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- ItemOpen AccessDiagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study)(BMC, 2025-05-01) Shankar, Jai; Alcock, Susan; Leeies, Murdoch; Ayroso, Marco; Unrau, Sarah; Park, JaeYeon; Blackwood, Benjamin ; Trivedi, Reva; Marin, Roman; Raja, Muhammed; Sinha, Namita; Trivedi, Anurag; Essig, Marco; Martin, Douglas; Grierson, Robert; Zeiler, Frederick A.Abstract Background Severe traumatic brain injury (TBI) stands as the leading cause of post-injury hospitalization, disability, and mortality globally. Imaging serves as a cornerstone in the assessment of patients with severe TBI and CT Perfusion (CTP) has emerged as an early prognostic tool. Our study aims to validate CTP features of non-survivable brain injury, upon hospital admission to characterize in-hospital mortality, through a well-powered prospective cohort study. Methods In a prospective cohort study, adult patients with severe TBI were recruited to undergo whole head CTP at the time of their first imaging. Interpretation of the CTP images were conducted by two independent neuroradiologists (JS and ME), blinded to clinical results and each other’s assessment. Non-survivable brain injury was defined as a matched decrease of cerebral blood flow (CBF) and cerebral blood volume (CBV) in the brainstem. The results of CTP were not disclosed to the clinical team providing patient care, and the patients received standard institutional management. The primary outcome was a binary outcome of in-hospital mortality. The primary validity analysis involved calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for features of non-survivable brain injury on admission CTP compared to in-hospital mortality, along with 95% confidence intervals. Results Out of the 201 patients initially enrolled in the study, 195 patients (mean age 42.9 years; Male- 160, 82%) were included in the final analysis. Among the participants, a total of 55 patients (28.2%) died during their hospital stay. The odds ratio (OR) was highest for the presence of intracranial hemorrhage (ICH) (OR-20.25; 95% CI- 7.08–71.80, p < 0.001) and gun shot wound (GSW) (OR-22.67; 95% CI- 3.66–257.5, p = 0.003), which were independently associated with in-hospital mortality. With every decade of age, there was 1.77 times of (95% CI- 1.37–2.36, p < 0.001) higher odds of in-hospital mortality. Of the 55 patients with in-hospital mortality, 17 (31%) met the criteria of non-survival brain injury on the CTP at the time of hospital admission. Both CTP and CT-angiogram (CTA)A had 100% specificity and PPV. The highest sensitivity of 33% and NPV of 80% was seen with non-survivable criteria of CTP. As a result, this variable exhibited the highest accuracy of 82% with an area under the curve (AUC) of 0.67. The inter-rater reliability for CTP ranged from poor (kappa = 0.07) to fair (kappa = 0.44), indicating variability in agreement between raters. In contrast, the inter-rater reliability for CTA scales ranged from fair (kappa = 0.39) to substantial (kappa = 0.79), suggesting more consistent agreement among raters. CTP was found to be safe as no patients experience any complications associated with CTP. Conclusion CTP features of non-survivable brain injury showed very high specificity and positive predictive value for diagnosing in-hospital mortality in patients with severe TBI.
- ItemOpen AccessFunctional work disability from the perspectives of persons with systemic lupus erythematosus: a qualitative thematic analysis(BMC, 2025-05-26) Nowrouzi-Kia, Behdin; Howe, Aaron S.; Li, Anson; Tan, Jeremy; Saade-Cleves, Natalia; Jules, Kevon; Sadek, Malak; Bani-Fatemi, Ali; Avina-Zubieta, Antonio; Fox, Mary T.; Shaw, William; Haaland, Derek; Pope, Janet; Fortin, Paul R.; Bingham, Kathleen S.; Peschken, Christine; Reynolds, Jennifer; Ivory, Catherine; Gladman, Dafna D.; Urowitz, Murray B.; Sanchez-Guerrero, Jorge; Lim, Lily S. H.; Keeling, Stephanie; Katz, Patti; Kavkan, Mahta; Bonilla, Dennisse; Nielsen, Wils; Touma, ZahiAbstract Background Systemic lupus erythematosus (SLE) disease symptoms that can significantly restrict work ability and work participation resulting in reduced mental well-being. This study investigates the significant impact of work participation and disability on the mental wellbeing, health-related quality of life, and disease-related outcomes in individuals with SLE. Methods With the objective of creating an SLE-related functional profile rooted in work disability (WD) prevention, 46 SLE patients were purposively recruited from Canadian medical centres. Through semi-structured interviews guided by a WD prevention framework, factors associated with WD and lived experiences of SLE-related WD were qualitatively explored. Braun and Clarke’s six-stage inductive thematic analysis was used to organize the data. Results Most participants experienced some form of work disability across their employment history related to their clinical manifestations of SLE, including hospitalizations, physical limitations, fatigue, and neurocognitive symptoms (e.g. brain fog). Thematic analysis revealed three key themes: (a) the influence of illness experience on work, (b) the stigmatization of illness disclosure, and (c) the availability of workplace resources/accommodations. Participants emphasized the desirability of work with reduced physical and mental demands, increased personal control, and workplace flexibility to prevent WD. Conclusion The study underscores the need for a collaborative, multi-component, and multidisciplinary intervention targeting psychosocial and workplace factors to establish a goal-oriented preventative framework, potentially improving WD outcomes in SLE individuals.
