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Item Open Access A theory of change for patient-initiated follow-up care in rheumatoid arthritis(2025-03-12) Ester, Manuel; White, Krista; Dhiman, Kiran; Zafar, Saania; Subdar, Shakeel; Zimmermann, Gabrielle L.; Hoens, Alison M.; Manske, Sarah L.; Hazlewood, Glen; Lacaille, Diane; Barber, Megan R. W.; Panich, Niki; Jung, Michelle; Perry, Mark G.; Twilt, Marinka; Then, Karen L.; Charlton, Alexandra; Barber, Claire E. H.Abstract Background Timely, high-quality care is critical to rheumatoid arthritis (RA) management. In Alberta, thousands of individuals with RA are waiting for care due to the resource-intensive nature of lifelong follow-ups and rheumatologist shortages. With 20–50% of routine follow-ups not leading to treatment changes or raising new concerns, many appointments may be avoidable if care were restructured. Patient-initiated models extend rheumatologist follow-up intervals beyond 12 months where appropriate, which can reduce inefficiencies and improve care access. To address provincial RA care challenges, we co-developed a theory of change (TOC) for patient-initiated follow-up care. Methods A TOC serves to define health services interventions and their intended impact prior to implementation testing. We worked with 35 healthcare leaders, implementation experts, and patient partners to co-develop a TOC for patient-initiated RA follow-up care. During the scoping phase, we held discussions with healthcare leaders and reviewed evidence on patient-initiated follow-up models to assess their implementation potential. During the development phase, we drafted a TOC map using scoping phase findings and clinical and patient expertise. During the refinement phase, feedback was collected to optimize the TOC. Meetings were recorded, transcribed, and analyzed using deductive qualitative content analysis alongside anonymous poll results and informal feedback to guide TOC refinement. Results The scoping phase identified challenges in RA care, including long waitlists and unnecessary appointments, which patient-initiated follow-up models have the potential to address. TOC discussions highlighted two intended impacts: (1) efficient and effective care for patients when needed, and (2) a sustainable model for RA care. Feedback in the refinement phase covered 4 topics: (1) preference for an interdisciplinary flare clinic, (2) patient selection, (3) patient education, and (4) patient monitoring. Tools and strategies were co-developed with partners to support patients (e.g., decision tool for patient-provider discussions) and the health system (e.g., monthly meetings to monitor burden). The final TOC for patient-initiated follow-up in RA details the care pathway, key resources and considerations, and evaluation outcomes. Conclusions A patient-centered, context-specific patient-initiated RA follow-up care model was co-developed with patient and healthcare partners. An implementation pilot will test its ability to address RA care challenges. Clinical trial registration Not applicable.Item Open Access Supporting partnerships in knowledge mobilization: what existing implementation strategies can tell us(2025-03-12) MacKenzie, Nicole E.; Chambers, Christine T.; Birnie, Kathryn A.; Jordan, Isabel; Cassidy, Christine E.Abstract Background The need for partnership between knowledge producers and knowledge users to foster effective implementation is well-established in the implementation science literature. While many theories, models, and frameworks (TMF) have been developed to guide knowledge mobilization (KM) activities, seldom do these frameworks inform approaches for establishing and maintaining KM partnerships (i.e., relationships between researchers and individuals with relevant expertise in KM activities). Thus, there is a significant knowledge-to-action gap related to operationalizing engagement in partnerships and leveraging the evidence that exists to support them. Given the abundance of TMFs, it is prudent to consider whether any may be suitable to inform approaches to partnership. The aim of this commentary is to discuss the necessity for strategies to support engagement in partnerships for KM activities, as well as to explore the potential to apply strategies from an existing implementation taxonomy to inform partnerships approaches in KM. Main body Using a case study, this commentary explores the opportunity to apply existing implementation strategies put forward by the Expert Recommendations for Implementing Change (ERIC) taxonomy to inform partnership strategies. This case study utilized qualitative evidence from a qualitative study about KM in children’s pain management informed by the Consolidated Framework for Implementation Research (CFIR). It explored partner perspectives (i.e., knowledge producers and users) on factors that supported their engagement in KM activities. The factors generated were subsequently mapped onto the ERIC taxonomy to identify relevant strategies to support partnerships development for KM activities (e.g., shared goals among team members mapped onto the ERIC strategy Build a Coalition). Each factor generated