MSpace

MSpace is the University of Manitoba’s Institutional Repository. The purpose of MSpace is to acquire, preserve and provide access to the scholarly works of University faculty and students within an open access environment.

 

Recent Submissions

Item
Embargo
Introgression of blackleg resistance genes from related Brassica species to B. napus
(2024-04-08) Shah, Keval Pravinchandra; McCartney, Curt (Plant Science); Bandara, Nandika (Food and Human Nutritional Sciences); Chen, Guanqun (Gavin) (University of Alberta); Duncan, Robert; Stasolla, Claudio
Canola (Brassica napus L.) is one of the most important oilseed crops, contributing more than $26 billion annually to the Canadian economy. Blackleg is caused by fungal plant pathogen Leptosphaeria maculans (Desm) Ces. et de Not. In canola, blackleg disease causes more than $1 billion in yield losses globally. There are different disease management strategies, and using resistant cultivars is one of the economically viable and environmentally sustainable approaches. There are reports of a breakdown of blackleg disease resistance in Australia, France, and Canada due to severe pathogen pressure. Twenty-two blackleg-specific resistance genes have been identified in different Brassica species. Out of these, the B-genome blackleg-specific resistance genes provide resistance throughout a plant's life. This thesis addresses the identification of putative novel sources of resistance from Brassica juncea and hexaploid Brassica into B. napus. In the first project, different B. juncea UM lines were used to identify a high level of resistance against blackleg disease and were screened with L maculans isolate 03-15-03 (AvrLm2, AvrLm3, AvrLm5-9, AvrLm6, AvrLm10, and AvrLm11) and PG4-1-M (AvrLm2, AvrLm5-9, AvrLm6, AvrLm10, and AvrLm11). Plants were inoculated with different L. maculans (AvrLm3 and avrLm3; AvrLm5 AvrLm6, AvrLm5 avrLm6, and avrLm5 avrLm6) isolates to identify the novel source of resistance in Brassica napus Westar x Brassica juncea UM3073 (UMBJ16) genotypes. For genotyping, UMBJ16 genotypes were tested for all the available blackleg-specific resistance gene-linked Kompetitive Allele-Specific PCR (KASP) (Rlm1, Rlm2, Rlm3, Rlm4, Rlm7, Rlm9, LepR1, LepR2, LepR3, and LepR4) and Simple Sequence Repeats (SSR) markers (Rlm6 and rjlm2). In the second project, the B-genome blackleg-specific resistance genes were introgressed from hexaploid Brassica into B. napus. Similar phenotyping and genotyping approaches were followed to identify the putative novel source of resistance against L. maculans isolate 03-15-03 and PG4-1-M in Brassica napus Westar x hexaploid Brassica crosses (BNHB16). This resulted in the identification of a putative novel source of resistance against L. maculans isolate PG4-1-M in UMBJ16 and BNHB16 genotypes. This newly developed germplasm will help to develop blackleg-resistant breeding material in canola and rapeseed breeding programs.
Item
Open Access
Current Impacts of The Health at Every Size Model Upon Adolescent Health Outcomes: A Literature Review
(2023-05-15) Wooldridge, Joelle
Introduction: Child and adolescent obesity is a global concern. The number of youths with obesity is increasing exponentially with subsequent increases in obesity related co-morbidities. Current approaches to treat obesity include weight-normative style interventions which provide no longterm benefits and have increased risk of physical and psychological harms. The Health at Every Size (HAES) model is a safe and inclusive alternative to traditional diet and exercise prescriptions. This approach has been shown to improve patients’ overall health within adult populations. Based on these prior studies, HAES shows great promise for use in adolescent health. Objective: The purpose of this review is to consolidate the current literature available pertaining to use of Health at Every Size and other weight-inclusive strategies within the adolescent population. Through analysis of current evidence, this literature review aims to determine which of the five principles of the Health at Every Size model are effective for improving overall health in the adolescent population. Methods: A literature search using PubMed, Wiley Online Library and the University of Manitoba Online Library databases was conducted using key terms pertaining to Health at Every Size ideology and its associated principles. Eleven articles and one clinical practice guideline were found to meet the inclusion criteria and were included in this literature review. Results: Common themes found across the twelve documents reviewed included positive outcomes in both mental health and sustainable personal care practices in the weight-inclusive intervention groups. Both weight-inclusive and weight-normative groups found improvements in physical health measures. There were minimal improvements in participant weight biases and stigmatization in intervention groups. Conclusion: The Health at Every Size approach to adolescent obesity and health enhancement is effective for improving physical and psychological health. In addition, it teaches sustainable health practices with very little risk to the patient. Adolescence is a time of great change and vulnerability and using an approach that is protective of long-term physical and psychological health outcomes is of the utmost importance. Further research is required on promotion and incorporation of this strategy into primary adolescent care.
