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Open Access
Paving a Path for Pediatric Hospital Medicine in Canada: Defining National Competencies Using Delphi Methodology
(2024-07-01) Vetere, Peter Joseph; Cooke, Suzette; Beran, Tanya; Millar, Kelly; Kassam, Aliya; Lorenzetti, Diane
Background: The field of Pediatric Hospital Medicine (PHM) has grown considerably in North America over the last three decades in response to the increasing complexity and acuity of the pediatric in-patient population. Although PHM fellowship programs have been developed in Canada, no national competencies framework currently exists to guide curricular content. This study aimed to identify competencies required for the practice of PHM in Canada. Methods: Using Delphi methodology, a national panel of experts in PHM iteratively rated potential competencies, on a 5-point scale, to determine their priority for inclusion. Responses were analyzed after each round. Competencies that were assigned a rating of three or less by 80% or more of panelists were removed from subsequent rounds. The remaining competencies were re-sent to panelists for further ratings until consensus was reached, defined as Cronbach’s α ≥0.95 and after a minimum of two survey rounds. At the conclusion of the Delphi process, competencies where 80% or more of the panelists assigned a rating or four or higher were included. Results: Two rounds of the Delphi process were required to reach consensus. Thirty-five participants completed both survey rounds. The participants represented 13 Canadian pediatric tertiary care centers and five community hospitals. Of 176 initial competencies, 109 PHM competencies achieved consensus. Conclusion: This is the first study to define national competencies for PHM in Canada. The competencies identified provide a framework for PHM fellowship program directors to shape local curricula. The results may also be used to inform the development of comprehensive national PHM fellowship curricula.
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Open Access
Energetics and Biomechanics of Uneven Walking for Young and Older Adults
(2024-07-02) Hosseini Yazdi, Seyed Saleh; Kuo, Arthur; Bertram, John; Pfau, Thilo; Rogers-Bradley, Emily
Humans walk on various surfaces, expending considerable energy in the process. The biomechanics and energetics of walking suggest that humans adjust and select gait variables to optimize energy economy, as evidenced by experiments on even terrain. However, natural terrains are often complex, requiring significantly more energy for walking. Nevertheless, most biomechanical researches and experimental methods have focused on even terrain, necessitating a more quantitative understanding of biomechanical adjustments on complex terrains and their relation to energy expenditure. Therefore, new approaches are needed to understand better how humans walk on uneven terrains as a subset of complex terrains. Consequently, the initial goal of this study was to develop laboratory equipment to evaluate human adjustments during uneven walking while controlling other study parameters. Accordingly, an instrumented treadmill was structurally modified to accommodate uneven terrains. Subsequently, three uneven terrains with different amplitudes (peak-to-peak heights) were fabricated to examine the influence of increased terrain amplitude. Limb-by-limb ground reaction forces were measured while collecting energetics and motion capture data, with age, state of lookahead, and walking speed as controlled parameters.
With the normal lookahead, it was observed that humans made anticipatory adjustments perhaps to minimize the total walking mechanical work over the course of walking. The average mechanical work increased proportionally with the cube of walking velocity, the square of terrain amplitude, restricted lookahead, and age, as did walking step variabilities, indicating active walking corrections. Terrain amplitudes altered the relative timing of active work (push-off) and subsequent walking dissipation (collision), known as push-off lead time. Push-off lead time varied with age and restricted lookahead, with the preferred order of push-off and collision reversed in some instances. This aligned with the hypothesis that timing disruptions increase active work during mid-flight, corresponding to previously reported uneven walking redistribution of joint powers from distal to proximal. Older adults exhibited differences from young adults in walking patterns. While feedback control (applied with restricted lookahead) resembled that of young adults, anticipatory (feedforward) control appeared poor, consistent with older adults' tendency to use passive control strategies such as wider steps. Compared to young adults, the excess positive work of older adults was speculated to be associated with higher soft tissue dissipations. I observed that metabolic energy varied in proportion to step mechanical work. Walking energetics in older adults increased at higher rates with the interaction of age and rising terrain amplitude, similar to step mechanical work. Therefore, the decline in muscle delta efficiency across terrains might be associated with this interaction. Step mechanical work also explained most of the energetics of walking, as evidenced by the regression analysis coefficient of determination. The fraction of energetics not explained by step work was likely due to peripheral work, continuous corrections reflected as variabilities, deviations from nominal walking, muscle coactivation, posture maintenance, and other factors.
Overall, I could quantify the walking energetics variations with age, state of lookahead, and terrain amplitude and explore the mechanical determinants associated with the parameters of interest. It exhibited increased positive work performance that is physiologically expensive, aligned with the metabolic rate changes.
