Genetic testing for amyotrophic lateral sclerosis in Canada - an assessment of current practices.

Objective: To understand current genetic testing practices at Canadian ALS clinics. Methods: An online survey and phone interviews, with clinicians practicing in 27 ALS clinics in Canada, were employed to collect data. Quantitative and qualitative analyses were conducted. Results: Ninety-three percent (25/27) of ALS clinics in Canada are routinely ordering genetic testing for familial ALS, while 33% (9/27) of clinics are routinely ordering genetic testing for sporadic ALS. Barriers to genetic testing include a perceived lack of an impact on treatment plan, difficulty in obtaining approvals, primarily from provincial Ministries of Health, and limited access to genetic counseling. Predictive testing practices were found to be the most variable across the country. The average wait time for a symptomatic patient living with ALS to see a genetic counselor in Canada is 10 months (range 0-36 months). Conclusions: Access to genetic testing, and testing practices, vary greatly across Canadian ALS clinics. There may be patients with a monogenetic etiology to their ALS who are not being identified given that genetic testing for patients diagnosed with ALS is not routinely performed at all clinics. This study highlights potential inequities for patients with ALS that can arise from variability in health care delivery across jurisdictions, in a federally-funded, but provincially-regulated, health care system. Clinical trials for both symptomatic ALS patients and pre-symptomatic ALS gene carriers are ongoing, and ALS clinicians in Canada are motivated to improve access to genetic testing for ALS.

Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial.

BACKGROUND: Strong evidence supports beginning stroke rehabilitation as soon as the patient's medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients' adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. METHODS: In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). RESULTS: Our Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS: This study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32134.

Organic and aqueous extraction of lipids from birch pollen grains exposed to gaseous pollutants.

The lipid fraction of birch pollen grains (BPGs) is not yet fully described, although pollen lipid molecules may play a role in the allergic immune response. The mechanisms by which atmospheric pollutants modify allergenic pollen grains (PGs) are also far from being elucidated despite high potential effects on allergic sensitization. This work is a contribution to a better description of the lipid profile (both external and cytoplasmic) of BPGs and of alterations induced by gaseous air pollutants. Several lipid extractions were performed using organic and aqueous solvents on BPGs following exposure to ozone and/or nitrogen dioxide and under conditions favoring the release of internal lipids. Ozone reacted with alkenes to produce aldehydes and saturated fatty acids, while nitrogen dioxide was shown to be unreactive with lipids. NO2 exhibited a protective effect against the reactivity of alkenes with ozone, probably by competition for adsorption sites. The decreased reactivity of ozone during simultaneous exposure to NO2/O3 raised the possibility of a Langmuir-Hinshelwood mechanism. Oxidation reactions induced by exposure of BPGs to ozone did not substantially modify the extraction of lipids by aqueous solvent, suggesting that the bioaccessibility of lipids was not modified by oxidation. On the contrary, the rupture of PGs appeared to be a key factor in enhancing the bioaccessibility of bioactive lipid mediators (linoleic and α-linolenic acids) in an aqueous solution. The internal lipid fraction of BPGs has specific characteristics compared with external lipids, with more abundant hexadecanoic acid, tricosanol, and particularly unsaturated fatty acids (linoleic and α-linolenic acids). Several mechanisms of action of gaseous pollutants on allergenic pollen were identified in this study: gaseous air pollutants can (i) modify the external lipid fraction by reactivity of alkenes, (ii) adsorb on the surface of PGs and be a source of oxidative stress after inhalation of PGs, and (iii) promote the release of cytoplasmic bioactive lipids by facilitating pollen rupture.

Uptake of ozone and modification of lipids in Betula Pendula pollen.

