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Oral Presentations iHR Day 2013
Atkinson, Paul
Wake Up: Head Injury Management Around the Clock
Flewelling, Andrew
Bioactive Natural Products from Marine Macroalgal
Endophytes of the Shetland Islands, UK
Renfrew, Paul D.
Are there Geographic Disparities in Access to Liver
Transplantation in Atlantic Canada?
Bonnar, Paul
Identifying and Treating Patients with Difficult-to-Control Blood
Pressure
Parks, Adam
Can Medical Learners Achieve Ultrasound Competency Using a
High-Fidelity Ultrasound Simulator?
Pulinilkunnil, Thomas
Increased Adipose Triglyceride Lipase Expression Impairs
Myocardial Recovery Following Acute Ischemia Reperfusion
Howlett, Michael
Do Certain Coping Styles Influence Burnout and Emergency
Health Care Staff Wanting to Leave their Career Prematurely? A
Mediation Analysis
The Impact of Spirituality and Religiosity on Physician Empathy
and Wellbeing
Jee, Catherine
March 15, 2013
MacIntosh, Judith
Effects of Workplace Bullying on Men and Women
Tremblay, Philippe
Expression and Prognostic Significance of TRPV6, a Novel
Therapeutic Target Protein in Multiple Myeloma
Keeping-Burke, Lisa
Patient and Family Member Perspectives of Experiencing an
Adverse Event in Health Care: A Systematic Review
Clark, Trevor
Isolation of an Antimycobacterial Natural Plant Product from a
Fungal Endophyte of the Medicinal Plant Fragaria Virginiana
Dube, Anik
HIV/HCV Prevention among Youth: A Provincial Policy Review
1
“Wake Up: Head Injury Management Around the Clock“
Presenting Author
Paul Atkinson, Physician, Horizon Health Network
Other Authors
Jacqueline Fraser, Department of Emergency Medicine, Saint John Regional Hospital
Susan Benjamin, NB Trauma Program, Horizon Health Network
Erin Sproul, Department of Emergency Medicine, Saint John Regional Hospital
Alysha Mehta, Memorial University
Background: We aimed to determine whether the time of day and the severity of the injury affected the time to CT scan
of patients with head injury presenting to the emergency department at a Level 1 trauma centre.
Methods: The study was a retrospective chart review of all head CT scans performed for trauma patients over a fiveyear period, identified from the trauma database. (n=904). Our primary outcome was time from emergency physician
assessment to CT scan. Data was analyzed according to severity of head injury, time of presentation and disposition
using non-parametric tests (Graph-Pad Prism).
Results: Mild head injury (GCS 13-15) median times to CT (68 min) were longer than Moderate (GCS 9-12; 50 min) and
Severe (GCS 3-8; 53 min) head injuries respectively (Kruskal-Wallis test p <0.05). There was a significantly longer median
time to CT scan overnight (midnight to 8am) for all patients (79 min) when compared to day/evening presentations (63
min; Mann Whitney test p < 0.0001). For clinically significant head injuries (defined as moderate or severe; GCS 3-12)
there was also a significantly longer median time to CT scan overnight (59 min) vs. 47 min; Mann Whitney test p =
0.044). For patients who died, went to the operating room or intensive care, there was a trend towards longer median
times to CT overnight (59 min vs. 55 min; Mann Whitney test p=0.051).
Discussion: Severity of head injury, and arrival to hospital after midnight, were associated with significantly longer times
to head CT in this Level 1 trauma centre. Further investigation is indicated to determine what factors contribute to this
delay.
March 15, 2013
2
”Bioactive Natural Products from Marine Macroalgal Endophytes of the
Shetland Islands, UK”
Presenting Author
Andrew Flewelling, Student, UNB Saint John
Other Authors
John A. Johnson, UNB Saint John
Chris Gray, UNB Saint John
Background: Very little research has been reported on the natural products chemistry of endophytes from algae. The
ability to produce bioactive compounds, coupled with the stresses imposed on algae in the marine environment
(prolonged periods of exposure, varying salt concentration and high predation pressure) suggests that algal endophytic
microorganisms could represent an important source of biologically active secondary metabolites.
Methods: Fungal endophytes were isolated from nine marine algae species (four brown, three red and two green),
collected from the Shetland Islands, United Kingdom in October 2010. Algae were surface sterilized to ensure that
fungal growth from algal tissues was endophytic and not epiphytic. Endophyte isolates were identified using traditional
taxonomy and through the use of molecular biological techniques (PCR anplification and sequencing of the internal
trancribed spacer region of ribosomal DNA). Chemical extracts from the endophytic fungi were screened for cytotoxic
and antimicrobial activities. One extract with promising bioactivity was subjected to bioassay guided fractionation to
isolate and identify the biologically active constituents.
Results: Sixty four distinct endophyte isolates encompassing 47 species were isolated from the nine algal host species.
Extracts of the endophytes were screened using standard bioassays with 16 fungi showing cytotoxicity, 25 fungi showing
antibacterial activity and 24 fungi showing antifungal activity. An extract from a Penicillium species was subjected to
bioassay-guided fractionation resulting in the isolation of (±)-patulin (IC50 47 ± 1 μg/mL against Staphylococcus aureus
and 139 ± 2 μg/mL against Pseudomonas aeruginosa) as the major bioactive constituent and three other compounds
(epiepoformin, phyllostine, and cladosporin) that exhibited weak bioactivity.
Discussion: Endophytic fungi from marine algae have been shown to be excellent producers of cytotoxic and
antimicrobial secondary metabolites. Currently, additional fungal extracts showing promising activity are being
fractionated for the identification of their natural products. Fungal extracts are also being screened for their efflux
inhibition potential to identify natural products that could be used to fight the rise in microbial resistance occurring with
current medications.
March 15, 2013
3
”Are there Geographic Disparities in Access to Liver Transplantation in Atlantic Canada?”
Presenting Author
Paul Douglas Renfrew, Physician, Horizon Health Network
Other Authors
Michele Molinari, Physician, Horizon Health Network
Background: The Multi-Organ Transplant Programme (MOTP), based in Halifax, Nova Scotia, provides liver transplant
services for adults residing in the four provinces of Atlantic Canada. We sought to characterize the patient population
referred to the MOTP for consideration of liver replacement during the first five years of activity of the current iteration
of the liver transplant service.
Methods: Data from a prospective institutional database, supplemented by retrospective medical record review, was
used to identify and characterize, via descriptive statistics, the cohort of patients assessed for consideration of first liver
transplant, between December 1st 2004 and December 1st, 2009. Population standardized incidences of; transplant
assessment, wait-list assignment and liver transplantation were calculated, based on the 2006 Canadian census, and
inter-provincial comparisons were performed using Fisher’s exact. For secondary analyses, univariable, Kaplan-Meier,
and multivariable, Cox proportional hazards regression, methods for censored time-to-event data were used to describe
and compare; assessment time-to-completion, wait-list survival and waiting time-to-transplant.
Results: In the five year period after reactivation, the programme assessed 337 patients for first liver transplant. The
median age at referral for this group of 199 males (59.0%) and 138 females (41.0%) was 56.1 years (range: 16.3 – 72.3).
The leading three liver diseases indicating liver replacement were alcohol-related end-stage liver disease (20.5%),
hepatocellular cancer (16.6%), and hepatitis C-related end-stage liver disease (14.0%). When evaluated by provincial
population standardized incidence, we found significant differences in the incidence of liver transplant assessment
between the four Atlantic Canadian provinces (per 100,000 inhabitants: NS 19.8, NB 13.0, NL 9.1, PE 11.0; Fisher’s exact
p < 0.001). Assessment time-to-completion was not found to differ by province of residence (Kaplan-Meier estimate of
median days to assessment completion: NS 73, NB 80, NL 76, PE 77; log rank p = 0.594). Of the 337 individuals that
began the assessment process, 153 (45.4%) were assigned to the waiting list. The probability of an individual being
assigned to the wait-list was not found to differ significantly by province of residence (NS 45.3%, NB 40.0%, NL 58.7%, PE
40.0%; Fisher’s exact p = 0.206). After controlling for significant covariates (Model for End-Stage Liver Disease score and
ABO blood group status) there were no significant interprovincial differences in wait-list survival or waiting time-totransplant. Additionally, a candidate’s probability of receiving a liver transplant did not appear to differ significantly by
province of residence (NS 65.9%, NB 70.0%, NL 64.3%, PE 50.0%; Fisher’s exact p = 0.798).
Discussion: In characterizing this 5-year cohort of individuals referred to the MOTP for consideration of candidacy for
first liver replacement, we uncovered evidence that suggests significant inter-provincial disparities in access to liver
transplantation exist in Atlantic Canada. It would appear that the observed differences are a function of relative
differences in incidence of referral for transplant assessment as, once assessed by our service, there was no evidence of
province-of-residence-related differences in probability of being assigned to the waiting list, survival whilst awaiting a
liver, probability of receiving a liver or waiting time-to-transplant. Secondary analyses demonstrated that inter-provincial
differences in incidence of assessment translated into differences in population standardized incidence of waiting list
assignment and ultimately to receipt of liver transplant. These results suggest a need for the MOTP to implement
measures to increase the recognition and referral of patients with terminal liver diseases for liver transplantation.
March 15, 2013
4
“Identifying and Treating Patients with Difficult-to-Control Blood Pressure”
Presenting Author
Paul Bonnar, Medical Resident, Dalhousie Medicine NB
Other Authors
Martin MacKinnon, Physician, Horizon Health Network
Anita Fenn, Horizon Health Network
Background: The serious medical complications of hypertension (HTN) are well known but diagnosing and treating HTN
can be challenging. As a result, clinics that specialize in managing HTN have been developed. Blood pressure (BP) is often
more difficult to control in certain patient populations including older, obese, inactive, and smoking patients. Also, there
exist numerous patterns of HTN based on ambulatory BP monitoring (ABPM) that records BP over a 24 to 48 hour period
in non-clinical settings. Such patterns include white coat HTN (BP higher in clinic), masked HTN (BP higher outside of
clinic on ABPM), and sustained HTN (BP elevated in clinic and ABPM). These differences likely contribute to the difficulty
in accurately diagnosing and managing HTN.
There were three objectives of this study: 1) determine the efficacy of the Saint John Regional Hospital (SJRH) HTN clinic;
2) identify factors that are associated with difficult to control HTN; 3) assess the frequency and characteristics of white
coat HTN, masked HTN, and sustained HTN.
Methods: This study was an ethics approved, retrospective analysis using a database compiled from chart reviews and
questionnaires. Efficacy of the clinic was calculated by analyzing BP changes over time. Logistic regression analysis
identified significant characteristics that were associated with BP control in this population. The characteristics included
age, gender, body mass index, renal disease, diabetes, number of medications, drug plan, smoking, number of visits,
adherence, home monitoring, ABPM, and initial BP. Finally, the ABPM measurements were compared to clinic BP
measurements to identify the proportion of patients with white coat HTN, masked HTN, and sustained HTN. The BP and
number of antihypertensive medications were compared among these groups.
Results: Blood pressure significantly decreased from the initial to final measurements for systolic (initial: 145±2.5
mmHg; final: 134±2.0 mmHg; p<0.001) and diastolic BP (initial: 80±1.5 mmHg; final: 77±1.3 mmHg; p=0.017). The
number of antihypertensive medications significantly increased from initial (3.16±0.16) to final (3.34±0.15) clinic visits
(p=0.049). Logistic regression comparing factors between controlled and uncontrolled patients at the last visit showed
an association between controlled BP and renal disease, diabetes, and initial systolic BP.
Finally, there was a small sample of individuals with white coat HTN (n=9). Clinic measurements of BP did not differ
between white coat HTN (149/78 mmHg) and sustained HTN (153/82 mmHg) patients (systolic: p=0.517; diastolic:
p=0.345). Regarding antihypertensive medications, there was no significant difference between these two groups at the
initial (white coat: 3.22; sustained: 3.25; p=0.678) or final clinic visit (white coat: 3.00; sustained: 3.36; p=0.570).
Discussion: The SJRH HTN clinic is efficacious in lowering BP. It is important to identify factors that are associated with
difficult to control BP, such as renal disease, diabetes, and initial systolic BP, so that such patients can be identified
earlier and followed closely to minimize the consequences of HTN. In addition, the use of ABPM to categorize patients
may be beneficial in treating HTN since clinical BP measurements may be misleading.
March 15, 2013
5
“Can Medical Learners Achieve Ultrasound Competency Using a High-Fidelity Ultrasound Simulator?”
Presenting Author
Adam Parks, Medical Resident, Dalhousie Medicine NB
Other Authors
Dr. Glenn Verheul, Physician, Emergency Medicine, Horizon Health Network
Dr. Paul Atkinson, Physician, Emergency Medicine, Horizon Health Network
Introduction: Goal-directed point-of-care ultrasound (PoCUS) protocols have been developed to provide a structured
approach to improving the diagnostic accuracy of the initial clinical assessment of the critically ill patient. We assessed
the diagnostic impact of the addition of a simulated Abdominal and Cardiothoracic Evaluation by Sonography (ACES)
protocol into simulated emergency medical scenarios.
Methods: Following a PoCUS training program involving reading, videos and an interactive workshop, we tested the
diagnostic accuracy of 12 medical learners (clerks and residents) participating in standardized scenarios using a highfidelity mannequin simulator (SimMan 3G)with a high-fidelity ultrasound simulator (CAE Vimedix).
Participants were assessed during 72 simulated emergency cardiorespiratory scenarios using the two simulators.
Differential diagnoses were collected from participants before and after PoCUS simulator incorporation in each scenario,
and confidence surveys were completed. Data was analyzed using GraphPad Prism.
Results: The addition of a goal-directed PoCUS protocol led to an improvement in differential diagnoses. Prior to use of
PoCUS, 45 (62.5%), correct primary diagnoses were made during the simulated scenarios compared with 64 (88.9%)
correct diagnoses following PoCUS (chi-square 14, 1df, p=0.0002).
