A cortically-weighted versus total Alberta Stroke Program Early Computed Tomography Score in thrombectomy outcome models

OBJECTIVES

Individual subcortical infarct scoring for the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) can be difficult and is subjected to higher inter-reader variability. This study compares performance of the 10-point ASPECTS with a new 7-point cortically-weighted score in predicting post-thrombectomy functional outcomes.

MATERIALS AND METHODS

Prospective registry data from two comprehensive stroke centers (Site 1 2016-2021; Site 2: 2019-2021) included patients with either M1 segment of middle cerebral artery or internal carotid artery occlusions who underwent thrombectomy. Two multivariate proportional odds training models utilizing either 10-point or 7-point ASPECTS predicting 90-day shift in modified Rankin score were generated using Site 1 data and validated with Site 2 data. Models were compared using multiclass receiver operator characteristics, corrected Akaike's Information Criterion, and likelihood ratio test.

RESULTS

Of 328 patients (Site 1 = 181, Site 2 = 147), median age was 71y (IQR 61-82), 119 (36%) had internal carotid artery occlusions, and median 10-point ASPECTS was 9 (IQR 8-10). There was no difference in performance between models using either total or cortically-weighted ASPECTS (p=0.14). Validation cohort data were correctly (i.e., predicting modified Rankin score within one point) classified 50% (cortically-weighted score model) and 56% (total score model) of the time.

CONCLUSIONS

The 7-point cortically-weighted ASPECTS was similarly predictive of post-thrombectomy functional outcome as 10-point ASPECTS. Given noninferior performance, the cortically-weighted score is a potentially reliable, but simplified, alternative to the traditional scoring paradigm, with potential implications in automated image analysis tool development.

Lessons from CanSpotASF: Moving towards risk-based African Swine Fever surveillance with rule-out testing in Western Canada

African swine fewer (ASF) is a serious disease present in Africa, Eurasia, and the Caribbean but not in continental North America. CanSpotASF describes the ASF surveillance in Canada as a phased in approach. The first enhancement to the passive surveillance was the risk-based early detection testing (rule-out testing) where eligible cases were tested for ASF virus (ASFv). The objective was to describe how the eligibility criteria were applied to cases in western Canada. In particular, to assess if cases tested for ASFv had eligible conditions and if pathology cases with eligible conditions were tested for ASFv based on the data collated by Canada West Swine Health Intelligence Network (CWSHIN) from British Columbia, Alberta, Saskatchewan, and Manitoba. The study period was August 2020 to December 2022 and the data included two study laboratories. We found that over 90% of cases tested for ASFv had eligible conditions as defined in CanSpotASF. The eligibility criteria were applied at three stages of the disease investigation process: 1) the clinical presentation in the herd; 2) at the initial laboratory assessment; and 3) the final pathology diagnosis. At the two study laboratories the proportion of all submitted cases (culture, serology, PCR, pathology) tested for ASFv was very low 1%. However, in the pathology cases specifically targeted in CanSpotASF, and the proportion of tested cases was 12%. In addition, for eligible pathology cases (eligible diagnosis or test) the proportion tested was higher 15%. These results indicated that CanSpotASF targeted herds with submissions for pathological examination and to some degree eligible conditions which would be herds with health issues (known or unknown). We interpret this as a first step towards risk-based surveillance with health as the defining factor.

The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study

OBJECTIVES

Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada.

METHODS

Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities.

RESULTS

Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines.

CONCLUSION

Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.

One Health communication channels: a qualitative case study of swine influenza in Canada in 2020

BACKGROUND

With increased attention to the importance of integrating the One Health approach into zoonotic disease surveillance and response, a greater understanding of the mechanisms to support effective communication and information sharing across animal and human health sectors is needed. The objectives of this qualitative case study were to describe the communication channels used between human and animal health stakeholders and to identify the elements that have enabled the integration of the One Health approach.

METHODS

We combined documentary research with interviews with fifteen stakeholders to map the communication channels used in human and swine influenza surveillance in Alberta, Canada, as well as in the response to a human case of H1N2v in 2020. A thematic analysis of the interviews was also used to identify the barriers and facilitators to communication among stakeholders from the animal and human health sectors.

RESULTS

When a human case of swine influenza emerged, the response led by the provincial Chief Medical Officer of Health involved players at various levels of government and in the human and animal health sectors. The collaboration of public and animal health laboratories and of the swine sector, in addition to the information available through the surveillance systems in place, was swift and effective. Elements identified as enabling smooth communication between the human and animal health systems included preexisting relationships between the various stakeholders, a relationship of trust between them (e.g., the swine sector and their perception of government structures), the presence of stakeholders acting as permanent liaisons between the ministries of health and agriculture, and stakeholders' understanding of the importance of the One Health approach.

CONCLUSIONS

Information flows through formal and informal channels and both structural and relational features that can support rapid and effective communication in infectious disease surveillance and outbreak response.

Use of rational subgrouping to understand variation and opportunity for improvement in time to ultrasound

OBJECTIVE

To understand factors that contribute to variation in time to abdominal and/or pelvic ultrasound in pediatric patients in an emergency department (ED) by utilizing rational subgrouping to assess opportunity for improvement.

METHODS

All abdominal and pelvic ultrasounds conducted in the Alberta Children's Hospital ED from May 2019 to April 2021 were included. Time of study order and time of study completion were obtained from the electronic health record. Statistical process control (SPC) I-charts were used to analyze the quarterly median number of minutes from ultrasound order to completion. Rational subgrouping was used to stratify the data based on sex, age, and ED shift type, and identify special cause variation between groups. Findings were used to inform local decision-making.

RESULTS

Special cause variation was detected among subgroups for sex, age group, and shift type. The median time from order of an abdominal and/or pelvic ultrasound to completion of study was 155 min. Females had a median order to completion time of 178 min, while males had a completion time of 131 min. From age 0 to 3, the median time was 110 min, compared to 149 min for ages 4 to 11 and 171 min for ages 12 and older. Day shifts had a median order to completion time of 145 min, compared to 129 min for evening shifts and 269 min for night shifts.

CONCLUSIONS

Longer time to study completion was observed in female patients, older patients, and during night shifts. Use of rational subgrouping supported understanding of variation among subgroups of patients evaluated with abdominal and/or pelvic ultrasound. This allowed informed decision-making regarding opportunities for improvement. Rational subgrouping is a useful methodology in planning QI initiatives as it identifies sources of variation within a nonhomogeneous population and allows for judicious decision-making in a context of limited resources.

Limited reduction in Clostridioides difficile and Methicillin-Resistant Staphylococcus aureus with the use of an aerosolized hydrogen peroxide disinfection system in tertiary health care facilities in Alberta, Canada

BACKGROUND

Nonmanual room disinfection systems may reduce the transmission of infections. A variety of systems have emerged; however, a paucity of evidence exists to make an evidence-informed decision for the implementation of a specific system. Alberta Health Services assessed one of these systems.

METHODS

A quasi-experimental prepost design assessed an aerosolized hydrogen peroxide disinfection system on 6 units at 3 acute care facilities in Alberta. To assess clinical effectiveness an interrupted time-series analysis with Poisson distribution compared changes in hospital-acquired Clostridioides difficile infection (HA-CDI) and hospital-acquired Methicillin-resistant Staphylococcus aureus (HA-MRSA) between preintervention, intervention, and postintervention periods. To assess operational feasibility cleaning turnaround time, time to operate, and utilization were considered. A participatory research framework was used to understand the benefits and challenges of operationalization.

RESULTS

Incidence rate ratio (IRR) of HA-CDI decreased by 25.7% on FMC-A and 6.9% on RAH-B. Following withdrawal, the IRR of HA-CDI continued to decrease. IRR of HA-MRSA decreased by 25.0% on RAH-B. Following withdrawal, the IRR of HA-MRSA continued to decrease. None of the results were statistically significant. The average time to operate was 3.2 hours. Utilization was between 1.7% and 25.6%. Most staff reported benefits and challenges.

DISCUSSION

None of the changes observed in HA-CDI and HA-MRSA after the introduction of the aerosolized hydrogen peroxide system were statistically significant. While most respondents reported multiple benefits and challenges in using the system, the core challenge was delays in inpatient admissions due to the time operate the system.

CONCLUSION

Successful implementation of a nonmanual room disinfection system as an addition to standard cleaning and disinfection requires significant investment and must consider a variety of factors.

Gene Expression Profiling in Pediatric Appendicitis

Importance

Appendicitis is the most common indication for urgent surgery in the pediatric population, presenting across a range of severity and with variable complications. Differentiating simple appendicitis (SA) and perforated appendicitis (PA) on presentation may help direct further diagnostic workup and appropriate therapy selection, including antibiotic choice and timing of surgery.

Objective

To provide a mechanistic understanding of the differences in disease severity of appendicitis with the objective of developing improved diagnostics and treatments, specifically for the pediatric population.

