Publications by authors named "Brandon Tang"

11 Publications

  • Page 1 of 1

Student-initiated near-peer information panel on residency application process.

Can Med Educ J 2020 Jul 15;11(3):e141-e143. Epub 2020 Jul 15.

MD Program, Faculty of Medicine, University of Toronto, Ontario, Canada.

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http://dx.doi.org/10.36834/cmej.53161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378140PMC
July 2020

Inactivation of Rho GTPases by Burkholderia cenocepacia Induces a WASH-Mediated Actin Polymerization that Delays Phagosome Maturation.

Cell Rep 2020 06;31(9):107721

Program in Cell Biology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.

Burkholderia cenocepacia is an opportunistic bacterial pathogen that causes severe pulmonary infections in cystic fibrosis and chronic granulomatous disease patients. B. cenocepacia can survive inside infected macrophages within the B. cenocepacia-containing vacuole (BcCV) and to elicit a severe inflammatory response. By inactivating the host macrophage Rho GTPases, the bacterial effector TecA causes depolymerization of the cortical actin cytoskeleton. In this study, we find that B. cenocepacia induces the formation of large cytosolic F-actin clusters in infected macrophages. Cluster formation requires the nucleation-promoting factor WASH, the Arp2/3 complex, and TecA. Inactivation of Rho GTPases by bacterial toxins is necessary and sufficient to induce the formation of the cytosolic actin clusters. By hijacking WASH and Arp2/3 activity, B. cenocepacia disrupts interactions with the endolysosomal system, thereby delaying the maturation of the BcCV.
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http://dx.doi.org/10.1016/j.celrep.2020.107721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315377PMC
June 2020

A Computerized Frailty Assessment Tool at Points-of-Care: Development of a Standalone Electronic Comprehensive Geriatric Assessment/Frailty Index (eFI-CGA).

Front Public Health 2020 31;8:89. Epub 2020 Mar 31.

Health Sciences and Innovation, Surrey Memorial Hospital, Surrey, BC, Canada.

Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.
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http://dx.doi.org/10.3389/fpubh.2020.00089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137764PMC
March 2020

Clinical teaching unit design: a realist systematic review protocol of evidence-based practices for clinical education and health service delivery.

BMJ Open 2020 02 27;10(2):e034370. Epub 2020 Feb 27.

Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: The clinical teaching unit (CTU) has emerged as a near-ubiquitous model of clinical education across Canadian and international medical schools since it was first proposed over 50 years ago. However, while healthcare has changed dramatically over this period, the CTU model has remained largely unchanged. We thus aimed to systematically review principles of CTU design that contribute to improved outcomes in clinical education and health service delivery.

Methods And Analysis: We will perform a realist systematic review in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II protocol for realist reviews. Databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews and Cumulative Index of Nursing and Allied Health Literature (CINAHL), were searched to find primary research articles published from 1993 to 2019 involving CTUs or other teaching wards, and outcomes related to either trainee education or health service delivery. Two reviewers will independently screen studies in a two-stage process. Retrieved titles and/or abstracts of studies will be screened in the first stage, with full texts reviewed in the second stage. Selected articles meeting inclusion criteria will undergo data abstraction using a standardised, pre-piloted form for assessment of study quality and knowledge synthesis.

Ethics And Dissemination: This review will generate higher quality evidence on the design of CTUs as a model for both clinical education and health service delivery. In addition, further knowledge translation efforts may be necessary to ensure that known best practices in CTU design become common practice.
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http://dx.doi.org/10.1136/bmjopen-2019-034370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050373PMC
February 2020

Access to WHO Essential Medicines for Childhood Cancer Care in Trinidad and Tobago: A Health System Analysis of Barriers and Enablers.

JCO Glob Oncol 2020 02;6:67-79

Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: Improving access to essential medicines is necessary to reduce global mortality resulting from childhood cancer. However, there is a lack of context-specific data in many low- to middle-income countries on the determinants of access to essential childhood cancer medicines. We conducted a mixed-methods case study of the barriers to and enablers of access to WHO essential medicines for childhood cancer care in Trinidad and Tobago, in response to domestic calls for policy attention and reform.

Methods: We interviewed stakeholders (N = 9) across the pharmaceutical supply system using a novel analytic framework and qualitative interview guide. Interviews were recorded, transcribed, and analyzed with constant comparative methods to capture emergent themes. Quantitatively, we examined alignment of the national essential medicines list with the 2017 WHO Essential Medicines List for Children (EMLc). National buyer prices for EMLc cancer medicines were compared with median international prices, with calculation of median price ratios to assess procurement efficiency.

Results: Principal barriers identified included a lack of data-driven procurement, low supplier incentive to engage in tenders, reactive rather than proactive processes in response to stockouts, and siloed information systems. Recurring themes of regionalization, standardization, and proactivity emerged as priorities for policy reform. Quantitative analysis of the national essential medicines list and median price ratios for procured medicines aligned with findings reported qualitatively.

