TREATING EARLY CHILDHOOD CARIES UNDER GENERAL ANESTHESIA: A NATIONAL REVIEW OF CANADIAN DATA.

INTRODUCTION: Many Canadian children are affected by early childhood caries (ECC) and require treatment under general anesthesia. The purpose of this study was to determine the burden of day surgery for children with ECC in Canada. METHODS: Day surgery abstracts for children 6 years of age with ECC were extracted from the Canadian Institute for Health Information Discharge Abstract Database and National Ambulatory Care Reporting System for 4 years, 2010/11 to 2013/14. All provinces and territories participated except Quebec. Variables considered included sex, age, proportion of immigrants in the neighbourhood, Aboriginal concentration, material deprivation index and rurality. Rates were calculated for the pooled 4-year cohort. RESULTS: The overall rate of dental surgery to treat ECC was 12.1 per 1000 children 12-59 months of age, accounting for 31.0% of all day surgeries performed on this age group in Canada. Rates of dental surgery for children from neighbourhoods with a high proportion of Aboriginal people were 7.8 times those for children living in areas with a low proportion (84.5 vs. 10.9 per 1000). For children from rural regions of Canada, rates were 3.2 times those of urban dwelling children (31.2 vs. 9.8 per 1000). Children from the least-affluent regions had dental surgery rates 3.7 times higher than those from the most-affluent communities (25.7 vs. 6.9 per 1000). Total hospital-associated costs of treating ECC under general anesthesia averaged $21184545 annually. CONCLUSION: Dental surgery for ECC is far too common and occurs more often among children from the least-affluent households, rural regions and communities with a high proportion of Aboriginal people. Dental surgery rates can serve as an important population health indicator.

Using personal health insurance numbers to link the Canadian Cancer Registry and the Discharge Abstract Database.

BACKGROUND: Linking cancer registry and administrative data can reveal health care use patterns among cancer patients. The Canadian Cancer Registry (CCR) contains personal health insurance numbers (HINs) that facilitate linkage to hospitalization information in the Discharge Abstract Database (DAD). DATA AND METHODS: Valid HINs, captured in the CCR or obtained through probabilistic linkages to provincial health insurance registries, were used to deterministically link prostate, female breast, colorectal and lung cancers diagnosed from 2005 through 2008 with the DAD for fiscal years 2004/2005 to 2010/2011. RESULTS: At least 98% of tumours diagnosed from 2005 through 2008 had valid HINs in the CCR or obtained through probabilistic linkages. For provinces submitting day surgeries to the DAD, linkage rates to at least one DAD record were higher for female breast (95.6% to 98.1%), colorectal (96.9% to 98.7%) and lung cancers (92.8% to 96.3%) than for prostate cancers (77.2% to 91.6%). Among linked records, agreement was high for sex (99% or more) and complete date of birth (97% or more); the likelihood of a consistent diagnosis in the CCR and on at least one linked DAD record was higher for female breast (86.8% to 97.2%), colorectal (94.6% to 97.7%) and lung cancers (90.3% to 95.5%) than for prostate cancers (77.4% to 87.8%). INTERPRETATION: Deterministically linking the CCR and DAD using personal HINs is a feasible and valid approach to obtaining hospitalization information about cancer patients.

Electronic Physician Profiles: Developing an Interactive Web-Based Report for Physicians at Island Health.

Evidence based measurement is accepted as an important aspect of quality improvement. Making this data available to physicians to support them in quality improvement and to inform their practice presents a broad range of challenges. Addressing these challenges requires a solution that allows physicians to leverage the data repositories in the Enterprise Data Warehouse to develop and use evidence based clinical measures using an interactive, user-friendly, and secure infrastructure. In this talk, we discuss key aspects of the development of an interactive web-based report for physicians at Island Health, and present the final product. Given the privacy and security issues surrounding this type of data, a mock profile will be presented, rather than true results for actual physicians.Here, we have developed an initial prototype of a physician level report delivered via Microsoft Power BI as a possible dynamic tool to share these important data.

Experience with a category alters hemispheric asymmetries for the detection of anomalies.

Previous research with both brain-damaged and neurologically intact individuals suggests that the right cerebral hemisphere (RH) is superior to the left cerebral hemisphere (LH) at detecting anomalies in objects. The current research assesses whether experience with a category is necessary for this RH advantage to emerge. Participants were taught the diagnostic criteria necessary to categorize two fictitious species of animals ("Dleebs" and "Tazes"). After training, participants were given a test in which half of the items were congruent with the diagnostic rules and half of the items were incongruent. Participants were tested on two occasions-once after the initial training session and once after five training sessions. The results demonstrated that experience is required for the RH advantage for anomaly detection to occur. On the first test, reaction times were faster when items were presented to the LH. After 5 days of training, reaction times were faster when items were presented to the RH. This interaction could be due to the fact that participants reported analyzing the items in terms of a series of features during the initial test, but analyzed the items as a configural whole as experience with the category increased.

