Mitigating the impact of the COVID-19 pandemic on Inuit living in Manitoba: community responses

We document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collected in 2021.Although Public Health orders led to the closure of the Manitoba Inuit Association's doors to community events and drop-in activities, it also created opportunities for the creation of programming and events delivered virtually and through outreach. The pandemic exacerbated pre-existing health and social system's shortcomings (limited access to safe housing, food insecurity) and trauma-related tensions within the community. The Manitoba Inuit Association achieved unprecedented visibility with the provincial government, receiving bi-weekly reports of COVID-19 testing, results and vaccination rates for Inuit. We conclude that after over a decade of advocacy received with at best tepid enthusiasm by federal and provincial governments, the Manitoba Inuit Association was able effectively advocate for Inuit-centric programming, and respond to Inuit community's needs, bringing visibility to a community that had until then been largely invisible. Still, many programs have been fueled with COVID-19 funding, raising the issue of sustainability.

Kivalliq Inuit women travelling to Manitoba for birthing: findings from the Qanuinngitsiarutiksait study

BACKGROUND

The Qanuinngitsiarutiksait study aimed to develop detailed profiles of Inuit health service utilization in Manitoba, by Inuit living in Manitoba (approximately 1,500) and by Inuit from the Kivalliq region of Nunavut who travel to Manitoba to access care not available in Nunavut (approximately 16,000 per year).

METHODS

We used health administrative data routinely collected in Manitoba for all services provided and developed an algorithm to identify Inuit in the dataset. This paper focused on health services used by Inuit from the Kivalliq for prenatal care and birthing.

RESULTS

Our study found that approximately 80 percent of births to women from the Kivalliq region occur in Manitoba, primarily in Winnipeg. When perinatal care and birthing are combined, they constitute one third of all consults happening by Kivalliq residents in Manitoba. For scale, hospitalizations for childbirths to Kivalliq women about to only 5 percent of all childbirth-related hospitalizations in Manitoba.

CONCLUSIONS

The practice of evacuating women from the Kivalliq for perinatal care and birthing is rooted in colonialism, rationalized as ensuring that women whose pregnancy is at high risk have access to specialized care not available in Nunavut. While defendable, this practice is costly, and does not provide Inuit women a choice as to where to birth. Attempts at relocating birthing to the north have proven complex to operationalize. Given this, there is an urgent need to develop Inuit-centric and culturally appropriate perinatal and birthing care in Manitoba.

Non-clinical determinants of Medevacs in Nunavut: perspectives from northern health service providers and decision-makers

A medevac involves the transport of a critically ill patient, usually by plane or helicopter, to access necessary and at times life-saving care, most often only accessible in urban centres. Medevacs are commonly used in resource-limited and geographically isolated areas in Canada.

The objective of this study was to explore the determinants of medevac decision-making from the perspective of frontline care providers and decision-makers in Nunavut. For this purpose, we conducted a secondary analysis of 90 in-depth interviews.

Findings indicate that medevacs can be the result of a number of intersecting factors, including the referring and receiving provider’s experience, insufficient staffing in health centres, lack of access to diagnostic or treatment-related, and challenges related to recruitment and retention. An expanded scope of practice for frontline care providers, and a related lack of training and/or confidence in skills, only add to these challenges.

Medevacs play an important role related to managing shifting community nursing workloads, which expands and contracts in response to local needs. Attention to structural issues, putting in place virtual peer support systems, resolving vacancies left by the lag between attrition and recruitment, increasing access to training, and local diagnostic and treatment equipment, might decrease reliance of medevacs.

Effects of aerobic exercise, resistance exercise or both, on patient-reported health status and well-being in type 2 diabetes mellitus: a randomised trial

AIMS/HYPOTHESIS

The Diabetes Aerobic and Resistance Exercise (DARE) study showed that aerobic and resistance exercise training each improved glycaemic control and that a combination of both was superior to either type alone in patients with type 2 diabetes mellitus. Here we report effects on patient-reported health status and well-being in the DARE Trial.

METHODS

We randomised 218 inactive participants with type 2 diabetes mellitus in parallel to 22 weeks of aerobic exercise (n = 51), resistance exercise (n = 58), combined aerobic and resistance exercise (n = 57) or no exercise (control; n = 52). Intervention allocation was managed by a central office. Outcomes included health status as assessed by the physical and mental component scores of the Medical Outcomes Trust Short-Form 36-item version (SF-36) and well-being as measured by the Well-Being Questionnaire 12-item version (WBQ-12); these were measured at the Ottawa Hospital.