Design, Setting, and Participants

The Gene Expression Profiling of Pediatric Appendicitis (GEPPA) study was a single-center prospective exploratory diagnostic study with transcriptomic profiling of peripheral blood collected from a cohort of children aged 5 to 17 years with abdominal pain and suspected appendicitis between November 2016 and April 2017 at the Alberta Children's Hospital in Calgary, Alberta, Canada, with data analysis reported in August 2023. There was no patient follow-up in this study.

Exposure

SA, PA, or nonappendicitis abdominal pain.

Main Outcomes and Measures

Blood transcriptomics was used to develop a hypothesis of underlying mechanistic differences between SA and PA to build mechanistic hypotheses and blood-based diagnostics.

Results

Seventy-one children (mean [SD] age, 11.8 [3.0] years; 48 [67.6%] male) presenting to the emergency department with abdominal pain and suspected appendicitis were investigated using whole-blood transcriptomics. A central role for immune system pathways was revealed in PA, including a dampening of major innate interferon responses. Gene expression changes in patients with PA were consistent with downregulation of immune response and inflammation pathways and shared similarities with gene expression signatures derived from patients with sepsis, including the most severe sepsis endotypes. Despite the challenges in identifying early biomarkers of severe appendicitis, a 4-gene signature that was predictive of PA compared to SA, with an accuracy of 85.7% (95% CI, 72.8-94.1) was identified.

Conclusions

This study found that PA was complicated by a dysregulated immune response. This finding should inform improved diagnostics of severity, early management strategies, and prevention of further postsurgical complications.

"Your Kid Has Potential, But They Need Sleep": Teacher Perspectives on School-Based Sleep Promotion in Alberta, Canada

BACKGROUND

Insufficient sleep is a growing public health concern. Thirty percent of Canadian children and youth are not meeting national sleep recommendations. Inadequate sleep can negatively influence students' academics and physical and psychosocial health. Schools have been identified as ideal health promotion settings to influence children's health including their sleep behaviors. The objective of this study was to explore teachers' perspectives on sleep behaviors and their role in school-based sleep promotion.

METHODS

Nineteen elementary teachers were purposively sampled from the greater Edmonton area, Alberta, Canada. Interpretive description was used as the guiding method, and data were generated through one-on-one semi-structured interviews. Inductive descriptive thematic analysis was used to identify interview themes.

RESULTS

Three themes related to teachers' perspectives on sleep behaviors and school-based sleep promotion were identified: the importance of students' sleep, prioritizing sleep as part of teaching and learning, and a culture of healthy sleep habits.

CONCLUSIONS

This study found that teachers considered sleep to be essential for elementary students' academic success and wellbeing, and a whole school approach was necessary to support a healthy sleep culture in schools.

Measurement constrained emission estimates of alkylated polycyclic aromatic hydrocarbons in the Canadian Athabasca oil sands region

Alkylated polycyclic aromatic hydrocarbons (APAH) are important contaminants of crude oil production and exhibit similar toxicity to their parent compounds. This study developed an emission inventory of APAH in a major oil sands development region of Alberta, Canada, and validated the inventory with ambient concentration measurements through dispersion modeling. The initial estimate of regional total annual emissions of 21 APAH species was 362 tonnes/year in the last decade, of which 309 and 53 tonnes/year were in particle-bound and gas-phase APAH, respectively. Fugitive dust from oil sands mining activities is the primary source of particle-bound APAH, emitting 274 tonnes/year. Other major sources of APAH include point sources (31), tailings ponds (21), anthropogenic fuel consumption from mine fleet (17), and local transportation (13). The group of species with highest emissions was C1-C4 alkylnaphthalenes (53%), followed by C1-C4 alkylphenanthrenes/anthracenes (19%), C1-C4 fluorenes (13%), and C1-C4 fluoranthenes/pyrenes and C1-C4 benz[a]anthracenes/chrysene/triphenylenes (7% each). CALPUFF dispersion modeling was performed using the APAH emissions as model input. The model-predicted annual average ambient APAH concentrations at 17 monitoring sites were 1%-52% (19% on average) lower than the measurements. Inverse dispersion modeling was then applied to adjust APAH emissions higher by 19% for each of the 21 APAH species, which resulted in a revised estimate of APAH emissions to 431 tonnes/year. With the revised emissions as model input, model bias in the predicted ambient concentration was reduced from -19% to -8%. The model results showed the highest concentrations of APAH were near tailings ponds and open mining faces and downwind areas, with total APAH concentrations being higher than 50 ng/m3.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study

BACKGROUND

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions.

OBJECTIVE

The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada.

METHODS

Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results.

RESULTS

The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots.

CONCLUSIONS

Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

Spatio-temporal variations in dissolved trace elements in peat bog porewaters impacted by dust inputs from open-pit mining activities in the Athabasca Bituminous Sands (ABS) region

Considerable volumes of dust are generated from open-pit bitumen mining operations in northern Alberta, Canada. The reactive mineral phases of these dust particles can potentially dissolve in acidic (pH < 4) bog waters. Their dissolution could release trace elements (TEs), which could eventually alter these bog ecosystems. The impact of dust dissolution on the abundance of TEs in the dissolved (<0.45 μm) fraction of porewaters from excavated pits (30-40 cm deep) in the ombrogenic zone of five peatlands was evaluated. Porewaters were collected from four bogs situated within 70 km of mines and upgraders in the Athabasca Bituminous Sands (ABS) region, Alberta, Canada, and from a reference bog situated 264 km away. Over two consecutive years, the dissolved concentrations of some conservative (Al, Th, Y) and mobile lithophile elements (Fe, Li, Mn, Sr), as well as the metals enriched in bitumen (V, Ni, Mo), all increased with proximity to the mining area, in the ABS region. These trends reflect the observed increase in dust deposition with proximity to the mining area from independent studies of snow, lichens, and Sphagnum moss. Contrarily, the impact of dust dissolution on the concentration of potentially toxic TEs (As, Cd, Pb, Sb, and Tl) was negligible. Thus, the elements which are more abundant in the porewaters near industry are either ecologically benign (e.g. Li and Sr) or essential micronutrients (e.g. Fe, Mn, Ni, and Mo). Manganese was the only element which was enriched by more than 10x at all sites near the mining area, compared to its concentration at the reference site. The enrichments of all other elements were <10x, indicating that anthropogenic dust emissions from mining areas have had only a modest effect on the TEs abundance in peat porewaters.

The effects of protein supplementation, fumagillin treatment, and colony management on the productivity and long-term survival of honey bee (Apis mellifera) colonies

In this study, we intensively measured the longitudinal productivity and survival of 362 commercially managed honey bee colonies in Canada, over a two-year period. A full factorial experimental design was used, whereby two treatments were repeated across apiaries situated in three distinct geographic regions: Northern Alberta, Southern Alberta and Prince Edward Island, each having unique bee management strategies. In the protein supplemented treatment, colonies were continuously provided a commercial protein supplement containing 25% w/w pollen, in addition to any feed normally provided by beekeepers in that region. In the fumagillin treatment, colonies were treated with the label dose of Fumagilin-B® each year during the fall. Neither treatment provided consistent benefits across all sites and dates. Fumagillin was associated with a large increase in honey production only at the Northern Alberta site, while protein supplementation produced an early season increase in brood production only at the Southern Alberta site. The protein supplement provided no long-lasting benefit at any site and was also associated with an increased risk of death and decreased colony size later in the study. Differences in colony survival and productivity among regions, and among colonies within beekeeping operations, were far larger than the effects of either treatment, suggesting that returns from extra feed supplements and fumagillin were highly contextually dependent. We conclude that use of fumagillin is safe and sometimes beneficial, but that beekeepers should only consider excess protein supplementation when natural forage is limiting.

A comparison of Tier 1, 2, and 3 methods for quantifying nitrous oxide emissions from soils amended with biosolids

Municipal biosolids are a nitrogen (N)-rich agricultural fertilizer which may emit nitrous oxide (N2O) after rainfall events. Due to sparse empirical data, there is a lack of biosolids-specific N2O emission factors to determine how land-applied biosolids contribute to the national greenhouse gas inventory. This study estimated N2O emissions from biosolids-amended land in Canada using Tier 1, Tier 2 (Canadian), and Tier 3 (Denitrification and Decomposition model [DNDC]) methodologies recommended by the Intergovernmental Panel on Climate Change (IPCC). Field data was from replicated plots at 8 site-years between 2017 and 2019 in the provinces of Quebec, Nova Scotia and Alberta, Canada, representing three distinct ecozones. Municipal biosolids were the major N source for the crop, applied as mesophilic anaerobically digested biosolids, composted biosolids, or alkaline-stabilized biosolids alone or combined with an equal amount of urea-N fertilizer to meet the crop N requirements. Fluxes of N2O were measured during the growing season with manual chambers and compared to N2O emissions estimated using the IPCC methods. In all site-years, the mean emission of N2O in the growing season was greater with digested biosolids than other biosolids sources or urea fertilizer alone. The emissions of N2O in the growing season were similar with composted or alkaline-stabilized biosolids, and no greater than the unfertilized control. The best estimates of N2O emissions, relative to measured values, were with the Tier 3 > adapted Tier 2 with biosolids-specific correction factors > standard Tier 2 = Tier 1 methods of the IPCC, according to the root mean square error statistic. The Tier 3 IPCC method was the best estimator of N2O emissions in the Canadian ecozones evaluated in this study. These results will be used to improve methods for estimating N2O emissions from agricultural soils amended with biosolids and to generate more accurate GHG inventories.