Spiking Phineas Gage: a neurocomputational theory of cognitive-affective integration in decision making.

The authors present a neurological theory of how cognitive information and emotional information are integrated in the nucleus accumbens during effective decision making. They describe how the nucleus accumbens acts as a gateway to integrate cognitive information from the ventromedial prefrontal cortex and the hippocampus with emotional information from the amygdala. The authors have modeled this integration by a network of spiking artificial neurons organized into separate areas and used this computational model to simulate 2 kinds of cognitive-affective integration. The model simulates successful performance by people with normal cognitive-affective integration. The model also simulates the historical case of Phineas Gage as well as subsequent patients whose ability to make decisions became impeded by damage to the ventromedial prefrontal cortex.

Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study.

BACKGROUND: Surgery is a common and important component of breast cancer treatment. We assessed the rates of breast cancer surgery across Canada from 2007/08 to 2009/10. METHODS: We used hospital and day surgery data from the Canadian Institute for Health Information to assemble a cohort of women who had undergone breast cancer surgery. We identified the index surgical procedure and subsequent surgical procedures performed within 1 year for each woman included in the analysis. We calculated the crude mastectomy rate for each province, and we calculated the adjusted mastectomy rate for select jurisdictions using a logistic regression model fitted using age, neighbourhood income quintile and travel time. RESULTS: In total, 57 840 women underwent breast cancer surgery during the study period. Among women with unilateral invasive breast cancer, the crude mastectomy rate was 39%. Adjusted rates for mastectomy varied widely by province (26%-69%). The rate of re-excision within 1 year for women who had breast-conserving surgery as their index procedure was 23% and varied by province in terms of frequency and type (mastectomy or repeat breast-conserving surgery). Among women who underwent mastectomy for unilateral invasive breast cancer, 6% also underwent contralateral prophylactic mastectomy, and 7% had immediate breast reconstruction following surgery. Of mastectomy procedures, 20% were performed as day surgery; for breast-conserving surgery, 70% were performed as day surgery. INTERPRETATION: There is substantial interprovincial variation in surgical care for breast cancer in Canada. Further research is needed to better understand such variation, and continued monitoring should be the focus of quality initiatives.

A public health approach to fall prevention among older persons in Canada.

In 2008 to 2009, there were 53,545 fall-related hospitalizations among Canadian seniors, accounting for 85% of all injury-related hospitalizations and 7% of all hospitalizations for those aged 65 years and older. The estimated cost of fall-related injuries to the Canadian health care system in 2004 was more than $2 billion among a population of 4.1 million seniors. This article describes highlights of how policy makers, researchers, and practitioners are applying a public health approach to the issue of seniors' falls in Canada, including the successes, challenges, and recommendations for the future.

Affective guidance in the Iowa gambling task.

It has been suggested that affective states can guide higher level cognitive processes and that such affective guidance may be particularly important when real-life decisions are made under uncertainty. We ask whether affect guides decisions in a laboratory task that models real-life decisions under uncertainty. In the Iowa gambling task (IGT), participants search for monetary payoffs in an uncertain environment. Recent evidence against an affective guidance interpretation of the IGT indicates a need to set a standard for what counts as evidence of affective guidance. We present a novel analysis of IGT, and our results show that participants' galvanic skin response (GSR) reflects an affective process that precedes and guides cognition. Specifically, prior to participants' knowledge of the optimal strategy, their GSRs are significantly higher when they are about to select from a bad deck, relative to a good deck, and this difference in GSR is correlated with a behavioral preference for the good deck.

Past experience influences object representation in working memory.

The nature of object representation in working memory is vital to establishing the capacity of working memory, which in turn shapes the limits of visual cognition and awareness. Although current theories discuss whether representations in working memory are feature-based or object-based, no theory has considered the role of past experience. However, work with humans and non-human primates suggests that once participants learn which features are important for category membership, these diagnostic features become more salient than non-diagnostic features in long-term memory and object recognition. Critically, the brain areas involved in this diagnosticity effect are also recruited during working memory tasks. We report two experiments testing whether a diagnosticity effect exists in working memory; and whether it is present when visual information is encoded into working memory, or if it is the result of maintenance within working memory. Results showed a diagnosticity effect which was present at encoding. Maintenance did not influence the nature of object representation in working memory. These findings show that the meaning we glean from our past experience has a profound influence on the nature of object representation in working memory.

Using computational neuroscience to investigate the neural correlates of cognitive-affective integration during covert decision making.

We presented a proposed neural level mechanism for the integration of cognitive and affective information during covert decision making. The central idea is that the ventromedial prefrontal cortex establishes predicted outcomes of responses through its connections with the amygdala, and that this information is passed through the context-moderated gateway in the nucleus accumbens in order to promote behaviours that are most beneficial to the long term survival of the organism. We then implemented the proposed mechanism in a network of spiking neurons, and tested one of its central claims. Results showed that the model was capable of producing behaviour similar to that observed in normal humans, as well as that exhibited during VMPFC damage.