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Cement-stabilized marine clay under thermal cycling: strength, suction, and microstructure
(2026-06-01) Liu, Zhe; Fall, Mamadou
Abstract This study investigates the influence of realistic summer daily thermal cycles on the mechanical, hydraulic, and microstructural properties of cement-stabilized sensitive marine clay (SMC), a problematic marine soil widely found in Eastern Canada. SMC samples treated with 5% and 20% cement were subjected to two curing regimes: constant temperature (20 °C) and simulated daily thermal cycles, and tested after 1, 3, 7, and 28 days of curing. Unconfined compressive strength (UCS) and secant modulus tests were performed to assess mechanical performance, while matric suction monitoring, thermogravimetric analysis (TG/DTG), and mercury intrusion porosimetry (MIP) were used to evaluate hydration behavior and microstructural evolution. Results show that daily thermal cycles significantly accelerate strength and stiffness development at early curing stages by enhancing cement hydration, leading to finer pore structures and higher matric suction due to rapid self-desiccation. However, a “crossover effect” was observed in TG/DTG results, where prolonged thermal cycling reduced hydration product formation at later stages. MIP results, in contrast, showed continued microstructural densification, likely due to a dilution effect associated with high water-to-cement ratios. These findings provide practical insights for optimizing curing strategies and binder dosages in road and infrastructure projects involving sensitive marine clays under fluctuating thermal conditions.
Lessons learned from longitudinal biomonitoring and birth cohort studies: informing the future of reproductive health research in Canada
(2026-05-29) Ashley-Martin, Jillian; Fisher, Mandy; Khoury, Cheryl; Sathiyamoorthy, Aranee; Borghese, Michael M.; England-Mason, Gillian; Pollock, Tyler; Arbuckle, Tye E.; A. Wise, Lauren; Braun, Joseph M.; Metcalfe, Amy; Buckley, Jessie P.; Palmert, Mark R.; Ricci, Christina; Phipps, Erica; Banerjee, Gopal; Fuller, Erin; Booij, Linda; Hopperton, Kathyrn; Weiler, Hope; MacFarlane, Amanda J.; Bertinato, Jesse; Rawn, Dorothea F. K.; Lavigne, Eric; Timmermann, Amalie; Oken, Emily; Wolfson, Christina; Brandlistuen, Ragnhild E.; Shutt, Robin
Abstract Longitudinal biomonitoring studies during preconception, pregnancy and early childhood are highly valuable tools for assessing environmental chemical exposures during sensitive windows and their effects on health and development. For the past 15 years, the Maternal-Infant Research on Environmental Chemicals (MIREC) Research Platform has been Canada’s flagship study of the long-term effects of early life exposure to environmental chemicals. In light of the evolving scientific and legislative landscapes and need to address emerging research questions, MIREC Platform researchers at Health Canada consulted with scientific investigators of other cohort studies to inform the development of a future preconception or pregnancy longitudinal biomonitoring study. This effort included 1) hybrid consultation meetings on Dec 6, 2024 (Toronto, ON) and Jan 21, 2025 (Ottawa, ON) and 2) a virtual seminar series from October 2024 to June 2025 hosted by the Health Canada MIREC team. Our objective here is to share lessons learned from this consultation. We report on key lessons learned related to the themes of: 1) participant engagement, recruitment and retention, 2) validity and causal inference, and 3) study longevity. While the ultimate goal of this consultation was to inform future longitudinal biomonitoring studies in Canada, the content is largely generalizable and relevant to others planning, modifying, or evaluating observational research in reproductive and environmental epidemiology.
Timing of suicide attempts by children and adolescents admitted to an inpatient psychiatry unit: a retrospective study
(2026-03-10) Boafo, Addo; Cantin, Christina; Kashala-Abotnes, Esperance; Alamri, Asma; Tariq, Khadeeja; Bukhari, Bayan; Slodovnick, Paul; Tavakoli, Paniz; Al Bagshi, Doaa; De Koninck, Joseph; Tsampalieros, Anne
Abstract Background Suicide is a leading cause of death in adolescents in Canada and has been documented to occur mainly during evening hours. It is suspected to be due to the accumulation of waking hours combined with sleep disturbances causing poor decision making. Identifying modifiable factors associated with suicide risk remains an important part of suicide prevention. Aims To examine the timing of suicide attempts in adolescents admitted to a pediatric hospital following a suicide attempt and known to present sleep disturbances, to further strengthen the relationship between sleep disturbance and suicidality and its chronobiological manifestation. Method Descriptive retrospective study of patients < 18 years (N = 128) admitted to a tertiary care hospital for a suicide attempt between January 1, 2022, to June 30, 2023. Results As expected, a higher percentage of attempts occurred between 18:00–23:59, as compared to other time periods (p < 0.001), with peak days Sunday and Monday, for the 18:00–23:59 group. Time of day was not found to differ by gender (p = 0.45) nor was weekday/weekend (p = 0.48). The most common method of attempt was ingestion. Limitations Small sample limited to hospitalized patients and retrospective design. Conclusion The observation that this group of suicidal adolescents is known to present sleep disruptions offers an additional prevention opportunity. Knowledge of the presence of sleep disturbances and the peak time of suicide attempts could help in suicide prevention efforts. Future exploration of the evening phenomenological experience of this population to develop interventions for parents, community resources, pharmacies, and schools to further detect risk factors in adolescent suicidality.
