McMaster Divinity College

The model of family functioning being presented is the product of over twenty years of research in clinical work with family units. A method of family therapy has been developed based upon this model and will be described in a future issue. The model utilizes a general systems theory approach in an attempt to describe the structure, organization, and transactional patterns of the family unit. It allows examination of families along the total spectrum ranging from healthy to severely pathological in their functioning. It is based upon a Judaeo‐Christian value set, and allows attention to be paid to cultural differences and other issues of cultural relativity .

Macrophage-derived leukocytic pyrogen (LP) is thought to be similar if not identical to interleukin 1 (IL 1). In addition to macrophages, keratinocytes produce a factor that has similar biologic and biochemical characteristics to IL 1, called epidermal cell thymocyte-activating factor (ETAF). Because many diseases affecting the skin are characterized by infiltration of polymorphonuclear leukocytes (PMN) and some of these disorders are associated with fever, we investigated whether ETAF like LP had pyrogenic activity, and whether ETAF or LP were chemoattractants. ETAF or LP purified by column chromatography and isoelectric focusing were found to have chemotactic activity for PMN. The fractions containing maximal chemotactic activity corresponded to maximal fever-inducing activity and maximum thymocyte-activating activity. Furthermore, the chemotactic activity of ETAF and LP could be blocked by an antibody directed against LP. The results of this study indicate that these mediators, which arise from distinct cell populations, are closely related and may play a vital role in skin as well as distant inflammatory and immunologic events.

Controversy remains about the causative mediators in the bronchoconstrictive response to exercise in asthma. This study examined whether mast cell activation is a feature of exercise-induced bronchoconstriction by measuring urinary metabolites of mast cell mediators. Twelve nonsmoking subjects with mild asthma and a history of exercise-induced bronchoconstriction exercised on a stationary bicycle ergometer for 5 min at 80% maximum work load. Pulmonary function was monitored and urine was collected before and 30 and 90 min after the provocation. The urinary concentrations of the mast cell markers 9alpha,11beta-prostaglandin (PG)F2 and Ntau-methylhistamine, as well as leukotriene E4 (LTE4) were determined by immunoassay. Seven of the 12 subjects (responders) experienced bronchoconstriction (>15% fall in the forced expiratory volume in one second) following exercise, whereas the pulmonary function of the remaining five subjects (nonresponders) remained stable. The urinary excretion (mean+/-SE) of 9alpha,11beta-PGF2 in the responders increased significantly compared with the nonresponders at 30 (77.1+/-14.4 versus 37.2+/-5.6; p<0.05) and 90 min (79.3+/-8.6 versus 40.4+/-8.5, p<0.05) after exercise challenge. The urinary excretion of Ntau-methylhistamine and LTE4 was not significantly different between the two groups at 30 or 90 min after exercise. The findings represent the first documentation of increased urinary levels of 9alpha,11beta-prostaglandin F2 in adults following exercise challenge and provides clear evidence for mast cell activation during exercise-induced bronchoconstriction in asthmatics.

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.

Repeated low-dose allergen challenge increases airway hyperresponsiveness in atopic asthmatics. However, it is not known whether low-dose allergen challenge increases airway inflammation. Eight atopic asthmatics were enrolled in a controlled, cross-over study to evaluate the effect and time course of repeated low-dose allergen challenge on airway inflammation and hyperresponsiveness. The dose of allergen to reduce forced expiratory volume in one second (FEV1) by approximately 5% was selected in a screening allergen challenge. The subjects then were challenged for five consecutive days with either diluent or the selected low-dose of allergen. Methacholine airway hyperresponsiveness (PC20,meth) was measured and sputum induced on days 1, 3 and 5 of the repeated challenge, and then 1 day and 3 days after the last challenge. Repeated low-dose allergen challenge caused small reductions in FEV1, but increased airway eosinophils and interleukin (IL)-5, airway hyperresponsiveness, asthma symptoms and beta2-agonist use, all of which peaked on days 3 or 5 of the challenge. The mean (SEM) percentage sputum eosinophils was 21.2 (0.7)% after allergen versus 3.9 (0.1)% after diluent (p<0.001); percentage EG2+ cells were 13.4 (03)% after allergen versus 1.1 (0.04)% after diluent (p<0.01) and geometric mean (GSEM) eosinophil cationic protein (ECP) was 1061.8 (1.6) microg x L(-1) after allergen versus 447.03 (1.2) microg x L(-1) after diluent (p<0.05). Geometric mean (GSEM) IL-5 was 71.4 (1.4) pg x mL(-1) after allergen versus 18.4 (1.04) pg x mL(-1) after diluent (p<0.01). All the changes had resolved by 3 days after the last challenges. The study demonstrated that repeated inhalation of a low-dose of allergen causes airway eosinophilia and increases in interleukin-5, associated with airway hyperresponsiveness, and mild worsening of asthma control, without the development of marked acute bronchoconstriction or the development of late responses.

