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1.  Cross-disciplinary research in cancer: an opportunity to narrow the knowledge–practice gap 
Current Oncology  2013;20(6):e512-e521.
Health services researchers have consistently identified a gap between what is identified as “best practice” and what actually happens in clinical care. Despite nearly two decades of a growing evidence-based practice movement, narrowing the knowledge–practice gap continues to be a slow, complex, and poorly understood process. Here, we contend that cross-disciplinary research is increasingly relevant and important to reducing that gap, particularly research that encompasses the notion of transdisciplinarity, wherein multiple academic disciplines and non-academic individuals and groups are integrated into the research process. The assimilation of diverse perspectives, research approaches, and types of knowledge is potentially effective in helping research teams tackle real-world patient care issues, create more practice-based evidence, and translate the results to clinical and community care settings. The goals of this paper are to present and discuss cross-disciplinary approaches to health research and to provide two examples of how engaging in such research may optimize the use of research in cancer care.
PMCID: PMC3851347  PMID: 24311951
Knowledge translation; evidence-based practice; cross-disciplinary research; cancer
2.  Factors related to the implementation and use of an innovation in cancer surgery 
Current Oncology  2011;18(6):271-279.
Nationally, efforts to implement an innovation in cancer surgery—a Web-based synoptic reporting tool—are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia.
We used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use.
Key factors influencing implementation were these:
Innovation–values fit
Flexibility with the innovation and implementation
The innovation is not flawless
Strengthening the climate for implementation
Resource needs and availability
Partner engagement
Surgeon champions and involvement
In a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool.
An improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts.
PMCID: PMC3224028  PMID: 22184488
Implementation; synoptic reporting; cancer; surgery
3.  Bone mass and geometry of the tibia and the radius of master sprinters, middle and long distance runners, race-walkers and sedentary control participants: A pQCT study 
Bone  2009;45(1):91-97.
Mechanical loading is thought to be a determinant of bone mass and geometry. Both ground reaction forces and tibial strains increase with running speed. This study investigates the hypothesis that surrogates of bone strength in male and female master sprinters, middle and long distance runners and race-walkers vary according to discipline-specific mechanical loading from sedentary controls.
Bone scans were obtained by peripheral Quantitative Computed Tomography (pQCT) from the tibia and from the radius in 106 sprinters, 52 middle distance runners, 93 long distance runners and 49 race-walkers who were competing at master championships, and who were aged between 35 and 94 years. Seventy-five age-matched, sedentary people served as control group.
Most athletes of this study had started to practice their athletic discipline after the age of 20, but the current training regime had typically been maintained for more than a decade. As hypothesised, tibia diaphyseal bone mineral content (vBMC), cortical area and polar moment of resistance were largest in sprinters, followed in descending order by middle and long distance runners, race-walkers and controls. When compared to control people, the differences in these measures were always > 13% in male and > 23% in female sprinters (p < 0.001). Similarly, the periosteal circumference in the tibia shaft was larger in male and female sprinters by 4% and 8%, respectively, compared to controls (p < 0.001). Epiphyseal group differences were predominantly found for trabecular vBMC in both male and female sprinters, who had 15% and 18% larger values, respectively, than controls (p < 0.001). In contrast, a reverse pattern was found for cortical vBMD in the tibia, and only few group differences of lower magnitude were found between athletes and control people for the radius.
In conclusion, tibial bone strength indicators seemed to be related to exercise-specific peak forces, whilst cortical density was inversely related to running distance. These results may be explained in two, non-exclusive ways. Firstly, greater skeletal size may allow larger muscle forces and power to be exerted, and thus bias towards engagement in athletics. Secondly, musculoskeletal forces related to running can induce skeletal adaptation and thus enhance bone strength.
PMCID: PMC2832729  PMID: 19332164
Veteran athletes; Track and field runners; Race-walking; Bone strength; Volumetric bone mineral density; Exercise
4.  The genome of the simian and human malaria parasite Plasmodium knowlesi 
Nature  2008;455(7214):799-803.
Plasmodium knowlesi is an intracellular malaria parasite whose natural vertebrate host is Macaca fascicularis (the ‘kra’ monkey); however, it is now increasingly recognized as a significant cause of human malaria, particularly in southeast Asia1,2. Plasmodium knowlesi was the first malaria parasite species in which antigenic variation was demonstrated3, and it has a close phylogenetic relationship to Plasmodium vivax​4, the second most important species of human malaria parasite (reviewed in ref. 4). Despite their relatedness, there are important phenotypic differences between them, such as host blood cell preference, absence of a dormant liver stage or ‘hypnozoite’ in P. knowlesi, and length of the asexual cycle (reviewed in ref. 4). Here we present an analysis of the P. knowlesi (H strain, Pk1(A+) clone5) nuclear genome sequence. This is the first monkey malaria parasite genome to be described, and it provides an opportunity for comparison with the recently completed P. vivax genome4 and other sequenced Plasmodium genomes6-8. In contrast to other Plasmodium genomes, putative variant antigen families are dispersed throughout the genome and are associated with intrachromosomal telomere repeats. One of these families, the KIRs9, contains sequences that collectively match over one-half of the host CD99 extracellular domain, which may represent an unusual form of molecular mimicry.