- ItemOpen AccessContextual factors related to aging determine force-based manipulation dosage: a prospective cross-sectional study(BMC, 2025-05-21) Maiers, Michele J.; Sundin, Alexander R.; Oster, Ryan J.; Kreul, Steven; Malone, Quinn; Passmore, Steven R.Abstract Background Contextual factors influence clinicians’ delivery of force-based manipulation (FBM), like spinal manipulative therapy (SMT). It is particularly important to discern how contextual factors interact with therapeutic forces delivered to an older adult population, to minimize risk and identify ideal dosage. This study aimed to determine whether contextual factors pertaining to aging result in the modulation of kinetic and kinematic parameters used by experienced clinicians when delivering SMT. Methods Participants were randomly presented with a series of 12 AI-generated patient vignettes, featuring both visual and auditory content and representing varying age-related contextual factors. Factors included chronological (35-, 65- and 85-year-old), pathological (“healthy” vs degenerative spine), and felt (perceived as “young” vs. “old”) age. Participants delivered SMT to a human analogue manikin based on each vignette, presented six times in randomized order. Kinetic and kinematic parameters were collected and analyzed for differences between “young” and “old” contextual factors of age, using a 3-way repeated measures ANOVA model. Results Sixteen licensed chiropractors (8 female, 8 male) participated, with an average age of 45.4 (SD = 9.7, range 34–64) years and 18.3 (SD = 10.8, range 5–39) years of experience. A main effect in peak force was found for both chronological (F(2,30) = 26.18; p <.001, ηp2 = 0.636) and pathological age (F(1,15) = 11.58; p =.004, ηp2 = 0.436), following a stepwise progression of decreased force with increased age and with pathology. No statistically significant differences were found in peak force based on felt age, or in time to peak force for any factor. A main effect was found for chronological age with peak acceleration (F(2,20) = 9.50; p <.001, ηp2 = 0.487) and peak velocity (F(2,20) = 7.20; p =.004, ηp2 = 0.419), but not for pathological or felt age. There was a significant difference in time to peak velocity for felt age (F(1,10) = 12.23; p =.006, ηp2 = 0.550), with a shorter time to peak velocity in response to vignettes with older felt age. Conclusion Contextual factors of aging modulated certain kinetic and kinematic characteristics when delivering SMT. This provides evidence that practitioners differentially discern aspects of aging to inform how they deliver FBM dosage. Future research is needed to identify ideal kinetic and kinematic characteristics based on considerations of aging.
- ItemOpen AccessRural community-based participatory research with families of people who use drugs: key considerations from a multi-provincial research partnership(BMC, 2025-05-30) Mathias, Holly; Duff, Elsie; Schulz, Petra; Auger, Sarah; Gravel-Ouellette, Antoinette; Lockhart, Teresa; McCorriston, Willi; McCrindle, Jenn; Mirza, Nyal; Pijl, Em; Savard, Tyla; Hyshka, ElaineAbstract Background North America continues to contend with an unregulated drug crisis that is impacting communities of all sizes. Community-based participatory research that meaningfully engages people who use drugs, families, and their wider communities is one way of advancing social justice and improving population health. As more community-academic partnerships are formed in this space, some organizations have launched guidelines and considerations for engaging in community-based participatory research (CBPR). However, to our knowledge, none provide guidance for engaging in CBPR with people who use drugs and their families in rural settings. Main body This paper presents insights gained from our experiences collaborating to conduct CBPR with families providing unpaid support for people who use drugs in rural Canada. Key considerations are thematically organized in four sections: Dreaming (Building the team and setting a vision), Designing (Key definitions, budget and ethical consideration), Doing (Bringing research to life), and Disseminating (Moving research into action). Conclusions By building on existing principles and guidelines for working with PWUD and their families, these considerations will be a valuable resource for other partnerships seeking to engage in community-based participatory substance use research in rural settings.
- ItemOpen AccessIdentifying promising or priority effective adolescent, sexual and reproductive health interventions in Ghana: what frameworks should guide the selection of interventions?(BMC, 2025-05-31) Achala, Daniel M.; Fenny, Ama P.; Atim, Chris; Ataguba, John Ele-OjoAbstract Background Adolescent sexual and reproductive health (ASRH) is an integral part of the global health agenda. It is strongly featured in the universal health coverage (UHC) agenda of the sustainable development goals (SDGs). The need to expand ASRH services to accelerate progress on UHC is urgent in Africa, compared to other regions, given its youthful population and unmet ASRH needs. Limited access to ASRH services increases the risk and vulnerability of adolescents to poor health outcomes such as unintended pregnancies, high adolescent birth rate, poor birth outcomes, high maternal and neonatal mortalities and high exposure to sexually transmitted infections. The unavailability and inaccessibility of ASRH interventions to adolescents and young adults in most African countries, including Ghana, arise from several limitations, including inadequate funding of interventions, cultural barriers and norms, lack of education, and inadequate supplies of ASRH services and commodities, among others. However, gains from investments in ASRH interventions, especially following the implementation of the Millennium Development Goals, highlight the importance of identifying and prioritising adequate funding for effective ASRH interventions. This paper identifies priority ASRH interventions that can potentially advance the sexual and reproductive health (SRH) needs of adolescents in Ghana to accelerate progress towards UHC. Methods Qualitative descriptive methods, combining literature review and stakeholder engagement, were used for this study. A literature review complemented by stakeholder engagement ensured the listing, ranking and validation of interventions. Results Adapting an established framework designed by the West African Health Organization (WAHO) through stakeholders’ engagement process, the paper identifies four of seven priority interventions ranked and validated by stakeholders for addressing the SRH needs of adolescents in Ghana. Consistent with the literature, several interventions exist to address ASRH needs. The most effective priority or promising four interventions in Ghana, according to stakeholders, include adolescent health clubs programmes, girls’ empowerment programmes through comprehensive sexuality education, national capacity-building programmes to deliver high-quality integrated family planning and comprehensive maternal health services, and electronic health (eHealth)/digital health programmes. Conclusion Identifying effective priority interventions for addressing the SRH needs of adolescents is a consultative process facilitated by proven and valid frameworks adapted to align with specific country contexts.