was determined to have a corresponding ERIC strategy to support the operationalization of that factor. Conclusions This case example and discussion bolster the utility of existing taxonomies and frameworks to support the development and sustainability of partnerships to support engagement in KM activities, a promising next step for developing strategies to support partnerships. Opportunities for future development are also discussed, including identifying other theories, models, and frameworks that may contribute to a comprehensive suite of empirically informed partnership strategies, as well as the necessity to make strategies and approaches available to non-specialist audiences.Item Open Access Comprehensive profiling of genomic invertons in defined gut microbial community reveals associations with intestinal colonization and surface adhesion(2025-03-10) Jin, Xiaofan; Cheng, Alice G.; Chanin, Rachael B.; Yu, Feiqiao B.; Dimas, Alejandra; Jasper, Marissa; Weakley, Allison; Yan, Jia; Bhatt, Ami S.; Pollard, Katherine S.Abstract Background Bacteria use invertible genetic elements known as invertons to generate heterogeneity among a population and adapt to new and changing environments. In human gut bacteria, invertons are often found near genes associated with cell surface modifications, suggesting key roles in modulating dynamic processes such as surface adhesion and intestinal colonization. However, comprehensive testing of this hypothesis across complex bacterial communities like the human gut microbiome remains challenging. Metagenomic sequencing holds promise for detecting inversions without isolation and culturing, but ambiguity in read alignment limits the accuracy of the resulting inverton predictions. Results Here, we developed a customized bioinformatic workflow—PhaseFinderDC—to identify and track invertons in metagenomic data. Applying this method to a defined yet complex gut community (hCom2) across different growth environments over time using both in vitro and in vivo metagenomic samples, we detected invertons in most hCom2 strains. These include invertons whose orientation probabilities change over time and are statistically associated with environmental conditions. We used motif enrichment to identify putative inverton promoters and predict genes regulated by inverton flipping during intestinal colonization and surface adhesion. Analysis of inverton-proximal genes also revealed candidate invertases that may regulate flipping of specific invertons. Conclusions Collectively, these findings suggest that surface adhesion and intestinal colonization in complex gut communities directly modulate inverton dynamics, offering new insights into the genetic mechanisms underlying these processes. Video AbstractItem Open Access Correction: Canadians’ knowledge of cancer risk factors and belief in cancer myths(2025-03-10) Rydz, E; Telfer, J; Quinn, EK; Fazel, SS; Holmes, E; Pennycook, G; Peters, CEItem Open Access Efficacy and safety of corticosteroids for stroke and traumatic brain injury: a systematic review and meta-analysis(2025-03-04) Wang, Yanan; Huang, Linrui; Li, Jingjing; Duan, Jiangang; Pan, Xiaohua; Menon, Bijoy K.; Anderson, Craig S.; Liu, Ming; Wu, SimiaoAbstract Background Corticosteroids are frequently used in practice to treat patients with neurological disorders. However, its effect for stroke and traumatic brain injury (TBI) remains controversial. This study aimed to systematically review and evaluate efficacy and safety of corticosteroids for the treatment of stroke and TBI. Methods We searched Ovid-Medline and Ovid-Embase databases for randomised controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of corticosteroids in patients with ischaemic stroke, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or TBI. The treatment intervention was corticosteroid, and the control was placebo or routine care. Outcome measures were death, functional outcomes and adverse events. We calculated odds ratio (OR) and 95% confidence interval (CI) for the effect size, pooled the results using random-effects modelling, and assessed heterogeneity by I2 statistic. Results We identified 47 studies (41 RCTs and 6 cohort studies). Nine studies enrolled patients with ischaemic stroke (n = 2806), 6 studies for ICH (n = 1229), 1 study recruited both ischaemic stroke (n = 13) and ICH (n = 27), 10 studies for SAH (n = 1318) and 21 studies for TBI (n = 12,414). Dexamethasone was the most used corticosteroid (28 studies). Corticosteroids reduced risk of death at 3 months after ischaemic stroke (n = 1791; 31% vs. 26%, OR 0.77, 95% CI 0.62–0.95; df = 1, I2 = 0%) and after ICH (1 study; n = 850; 44% vs. 27%, OR 0.48, 95% CI 0.35–0.64), had no effect on death at 1 month after SAH (1 study; n = 140; 22% vs. 32%, OR 1.73, 95% CI 0.81–3.68), and increased risk of death at 6 months after TBI (n = 10,755; 23% vs. 27%, OR 1.20, 95% CI 1.10–1.32; df = 6, I2 = 0%). The pooled analyses found no significant effect of corticosteroids on functional outcome after ischaemic stroke, ICH, SAH or TBI, respectively. Conclusion Corticosteroids reduced the risk of death and in selected patients with