PMCID: PMC2656934  PMID: 18843368
5.  Comparison of Rectoanal Mucosal Swab Cultures and Fecal Cultures for Determining Prevalence of Escherichia coli O157:H7 in Feedlot Cattle 
Applied and Environmental Microbiology  2005;71(10):6431-6433.
We compared fecal samples with samples collected with rectoanal mucosa swabs (RAMS) to determine the prevalence of Escherichia coli O157 in feedlot cattle (n = 747). Escherichia coli O157 was detected in 9.5% of samples collected with RAMS and 4.7% of samples tested by fecal culture. Pulsed-field gel electrophoresis analysis of isolates suggested that the strains colonizing the rectoanal junction were the same as those from the feces. Mucosal swab sampling was more sensitive than fecal sampling for determining the prevalence of E. coli O157 in feedlot cattle.
PMCID: PMC1265949  PMID: 16204574
6.  Effect of Forage or Grain Diets with or without Monensin on Ruminal Persistence and Fecal Escherichia coli O157:H7 in Cattle†  
Twelve ruminally cannulated cattle, adapted to forage or grain diet with or without monensin, were used to investigate the effects of diet and monensin on concentration and duration of ruminal persistence and fecal shedding of E. coli O157:H7. Cattle were ruminally inoculated with a strain of E. coli O157:H7 (1010 CFU/animal) made resistant to nalidixic acid (Nalr). Ruminal and fecal samples were collected for 11 weeks, and then cattle were euthanized and necropsied and digesta from different gut locations were collected. Samples were cultured for detection and enumeration of Nalr E. coli O157:H7. Cattle fed forage diets were culture positive for E. coli O157:H7 in the feces for longer duration (P < 0.05) than cattle fed a grain diet. In forage-fed cattle, the duration they remained culture positive for E. coli O157:H7 was shorter (P < 0.05) when the diet included monensin. Generally, ruminal persistence of Nalr E. coli O157:H7 was not affected by diet or monensin. At necropsy, E. coli O157:H7 was detected in cecal and colonic digesta but not from the rumen. Our study showed that cattle fed a forage diet were culture positive longer and with higher numbers than cattle on a grain diet. Monensin supplementation decreased the duration of shedding with forage diet, and the cecum and colon were culture positive for E. coli O157:H7 more often than the rumen of cattle.
PMCID: PMC520928  PMID: 15345418
7.  Nurse practitioners. 
PMCID: PMC1410015  PMID: 9624758
8.  PCR-Based DNA Amplification and Presumptive Detection of Escherichia coli O157:H7 with an Internal Fluorogenic Probe and the 5′ Nuclease (TaqMan) Assay† 
Presumptive identification of Escherichia coli O157:H7 is possible in an individual, nonmultiplexed PCR if the reaction targets the enterohemorrhagic E. coli (EHEC) eaeA gene. In this report, we describe the development and evaluation of the sensitivity and specificity of a PCR-based 5′ nuclease assay for presumptively detecting E. coli O157:H7 DNA. The specificity of the eaeA-based 5′ nuclease assay system was sufficient to correctly identify all E. coli O157:H7 strains evaluated, mirroring the previously described specificity of the PCR primers. The SZ-primed, eaeA-targeted 5′ nuclease detection assay was capable of rapid, semiautomated, presumptive detection of E. coli O157:H7 when ≥103 CFU/ml was present in modified tryptic soy broth (mTSB) or modified E. coli broth and when ≥104 CFU/ml was present in ground beef-mTSB mixtures. Incorporating an immunomagnetic separation (IMS) step, followed by a secondary enrichment culturing step and DNA recovery with a QIAamp tissue kit (Qiagen), improved the detection threshold to ≥102 CFU/ml. Surprisingly, immediately after IMS, the sensitivity of culturing on sorbitol MacConkey agar containing cefeximine and tellurite (CT-SMAC) was such that identifiable colonies were demonstrated only when ≥104 CFU/ml was present in the sample. Several factors that might be involved in creating these false-negative CT-SMAC culture results are discussed. The SZ-primed, eaeA-targeted 5′ nuclease detection system demonstrated that it can be integrated readily into standard culturing procedures and that the assay can be useful as a rapid, automatable process for the presumptive identification of E. coli O157:H7 in ground beef and potentially in other food and environmental samples.