Goal-directed PoCUS was also shown to increase participants’ confidence in their diagnoses. The mean confidence in
diagnosis score pre-PoCUS was 52.2 (SD=14.7) while the mean post-PoCUS score was 81.7 (SD= 9.5). The estimated
difference in means (-28.36) was significant (t=-7.71, p<0.0001).
Using PoCUS, participants were further able to narrow their differentials. The median number of diagnoses for each
patient pre-PoCUS was 3.5 (IQR=(3.0, 3.8)) with a median of 2.3 (IQR= (1.5, 2.9) diagnoses post-PoCUS. The difference
was significant (W=0, p<0.001).
Conclusion: We have demonstrated that the addition of a PoCUS protocol (ACES) to standard clinical assessment
improves diagnostic accuracy and confidence in simulated cardiorespiratory scenarios. This is keeping with clinical
studies and supports the use of ultrasound during medical simulation.
March 15, 2013
6
“Increased Adipose Triglyceride Lipase Expression Impairs Myocardial Recovery Following Acute Ischemia
Reperfusion”
Presenting Author
Dr. Thomas Pulinilkunnil, Physician, Dalhousie Medicine NB
Other Authors
Jeevan Nagendran, University of Alberta
Jason R B Dyck, University of Alberta
Petra C Kienesberger, University of Alberta
Martin E Young, University of Alabama USA
Background: To maintain normal function, cardiac tissue acquires 60 - 70% of its energy from fatty acid (FA) oxidation
and the remainder from glucose and amino acid. FAs that are not immediately oxidized are incorporated into
triacylglycerol (TAG). Upon energetic demand, intracellular TAG is catabolized by adipose triglyceride lipase (ATGL) to
release FA. Evidently patients undergoing myocardial ischemia reperfusion (I-R), often exhibit inflexibility in cardiac
energy metabolism resulting in energy deficit. Since extensive studies have highlighted the importance of altered
glucose and FA oxidation but not TAG catabolism in regulating myocardial function during I-R, we examined the
influence of ATGL in this process.
Methods: To address the role of ATGL and TAG metabolism in ischemic heart disease, C57BL6 control mice and a mouse
model with cardiac-restricted overexpression of ATGL (MHC-ATGL) were utilized. Ex vivo and in vivo model of acute
ischemia reperfusion was employed. Mouse hearts were subjected to ex vivo perfusions in the working mode with
modified Krebs-Henseleit solution containing 5 mmol/l [U-14C] glucose, and 1.2 mmol/l [9,10-3H] palmitate (FA) prebound to 3% fatty acid-free albumin in the presence of 50 µU/ml insulin. Hearts were perfused for a 30 min aerobic
period followed by 18 min of global no-flow ischemia and 40 min of aerobic reperfusion. Oxidation of glucose and
palmitate and glycolytic rates were measured by quantitative collection of 14CO2 and 3H2O with parallel analysis of
functional parameters. Ex vivo changes were also recapitulated in an in vivo model of I-R by ligating the mouse coronary
artery for 30 min (ischemic phase) followed by removal of ligation for 120 min (reperfusion phase). Hearts were snap
frozen in liquid N2 for biochemical analysis.
Results and Discussion: Hearts from C57BL6 mice subjected to I-R exhibited increased ATGL protein expression and
cardiac TAG content (aerobic vs. I-R; 0.7660.06 vs. 1.2210.08 nmol TAG per mg heart weight, meanSEM, n=4-5,
p<0.01), suggesting augmented TAG turnover. To determine whether increased ATGL is beneficial or detrimental for the
functional recovery of the reperfused myocardium, WT and MHC-ATGL mouse hearts were subjected to ex vivo I-R
protocol. During the pre-ischemic period, MHC-ATGL hearts exhibited a 70% reduced myocardial TAG content (n=6,
p<0.0001), a 2.7-fold increase in glycolysis (n=4-5, p<0.01), a 1.5-fold increase in glucose oxidation (n=4-5, p<0.01), and a
significant decrease in palmitate oxidation (WT vs. MHC-ATGL; 1010146 vs. 712107 nmol per gram dry weight per
min, meanSEM, n=4-5, p<0.01) without alterations in cardiac function. However following I-R, MHC-ATGL but not WT
hearts exhibited a significant decrease in palmitate oxidation but not glycolysis and glucose oxidation. Indices of cardiac
function were significantly poor in MHC-ATGL hearts (LV minute work; WT vs. MHC-ATGL; 6.71.3 vs. 0.190.05 Joules
per g dry weight, meanSEM, n=5-6, p<0.05) following I-R, which was accompanied by decreased ATP-AMP and PCr-Cr
ratios. Ex vivo changes were also recapitulated in an in vivo model of I-R wherein enhanced necrosis was observed in
MHC-ATGL compared to WT hearts suggesting that following I-R, chronic reduction in myocardial TAG levels by ATGL
overexpression compromises functional recovery.
March 15, 2013
7
“Do Certain Coping Styles Influence Burnout and Emergency Health Care Staff Wanting to Leave their Career
Prematurely? A Mediation Analysis”
Presenting Author
Dr. Michael Howlett, Physician, Emergency Medicine, Horizon Health Network
Other Authors
Dr. Paul Atkinson, Physician, Emergency Medicine, Horizon Health Network
Jacqueline Fraser, Emergency Medicine, Horizon Health Network
Ken Doddy, Department of Psychology, Horizon Health Network
Denise Leblanc-Duchin, Research Services, Horizon Health Network
Joshua Murray, Research Services, Horizon Health Network
Background: Associations between coping styles in stressful situations and levels of burnout have been documented in
health care professionals. Understanding how coping styles and burnout can work together to impact professional
outcomes has not been studied. The authors investigated the mediated effects of coping styles through levels of
burnout, on wanting to leave emergency health care (ED) professions.
Methods: 286 ED professionals completed the Maslach Burnout Inventory (MBI), the Coping Inventory for Stressful
Situations (CISS), and a demographic questionnaire. Mediation analysis studies the indirect effect of a factor on an
outcome, mediated through another factor. A multiple mediator model was hypothesised where the MBI subscales
work in conjunction to mediate the effects of the CISS variables on wanting to leave an ED profession. A total of three
mediation models were examined as outlined in Baron and Kenny (1986).
Results: Two of the 3 models showed evidence of a significant mediated effect. Higher emotion oriented coping (CISS)
was associated with higher emotional exhaustion (MBI), which in turn was associated with a higher likelihood of wanting
to leave (Indirect = 0.059, 95% Bootstrap CI = (0.029, 0.094)). Conversely, increases in task orientated coping (CISS) was
associated with decreased emotional exhaustion (MBI), which was associated with a lower likelihood of wanting to leave
(Indirect = -0.042, 95% Bootstrap CI = (-0.08, -0.02)).
Discussion: The results demonstrate a directional relationship between coping styles and wanting to leave an ED
profession; a consequence that may affect staff well-being and human resources. An intervention targeting the coping
styles of ED professionals may reduce levels of burnout, which in turn may reduce the number of staff wanting to leave.
March 15, 2013
8
“The Impact of Spirituality and Religiosity on Physician Empathy and Wellbeing”
Presenting Author
Catherine Jee, Medical Student, Dalhousie Medicine NB
Other Authors
Dr. Wendy Stewart, Dalhousie Medicine NB
Enrico DiTommasso, University of New Brunswick
Pam Driedger, Horizon Health Network
Background: There is growing interest in the importance of physician wellbeing and life satisfaction. This has
implications for physicians themselves, but also for patient care and the sustainability of medicine as a career. A recent
report suggested that nearly 90% of physicians feel stressed every day. Physicians are also at significantly increased risk
for suicide, mood disorders and addiction. Although many studies have demonstrated that religiosity and spirituality of
patients are associated with improvements in their physical and mental health, there is limited data, especially in
Canada, on how spirituality and religiosity impact physicians. To improve not only the patient care that physicians
provide but also their life satisfaction, it is important to understand what factors could affect physicians’ wellbeing. We
are interested in the spirituality and religiosity of Maritime physicians and how they are related to empathy and
wellbeing. It is hypothesized that spirituality/religiosity will be significantly correlated with empathy and satisfaction
with life.
Methods: To this point, 274 physicians from the three Maritime Provinces have completed on-line measures of
spirituality, religiosity, empathy and satisfaction with life. Additionally, information on gender, province and area of
practice was collected.
Results: Of those who responded 126 were female and 146 male. Ninety one were family physicians and 176 specialists.
Females reported significantly greater empathy and spiritual connectedness than males. Those practicing family
medicine reported greater religious sentiment and prayer fulfillment than specialists. Less religious crisis, greater
transcendent unity, prayer fulfillment and transcendent connectedness were associated with greater empathy (r=-0.17,
r=.33, r=0.13, r=0.22 respectively).
Discussion: The current results are generally in line with our hypothesis that spirituality/religiosity would be related to
physician empathy and satisfaction with life. More broadly, once all the data are analyzed, the results should provide
guidance on benefits of incorporating a spiritual component into the development of programs that will promote
greater physician wellness. A previous study found that medical students who participated in both empathy and
spirituality seminars showed higher levels of empathy compared to the control groups. This study suggests that it may
be possible to increase the levels of physicians’ wellbeing and empathy through spirituality training. Thus, the results of
the current study could provide insight into how we might further incorporate aspects of spiritual self-care and
reflection in undergraduate and postgraduate medical programs.
March 15, 2013
9
“Effects of Workplace Bullying on Men and Women”
Presenting Author
Judith MacIntosh, University of New Brunswick, Faculty of Nursing
Background: Workplace bullying is prevalent abuse consisting of offensive behaviours humiliating or intimidating others
at work (Carbo and Hughes, 2010). Incidence rates vary with abuse type and measurement methods but rates are
increasing and workplace violence is identified as an international problem (World Health Organization, n.d.). We know
that workplace bullying has effects on physiological, psychological, social, and economic health (MacIntosh, 2005). Our
purpose was to study what is less well-known: how people bullied at work (called targets) look after themselves and
approach their work afterwards.
Methods: We used grounded theory methods of constant comparison, simultaneous data collection and analysis, and
theoretical coding. In two separate grounded theory studies (one with men and one with women), we developed
substantive theories of how targets promote health and engage in work. We recruited community samples and recorded
semi-structured interviews with 36 men and 40 women in Canada. They worked in many types of workplaces and lived
in urban and rural locations. Ages and education varied.
Results: In these studies, we identified the main issues for targets and we identified basic processes they used to
address the central problem for them. Here, I compare the central problems for men and women as targets, how those
problems interfered with promoting health, how targets managed to resume promoting health, and the impact bullying
had on their work.
Discussion: I discuss implications of similarities and differences of how to help men and women as targets promote
health during and after bullying and I identify how professionals can assist in restoring health promotion practices,
including recommendations for policy and workplace strategies to create respectful workplaces to promote worker
health overall.
March 15, 2013
10
“Expression and Prognostic Significance of TRPV6, a Novel Therapeutic Target Protein in Multiple Myeloma“
Presenting Author
Philippe Tremblay, Medical Student, Dalhousie Medicine NB
Other Authors
Dr. Tony Reiman, Horizon Health Network, University of New Brunswick, Dalhousie Medicine NB
Jane Agar, Horizon Health Network
Kim Miller, Horizon Health Network
Tarek Rahmeh, Horizon Health Network
Background: Multiple myeloma is an incurable, debilitating bone marrow cancer with a median life expectancy of
approximately four years. Drug treatment is the main form of therapy. Eventually, myeloma drug resistance and/or
patient intolerance to currently available treatments limits our ability to control the disease. New treatments are
needed.
TRPV6 is a calcium channel that has been found in elevated quantities in different cancer types including prostate, colon,
and breast tumours. Pre-clinical studies have indicated the therapeutic potential of TRPV6 targeted peptides against
selected solid tumours, and the lead peptide is now entering human clinical trials. In this study we examined the range
of expression of TRPV6 in primary myeloma bone marrow plasma cells, and correlated expression levels to clinical
characteristics such as response to conventional therapy and overall survival.
Methods: As the definitive diagnosis of multiple myeloma requires a bone marrow biopsy, the records of our
institution’s pathology department were searched for reports of myeloma bone marrow samples and a list of confirmed
patients was populated. Subsequently, medical records were pulled for this list of patients and pertinent patient
information with which to correlate our laboratory findings was extracted. The markers used in this study have been
shown to carry prognostic value in treatment response and overall survival. A database containing clinical information
required for the study was constructed.
In the initial diagnostic workup of multiple myeloma patients, a bone marrow biopsy is performed. Tissue blocks
corresponding to the diagnostic bone marrow biopsies of the patients included in the clinical database were pulled from
storage and reviewed by a pathologist who identified areas dense with myeloma cells. Microarrays were constructed to
facilitate the rapid analysis of multiple samples.
In order to quantify the amount of TRPV6 channels in the samples, an anti-TRPV6 antibody (#ACC-036) from Alomone
Labs was used. As a control, human duodenum was used as the calcium channel has been shown to be abundant in this
tissue. The TRPV6 protein was then measured by immunohistochemistry and scored semi-quantitatively by a
pathologist.
All work was completed under an REB approved protocol.
Results: The measurement of TRPV6 expression in our samples is still ongoing but results will be available in time for
presentation at the iHR conference. Results to date suggest that TRPV6 is expressed in most cases of multiple myeloma.
We will also present results regarding the correlation of TRPV6 expression to known prognostic factors, as well as
survival and response to conventional therapy.
Discussion: This work will inform our examination of TRPV6 as a therapeutic target in multiple myeloma, and the
potential of TRPV6-targeted therapy as a novel strategy to treat the disease.