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Open Access
Beyond the Bard: A Filipino Director’s Reflection on Re-imagining Shakespeare in Love
(2024-06-28) Conde, Steven; Brubaker, Christine; Garton Stanley, Sarah; Balkwill, Peter; Brubaker, Christine
Shakespeare in Love was adapted for the stage by Lee Hall and originally written by Marc Norman and Tom Stoppard. It was produced by the University of Calgary Drama Division in the School of Creative and Performing Arts from November 24th to December 2nd, 2023 at the Reeve Theatre. This artist statement is a thoughtful examination of my directorial process from re-imagining the material and building the world of the play to managing rehearsals and navigating obstacles along the way. I also pay particular attention to my discoveries as a Filipino-born and raised director adjusting to and learning from Canadian theatre practice.
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Open Access
Vegetation and Forest Fire Dynamics in Alberta: A Ground and Remote Sensing Data Analysis
(2024-07-02) Dastour, Hatef; Hassan, Quazi K.; Achari, Gopal; Ahmed, M. Razu
This thesis presents a comprehensive analysis of the interplay between forest fires and vegetation dynamics in Alberta, Canada, under the lens of climate change. By synthesizing data from remote sensing, climate records, and fire databases, the study reveals the intricate relationships between vegetation cover changes and climatic factors throughout 2001–2022. It highlights the significant lead and lag times between the Normalized Difference Vegetation Index (NDVI) and climate variables such as Land Surface Temperature (LST), relative humidity, and precipitation, offering insights into the temporal dynamics of vegetation response to climatic influences. The research further explores the patterns and trends of forest fires, correlating them with interpolated climate data across various subregions. Using trend analysis and anomaly detection methods, the study identifies significant warming and drying trends, alongside variable precipitation changes, which have influenced both human-caused and lightning-induced forest fires. The findings underscore the differential impact of climate variables on fire occurrence and source, with notable patterns emerging in subregions like Athabasca Plain and Central Mixedwood. Building on these insights, the thesis develops a robust forest fire spread model, validated through high-precision simulations of the 2011 Slave Lake and 2016 Fort McMurray wildfires. The model leverages regional physical features, climatic data, and MODIS datasets to offer accurate fire behavior predictions. The phased simulation approach adapts to dynamic factors such as weather conditions and firefighting strategies, enhancing the model's applicability for effective fire management. Ultimately, this thesis aims to bridge the gap between theoretical understanding and practical application, providing valuable contributions to Alberta's forest fire management and community protection strategies. The research paves the way for more informed decision-making in the face of climate change by offering a nuanced understanding of fire-vegetation-climate interactions and developing an advanced predictive model.
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Embargo
Regulation of K+ -dependent Na+/Ca2+ -exchanger subtype 4, NCKX4, by palmitoylation
(2024-06-28) Al-Khannaq, Maryam; Lytton, Jonathan; Braun, Andrew; MacDonald, Justin; Leslie, Elaine; Krawetz, Roman
Mammalian K+-dependent Na+/Ca2+-exchangers (NCKX), encoded by the SLC24 gene family, are Ca2+ extrusion proteins crucial for Ca2+ homeostasis. NCKX4 is widely expressed, particularly in the brain, and is significant in visual and olfactory sensory neurons, neuronal satiety pathways, and dental enamel formation. The regulation of NCKX4 remains largely unexplored. Investigating dynamic regulation of NCKX4 will further our understanding of Ca2+ homeostasis in biological functions and may identify therapeutic targets for eating disorders. Palmitoylation is a post-translational modification that regulates many features of membrane proteins. This study investigates NCKX4 regulation by palmitoylation and examines its effects on NCKX4 cellular localization and function. Understanding NCXK4 palmitoylation is of fundamental importance for advancing our knowledge of transporter regulation and function. Using Acyl-RAC and palmitate-based click-chemistry methods, it was found that approximately 14% of NCKX4 is palmitoylated in both endogenous and transfected systems. This level of palmitoylation was dynamically regulated and could be decreased and increased by inhibitors of palmitoylation (2-bromopalmitate; 2BP) and depalmitoylation (palmostatin B; palmB), respectively. Palmitoylation sites were determined using site-directed mutagenesis of six cysteines, two of which (C118S and C425S) significantly reduced the level of NCKX4 palmitoylation. However, the C118S/C425S double mutant did not eliminate all palmitoylation, indicating the presence of additional palmitoylation sites in NCKX4. The cellular localization of palmitoylated NCKX4 was examined using palmitate-based click-chemistry combined with proximity ligation. Palmitoylated NCKX4 is distributed across multiple cellular membrane compartments. The effect of palmitoylation on NCKX4 cellular localization was examined using 2BP and PalmB with Na+/K+ -ATPase as a plasma membrane marker. The data show a significantly higher fraction of NCKX4 is found in the plasma membrane when palmitoylation is inhibited with 2BP. The effect of palmitoylation on NCKX4 activity was investigated using a Ca2+ imaging assay in HEK293T and MEB4 cells treated with 2BP and PalmB. No significant difference was found in the activity NCKX4 under these different conditions. In conclusion, NCKX4 is palmitoylated at several sites on the protein. The extent of palmitoylation is dynamically regulated, and palmitoylation affects NCKX4 cellular distribution, while it has no measurable effect on aggregate NCKX4 Ca2+ transport activity.