Pollen allergy risk is modified by air pollutants, including ozone, but the chemical modifications induced on pollen grains are poorly understood. Pollen lipidic extract has been shown to act as an adjuvant to the allergenic reaction and therefore, the modification of lipids by air pollutants could have health implications. Birch pollen was exposed in vitro to ozone to explore the reactivity of O3 on its surface and on its lipidic fraction. Uptake coefficients of ozone were determined for ozone concentration of 117 ppb on the surface of native birch pollen (8.6 ±â€¯0.8 × 10-6), defatted pollen (9.9 ±â€¯0.9 × 10-6), and for crushed pollen grains (34±3 × 10-6). The mass of ozone uptaken was increased by a factor of four for crushed pollen compared to native pollen showing a higher susceptibility to ozone of cytoplasmic granules and broken pollen grains. A total mass of extractible lipids of 27 mg per gram of birch pollen was found and a fraction of these lipids was identified and quantified (fatty acids, alkanes, alkenes and aldehydes). The distribution of lipids was modified by ozone exposure of 115 and 1000 ppb for 16 h with the following reactivity: consumption of alkene, formation of aldehydes and formation of nonanoic acid and octadecanoic acid. The quantity of ozone trapped in the lipidic fraction during 15 min at 115 ppb is enough to contribute to the reactivity of one-third of the alkenes demonstrating that pollen could be susceptible to an atmospheric increase of ozone concentration even for a very short duration complicating the understanding of the link between pollen allergy and pollution.

Chemical modification of coating of Pinus halepensis pollen by ozone exposure.

Pollen coating, located on the exine, includes an extractible lipid fraction. The modification of the pollen coating by air pollutants may have implications on the interactions of pollen with plant stigmas and human cells. Pinus halepensis pollen was exposed to ozone in vitro and the pollen coating was extracted with organic solvent and analyzed by GC-MS. Ozone has induced chemical changes in the coating as observed with an increase in dicarboxylic acids, short-chain fatty acids and aldehydes. 4-Hydroxybenzaldehyde was identified as the main reaction product and its formation was shown to occur both on native pollen and on defatted pollen. 4-Hydroxybenzaldehyde is very likely formed via the ozonolysis of acid coumaric-like monomers constitutive of the sporopollenin. Modification of pollen coating by air pollutants should be accounted for in further studies on effect of pollution on germination and on allergenicity.

Kinetic of NO2 uptake by Phleum pratense pollen: chemical and allergenic implications.

Phleum pratense pollen was exposed to NO(2) in a reactor allowing a continuous analysis of NO(2) concentration by FTIR. The uptake coefficient of NO(2) on pollen was calculated postulating a first order kinetic reaction and a value of (1.1 ± 0.1) x 10(-7) was determined. NO(2) uptake was faster when the pollen water content was increased and when the pollen was pre-treated with ozone. The effect of NO(2) exposure on pollen allergic properties was investigated by quantifying Th2- and Th1-associated chemokines in a model of human dendritic cells. Cellular analysis clearly showed that cells exposed to fumigated pollen favored the production of chemokines known to promote Th2-cell responses. Altogether these data demonstrate that NO(2) uptake by pollen directly correlates with increased Th2 response in human cells,and are in favor of the involvement of NO(2) pollution in the increase of allergic diseases.

Reactive and nonreactive ozone uptake during aging of oleic acid particles.

The ozonolysis of submicrometer (150 nm) oleic acid (OL) particles in an aerosol flow tube has been studied for a wide range of initial ozone concentrations from 25 ppb to 1100 ppb. Both reactants were monitored, as well as the four main reaction products (nonanal, azelaic acid, nonanoic acid, and 9-oxononanoic), by gas chromatography-mass spectrometer, high resolution-time of flight-aerosol mass spectrometer, proton transfer reaction-time of flight-mass spectrometer, and ozone analyzer. The values for the initial uptake coefficients derived from each reactant decay are in the same range: γO3-0 = (1.5 ± 0.1) × 10(-3) and γOL-0 = (1.0 ± 0.2) × 10(-3). The ozone uptake coefficient is highly decreased when particles are in an advanced oxidized state (γO3-∞ = 5 × 10(-5)). Concerning reaction products, nonanal was mainly observed in the gas-phase (∼80%) with a carbon yield of ∼29%. Nonanoic, azelaic, and 9-oxonanonoic acids have been quantified in the condensed phase with carbon yields of respectively 6.6%, 5.3%, and 31.4%. The changes in chemical composition induce a slight rise in particle density, whereas the aerodynamic particle diameter increases by 10%. The initial molar quantities of ozone and OL were chosen to obtain different initial stoichiometries in order to explore conditions where either of them is the limiting reactant. Drastic changes in reactivity were observed as a function of the initial stoichiometry. In conditions where OL was the initial limiting reactant, up to a total of four molecules of O3 were lost from the gas phase, whereas only one OL molecule was consumed.