BACKGROUND: Historically, trainees in undergraduate and graduate health professions education have relied on secondary resources, such as textbooks and lectures, for core learning activities. Recently, blogs and podcasts have entered into mainstream usage, especially for residents and educators. These low-cost, widely available resources have many characteristics of disruptive innovations and, if they continue to improve in quality, have the potential to reinvigorate health professions education. One potential limitation of further growth in the use of these resources is the lack of information on their quality and effectiveness. OBJECTIVE: To identify quality indicators for secondary resources that are described in the literature, which might be applicable to blogs and podcasts. METHODS: Using a blended research methodology, we performed a systematic literature review using Google Scholar, MEDLINE, Embase, Web of Science, and ERIC to identify quality indicators for secondary resources. A qualitative analysis of these indicators resulted in the organization of this information into themes and subthemes. Expert focus groups were convened to triangulate these findings and ensure that no relevant quality indicators were missed. RESULTS: The literature search identified 4530 abstracts, and quality indicators were extracted from 157 articles. The qualitative analysis produced 3 themes (credibility, content, and design), 13 subthemes, and 151 quality indicators. CONCLUSIONS: The list of quality indicators resulting from our analysis can be used by stakeholders, including learners, educators, academic leaders, and blog/podcast producers. Further studies are being conducted, which will refine the list into a form that is more structured and stratified for use by these stakeholders.

BACKGROUND: Children with cerebral palsy (CP) demonstrate reduced physical activity levels compared with children with typical development. Sedentary behavior, including the duration and frequency of sedentary bouts, has not yet been objectively examined in this population but may have clinical implications for the development of secondary health complications. OBJECTIVE: The aim of this study was to identify time spent sedentary and frequency of breaks interrupting sedentary time in youth with CP compared with youth without CP. It was hypothesized that individuals with CP would spend more hours sedentary than their peers and take fewer breaks to interrupt sedentary time. DESIGN: This was a cross-sectional, prospective study. METHODS: A convenience sample of 17 ambulatory children with CP (15 boys and 2 girls) (mean age=13.0 years, SD=2.2) and 17 age-, sex-, and season-matched youth who were developing typically (TD group) (mean age=12.9 years, SD=2.5) wore an accelerometer over a 7-day period. Sedentary time (in minutes) and number of breaks from sedentary time, corrected for monitoring and sedentary time, respectively, were examined. Differences between groups were determined with an independent-samples t test. RESULTS: Children with CP engaged in significantly more sedentary time (X̅=47.5 min/h, SD=4.9) compared with the TD group (X̅=43.6 min/h, SD=4.2), with significantly fewer breaks from sedentary time (CP group: X̅=179, SD=70; TD group: X̅=232 breaks/h sedentary, SD=61). LIMITATIONS: The sample included only ambulatory youth with CP, classified as Gross Motor Function Classification System levels I to III. CONCLUSIONS: Sedentary time was higher in the CP group and was characterized by less frequent breaks compared with the TD group. Future research should examine the extent to which sedentary time is associated with cardiovascular and metabolic risk in youth with CP.

BACKGROUND: Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system. METHODS: Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use. RESULTS: Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6. CONCLUSIONS: To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

Plasmodium falciparum-infected erythrocytes (IEs) sequester in the intervillous space (IVS) of the placenta causing placental malaria (PM), a condition that increases a woman's chances of having a low-birth-weight baby. Because IEs sequester, they frequently are not observed in peripheral blood smears, resulting in women with PM being misdiagnosed and thus not treated. Because sequestered IEs induce inflammation in the IVS, detection of inflammatory mediators in the peripheral blood may provide an approach for diagnosing PM. Two counterregulatory molecules, TNF-αR (TNFR) 1 and TNFR2, modulate the pathological effects of TNF-α. Levels of these soluble TNFRs (sTNFRs) are reported to be elevated in children with severe malaria, but it is unclear if they are increased in the peripheral blood of PM-positive women with asymptomatic infections. In this study, sTNFR levels were measured throughout the course of pregnancy, as well as at delivery, in women with asymptomatic infections and those who remained uninfected. Results showed that both sTNFRs were significantly increased in the peripheral blood of women with asymptomatic malaria (p < 0.0001) and were positively correlated with parasitemia (p < 0.0001 for sTNFR1 and p = 0.0046 for sTNFR2). Importantly, levels of sTNFR2 were elevated in the peripheral blood of women who were PM-positive but peripheral blood-smear negative (p = 0.0017). Additionally, sTNFR2 levels were elevated in the blood of malaria-positive women who delivered low-birth-weight babies. In vitro studies demonstrated that syncytiotrophoblasts were not a major source of sTNFR. These data suggest that sTNFR2 may be a valuable biomarker for detection of malaria-associated inflammation.