Efficacy of commercially available entomopathogenic nematodes against insect pests of canola in Alberta, Canada

Certain entomopathogenic nematodes (EPNs) in the families Steinernematidae and Heterorhabditidae are among the most studied biocontrol tools, some of which are commercially available against pest insects. Their use against foliar and subterranean insect pests is largely unexplored in the Canadian Prairies. We conducted a laboratory-based study to produce baseline information on the biocontrol potential of a few commercial EPN species. Percent mortality of flea beetles, diamondback moths (DBMs), lygus, cabbage root maggots, and black cutworms (BCWs) was assessed after 72 hours exposure to Steinernema carpocapsae, S. kraussei, S. feltiae, and Heterorhabditis bacteriophora at varying concentrations (25, 50, 100, and 200 infective juveniles (IJs) per larvae, pupae, or cm2 of soil surface). Irrespective of concentration level, S. carpocapsae and S. kraussei caused significant mortality in DBM and BCW larvae compared with H. bacteriophora.S. kraussei, and S. feltiae were more efficient than S. carpocapsae in controlling root maggot larvae. H. bacteriophora caused zero mortality to root maggots at any concentration. Root maggot pupae were resistant to entry to EPN species tested, likely due to hard outer covering. Compared with root maggot pupae, a moderate level of mortality was observed in DBM pupae, suggesting differential ability of the tested EPNs in killing different life stages of certain pests. All nematode species tested caused low mortality (≤10%) in flea beetle adults. The findings of this investigation form fundamental data essential for carrying out field-based studies on canola and other related crops aimed at control and management of these pest species.

Adjuvant Ovarian Function Suppression in Premenopausal Hormone Receptor-Positive Breast Cancer

Importance

Few oncology studies have assessed the effectiveness of adjuvant ovarian function suppression (OFS) in observational settings for premenopausal hormone receptor-positive breast cancer. Target trial emulation is increasingly used for estimating treatment outcomes in observational cohorts.

Objectives

To describe hormone therapy and OFS treatment patterns (aim 1), examine the association between adding OFS to tamoxifen (TAM) or aromatase inhibitor (AI) and survival (aim 2), and examine the association between duration of hormone treatment (TAM or AI) plus OFS (H-OFS) and survival (aim 3).

Design, Setting, and Participants

This population-based cohort study included all premenopausal, early-stage breast cancer diagnoses between 2010 and 2020 in Alberta, Canada. Target trial emulation was conducted. Eligibility criteria were directly modeled after the Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT). Participants were followed up for a maximum of 5 years. Data were analyzed from July 2022 through March 2023.

Exposures

For aim 2, exposures were receiving the following baseline treatments for 2 years: AI + OFS (AI-OFS), TAM + OFS (T-OFS), and TAM alone. For aim 3, exposures were a 2-year or greater and a less than 2-year duration of H-OFS.

Main Outcomes and Measures

Recurrence-free survival was the primary outcome of interest. Marginal structural Cox models with inverse probability treatment and censoring weights were used to estimate hazard ratios (HRs), adjusted for baseline and time-varying confounding variables.

Results

Among 3434 female patients with premenopausal, early-stage breast cancer diagnoses (median [IQR] age, 45 [40-48] years), 2647 individuals satisfied SOFT and TEXT eligibility criteria. There were 2260 patients who initiated TAM, 232 patients who initiated T-OFS, and 155 patients who initiated AI-OFS; 192 patients received H-OFS for 2 or more years, and 195 patients received H-OFS for less than 2 years. The 5-year recurrence risks were not significantly lower in AI-OFS vs TAM (HR, 0.76; 95% CI, 0.38-1.33) or T-OFS vs TAM (HR, 0.87; 95% CI, 0.50-1.45) groups. Patients receiving H-OFS for 2 or more years had significantly better 5-year recurrence-free survival compared with those receiving H-OFS for less than 2 years (HR, 0.69; 95% CI, 0.54-0.90).

Conclusions and Relevance

This study found no significant reductions in recurrence risk for AI-OFS and T-OFS compared with TAM alone. H-OFS duration for at least 2 years was associated with significantly improved recurrence-free survival.

Region-specific interobserver agreement of the Alberta Stroke Program Early Computed Tomography Score: A meta-analysis

BACKGROUND AND PURPOSE

The Alberta Stroke Program Early CT Score (ASPECTS) is a widely used scoring system for evaluating ischemic stroke to determine therapeutic strategy. However, there is variation in the interobserver agreement of ASPECTS. This systematic review and meta-analysis aimed to investigate the interobserver agreement of total and regional ASPECTS.

METHODS

A comprehensive search was conducted in the Web of Sciences, PubMed, and Scopus databases to identify relevant studies. Inclusion criteria were studies of noncontrast CT performed within 24 hours of ischemic stroke in the middle cerebral artery territory.

RESULTS

A total of 20 studies, with 3482 patients, reporting interobserver agreement of total and regional ASPECTS were included in the meta-analysis. The interobserver agreement for total ASPECTS in studies using Kappa coefficient (κ) analysis was substantial (κ = .67, 95% confidence interval [CI]: .57-.78). In studies using intraclass correlation coefficient (ICC) analysis, agreement was excellent (ICC = .84, 95% CI: .77-.90). Interobserver agreement was higher in studies in which the observer was unblinded to clinical scenario in both groups (κ = .74, 95% CI: .59-.89, and ICC = .82, 95% CI: .79-.85). Per-region analysis showed that the caudate nucleus had the highest agreement (κ = .68, 95% CI: .60-.76, and ICC = .84, 95% CI: .74-.93), while M2 and internal capsule in Kappa studies (κ = .45, 95% CI: .34-.55 and κ = .47, 95% CI: .28-.66), and M4 and internal capsule in ICC studies (ICC = .54, 95% CI: .43-.64 and ICC = .55, 95% CI: .18-.91) had the lowest agreement.

CONCLUSION

This meta-analysis demonstrates substantial to excellent interobserver agreement for total ASPECTS, which supports using this method for stroke treatment. However, findings emphasize the need to consider interobserver agreement in specific regions of ASPECTS for treatment decisions.

Unsupervised item response theory models for assessing sample heterogeneity in patient-reported outcomes measures

PURPOSE

Unsupervised item-response theory (IRT) models such as polytomous IRT based on recursive partitioning (IRTrees) and mixture IRT (MixIRT) models can be used to assess differential item functioning (DIF) in patient-reported outcome measures (PROMs) when the covariates associated with DIF are unknown a priori. This study examines the consistency of results for IRTrees and MixIRT models.

METHODS

Data were from 4478 individuals in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry who received cardiac angiography in Alberta, Canada, and completed the Hospital Anxiety and Depression Scale (HADS) depression subscale items. The partial credit model (PCM) based on recursive partitioning (PCTree) and mixture PCM (MixPCM) were used to identify covariates associated with differential response patterns to HADS depression subscale items. Model covariates included demographic and clinical characteristics.

RESULTS

The median (interquartile range) age was 64.5(15.7) years, and 3522(78.5%) patients were male. The PCTree identified 4 terminal nodes (subgroups) defined by smoking status, age, and body mass index. A 3-class PCM fits the data well. The MixPCM latent classes were defined by age, disease indication, smoking status, comorbid diabetes, congestive heart failure, and chronic obstructive pulmonary disease.

CONCLUSION

PCTree and MixPCM were not consistent in detecting covariates associated with differential interpretations of PROM items. Future research will use computer simulations to assess these models' Type I error and statistical power for identifying covariates associated with DIF.