Immersive learning in quality improvement: evaluating a virtual reality escape room for medical learners and faculty
(2026-04-18) Weagle, Rachael; Venables, Maddie J.; Jolin-Dahel, Kheira
Abstract Background Didactic approaches to quality improvement (QI) are often perceived as insufficiently engaging, which may limit learner motivation and application of QI concepts. We developed a virtual reality (VR) escape room to reinforce core QI principles and conducted a Phase 1 evaluation focused on feasibility, usability, and perceived educational utility among medical learners and faculty. Methods We designed a 60-90-minute multi-puzzle VR escape room aligning with QI principles (terminology, SMART aims, root cause analysis, change ideas, Plan-Do-Study-Act cycles, run charts). Twenty-seven participants (undergraduate medical students, residents, faculty) formed teams of three to four. We collected post-session surveys (Likert, yes/no, free-text) and concurrent “think-aloud” observations during gameplay to characterize usability and perceived educational utility. Survey data were collected using a standardized questionnaire administered either electronically or verbally with items read verbatim and responses recorded without prompting. Free-test survey responses and think-aloud field notes were analyzed using a consistent inductive, theme-based approach, and closed-ended survey items were summarized descriptively. This evaluation was intended to inform iterative refinement of the intervention. Results Overall enjoyment was high (mean 3.9/5). Twenty-three of 27 participants (85%) reported that the VR escape room was perceived as helpful in reinforcing previously taught QI concepts. Analysis of survey free-text responses identified three themes: strengths of the experience (teamwork, engagement, collaborative problem solving), usability challenges (motion sickness, session length), and design preferences (variation in puzzle clarity and perceived linkage to QI concepts). Think-aloud findings similarly highlighted immersion, discussion, and collaboration as positive features, while hardware constraints and physical discomfort limited usability for some participants. Participant feedback informed iterative refinements related to puzzle design, facilitation, and technical setup. Conclusion This Phase 1 pilot demonstrated that a VR escape room is a feasible and acceptable adjunct to existing QI teaching, providing learners with an immersive opportunity to apply previously introduced concepts. The main contribution of this study is feasibility and usability evidence, as well as implementation considerations (space, staffing, tolerability, and technical setup) to support educators considering immersive QI reinforcement activities. As objective knowledge outcomes were not assessed, future work will evaluate educational effectiveness using pre/post testing and comparative non-VR conditions following further refinement and curricular integration.
Objective and perceived neighbourhood walkability: population-average associations with transportation and recreational physical activity in urban-dwelling Canadian adults
(2026-04-17) Frehlich, Levi; Lang, Justin J.; Prince, Stephanie A.; McCormack, Gavin R.
Abstract Background The extent to which objective and perceived neighbourhood walkability together shape physical activity is not well understood. Using data from a national sample of urban-dwelling adults in Canada, our study examined whether perceived walkability moderated associations between objective walkability and physical activity undertaken for transportation (TPA) and recreation (RPA). Methods National data from 3,995 adults (Canadian Health Measures Survey; 2016-2019) including self-reported sociodemographic characteristics, perceived walkability, and TPA and RPA were linked to objective walkability scores from the 2016 Canadian Active Living Environments (Can-ALE) dataset. Pooled and sex-stratified covariate-adjusted Hurdle models estimated associations between objective and perceived walkability (main and interaction effects), used to determine population-average weekly minutes of TPA and RPA. Results Objective walkability was positively associated with TPA in the pooled (β = 9.39; 95% CI: 0.61 to 11.18) and sex-stratified samples (male β = 7.75; 95% CI: 5.42 to 10.08 and female β = 11.60; 95% CI: 8.88 to 14.31). Perceived walkability was positively associated with TPA in the pooled (β = 5.53; 95% CI:1.55 to 9.51) and male-only sample (β = 6.00; 95% CI: 0.31 to 11.68). Among males, perceived walkability was also associated with RPA (β = 8.13; 95% CI: 0.61 to 15.66). For males, the objective-by-perceived walkability interaction had a synergistic effect on TPA but an antagonistic effect on RPA. No interactions were observed among females. Conclusions Objective and perceived walkability were positively associated with TPA. Perceived walkability was also linked to RPA among males. Their combined influence enhanced TPA but reduced RPA in males, suggesting physical and perceptual aspects of the neighbourhood built environment may interact differently across physical activity domains and sex.
Strengthening health literacy among urban marginalised populations through a tailored primary care model: a mixed-methods study
(2026-04-18) McLellan, Andrew; Kabir, Monisha; Lacombe, Corina; Khorsand, Soha; Geller, Carol; Bair, Lissa; Eyre, Alison
Abstract Background Urban marginalised populations face intersecting barriers, such as poverty, unstable housing and discrimination, that erode health literacy in primary-care contexts. We examined whether an inter-professional, low-barrier primary care model improves health literacy competencies compared with usual care. Methods A convergent mixed-methods study took place at Centretown Community Health Centre (CCHC), Ottawa (2019–2023). Phase 1 compared Health Literacy Questionnaire (HLQ) scores between clients receiving tailored care (n = 37) and matched community members using usual services (n = 36). Phase 2 explored experiences through four focus groups and semi-structured interviews (n = 23). Independent samples t-tests and inductive thematic analysis were used. Results Overall health literacy was moderate in both groups; however, the tailored-care group scored higher on appraisal of health information (M = 3.03 ± 0.57 vs. 2.76 ± 0.46, p = 0.025, d = 0.53). Qualitatively, tailored-care participants described clearer chronic-disease self-management, strategic navigation of appointments, and fewer inappropriate emergency department visits. Persistently low social support scores highlighted systemic isolation. Conclusions Embedding social supports, outreach, and client-centred education within primary care can strengthen critical appraisal skills in marginalised settings. Scaling such models should pair literacy interventions with broader community-support strategies. Trial registration Not applicable (observational study).