March 15, 2013
11
“Patient and Family Member Perspectives of Experiencing an Adverse Event in Health Care: A Systematic
Review”
Presenting Author
Lisa Keeping-Burke, University of New Brunswick
Other Authors
Janice McVeety, RN, MHA, Queens University
Christina Godfrey, RN, PhD., Queen’s University
Amanda Ross-White, MLS, Queen’s University
Margaret Harrison, RN, PhD., Queen’s University
Background: The occurrence of preventable adverse events in health care and the impact on patient safety is currently
receiving a great deal of attention in the literature and media. Despite the potential positive impact that patients and
family members could make in the field of patient safety, to date, no international systematic review has been
performed to analyze and/or evaluate patient and family member perspectives of encountering an adverse event while
receiving health care. A focus on patient safety for patients and families is not just about providing quality improvement
in health care as events suffered by patients are personal and often devastating.
Objective: To conduct a systematic review of both no harm and harmful incidents encountered whilst receiving health
care, with a goal towards further understanding patient and family members’ perspectives of such occurrences.
Method: This review was conducted through the Queen’s Joanna Brigg’s Collaborating Centre (QJBC), a registered
centre with the Joanna Briggs Institute (JBI) at the University of Adelaide, Adelaide, Australia. The search strategy sought
to find both published and unpublished research studies from 1970 to 2012, and was limited to papers written in
English. Two reviewers independently assessed the methodological quality of each study and extracted and analysed
qualitative data using the critical appraisal instruments from the System for the Unified Management, Assessment and
Review of Information (SUMARI) package of JBI.
Results: Fourteen qualitative studies comprised the final data set, from which 88 findings were extracted into 26
categories. Preliminary analyses indicate an upwards of 9 potential themes for what reflect patient and family members’
perceptions of what it is like for them to deal with an adverse event. Initial themes relate to the: 1) apology, 2)
communication, 3) consequences and impacts of the adverse event, 4) disclosure process, 5) fears for reprisal and/or
interference with care, 6) measures of safeguarding, 7) learned helplessness, 8) self-discovery and awareness of errors,
and 9) violations of trust.
Discussion: Research into an understanding of patient and family member perspectives of encountering an adverse
event as a result of receiving health care is a new and evolving area of research. Much of the research purporting to
address such an experience has often focused on individual satisfaction with the care received, rather than on how an
actual adverse event was perceived. These preliminary results further reflect that patient and family members’
perceptions of an adverse event occurrence is complex, involving both physical and emotional sequelae.
March 15, 2013
12
“Isolation of an Antimycobacterial Natural Plant Product from a Fungal Endophyte of the Medicinal Plant
Fragaria Virginiana”
Presenting Author
Trevor Clark, University of New Brunswick
Other Authors
Chris Gray, University of New Brunswick
John A. Johnson, University of New Brunswick
Katie Ellsworth, University of New Brunswick
Background: Natural products continue to play an unparalleled role in drug discovery and development. Fungal
endophytes are a relatively unstudied source of new bioactive natural products, primarily due to the difficulties
associated with their isolation. We have recently isolated a library of 94 fungal endophytes from 12 traditionally used
medicinal plants found in New Brunswick.
Methods: Fungal extracts were prepared from liquid cultures of the endophyte isolates and were screened for
bioactivity in a suite of laboratory bioassays. Isolate KE5-075 was selected for further investigation and was subjected to
bioassay guided fractionation using the microplate resazurin assay to evaluate activity against Mycobacterium
tuberculosis (H37Ra). Standard spectroscopic and spectrometric methods were used to identify the primary
antimycobacterial constituent of the endophyte extract.
Results: Bioassay screening data showed that from a total of 188 extracts (two extracts per isolate) 18 extracts were
cytotoxic, 10 extracts inhibited the growth of Staphylococcus aureus, 11 extracts inhibited the growth of Candida
albicans, and 50 extracts inhibited the growth of Mycobacterium tuberculosis. Bioassay guided fractionation of an
extract of the spent culture broth of a bench-scale fermentation of Nigrospora sp. led to the isolation of a single
antimycobacterial constituent (IC50 of 40.7 µg/ml). Analysis of spectroscopic and spectrometric data obtained for the
bioactive compound allowed its identification as abscisic acid (ABA), a plant hormone involved in numerous
developmental processes of plants.
Discussion: The strong antimycobacterial activity observed for endophyte KE5-075 (Nigrospora sp) isolated from
Fragaria virginiana prompted detailed investigation of the antimycobacterial constituents of this fungus. Abscisic acid is
a plant hormone that was isolated through a bioassay guided approach by antimycobacterial activity from a fungal
extract. ABA has not been previously reported to have antimycobacterial and as such may allow the identification of
new mode of action that can be employed in future antituberculosis drug development.
March 15, 2013
13
“HIV/HCV Prevention among Youth: A Provincial Policy Review”
Presenting Author
Anik Dube, University of New Brunswick
Other Authors
Margaret Dykeman, University of New Brunswick
Gregory Harris, Memorial University
Maryanne Tucker, Memorial University
Jacqueline Gahagan, Dalhousie University
Pamela Hudson, Dalhousie University
Alexandra Hill-Mann, Dalhousie University
Lois Jackson, Dalhousie University
Jo-Ann MacDonald, Prince Edward Island University
Background: Negative health outcomes related to HIV/HCV can have profound impacts on the lives of youth living New
Brunswick, as well as cause significant burdens on the healthcare system as a whole. Understanding the provincial
policies related to these infectious diseases is important to create effective prevention programs and service delivery
models. As part of a larger study in the Atlantic region, researchers in the Our Youth Our Response study conducted a
scoping review to assess HIV/HCV primary and secondary prevention policies, programs, and services targeting youth in
the province of New Brunswick.
Methods: This study was conducted in two interconnected and iterative phases. The first phase of the study included a
scoping review of key policies, programs, and service delivery documents pertaining to HIV/HCV primary and secondary
prevention of youth across the Atlantic region. Team members and key informants identified search terms for
document retrieval and search engines, including literature searches targeting the education, justice, health and
community sectors. Both academic and grey literatures were accessed. The second phase involved team members
coding the documents using a sex and gender based analytical framework, which built upon an existing sex- and genderbased analysis framework (Clow, Pederson, Haworth-Brockman, & Bernier, 2009). The concepts of partnership and
youth involvement, youth focus, urban and/or rural settings were added to complete the provincial analyses. To allow
consistency within analyses, the team coded the documents using a scale of 1 to 3 (i.e. 1- highly featured, 2- not fully
explored, 3- absent).
Results: In New Brunswick, the lack of policies concerning HIV/HCV among youth is problematic. Currently there is no
gender-based policy guiding the development of policy and program planning in HIV/HCV prevention, which implies
health policies, programs, and services encompass the gender-specific needs of both young men and women (i.e. 125.93%, 2- 17.28%, 3- 56.79%). Further, little mention of diversity and equity was found in the documents. Findings also
indicated that most documents were not youth focus, nor developed in partnership with youth, and many did not
include urban or rural significance to HIV/HCV prevention program initiatives and service delivery models.
Discussion: The provincial landscape has gone through significant changes in recent years, including government, health
authorities, and education sectors. New population-based strategies, program initiatives, and service delivery models of
care are being drafted and implemented within several sectors of the province creating ripple effects on primary and
secondary prevention of HIV/HCV among youth. For New Brunswick, the fact remains that integrating a sex, gender,
diversity, and equity approach to a population- based approach would encourage non-judgemental, youth friendly, and
gender sensitive programs and services in the province.
March 15, 2013
14
Poster Presentations iHR Day 2013
Abraham, Edward
Subjective Patient Outcomes and Surgical Morbidity in Decompression with an
Interspinous Process Device vs. Decompression and Fusion for Treatment of Stable
Degenerative Spondylolisthesis
Adam, Danielle
Evaluation of Family Physicians' Level of Comfort with Respect to the Evaluation
and Treatment of Children with Learning, Behavioural and Developmental
Concerns
Aladetoyinbo, Adenike
Looking Beyond the “Health Settlement Period” for Immigrants and Refugees in
New Brunswick
Atkinson, Paul
Aces High: How Realistic is High Fidelity Ultrasound Simulation for Abdominal and
Cardiothoracic Assessment with Sonography in Shock?
Atkinson, Paul
Block First, Opiates Later? The Use of the Fascia Ilica Block for Patients with Hip
Fractures in the Emergency Department: A Systematic Review
Atkinson, Paul
Aceing It: Can Abdominal and Cardiothoracic Assessment with Sonography in Shock
be Learned using High Fidelity Simulation?
Bos, Allyson
Antimycobacterial Natural Products from Populus tremuloides
Bulman, Donna
“Rigger Culture”: Social Disruption, Mobility, and HIV/AIDS
Burgess, Jean
Patient Voice: Appreciative Inquiry into Participants’ Stories about Living Well with
Diabetes
Cameron, Kayla
Can a Collaborative Community Mental Health Smoking Cessation Program Reduce
Cigarette Consumption?
Ciszewski, Stefanie
Validity and Reliability of the Behaviour Rating Inventory of Executive Function
(Adult Version) in a Clinical Sample of Patients with Eating Disorders
Cowie, Andrew
Advances in Omics and Bioinformatics in Environmental Toxicology and Human
Health
Cowie, Andrew
Transciptomic Meta-Analysis of Gamma-Aminobutyric Acid (GABA): A Receptor
Non-Competitive Antagonist and Possible Linkages to Neurodegenerative Diseases
Fanjoy, Lillian
Exercise Habits of Female University Undergraduates
Keeping-Burke, Lisa
A Systematic Review of Safety in Homecare: The Current State of Evidence
Leclerc, Jon
General Anesthetic Gas Usage at the Saint John Regional Hospital
March 15, 2013
15
Lewis, Brad
One and two level Decompression and Fusion of the Lumbar Spine: Post-Operative
Serum CK Values as a Predictor of ODI and VAS scores: A Retrospective Study
Li, Haoxin
Fatty Acids and Triacyl Glycerols: Nuisance Compounds and False Positives in
Natural-Product-Based Antimycobacterial Drug Discovery
MacLeod, Jeffrey
The Impact of Language, Socioeconomic Status and Place of Residence on Access to
and Outcomes Following Cardiac Surgery in New Brunswick
McCullum, Brent
Searching for a Fungal Source of Deoxypodophyllotoxin in the Medicinal Plant
Juniperus Communis
Melvin, Kathryn
Seasonal and Tissue Variation of Falcarindiol, the Primary Antimycobacterial
Constituent of the Canadian Medicinal Plant Heracleum Maximum
Morrison, Kate
The HEALTH (Healthy Eating, Active Living for Tomorrow’s Health) Study: An
Intervention for Improving Health-Related Fitness in Class I and II Obese Adults
Naylor, Heather
Escalating Tacrolimus Dosage Requirements after Rifampin Administration in a
Renal Transplant Patient: A Review of Rifampin Drug Interactions
O’Connell, Katie
Psychosocial Needs of Offenders with Psychotic Disorders Referred to a Mental
Health Court
Pawsey, Ryan
Prostate-Specific Antigen as a Predictive Tool for Prostate Volume in New
Brunswick Men without Prostate Cancer
Pelletier-Hibbert, Maryse
Husbands Living with Women on Dialysis: Embracing Their Transformed Life
Rouse, Colin
Differences in Arousal between High- and Low-Risk Gambling Groups: Decision
Making During a Gambling Task
Shannon, Amy
Personality Correlates of Alcohol Abuse and Dependence
Shi, Yunnuo
Effects of Co-Culture on the Biosynthesis of Bioactive Natural Products from
Endophytic Fungi
Tassone, Rossana
Is Anti-Cigarette Smoking Video Containing Local Content Effective in Improving
Knowledge, Attitude and Behaviour among Grade 9 Students?
Ward, Mellissa
Sizing of Aortic Valve for TAVI: Accuracy of Simplified CT Protocol Versus Standard
TEE
March 15, 2013
16
“Subjective Patient Outcomes and Surgical Morbidity in Decompression with an Interspinous Process Device
vs. Decompression and Fusion for Treatment of Stable Degenerative Spondylolisthesis”
Poster Presentation Author
Edward Abraham, Canada East Spine Center, Horizon Health Network
Other Authors
Dr. Neil Manson, Canada East Spine Center, Horizon Health Network
Alana Green, Canada East Spine Center, Horizon Health Network
Background: Indirect decompression with an Interspinous Process Device (IPD) has recently emerged as an alternative
to decompression and fusion for patients with stable degenerative spondylolisthesis. However, there is little research
comparing the applied outcomes of these methods. This study assessed surgical morbidity and subjective patient
outcomes between decompression with an IPD (DIPD) and decompression and fusion (DF).
Methods: Patients (n=57, 29:28 M:F) were recruited using data from the Canada East Spine Centre’s prospective surgical
outcomes database. Baseline variables were examined using independent samples t-tests and chi-squared tests. OR time
and blood loss were log-transformed and compared using t-tests. Patient satisfaction was tested with a chi-square test.
Time-varying outcomes (i.e. changes in pain, physical and mental functioning) were examined with a multilevel model of
change.
Results: No differences in baseline characteristics were found between the two surgical groups. Average age was 65.42
years, and average BMI was 29.91. Compared to the DF group, patients in the DIPD group had shorter OR times (DIPD:
79.48min; DF: 153.50min; t=-8.89, p<0.00), lost less blood (DIPD: 49.66mL; DF: 382.14mL; t=-11.28, p<0.00) and had
shorter hospitalization (DIPD: 0.45days; DF: 5.57days, t=10.09, p=0.02). There was no statistical difference in overall
treatment satisfaction, with more than 90% of patients reporting high satisfaction in both groups. Overall, patients
experienced significantly lower ODI scores, and higher physical and mental functioning over the course of the two-year
follow up. Although there was marked variation in the rate of improvement, there were no significant differences
between groups.
Discussion: Lower surgical morbidity, equivalent reoperation rate, and similar patient outcomes indicate that DIPD may
be a valuable alternative to DF for the treatment of stable degenerative spondylolisthesis. There may also be reduced
costs associated with DIPD. Further studies should aim to quantify the cost benefits and evaluate long-term patient
outcomes of DIPD vs. DF.