Establishing peat-forming plant communities: A comparison of wetland reclamation methods in Alberta's oil sands region

The Sandhill Wetland (SW) and Nikanotee Fen (NF) are two wetland research projects designed to test the viability of peatland reclamation in the Alberta oil sands post-mining landscape. To identify effective approaches for establishing peat-forming vegetation in reclaimed wetlands, we evaluated how plant introduction approaches and water level gradients influence species distribution, plant community development, and the establishment of bryophyte and peatland species richness and cover. Plant introduction approaches included seeding with a Carex aquatilis-dominated seed mix, planting C. aquatilis and Juncus balticus seedlings, and spreading a harvested moss layer transfer. Establishment was assessed 6 years after the introduction at SW and 5 years after the introduction at NF. In total, 51 species were introduced to the reclaimed wetlands, and 122 species were observed after 5 and 6 years. The most abundant species in both reclaimed wetlands was C. aquatilis, which produced dense canopies and occupied the largest water level range of observed plants. Introducing C. aquatilis also helped to exclude marsh plants such as Typha latifolia that has little to no peat accumulation potential. Juncus balticus persisted where the water table was lower and encouraged the formation of a diverse peatland community and facilitated bryophyte establishment. Various bryophytes colonized suitable areas, but the moss layer transfer increased the cover of desirable peat-forming mosses. Communities with the highest bryophyte and peatland species richness and cover (averaging 9 and 14 species, and 50%-160% cover respectively) occurred where the summer water level was between -10 and -40 cm. Outside this water level range, a marsh community of Typha latifolia dominated in standing water and a wet meadow upland community of Calamagrostis canadensis and woody species established where the water table was deeper. Overall, the two wetland reclamation projects demonstrated that establishing peat-forming vascular plants and bryophytes is possible, and community formation is dependent upon water level and plant introduction approaches. Future projects should aim to create microtopography with water tables within 40 cm of the surface and introduce vascular plants such as J. balticus that facilitate bryophyte establishment and support the development of a diverse peatland plant community.

Modelling the potential increase in eligible participants in clinical trials with inclusion of community intensive care unit patients in Alberta, Canada: a decision tree analysis

PURPOSE

Critical care research in Canada is conducted primarily in academically affiliated intensive care units (ICUs) with established research infrastructure. Efforts are made to engage community hospital ICUs in research, although the impacts of their inclusion in clinical research have never been explicitly quantified. We therefore sought to determine the number of additional eligible patients that could be recruited into critical care trials and the change in time to study completion if community ICUs were included in clinical research.

METHODS

We conducted a decision tree analysis using 2018 Alberta Health Services data. Patient demographics and clinical characteristics for all ICU patients were compared against eligibility criteria from ten landmark, randomized, multicentre critical care trials. Individual patients from academic and community ICUs were assessed for eligibility in each of the ten studies, and decision tree analysis models were built based on prior inclusion and exclusion criteria from those trials.

RESULTS

The number of potentially eligible patients for the ten trials ranged from 2,082 to 10,157. Potentially eligible participants from community ICUs accounted for 40.0% of total potentially eligible participants. The recruitment of community ICU patients in trials would have increased potential enrolment by an average of 64.0%. The inclusion of community ICU patients was predicted to decrease time to trial completion by a mean of 14 months (43% reduction).

CONCLUSION

Inclusion of community ICU patients in critical care research trials has the potential to substantially increase enrolment and decrease time to trial completion.

Evaluation of a community helpers' mental health and suicide awareness training programme for youth and young adults in Alberta, Canada

OBJECTIVE

The Community Helpers Programme (CHP) is a peer-helping programme providing youth and young adults with tools to support their peers to problem solve and seek mental health and suicide prevention support. This study aims to evaluate the effectiveness of the provincial programme (primary outcomes = knowledge, self-efficacy; secondary outcome = awareness of stigma) and describe the experience of participants, coordinators, and others.

STUDY DESIGN

The mixed methods evaluation included a longitudinal panel design outcome evaluation along with follow-up interviews.

METHODS

A series of three surveys collecting participant characteristics, knowledge, self-efficacy, and awareness of stigma at pre-training (T0), post-training (T1), and six-months follow-up (T2) were conducted. Mean group scores were calculated for completers (T0 and T1 completers and T0, T1, and T2 completers). Friedman tests were conducted to assess change over time and follow-up Wilcoxon Signed Rank tests determined the significance of changes in scores between each timepoint. Content analysis was conducted on qualitative data.

RESULTS

Participants' knowledge of mental health, suicide, and available supports along with self-efficacy increased from T0 to T1, and declined at T2. Awareness of stigma was high at all timepoints. Themes from the qualitative analysis included skill and knowledge development facilitators (e.g., consideration of learner needs, passionate coordinators, engaged learning approaches), sustaining community helper connectedness (e.g., helpers' network, awareness of and communication with local resources), and role and impact of CHP (e.g., addressing stigma, success stories).

CONCLUSIONS

This evaluation demonstrated that CHP was effective and offered feedback on experiences, including suggestions on CHP strengths and aspects to explore.

Legacy coal mining impacts downstream ecosystems for decades in the Canadian Rockies

Mountaintop removal coal mining leaves a legacy of disturbed landscapes and abandoned infrastructure with clear impacts on water resources; however, the intensity and persistence of this water pollution remains poorly characterized. Here we examined the downstream impacts of over a century of coal mining in the Crowsnest Pass (Alberta, Canada). Water samples were collected downstream of two historical coal mines: Tent Mountain and Grassy Mountain. Tent Mountain hosts a partially reclaimed surface mine that closed in 1983. Selenium concentrations downstream of Tent Mountain reached 185 μg/L in a lake below the mine spoil pile, and up to 23 μg/L in Crowsnest Creek, which drains the lake and the mine property. Further downstream, a well-dated sediment core from Crowsnest Lake records increases in sediment, selenium, lead, carbon, nitrogen, and polycyclic aromatic compounds that closely tracked the history of mining at Tent Mountain. In contrast, episodic discharge of mine water from abandoned underground adits at Grassy Mountain drive periodic (but short-term) increases in iron, various metals, and suspended sediment. These results underscore the lasting downstream impacts of abandoned and even reclaimed coal mines.

Part I - Identification of forensically relevant vertebrate scavengers

As a body decomposes in an outdoor environment, numerous taphonomic agents can act on the process of human decomposition. It is important to understand the impact of these agents as they can vary the rate of soft and hard tissue loss which may alter postmortem interval estimations. One taphonomic factor which has not been extensively investigated in many regions of the world, including Canada, are vertebrate scavengers. The current study aimed to identify scavenger guilds in the peri-urban and rural regions of two major cities in Alberta (Calgary and Edmonton) where human remains are frequently located. Vertebrate scavenger activity was recorded continuously using cellular and noncellular trail cameras. Images were analyzed to determine how the scavenging profiles (i.e., scavenger species, arrival time, and feeding behavior) impacted the loss of soft and hard tissue. We identified a range of mammalian and avian scavengers and found that coyote and black-billed magpie were the predominant scavengers recorded at the Edmonton peri-urban and rural sites, and the Calgary peri-urban sites. In contrast, when a site was within bear territory such as the Calgary rural sites, black and grizzly bears were the predominant scavengers. At all sites, the large mammalian scavengers were responsible for most soft tissue loss and subsequent hard tissue dispersal. None of the scavengers demonstrated a clear preference for open versus closed sites. This taphonomic information is important to consider when searching for human remains at these locations or in other North American regions with comparable scavenger guilds.

Response shift in coronary artery disease

PURPOSE

Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies.

METHODS

Data were from patients with CAD in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease (APPROACH) registry who completed the 16-item Canadian version of the Seattle Angina Questionnaire at 2 weeks and 1 year following a coronary angiogram. Multi-group confirmatory factor analysis (MG-CFA) was used to assess measurement invariance across treatment groups at week 2. Longitudinal MG-CFA was used to test for RS according to receipt of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical therapy (OMT) alone.

RESULTS

Of the 3116 patients included in the analysis, 443 (14.2%) received CABG, 2049(65.8%) PCI, and the remainder OMT alone. The MG-CFA revealed a partial-strong invariance across the treatment groups at 2 weeks (CFI = 0.98, RMSEA [90% CI] = 0.05 [0.03, 0.06]). Recalibration RS was detected on the Angina Symptoms and Burden subscale and its magnitude in the OMT, PCI, and CABG groups were 0.32, 0.28, and 0.53, respectively. After adjusting for RS effects, the estimated target changes were largest in the CABG group and negligible in the OMT group.

CONCLUSION

Adjusting for RS is recommended in studies that use SAQ-CAN to assess changes in patients with CAD who have received revascularization versus OMT alone.

Surveying the landscape: First Nations, Métis, and Inuit cancer resources in radiation therapy

INTRODUCTION/BACKGROUND

Alberta Health Services (AHS) is Canada's largest provincial integrated health care authority. AHS services over four million people with over 100,000 employees. In 2018, AHS introduced Indigenous training modules which were mandatory for all staff. These eight modules included topics detailing residential schools, Indian hospitals, The Indian Act, The 60's Scoop, Alberta's Indigenous populations, present day realities, including customs, practices and traditional medicines. Limited research exists in general in the field of radiation therapy with Canadian Indigenous populations. No formal research exists on the effectiveness of these AHS training modules.

METHODS

A mixed methods survey was developed and distributed by the radiation therapy managers to practicing radiation therapists in the four cancer centers in Alberta. The survey contained both drop down and open text boxes.