RESULTS

Using a p value of 0.0125 for statistical significance due to multiple comparisons, mixed model analyses indicated that resistance exercise led to clinically but not statistically significant improvements in the SF-36 physical component score compared with aerobic exercise (Delta = 2.7 points; p = 0.048) and control (i.e. no exercise; Delta = 3.3 points; p = 0.015). For mental component scores, there were clinically important improvements favouring no (control) compared with resistance (Delta = 7.6 points; p < 0.001) and combined (Delta = 7.2 points; p < 0.001) exercise. No effects on WBQ-12 scores were noted. Overall, 59/218 (27%) of participants included in this analysis sustained an adverse event during the course of the study, including 16 participants in the combined exercise group, 19 participants in the resistance exercise group, 16 participants in the aerobic exercise group, and eight participants in the control group. All participants were included in the intent-to-treat analyses. The trial is now closed to follow-up.

CONCLUSIONS/INTERPRETATION

Resistance exercise was better than aerobic or no exercise for improving physical health status in these patients. No exercise was superior to resistance or combined exercise for improving mental health status. Well-being was unchanged by intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00195884

FUNDING

This study was funded by the Canadian Institutes of Health Research (grant MCT-44155) and the Canadian Diabetes Association (The Lillian Hollefriend Grant).

Improving immunoassays based on the analysis of scanning force microscopy images

Scanning force microscopy has been demonstrated to be an effective binding event detection step for immunoassays. In its simplest form--analysing small area images--the detection limit of the scanning force microscopic immunoassay (SFMIA) has been shown to be comparable to existing techniques. In the present work, we have examined how the performance of image analysis-based SFMIA can be improved. Firstly, we have used a surface analysis parameter that increases linearly with the concentration of binding events. This parameter--the surface area ratio--is the ratio of the surface area after antigen binding to the surface area of the original biospecific surface. With this parameter, SFMIA images can be rapidly analysed and converted into assay units. Secondly, we have demonstrated that by using silicon wafer supports that carry fiducial marks we can relocate to very high accuracy onto the biospecific surfaces and identify the changes due to antigen binding. By relocating in this manner the signal to noise ratio of the technique is enhanced. Thirdly, from simulations we have determined the SFM tip size and image area that optimizes the immunoassay sensitivity.

Atomic force microscopy of BHK-21 cells: an investigation of cell fixation techniques

The atomic force microscope (AFM) has been used to image a wide variety of biological samples, including cultured cells, in air. Whilst cultured cells have been prepared for AFM analysis using a variety of matrices and fixatives, a definitive study of sample preparation and its effects on cell morphology has not, as far as the authors are aware, previously been reported. Although a considerable number of cell fixatives exist, no single fixative is ideal for all investigations. Prior to the performance of specialised techniques, such as atomic force microscopy of cultured cells in air, the cell fixation method must be investigated and optimised. The fixative abilities of 2% paraformaldehyde-lysine-periodate, 0.25% glutaraldehyde, paraformaldehyde-glutaraldehyde, 4% phosphate-buffered formal saline, 1% formaldehyde, methanol:acetone, formal saline, 4% paraformaldehyde and ethanol:acetic acid were assessed in this study. A qualitative assessment system was used to evaluate the efficacy of the above fixatives using conventional fixation criteria (i.e. the presence of fibroblastic morphology consistent with optical microscopy and the absence of fixation artifacts). The optimal fixative was identified as 4% paraformaldehyde, which was capable of providing optically consistent images of BHK-21 (fibroblastic) cells, whose heights remained within the measurement capability of the AFM instrument used in this study.

