst lipid-lowering drugs users the proportion of patients that would meet accepted dyslipidemia management guidelines. To assess the community-based effectiveness of anti-hyperlipidemic drugs., Methods: Patients filling a prescription for any anti-hyperlipidemia therapy in selected pharmacies in Ontario (ON), Quebec (PQ), British Columbia (BC) and Nova Scotia (NS). All eligible patients were interviewed over the telephone. Physicians who were providing healthcare to the participating patients were requested to provide information from the patient's medical record., Results: The mean patient age was > 60 yr in all four provinces. There were some differences amongst the four provinces pertaining to patient characteristics, prescription patterns and therapeutic indicators, but not to outcomes. Anti-hyperlipidemia therapy was associated with a 1.81 mmol/L decrease in LDL-Cholesterol (P < 0.001); however only 73% of patients achieved target LDL-Cholesterol concentrations. A lag time of 1.96 yr (P < 0.0001) was observed from the diagnosis of dyslipidemia until the drug treatment was initiated. Patients had an average of 2.8 cardiovascular (CV) risk factors and 86% of patients had at two or more CV risk factors. Thirty-nine percent (95% CI, 36% - 42%) of the patients were being treated for secondary prevention. Thirteen percent (11-16%) of patients who were being treated for primary prevention had diabetes. Metabolic syndrome was observed in 32% (29-35%) of patients., Conclusion: Almost all patients fulfilled guideline requirements for the use of anti-hyperlipidemic therapy. Although the use of pharmacotherapy was associated with a lowering of LDL cholesterol more aggressive management is required to attain target LDL cholesterol concentrations.

Objective: To determine the potential clinical efficacy of combination antibiotic therapy in treating rheumatoid arthritis (RA)., Methods: Twenty-one patients with active RA despite second-line treatment were randomized to receive either combination antibiotic therapy (treatment group, n = 11) or no additional therapy (control group, n = 10). Antibiotic therapy was given for 12 months and comprised oral tetracycline 250 mg twice daily, 3 times per week, and intravenous clindamycin infused on 5 consecutive days (300, 300, 600, 600, and 900 mg) followed by weekly infusions of 900 mg for 3 weeks and then fortnightly infusions for the remainder of the 12 months. The primary outcome measure was the American College of Rheumatology 20% (ACR20) response at the end of the initial treatment period of 12 months., Results: Five patients in the treatment group (45%) achieved an ACR20 response at 1 year compared to none in the control group (p = 0.04). Eight patients in the treatment group and 1 in the control group had a greater than 20% improvement in tender joint count (p = 0.008). There were also significant differences between the groups in physician and patient global assessments. Nine patients in the treatment group completed the 6 months' followup; of these, 3 sustained the ACR20 response., Conclusion: Combined antibiotic therapy with intravenous clindamycin and oral tetracycline may be useful in the management of active RA. A double-blind, placebo-controlled trial of therapy is justified.