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

BACKGROUND: The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. METHODS/DESIGN: This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. STUDY/TRIAL REGISTRATION: ClinicalTrials.gov: NCT01848080.

Heterogeneous reactivity of chlorine atoms with ammonium sulfate and ammonium nitrate particles.

In this laboratory study, model particles of ammonium sulfate (AS) and ammonium nitrate (AN) were exposed to chlorine atoms and uptake experiments were performed in a coated wall flow tube reactor coupled to a molecular beam mass spectrometer. The reactive surfaces were prepared by coating the inner surface of the reactor using two different methods: either by depositing size-selected particles on the halocarbon wax or by spray depositing thin films using a constant output atomizer. The observed uptake coefficients vary for (NH(4))(2)SO(4), ranging from γ(Cl)(AS)≈ 1 × 10(-3) for size-selected particles to γ(Cl)(AS)≈ 6 × 10(-2) for thin films prepared by spray. An uptake coefficient of γ(Cl)(AN)≈ 2.5 × 10(-3) of Cl˙ on size-selected NH(4)NO(3) particles was measured. A heterogeneous recombination of Cl atoms to from Cl(2) molecules was observed for the two surfaces. Furthermore, an ageing process was observed for AS particles, this phenomenon leading to the formation of new chlorine species on the solid substrate.

Heterogeneous reactivity of chlorine atoms with sodium chloride and synthetic sea salt particles.

The uptake of chlorine atoms on sodium chloride (NaCl) and synthetic sea salt (SSS) particles was studied using a discharge flow reactor coupled to a molecular beam mass spectrometer. The reactive surfaces were prepared by coating the inner surface of the reactor using two different methods: either by depositing size-selected particles on halocarbon wax or by spray depositing thin films using a constant output atomizer. The observed uptake coefficients of Cl˙ on NaCl particles are γ(NaCl)(Cl) ≈ 2 × 10(-2) for size-selected particles or γ(NaCl)(Cl) ≈ 5 × 10(-2) for thin films and for SSS particles γ(SSS)(Cl) ≈ 4 × 10(-3). Heterogeneous recombination of Cl atoms to Cl(2) molecules was observed for the two solid surfaces. The study was performed over the temperature range 258 to 353 K. The temperature dependence of the uptake was observed and the heat of adsorption of Cl˙ on NaCl particles was estimated at Q(ads) = 63 kJ mol(-1) assuming an Eley-Rideal mechanism. The role of surface adsorbed water has also been shown. The atmospheric implications of these findings are discussed briefly.

Industry-contract research organization pathology interactions: a perspective of contract research organizations in producing the best quality pathology report.

This article provides observations on the features of sponsor-contract research organization communication that will achieve the best quality pathology report based on our collective experience. Information on the test article and any anticipated findings should be provided, and initial slide examination should be done with knowledge of treatment group (but may be followed by blinded review of target tissues to determine no-effect levels). Only a pathologist should write or revise the pathology report or the pathology section of the overall study report. To address concerns related to undue sponsor influence, comments by sponsors should be presented as suggestions rather than directives. Adversity should be defined for each finding by the study pathologist, but the no-observed adverse effect level should not be discussed in the pathology report. Board-certified pathologists are recommended, but are not essential. Sponsors that have a particular format or report preferences should make them known well in advance. Histologic processing "to glass" of protocol-specified tissues from all dosage groups is recommended for rapid evaluation of target tissues. Telepathology is beneficial in certain situations, but it is usually more efficient for the study pathologist and reviewing pathologist to be in the same physical location to review differences of opinion and reach a consensus.

Contribution of treated wastewater to the microbiological quality of Seine River in Paris.