Conversation cards for pregnancy: a protocol for a multi-method study
(2026-04-10) Alberga, Angela S.; Forouhar, Vida; Lurye, Valentina; Adamo, Kristi B.; Avery, Susan; Ball, Geoff D. C.; Farnesi, Biagina-Carla; Gaudet, Laura; Nagpal, Taniya S.; Piccinini-Vallis, Helena; Ramos Salas, Ximena; Rhodes, Ryan E.; Vallis, Michael; Cook, Jocelynn; Graham, Taryn M.; Stanworth-Belleville, Karah; Cohen, Tamara R.
Abstract Background Conversations regarding health behaviours, mental health, and socioeconomic contexts are recommended during prenatal visits to optimize maternal and fetal health outcomes. This study was designed to develop and evaluate the acceptability of a clinical dialogue tool called Conversation Cards for Pregnancy (PregnancyCards for short). PregnancyCards are being designed as a practical, person-centered clinical dialogue tool to empower pregnant individuals to talk with their prenatal care providers about potentially sensitive topics regarding health behaviours that are important to them during their prenatal visits. Methods This two-step, 3-year, multi-method study, guided by the Obesity-Related Behavioural Interventions Trial (ORBIT) model, is grounded in the Capability, Opportunity, and Motivation (COM-B) framework for understanding behaviour. Pregnant individuals and prenatal care providers will be recruited by our partners from across Canada, in clinical and community settings. Step 1: Identify topics of interest related to health behaviours by conducting virtual semi-structured interviews with pregnant individuals (n ~ 20) and prenatal health care providers (n ~ 10–15) and by analyzing data using thematic analysis. Step 2: Topics generated in Step 1 will be used to create a prototype deck of PregnancyCards that will be evaluated in clinical settings with pregnant individuals (n ~ 40) to assess acceptability, appropriateness, and feasibility, and qualitative experiences of using the cards. Prenatal care providers (n ~ 15) will be recruited at one time point to capture their perceptions of usability, acceptability and likability of the prototype cards as well. Results Currently, a total of 21 pregnant individuals and 14 prenatal care providers have already participated in Step 1 of this study. All participants (pregnant individuals and prenatal care providers) engaged in semi-structured interviews to determine the topics of interest related to health behaviours. Thematic analysis of interview data has been completed and the results informed the development of a prototype deck of PregnancyCards, which will be tested in Step 2. Discussion We seek to gain a better understanding of pregnant individuals’ perceived needs for conversations related to health behaviours and provide insight into the acceptability, appropriateness, and feasibility of PregnancyCards in clinical settings. PregnancyCards has the potential to serve as a practical clinical dialogue tool to help empower pregnant individuals and optimize discussions about health behaviours that matter to them during pregnancy. The two studies outlined in this protocol paper will inform future research to test the efficacy and effectiveness of PregnancyCards as a behavioural intervention aimed at improving health behaviours in pregnancy.
Reviewing ecosystems of evidence: synthesising the evidence on the commercial determinants of health from a complex systems perspective
(2026-05-22) Tompson, Alice; Thomas, James; Rutter, Harry; Blanchard, Laurence; Cott, Éadaoin; Glover, Rebecca E.; Knai, Cecile; Maani, Nason; van Schalkwyk, May C.; Welch, Vivian; Petticrew, Mark
Abstract The Commercial Determinants of Health (CDoH) are the systems, practices, and pathways through which commercial actors drive health and equity. This includes their influence on systems of evidence production and dissemination (evidence ecosystems) in order to protect and promote commercial interests. In the Commercial Determinants of Health and Evidence Synthesis (CODES) methodological guidance, we provided advice for conducing CDoH relevant evidence syntheses, from developing a protocol to reporting the review and planning an update. This follow-up paper considers reasons and practical implications for integrating a complex systems perspective in such reviews. This commentary describes how a complex systems perspective can benefit research, including evidence synthesis related to the CDoH, by embracing the complexity of the real world, understanding interventions in context, rendering visible the corporate playbook, and exposing the power dynamics that drive inequity. We then reflect on the practical implications of adopting a complex systems approach in CDoH evidence synthesis, including drawing on a systems lens and/or incorporating specific systems methods in the review. This commentary complements existing CODES guidance in highlighting considerations for conducting CDoH relevant evidence synthesis from a complex systems perspective. It can help interpreting such reviews and raise awareness of how commercial actors can shape evidence ecosystems, particularly evidence synthesis. Having a robust evidence base that considers systems elements and dynamics will support effective action to address the CDoH, improve public health and reduce inequity at scale.