stroke, such as those with large artery occlusion after thrombectomy, but increased the risk of death after TBI, had no effect on functional outcomes. Further trials are needed to identify individual stroke patients who may benefit from corticosteroids. Systematic review registration International Prospective Register of Systematic Reviews (CRD42023474473).Item Open Access Attitudes and perceptions regarding knowledge translation and community engagement in medical research: the PERSPECT qualitative study(2025-03-03) Drozdowska, Bogna A.; Cristall, Nora; Fladt, Joachim; Jaroenngarmsamer, Tanaporn; Sehgal, Arshia; McDonough, Rosalie; Goyal, Mayank; Ganesh, AravindAbstract Background The medical research community widely endorses the importance of ensuring that research outputs are relevant and accessible to knowledge users, as well as the value of engaging the latter in the conduct of research to achieve these goals. However, it appears these principles are reflected in actual medical research practices to a limited extent. To better understand this dissonance, we conducted a qualitative investigation into the perspectives of key stakeholders on bridging the knowledge-to-action gap and patient and public engagement. Methods The Priorities and Expectations of Researchers, Donors, Patients and the Public Regarding the Funding and Conduct of Medical Research (PERSPECT) qualitative study involved in-depth, semi-structured interviews with representatives of four stakeholder groups. Among other topics, participants were asked to discuss issues related to moving medical research knowledge into action (knowledge translation), including patient and public engagement during the research journey as a prerequisite to the success of this process. We analysed collected data employing an interpretative grounded theory approach. Data collection was ended once thematic saturation had been attained. Results A total of 41 interviews were completed and analysed (with 10 patients, 10 members of the general public, 11 researchers and 10 funders). Many participants expressed a belief in the importance of engaging patients in the research process, as well as ensuring that study findings reach beyond academic communities. However, multiple challenges and barriers were identified to implementing these values in practice, including: researchers having limited knowledge and tools to foster partnerships with community members; research outputs being inaccessible to the wider public; and the public having insufficient capacity – in view of the required time, effort and knowledge – to assimilate findings and contribute to ongoing research. Cumulatively, interviews indicated a continuing disconnect between research and lay communities, where each stakeholder group holds some responsibility for improving the current paradigm. Conclusions Existing gaps in communication, knowledge and relevant competencies are fuelling a disconnect between research and lay communities. Successfully moving research knowledge into action requires joint efforts of multiple stakeholder groups with support from external resources to ensure necessary training, expertise and credible dissemination platforms.Item Open Access Trends in symptom severity and complexity in patients undergoing radiation therapy(2025-03-04) Yannitsos, Demetra; Qi, Siwei; Davies, Oluwaseun; Watson, Linda; Barbera, LisaAbstract Symptom severity and complexity have considerable impact on a patient’s cancer care journey. This study describes symptom scores of radiotherapy patients across their radiotherapy care trajectory and factors associated with symptom complexity. Patients who received radiotherapy at a single tertiary cancer center, who also completed at least one symptom-reporting questionnaire, the Edmonton Symptom Assessment Scale– Revised (ESAS-r) between October 1, 2019 and April 1, 2020 were included in this retrospective analysis. Symptom assessment time points were pre-treatment, start and end of radiation treatment and post-treatment follow-up. Mean ESAS-r scores for individual symptoms were descriptively analyzed by assessment timing and tumour group. We calculated a symptom complexity score for each ESAS-r measurement, using a validated algorithm, and assigned overall symptom complexity as low, moderate or severe. We modelled the association between assessment timing, and tumor group, with symptom complexity using Generalized Estimating Equations (GEE). The study cohort consisted of 1,632 patients who completed 2,519 ESAS-r questionnaires. Patients with lung and H&N cancers reported higher mean symptom scores compared to other tumour groups. Patients at the start of treatment had significantly lower odds of having a more severe symptom complexity, compared with patients pre-treatment (OR = 0.77, 95% CI = 0.64–0.93). Patients with H&N and lung cancer and patients prior to starting radiation may benefit most from increased symptom support and management.Item Open Access Estimating the impact of light pollution on quantum communication between QEYSSat and Canadian quantum ground station sites(2025-02-27) Yastremski, Mathew; Godin, Paul