March 15, 2013
17
“Evaluation of Family Physicians' Level of Comfort with Respect to the Evaluation and Treatment of Children
with Learning, Behavioural and Developmental Concerns”
Poster Presentation Author
Danielle Adams, Dalhousie Medicine NB
Other Authors
Dr. Marc Nicholson, Pediatrics, Horizon Health Network
Denise Leblanc-Duchin, Research Services, Horizon Health Network
Background: Attention Deficit Hyperactivity Disorder (ADHD) and other behavioural conditions are common pediatric
disorders that affect a child’s academic achievement, social interactions, and their quality of life. Unfortunately, there is
a large volume of new pediatric behavioural referrals every year in Saint John and children frequently have to wait long
periods of time to be assessed and treated. The objective of this study was to evaluate the comfort level of local family
physicians with respect to the evaluation and treatment of children with learning, behavioural, and developmental
concerns.
Methods: A survey was distributed to 131 family physicians in the Saint John area and consisted of two broad questions
that were aimed at assessing the comfort level of the physician concerning (i) the diagnosis and, (ii) the follow-up of four
disorders: ADHD, Pervasive Developmental Disorders, learning disorders, and Oppositional Defiant Disorder. With
regards to stimulants, comfort levels were assessed for both initiating and managing medication.
Furthermore, years of practice were correlated with individual comfort levels. Responses were measured using Likert
scales and all responses were anonymous.
Results: Response rate was 51.1% (n = 67 physicians) with an average (± SD) of 20.0 ± 12.7 years of practice. There was
no correlation between years of practice and comfort level for diagnosis (r = 0.01, p = 0.92) and for follow-up of
disorders (r = 0.15, p = 0.24). The mean (± SEM) level of comfort for all disorders was significantly greater (p < 0.001) for
follow-up (5.75 ± 0.22) than for diagnosis (4.69 ± 0.23). Overall, the greatest comfort level reported was in treating
ADHD (6.62 ± 0.24) and this level was greater than all of the other disorders (p < 0.001). There was a significant effect of
treatment stage, such that follow-up was more preferable than diagnosis regardless of disorder (F1, 66 = 27.76, p < 0.001).
There was a statistically significant difference between initiating and managing stimulant medication (t66 = 6.00, p
<0.001).
Discussion: Taken together, these results justify the need for more educational opportunities for local family physicians
in the area of pediatric behavioural disorders. Future research should be aimed at evaluating the educational
opportunities available to local family physicians and correlating education with level of comfort making diagnoses of
common behavioural disorders and initiating stimulant medication (as there was no correlation with years of practice).
By targeting weaknesses in the referral process, changes can be made to improve the care of these children.
March 15, 2013
18
“Looking Beyond the “Health Settlement Period” for Immigrants and Refugees in New Brunswick”
Poster Presentation Author
Adenike Aladetoyinbo, Horizon Health Network
Other Authors
Lisa Frechette
Oluwole Oni
Aim: To sensitize primary care physicians to the burden of hemoglobinopathies within at risk communities.
Background: The healthcare needs of newcomers often differ from those of their Canadian-born counterparts. Even
though there are established guidelines that focus on clinical care gaps in the first five years of residence (health
settlement period) of immigrants and refugees in a new country, these focus on vaccination, infectious diseases and
parasitic infestations, mental health issues, vision and dental health as well cervical cancer screening. Iron-deficiency
anaemia screening is targeted for children aged 1-4 years and women of reproductive age. CMAJ, (2011).
This paper highlights the need to look beyond iron deficiency anaemia and to sensitize healthcare providers to peculiar
inherited conditions especially haemoglobinopathies. Early screening leads to better outcomes with improvements in
quality of life, morbidity and mortality as the natural history of the disease process is modified.
Currently in Canada, targeted thalassemia screening for carrier detection and prenatal diagnosis is available in Montréal,
Québec and Hamilton while newborn screening for sickle cell is mandatory in all 50 states in the United States of
America.
Method: Carrier rates for haemoglobinopathies within the at risk migrant community in Saint John, New Brunswick
were extrapolated from World Health Organisation (WHO), Centre for Disease Control (CDC) and the Thalassemia
Organization estimates.
Thus for sickle cell trait, prevalence is 20-30% with a 2% prevalence for sickle cell disease in the at risk countries of
Africa, while the prevalence of α-thalassemia and haemoglobin E in South East Asia is 15-30%. Carrier rates for βthalassemia ranges from 2-18% in the ethnically at risk population of Eastern Mediterranean and Asia.
Results: Between 2009 and 2012 there was a total of 201 government assisted refugees (GAR) in Saint John, made up of
11 different nationalities, 68 (34%) of which were children. 172 (86%) refugees were from the Western and South East
Asia out of which 63(31%) were children. Sub Sahara Africa accounted for 27 (13%) refugees comprising of 24 adults and
3 (1%) children. 6 (3%) refugees were from South America, 2 (1%) of whom were children.
In this cohort, there is a potential of up to 25-50 individuals carrying the thalassemia or Haemoglobin E variant while 5-8
individuals may be carrying the sickle cell trait.
Conclusion: The burden of hemoglobinopathies is high within at risk migrant population and this is likely to increase as
the demographics of Saint John changes to reflect the peculiar inter-marriage practices amongst newcomers from Asia
and Africa.
A province wide screening policy which should include a focused history, as well as prenatal and newborn testing will
help to streamline screening and ensure the early institution of appropriate genetic counselling and medical
management of affected individuals.
March 15, 2013
19
“Aces High: How Realistic is High Fidelity Ultrasound Simulation for Abdominal and Cardiothoracic
Assessment with Sonography in Shock?”
Poster Presentation Author
Paul Atkinson, Emergency Medicine, Horizon Health Network
Other Authors
Dr. Glenn Verheul, Emergency Medicine, Horizon Health Network
Dr. David Lewis, Emergency Medicine, Horizon Health Network
Background: Shock ultrasound training can be limited by the availability of patients with pathology. Simulation may
provide a more efficient way of training. We assessed high fidelity ultrasound simulation for how realistic it appeared for
normal anatomy and pathology seen when performing Abdominal and Cardiothoracic Evaluation by Sonography in
Shock (ACES) scans.
Methods: 42 physicians participated in educational sessions which included didactic learning followed by supervised
scanning normal volunteers and patients with pathology using portable ultrasound machines (GE & Sonosite).
Participants performed focused ACES scans using a high fidelity ultrasound simulator (VIMEDIX), imaging the heart,
chest, abdomen, aorta, and inferior vena cava (IVC). All participants were then surveyed using a standardized 5-point
Likert scale for how realistic normal anatomy and pathology appeared. Data was analyzed using ANOVA (GraphPad
Prism).
Results: All 42 surveys were completed. 27 (64.3%) had previous ultrasound training, and two (4.8%) had previously
used the ultrasound simulator. The simulator was rated as realistic to very realistic for real time demonstration of
cardiac (Mean score 4.3; 95% CI 4.0-4.5), chest (4.2; 3.9-4.4), abdominal (4.1; 3.9-4.3), aortic (4.1; 3.8-4.4), and IVC (4.2;
4.0-4.5) pathology and for normal cardiac (4.2; 4.0-4.5), chest (4.2; 4.0-4.5), abdominal (4.1; 3.9-4.4), aortic (4.1; 3.94.4), and IVC (4.3; 4.1-4.5) anatomy. 41 (97.6%) participants stated that they would use high fidelity ultrasound
simulation to further develop and maintain skills with trauma ultrasound. All simulation groups scored significantly
better than neutral (“neither realistic or non-realistic”; p<0.05).
Discussion: Simulated ultrasound was rated as realistic for normal anatomy and pathology for all ACES windows. It is
likely that ultrasound simulation will have an increasingly important role in shock ultrasound education and skills
maintenance, though is unlikely to replace the need for training on live patients.
March 15, 2013
20
“Block First, Opiates Later? The Use of the Fascia Ilica Block for Patients with Hip Fractures in the Emergency
Department: A Systematic Review”
Poster Presentation Author
Paul Atkinson, Emergency Medicine, Horizon Health Network
Other Author
Adam Chesters, Cambridge University Hospital
Background: Patients who suffer hip fractures often require large doses of opiate analgesia during their initial
assessment. We performed a systematic review of the literature to determine the efficacy of the fascia iliaca block in
providing adequate analgesia to patients presenting with hip fracture in the emergency department.
Methods: EMBASE, PubMed, CINAHL, and Google Scholar were searched. Free text keywords for population,
intervention and outcome were identified to create a search string. The reference lists from articles identified in the
primary electronic search were hand-searched. The search strategy was repeated using the System for Information on
Grey Literature in Europe. Potentially eligible studies were identified based on review of the title and abstract. If
eligibility was unclear from the title and abstract, the full text was examined. Randomised controlled trials comparing
the fascia iliaca block with standard analgesia were included. A standardised appraisal of the methodological quality of
the studies was performed.
Results: 39 articles were identified, of which 13 were duplicates. Of the remaining 26, 14 were relevant to the question
and suitable for further sorting. Of these 14 papers, 2 were randomised controlled trials, 5 were cohort studies, and 4
were reports of audit of practice. There were 3 abstracts of conference submissions, which were descriptions of reviews
or service development projects. The 2 randomised controlled trials showed statistically significant superior or equal
pain relief between the fascia iliaca block and other forms of acute pain relief.
Discussion: The fascia iliaca block could have an important role in first line pain control for patients presenting to the
emergency department with a hip fracture. There is potential to reform the acute management of this common group of
patients, which could lead to decreased opiate use in this elderly population.
March 15, 2013
21
“Aceing It: Can Abdominal and Cardiothoracic Assessment with Sonography in Shock be Learned using High
Fidelity Simulation?”
Poster Presentation Author
Paul Atkinson, Emergency Medicine, Horizon Health Network
Other Authors
Dr. Glenn Verheul, Emergency Medicine, Horizon Health Network
Dr. David Lewis, Emergency Medicine, Horizon Health Network
Background: Shock ultrasound training can be limited by the availability of patients with pathology. Simulation may
provide a more efficient way of training. We assessed ultrasound simulation for teaching ultrasound technique when
learning the Abdominal and Cardiothoracic Evaluation by Sonography in Shock (ACES) protocol.
Methods: 42 physicians participated in educational sessions which included didactic learning, followed by supervised
scanning on normal volunteers and patients with pathology using portable ultrasound machines (GE & Sonosite).
Participants performed focused ACES scans using a high fidelity ultrasound simulator (VIMEDIX), imaging the heart,
chest, abdomen, aorta, and inferior vena cava (IVC). All participants were then surveyed using a standardized 5-point
Likert scale on using simulation and volunteer/patients for learning technique, and for training overall. Data was
analyzed using paired T-test (GraphPad Prism).
Results: All 42 surveys were completed. 27 (64.3%) had previous ultrasound training, and two (4.8%) had previously
used the ultrasound simulator. As a method for learning ultrasound technique there was no significant difference in
mean scores between patient/volunteers and the simulator for cardiac (4.5 vs. 4.4; p=0.435), chest (4.4 vs. 4.3, p=0.249),
aorta (4.5 vs. 4.3; p=0.154) or IVC (4.2 vs. 4.4; p=0.465) scanning. For abdominal (free fluid) scanning, learning scanning
technique was superior with patients/volunteers (4.6 vs. 4.3, p=0.032). 41 (97.6%) participants stated that they would
use high fidelity ultrasound simulation to further develop and maintain skills.
Discussion: Simulated ultrasound compared favourably to real ultrasound for learning scanning technique for all but
one of the ACES windows. It is likely that ultrasound simulation will have an increasingly important role in shock
ultrasound education and skills maintenance, though is unlikely to replace the need for training on live patients.
March 15, 2013
22
“Antimycobacterial Natural Products from Populus tremuloides”
Poster Presentation Author
Allyson Bos, UNB Saint John
Other Authors
Haoxin Li, UNB Saint John
John A. Johnson, UNB Saint John
Duncan Webster, Horizon Health Network
Christopher A. Gray, UNB Saint John
Background: Tuberculosis, caused by Mycobacterium tuberculosis, was responsible for infecting nearly 9 million people
and causing approximately 1.5 million deaths worldwide in 2010. Due to the immensity of this global health emergency
and the increasing emergence of resistant mycobacterial strains, new tuberculosis drugs are urgently needed. Natural
products have historically provided the majority of anti-infective agents and represent a promising source of
antimycobacterial compounds. The medicinal plant Populus tremuloides (trembling aspen) has been used extensively by
First Nations peoples for a variety of illnesses and has been reported to possess antimycobacterial activity. The objective
of this research was to isolate and identify the antimycobacterial constituents of Populus tremuloides.
Methods: Methanolic extracts derived from the bark and twigs of P. tremuloides were subjected to bioassay guided
fractionation using the microplate resazurin assay to assess antimycobacterial activity.
Results: The crude P. tremuloides extract exhibited strong inhibitory activity against M. tuberculosis (H37Ra) and
bioassay guided fractionation has resulted in numerous fractions that are currently being investigated. Salicin has been
identified as a constituent of one of the bioactive fractions and was found to possess modest antimycobacterial activity.
Further work is in progress to identify the other chemical constituent(s) responsible for the observed antimycobacterial
activity of P. tremuloides.
Discussion: Our research continues to provide evidence that medicinal plants used by the First Nations communities of
the Canadian Maritime provinces represent an important source of biologically active compounds. Preliminary results
show that P. tremuloides contains a significant number of antimycobacterial constituents and, as such, this plant has
significant potential to contribute to the development of antimycobacterial agents in the future.
March 15, 2013
23
“Rigger Culture’: Social Disruption, Mobility, and HIV/AIDS”
Poster Presentation Author
Donna Bulman, UNB Saint John
Other Authors
Dr. Margaret Dykeman, UNB Saint John
Dr. Maria Mathews, Memorial University
Background: This qualitative research study explores lifestyle changes associated with mobile work that may put one at
risk for acquiring HIV/AIDS or other STIs.
Method: Data collection for this qualitative research study occurred between 2008 and 2011. Sixteen men and women
from New Brunswick and Newfoundland participated. All participants had worked in the oil sands at Fort McMurray and
had travelled back to Atlantic Canada at least once in the year prior to data collection. Participants discussed lifestyle
factors related to mobility, social disruption and “place” that might put them at risk for acquiring HIV/AIDS or other
STI’s. A thematic analysis was completed.