RESULTS

Survey respondents indicated that 90 % of radiation therapists completed the AHS Indigeneous training modules. However, 50 % of the respondents did not know what resources are available for their Indigenous patients. Furthermore, only 67 % felt that the information provided in the modules created enough comfort for them to have a conversation with Indigenous patients with cancer and their families.

DISCUSSION

Respondents indicated that although they felt knowledgeable and educated from the training modules, this did not necessarily translate into daily clinical practice. This included a lack of confidence to lead a conversation, knowing what resources are available and how to document if patient education material was given.

CONCLUSION

Creation of an Indigenous specific oncology module highlighting both resource availability and cultural customs that may be part of a person's cancer journey, may be of benefit to health care providers providing radiation treatment. Having Elders and Knowledge Keepers be part of the development of an oncology module may help create mutual understanding for both the cancer patient and their families and health care providers. This research suggests that the current cultural competency training for radiation therapists at AHS may not be enough for radiation therapists to feel comfortable with translating learnings from Indigenous online modules into their practice.

Doctor Versus Artificial Intelligence: Patient and Physician Evaluation of Large Language Model Responses to Rheumatology Patient Questions in a Cross-Sectional Study

OBJECTIVE

The objective of the current study was to assess the quality of large language model (LLM) chatbot versus physician-generated responses to patient-generated rheumatology questions.

METHODS

We conducted a single-center cross-sectional survey of rheumatology patients (n = 17) in Edmonton, Alberta, Canada. Patients evaluated LLM chatbot versus physician-generated responses for comprehensiveness and readability, with four rheumatologists also evaluating accuracy by using a Likert scale from 1 to 10 (1 being poor, 10 being excellent).

RESULTS

Patients rated no significant difference between artificial intelligence (AI) and physician-generated responses in comprehensiveness (mean 7.12 ± SD 0.99 vs 7.52 ± 1.16; P = 0.1962) or readability (7.90 ± 0.90 vs 7.80 ± 0.75; P = 0.5905). Rheumatologists rated AI responses significantly poorer than physician responses on comprehensiveness (AI 5.52 ± 2.13 vs physician 8.76 ± 1.07; P < 0.0001), readability (AI 7.85 ± 0.92 vs physician 8.75 ± 0.57; P = 0.0003), and accuracy (AI 6.48 ± 2.07 vs physician 9.08 ± 0.64; P < 0.0001). The proportion of preference to AI- versus physician-generated responses by patients and physicians was 0.45 ± 0.18 and 0.15 ± 0.08, respectively (P = 0.0106). After learning that one answer for each question was AI generated, patients were able to correctly identify AI-generated answers at a lower proportion compared to physicians (0.49 ± 0.26 vs 0.97 ± 0.04; P = 0.0183). The average word count of AI answers was 69.10 ± 25.35 words, as compared to 98.83 ± 34.58 words for physician-generated responses (P = 0.0008).

CONCLUSION

Rheumatology patients rated AI-generated responses to patient questions similarly to physician-generated responses in terms of comprehensiveness, readability, and overall preference. However, rheumatologists rated AI responses significantly poorer than physician-generated responses, suggesting that LLM chatbot responses are inferior to physician responses, a difference that patients may not be aware of.

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada

BACKGROUND

Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management.

METHODS

A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI).

RESULTS

A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management.

CONCLUSIONS

This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.

Automated ASPECTS calculation may equal the performance of experienced clinicians: a machine learning study based on a large cohort

OBJECTIVES

The Alberta Stroke Program Early CT Score (ASPECTS) is a semi-quantitative method to evaluate the severity of early ischemic change on non-contrast computed tomography (NCCT) in patients with acute ischemic stroke (AIS). In this work, we propose an automated ASPECTS method based on large cohort of data and machine learning.

METHODS

For this study, we collected 3626 NCCT cases from multiple centers and annotated directly on this dataset by neurologists. Based on image analysis and machine learning methods, we constructed a two-stage machine learning model. The validity and reliability of this automated ASPECTS method were tested on an independent external validation set of 300 cases. Statistical analyses on the total ASPECTS, dichotomized ASPECTS, and region-level ASPECTS were presented.

RESULTS

On an independent external validation set of 300 cases, for the total ASPECTS results, the intraclass correlation coefficient between automated ASPECTS and expert-rated was 0.842. The agreement between ASPECTS threshold of ≥ 6 versus < 6 using a dichotomized method was moderate (κ = 0.438, 0.391-0.477), and the detection rate (sensitivity) was 86.5% for patients with ASPECTS threshold of ≥ 6. Compared with the results of previous studies, our method achieved a slight lead in sensitivity (67.8%) and AUC (0.845), with comparable accuracy (78.9%) and specificity (81.2%).

CONCLUSION

The proposed automated ASPECTS method driven by a large cohort of NCCT images performed equally well compared with expert-rated ASPECTS. This work further demonstrates the validity and reliability of automated ASPECTS evaluation method.

CLINICAL RELEVANCE STATEMENT

The automated ASPECTS method proposed by this study may help AIS patients to receive rapid intervention, but should not be used as a stand-alone diagnostic basis.

KEY POINTS

NCCT-based manual ASPECTS scores were poorly consistent. Machine learning can automate the ASPECTS scoring process. Machine learning model design based on large cohort data can effectively improve the consistency of ASPECTS scores.

Exploring patient perspectives on EQ-5D-5L data visualization within an individualized decision aid for total knee arthroplasty (TKA) in Alberta, Canada

BACKGROUND

Decision aids can help patients set realistic expectations. In this study, we explored alternative presentations to visualise patient-reported outcomes (EQ-5D-5L) data within an online, individualized patient decision aid for total knee arthroplasty (TKA) that, in part, generates individualized comparisons based on age, sex and body mass index, to enhance usability prior to implementation into routine clinical practice.

METHODS

We used data visualization techniques to modify the presentation of EQ-5D-5L outcomes data within the decision aid. The EQ-5D-5L data was divided into two parts allowing patients to compare themselves to similar individuals (1) pre-surgery and (2) 1-year post-surgery. We created 2 versions for each part and sought patient feedback on comprehension, usefulness, and visual appeal. Patients from an urban orthopedic clinic were recruited and their ratings and comments were recorded using a researcher-administered checklist. Data were managed using Microsoft Excel, R version 3.6.1 and ATLAS.ti V8 and analyzed using descriptive statistics and directed content analysis.

RESULTS

A total of 24 and 25 patients participated in Parts 1 and 2, respectively. Overall, there was a slight preference for Version 1 in Part 1 (58.3%) and Version 2 in Part 2 (64%). Most participants demonstrated adequate comprehension for all versions (range 50-72%) and commented that the instructions were clear. While 50-60% of participants rated the content as useful, including knowing the possible outcomes of surgery, some participants found the information interesting only, were unsure how to use the information, or did not find it useful because they had already decided on a treatment. Participants rated visual appeal for all versions favorably but suggested improvements for readability, mainly larger font and image sizes and enhanced contrast between elements.

CONCLUSIONS

Based on the results, we will produce an enhanced presentation of EQ-5D-5L data within the decision aid. These improvements, along with further usability testing of the entire decision aid, will be made before implementation of the decision aid in routine clinical practice. Our results on patients' perspectives on the presentation of EQ-5D-5L data to support decision making for TKA treatments contributes to the knowledge on EQ-5D-5L applications within healthcare systems for clinical care.

Colorectal Cancer Patients' Reported Frequency, Content, and Satisfaction with Advance Care Planning Discussions

(1) Background: This observational cohort study describes the frequency, content, and satisfaction with advance care planning (ACP) conversations with healthcare providers (HCPs), as reported by patients with advanced colorectal cancer. (2) Methods: The patients were recruited from two tertiary cancer centers in Alberta, Canada. Using the My Conversations survey with previously validated questions, the patients were asked about specific ACP elements discussed, with which HCPs these elements were discussed, their satisfaction with these conversations, and whether they had a goals of care designation (GCD) order. We surveyed and analyzed data from the following four time points: enrollment, months 1, 2, and 3. (3) Results: In total, 131 patients were recruited. At enrollment, 24% of patients reported discussing at least one ACP topic. From enrollment to month 3, patients reported a high frequency of discussions (80.2% discussed fears, 71.0% discussed prognosis, 54.2% discussed treatment preferences at least once); however, only 44.3% of patients reported discussing what is important to them in considering health care preferences. Patients reported having ACP conversations most often with their oncologists (84.7%) and cancer clinic nurses (61.8%). Patients reported a high level of satisfaction with their ACP conversations, with over 80% of patients reported feeling heard and understood. From enrollment to month 3, there was an increase in the number of patients with a GCD order from 53% to 74%. (4) Conclusions: Patients reported more frequent conversations compared to the literature and clinical documentation. While the satisfaction with these conversations is high, there is room for quality improvement, particularly in eliciting patients' personal goals for their treatment.