AI Methods for Implementation Science (AIM-IS): developing a framework, toolkit, and reporting standard for the responsible use of AI in implementation practice and research
(2026-04-14) Fontaine, Guillaume; Michie, Susan; Beidas, Rinad S.; Geng, Elvin; Fahim, Christine; Powell, Byron J.; Welch, Vivian; Thomas, James; Chan, Jeffery; Abbasgholizadeh-Rahimi, Samira; Légaré, France; Hastings, Janna; Lambert, Sylvie D.; Presseau, Justin; Straus, Sharon E.; An, Ruopeng; Saran, Ashrita; Taylor, Natalie
Abstract Background Artificial intelligence (AI), including machine learning, natural language processing, and large language models, may support implementation practice and research in tasks such as evidence synthesis, determinant assessment, strategy selection, monitoring, adaptation, and theory development. However, these applications of AI do not form a single, uniform category. They span a continuum from practice-facing applications that support local implementation work to research- and methods-facing applications that support evidence generation and synthesis. The guidance on how to classify, evaluate, and report these uses of AI remains limited. The AI Methods for Implementation Science (AIM-IS) program aims to develop, validate, and maintain a suite of products to guide the responsible use of AI across implementation practice, implementation research, and bridging use cases. Methods AIM-IS is a multi-phase, multi-method methodological development program. The unit of analysis is the AI-for-implementation use case: a specific AI capability supporting a defined implementation practice or research task within a workflow, decision point, and governance context. Phase 1 is a living scoping review mapping published AI use cases in implementation science, including how they are evaluated and what risks they raise. Phase 2 is a qualitative interview study with implementation researchers, practitioners, AI experts, community members, and data infrastructure and governance experts to refine use cases and identify feasibility constraints, outcome priorities, and reporting needs. Phase 3 will integrate findings from Phases 1 and 2 to develop the draft AIM-IS products, including a framework, a taxonomy of use cases, guardrails for responsible use, a practical guide, outcome domains, and reporting items. Phase 4 will use an eDelphi process and consensus meeting to refine and finalize these products. Phase 5 will conduct usability testing to improve clarity and ease of use, resulting in the finalized AIM-IS products. AIM-IS is informed by implementation science, sociotechnical systems, equity, and responsible AI frameworks, and includes a living-update approach to support ongoing refinement. Discussion The AIM-IS program will deliver a suite of products, including a framework, toolkit and reporting standard, to support the specification, governance, evaluation, and reporting of AI in implementation science. Together, these products aim to strengthen transparency, comparability, accountability, and attention to equity in how AI is used by implementation practitioners and researchers over time. Registration Open Science Framework, March 15, 2026: https://doi.org/10.17605/OSF.IO/BX35K
Single dose IV ketamine for adolescent suicidal ideation in the emergency department: a pilot randomized trial
(2026-04-06) Schlegelmilch, Michael; Plint, Amy C.; Barrowman, Nicholas; Gray, Clare; Crawford, Tyrus; Kutcher, Stephen A.; Bhatt, Maala
Abstract Background Suicidal ideation (SI) is a common reason for emergency department (ED) visits by adolescents. While intravenous (IV) ketamine rapidly reduces SI in adults, its efficacy in adolescents remains unstudied. We assessed the feasibility of a trial of a single dose IV ketamine to reduce adolescent SI in the ED. Methods This double-blind, randomized, placebo-controlled pilot trial was conducted from Jan-May 2024. Medically stable adolescents aged 12 to 17 years with moderate-to-severe SI were eligible. Participants were randomized to IV ketamine (0.5 mg/kg; max 50 mg) or IV normal saline (0.5 ml/kg; max 50 mL), infused over 40 min. They were monitored for 120 min and then received usual ED mental health care. The primary outcome was trial feasibility (enrolment and follow-up success). The primary clinical outcome was SI severity at 40 min post-infusion (T-40), measured using the Beck Scale for SI (SSI5), Montgomery-Asberg Depression Rating Scale item 10 (MADRS10) and Beck Depression Inventory item 9 (BDI9). Additional outcomes included hospital admission, adverse events, 30-day ED revisits and death. Results Twenty participants were eligible and were enrolled. All participants completed the infusion and day-1 follow-up; 90% completed day-7 follow-up. No serious adverse events occurred. While SI severity did not differ significantly between groups at T-40 (SSI5: p = 0.06; MADRS10: p = 0.19; BDI9: p = 0.18), fewer participants randomized to ketamine were hospitalized at the initial visit (risk difference 40%, 95%CI: 7, 69%). Conclusions Recruiting adolescents to an ED-based IV ketamine study for SI is feasible. A larger trial is needed to clarify potential clinical benefits. Trial registration ClinicalTrials.gov ID NCT06366334 (Registered 20240412).
From chaos to clarity: schema-constrained AI for auditable biomedical evidence extraction from full-text PDFs
(2026-04-14) Mortezaagha, Pouria; Shaw, Joseph; Sun, Bowen; Rahgozar, Arya
Abstract Background Biomedical evidence synthesis depends on accurate extraction of methodological, laboratory, and outcome variables from full-text research articles. These variables are predominantly embedded in complex scientific PDFs that interleave multi-column text, tables, figures, and captions, making manual abstraction time-intensive, error-prone, and increasingly impractical at the scale of contemporary systematic reviews. Despite advances in layout-aware and multimodal document models, end-to-end extraction systems suitable for evidence synthesis remain constrained by limited throughput, OCR error propagation, and insufficient auditability. Methods We propose a schema-constrained AI extraction system that transforms full-text biomedical PDFs into structured, analysis-ready records by explicitly restricting model inference through typed schemas, controlled vocabularies, and evidence-gated decisions. Documents are ingested using resume-aware hashing, partitioned into page-level and caption-aware chunks, and processed asynchronously under explicit concurrency and rate-limiting controls. A high-accuracy OCR model is guided by multiple domain-specific schemas covering bibliographic metadata, study design, populations, laboratory assays, timing and thresholds, clinical outcomes, and diagnostic performance. Chunk-level outputs are deterministically merged into study-level records using controlled vocabularies, conflict-aware handling of scalar fields, set-based aggregation of list-valued fields, and sentence-level evidence capture to enable traceability and post-hoc audit. Results Applied to a corpus of 734 biomedical articles on direct oral anticoagulant (DOAC) level measurement, the pipeline processed all documents without manual intervention while maintaining stable throughput. Schema-constrained extraction exhibited strong internal consistency, with sentence-level provenance populated for nearly all supported decisions. Iterative schema and prompt refinement yielded substantial improvements in extraction fidelity, particularly for outcome definitions, assay classification, and global coagulation testing. Outputs included reproducible CSV/Parquet datasets and caption-aware multimodal markdown reconstructions supporting efficient expert review. Conclusions Schema-constrained AI extraction enables scalable and auditable extraction of structured evidence from heterogeneous scientific PDFs. By combining deterministic chunking, asynchronous orchestration, controlled vocabularies, sentence-level provenance, and aggregated analytical outputs, the proposed pipeline aligns modern document understanding capabilities with the transparency, reproducibility, and reliability demands of biomedical evidence synthesis.