J.; Bayat, Nouralhoda; Oh, Sungeun; Chang, Ziheng; Kuntz, Katanya B.; Oblak, Daniel; Jennewein, ThomasAbstract Satellite to ground quantum communication typically operates at night to reduce background signals, however it remains susceptible to noise from light pollution of the night sky. In this study we compare several methodologies for determining whether a Quantum Ground Station (QGS) site is viable for exchanging quantum signals with the upcoming Quantum Encryption and Science Satellite (QEYSSat) mission. We conducted ground site characterization studies at three locations in Canada: Waterloo, Ontario, Calgary, Alberta, and Priddis, Alberta. Using different methods we estimate the background counts expected to leak into the satellite-ground quantum channel, and determined whether the noise levels could prevent a quantum key transfer. We also investigate how satellite data recorded from the Visible Infrared Imaging Radiometer Suite (VIIRS) can help estimate conditions of a particular site, and find reasonable agreement with the locally recorded data. Our results indicate that the Waterloo, Calgary, and Priddis QGS sites should allow both quantum uplinks and downlinks with QEYSSat, despite their proximity to urban centres. Furthermore, our approach allows the use of satellite borne instrument data (VIIRS) to remotely and efficiently determine the potential of a ground site.Item Open Access Correction: Intricate interplay of CRISPR-Cas systems, anti-CRISPR proteins, and antimicrobial resistance genes in a globally successful multi-drug resistant Klebsiella pneumoniae clone(2025-02-24) Jiang, Jianping; Cienfuegos-Gallet, Astrid V.; Long, Tengfei; Peirano, Gisele; Chu, Tingyu; Pitout, Johann D. D.; Kreiswirth, Barry N.; Chen, LiangItem Open Access Multi-societal expert consensus statement on the safe administration of ultrasound contrast agents(2025-02-21) Strom, Jordan B.; Appis, Andrew; Barr, Richard G.; Chammas, Maria C.; Clevert, Dirk-André; Darge, Kassa; Feinstein, Linda; Feinstein, Steven B.; Fowlkes, J. B.; Gorman, Beverly; Huang, Pintong; Kono, Yuko; Lopez-Mattei, Juan; Lyshchik, Andrej; Main, Michael L.; Matthias, Wilson; Merrill, Christina; Mulvagh, Sharon L.; Nihoyannopoulos, Petros; Olson, Joan; Piscaglia, Fabio; Porter, Thomas; Rabischoffsky, Arnaldo; Senior, Roxy; Stout, Jessica L.; Stanczak, Maria; Wilson, Stephanie R.Abstract Contrast enhanced ultrasound (CEUS) offers a safe, reliable imaging option to establish a clinical diagnosis across a variety of multidisciplinary settings. This Expert Consensus Statement serves to outline expert opinion on what constitutes appropriate supervision and the essential components of safe CEUS practice. The purpose of this document is to empower institutions to allow sonographers, along with other trained medical professionals, to administer UCAs at the point of care, consistent with the updated scope of practice documentation and within the broad parameters of an individual’s training and licensure, while subject to appropriate supervision and meeting or exceeding minimum safety standards. This guidance was developed by the International Contrast Ultrasound Society and endorsed by the following organizations that represent ultrasound professionals: the British Society of Echocardiography, the Canadian Society of Echocardiography, the Society of Diagnostic Medical Sonography, the Society for Pediatric Radiology, the World Federation of Ultrasound in Medicine and Biology, the Brazilian College of Radiology, the Joint Review Committee for Diagnostic Medical Sonography, the Chinese Ultrasound Doctors Association, and the American Society of Neuroimaging. Additionally, this guidance document was affirmed or supported by the American Society of Echocardiography, the Association for Medical Ultrasound, and the Society for Vascular Ultrasound.Item Open Access Integrated access to cancer screening: expanding access for cervical and colorectal cancer screening in rural and remote Northern Alberta, Canada using a mobile service to bring cancer screening closer to home(2025-02-17) Wiseman, Jessica; Patterson, Kara; Kliewer, Gordon; Mueller, Mary; Mutti-Packer, Seema; Newsome, James; Lockerbie, Stacy; Hauber, Joan; Schwann, Monica; Yang, HuimingAbstract Background The goal of the Integrated Access to Cancer Screening (IACS) initiative was to help reduce the disparity in cancer screening participation across Alberta by implementing an integrated mobile service delivery model for breast, cervical, and colorectal cancer screening in rural and remote communities in Northern Alberta, performed by Nurse Practitioners (NPs) that addressed barriers to access. The aim of this study was to evaluate the outcomes and impact the IACS initiative had on the communities and residents of Northern Alberta. This article describes the initiative design, implementation, outcomes, and impact of the initiative. Methods The IACS model was implemented in a total of 36 visited communities in Northern Alberta from December 2020 to December 2021. The impact of the IACS initiative was measured using a mixed methods approach. The participation rate, cancer screening overdue status, and connection to a PCP were assessed using quantitative data collected through the existing clinical information system. Patient and provider feedback were collected from opened-ended surveys, and all data was analyzed by the research team. This study evaluated the impact the IACS initiative had on patient cancer screening participation and cancer screening knowledge, addressing known barriers to service delivery in rural and remote Northern Alberta, and to understand how this service might be sustained for future operation. Results Six hundred fifty-three people participated in screening offered through the IACS initiative. 