A method for measuring the size distribution of latex particles by scanning force microscopy

A methodology has been developed to accurately determine the size distribution of latex particles using the scanning force microscope (SFM). Unlike other workers, who have generally measured the lateral dimensions of monolayers of latex particles using a global quantification method, we have measured the heights of individual latex particles located at the edges of latex monolayers that were immobilised onto mica substrates. In agreement with other work, we noted that the edges of monolayers of latex particles provided stable and reproducible scanning force imaging. Whilst SFM imaging noise, image processing artifacts, tip/sample forces and variations in the mica substrate are sources of measurement error that should not be overlooked, our experience has been that the variation over time of the sensitivity of the Z actuator is the greatest potential uncertainty in determining the heights of latex particles. The methodology that we used requires frequent calibration of the Z actuator of the SFM, typically before and after two or three images, in order to ensure that the uncertainties in the Z sensitivity are known and minimised. This methodology was developed for an SFM instrument that was equipped with open loop piezoelectric actuators following a careful study of the behaviour of those actuators. Using this methodology, we have measured the size distributions of populations of 300-400 latex particles from each of several different latex samples, with the maximum variation in the Z-actuator calibration experienced during the measurement of a sample being less than 2%, often about 1% and occasionally better still. In so doing, we have demonstrated that SFMs equipped with open loop actuators can be used for high confidence quantitative measurements of step heights.

Atomic force microscopy analysis of enveloped and non-enveloped viral entry into, and egress from, cultured cells

Since its invention, the atomic force microscope has been used to image a wide variety of biological samples, including viruses. Viral entry into, and egress from, cultured cells has been extensively studied using numerous scientific techniques and to a limited extent using atomic force microscopy. One of the main structural differences that can exist between viruses is the absence, or presence, of an envelope and this factor has consequences for the mode of viral entry and egress. In this study, the entry into, and egress from, cultured cells of enveloped and non-enveloped viruses were investigated using atomic force microscopy. No significant cell surface changes were observed following infection with enveloped or non-enveloped viruses. Although roughness analysis of viral entry revealed cell smoothing post-infection, no differences between the roughness values of enveloped and non-enveloped viral entry were observed. Line analysis of viral entry revealed minor differences between cells infected with an enveloped rather than a non-enveloped virus. These differences may represent a distinction between the uptake processes of enveloped and non-enveloped viruses. Studies of viral egress revealed that infected cells were undergoing cytopathic changes. Whilst topographic, height and roughness differences clearly occurred between virally- and mock-infected cells, no significant differences were elucidated between enveloped and non-enveloped viral egress.

A non-contact mode scanning force microscope optimised to image biological samples in liquid

Given that biological samples are particularly soft in their natural state and that a liquid is the most difficult operating environment for non-contact mode scanning force microscopy, the development of a scanning force microscope that is optimised to image biological samples in vitro presents significant challenges. The performance of the instrument described here has been optimised for such an application by incorporating magnetic excitation and active-Q control of the cantilever. The application of this instrument has been validated by imaging monolayers of immobilised antibodies in liquid and achieving image qualities comparable to those achieved in air for such samples.

Immobilisation of Semliki forest virus for atomic force microscopy

Semliki Forest virus (SFV), an alphavirus, is a single-stranded positive-sense RNA virus. The RNA genome is surrounded by a protein shell known as the capsid which itself is surrounded by a lipid envelope of host cell origin. In this study, SFV strain L10 enveloped virus and its capsid were immobilised onto silicon wafer supports which had been pre-coated with a monolayer of the relevant anti-viral antibody. After drying, the samples were imaged in air, using non-contact mode atomic force microscopy (AFM). Quantification of the AFM images has revealed that both the strain L10 enveloped virus and capsid collapse when immobilised in this manner. The capsid undergoes more significant collapse compared to the enveloped virus. The dimensions of the immobilised enveloped virus and capsid have been compared to a model where the free spherical particles collapse into ellipsoids during immobilisation. For the immobilised capsid the dimensions are consistent with this model whereas for the enveloped virus the model is less effective. The dimensions of the enveloped virus appear to be affected by the antibody used for immobilisation.

Quantification of red blood cells using atomic force microscopy

For humans the sizes and shapes of their red blood cells are important indicators of well being. In this study, the feasibility of using the atomic force microscope (AFM) to provide the sizes and shapes of red blood cells has been investigated. An immobilisation procedure has been developed that enabled red blood cells to be reliably imaged by contact AFM in air. The shapes of the red blood cells were readily apparent in the AFM images. Various cell quantification parameters were investigated, including thickness, width, surface area and volume. Excellent correlation was found between the AFM-derived immobilised mean cell volume (IMCV) parameter and the mean cell volume (MCV) parameter used in current haematological practice. The correlation between MCV and IMCV values has validated the immobilisation procedure by demonstrating that the significant cell shrinkage that occurs during immobilisation and drying does not introduce quantification artifacts. Reliable IMCV values were obtained by quantifying 100 red blood cells and this typically required 3-5 AFM images of 100 microm x 100 microm area. This work has demonstrated that the AFM can provide in a single test the red blood cell size and shape data needed in the assessment of human health.