Endovascular thrombectomy plus medical care versus medical care alone for large ischaemic stroke: 1-year outcomes of the SELECT2 trial

BACKGROUND

Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.

METHODS

SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand. Patients aged 18-85 years with ischaemic stroke due to proximal occlusion of the internal carotid artery or of the first segment of the middle cerebral artery, showing large ischaemic core on non-contrast CT (Alberta Stroke Program Early Computed Tomographic Score of 3-5 [range 0-10, with lower values indicating larger infarctions]) or measuring 50 mL or more on CT perfusion and MRI, were randomly assigned, within 24 h of ischaemic stroke onset, to thrombectomy plus medical care or to medical care alone. The primary outcome for this analysis was the ordinal modified Rankin Scale (range 0-6, with higher scores indicating greater disability) at 1-year follow-up in an intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT03876457) and is completed.

FINDINGS

The trial was terminated early for efficacy at the 90-day follow-up after 352 patients had been randomly assigned (178 to thrombectomy and 174 to medical care only) between Oct 11, 2019, and Sept 9, 2022. Thrombectomy significantly improved the 1-year modified Rankin Scale score distribution versus medical care alone (Wilcoxon-Mann-Whitney probability of superiority 0·59 [95% CI 0·53-0·64]; p=0·0019; generalised odds ratio 1·43 [95% CI 1·14-1·78]). At the 1-year follow-up, 77 (45%) of 170 patients receiving thrombectomy had died, compared with 83 (52%) of 159 patients receiving medical care only (1-year mortality relative risk 0·89 [95% CI 0·71-1·11]).

INTERPRETATION

In patients with ischaemic stroke due to a proximal occlusion and large core, thrombectomy plus medical care provided a significant functional outcome benefit compared with medical care alone at 1-year follow-up.

FUNDING

Stryker Neurovascular.

'I do hope more people can benefit from it.': The qualitative experience of individuals living with osteoarthritis who participated in the GLA:D™ program in Alberta, Canada

INTRODUCTION

The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation.

METHODS

Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program.

RESULTS

Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants.

CONCLUSION

The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion.

Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia

BACKGROUND

Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap.

METHODS

We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants.

DISCUSSION

This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.

Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research

BACKGROUND

Screening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings.

OBJECTIVE

To explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR).

METHODS

We conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data.

RESULTS

A total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients' readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors.

CONCLUSION

The CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.

Improving Childhood Vaccination Rates with Process Innovation in Central Zone, Alberta

This project aimed to accurately assess the current state of routine immunization program delivery in a Central Zone community in Alberta and provide actionable recommendations supported by literature review. Engaging with frontline public health nurses responsible for immunization program delivery in the community, contributing factors to low vaccination rates, process inefficiencies and policy gaps were identified. Based on additional literature, strategies to mitigate these gaps with the goal of increasing vaccination rates were proposed and validated. Although in this case, strategies to mitigate process inefficiencies were the most supported given program funding, a multi-pronged approach is still recommended to drive long-term improvements in vaccination rates.

Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada

OBJECTIVE

FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability.

DESIGN

We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model.

SETTING

Individuals living in Alberta, Canada.

PARTICIPANTS

In total, fifteen adults with T2DM and experiences of household food insecurity.

RESULTS

People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy).

CONCLUSION

Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.

Patient compliance with the implementation of a decolonization strategy for Staphylococcus aureus in hip and knee replacements

BACKGROUND

A preoperative, in-community antimicrobial decolonization protocol combining chlorohexidine gluconate (CHG) sponges and mupirocin ointment to reduce surgical site infections amongst hip and knee replacement patients has been adopted in Alberta, Canada. Patient compliance with the protocol is essential for effectiveness. It is, therefore, important to understand patterns, and reasons why, patients do, and do not, comply.

METHODS

A descriptive survey of patients having elective total hip or knee replacement at seven clinics in Alberta was conducted to determine patient compliance and reasons for noncompliance. Descriptive statistics and multivariate logistic regression were computed.

RESULTS

Patient compliance was assessed in 3,427 patients. There were no differences in compliance based on the baseline protocols and enhanced protocols, but there was a difference based on clinic location. The odds of compliance with three CHG sponges were 4.47 times higher in rural versus urban clinics (P < .001). The most common reason for noncompliance for patients instructed to use 3 CHG sponges was "patient forgot".

CONCLUSIONS

Compliance did not change when enhanced protocols were introduced; however, compliance differed by clinic location. Reasons for noncompliance included "sponges not provided", "patient forgot", and "surgery date moved". Results may inform clinics on areas where improvements could be made to increase patient compliance.

Comparative Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke Patients with ASPECTS 2-3 vs. 4-5

BACKGROUND

The influence of Alberta Stroke Program Early CT Score (ASPECTS) on outcomes following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients with low ASPECTS remains unknown. In this study, we compared the outcomes of AIS patients treated with MT for large vessel occlusion (LVO) categorized by ASPECTS value.

METHODS

We conducted a retrospective analysis involving 305 patients with AIS caused by LVO, defined as the occlusion of the internal carotid artery and/or the M1 segments of the middle cerebral artery, stratified into two groups: ASPECTS 2-3 and 4-5. The primary outcome was favorable outcome defined as a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes were 90-day mRS 0-2, 90-day mortality, any intracerebral hemorrhage (ICH), and symptomatic ICH (sICH). We performed multivariable logistic regression analysis to evaluate the impact of ASPECTS 2-3 vs. 4-5 on outcomes.

RESULTS

Fifty-nine patients (19.3%) had ASPECTS 2-3 and 246 (80.7%) had ASPECTS 4-5. Favorable outcomes showed no significant difference between the two groups (adjusted odds ratio [aOR]= 1.13, 95% confidence interval [CI]: 0.52-2.41, p=0.80). There were also no significant differences in 90-day mRS 0-2 (aOR= 1.65, 95% CI: 0.66-3.99, p=0.30), 90-day mortality (aOR= 1.14, 95% CI: 0.58-2.20, p=0.70), any ICH (aOR= 0.54, 95% CI: 0.28-1.00, p=0.06), and sICH (aOR= 0.70, 95% CI: 0.27-1.63, p = 0.40) between the groups.

CONCLUSIONS

AIS patients with LVO undergoing MT with ASPECTS 2-3 had similar outcomes compared to ASPECTS 4-5.

Vegetation type and trail use interact to affect the magnitude and extent of recreational trail impacts on plant communities

Protected areas may prohibit large-scale deforestation and development, but still allow recreation via networks of roads and trails. Managers need to understand how the type of trail usage and the habitat the trail traverses influence the nature and extent of the trail impact. We measured the effect of trails on plant communities in a large, protected area in the southern Rocky Mountains of Alberta, Canada. We surveyed 118 transects adjacent to trails and 24 control transects at least 100 m from trails, recording the presence and abundance of all vascular plant species. We modelled changes in species richness, community composition, and the presence of exotic species as a function of trail type, vegetation type, and the distance from the trail edge. Overall, species richness increased with proximity to trails and community composition shifted significantly, with a greater likelihood of exotic species presence closer to trails. Heightened species richness and greater probability of exotic species presence extended a greater distance from off-highway vehicle trails than from footpaths, but only in shrubland and mixed forest vegetation. In addition, exotic species at higher elevations were most often associated with off-highway vehicle trails. Our study shows that the magnitude and extent of trail impacts on plant communities varies depending on trail type, vegetation type, and sometimes interactions between the two. The high frequency and intensity of off-highway vehicle trail use likely increases both propagule pressure and the severity of disturbance, while vegetation type determines light availability and hence invasibility. Managers can use this information to prioritize trail areas for exotic species monitoring and restrict high-intensity off-highway vehicle trails to less sensitive vegetation types at lower elevations.

The psychometric properties and feasibility of the Alberta infant motor scale used in telehealth: A scoping review

BACKGROUND

Telehealth can be a viable option for improving equitable access to early motor assessment for financially vulnerable individuals.

AIM

This review aimed to identify the psychometric properties of the Alberta Infant Motor Scale (AIMS) when applied via telehealth and assess its feasibility.

METHODS

Papers were systematically retrieved from electronic databases until October 4, 2023. We included studies that assessed the motor development of infants using the AIMS through telehealth.

RESULTS

Thirteen studies, encompassing 897 infants (449 male and 396 female), were included in this review. Among them, 805 were typical infants and 92 were at risk of motor delay. The age range of participants spanned from 4.9 weeks to 20 months. The studies found good concurrent validity between telehealth and in-person assessments (ICC > 0.98, SEM < 1.6, mean difference = 0.5) and good to excellent reliability (ICC > 0.80) using home videos recorded by parents or video calls with researchers. Telehealth was perceived as feasible by parents, who expressed high satisfaction, and the quality of images and assessments met commendable standards.