99% of Pap screenings offered to patients were accepted, and 98% of FIT kits were accepted from the NPs, with a completion rate of 84%. The clinical data and survey responses from patients and providers indicated support for sustaining the IACS initiative. The IACS model of screening was favoured by most female patients. It also increased screening uptake in the communities we visited in the North Zone of Alberta, where screening rates are low. Conclusion These findings highlight that the IACS initiative was well-received and brought value to underserved communities in Northern Alberta. The IACS model effectively facilitated screening for those who were overdue or have never been screened before. The reach of the IACS model was broader than anticipated, with those who are attached to a PCP also finding the integrated mobile screening model beneficial, bringing the services closer to home.Item Open Access An environmental scan of financial incentives to increase access to healthy foods: How, how much, and how often?(2025-02-19) Quach, Anita; Yohannes, Sabrina; Olstad, Dana L.; Campbell, David J.; Corrigan, Crystal; Beall, Reed F.Highlights This environmental scan identified four main incentive structures for promoting healthy food purchases: price discounts, food vouchers, rewards, and hybrid structures. The median weekly incentive value across all programs was $14.38 USD, with significant variation. Incentives were most commonly distributed on a weekly basis (29%). Few programs provided evidence-based justifications for their chosen incentive structures, values, or distribution frequencies. Further research is needed to directly compare the effectiveness of different incentive structures, values, and frequencies in promoting healthier food purchases.Item Open Access Bovine milk-derived extracellular vesicles reduce oxidative stress and ferroptosis induced by Klebsiella pneumoniae in bovine mammary epithelial cells(2025-02-14) Liang, Bingchun; Xiong, Yindi; Cobo, Eduardo R.; Kastelic, John; Tong, Xiaofang; Han, Bo; Gao, JianAbstract Background Ferroptosis is characterized by increased production of reactive oxygen species (ROS) and membrane lipid peroxidation that can exacerbate inflammatory damage. Extracellular vesicles (EVs) isolated from bovine milk have many biological functions, including antioxidant properties. However, the role of EVs on Klebsiella pneumoniae-induced ferroptosis and oxidative stress in bovine mammary epithelial cells (bMECs) and murine mammary tissue is unclear. In this study, EVs were isolated from bovine colostrum, mature milk and clinical mastitis milk (defined as C-EVs, M-EVs and CM-EVs, respectively) and assessed by transmission electron microscopy, Western blot and transcriptome sequencing. Effects of EVs on K. pneumoniae-induced ferroptosis and oxidative stress in bMECs were evaluated with immunofluorescence and Western blot. Results In bMECs, infection with K. pneumoniae induced oxidative stress, decreasing protein expression of Nrf2, Keap1 and HO-1 plus SOD activity, and increasing ROS concentrations. However, protein expression of GPX4, ACSL4 and S100A4 in bMECs, all factors that regulate ferroptosis, was downregulated by K. pneumoniae. Furthermore, this bacterium compromised tight junctions in murine mammary tissue, with low expression of ZO-1 and Occludin, whereas protein expression of Nrf2 and GPX4 was also decreased in mammary tissue. Adding C-EVs, M-EVs or CM-EVs reduced oxidative stress and ferroptosis in K. pneumoniae-infected bMECs in vitro and murine mammary tissues in vivo. Conclusion In conclusion, all 3 sources of milk-derived EVs alleviated oxidative stress and ferroptosis in K. pneumoniae-infected bMECs and mammary tissues.Item Open Access Multifunctional hyaluronic acid-based biomimetic/pH-responsive hybrid nanostructured lipid carriers for treating bacterial sepsis(2025-02-11) Elhassan, Eman; Omolo, Calvin A.; Gafar, Mohammed A.; Ismail, Eman A.; Ibrahim, Usri H.; Khan, Rene; Lesouhaitier, Mathieu; Kubes, Paul; Govender, ThirumalaAbstract Introduction The application of biomimetic and stimuli-responsive nanocarriers displays considerable promise in improving the management of bacterial sepsis and overcoming antimicrobial resistance. Therefore, the study aimed to synthesize a novel hyaluronic acid-lysine conjugate (HA-Lys) and to utilize the attributes of the synthesized HA-Lys with Tocopherol succinate (TS) and Oleylamine (OLA) in the formulation of multifunctional biomimetic pH-responsive HNLCs loaded with vancomycin (VCM-HNLCs), to combat bacterial sepsis. Methods A novel hyaluronic acid-lysine conjugate (HA-Lys) was synthesized and characterized using FTIR and 1H NMR spectroscopy. Vancomycin-loaded hybrid nanosystems (VCM-HNLCs) were prepared through hot homogenization ultrasonication and evaluated for particle size, polydispersity index (PDI), zeta potential (ZP), and encapsulation efficiency (EE%). In vitro biocompatibility was assessed via MTT assay and red blood cell hemolysis test. The binding affinity to TLR2 and TLR4 was measured using microscale thermophoresis (MST). Drug release was evaluated using the dialysis bag method. Antimicrobial activity against MRSA and efflux pump inhibition were also determined. Efficacy was demonstrated in an MRSA-induced sepsis mice model. Results The VCM-HNLCs, produced via hot homogenization ultrasonication, exhibited particle size (PS), polydispersity index (PDI), zeta potential (ZP), and encapsulation efficiency (EE%) of 110.77 ± 1.692 nm, 0.113 ± 0.022, − 2.92 ± 0.210 mV, and 76.27 ± 1.200%, respectively. In vitro, biocompatibility was proven by hemolysis and cytotoxicity studies. The VCM-HNLCs demonstrated targetability to human Toll-like receptors (TLR 2 and 4) as validated by microscale thermophoresis (MST). VCM-HNLCs showed a twofold reduction in MIC values at physiological pH compared to the bare VCM against S. aureus and MRSA for 48 h. While at pH 6.0, MIC values were reduced by fourfold in the first 24 h and by eightfold in the subsequent 48 and 72 h against tested strains. Furthermore, VCM-HNLCs showed inhibitory effects against MRSA efflux pumps, reactive oxygen species (ROS), and lipopolysaccharide (LPS)-induced hyperinflammation. In an MRSA-induced sepsis mice model, VCM-HNLCs demonstrated superior efficacy compared to free VCM, significantly eliminated bacteria and improved survival rates. Conclusions Overall, these results highlight the potential of VCM-HNLCs as novel multifunctional nanocarriers to combat antimicrobial resistance (AMR) and enhance sepsis outcomes. Graphical AbstractItem Open Access Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper(2025-02-13) De Simone, Belinda; Abu-Zidan, Fikri M.; Boni, Luigi; Castillo, Ana M. G.; Cassinotti, Elisa; Corradi, Francesco; Di Maggio, Francesco; Ashraf, Hajra; Baiocchi, Gian L.; Tarasconi, Antonio; Bonafede, Martina; Truong, Hung; De’Angelis, Nicola; Diana, Michele; Coimbra, Raul; Balogh, Zsolt J.; Chouillard, Elie; Coccolini, Federico; Kelly, Micheal D.; Di Saverio, Salomone; Di Meo, Giovanna; Isik, Arda; Leppäniemi, Ari; Litvin, Andrey; Moore, Ernest E.; Pasculli, Alessandro; Sartelli, Massimo; Podda, Mauro; Testini, Mario; Wani, Imtiaz; Sakakushev, Boris; Shelat, Vishal G.; Weber, Dieter; Galante, Joseph M.; Ansaloni, Luca; Agnoletti, Vanni; Regimbeau, Jean-Marc; Garulli, Gianluca; Kirkpatrick, Andrew L.; Biffl, Walter L.; Catena, FaustoAbstract Background Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient’s risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. Aim This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. Methods Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. Results ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5–10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. Conclusions Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures—areas traditionally reliant on the surgeon’s visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures. Graphical abstractItem Open Access Suicidal ideation among mental health patients at hospital discharge: prevalence and risk factors(2025-02-11) Mao, Wanying; Shalaby, Reham; Owusu, Ernest; Elgendy, Hossam E.; Agyapong, Belinda; Eboreime, Ejemai; Silverstone, Peter H.; Chue, Pierre; Li, Xin-Min; Vuong, Wesley; Ohinmaa, Arto; Taylor, Valerie; Greenshaw, Andrew J.; Agyapong, Vincent I.Abstract Background Evidence indicates that suicide risk is much higher for psychiatric patients in the weeks immediately following discharge from the hospital. It is, therefore, crucial to evaluate suicide risk accurately at discharge to provide supportive and lifesaving interventions as appropriate. Aim: In this study, the prevalence and risk factors for suicide ideations were examined among patients ready to be discharged from psychiatric units in Alberta province, Canada. Methods Researchers conducted face-to-face meetings with potential participants to determine if they were interested in participating. Eligible individuals in this epidemiological cross-sectional study used an online quantitative survey to assess suicide ideations using the appropriate question contained in the Patient Health Questionnaire (PHQ-9) scale. Information was also gathered regarding patient demographics, clinical information, and responses to the Generalized Anxiety Disorder (GAD-7), and World Health Organization Well-Being Index (WHO-5) questionnaires. Results We recruited 1,004 patients from an initial pool of 1,437 patients. We found that the prevalence of suicidal ideation among patients about to be discharged was 48.9%, i.e., nearly half of all patients had active suicidal thinking prior to discharge. We found that factors that were