Results: Social disruption, mobility, “rigger culture” and limited health services contributed to risky behaviours that
could put participants at risk for acquiring HIV/AIDS or other STIs.
Discussion: Additional research, including ethnographic studies, are required prior to making recommendations to
influence health promotion, harm reduction and occupational health and safety policies. This research could involve
participants from both host and receiver communities.
March 15, 2013
24
“Patient Voice: Appreciative Inquiry into Participants’ Stories about Living Well with Diabetes”
Poster Presentation Author
Jean Burgess, UNB Fredericton, Atlantic Regional Training Centre
Background: Patients with chronic conditions develop experiential health management knowledge through self-care
(Lorig, 2002). This largely undocumented knowledge is a potential resource for researchers, patient-centered
practitioners, health services policymakers and newly diagnosed peers (Caron-Flinterman, Broerse, & Bunders, 2005;
Health Canada, 2000; Montague, 2004; Wagner, 2006). This study assessed the use of appreciative inquiry as a
methodology to learn from the patient’s experience of diabetes self-management (Reed, 2007). Appreciative inquiry is
an innovative methodology for researching positive topics through appreciative questions about achievements,
strengths and visions.
Methods: A convenience sample of 13 participants, self-identified as having diabetes or being at risk, was invited to
share stories of successful diabetes management in individual interviews with the author. Thematic analysis (Braun &
Clarke, 2006) was used to examine the positive stories elicited.
Results: Participants who self-report living well with diabetes simultaneously embrace their condition and embrace life.
They do so through the complex interaction of experiential knowledge, interpersonal support, and personal qualities.
Discussion: Participants’ stories demonstrate the appreciative power of focusing on what works and what can be built
on going forward. These stories of living well with diabetes are interpreted within the framework of Frank’s (1995)
illness narrative theory which proposes three kinds of illness narrative: chaos, restitution, and quest. Study participants
overcome the chaotic disruptions of a chronic illness diagnosis. There was no restitution of a condition-free life, in
contrast to acute illness stories. Instead there was an ongoing quest for integration and meaning in life as it is.
Patient experiential knowledge of living well with diabetes is both particular and holistic. Such knowledge usefully
complements general evidence-based health services knowledge. Patient experiential knowledge of self-care can be
supported, enhanced, and benefited from through health services policies and practices which recognize its value
(Rachlis, 2005). Study recommendations are: Consider use of an appreciative inquiry design in asset-focused
investigations of patient experiential knowledge of self-management. Assess how consideration of patient experiential
knowledge, interpersonal support and personal qualities is integrated into patient-centered care. Remember the
patient’s quest for connection, meaning, and the good life permeates health related activity.
March 15, 2013
25
“Can a Collaborative Community Mental Health Smoking Cessation Program Reduce Cigarette
Consumption?”
Poster Presentation Author
Kayla Cameron, Pharmacy Resident, Horizon Health Network
Other Author
Andrew Brillant, Pharmacist, Horizon Health Network
Background: People with mental illness are thought to be approximately twice as likely to smoke compared to the
general population. Smokers with mental illness who participate in smoking cessation groups offered to the general
population may feel misunderstood or unwelcome by those who do not live with a mental illness; therefore a supportive
approach to smoking cessation is recommended in this population. Even just reducing cigarette consumption may
predict future success of complete cessation. Certain psychotropic drugs such as clozapine and olanzapine can be
affected by reducing cigarette consumption and warrant an increase in monitoring of toxicities. The evidence for
smoking cessation outcomes in the mental health population is limited and even sparser for community based trials but
trends toward the finding that there is success in quit rates or reduction in smoking without having negative effects on
mental health thus encouraging more effort to be put into smoking cessation interventions for this population.
Objective: The primary objective is to determine if participants from a community mental health recovery center will
reduce cigarette consumption with implementation of a smoking cessation program (with encouraged use of nicotine
replacement therapy) in six to eight weeks compared to baseline. Secondary objectives include changes in nicotine
dependence, medication changes (factual change or dose change) that may be a result of tobacco reduction, and
participant satisfaction.
Methods: Observational data will be obtained prospectively at a single community mental health recovery center pre
and post implementation (between weeks 6 and 8) of a 12 week smoking cessation program using a self reported data
collection questionnaire and then compared in order to assess outcome measures. The intended population will be
selected by voluntary enrollment at the mental health recovery center with a target population being those living in
community with mental illness who are current smokers. Group sessions will primarily be conducted by a registered
nurse with experience working in addictions and a pharmacist will be involved in education on nicotine replacement
therapy and will be accessible over the course of the program.
Results: Data collection and patient enrolment is currently underway.
Discussion: To determine if community based smoking cessation groups are of benefit in the mental health population
this study hopes to show that a smoking cessation group based program (with the option to use nicotine replacement
therapy) at a community mental health recovery center will result in a reduction of number of cigarettes smoked per
day. We also hope to show reduced nicotine dependence, high participant satisfaction, and no relevant medication
changes that may be a result of reducing cigarette consumption. We plan to contribute to the growing body of evidence
for naturalistic community based smoking cessation interventions in the mental health population and to support the
utilization of these interventions. Our desire is that those living with mental illness in the community will gain access to
more smoking cessation programs, feel comfortable attending, and obtain benefit and satisfaction while paving their
way to a healthier lifestyle.
March 15, 2013
26
“Validity and Reliability of the Behaviour Rating Inventory of Executive Function (Adult Version) in a Clinical
Sample of Patients with Eating Disorders”
Poster Presentation Author
Stefanie Ciszewski, UNB Saint John
Other Authors
Dr. Kylie Francis, The Ottawa Hospital, The Ottawa Hospital Research Institute
Dr. Giorgio A. Tasca, The Ottawa Hospital, The Ottawa Hospital Research Institute
Dr. Paul Mendella, The Ottawa Hospital, The Ottawa Hospital Research Institute
Background: Eating disorders, an Axis I disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition Revised (DSM-IV-TR; American Psychiatric Association, 2000) are characterized by severe disturbances in eating
behaviour. Research has indicated that some eating disorder patients have deficits in certain domains of executive
function (EF), which could reduce the effectiveness of treatment. EF is a neuropsychological construct, which
encompasses higher order cognitive processes such as planning, prioritizing, emotional reactivity, and controlling
impulse behaviour. These processes are involved in the regulation and execution of cognition, emotion and behaviour.
To date, no self-report measure of EF has been validated in an eating disorder population. The purpose of the present
study was to determine the validity and reliability of the Behaviour Rating Inventory of Executive Function – Adult
Version (BRIEF-A) in a clinical sample of women with eating disorders.
Methods: Participants included 254 adults (252 females and 12 males) who were referred to the Regional Centre for the
Treatment of Eating Disorders at The Ottawa Hospital. At their initial consultation, participants completed a package of
questionnaires that included the BRIEF-A. A friend or family member who could comment on the behaviour of the
participant completed the BRIEF-A informant report. Internal consistency reliability of the BRIEF-A was assed using
Cronbach’s alpha and mean inter-item correlations for each of the nine clinical scales of the BRIEF-A. An exploratory
factor analysis of the nine subscales was used to determine construct validity. Pearson’s correlations were also used to
assess construct validity, as well as convergent validity of the BRIEF-A.
Results: The nine clinical scales of the BRIEF-A achieved adequate internal consistency (α =. 69 - .91), and high internal
consistency for the two indices and Global Executive Composite (α =. 94 - .96). In a test of convergent validity, Pearson’s
correlations revealed a high positive relationship between the self-report and the informant report of the BRIEF-A. In a
final test of construct validity, an exploratory factor analysis using principal axis factoring and an oblique promax
rotation resulted in the expected two-factor higher order structure.
Discussion: The BRIEF-A appears to be a reliable and valid tool for measuring EF in an ED population. With information
about EF, clinicians may be able to better tailor ED treatments to increase their effectiveness.
March 15, 2013
27
“Advances in Omics and Bioinformatics in Environmental Toxicology and Human Health”
Poster Presentation Author
Andrew Cowie, UNB Saint John
Other Authors
Jennifer Loughery, UNB Saint John
Matthew Hindle, UNB Saint John
Yasmin Chishti, UNB Saint John
Alexander Riazanov, UNB Saint John
Christopher J. O. Baker, UNB Saint John
Christopher J. Martyniuk, UNB Saint John
Environmental pollutants are present in many water systems in concentrations that induce adverse biological effects in
vertebrate models. Many of these pollutants are capable of affecting reproductive processes by interfering with
hormone signaling and neural function of organisms. Studies in our laboratory have investigated the molecular pathways
associated with herbicides (linuron), pesticides (dieldrin) polycyclic aromatic hydrocarbons (associated with oil
production and refining; phenanthrene and pyrene), pharmaceuticals (flutamide and 17α-ethyinylestradiol) and steroids
(dihydrotesterone (DHT) and progesterone) in gonadal, hepatic and hypothalamus/telencephalon tissues of the fathead
minnow (FHM, Pimephales promelas).
Omics technologies (i.e. transcriptomics and proteomics) are used to identify pathways significantly affected by
exposure through gene set enrichment and sub-network enrichment analyses. Moreover, the bioinformatics
techniques—support vector machine--allowed us to classify linuron’s mode of action as anti-androgenic in the FHM’s
ovary. Our future work will continue characterizing transcriptomics and proteomic responses in the FHM reproductive
axis to environmental pollutants such as dieldrin, pyrene and linuron as well as characterizing the neuroendocrine
response of the zebrafish (Danio rerio) to β-methylamino-L-alanine, a cyanotoxin, and dieldrin; both of which are
implicated in neurotoxicity and neurodegeneration.
These studies improve knowledge about mechanism of how these chemicals are related to impaired reproduction and
human disease, thus providing important information for risk assessment and management to human health and
mechanistic information for biomedical research.
March 15, 2013
28
“Transciptomic Meta-Analysis of Gamma-Aminobutyric Acid (GABA): A Receptor Non-Competitive
Antagonist and Possible Linkages to Neurodegenerative Diseases”
Poster Presentation Author
Andrew Cowie, UNB Saint John
Other Authors
Christopher J. O. Baker, UNB Saint John
Christopher J. Martyniuk, UNB Saint John
Alexander Riazanov, UNB Saint John
Pesticides, pharmaceuticals, industry by-products and cyanotoxins are environmental pollutants linked to human
diseases. Molecular and epidemiological studies are demonstrating increased risks to neurodegeneration by
environmental pollutants. A target for several of these pollutants is the GABAergeric system, in particular the GABAA
receptor. GABA is the major inhibitory neurotransmitter in the vertebrate nervous system and abnormalities in the
GABAergeric system have been linked to epilepsy, Parkinson’s and Alzheimer’s disease and sleep disorders.
Therefore, the objective of this study is to characterize expression similarities and differences between GABAA receptor
non-competitive agonists (dieldrin, RDX, and fipronil) in the brain using fish models. Microarray studies from Gene
Expression Omnibus were extracted and analyzed for gene set enrichment, sub-network enrichment analysis and
functional enrichment. Using Pathway Studio and Semantic Automated Discovery and Integration (SADI), we probed the
literature and online databases to determine how gene expression patterns are related to neurodegenerative diseases.
This study improves knowledge regarding the effect of GABAA receptor antagonism on the transcriptomics repsonses in
the central nervous system and identifies putative linkages to disease, which may allow for better risk assessment of
these pollutants.
March 15, 2013
29
“Exercise Habits of Female University Undergraduates”
Poster Presentation Author
Lillian Fanjoy, UNB Saint John
Other Authors
Luke McNeill, UNB Saint John
Dr. Lisa Best, UNB Saint John
Background: There has been an abundance of research describing the harmful impact of physical inactivity on overall
health. For instance, the World Health Organization (WHO) classifies physical inactivity as the fourth leading risk factor
for global mortality (WHO; Global Recommendations on Physical Activity for Health, 2010). As a result, there has been
an increased emphasis on achieving adequate amounts of exercise in recent years. For an adult between the ages of 18
and 64 to derive a health benefit from exercise, the Canadian Physical Activity guidelines recommend an average of 20
minutes of physical activity per day, or a total of 150 minutes per week (Global Recommendations on Physical Activity
for Health, 2010). The current study seeks to find out whether female university students are achieving these guidelines.
Methods: Data was collected from 69 female students from introductory psychology classes at the University of New
Brunswick, Saint John. The data used for this analysis was obtained using the Leisure Time Activity Questionnaire (LTAQ),
a 6-item self-report questionnaire that measures the amount of time that a participant spends exercising in an average
week and the types of activities in which participants engage. Data was also collected using the Eating Attitudes Test
(EAT-26), a 26-item questionnaire measuring atypical behaviours and attitudes about eating, as well as the Exercise
Dependence Scale-21, a 21-item self-report questionnaire which determines level of exercise dependence.
Results: On average, females in this sample exercised 3.4 times per week (SD = 1.8) for a period of 1.4 hours (SD = .54)
per day. This translates to approximately 84 minutes of daily exercise. As a group, participants indicated 27 different
activities that they engaged in to achieve their exercise. The most frequent activity reported by participants was walking
(N = 21; 30.4%), followed by running (N = 10; 14.5%) and exercising at the gym (N = 5; 7.2%). Exercise dependence
scores were positively correlated with exercise frequency (r = .564, p < .001), exercise time (r = .259, p = .034), and
disordered eating scores (r = .366, p = .002).
Discussion: If the results of this study are any indication, female university students seem to be engaging in adequate
amounts of physical activity. In fact, the average female in this study reported three times the minimum amount of
exercise as recommended by the Canadian Physical Activity guidelines. There could be several reasons for this. The
UNBSJ campus has many health and fitness facilities available to students, including the G. Forbes Elliot Athletics Centre
and the Canada Games Stadium. The campus also offers regular fitness classes, which are free to all students. These
results are important, as increased exercise is associated with increased exercise dependence, which in turn is correlated
with higher levels of disordered eating. Future research may investigate the reasons behind student activity and
inactivity in order to more effectively promote physical health during the university experience.