Item
Open Access
CHARACTERISTICS AND OUTCOMES OF INDIVIDUALS WHO ENGAGE IN UFITT AFTERCARE FOLLOWING A MENTAL HEALTH CRISIS PRESENTATION
(2023-05-15) Ward, Julie
Introduction: The Urgent Follow-up Integrated Treatment Team (UFITT) program is the primary mental health follow-up program for individuals attending the Crisis Response Centre (CRC) and Health Sciences Centre emergency department. Although approximately 130 individuals are referred to the UFITT program each month, there is a high rate of no-shows. No research has been done on these individuals referred to UFITT regarding their demographics, characteristics, or what happens after their referral. This study aimed to better understand if there are common clinical and demographic characteristics that can be identified within the individuals that attend aftercare following their UFITT referral, compared to those that do not. Furthermore, it was hypothesized that individuals who do not engage in any part of the UFITT program represent with a mental health crisis faster and more often compared to those who do attend follow-up care through the program. Methods: The study period was from August 1 to November 30, 2022 and included all individuals who presented to either the Crisis Response Centre, emergency department, urgent care, or Crisis Stabilization Unit between August 1 and September 30, 2022 with a mental health crisis who were referred to and accepted by UFITT. These individuals were then divided into two cohorts, those that attended at least one visit to the UFITT program: “UFITT engagement”, and those that did not: “No UFITT engagement”. Using the CRC electronic health record program (Momentum), descriptive statistics were used to compare the two groups on clinical and sociodemographic characteristics at time of referral. Descriptive statistics were also used to compare the groups on the outcome of health service use within their 60-day follow-up period. Results: Of the 122 individuals, 73 (59.8%) did not engage in any UFITT services, while 49 (40.2%) of the remaining individuals engaged in one or more services offered by the UFITT program. The group that did not engage in UFITT follow-up were younger, more often unhoused, and had higher rates of personality disorders, previous hospitalizations, and almost half misused substances. Suicidal behavior did not distinguish the two groups. Twelve (16.4%) patients that had no UFITT engagement and 11 (22.4%) patients that engaged with UFITT services represented within 60 days of their initial presentation. There were more individuals who represented in the first 20 days in the No UFITT engagement group compared to the UFITT engaging group. Discussion: The first hypothesis is partially supported by the dissimilarities observed between cohorts as those in No UFITT were younger, had more previous hospitalizations, and higher rate of substance misuse. The results do not support the hypothesis that individuals who do not engage in UFITT aftercare return to the CRC more often. Although results provide support for the hypothesis that those not engaging with UFITT aftercare represent sooner, it is unknown if this is statistically significant. The No UFITT cohort was additionally observed to have marginally worse health outcomes. More research is needed to determine the significance of these dissimilarities.
Item
Open Access
Financial challenges faced by Physician Assistant students when seeking financial assistance to attend PA schools in Canada - A Survey based approach
(2023-05-15) Tso Deh, Miyosha
Introduction: Physician Assistant (PA) students find it challenging to obtain aid and/or loans to fund their PA school tuition costs in addition to their living expenses in Canada especially through private institutions. At present, there is no research as to why obtaining loans is challenging for PA students in Canada. The main goal of this study was to identify what reasons financial institutions proclaim when refusing a loan application to fund PA schools in Canada. Methods: We used a survey-based approach to gather our data. Online surveys were distributed to all three PA schools in Canada to obtain a higher number of responses. Results: Our results show that 39.6% of the participants stated that they worried about financial burden in PA school fairly often while 30.2% stated that they worried very often. 33.9% of the participants stated that their mental health was fair during PA school while 9.4% of the participants stated that their mental health was poor during PA school. 48.6% of the participants stated that it was extremely difficult to obtain private loans from financial institutions. Conclusion: This study showed that obtaining funding for PA schools from financial institutions in Canada is challenging as we expected. The survey respondents provided various reasons for why this is the case which were explored throughout the paper. Students were also stressed in PA school and most participants rated their mental health as poor or fair in our study.