Effectiveness of inpatient geriatric rehabilitation in those with cognitive impairment: a secondary analysis of meta-analysis data
(2026-04-15) Wong, Eric K. C.; Hoang, Peter M.; Kouri, Andrew; Gill, Sandeep; Huang, Yu Q.; Lee, Janice C.; Weiss, Sophie M.; Daniel, Raymond; McGowan, Jessie; Amog, Krystle; Sale, Joanna E. M.; Isaranuwatchai, Wanrudee; Naimark, David M. J.; Tricco, Andrea C.; Watt, Jennifer A.; Straus, Sharon E.
Abstract Background Geriatric rehabilitation reduces mortality and long-term care home (LTCH) admission. However, cognitive impairment is often perceived to be a barrier for successful rehabilitation. Our objective was to determine the impact of cognitive impairment on rehabilitation outcomes using a systematic review of inpatient geriatric rehabilitation. Methods We conducted a secondary analysis of a recent systematic review and meta-analysis of geriatric rehabilitation in the inpatient settings. We screened 29 randomized controlled trials (RCTs) included in the original systematic review for those that reported rehabilitation outcomes (e.g. mortality, LTCH admission) by cognitive status (high vs. low cognition as defined by score cutoff or dementia diagnosis). Results were analyzed by (i) a meta-analysis of outcomes in those with cognitive impairment and (ii) pooling the within study interaction by cognitive status. Results Of 29 RCTs, 8 RCTs (1134 patients) reported outcomes by cognitive status. For the subgroup of patients with cognitive impairment, the risk ratio (RR) of mortality at the longest follow up was 0.75 (95% confidence interval [CI] 0.39 to 1.45, I2 = 61.0%) and the RR of LTCH admission was 0.89 (95% CI 0.62 to 1.28, I2 = 0). There was no interaction between baseline cognitive status and mortality (pooled interaction of difference in logRR − 0.12, 95% CI -0.72 to 0.48) or LTCH admission (pooled interaction 0.17, 95% CI -0.34 to 0.68). Conclusions There is no interaction between baseline cognitive status and the outcomes in this systematic review, suggesting that baseline cognitive impairment does not alter the mortality and institutionalization benefits of geriatric rehabilitation. Review registration PROSPERO: CRD42022345078.
Real-World Safety and Effectiveness of 24-Hour Foslevodopa/Foscarbidopa in Parkinson's Disease: ROSSINI Study 6-Month Interim Results
(2026-05-07) Jost, Wolfgang H.; Bergquist, Filip; Evans, Andrew; Hassin-Baer, Sharon; Hauser, Robert A.; Henriksen, Tove; Malaty, Irene A.; Mestre, Tiago A.; Mir, Pablo; Rodriguez, Ramon; Schwingenschuh, Petra; Simu, Mihaela; Bergmann, Lars; Zhou, Teresa T.; Caughlin, Sarah; Gopalkrishnan, Mallika; Kukreja, Pavnit; O’Meara, Marie; Parra, Juan C.; Shah, Megha B.; Aldred, Jason
Abstract Introduction Foslevodopa/foscarbidopa (LDp/CDp) is a nonsurgical 24-h continuous subcutaneous infusion for patients with advanced Parkinson’s disease (aPD) and motor fluctuations uncontrolled on oral medications. We present the first multicountry real-world data from routine clinical practice. Methods ROSSINI (NCT06107426) is an ongoing 3-year multicountry, prospective, observational study of adults with aPD who are LDp/CDp-naïve (cohort A) or transitioning from LDp/CDp open-label extension studies (NCT04379050/NCT04750226, cohort B). For this interim analysis, the primary endpoint was change from baseline to 6 months in OFF time [Movement Disorder Society Unified Parkinson’s Disease Rating Scale Part IV (MDS-UPDRS-IV) modified item 4.3]. Safety was assessed by monitoring adverse events (AEs). Interim results for 105 cohort A patients enrolled ≥ 6 months by March 24, 2025 are presented only; cohort B results were limited (n = 5). Mixed-effects models for repeated measurements (continuous outcomes) were utilized, adjusted for country. Results Cohort A patients had a mean (SD) age of 68.5 (9.5) years, PD duration of 12.1 (5.3) years, and least squares mean (SE) OFF time of 5.2 (0.6) h at baseline. Patients on LDp/CDp showed statistically significant reductions (95% CI) in OFF time [(− 2.8 h (− 3.6, − 1.9), P ≤ .001, n = 47/40 at baseline/month 6], dyskinesia time [− 1.8 h (− 2.6, − 0.9), P ≤ 0.001], MDS-UPDRS-III [− 5.0 (− 8.2, − 1.9), P = 0.002], Parkinson’s Disease Sleep Scale-2 [− 5.2 (− 8.0, − 2.4), P ≤ .001], and 39-item Parkinson’s Disease Questionnaire [PDQ-39, − 5.6 (− 9.2, − 2.0), P = .002] from baseline to month 6. Freezing of Gait Questionnaire, Gastrointestinal Dysfunction Scale in PD, and King’s PD Pain Scale likewise showed statistically significant decreases (P < .05). Overall, 58 (55.2%) reported ≥ 1 AE, primarily nonserious and mild-to-moderate (12.4% serious, 17.1% severe), with hallucinations and infusion site events the most frequently reported events (5.7% each). Conclusions ROSSINI demonstrates reductions in motor fluctuations and nonmotor symptoms, and increased quality of life in patients with aPD after 6 months of LDp/CDp treatment. The safety profile was consistent with clinical trials. Trial registration ClinicalTrials.gov identifier, NCT06107426.