most significantly associated with this were age, ethnicity, employment status, primary mental health diagnoses, anxiety, and poor well-being at baseline. Conclusion Here, in a large cohort of psychiatric patients in Alberta, Canada, we found that nearly half of patients being discharged from an acute psychiatric unit reported suicidal ideation. Given the increased short-term risk to this group, there is an urgent need for additional research on the underlying reasons and reliable predictors of suicidal ideation in these patients. Additionally, appropriate interventions and supportive services must be provided both prior and after discharge to mitigate this substantial risk.Item Open Access Implication of region-dependent material properties of articular cartilage in the contact mechanics of porcine knee joint(2025-02-14) Hamsayeh Abbasi Niasar, Erfan; Li, LePingAbstract Background The site-specific tissue properties of knee cartilage may play an essential role in knee joint mechanical function, and mitigate joint injury and cartilage degeneration. The present study aimed to determine the significance of tissue inhomogeneity in knee joint contact mechanics using a porcine model. Methods Finite element models were developed for a porcine knee with intact and total meniscectomy conditions to simulate whole-joint compression-relaxation tests under a 1.2-mm ramp-compression at 0.01, 0.1, or 1 mm/s. Two reference benchmarks were introduced for the implementation of poromechanical material properties of fibril-reinforced cartilage: Benchmark II consisted of 17 sets of cartilage properties, each for a region in the knee, representing site-specific inhomogeneity averaged from cartilage indentation maps of 14 porcine knees. Benchmark I was comprised of a single set of properties by taking the average properties of 17 regions in Benchmark II, assuming tissue homogeneity. To validate the modeling method, the reference benchmarks were used to produce results against whole-joint compression test data. Results Both benchmarks were able to approximate experimental force-compression data obtained from the same knee with intact menisci and total meniscectomy, provided that the average properties from 14 knees were appropriately scaled to account for individual joint differences. Noticeable differences in stress and pressure distributions were observed between the benchmarks. For instance, benchmark I generated higher peak contact and fluid pressures in the medial tibial cartilage, but benchmark II produced the higher ones in the lateral tibial cartilage. The load sharing asymmetry between the lateral and medial compartments was reduced in benchmark II which was more pronounced for higher compression rates. On the other hand, benchmark II produced a more uniform stress distribution or lower maxima. Meniscectomy caused a slight shift of the contact centers in the tibial plateaus as compared to the intact joint. Conclusion The modeling results demonstrated substantial differences in loading distributions in the joint between the homogeneous and nonhomogeneous models represented by the two benchmarks, indicating the role of tissue inhomogeneity in the joint contact mechanics. Region-dependent tissue properties may need to be implemented in joint mechanical modeling to evaluate the site of cartilage prone to injury or degeneration.Item Open Access Long-term cardiac MRI follow up of MANTICORE (Multidisciplinary Approach to Novel Therapies in Cardio-Oncology REsearch)(2025-02-08) Labib, Dina; Haykowsky, Mark; Sonnex, Emer; Mackey, John R.; Thompson, Richard B.; Paterson, D. I.; Pituskin, EdithAbstract Background This study investigates the long-term cardiac effects of trastuzumab-based chemotherapy in early breast cancer (EBC) survivors. We extend the original MANTICORE trial which showed that angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers (BB) could mitigate the decline in left ventricular (LV) ejection fraction (EF) during the first year of trastuzumab treatment. Objectives We hypothesized that, over time, cardiac function would decline further and adverse changes in cardiac geometry would occur due to the aging of the population and prior treatment. Methods The study enrolled 52 participants from the original MANTICORE trial cohort, with cardiac magnetic resonance (CMR) imaging conducted at a median of 6.5 years post randomization to treatment. Results We found that, contrary to the hypothesis, participants maintained LV EF over the follow-up period. Specifically, the placebo group exhibited a recovery in LV EF to levels comparable with the treatment groups, suggesting no long-term differential impact on cardiac function. However, a significant reduction in LV mass was observed across all groups, the clinical implications of which remain unclear. Conclusions The findings suggest that in a selected population receiving trastuzumab-based chemotherapy, extended cardiac imaging surveillance beyond one-year post-treatment may be unnecessary. We posit that the presence of HER2 overexpressing breast cancer influenced hypertrophic changes to cardiac geometry observed at baseline and one year, which