Urban part of Seine River serving as drinking water supply in Paris can be heavily contaminated by Cryptosporidium spp. and Giardia duodenalis. In the absence of agricultural practice in this highly urbanized area, we investigated herein the contribution of treated wastewater to the microbiological quality of this river focusing on these two parasites. Other microorganisms such as faecal bacterial indicators, enteroviruses and oocysts of Toxoplasma gondii were assessed concurrently. Raw wastewaters were heavily contaminated by Cryptosporidium and Giardia (oo)cysts, whereas concentrations of both protozoa in treated wastewater were lower. Treated wastewater, flowed into Seine River, had a parasite concentration closed to the one found along the river, in particular at the entry of a drinking water plant (DWP). Even if faecal bacteria were reliable indicators of a reduction in parasite concentrations during the wastewater treatment, they were not correlated to protozoal contamination of wastewater and river water. Oocysts of T. gondii were not found in both raw and treated wastewater, or in Seine River. Parasitic contamination was shown to be constant in the Seine River up to 40 km upstream Paris. Altogether, these results strongly suggest that treated wastewater does not contribute to the main parasitic contamination of the Seine River usually observed in this urbanized area.

Monitoring of Cryptosporidium and Giardia river contamination in Paris area.

This study evaluates the protozoan contamination of river waters, which are used for drinking water in Paris and its surrounding area (about 615,000 m(3) per day in total, including 300,000 m(3) for Paris area). Twenty litre samples of Seine and Marne Rivers were collected over 30 months and analyzed for Cryptosporidium oocysts and Giardia cysts detection according to standard national or international methods. Cryptosporidium oocysts and Giardia cysts were found, respectively, in 45.7% and 93.8% of a total of 162 river samples, with occasional high concentration peaks. A significant seasonal pattern was observed, with positive samples for Cryptosporidium more frequent in autumn than spring, summer and winter, and positive samples for Giardia less frequent in summer. Counts of enterococci and rainfalls were significantly associated with Giardia concentration but not Cryptosporidium. Other faecal bacteria were not correlated with monitored protozoan. Marne seems to contribute mainly to the parasitic contamination observed in Seine. Based on seasonal pattern and rainfall correlation, we hypothesize that the origin of contamination is agricultural practices and possible dysfunction of sewage treatment plants during periods of heavy rainfalls. High concentrations of protozoa found at the entry of drinking water plants justify the use of efficient water treatment methods. Treatment performances must be regularly monitored to ensure efficient disinfection according to the French regulations.

Triphasic waves versus nonconvulsive status epilepticus: EEG distinction.

BACKGROUND: Triphasic waves (TWs) and generalized nonconvulsive status epilepticus (GNCSE) share morphological features that may create diagnostic ambiguity. OBJECTIVE: To describe electroencephalographic differences between TWs and GNCSE. METHODS: We retrospectively compared the electroencephalograms (EEGs) of two groups of patients presenting with decreased level of consciousness; those with TWs associated with metabolic encephalopathy and those with GNCSE. We studied the following: demographics, etiology and EEG morphological features. All EEGs were classified blindly (TWs or GNCSE) by two expert EEGers. Agreement between experts and concordance with clinical diagnosis were measured. RESULTS: We analysed 87 EEGs (71 patients) with TWs and 27 EEGs (13 patients) with GNCSE. Agreement between experts and concordance with clinical diagnosis were excellent. When compared to TWs, epileptiform discharges associated with GNCSE had a higher frequency (mean=2.4Hz vs 1.8Hz) (p<0.001), a shorter duration of phase one (p=0.001), extra-spikes components (69% vs 0%) (p<0.001) and less generalized background slowing (15.1% vs 91.1%) (p<0.001). Amplitude predominance of phase two was common with TWs (40.8% vs 0%) (p=0.01). Lag of phase two was absent in all cases of GNCSE but present in 40.8% of patients with TWs. Noxious or auditory stimulation frequently increased the TWs (51%) while it had no effect on the epileptiform pattern (p=0.008). CONCLUSIONS: Certain EEG morphological criteria and the response to stimulation are very helpful in distinguishing TWs from GNCSE.