Altitude sickness

Altitude sickness is a clinical syndrome that occurs with abrupt ascents to altitudes of 3000 metres and above. Symptoms include headache, malaise, fatigue, dizziness, anorexia, nausea and vomiting, and oliguria. At higher altitudes more severe illness resulting from pulmonary oedema or cerebral oedema can occur.

Breathing management: a simple stress and pain reduction strategy for use on a pediatric service

A review of the pediatric literature on pain and stress reducing strategies is followed by a description of a breathing management and relaxation technique. Its use as a pain coping method is illustrated by two cases on a pediatric service. The positive responses of stress affected patients suggests that this approach can be effective in reducing feelings of panic and anxiety as a reaction to pain and the anticipation of pain.

The oxidation of tryptamine by the two forms of monoamine oxidase in human tissues

The selective monoamine oxidase inhibitors clorgyline and (-)-deprenyl have been used to determine the activities of monoamine oxidase-A and -B towards tryptamine in several human tissues. The results were compared with those obtained with the A-form-selective substrate 5-hydroxytryptamine, the B-form-selective substrate 2-phenethylamine and the common substrate tyramine. Tryptamine was found to be a substrate for both forms of the enzyme in human liver, kidney cortex and medulla and in seven different brain regions. The Km values of the two forms towards this substrate were similar in all the human tissues examined but the maximum velocities differed. Thus the A-form would contribute approximately 50% of the total monoamine oxidase activity towards this substrate in human cerebral cortex, whereas it would contribute about 60% in kidney cortex and medulla and 75% in liver. These results suggest that both forms of monoamine oxidase would contribute to the metabolism of tryptamine in human tissues and are difficult to reconcile with suggestions that tryptamine excretion may provide a simple index of monoamine oxidase-A inhibition.

Music therapy: meeting the psychosocial needs of hospitalized children

Music therapy offers a unique approach for reducing the stresses of hospitalization for children. By meeting important psychosocial needs, music therapy lessens anxiety, aids adaptation and contributes to making the hospital experience a more positive one. The use of music therapy is described and illustrated with three patients all of whom underwent painful and prolonged hospitalization with immobilization and severe movement restriction.

CEA-like material in cytosols from human breast carcinomas. Correlation with biochemical and pathologic parameters

CEA-like material was found in 51 of 62 primary human breast carcinomas and in only 2 of 12 fibroadenomas. Levels of carcinoma CEA-like material correlated weakly with cytoplasmic estradiol receptor levels, total cytosol estrogens, and cytosol progesterone. Levels of CEA-like material showed no significant correlation with carcinoma stage, grade, cellularity, size or histologic type. Levels, however, correlated inversely with lymphocyte infiltration.

Studies on nuclear estradiol receptors in human mammary carcinomas

Nuclear estradiol receptors (NER) were measured in human breast carcinomas by extracting nuclei with 0.6 mol/l KCl and adsorption to hydroxylapatite. NER were found in 34/58 tumors containing cytoplasmic estradiol receptors (CER) and in only 8/34 tumours without CER. NER correlated with CER but not with cytosol total estrogens or progesterone. NER levels also showed no significant correlation with either tumor stage, grade, cellularity, size, or presence or absence of axillary node metastases.

Lung scar cancer--a reappraisal

A retrospective clinicopathological study of 100 necropsy cases of lung carcinoma revealed three scar cancers. The scarring in a further 11 probably occurred secondary to the tumour. The premise that lung scars initiate malignancy is questioned.

Medullary carcinoma of the thyroid presenting as tumours of the pharynx and larynx

Two cases of medullary carcinoma of the thyroid presenting as tumours of the pharynx and larynx are described. One patient had a tonsillar mass that resembled a carotid body tumour clinically, radiologically and microscopically. The other had an arytenoid tumour with multiple cervical lymph node metastases but without intrathyroidal carcinoma. The endocrine nature of the neoplasms was indicated by the presence of stromal amyloid, cellular argyrophilia and secretory granules whilst the demonstration of calcitonin and carcinoembryonic antigen provided evidence that they were medullary carcinomas.