resolved after completing HER2-blocking treatment. The study also highlights the need for further research to understand the significance of changes in cardiac geometry during and after breast cancer treatment.Item Open Access Examining differences in exposure to digital marketing of unhealthy foods reported by Canadian children and adolescents in two policy environments(2025-02-07) Vergeer, Laura; Soto, Carolina; Bagnato, Mariangela; Pauzé, Elise; Amson, Ashley; Ramsay, Tim; Olstad, Dana L.; Welch, Vivian; Potvin Kent, MoniqueAbstract Background There has been relatively little research on youth’s exposure to food marketing on digital media, which is important as new digital platforms emerge and youth spend more time online. Evidence evaluating different policy approaches to restricting digital food marketing to children is also limited. This study examined differences in self-reported exposure to digital food marketing between children and adolescents in different policy environments: Ontario (where food marketing is self-regulated) and Quebec (where advertising is government regulated). Methods An observational cross-sectional online survey was conducted in April 2023 among children (aged 10–12 years) and adolescents (13–17 years) from Ontario and Quebec, recruited by Leger Marketing. Participants self-reported their frequency of exposure to food marketing via various digital platforms and marketing techniques. Logistic regression and proportional odds models examined differences in exposure by province and age group, adjusting for sociodemographic characteristics and digital device usage. Results The odds of reporting more frequent exposure to marketing of sugary drinks (OR: 0.48; 95% CI: 0.33, 0.69), sugary cereals (OR: 0.59; 95% CI: 0.41, 0.86), salty/savoury snacks (OR: 0.67; 95% CI: 0.47, 0.96), fast food (OR: 0.65; 95% CI: 0.45, 0.92), and desserts/sweet treats (OR: 0.54; 95% CI: 0.37, 0.78) were lower among Quebec children than Ontario children. Quebec children were less likely than Ontario children (OR: 0.56; 95% CI: 0.38, 0.84), but more likely than Quebec adolescents (OR: 1.58; 95% CI: 1.04, 2.42), to report exposure to unhealthy food marketing on one or more gaming/TV/music streaming platform/website(s). Compared with Ontario children, Quebec children were less likely to report exposure to marketing featuring characters or child/teenage actors (OR: 0.51; 95% CI: 0.34, 0.76), child-appealing subjects, themes and language (OR: 0.59; 95% CI: 0.40, 0.89), and visual design, audio and special effects (OR: 0.64; 95% CI: 0.41, 0.99), and to report exposure to a greater number of marketing techniques (OR: 0.60; 95% CI: 0.43, 0.84). Conclusions Exposure to unhealthy food marketing on digital media is high for youth from Ontario and Quebec, particularly for Ontario children. These findings reinforce the need for federal regulations to protect Canadian youth from unhealthy food marketing on digital media.Item Open Access Exploring predictors of the five-time sit-to-stand test based on cross-sectional findings from the Swedish National Study on Aging and Care (SNAC)(2025-02-04) Niklasson, Joakim; Fagerström, Cecilia; Backåberg, Sofia; Bergman, Patrick; Lindberg, TereseAbstract Background As we age, staying physically active and reducing sedentary behavior becomes crucial. To understand how to achieve this, factors related to daily physical function such as five-time sit-to-stand (STS) time should be explored. This study aimed to investigate the associations between STS time, self-rated physical activity, physical function, health-related quality of life, physical and mental health in community-dwelling older adults aged ≥ 60 years. Method Cross-sectional design with self-reported and objectively measured data from adults aged ≥ 60 years (n = 819), acquired from the Swedish National Study on Aging and Care. Data was analyzed through multiple linear regression. Results The model (R2 = 0.268) showed that STS time was predicted by grip strength (β’ = -0.204, p < 0.05), age (β’ = 0.202, p < 0.05), health-related quality of life (β’ = -0.192, p < 0.05), having fallen within the preceding twelve months (β’ = -0.127, p < 0.05), physical activities of perceived light to moderate intensity (β’ = -0.121, p < 0.05), one-leg stand (β’ = -0.099, p < 0.05), and education level (β’ = -0.092, p < 0.05). For STS time, health-related quality of life (β = -0.354, confidence interval [CI] (-0.509)–(-0.199)), having fallen within the preceding twelve months (β = -0.222, CI (-0.365)–(-0.078)), and physical activities of perceived light to moderate intensity (β = -0.166, CI (-0.278)–(-0.053)) were the most prominent predictors. Conclusion The model highlights the importance of grip strength and health-related quality of life in predicting STS time in older adults. Clinicians can use these insights to develop interventions that maintain physical function by regularly assessing and monitoring these factors. Future research should explore the relationship between fall history, faster STS time, and the impact of grip strength and health-related quality of life on sedentary behavior among older adults.