Item
Open Access
Exploring the physician assistant-psychiatrist supervisory relationship and practice model at the Crisis Response Centre
(2023-05-15) Skaritko, Dana
Introduction: 1 in 3 Manitobans will be faced with a mental illness in their lifetime.1 Given the limited number of psychiatrists in Manitoba, coupled with the high burden of mental illness in the population, physician assistants (PA) represent a critical resource in ensuring access to specialty psychiatric services. The Crisis Response Centre (CRC) is an innovative and resourceful 24/7 central access point for mental health services.2 This study aims to determine how to best utilize PAs in practice at the CRC and ensure continued quality improvement in our healthcare system. Methods: This study examined the current supervisory practice model using an online survey distributed to both PAs and psychiatrists currently employed at the CRC. The survey focused on: 1. Gaining an understanding of the level of comfort in the current model from both psychiatrist and PA perspectives, 2. Identifying the roles and responsibilities that could be safely added if there was a change to practice, and 3. Examining PA- and psychiatrist-factors that influenced their level of comfort in the supervisory model. Results: Ninety-seven percent of psychiatrists agree that the presence of PAs has improved overall patient care at the CRC. There appears to be significant comfort under the current practice model from both PAs and psychiatrists and an evident willingness for PAs to have further autonomy, increased roles, and responsibilities. All PAs supported a model of only reviewing cases with which they are unsure of their management. Conclusion: Optimizing PA autonomy at CRC supports the community by utilizing the practice model to increase access to care and further this reach. It supports the growth of the PA model in psychiatry locally and nationally, as the CRC site is the principal employer of PAs in mental health in the country.
Item
Open Access
Factors That Influence Physician Assistant Job Satisfaction and Retention in Manitoba: A Survey Response
(2023-05-15) Rowed, Casey
Introduction: A significant amount of healthcare providers in Canada are suffering from job dissatisfaction, burnout, or plan to leave healthcare in the next few years. Physician Assistants (PA) were the fastest-growing sector of this Canadian healthcare workforce in 2021. Despite this, very little research has been conducted to date on the factors that influence PA job satisfaction and retention in Canada. Research from the United States has shown that autonomy, compensation, physician support, and role flexibility are highly associated with job satisfaction among PAs. Objective: The objective of this study was to undertake a census of working PAs in Manitoba and to determine what employment conditions were considered important to PAs and may influence job satisfaction and retention. Methods: An online survey was constructed and distributed to 153 registered and licensed PAs in the province of Manitoba. The survey consisted of a demographic collection section, a quantitative assessment of relevant employment conditions on a 5-point Likert scale, and a qualitative section with open questions analyzed via keyword analysis. Results: Employment conditions found to be the most important were schedule, hours worked per week, amount of vacation, physician/supervisor support, work culture or co-workers, and type of contract. Conditions considered important were compensation level, autonomy, receiving benefits/pension, practice area/specialty, type of employer, location of work, career advancement, and scope of practice. The most frequently encountered keywords were supervisor, flexibility, contract, and schedule. Conclusion: This study demonstrated that autonomy and physician support continue to be key factors that drive PA retention and job satisfaction as seen in previous literature. However, greater attention should be given to job flexibility, scheduling, hours worked, and time away from work as they are of significant importance to PAs practicing in Manitoba and could reflect a broader professional trend in Canada.
Item
Open Access
STRATEGIES TO OPTIMIZE ANTIBIOTIC STEWARDSHIP IN THE OUTPATIENT PEDIATRIC POPULATION: A REVIEW OF THE LITERATURE
(2023-05-15) Narrandes, Zandhirsingh
Introduction: About one-third of all antimicrobial prescriptions are clinically unnecessary and potentially harmful in the outpatient pediatric setting, which is an area that commonly features physician assistants prescribe medications. Behavioural factors were found to influence prescription rates. Purpose of Review: The purpose of this literature review is to present a comprehensive overview of the best available evidence regarding the effectiveness of strategies to optimize prescribing behaviours in outpatient pediatric settings. Methods: 23 articles pertained to five individual stewardship strategies and bundled interventions. Search terms were created from four main categories. Databases were searched for articles by title and abstract for highlighting pediatrics/adolescents, outpatient prescription rates, and effectiveness of antibiotic stewardship strategies. 39 articles were found and 19 articles were chosen for review. Older studies (pre-2017) and those with adult samples were included if recent literature on a strategy was scarce and/or datasets were large. Discussion: Bundled and non-bundled approaches were associated with better first-line antibiotic prescribing, reduced broad-spectrum antibiotic prescribing, reduced prescribed antibiotic durations, increased delayed antibiotic prescriptions, and sustained effects in studies with postintervention periods. However, multiple studies did not utilize a pediatric sample and may limit its generalizability. Conclusion: By engaging in more than one behavioural strategy to combat unnecessary antimicrobial prescriptions, physician assistants in outpatient pediatric settings will be better able to adhere to the judicious use of antimicrobial prescriptions. More research should be undertaken that is specific to a pediatric population, within the Canadian context, and involving physician assistants employed in the community.