Association between neurofilament light chain concentrations and outcomes in patients with moderate to severe traumatic brain injury: a systematic review and meta-analysis
(2026-05-04) Bouras, Marwan; Pageau, Mathieu; Gagnon, Marc-Aurèle; Costerousse, Olivier; Demers, Karolane; Grenier-Gagnon, Anouk; Isaac, Chartelin J.; Torkomyan, Tomas H.; Lauzier, François; Zarychanski, Ryan; Francoeur, Charles L.; Gerges, Peter; Abiala, Godwill; Moore, Lynne; Englis, Shane W.; Turgeon, Alexis F.
Abstract Background Moderate to severe traumatic brain injury (TBI) is associated with high rates of mortality and long-term disability. Accurate biomarkers are needed to predict longterm neurological outcomes and guide decision-making early after TBI. Neurofilament light chain (NfL), a structural protein of neurons, has emerged as a promising candidate, but its association with outcomes in this population remains uncertain. Methods We conducted a systematic review and meta-analysis to assess the association between blood or cerebrospinal fluid NfL concentrations and outcomes in adults with moderate to severe TBI. We searched MEDLINE, Embase, Cochrane CENTRAL and Web of Science from inception to October 2025. Eligible studies included cohort studies or randomized controlled trials reporting NfL levels measured during the acute phase and reporting at least one outcome of interest. Our primary outcome was long-term neurological function, defined as the latest available Glasgow Outcome Scale (GOS) or Glasgow Outcome Scale–Extended (GOS-E) score, dichotomized into unfavorable (GOS ≤ 3 or GOS-E ≤ 4) and favorable (GOS > 3 or GOS-E > 4). Mortality, at any time point, was a secondary outcome. Risk of bias was assessed using an adapted scale from the QUADAS-2 tool, and certainty of evidence was evaluated using GRADE criteria. Results Fourteen studies (2,905 participants) were included, with ten (n = 1,648) contributing to the meta-analysis for our primary outcome. Higher NfL concentrations were associated with unfavorable neurological outcomes, with moderately higher levels in patients with poor outcomes compared with those with favorable outcomes (SMD 0.45, 95% CI 0.33–0.56; I² = 12%). Six studies (n = 483) assessed mortality; higher NfL concentrations were associated with increased mortality (SMD 0.71, 95% CI 0.04–1.39; I² = 82%), with a more consistent association when NfL was measured within 24 h after injury (I² = 0%). The certainty of evidence was graded as very low for both outcomes, reflecting risk of bias and, for mortality, additional inconsistency and imprecision. Conclusions Higher NfL concentrations were associated with unfavorable neurological outcomes after moderate-to-severe TBI. The association with mortality was more uncertain and should be interpreted with caution given the substantial heterogeneity across studies. Its incremental prognostic value beyond known predictors remains uncertain. Trial registration PROSPERO CRD42022332110, 22 May 2022.
Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review
(2026-03-26) Binda, Catherine; Livergant, Rachel; Tersago, Jamie; Jami, Zainab; Chen, Le Q.; Birch, Leah; Blackman, Chloe; Chin, Esther; Wild, Hannah; Joos, Emilie; Joharifard, Shahrzad
Abstract Background Task shifting and task sharing (TS/S) redistribute responsibilities across cadres to expand access to healthcare, particularly in underserved areas. TS/S addresses workforce shortages and improves the availability of essential surgical procedures. The scope and geographical distribution of surgical TS/S programs are well documented, less is known about how TS/S initiatives are monitored and evaluated, especially with respect to trainee, program, and health systems outcomes. This review describes existing approaches to evaluation within surgical TS/S initiatives. Methods We searched nine electronic databases (MEDLINE [Ovid], Embase [Ovid], CINAHL [EBSCO], Scopus, CABI Digital Library, Clarivate Web of Science, Evidence Aid, Global Index Medicus, and Eldis) on 31 January 2024 and 12 March 2025, using MeSH terms and keywords related to “Task Sharing” AND “Surgery”. All patient populations, practice settings, surgical skills, and study designs were eligible. No language or time restrictions were utilized. Publications that did not describe the evaluation of surgical skills, or that focused on skills within a practitioner’s typical scope of practice, were excluded. Two reviewers independently screened and extracted data. Risk of bias was assessed with MINORS. Findings were synthesized using inductive content analysis. Results were tabulated and presented graphically. Results Of 2483 identified records, 1609 unique publications were screened, 452 underwent full-text review, and 228 were included in the review. Most studies reported surgical TS/S in low-income countries (41.7%, 95/228). Obstetric and gynaecological procedures were most commonly taught (61.4%, 140/228). In total, 1753 examples of evaluation metrics were extracted from the 228 included publications. The evaluation metrics were sorted into three themes, including metrics that evaluated TS/S providers (72.6%, 1272/1753), training programs (7.5%, 132/1753), and systems (19.9%, 349/1753). Conclusion This scoping review comprehensively describes existing evaluation strategies. While evaluation of surgical TS/S initiatives remains heterogeneous, limiting the generalizability of any single approach, we successfully grouped monitoring and evaluation metrics into three key domains: provider, program, and health systems. Future work should focus on proposing a comprehensive but adaptable monitoring and evaluation framework that can be used by surgical TS/S programs across the globe.