CONCLUSION

Considering the limited number of studies that have assessed infants with neuromotor disorders, this scale has the potential for telehealth application in evaluating typical infants.

Factors Associated With Attainment of Glycemic Targets Among Adults With Type 1 and Type 2 Diabetes in Canada: A Cross-sectional Study Using Primary and Specialty Care Electronic Medical Record Data

OBJECTIVE

Using a new database combining primary and specialty care electronic medical record (EMR) data in Canada, we determined attainment of glycemic targets and associated predictors among adults with diabetes.

METHODS

We conducted a cross-sectional observational study combining primary and specialty care EMR data in Canada. Adults with diabetes whose primary care provider contributed to the National Diabetes Repository or who were assessed at a diabetes specialty clinic (LMC Diabetes and Endocrinology) between July 3, 2015, and June 30, 2019, were included. Diabetes type was categorized as type 2 diabetes (T2D) not prescribed insulin, T2D prescribed insulin, and type 1 diabetes (T1D). Covariates were age, sex, income quintile, province, rural/urban location, estimated glomerular filtration rate, medications, and insulin pump use. Associations between predictors and the outcome (glycated hemoglobin [A1C] of ≤7.0%) were assessed by multivariable logistic regressions.

RESULTS

Among 122,106 adults, consisting of 91,366 with T2D not prescribed insulin, 25,131 with T2D prescribed insulin, and 5,609 with T1D, attainment of an A1C of ≤7.0% was 60%, 25%, and 23%, respectively. Proportions with an A1C of ≤7.5% and ≤8.0% were 75% and 84% for those with T2D not prescribed insulin, 41% and 57% for those with T2D prescribed insulin, and 37% and 53% for those with T1D. Highest vs lowest income quintile was associated with greater odds of meeting the A1C target (adjusted odds ratio [95% confidence interval] for each diabetes category: 1.15 [1.10 to 1.21], 1.21 [1.10 to 1.33], and 1.29 [1.04 to 1.60], respectively). Individuals in Alberta and Manitoba had less antihyperglycemic medication use and attainment of A1C target than other provinces.

CONCLUSIONS

Attainment of glycemic targets among adults with diabetes was poor and differed by income and geographic location, which must be addressed in national diabetes strategies.

Attitudes of western Canadian dairy farmers toward technology

Dairy farms have become more reliant on technology. The overall aim of this study was to better understand how dairy farmers view technology and its effects on animal care, including their views on the prospect of integrating gene-editing technology in the future. Virtual-semistructured interviews were conducted with dairy farmers (n = 11) from British Columbia and Alberta. To facilitate discussion, the participants were asked to develop and discuss a timeline describing when and why various technologies were adopted on their farm. Although farmers defined technology broadly and affecting multiple aspects of farm management, this paper focuses on their views regarding how technology can affect animal care. Following thematic analysis of the data, the following 3 themes emerged: (1) the changing role of the farmer (including intergenerational considerations and learning new technology), (2) the effect of technology on the cow and her relationship with the farmer and, (3) technology as the future of the farm. The discussions also highlight the concerns that some farmers have regarding challenges associated with reduced human-animal interactions and effective use of the large amounts of data that are collected through technology. We also specifically asked the participants their views about gene editing as a potential future technology. Most of the participants did not specifically address their views on gene editing, but they spoke about the effect on genetic technologies more generally, often making references to genomic testing. However, some questioned how this technology may affect farmers more generally and spoke about how it could affect human-animal relationships. These results illustrate differences among farmers in the way they view technology and how this can affect the dairy cattle they care for.

Social acceptability of psilocybin-assisted therapy for existential distress at the end of life: A population-based survey

BACKGROUND

Internationally, there is a growing interest in the potential benefits of psilocybin-assisted therapy to treat existential distress at the end of life. However, the social acceptability of this therapy is not yet well known.

AIM

This study assesses the social acceptability of the medical use of psilocybin to treat existential distress at the end of life.

DESIGN

An online survey was conducted in Canada between November 23 and December 4, 2022. The questionnaire included items pertaining to perceptions, attitudes and concerns towards psilocybin-assisted therapy to treat existential distress at the end of life.

PARTICIPANTS

The sample (n = 2800) was stratified by province, age and sex. Participants were adults from four provinces of Canada: Québec, Ontario, Alberta and British Columbia.

RESULTS

Overall, 79.3% considered psilocybin-assisted therapy a reasonable medical choice for a patient suffering from existential distress at the end of life, 84.8% agreed that the public health system should cover the costs of the intervention and 63.3% would welcome the legalisation of psilocybin for medical purposes. Previous psilocybin use (p < 0.0001, for all dependent variables), exposure to palliative care (p < 0.05, for all dependent variables) and a progressive political orientation (p < 0.05, for all dependent variables) were associated with more favourable attitudes towards psilocybin-assisted therapy at the end of life.

CONCLUSION

The social acceptability of psilocybin-assisted therapy for existential distress at the end of life is rather high in Canada. These findings may contribute to efforts to mobilise resources and improve access to this emerging therapy in palliative and end of life care settings.

Shortening fire return interval predisposes west-central Canadian boreal peatlands to more rapid vegetation growth and transition to forest cover

Climate change in northern latitudes is increasing the vulnerability of peatlands and the riparian transition zones between peatlands and upland forests (referred to as ecotones) to greater frequency of wildland fires. We examined early post-fire vegetation regeneration following the 2011 Utikuma complex fire (central Alberta, Canada). This study examined 779 peatlands and adjacent ecotones, covering an area of ~182 km2 . Based on the known regional fire history, peatlands that burned in 2011 were stratified into either long return interval (LRI) fire regimes of >80 years (i.e., no recorded prior fire history) or short fire return interval (SRI) of 55 years (i.e., within the boundary of a documented severe fire in 1956). Data from six multitemporal airborne lidar surveys were used to quantify trajectories of vegetation change for 8 years prior to and 8 years following the 2011 fire. To date, no studies have quantified the impacts of post-fire regeneration following short versus long return interval fires across this broad range of peatlands with variable environmental and post-fire successional trajectories. We found that SRI peatlands demonstrated more rapid vascular and shrub growth rates, especially in peatland centers, than LRI peatlands. Bogs and fens burned in 1956, and with little vascular vegetation (classified as "open peatlands") prior to the 2011 fire, experienced the greatest changes. These peatlands tended to transition to vascular/shrub forms following the SRI fire, while open LRI peatlands were not significantly different from pre-fire conditions. The results of this study suggest the emergence of a positive feedback, where areas experiencing SRI fires in southern boreal peatlands are expected to transition to forested vegetation forms. Along fen edges and within bog centers, SRI fires are expected to reduce local peatland groundwater moisture-holding capacity and promote favorable conditions for increased fire frequency and severity in the future.

Changes in Medical Cannabis Use After Recreational Cannabis Legalization in Canada

Background: As part of its recreational cannabis legalization in October 2018, Canada imposed an excise tax of 10% (or $1 a gram, whichever is higher) on both recreational and medical cannabis. There is little evidence to inform the ongoing debate on whether the legalization had adverse impacts on medical cannabis use. Methods: We used an interrupted time series design and data on medical cannabis shipments (i.e., mail-order deliveries of cannabis from a licensed producer to a patient authorized to obtain medical cannabis) in Canada between quarter 1 of 2014 and quarter 1 of 2020. We examined changes in medical cannabis shipments after Canada's recreational cannabis legalization both across Canada and for each province. As this study used publicly available, province-level aggregate data, ethics approval was not required. Results: Recreational cannabis legalization was associated with significant reductions in medical cannabis use in 7 out of 10 Canadian provinces. Compared with the counterfactual estimated from prelegalization trends, the reduction in quarter 1 of 2020 varied from 500 shipments per 100,000 population (95% CI=312-688 shipments per 100,000 population) or 32% (95% CI=22-43%) in Newfoundland and Labrador to 3,778 shipments per 100,000 population (95% CI=2,972-4,585 shipments per 100,000 population) or 74% (95% CI=68-79%) in Alberta. At the national level, the number of medical cannabis shipments decreased by 823 per 100,000 population (95% CI=725-921 shipments per 100,000 population) or 48% (95% CI=45-52%). Conclusions: Recreational cannabis legalization was associated with reductions in medical cannabis use. Our findings call for policy attention to address possible adverse impacts of recreational cannabis legalization on medical cannabis users.