PMCID: PMC106737  PMID: 9726887
9.  Clinical mastitis in dairy cattle in Ontario: frequency of occurrence and bacteriological isolates. 
The objective of this study was to describe the frequency of occurrence of clinical mastitis in dairy herds in Ontario. The study group consisted of 65 dairy farms involved in a 2-year observational study, which included recording all clinical mastitis cases and milk sampling of quarters with clinical mastitis. Lactational incidence risks of 9.8% for abnormal milk only, 8.2% for abnormal milk with a hard or swollen udder, and 4.4% for abnormal milk plus systemic signs of illness related to mastitis were calculated for 2840 cows and heifers. Overall, 19.8% of cows experienced one or more cases of clinical mastitis during location. Teat injuries occurred in 2.1% of lactations. Standard bacteriology was performed on pretreatment milk samples from 834 cows with clinical mastitis. The bacteria isolated were Staphylococcus aureus (6.7%), Streptococcus agalactiae (0.7%), other Streptococcus spp. (14.1%), coliforms (17.2%), gram-positive bacilli (5.5%), Corynebacterium bovis (1.7%), and other Staphylococcus spp. (28.7%). There was no growth in 17.7% of samples, and 8.3% of samples were contaminated. Clinical mastitis is a common disease in dairy cows in Ontario; approximately 1 in 5 cow lactations have at lease one episode of clinical mastitis. There is, however, considerable variation in the incidence of clinical mastitis among farms. The majority of 1st cases of clinical mastitis occur early in lactation, and the risk of clinical mastitis increases with increasing parity. Environmental, contagious, and minor pathogens were all associated with cases of clinical mastitis.
PMCID: PMC1539829  PMID: 9442950
10.  Production indices, calf health and mortality on seven red veal farms in Ontario. 
Production, morbidity, mortality and culling were investigated on seven commercial red veal farms in Ontario. The total number of calves included in the study group was 2251. The mean exit weight of marketed calves was 291 kg, with an average daily gain of 1.52 kg/day over the entire production period. The percentage of calves receiving one or more treatment days was 55%, with an average number of individual treatment days per treated calf of 3.9. An increasing number of treatment days, particularly up to eight days of treatment, was associated with decreasing average daily gain, and an increased probability of being lost from production due to death or culling. The percentage of calves which died during production was 5.4, with 0.8% of calves culled.
PMCID: PMC1263696  PMID: 7954122
11.  Production practices, calf health and mortality on six white veal farms in Ontario. 
A group of 4863 white veal calves reared on six commercial white veal farms in Ontario were followed through production to describe calf characteristics and production levels. Patterns of morbidity, mortality, and culling were investigated at the farm, room and individual level. The majority of the calves were male Holsteins, with approximately half originating from Ontario. The mean average daily gain for shipped calves over the entire production period was 1.1 kg/day (SE = 0.002). The overall percentage of calves receiving at least one individual treatment was 59%, with an average number of treatment days per calf of 3.3. The majority of calves receiving one or more treatment days were first treated between the fourth and seventh week of production. The mortality rate was 3.7%, and 5.1% of the calves were culled. Pneumonia was the largest single cause of death. Peak death and cull losses occurred during the seventh and eighth week of production.
PMCID: PMC1263695  PMID: 7954121
12.  Circadian variation in physiological responses to exercise on a stationary bicycle ergometer. 
The responses of six healthy male subjects to submaximal and maximal exercise on a stationary bicycle ergometer have been investigated over a 24-hour period. Measurements were made on each subject at approximately three-hourly intervals and they included minute ventilation at a carbon dioxide output of 1-5 1 min-minus 1 (VE 1-5), tidal volume at a fixed VE of 30 1 min-minus 1 (VT 30), oxygen intake (VO2) at a work load (W) of 150 W (VO2 150), tympanic temperature (Tty) and cardiac frequency at a VO2 of 1-5 1 min-minus 1 (fH 1-5). The experiments were conducted in three parts: on the first occasion two subjects were measured during exercise; on the second occasion a further four subjects were observed in a similar way but starting from a baseline of zero load, and the measurements also included an estimate of cardiac output (Q) using a rebreathing technique. Finally the maximum aerobic power output (VO2max) was measured in three of the subjects in early morning and late evening. Diet and habitual physical activity were held constant between the exercise test on all three occasions. The results show that in the first two subjects fH 1-5 and Tty had a rhythmic pattern of variation with time of day whereas VE 1-5, VT30, and VO2 150 remained fairly constant. The variation in fH 1-5 was associated with Tty; the two variables reached a minimum at similar to 0500 hr and a maximum at similar 1200 hr. These results were confirmed on the remaining subjects but the changes in fH 1-5 and Tty were shown to be more variable and reduced in magnitude. Further, if the changes were calculated from a baseline of zero load, it was shown that the absolute changes observed in fH 1-5 and Tty were not due to the exercise per se but to changes in the basal level from which each subject operated. In addition it was shown that VO2 max and Q remained constant and were independent of the time of day. It is concluded that provided the exercise test conditions are rigidly standardized and subjects exercise from a controlled baseline there is no evidence for circadian variation in the change of responses to work at submaximal or maximal effort.
PMCID: PMC1008036  PMID: 1131337

Results 1-14 (14)