BACKGROUND: The levels of circulating cytokines fluctuate with age, acute illness, and chronic disease, and are predictive of mortality; this is also true for patterns of DNA (CpG) methylation. Given that immune cells are particularly sensitive to changes in the concentration of cytokines in their microenvironment, we hypothesized that serum levels of TNF, IL-6, IL-8 and IL-10 would correlate with genome-wide alterations in the DNA methylation levels of blood leukocytes. To test this, we evaluated community-dwelling adults (n = 14; 48-78 years old) recruited to a pilot study for the Canadian Longitudinal Study on Aging (CLSA), examining DNA methylation patterns in peripheral blood mononuclear cells using the Illumina HumanMethylation 450 K BeadChip. RESULTS: We show that, apart from age, serum IL-10 levels exhibited the most substantial association to DNA methylation patterns, followed by TNF, IL-6 and IL-8. Furthermore, while the levels of these cytokines were higher in elderly adults, no associations with epigenetic accelerated aging, derived using the epigenetic clock, were observed. CONCLUSIONS: As a preliminary study with a small sample size, the conclusions drawn from this work must be viewed with caution; however, our observations are encouraging and certainly warrant more suitably powered studies of this relationship.

BACKGROUND: Cytomegalovirus (CMV) is the primary viral cause of complications in transplant recipients. We sought to understand the mechanisms of its dissemination and induction of vascular disease, which may lead to transplant complications. Sialyl Lewis(x) (sLe(x)) and Lewis(x) (Le(x)) are known for their roles in mediating cell adhesion and as tumor-associated carbohydrate antigens. Herein we explore whether CMV induces surface expression of these important molecules in endothelial cells (EC). METHODS: Flow cytometry was used to detect surface expression of sLe(x) and Le(x) on CMV-infected human umbilical vein endothelial cells (HUVEC), with or without ultraviolet inactivation of the virus. To elucidate mechanisms of CMV-mediated induction, mRNA coding for predominant HUVEC sialyltransferases (ST) and fucosyltransferases (FT), key enzymes in sLe(x) and Le(x) synthesis, was analyzed by Northern blot. Dual immunohistochemical staining for sLe(x) and Le(x) expression of human colon and placental tissue was performed to investigate in vivo relevance. RESULTS: sLe(x) expression on CMV-infected HUVEC was strongly up-regulated by 8 days after inoculation. Le(x) expression was detectable earlier and increased steadily over time. In contrast, ultraviolet-inactivated CMV did not induce expression of these molecules. Northern blot assays demonstrated higher levels of important EC glycosyltransferases ST-IV, FT-III, and FT-IV in CMV-infected EC. Finally, high levels of sLe(x) and Le(x) were expressed in CMV-infected EC in vivo. CONCLUSIONS: Given the known biologic functions of sLe(x) and Le(x), we suggest that CMV induction of these molecules may have widespread consequences ranging from CMV dissemination to induction of CMV-associated vascular disease, including thrombosis.