Item
Open Access
Translating Interprofessional Education to Practice: The experiences of Physician Assistants within the first years of practice
(2023-05-15) Narrandes, Shavira
In response to the importance and demand of interprofessional collaboration (IPC) in healthcare settings, the World Health Organization acknowledged the need for Interprofessional Education (IPE) when training healthcare professionals. The University of Manitoba (U of M) implemented an IPE course to physician assistant (PA), medical, dentistry, nursing, pharmacy, and rehabilitation sciences students in 2016. Since then, no studies have been conducted to determine whether the IPC program impacted the practice of working PAs. We distributed the Interprofessional Socialization and Valuing Scale (ISVS) survey to graduate PAs from U of M Master of Physician Assistant Studies (MPAS) who did and did not complete a curriculum-integrated IPC course (classes of 2010-2022). The results were compared to ISVS surveys completed by MPAS graduates during their training (classes of 2018-2022) using the Mann-Whitney U-test. From the ISVS part A questions, “I feel comfortable in accepting responsibility delegated to me within a team” had a significant difference between the two groups of practicing PAs (p=0.024). From the part B questions, “I have gained an enhanced awareness of my own role on a team” (p=0.003) and “I feel comfortable being the leader in a team situation” (p=0.002) were significant between the three groups. Although the study did not provide conclusive answers regarding IPE during the MPAS curriculum, practicing PAs who completed IPE were shown to have gained an enhanced awareness of their role on a team. This is consistent with studies demonstrating that IPE can enhance a students’ knowledge of their role within a multidisciplinary team, as well as the roles of other healthcare professionals.
Item
Open Access
The impact of supervised consumption sites on acute care health services: A literature review
(2023-05-15) Mastromonaco, Carly
People who use illicit drugs (PWUD) have higher rates of health care utilization compared to the general population. Additionally, PWUD are more than four times as likely to leave hospital against medical advice, contributing to costly readmissions for incompletely treated medical issues. Addressing this issue and providing efficacious care to PWUD requires the integration of adequate harm reduction strategies in the community and in acute care facilities. Supervised consumption sites are legally sanctioned facilities with trained staff that supervise the use of pre-obtained drugs and provide clean and safe drug equipment to PWUD. The aim of these sites is to prevent accidental overdose and reduce the spread of infectious diseases, while providing a safe environment and community for PWUD to have access to addictions resources, health services and other social supports. The purpose of this literature review is to identify the degree to which supervised consumption sites can impact health care utilization amongst PWUD. Specifically, this review aims to identify the impact that community-based SCS have on overdose-related ambulance attendance, emergency department visits, and hospitalization, as well as the impact that hospital-based SCS have on reducing patientdirected discharges for PWUD and contributing to medical retention of patients. This literature review identifies that the implementation of community-based SCS significantly reduces the use of emergency medical services for PWUD and is associated with decreased healthcare costs. The literature identifies a clear demand for access to SCS for hospitalized PWUD, however more research is needed to understand the efficacy of hospital-based SCS at reducing harm and decreasing the rates of patient-directed discharge and costly readmissions in this population.
Item
Open Access
CASE STUDY INVESTIGATING DAILY FLUCTUATIONS IN CORE AND REGIONAL SKIN TEMPERATURES IN A PERSON WITH TETRAPLEGIA
(2023-05-15) Llew-Williams, Sarah
Introduction: Spinal cord injury (SCI) directly affects to a person’s ability to regulate core temperature, increasing their risk for hypo- and hyperthermia. Cognitive performance is also affected when exposed to low ambient temperatures. Although anecdotal reports of hypo- and hyperthermia exist, there are significant gaps in understanding how frequently core temperature fluctuations daily, and how varied ambient temperatures and exercise affect core temperature. An abbreviated literature review was conducted to partially address these gaps. Objective: To determine the presence of circadian rhythm and the effects of environmental temperature and exercise on the regulation of core temperature in a person with cervical SCI. Methods: An individual with cervical-level SCI had their core temperature continuously recorded over two seven-day periods during a warm (July) and a cold (November) season. Surface skin temperature and daily activity were also recorded in November. Daily minimum-maximum fluctuations were measured as well as periods of hypo- and hyperthermia. Results: Daily core temperature fluctuated an average 2.36°C ± 1.4°C in November, and 1.89°C ± 0.8°C in July. The participant demonstrated 17 instances of sub-normal core temperature and 3 instances of hyperthermia in November. An additional 12 instances of sub-normal core temperature and 12 instances of hyperthermia were observed in July. These findings demonstrate the relatively high frequency and duration of sub-normal and hyperthermic core temperatures experienced by this person with cervical SCI, despite taking steps to maintain a comfortable core temperature. Conclusion: These findings indicate temperature-related life quality of persons with cervical level SCI may be commonly and significantly impaired. This suggests the need to identify better means to monitor and pre-emptively regulate core temperatures in this population under different environmental conditions.