March 15, 2013
30
“A Systematic Review of Safety in Homecare: The Current State of Evidence”
Poster Presentation Author
Lisa Keeping-Burke, UNB Saint John
Other Authors
Margaret Harrison, Queen’s University
Janice McVeety, Queen’s University
Christina Godfrey, Queen’s University
Amanda Ross-White, Queen’s University
Background: This systematic review on safety in homecare was conducted to support a Pan-Canadian research study
titled Safety at Home: A Pan-Canadian Home Care Safety Study. The intent was to support the larger project by
providing a comprehensive, current synopsis of evidence in the Canadian and international literature.
Objectives: The objectives of this review were to: 1) develop/test a comprehensive search strategy on adverse events
(AEs) in the homecare environment to track emerging evidence; 2) determine what has been documented about AEs in
the homecare setting; and 3) advance the definition of safety in homecare by analysis of reported/published definitions.
Methods: The project followed the typology of ‘mapping review/systematic map’ characterized by a process of mapping
and categorizing the existing literature. This multi-step, iterative process used an explicit search and retrieval strategy
based on the Joanna Briggs Institute (JBI) methodology and included a quality assessment of sets of study designs and
graphic representation of the synthesis. A modified Problem, Intervention, Comparison, Outcome (PICO) template was
used to design the search. To facilitate concept clarification, key definitions relevant to patient safety and AEs in
homecare were catalogued. A purposeful search of the grey literature was conducted to identify information not
obtained from the peer reviewed sources. Multiple challenges arose with data extraction and synthesis.
Results: There is an emerging but neophyte evidence base of safety in homecare, but a predominant theme is lack of
conceptual clarity with patient safety and adverse events in the home environment. Innovative strategies/tools are
surfacing in peer-review and grey literature as quality initiatives with/without evaluation.
Discussion: Context (of care in the home) is an important issue, deserving increased attention in practice and policy
circles. A glaring limitation is the paucity of research on the occurrence of AEs and a lack of quality of research that
documents prevalence estimates/incidence rates. Interventional research to evaluate risk reduction strategies is very
limited and will advance only when tracking and documentation of various AEs improves.
March 15, 2013
31
“General Anesthetic Gas Usage at the Saint John Regional Hospital”
Poster Presentation Author
Jon Leclerc, Dalhousie Medicine NB
Other Author
Dr. David Hughes, Horizon Health Network
Background: Anesthetic gas usage has several advantages over IV usage, but is also associated with environmental
damage. Inhaled anesthetic agents are excreted largely unmetabolized by the body, and many of these volatile
compounds cause damage to the ozone layer. The purpose of this study was to examine the use of volatile anesthetic
agents in surgery at the Saint John Regional Hospital (SJRH) over a one-month period.
Methods: Over a one month period, total use of several volatile anesthetic compounds and gas usage was measured
using 14 electronic anesthetic machines around operating rooms at the SJRH. Cost estimations were included as well.
Results: Of the three main compounds observed (desflurane, sevoflurane and isoflurane), desflurane use was highest (in
liquid mL), followed closely by sevoflurane and finally isoflurane.
Discussion: In general, previous studies showed desflurane has the highest environmental impact, and so this may not
be the preferred anesthetic agent in the absence of clinical indications for its use over a compound like isoflurane which
is also relatively cheaper.
March 15, 2013
32
“One and two level Decompression and Fusion of the Lumbar Spine: Post-Operative Serum CK Values as a
Predictor of ODI and VAS scores: A Retrospective Study”
Poster Presentation Author
Brad Lewis, Dalhousie Medicine NB
Other Authors
Dr. Edward Abraham, Horizon Health Network
Dr. Neil Manson, Horizon Health Network
Melissa McKeon, Canada East Spine
Alana Green, Canada East Spine
Background: The pre- and post-operative measurement of Creatinine Kinase (CK) is a valid indicator of iatrogenic
paraspinal muscle tissue damage. It is common practice to use the Oswestry Disability Index (ODI) and the Visual
Analogue Scale for back and leg pain (VAS-B/L) as a measure of functionality and pain, respectively. There are several
theoretical benefits for the use of Minimally Invasive surgical (MIS) techniques over the use of Open Spinal Surgery (OSS)
which include a reduction in intraoperative intramuscular injury, blood loss (BL), and a decreased recovery time with
earlier ambulation. However, OSS requires less operating time (OT) with a decreased risk of technical difficulties. To
date, the literature comparing post-operative CK values and long-term outcomes of MIS and OSS are based on small
sample sizes and do not consistently demonstrate significant differences in pain or function between the surgical
techniques after a 1-year follow-up. The purpose of this retrospective pilot study is to evaluate patient outcome based
on post-operative CK values and their initial follow-up ODI and VAS-B/L scores who underwent a 1 or 2 level Lumbar
Fusion (LF) via MIS or OSS.
Methods: A retrospective analysis was performed on 31 patients (M=12, F=19) with a mean age of 57 ± 14.5 years who
had undergone a 1 or 2 level LF via MIS or OSS, between January 2010 and August 2012. Serum CK values were
measured before surgery and again, 1-2 and 3-4 days, post surgery. At the initial follow-up (8 week follow-up +/- 2
weeks), patients were asked to report their pain and function levels using the VAS-B/L and ODI, respectively. Data for
pre-operative (i.e. demographics, VAS-B/L and ODI scores), intra-operative (i.e. BL, OT), and post-operative (i.e. VAS-B/L
and ODI) was analyzed using an ANOVA to detect significant differences between groups and Pearson correlation to
assess the relationship of post-operative CK to pain/function, intraoperative and demographic information (p > 0.05).
Results: OSS and MIS for 1 and 2 level LF groups were similar in pre-operative ODI and VAS-B/L scores, age, and BMI.
Follow-up ODI and VAS-B/L scores were not significantly different between 1 and 2 level LF, or OSS and MIS groups. LF
level did not significantly effect Post-operative CK or follow-up ODI and VAS-B/L scores. OT and BL volumes were
significantly lower in the single LF. BL and surgery type was significantly correlated with increased 1-2 day post-operative
CK values. The MIS group had significantly lower intra-operative BL (217.6 vs. 550ml) and post-operative CK on days 1-2
(782.6 vs.1949 IU/L).
Discussion: Post-operative CK values did not indicate a significant effect on initial follow-up pain and function scores.
This study is limited by a small sample size and short follow-up period. Therefore, further research is needed to conclude
the relationship between post-operative CK and intra-operative muscle injury as measured by subjective patient
outcomes. Furture research will examine the relationship between 1-2 level spinal fusions via MIS/OSS and CK values at
a 2 year follow-up.
March 15, 2013
33
“Fatty Acids and Triacyl Glycerols: Nuisance Compounds and False Positives in Natural-Product-Based
Antimycobacterial Drug Discovery”
Poster Presentation Author
Haoxin Li, UNB Saint John
Other Authors
John A. Johnson, UNB Saint John
Christopher A. Gray, UNB Saint John
Duncan Webster, Horizon Health Network
Background: During the search of anti-mycobacterial natural products from the traditional used medicinal plants from
Canadian First Nation communities, we found that low polarity fractions of active plant crude extracts were likely to
significantly inhibit the growth of Mycobacterium tuberculosis (H37Ra). Surprisingly, our results suggested that linoleic
acid and its glycerol derivatives were the metabolites responsible for the bioactivity of the extracts. However, in the
absence of detailed bioactivity and spectroscopic literature data, it was difficult to confirm our experimental results.
Therefore, the objectives of this study were to synthesize and fully characterize linoleic acid glycerol derivatives and
evaluate their anti-mycobacterial activities.
Methods: Linoleic acid glycerol derivatives were synthesized using conventional esterification methods and their
structures were confirmed by nuclear magnetic resonance and mass spectrometric experiments. The microplate
resazurin assay (MRA) was used to assess the anti-mycobacterial activities of linoleic acid and the five linoleic acid
glycerol derivatives.
Results: All of the linoleic acid derivatives exhibited significant bioactivity, with linoleic acid being the most potent antimycobacterial compound with an IC50 of 0.78 µg/mL. All of these derivatives should therefore be considered nuisance
compounds as they present false-positives in antimycobacterial bioassay screens.
Discussion: Central to the success of any natural product based drug discovery program is the availability of reliable
procedures to screen biological extracts for bioactivity. When screening large libraries of extracts it is not uncommon for
false positives to be encountered and, when these occur, it is imperative that the nuisance compounds responsible can
be identified as early as possible either during project prioritization or the bioassay guided fractionation process. This
study has identified and provided detailed data for an important group of nuisance compounds that are responsible for
frequent false positive screening results in bioassays employing mycobacteria. As such, our findings will facilitate the
continued discovery of new antimycobacterial compounds from natural product drug discovery programmes.
March 15, 2013
34
“The Impact of Language, Socioeconomic Status and Place of Residence on Access to and Outcomes
Following Cardiac Surgery in New Brunswick”
Poster Presentation Author
Jeffrey MacLeod, New Brunswick Heart Centre, Horizon Health Network
Other Authors
Ansar Hassan, New Brunswick Heart Centre, Horizon Health Network
Sohrab Lutchmedial, New Brunswick Heart Centre, Horizon Health Network
Marc Pelletier, New Brunswick Heart Centre, Horizon Health Network
Alexandra M. Yip, New Brunswick Heart Centre, Horizon Health Network
Background: The Canadian health care system is mandated to provide equitable access to medical services. This study
investigated the effect of language, socioeconomic status (SES) and place of residence on access to and outcomes
following cardiac surgery in New Brunswick.
Methods: All patients undergoing cardiac surgery at the New Brunswick Heart Centre between April 2004 and March
2011 were identified. Language was defined as the language used most often at home. SES was estimated using a
regional deprivation index. Place of residence was based on the regional health authority (RHA) in which a patient
resided. Annual age- and sex-adjusted rates of cardiac surgery were calculated by RHA as were overall rates of inhospital and 30-day adverse events following surgery.
Results: 4575 patients were identified. Rates of surgery differed across RHA. Where RHA-4 had substantially lower
rates of surgery, this region was excluded. The predominance of English- vs. French-speaking patients differed across
RHA (p<0.0001). Similarly, SES differed across RHA (p<0.0001), with RHA-1, RHA-2 and RHA-3 emerging as the most
affluent regions. Patients from RHA-7 experienced greater median surgical wait times (19d vs. 9d, p<0.01). While rates
of in-hospital mortality did not differ across RHA (p=0.18), 30-day rates of any complication and/or readmission did
(p=0.01), with the highest rates occurring in RHA-1 and RHA-7.
Conclusion: Despite a single-tier health care system, New Brunswickers experience geographic variation in access to and
outcomes following cardiac surgery. Further analysis will determine the role that language and SES play in creating these
differences.
March 15, 2013
35
“Searching for a Fungal Source of Deoxypodophyllotoxin in the Medicinal Plant Juniperus Communis”
Poster Presentation Author
Brent McCullum, Horizon Health Network
Other Authors
Katie Ellsworth, UNB Saint John
Dr. John A. Johnson, UNB Saint John
Dr. Christopher A. Gray, UNB Saint John
Background: Natural products have proven to be an invaluable source of novel drugs that exhibit a diverse array of
biological effects including anti-inflammatory, antibacterial, and antitumor activities. One such natural product,
deoxypodophyllotoxin, not only displays a multitude of bioactivities, but can also be converted into the anticancer drug
precursor, podophyllotoxin. The natural sources of podophyllotoxin, Podophyllum plant species, are becoming
increasingly limited due to intensive collection and so the identification of a renewable source of deoxypodophyllotoxin
would be extremely beneficial. The recent isolation of deoxypodophyllotoxin from the Canadian medicinal plant
Juniperus communis and reports that this natural product can be biosynthesized by endophytic fungi prompted us to
investigate the potential of J. communis endophytes to produce deoxypodophyllotoxin.
Methods: Six endophytes isolated from the needles of J. communis were fermented in liquid culture and chemical
extracts of the broth and fungal material were prepared. The crude extracts were then subjected to an optimized highperformance liquid chromatography-mass spectrometry (LC-MS) protocol to quantify the amounts of
deoxypodophyllotoxin in the extracts.
Preliminary Results: Endophyte extracts have been prepared and optimal screening conditions have been developed.
Further work will involve screening the extracts for the presence of deoxypodophyllotoxin and quantifying the amounts
of the natural product present in the extracts.
Discussion: Deoxypodophyllotoxin is an important precursor of molecules used for the production of currently
prescribed cancer therapeutics (e.g. etoposide). Renewable sources of these precursors are becoming increasingly
scarce and alternative sources are currently being sought. The detection of deoxypodophyllotoxin in extracts of fungi
isolated from J. communis would provide a renewable source of this molecule and could allow its production through
fermentation techniques, thus addressing a major problem regarding the supply of natural product derived
chemotherapeutics.
March 15, 2013
36
“Seasonal and Tissue Variation of Falcarindiol, the Primary Antimycobacterial Constituent of the Canadian
Medicinal Plant Heracleum Maximum”
Poster Presentation Author
Kathryn Melvin, UNB Saint John
Other Authors
Taryn E. O’Neill, UNB Saint John
Dr. Christopher A. Gray, UNB Saint John
Dr. Duncan Webster, Horizon Health Network
Dr. John A. Johnson, UNB Saint John
Background: Natural products isolated from plants can be a rich source of new chemical entities that are important in
drug discovery and development. Heracleum maximum is a plant used by the First Nations of the Canadian Maritime
provinces for various medicinal applications including the treatment of tuberculosis and its associated symptoms.
Medicinal preparations of H. maximum are traditionally made using dried roots that were collected in the fall and we
recently showed that an extract of H. maximum roots collected in the fall of 2011 contained significant amounts of the
antimycobacterial diyne falcarindiol. In this study, we are investigating whether the antimycobacterial activity of H.
maximum varies both seasonally and within the organs of the plant and whether any variation in activity can be
correlated to the levels of falcarindiol in the plant tissue.