Development of an infant and early childhood mental health service at a tertiary care pediatric hospital: a needs assessment, community case study and logic model creation
(2026-03-26) M Matheson, Katherine; de Schaetzen, Constance; Sheridan, Nicole; Holahan, Anne-Lise; Vloet, Melissa; Gray, Sarah; Carstens, Jenny; Postl, Lara; Deren, Barbara; Pajer, Kathleen
Abstract Introduction Early attachment relationships and positive childhood experiences are foundational to lifelong mental health, yet specialized services for children under six remain critically scarce. This study sought to characterize the service gap in infant and early childhood mental health (IECMH) in Eastern Ontario, Canada, as a first step in developing a logic model to inform creation of a program to support this population. Methods We completed a regional estimation model of IECMH concerns, conducted a semi-structured focus group with community mental health agencies, and administered a survey to pediatric physicians at a regional children’s hospital. Findings from the aforementioned evaluations informed the development of a logic model for a new, responsive, tertiary-level IECMH service. Results Disruptive behaviours emerged as the most frequently encountered IECMH concern, and respondents identified multiple systemic barriers to accessing care, including insufficient specialist services, prolonged wait times, limited inter-agency collaboration, and a lack of provider awareness and resources. These findings underscored the urgent need to use the logic model to develop a dedicated IECMH clinic, tailored to the unique needs of this vulnerable population. Discussion While developed within a Canadian regional context, this framework may serve as a flexible template for other jurisdictions seeking to establish or strengthen tertiary-level IECMH services. Adaptation to local service structures, workforce capacity, and population needs will be essential to ensure feasibility and sustainability. Future evaluation will be necessary to assess implementation outcomes, service utilization, and impact on child and family trajectories.
Optimizing future Telehealth mental health programs: a secondary analysis of a prospective cohort study to identify key predictors of intervention response in the Telehealth intervention program for older adults (TIP-OA)
(2026-03-31) Rigas, Christina; Lavin, Paola; Su, Chien-Lin; Hassan, Mahdi; Cinalioglu, Karin; Vacaflor, Blanca; Dikaios, Elena; Goodman, Allana; Ibrahim, Marim; Gruber, Johanna; Se, Jade; Sasi, Neeti; Nazar, Rim; Bodenstein, Katie; Elbaz, Sasha; Fajzel, Hannah; Berkani, Sonia; Hanganu, Cezara; Noble, Helen; Looper, Karl; Bouchard, Stephane; Seitz, Dallas; Kumar, Sanjeev; Beauchet, Olivier; Launay, Cyrille; McDonald, Emily; Khoury, Bassam; Ryder, Andrew; Battistini, Bruno; Fallavollita, Pascal; Vahia, Ipsit; Sekhon, Harmehr; Bukhari, Syeda; Rej, Soham
Abstract Background The Telehealth Intervention Program for Older Adults (TIP-OA) was a volunteer-based phone support program for to older adults during the COVID-19 pandemic. While volunteer-based phone programs can be effective in providing mental health support, there is limited data on the predictors of response to such interventions. This study aimed to examine clinical and demographic predictors of response to the TIP-OA intervention among older adults. Methods This secondary analysis of a prospective cohort study included 82 TIP-OA users who expressed interest in the program’s research component, met inclusion criteria, and provided informed consent. Participants completed both baseline and 8-week assessments or had 4-week data carried forward using the last observation carried forward (LOCF) method. The intervention consisted of weekly supportive phone calls over eight weeks. Baseline mental health risk level was assessed by clinicians during intake and categorized as low, medium, or high based on symptom severity within specific symptom categories. Associations between baseline risk level and changes in stress (primary outcome), depression, and anxiety (secondary outcomes) were examined. The primary outcome was measured by the Perceived Stress Scale (PSS; scores ranging from 0 (never) to 4 (very often)). Secondary outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9; scores ranging from 0 (not at all) to 3 (nearly every day)), and the Generalized Anxiety Disorder-7 scale (GAD-7; scores can range from 0 (not at all sure) to 3 (nearly every day)). Results At 8 -week follow-up assessment, participants with higher baseline risk levels showed greater reductions in stress (mean difference in Perceived Stress Scale reduction by 2.13, (F(1,77) = 2.82, p = 0.09, 95% CI [−0.46, 5.56]) and depression (t(73) = −1.92, p = 0.059; Std. beta = −0.43, 95% CI [−0.87, 0.02]). Additionally, not identifying as a visible minority predicted lower stress scores, while male gender and a university education level were associated with greater reductions in depression scores. Conclusion TIP-OA participants with higher baseline mental health risk appeared to benefit more in terms of reductions in stress and depression. Non-minority status, male gender, and university education were also associated with better post-intervention outcomes in depression. Future studies should explore predictors of response in similar intervention programs through larger confirmatory studies. Trial registration Registered on clinicaltrials.gov (clinical trial no.: #NCT04523610) on 16/07/2020.