Spatial variation and chemical reactivity of dusts from open-pit bitumen mining using trace elements in snow

The chemical reactivity of trace elements (TEs) in dusts from bitumen mining, upgrading and related industrial activities in the Athabasca Bituminous Sands region (ABS), Alberta, Canada, was evaluated using the acid-soluble fraction of snow. Samples were collected at 14 sites along the Athabasca River (AR) and its tributaries, and at 3 remote locations. Following metal-free, ultra-clean procedures for processing and analysis, samples were leached with nitric acid (pH < 1), filtered (<0.45 μm), and analyzed using ICP-MS. Insoluble particles (>0.45 μm) were examined using SEM-EDS. Along the river, acid-soluble concentrations of TEs varied by 6 orders of magnitude, from 1 mg/L (Al) to less than 1 ng/L (Tl). Conservative (Al, Y, La, Th) and mobile (Li, Be, Cs, Sr) lithophile elements, those enriched in bitumen (V, Ni, Mo), and potentially toxic chalcophile elements (As, Cd, Pb, Sb, Tl) showed considerable spatial variation. Normalizing the concentrations of TEs in samples collected near industry to the corresponding concentrations in snow from the reference site (UTK), resulted in enrichments of V and most of the lithophile elements. Dust reactivity, quantified as the ratio of acid-soluble to total concentrations, was less than 50% suggesting limited bioaccessibility. The large differences in behaviour between Cd and Pb versus Ni and V could be due to the occurrence of the former pair in carbonate or sulfide minerals, versus acid-insoluble petcoke particles for the latter couple. Spatial variations in the reactivity of TEs most likely reflect the range in diversity and chemical stability of dust particles, and variations in their abundance in primary source areas. The leaching conditions employed here are extreme (pH < 1) and intended to identify an upper limit of chemical reactivity, with far less dust dissolution expected when these dusts encounter natural waters of the area which range in pH from 4 to 8.

Personalising haemodialysis treatment with incremental dialysis for incident patients with end-stage kidney disease: an implementation study protocol

INTRODUCTION

Incremental dialysis is a personalised dialysis prescription based on residual kidney function that allows for the initial use of shorter duration, less frequent and less intense dialysis. It has been associated with enhanced quality of life and decreased healthcare costs when compared with conventional dialysis. While nephrologists report prescribing incremental dialysis, few dialysis programmes offer a systematic approach in offering and evaluating its use. To move evidence into practice, and in order to improve the safety and quality of providing incremental dialysis care, we have designed an implementation study. This study aims to evaluate the systematic assessment of patients starting facility-based haemodialysis for eligibility for incremental dialysis, and the prescription and monitoring of incremental dialysis treatment.

METHODS AND ANALYSIS

A hybrid effectiveness and implementation study design is being used to evaluate the implementation of the programme at dialysis sites in Alberta, Canada. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to capture individual-level and organisational-level impact of the project. Clinical outcomes related to kidney function will be monitored on an ongoing basis, and patient-reported outcomes and experience measures will be collected at baseline and then quarterly throughout the first year of dialysis.

ETHICS AND DISSEMINATION

The study was approved by the Health Research Ethics Board of the University of Alberta. The study is funded by the Strategic Clinical Networks of Alberta Health Services. The study will help answer important questions on the effectiveness of incremental dialysis, and inform the acceptability, adoption, feasibility, reach and sustainability of incremental dialysis within provision of haemodialysis care.

Stratigraphic architecture of the Belly River Group (Campanian, Cretaceous) in the plains of southern Alberta: Revisions and updates to an existing model and implications for correlating dinosaur-rich strata

The Upper Cretaceous (Campanian) Belly River Group (BRG) of southern Alberta has a complex internal stratigraphic architecture derived from differential geometries of its component formations that resulted from regionalized tectonic influences and shifting source areas. A full understanding of BRG architecture has been compromised heretofore by a limited understanding of subsurface data in southwestern- and southeastern-most Alberta. In this study outcrop exposures throughout southern Alberta are tied to reference well logs and subsurface cross-sections allowing a more precise understanding of BRG architecture and how it relates to well-known vertebrate fossil producing areas. Modifications to an existing stratigraphic model of the BRG show that the Oldman and the Dinosaur Park formations have reciprocal north-to-south wedge-shaped geometries and a diachronous contact that become prominently expressed south of Twp 12. The updated model also demonstrates that the Oldman Formation thickens stratigraphically up-section to the south, and that the Foremost-Oldman contact is, essentially, a datum across much of southern Alberta. Identification of the Oldman Formation in the subsurface remains based on its relatively high gamma-ray response in mudstone successions, but it is also recognized that many of its sandstones exhibit relatively low gamma-ray responses like those in underlying and overlying formations. Nomenclature and subdivisions of the Oldman Formation are revised to accommodate this updated understanding, and modifications are also made to the definition of the Judith River-Belly River discontinuity, a newly recognized surface that marks the onset of accommodation and eustatic rise in sea-level in the northern Western Interior Basin at ~76.3 Ma.

The (un)caring experienced by racialized and/or ethnoculturally diverse residents in supportive living: a qualitative study

BACKGROUND

Racialized and/or ethnocultural minority older adults in supportive living settings may not have access to appropriate services and activities. Most supportive living facilities are mainstream (not specific to one group); however, culturally specific facilities are purpose-built to accommodate older adults from a particular group. Our objective was to describe the perspectives of diverse participants about access to culturally appropriate care, accessible services, and social and recreation activities in culturally specific and mainstream (non-specific) supportive living facilities.

METHODS

We conducted semi-structured interviews with 21 people (11 staff, 8 family members, 2 residents) from 7 supportive living homes (2 culturally specific and 5 mainstream) in Alberta, Canada. We used a rapid qualitative inquiry approach to structure the data collection and analysis.

RESULTS

Staff and family members described challenges in accessing culturally appropriate care in mainstream facilities. Family members expressed guilt and shame when their relative moved to supportive living, and they specifically described long waitlists for beds in culturally specific homes. Once in the facility, language barriers contributed to quality of care issues (e.g., delayed assessments) and challenges accessing recreation and social activities in both mainstream and culturally specific homes. Mainstream facilities often did not have appropriate food options and had limited supports for religious practices. Residents who had better English language proficiency had an easier transition to supportive living.

CONCLUSIONS

Racialized and/or ethnoculturally diverse residents in mainstream supportive living facilities did not receive culturally appropriate care. Creating standalone facilities for every cultural group is not feasible; therefore, we must improve the care in mainstream facilities, including recruiting more diverse staff and integrating a wider range of recreation and religious services and food options.

Real-World Treatment Patterns, Clinical Outcomes, and Healthcare Resource Utilization in Early-Stage Non-Small-Cell Lung Cancer

The prognosis of early non-small-cell lung cancer (eNSCLC) remains poor. An understanding of current therapies and outcomes can provide insights into how novel therapies can be integrated into clinics. We conducted a large, retrospective, population-based cohort study of patients with de novo eNSCLC (stages IB, IIA, IIB, and IIIA) diagnosed in Alberta, Canada, between 2010 and 2019. The primary objectives were to describe treatment patterns and survival outcomes among patients with eNSCLC. A total of 5126 patients with eNSCLC were included. A total of 45.3% of patients were referred to a medical oncologist, ranging from 23.7% in stage IB to 58.3% in IIIA. A total of 23.6% of patients initiated systemic therapy (ST), ranging from 3.5% in stage IB to 38.5% in IIIA. For stage IIB and IIIA individuals who received surgery, adjuvant ST was associated with a decreased likelihood of death (hazard ratios (HR) of 0.77 (95% CI: 0.56-1.07) and 0.69 (95% CI: 0.54-0.89), respectively). In a Canadian real-world setting, stage IIB and IIIA patients who received adjuvant ST tended to have better survival than patients who did not, but future studies that provide adjustment of additional confounders are warranted. Examining referral pathways that account for disparities based on age, sex, and comorbidities in the real world would also provide further insights.

A new species of Versteria (Cestoda: Taeniidae) parasitizing Neogale vison and Lontra canadensis (Carnivora: Mustelidae) from Western Canada

Via molecular and morphological analyses, we describe adult specimens of a new species of Versteria (Cestoda: Taeniidae) infecting mink and river otter (Carnivora: Mustelidae) in Western Canada, as well as larval forms from muskrat and mink. These sequences closely matched those reported from adult specimens from Colorado and Oregon, as well as larval infections in humans and a captive orangutan. We describe here a new species from British Columbia and Alberta (Canada), Versteria rafei n. sp., based upon morphological diagnostic characteristics and genetic distance and phylogeny. Versteria rafei n. sp. differs from the three other described species of the genus in the smaller scolex and cirrus sac. It also differs from V. mustelae (Eurasia) and V. cuja (South America) by having an armed cirrus, which is covered in hair-like bristles, and in the shape of its hooks, with a long thorn-like blade, and short or long handle (vs. a short sharply curved blade and no difference in handle size in previously described species). The poorly known V. brachyacantha (Central Africa) also has an armed cirrus and similarly shaped hooks. However, it differs from the new species in the number and size of hooks. Phylogenetic analysis of the cox1 and nad1 mitochondrial regions showed that our specimens clustered with isolates from undescribed adults and larval infections in North America, and separate from V. cuja, confirming them to be a distinct species from the American Clade.