Methods: Individual Heracleum maximum plants were collected in spring, summer and fall seasons of 2010, 2011 and
2012. The organs of the plants were separately extracted and the antimycobacterial activity of the extracts was
evaluated against Mycobacterium tuberculosis (H37Ra) using the microplate resazurin assay (MRA). The levels of
falcarindiol in the extracts are currently being quantified by liquid chromatography – mass spectrometry.
Preliminary results: The results from the MRA indicate that the antimycobacterial activity of H. maximum is variable
between years, seasons and plant organs. Antimycobacterial activity tended to be highest in the summer and flowers
were generally the most bioactive plant organ. Through the use of LC-MS, we will quantify the amount of falcarindiol in
the extracts and relate this to the observed bioactivity.
Discussion: From our results we hope to find a correlation between the amount of falcarindiol present in H. maximum
plant tissues and the antimycobacterial activity of the tissues. The antimycobacterial activity, low toxicity and reported
health benefits of falcarindiol and related molecules have recently stimulated interest in this class of natural products.
The identification of a readily available source of falcarindiol would facilitate further research and development of this
natural product.
March 15, 2013
37
“The HEALTH (Healthy Eating, Active Living for Tomorrow’s Health) Study: An Intervention for Improving
Health-Related Fitness in Class I and II Obese Adults”
Poster Presentation Author
Kate Morrison, Faculty of Kinesiology, UNB
Other Authors
Baukje (Bo) Miedema, Dalhousie University Family Medicine Teaching Unit
Stacey Reading, Faculty of Kinesiology, UNB
Lucia Tramonte, Sociology Department, UNB
Ryan Hamilton, Psychology Department, UNB
Verna McLean, MSc(c), Faculty of Kinesiology, UNB
Background: One quarter of the adult New Brunswick population is obese. Without appropriate intervention, these
adults may be at risk of developing serious cardiovascular and other chronic health problems. The HEALTH Study is a
multi-disciplinary, multi-site, 12 month intervention designed to assist class I and II obese adults with the management
of their condition. The primary goal of the study is to improve the following health outcomes: body mass index,
abdominal obesity, blood pressure and exercise tolerance. The intervention is delivered in two urban and two rural
community settings using existing infrastructure.
Methods: The intervention consists of one hour of physical activity three times per week under the guidance of
Certified Exercise Specialists for 27 weeks and a one-hour nutritional education session led by a Registered Dietitian
biweekly (11 sessions). Two groups (one urban and one rural) also receive a one-hour bi-weekly behaviour modification
session under the guidance of an exercise psychologist. Following the intervention, each participant enters a 6-month
self-management phase to measure lasting self-efficacy. Measures: Biometric and survey measurements were collected
before the intervention commenced (T0) and after the completion of the active intervention (T1) and will be collected at
the end of the self-management phase (T2). Participants: Two of the four sites (one urban and rural) have completed
the 6-month active intervention phase; 78 participants enrolled in the study.
Results: Of the 78 participants enrolled in the first rural and urban sites, most were female (86% vs. 14%). The mean age
of the participants was 50±11 years and the mean BMI was 37±3 kg/m2. Participants attended on average 70 to 75% of
the physical activity, nutrition and behaviour modification sessions. For those completing the program (n=46), BMI and
waist circumference significantly decreased by 1.4kg/m2 (95%CI; 0.9 to 1.8) and 2.8cm (95%CI; 1.1 to 4.6), respectively.
Systolic and diastolic blood pressure decreased by 7mmHg (95%CI; 2.5 to 10.5) and 3 mmHg (95%CI; -0.3 to 5.6)
respectively, though only the reduction in systolic blood pressure was significant. Aerobic capacity improved by 4
ml/kg/min (95%CI; 2.5 to 5). Participants also saw significant improvements in grip strength (8 kg (95%CI; 5.6 to 10.1))
and on average increased their number of modified push-ups by 5 (95%CI; 2.9 to 7.4), which are measures of overall
musculoskeletal strength and endurance. Similarly, participants were able to increase the number of chair sit-to-stand
in 30 seconds by 5 (95%CI; 4.1 to 6.7), which is a significant improvement in functionality.
Discussion: Significant improvements in health-related fitness were achieved by participants through attending at least
two-thirds of the physical activity sessions. Body mass index and systolic blood pressure were significantly reduced and
aerobic capacity, strength, endurance, and functionality were significantly increased from pre- to post-program.
Therefore, this group of class I and II obese adults in both rural and urban environments benefited from a communitybased, low-threshold intervention program. Community interventions such as these should adhere to an “in and out”
policy by recognizing that reduced participation from the ideal can still produce significant health benefits.
March 15, 2013
38
“Escalating Tacrolimus Dosage Requirements after Rifampin Administration in a Renal Transplant Patient: A
Review of Rifampin Drug Interactions”
Poster Presentation Author
Heather Naylor, Horizon Health Network
Other Author
Jenna Robichaud, Horizon Health Network
Background: Rifampin is a potent inducer of cytochrome P-450 (CYP450) oxidative enzymes as well as the Pglycoprotein transport system. Clinically relevant interactions with numerous drugs such as warfarin, oral
contraceptives, digoxin, ketoconazole, cyclosporine, and tacrolimus have been reported. To demonstrate the clinical
significance of rifampin drug interactions, we describe a case of escalating tacrolimus dosage requirements as a result of
rifampin administration in a renal transplant recipient.
Case summary: A 65-year old Caucasian woman with end-stage renal disease secondary to polycystic kidney disease
underwent renal transplantation from a deceased donor in 2006.Post-transplant immunosuppression was maintained
with mycophenolate sodium, prednisone, and tacrolimus (target blood trough levels = 5 to 8 ng/mL). The patient was
admitted to hospital in 2011 and subsequently started on rifampin for treatment of a CNS infection. Six days after
starting rifampin, the patient’s tacrolimus level fell from 11.4 ng/mL to 3.7 ng/L. More than a two-fold dose increase was
ultimately required in order to maintain desired therapeutic levels. The impact of rifampin on tacrolimus metabolism
was sustained for a period of time after rifampin was discontinued.
Discussion: This case demonstrates a strong drug-drug interaction between tacrolimus and rifampin. Addition of
rifampin results in clinically significant drug interactions with many medications. Health professionals should be
cognizant of these interactions when adding or discontinuing rifampin in order to avoid a decreased therapeutic
response, therapeutic failure, or toxic reactions.
March 15, 2013
39
“Psychosocial Needs of Offenders with Psychotic Disorders Referred to a Mental Health Court”
Poster Presentation Author
Katie O’Connell, UNB Saint John
Other Authors
Donaldo D. Canales, UNB Saint John
Ran Wei, UNB Saint John
Dr. Mary Ann Campbell, UNB Saint John
Angela E. Totten, UNB Saint John
Background: Past research has established that offenders with serious mental illness typically receive inadequate mental
health treatment services while incarcerated. When released back to the community, the lives of these individuals are
characterized by high rates of poverty, limited social supports, and limited involvement in vocational and educational
activities. When impoverished circumstances are combined with a worsening mental state, these individuals typically
reoffend with misdemeanor and nuisance crimes, as opposed to serious violent crimes. This results in a ‘revolving door
phenomenon’ of repeated involvement with the criminal justice system. In recent years, alternative methods of
managing mentally ill offenders, such as mental health courts (MHCs), have been developed. Although MHCs aim to
provide adequate interventions with the goal of improving mental health symptomatology and reducing reoffending
risk, MHCs should also strive to improve quality of life though psychosocial interventions. The aim of the current study
was to create a profile of psychosocial factors of mentally-ill offenders referred to a MHC, with a specific focus on
offenders with psychotic-related disorders.
Methods: The current study is archival in design and is part of a multi-year evaluation of the Saint John MHC located in
Saint John, New Brunswick, Canada. Based on retrospective file review, information was collected on six psychosocial
domains: intimate partner relationship quality, family relationship quality, employment status, educational status, living
arrangement stability, and financial stability. Psychosocial functioning was based on the preceding 12 month period
prior to MHC referral. Demographic, mental disorder severity and post-MHC referral recidivism (general and violent)
data were also collected.
Results: A total of 138 MHC clients were included in this study. The sample was mostly male (71.7%; female = 28.3%)
with an average age of 35.47 years (SD = 12.23) and minimal ethnic diversity (Caucasian = 95.7%). Forty percent (n = 56)
had a psychotic disorder. A series of Mann-Whitney U analyses revealed that compared to non-psychotic offenders,
individuals with a psychotic disorder had significantly lower mean rank (i.e., more impairment) in intimate partner
quality (U = 1633), living arrangement stability (U = 1736), and financial stability (U = 1740.50) domains (all p’s < .25).
Further, offenders with a psychotic disorder were found to have a significantly higher mean rank (i.e., more impairment)
for mental health severity (U = 1601, p < .001). However, these individuals were no more likely to recidivate generally
(χ2[1] = .01, p > .05) or violently (χ2[1] = .08, p > .05) compared to non-psychotic offenders.
Discussion: In addition to mental health and criminogenic-focused interventions, efforts to address the psychosocial
needs of mentally-ill offenders should be an important goal for MHCs. Offenders with psychotic disorders appear to
have particular vulnerability to psychosocial impairments in addition to having more severe mental health issues;
however, they are not recidivating more frequently than non-psychotic offenders. Interventions that improve quality of
life (i.e., enhancing social supports, employment opportunities and stable living arrangements) should be integrated into
MHC procedures.
March 15, 2013
40
“Prostate-Specific Antigen as a Predictive Tool for Prostate Volume in New Brunswick Men without Prostate
Cancer”
Poster Presentation Author
Ryan Pawsey, Dalhousie University
Other Authors
Dr. Thomas Whelan, Horizon Health Network
Denise Leblanc-Duchin, Horizon Health Network
Heather McBriarty, Horizon Health Network
Background: Prostate specific antigen (PSA) is a commonly used test in the diagnosis of prostate cancer and monitoring
of its treatment. Research has suggested a potential role for serum PSA to be used in the assessment of prostate
volume (PV) in order to assist with therapeutic decision-making for men with symptomatic benign prostatic hyperplasia
(BPH). This has influenced the Canadian Urological Association Guidelines for the management of BPH where it is noted
that serum PSA may be a useful surrogate marker for PV and may also predict risk of BPH progression in men without
prostate cancer.
This study aims to determine if similar conclusions can be found in a local, Saint John, population by incorporating the
research design of a well-recognized study that provides support for the clinical utility of PSA as a predictor of PV
(Roehrborn et al., 1999).
Methods: A prospectively collected Prostate Information Database of 2175 patients was reviewed and analyzed.
Patients with evidence of prostate cancer were excluded from the study and only patients with benign prostatic
conditions were analyzed. Patients with a serum PSA of greater than 10ng/ml were excluded in order to decrease the
possibility of including those patients with occult prostate cancer. Patients older than 80 years of age and younger than
50 years of age were excluded. The remaining patients were stratified by decade of life (50s, 60s, 70s).
Results: After exclusion criteria were implemented, 1111 patients were evaluated. A multiple regression analysis
indicated that PSA value and age stratification by decade of life were significant factors in the prediction of PV (R2 = .23,
F(3, 1013) = 100.7, p<.001). Cross-validation was conducted and confirmed the significance of age as a factor. Patients
with higher PSA values had higher log-PV where a unit increase of PSA resulted in an 8.4% increase in log-PV. Similarly, it
was shown that increases in age was associated with increases in log-PV where patients in their 60s and 70s had an
approximate 20% increase in log-PV compared to those in their 50s.
Receiver Operating Characteristic (ROC) curves were constructed to evaluate the ability of serum PSA to predict
threshold PVs in men with BPH. The ROC analyses revealed that PSA had good predictive value for assessing PV, with
areas under the curve ranging from 0.69 to 0.75 for various PV cutoff points (30, 40, 50ml). Similar to Roehrborn et al.,
our findings support PSA values of 1.6 ng/ml, 2.0 ng/ml, and 2.3 ng/ml for predicting PV of >40ml in men in their 50s,
60s, and 70s, respectively.
Discussion : The results from this study are consistent with Roehrborn et al. and add to the evidence supporting PSA
values and age as significant predictors of PV in men with BPH. Although these predictors are useful in directing
treatment, caution is advised until other potential factors are evaluated as predictors in prostate enlargement.
March 15, 2013
41
“Husbands Living with Women on Dialysis: Embracing Their Transformed Life”
Poster Presentation Author
Maryse Pelletier-Hibbert, UNB Fredericton
Purpose: The purpose of this qualitative study was to explore the adjustment process of husbands living with women on
dialysis.
Methods: Using Glaser’s (1978) grounded theory methodology, data were collected from 18 husbands through semistructured face-to-face or telephone tape-recorded interviews.
Results: In using the constant comparative method of data analysis, the most central issue for these husbands was
dealing with multiple changes imposed by the demands and impact of kidney failure and its treatment regimens on
various dimensions of their lives. The changes impacted roles and responsibilities at home and work, social and
recreational activities, finances, relationships with their spouse and others, home environment, daily routines, and
future plans, as well as health and/or sleep patterns. Although the impact of these changes created many hardships for
husbands, witnessing their wives’ suffering was more distressing. In response, these men involved themselves in
supporting their wives and engaging in the basic social process of embracing their transformed life. The four stages of
embracing a transformed life are becoming aware, involving themselves, centering life on their wives, and striving to
achieve balance. The marital relationship, the women’s health status, as well as the presence of informal support and
formal support are conditions which significantly influenced the process.
Discussion: The theory of embracing a transformed life provides a framework for understanding and explaining the
complex interplay of strategies undertaken by these husbands to respond to, adjust to, and integrate changes in their
daily and future lives. Moreover, the focus on husbands living with women on dialysis contributes towards closing an
existing gap in knowledge and the findings underscore the husbands’ abilities to learn and carry out complex roles,
responsibilities, and routines that require sophisticated observation, decision making, and technical and problem-solving
skills. The discrete stages of the theory guide nurses to better understand the various changes dialysis-caregivers may
experience during different phases of the patients’ illness trajectory and to implement supportive care to enhance their
adjustment and sustain their efforts.