Background: There is evidence of the benefits of exercise training in multiple sclerosis (MS); however, few studies have been conducted in individuals with progressive MS and severe mobility impairment. A potential exercise rehabilitation approach is total-body recumbent stepper training (TBRST). We evaluated the safety and participant-reported experience of TBRST in people with progressive MS and compared the efficacy of TBRST with that of body weight–supported treadmill training (BWSTT) on outcomes of function, fatigue, and health-related quality of life (HRQOL). Methods: Twelve participants with progressive MS (Expanded Disability Status Scale scores, 6.0–8.0) were randomized to receive TBRST or BWSTT. Participants completed three weekly sessions (30 minutes) of exercise training for 12 weeks. Primary outcomes included safety assessed as adverse events and patient-reported exercise experience assessed as postexercise response and evaluation of exercise equipment. Secondary outcomes included the Multiple Sclerosis Functional Composite, the Modified Fatigue Impact Scale, and the Multiple Sclerosis Quality of Life–54 questionnaire scores. Assessments were conducted at baseline and after 12 weeks. Results: Safety was confirmed in both exercise groups. Participants reported enjoying both exercise modalities; however, TBRST was reviewed more favorably. Both interventions reduced fatigue and improved HRQOL (P ≤ .05); there were no changes in function. Conclusions: Both TBRST and BWSTT seem to be safe, well tolerated, and enjoyable for participants with progressive MS with severe disability. Both interventions may also be efficacious for reducing fatigue and improving HRQOL. TBRST should be further explored as an exercise rehabilitation tool for patients with progressive MS.

The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.

Opioid use disorder risk assessment tools cannot be used in isolation. In combination with standardized clinical examination, and, when indicated, urine drug screening, a validated risk assessment tool, improves the ability to detect opioid misuse. Even though no single tool has been shown to have both high interobserver reliability and high sensitivity, the standardized approach has still been shown to be superior to subjective care giver assessment. This article will provide a global approach to risk assessment in addition to reviewing the available tools.

OBJECTIVE: To assess the effect of socioeconomic status (SES) on outcomes in patients with early inflammatory arthritis, using data from the Canadian Early Arthritis Cohort (CATCH) study. METHODS: In an incident cohort, 2023 patients were recruited, and allocated to low SES or high SES groups based on education and income. Outcomes at baseline and 12 months were analyzed in relation to SES including the 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), pain, patient's global assessment scale (PtGA), the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the SF12-v2 Health Survey, using the ANOVA, chi-squared test, and regression analyses. RESULTS: The CATCH population had 43% with high school education or less and 37% in the low-income group (< 50,000 Can$ per annum household income). The low-education group had higher DAS28 at baseline (p = 0.045), becoming nonsignificant at 12 months and lower physical component score on SF12-v2 at baseline (p = 0.022). Patients in the low-income group presented with higher HAQ-DI (p = 0.017), pain (p = 0.035), PtGA (p = 0.004), and SDAI (p = 0.022). Low-income versus high-income groups were associated with an OR above the median for HAQ-DI (1.20; 95% CI 1.00-1.45), PtGA (1.27; 95% CI 1.06-1.53), and SDAI (1.25; 95% CI 1.02-1.52) at baseline. The association with low income persisted at 12 months for HAQ-DI (OR 1.30; 95% CI 1.02-1.67), but not for other variables. CONCLUSION: Low SES was initially associated with higher disease activity, pain, and PtGA, and poorer function. At 1 year, outcomes were similar to those with high SES, with the exception of HAQ-DI.

A journal club provides an opportunity to critically appraise the medical literature and apply it to clinical practice. Traditional, in-person journal clubs face challenges of scheduling participants and facilitators, recruiting local experts, and having a limited, local impact.Journal clubs may help develop communities of practice involving “groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.”1 With the advent of modern digital technologies, online medical-related journal clubs are increasing: participation can be synchronous or asynchronous, experts can be recruited from a global pool, and discussions are digitally archived for broader dissemination. In addition, these journal clubs may disseminate educational innovations and interventions to a wider audience for further study, and they provide rapid feedback to authors regarding similar work occurring elsewhere. These online discourses, however, typically incorporate a single social media strategy, such as Twitter-based journal clubs (#UroJC,2 #NephJC, http://www.nephjc.com).In an age where we view, engage, and learn from multiple digital streams, a virtual journal club requires a multimodal social media strategy to optimize reach and engagement. In January 2015, a virtual medical education journal club called “JGME-ALiEM Hot Topics in Medical Education” was piloted as a joint collaboration between the Journal of Graduate Medical Education and Academic Life in Emergency Medicine (ALiEM, an education blog with 1.2 million page views per year).3 This Rip Out describes how to move from hosting an online, single platform to a virtual, multimodal journal club by using a blog platform as the central repository of information to house blog comments, embedded Twitter comments, and embedded Google Hangouts on Air video discussions.