Conclusion: Our study contributes to global efforts to improve childhood cancer care by identifying policy-relevant evidence on access to essential childhood cancer medicines and providing a model for future studies in other jurisdictions.
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http://dx.doi.org/10.1200/JGO.19.00300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998034PMC
February 2020

Online lectures in undergraduate medical education: how can we do better?

Can Med Educ J 2019 Mar 13;10(1):e137-e139. Epub 2019 Mar 13.

Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445307PMC
March 2019

Physician workforce planning in Ontario must move from short-term reactivity to long-term proactivity.

Can Med Educ J 2018 May 31;9(2):e84-e88. Epub 2018 May 31.

Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044305PMC
May 2018

Online Lectures in Undergraduate Medical Education: Scoping Review.

JMIR Med Educ 2018 Apr 10;4(1):e11. Epub 2018 Apr 10.

Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools-including online lectures-before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes.

Objective: The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design.

Methods: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education.

Results: In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use.

Conclusions: Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.
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http://dx.doi.org/10.2196/mededu.9091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915670PMC
April 2018

Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review.

J Ultrasound Med 2018 Jan 27;37(1):69-82. Epub 2017 Jul 27.

Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

The clinical applications of point-of-care ultrasound (US) have expanded rapidly over the past decade. To promote early exposure to point-of-care US, there is widespread support for the integration of US curricula within undergraduate medical education. However, despite growing evidence and enthusiasm for point-of-care US education in undergraduate medical education, the curricular design and delivery across undergraduate medical education programs remain variable without widely adopted national standards and guidelines. This article highlights the educational and teaching applications of point-of-care US with a focus on outcomes. We then review the evidence on curricular design, delivery, and integration and the assessment of competency for point-of-care US in undergraduate medical education.
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http://dx.doi.org/10.1002/jum.14333DOI Listing
January 2018

Triclosan elevates estradiol levels in serum and tissues of cycling and peri-implantation female mice.

Reprod Toxicol 2016 10 13;65:394-401. Epub 2016 Sep 13.

Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario L8S 4K1, Canada. Electronic address:

Triclosan, an antimicrobial agent added to personal care products, can modulate estrogenic actions. We investigated whether triclosan affects concentrations of exogenous and endogenous estradiol. Female mice were given injections of triclosan followed by 1μCi tritium-labeled estradiol. Mice given daily 2-mg triclosan doses (57.9mg/kg/dose) showed significantly elevated radioactivity in tissues and serum compared to controls. A single dose of 1 or 2mg triclosan increased radioactivity in the uterus in both cycling and peri-implantation females. We also measured natural urinary estradiol at 2-12h following triclosan injection. Unconjugated estradiol was significantly elevated for several hours following 1 or 2mg of triclosan. These data are consistent with evidence that triclosan inhibits sulfonation of estrogens by interacting with sulfotransferases, preventing metabolism of these steroids into biologically inactive forms. Elevation of estrogen concentrations by triclosan is potentially relevant to anti-reproductive and carcinogenic actions of excessive estrogen activity.
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http://dx.doi.org/10.1016/j.reprotox.2016.09.004DOI Listing
October 2016

Triclosan exacerbates the presence of 14C-bisphenol A in tissues of female and male mice.

Toxicol Appl Pharmacol 2014 Jul 29;278(2):116-23. Epub 2014 Apr 29.

Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario L8S 4K1, Canada. Electronic address:

Current human generations are commonly exposed to both triclosan (TCS), an antimicrobial agent, and bisphenol A (BPA), the monomer of polycarbonate plastics and epoxies. Both are readily absorbed into circulation and found distributed among diverse tissues. Potential interactions between TCS and BPA are largely unstudied. We investigated whether TCS exposure affects the distribution of ingested (14)C-BPA in select tissues. CF-1 mice were each subcutaneously injected with TCS then orally administered 50 μg/kg (14)C-BPA. Females received 0, 0.2, 0.6, 1, 2, or 18 mg TCS (equivalent respectively to 0, 6.3, 16.9, 30.1, 60.5, and 558.9 mg/kg). Males received 0, 0.2, 2, or 18 mg TCS (equivalent respectively to 0, 5.3, 53.4, and 415.0mg/kg). Levels of radioactivity were measured through liquid scintillation counting in blood serum and brain, reproductive, and other tissues. Significantly elevated levels of radioactivity were observed following combined TCS and (14)C-BPA administration, with minimally effective TCS doses being tissue-dependent (Females: lungs, 0.6 mg; uterus, 1mg; heart, muscle, ovaries, and serum, 18 mg. Males: serum, 0.2mg; epididymides, 2mg). Subsequently, we found that 2 or 6 mg TCS increased radioactivity in the ovaries and serum of females orally given only 5 μg/kg (14)C-BPA. These data indicate that TCS can interact with BPA in vivo, magnifying its presence in certain tissues and serum. The data are consistent with evidence that TCS utilizes enzymes that are critical for metabolism and excretion of BPA. Further research should investigate the mechanisms through which these two chemicals interact at environmentally-relevant doses.
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http://dx.doi.org/10.1016/j.taap.2014.04.017DOI Listing
July 2014