March 15, 2013
42
“Differences in Arousal between High- and Low-Risk Gambling Groups: Decision Making During a Gambling
Task”
Poster Presentation Author
Colin Rouse, UNB Saint John
Other Authors
Dr. Lisa Best, UNB Saint John
Vance MacLaren, Brandon University
Background: Pathological gambling (PG) is the inability to refrain from recurrent urges to gamble despite a negative
impact on the gambler and others (MacLaren, Fugelsang, et al, 2011) and the rate of PG among the general adult
population is between 0.15% and 3.5% (Stucki and Rihs-Middel, 2007). Although all forms of gambling have the potential
to become problematic, slot machines and VLTs pose the highest risk of promoting PG (Dowling et al., 2005) and a
recent survey of 2821 adult residents of New Brunswick found that 29% of VLT players had moderate or severe
symptoms of pathological gambling, which is over 7 times the rate found among the general population (Market Quest
Research, 2009). MacLaren, Best, et al (2011) found that high gambling scores were correlated with high Neuroticism,
low Agreeableness, and low Conscientiousness, and Impulsivity (MacLaren et al., 2011b). Furthermore, a meta-analysis
showed that PG was associated with Unconscientious Disinhibition and Low Premeditation, Negative Affect Negative
Urgency, and Disagreeable Disinhibition. These results suggest that personality characteristics may prove to be a useful
clinical indicator of vulnerability to PG, with problem gamblers showing a pattern of emotional dysregulation and
disinhibition similar to that found in Substance Use Disorders (Kotov et al, 2010).
Purpose: Using participants at high and low risk of PG, we investigated the relationship between psychophysiological
arousal and risk sensitivity during decision making in a novel video gambling task, Lucky Larry’s Lobstermania.
Methods: Twenty-four participants were selected to take part; 12 with high Neuroriticism and 12 had low Neuroticism
(measured by the Zuckerman Kuhlman Aluja Personality Questionnaire; Aluja, et al., 2010). In the lab, each participant
sat at a VLT simulator and was taught how to play. After ensuring familiarity, skin conductance electrodes were taped to
the index and ring finger of the non-playing hand. Participants played the simulator for 300 spins; in the no-choice
condition 5 credits were wagered on each spin and in the choice condition participants wagered between 1 and 9 credits.
Results: A 2 (personality) x 2 (wager) mixed ANOVA was used to examine differences in skin conductance. Although
there were no main effects of personality or wager type, there was a statistically significant interaction between
personality and wager type (F (1, 20) = 9.15, p = .007). The low risk group had higher skin conductance in the fixed
condition (Mfixed = 14.5, SD = 12.36; Mchoice = 11.4, SD = 10.19) and the high risk group had higher skin conductance in the
choice condition (Mfixed=9.6, SD=4.75; Mchoice=7.6, SD=4.60).
Discussion: Low risk participants had higher skin conductance in the no-choice condition when compared to the choice
condition. Although differing from our predictions, it supports the contention that game features that promote active
decision have different effects depending on individual risk for PG. The high skin conductance observed in the low risk
group during the fixed condition may result from frustration that occurred because they were unable to play the game
strategically. In the choice condition, participants could wager strategically, lowering frustration and skin conductance
responses. The fact that there were no skin conductance changes in high risk participants could be because the
frustration of not being able to wager strategically was replaced with arousal caused by the approach-avoidance conflict
of choosing the wager for each spin during the choice condition.
March 15, 2013
43
“Personality Correlates of Alcohol Abuse and Dependence”
Poster Presentation Author
Colin Rouse, UNB Saint John
Other Authors
Stephanie Ciszewski, UNB Saint John
Derek Gaudet, UNB Saint John
Colin Rouse, UNB Saint John
Dr. Lisa Best, UNB Saint John
Vance MacLaren, Brandon University
Background: Alcoholism is a chronic, relapsing syndrome with devastating effects on social, family, occupational, and mental health
outcomes. Alcohol Use Disorders are characterized by the chronic consumption of alcohol that leads to significant impairment or
distress. Alcohol use can be characterised in different ways and it is possible to differentiate between hazardous hazardous
consumption and dependence. Hazardous drinking involves a high level of consumption that increases the risk of harmful physical
and psychological consequences. Although people who are hazardous drinkers consume high levels of alcohol, they are not
necessarily alcohol dependent (characterised by behavioural, cognitive, and physiological changes that may develop with ongoing
alcohol use).
Personality dysfunction is intimately associated with addictive behavior (i.e., Ball, 2005; Ruiz et al., 2008). Low Agreeableness, low
Conscientiousness, and specific facets of Neuroticism and Extraversion that are associated with impulsivity (Whiteside & Lynam,
2001) have been found to relate significantly with alcohol use (Ruiz, et al., 2003). In a study examining the relationship between
personality characteristics and alcohol consumption, MacLaren and Best (2011) found that problematic drinking was associated with
higher disagreeable disinhibition, aggression-hostility, sensitivity to reward, and lower agreeableness.
Purpose: Our purpose was to examine individual characteristics that differentiate between those drinkers who are at elevated risk
for alcohol dependence and those who may drink often and in large amounts but who do not make the transition to addiction.
Methods: A total of 343 participants completed a questionnaire package that included questionnaires to assess general personality
traits and alcohol use. Questionnaires included an assessment of general personality (Zukerman Kuhlman Aluja Personality
Questionnaire; Aluja et al., 2010); sensitivity to reward and punishment (Torrubia et al., 2001); and, alcohol consumption (AUDIT;
Allen et al., 1997).
Results: Based on overall AUDIT scores, participants were classified as having no problems with alcohol (AUDIT<7), harmful
(AUDIT>7), and hazardous (AUDIT>15) consumption. According to these criteria, 92 participants (27.1%) had harmful consumption,
22 (6.5%) had hazardous consumption, 37 (10.9%) showed signs of alcohol dependence, and 37 (10.9%) showed signs of both high
consumption and dependence.
Overall Alcohol Consumption. To determine the relationship between alcohol consumption and personality, first order correlations
were examined and those with statistically significant linear correlations were entered as predictors into a multiple regression
model. The overall model was statistically significant, F(15, 319)=15.99, p=.0001, and accounted for 42.9% of the variability.
Specifically, higher scores on physical aggression, hostility, disinhibition, sociability, and sensitivity to reward and lower scores on
work energy were predictive of higher levels of alcohol use.
Alcohol Dependence. A second linear regression was conducted to determine the relationship between personality traits and
alcohol dependence scores. As before, variables that had statistically significant correlations with alcohol dependence were entered
as predictors. The overall model was statistically significant F(15, 319)=7.09, p=.0001, and accounted for 25% of the variability. In
this model, higher disinhibition, hostility, sociability, and sensitivity to reward and lower social warmth and work energy were
suggestive of higher levels of alcohol dependence.
Discussion: Although these results are from a nonclinical sample of undergraduate, they bear a strong resemblance to the pattern
of group differences between alcoholic and nonclincial control groups summarized by Kotov et al (2010). Results confirm previous
research and suggest specific personality characteristics may predict high levels of alcohol consumption. It is also interesting to note
the personality profiles of participants with high alcohol consumption were not identical to those of participants who had higher
alcohol dependence.
March 15, 2013
44
“Effects of Co-Culture on the Biosynthesis of Bioactive Natural Products from Endophytic Fungi”
Poster Presentation Author
Shi Yunnuo, UNB Saint John
Other AuthorsChristopher Gray, UNB Saint John
John Johnson, UNB Saint John
Recently, endophytic fungi from medicinal plants have received increasing attention as an important, new and
unexplored source of therapeutically relevant natural products. Research has shown that in general the fungal genome
contains many natural product biosynthetic gene clusters, but, in the absence of appropriate cues, only a small number
of these are expressed. The fermentation of fungi in monoculture under standard laboratory culture conditions does not
stimulate fungi to use their full biosynthetic potential and results in the production of a fraction of the chemical diversity
that these microorganisms are capable of constructing. Mixed cultures, in which two microorganisms in the same
environment compete for limited resources, is a possible strategy to induce the biosynthesis of bioactive compounds or
change the natural products that a an isolate would typically produce. Furthermore, the competitive ability of
microorganisms is strongly affected by nutrient availability in the culture, which in turn affects the ability of
microorganisms to produce bioactive secondary metabolites. In this study, four endophytic fungi isolated from St John’s
wort were co-cultured with other endophytes that were isolated from the same species and also two pathogenic
bacteria, under three different nutrient levels. The natural products produced under co-culture conditions were
extracted via bioassay-guided fractionation and tested against Staphylococcus aureus, Pseudomonas aeruginosa, and
Ccandida albicans. Metabolomics will be used to investigate the chemical composition of each of the endophyte
extracts. The bioassay and metabolomics data obtained from the endophyte co-cultures will be compared to that of the
extracts from single culture to evaluate the potential of this methodology to “switch on” cryptic biosynthetic genes in
endophytes. This would significantly increase the likelihood of isolating novel bioactive compounds from these fungi and
ensure that endophytes are recognised as an under-investigated source of new antibiotics.
March 15, 2013
45
“Is Anti-Cigarette Smoking Video Containing Local Content Effective in Improving Knowledge, Attitude and
Behaviour among Grade 9 Students?”
Poster Presentation Author
Rossana Tassone, Dalhousie Medicine NB
Background: Every 10 minutes, two Canadian teenagers start smoking cigarettes; One of them will lose his/her life
because of it. Cigarette smoking can result in nicotine addiction. Adolescents between the ages of 13 to 15 years are a
crucial target population since this is the age range when they are most likely to begin smoking. Young individuals who
start during this period of time are least likely to be successful at quitting. This means that these individuals will likely
present to their Primary Care Physician as middle aged adults with multiple and significant morbidities related to
smoking. This study used an innovative local content anti-tobacco video and evaluated its effectiveness in improving
knowledge, attitude and behaviour in prevention of initiation, reduction and cessation of cigarette smoking in
adolescents.
Methods: Adolescents in grade 9 were administered a 20-item questionnaire to ascertain their baseline knowledge,
attitude and behaviour pertaining to smoking. The survey was completed minutes prior to viewing a 22 minute local
content video. Two weeks later, the survey was again administered to the same students to determine the mid-term
retention of information and impact of the anti-tobacco educational tool.
Results: A total of 50 students responded to both surveys of which only four students reported being smokers pre-video
viewing and only two of the four students reported being smokers post-video viewing. There was a significant increase
in knowledge scores post-video viewing but no difference in attitudes towards smoking and no differences in any
measure between male and female students.
Discussion: Tobacco addiction in adolescents is influenced by many factors such as knowledge, attitudes, and
behaviors. The anti-tobacco video with local content used in this study effectively improved knowledge about the
negative impact of tobacco use and aids to quitting. With further testing such videos may prove invaluable as part of
anti-tobacco curriculums in school systems, in attempt to dissuade cigarette smoking which is a well known association
with a variety of diseases presenting to Family Physicians.
March 15, 2013
46
“Sizing of Aortic Valve for TAVI: Accuracy of Simplified CT Protocol Versus Standard TEE”
Poster Presentation Author
Mellissa Ward, Dalhousie Medicine NB
Other Authors
Brian Archer, Horizon Health Network
Rand Forgie, Horizon Health Network
Vernon Paddock, Horizon Health Network
Marc Pelletier, Horizon Health Network
Darren Ferguson, Horizon Health Network
Heather LeBlanc, Horizon Health Network
Ansar Hassan, Horizon Health Network
Geoffrey Douglas, Horizon Health Network
Background: Trans-aortic valve implantation (TAVI) is rapidly becoming a preferable therapy in high-risk patients with
severe aortic stenosis (AS). Accurate pre-operative sizing of the native valve is crucial to procedural success. While
transesophageal echocardiography (TEE) is most commonly used to estimate prosthesis size, it fails to account for the
oval shape of the aortic valve annulus. We postulate that a simple standardized CT protocol based on valve area may
improve sizing accuracy.
Methods: 33 TAVI patients with preoperative imaging including TEE and CT angiography were included in this study. TEE
and CT measurements at the “hinge point” were used to estimate the annular diameter. These were compared to
diameters obtained using a simplified cardiac gated CT protocol that measured aortic valve area at the valve plane level,
using 2 different methods: best elliptical fit and best hand-trace fit.
Results: The study group consisted of 19 males and 14 females with a mean age of 80 ± 7.4 years and mean NYHA score
of 3.4. Estimated STS mortality risk was 9.8%. All patients underwent successful TAVI implantation using the Sapien valve
by Edwards Lifesciences. Eleven cases were via transfemoral (TF) access and 22 via transapical (TA) access. The valve
sizes were 23 mm (n=14), 26 mm (n=11) and 29 mm (n=8). Most patients had no AI or mild AI (n=27) while 6 patients
were left with 2+ AI. No mortalities were observed. Average TEE and CT “hinge point” measurements were similar (22.2
± 2.9 mm vs. 22.8 ± 2.2 mm, p=0.08), but both significantly underestimated the size of the valve required (25.4 ± 2.4
mm, p<0.0001 for both methods). However, annular dimensions derived from CT, using either best-elliptical fit (24.9 ±
2.3 mm) or best hand-trace fit (25.1 ± 2.2 mm), were larger than those obtained by TEE (p<0.001). When compared to
the average size of the valve implanted (25.4 ± 2.4 mm), both the best elliptical fit and best hand-trace fit provided a
more accurate assessment of the actual valve size required (p=NS).
Conclusions: Standard TEE underestimates the diameter of the true aortic valve annulus by an average of 13% when
compared to the size of the implanted valve. A standardized CT protocol appears to provide a truer estimate between
the calculated diameter and the final valve implanted. Understanding the characteristics of each method is paramount
in the continued effort to improve sizing accuracy in TAVI.
March 15, 2013
47