Children need to sense that their way of being spiritual is honoured within learning environments that nurture the human spirit. This assertion rests on two assumptions: that children have different ways to express a desire to make the world a better place and that there are patterns to these ways that can be identified, understood and involved in educational practice. We define human spirituality as a sense of felt connection, a public‐domain concept that grounds the capacity to make meaning and to live meaningful lives. The human spirit as the communicative agency that makes meaning within the self and with others, Nature and God is drawn toward wholeness if it recognises its own style for making meaning and making the world a better place and also realises that its style is encouraged in educational settings. We will outline four styles that express spirituality through words, emotions, symbols and actions. We draw out the four spiritual styles to encompass a range of options for spiritual expressiveness that is described theoretically and uncovered in research with children. We hope this article will persuade educators to seriously consider the issues that surround these different expressive styles, and assess children accordingly, so that children come to see that their educational settings perceive, understand and invite the characteristic ways they express themselves spiritually.

BACKGROUND: Technologic advances, free open-access medical education (FOAM or #FOAMed), and social media have increased access to clinician-oriented medical education resources and interactions at the point of care (POC); yet, how, when, and why medical providers use these resources remains unclear. To facilitate the development and design of intuitive POC resources, it is imperative that we expand our understanding of physician knowledge-seeking behavior at the POC. METHODS: Individual semistructured interviews were conducted and analyzed using a qualitative, grounded theory approach. Twelve emergency medicine providers (three medical students, three residents, and six attending physicians) were interviewed in person or via video chat to explore how POC resources are used in the emergency department (ED). A coding system was developed by two investigators and merged by consensus. A third investigator audited the analysis. RESULTS: A conceptual framework emerged from the data describing the four main uses of POC resources (deep-dive, advanced clinical decision making, teaching patients, and teaching learners) and how practitioners' main use varied based on medical expertise. Junior learners prioritize their own broad learning. Experienced learners and physicians prefer to 1) seek answers to specific focused clinical questions and 2) disseminate POC information to teach patients and learners, allowing them to devote more of their time to other clinical and teaching tasks. CONCLUSION: The conceptual framework describes how physician knowledge-seeking behavior using POC resources in the ED evolves predictably throughout training and practice. Knowledge of this evolution can be used to enhance POC resource design and guide bedside teaching strategies.

OBJECTIVE: To determine whether nailfold capillary images, acquired using video capillaroscopy, can provide diagnostic information about diabetes and its complications. RESEARCH DESIGN AND METHODS: Nailfold video capillaroscopy was performed in 120 adult patients with and without type 1 or type 2 diabetes, and with and without cardiovascular disease. Nailfold images were analyzed using convolutional neural networks, a deep learning technique. Cross-validation was used to develop and test the ability of models to predict five5 prespecified states (diabetes, high glycosylated hemoglobin, cardiovascular event, retinopathy, albuminuria, and hypertension). The performance of each model for a particular state was assessed by estimating areas under the receiver operating characteristics curves (AUROC) and precision recall curves (AUPR). RESULTS: A total of 5236 nailfold images were acquired from 120 participants (mean 44 images per participant) and were all available for analysis. Models were able to accurately identify the presence of diabetes, with AUROC 0.84 (95% confidence interval [CI] 0.76, 0.91) and AUPR 0.84 (95% CI 0.78, 0.93), respectively. Models were also able to predict a history of cardiovascular events in patients with diabetes, with AUROC 0.65 (95% CI 0.51, 0.78) and AUPR 0.72 (95% CI 0.62, 0.88) respectively. CONCLUSIONS: This proof-of-concept study demonstrates the potential of machine learning for identifying people with microvascular capillary changes from diabetes based on nailfold images, and for possibly identifying those most likely to have diabetes-related complications.

Successful transitional care for young adults entails that healthcare teams recognize and understand the attitudes, perspectives, and developmental maturity of young adults. The aim of this study was to identify the needs of young adults with inflammatory bowel disease. Young adults 18-30 years of age were recruited from the McMaster University Medical Centre adult inflammatory bowel disease (IBD) clinic between July 2012 and May 2013. Semistructured interviews were audio taped, transcribed verbatim, and coded using a constant comparative method. QSR NVivo10 software was used to manage the data. Twenty-one young adults, including 15 subjects diagnosed as adolescents (younger than 18 years) and 6 subjects diagnosed as young adults, were interviewed. Four broad categories of needs were identified: psychosocial, informational, self-advocacy, and daily living needs. The most commonly reported needs were psychosocial and the least common were daily living needs. Results from this study may be used to inform clinical practitioners of potential needs that may be important to the overall quality of patient health during young adulthood. In addition, these findings may be used to evaluate existing transition and self-management tools to measure success of transition interventions more effectively.