Defining and measuring implementation climate: a scoping review and concept analysis
(2026-03-19) Elakpa, Daniel N.; Thomas, Aliki; Lambert, Sylvie; Fontaine, Guillaume
Abstract Background Implementation climate is a key organizational determinant of whether evidence-based interventions (EBIs) are adopted, delivered with fidelity, and sustained in healthcare. Despite its importance, the concept is inconsistently defined, often conflated with culture or readiness, and assessed with measures of unclear scope. We aimed to clarify how implementation climate is defined and used in healthcare, identify its defining attributes, antecedents, and consequences, delineate boundaries with related constructs, and synthesize quantitative and qualitative approaches to measurement. Methods We combined a Joanna Briggs Institute (JBI) scoping review with Walker and Avant’s eight-step concept analysis method. CINAHL, Embase, MEDLINE, and PsycINFO were searched in November 2024, supplemented by citation tracking and grey literature searching. Empirical and theoretical articles that defined, discussed or measured implementation climate in healthcare were eligible. Data were charted in Excel and synthesised inductively to derive definitions, attributes, antecedents, consequences, conceptual boundaries, and measurement indicators; attributes were mapped to the Consolidated Framework for Implementation Research (CFIR). Results We included 39 sources (24 quantitative, 7 qualitative, 5 theoretical/review, 3 mixed-methods). We propose a synthesized definition: implementation climate is the shared perception among staff that using a specific EBI is an organizational priority, actively supported through resources and HR processes, reinforced by incentives or recognition, and aligned with everyday values and workflows. Seven recurring attributes emerged: clear expectations for EBI use; tangible organizational support (e.g., protected time, training, leadership); incentives and recognition; compatibility with workflow and values; high relative priority; tension for change; and HR practices that select and socialize staff for EBI openness. Transformational leadership and deliberate resource allocation surfaced as dominant antecedents. Stronger implementation climates were associated with improved implementation outcomes (e.g., reach and fidelity) and workforce outcomes (e.g., retention, lower burnout). Measurement options include the Implementation Climate Scale (ICS), the briefer Implementation Climate Measure (ICM), the Equity-Oriented Implementation Climate tool, and qualitative assessments. Conclusion Implementation climate is a modifiable, measurable organizational lever for strengthening quality improvement and implementation efforts. Leaders can strengthen it by clarifying expectations, protecting time and training, aligning incentives, and ensuring workflow fit. Researchers should refine and adapt measures across contexts and test objective indicators alongside staff perceptions.
Frailty and long-term mortality in cardiogenic shock: a binational multicentre cohort study
(2026-03-25) Ling, Ryan R.; Lim, Shir L.; Kaye, David M.; Lim, Oliver; Low, Christopher J. W.; MacLaren, Graeme; McIsaac, Daniel I.; Shekar, Kiran; Ueno, Ryo; Pilcher, David; Ramanathan, Kollengode; Subramaniam, Ashwin
Abstract Background Frailty is increasingly recognised as a prognostic marker in cardiovascular disease, but its role in cardiogenic shock is less defined. Methods In this retrospective cohort study across 188 intensive care units (ICUs), we analysed data from the Australia and New Zealand Intensive Care Society Adult Patient Database on adults (≥ 16 years) with admitted with cardiogenic shock between 2017–2023, and a documented Clinical Frailty Scale (CFS). The primary outcome was death at up to four years using an adjusted Cox proportional hazards model, which we also assessed using a time-varying model. We conducted subgroup analyses based on age, sex, aetiology of cardiogenic shock, and a landmark survival analysis at ICU discharge. Results We included 71,359 patients (median age 68.6 years, 70.0% males); 11,087 had frailty. Frailty was associated with a higher hazard of death (adjusted Hazard ratio [aHR]: 2.27, 95% confidence interval [CI]: 2.05–2.51) in a non-linear incremental fashion; this was consistent across sensitivity analyses. Time-varying analysis found that frailty demonstrated the highest hazard for death at approximately six months post-ICU admission (HR: 3.71, 95%-CI: 3.29–4.18). Frailty was more strongly associated with death in patients with ischaemic than non-ischaemic cardiogenic shock, and in males more than females. Frailty was also associated with death in a landmark survival analysis at ICU discharge (aHR: 3.13, 95%-CI: 2.82–3.48). Conclusions Frailty is associated with mortality beyond ICU discharge in cardiogenic shock in a non-linear, stepwise fashion. These findings support the integration of frailty assessment into ICU risk stratification and post-discharge care planning.
Baseline disease duration of chronic spontaneous urticaria participants in phase III clinical trials
(2026-03-25) Gupta, Sana; Rao, Vinesh; Xiong, Grace; Abu-Hilal, Mohannad
Abstract Chronic spontaneous urticaria often follows a prolonged and variable course, yet baseline disease duration is inconsistently reported in clinical trials, limiting interpretation of treatment outcomes. Accordingly, this systematic review aimed to evaluate baseline disease duration and reporting practices in phase-III trials for chronic spontaneous urticaria. Of 36 trials identified, only 16 (44.4%) reported baseline disease duration (mean: 5.30 ± 1.81 years). Differences in average disease duration were observed by publication date and intervention of interest. Definitions of disease duration were frequently unspecified, and no trials examined efficacy stratified by disease duration. This review ultimately highlights a gap in disease duration reporting, underscoring the need for standardization and transparency in clinical trial design.

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