University of Manitoba Scholarship

Permanent URI for this collectionhttp://hdl.handle.net/1993/2964

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This collection contains open access research publications authored or co-authored by University of Manitoba researchers. Content within this collection includes pre and post-print versions of articles and book chapters, conference proceedings and technical reports. MSpace is where faculty and students can deposit their research output to meet the open access requirements of grant funding agencies and other related mandates. Deposit is subject to copyright compliance, distribution license and other license restrictions that may be imposed on the work.

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Access status: Open Access ,
Short-term caloric restriction partially reprograms immune and microbial networks during acute DSS-induced colitis
(BMC, 2026-02-27) Hechter, Drake T. D.; Kisselev, Ilya; McNicol, Ian J.; Good, Sara Victoria
Background and aims: The effects of caloric restriction (CR) during active colitis remain incompletely understood. We examined whether short-term CR, initiated during dextran sodium sulfate (DSS)-induced inflammation, modulates disease severity, host transcriptional responses, and gut microbiota composition. Cross-species transcriptomic analyses were used to contextualize these effects within established human ulcerative colitis (UC) signatures. Methods: Male C57BL/6 mice were assigned to control, CR, DSS, or DSS with concurrent CR (DSS.CR) groups. Clinical disease activity, histopathology, hematology, anxiety-like behavior, colon and spleen transcriptomes (RNA-seq), and fecal microbiota (16S rRNA) were assessed. Public UC microarray datasets were used to compare DSS and DSS.CR transcriptional profiles with human active and inactive UC. Results: Compared with DSS, DSS.CR mice showed modest but consistent improvements in stool consistency and bleeding, with limited effects on overall histopathological scores, and reduced splenic enlargement and disruption. Transcriptomic analysis revealed limited differential gene expression between DSS and DSS.CR, but gene set enrichment analysis indicated reduced activation of inflammatory pathways (e.g., NF-κB, IL-17, cytokine–cytokine receptor) and relative enhancement of epithelial renewal and proteostasis programs. CR also partially mitigated DSS-associated dysbiosis, modestly preserving microbial diversity and functional pathways linked to carbohydrate metabolism and detoxification. Human microarray meta-analyses confirmed that DSS recapitulates active UC signatures, while CR shifted these toward a remission-like profile. Conclusions: Short-term CR during acute DSS-induced colitis partially attenuated mucosal and systemic inflammation and modestly shifted transcriptional and microbial profiles toward epithelial repair and metabolic resilience. These findings highlight CR’s potential as a non-pharmacological adjunct for modulating intestinal inflammation and support further translational evaluation of feasible dietary restriction strategies in IBD.
Access status: Open Access ,
Enacting compassionate care at the end-of-life in long-term care: a qualitative interpretive study
(BMC, 2026-03-04) Lucchese, Stephanie; Magcalas, Julia; Sussman, Tamara; Hunter, Paulette V.; Wickson-Griffiths, Abigail; Thompson, Genevieve; Venturato, Lorraine; Rivas, Vanessa M.; Kaasalainen, Sharon
Background: Approximately one-quarter of the Canadian population will die in long-term care (LTC) homes, highlighting the importance of improving end-of-life (EOL) care in these settings. There is a growing recognition of the need to integrate palliative approach to care in these settings. Central to this approach is compassionate care, which supports the emotional, psychological, and spiritual needs of residents and their families at EOL. Compassion is fundamental to person-centered care and plays a critical role in shaping how staff and families experience dying, death and bereavement. Compassion in LTC settings fosters connection, meaning and dignity at the EOL. This study explored the perceptions of nurses and bereaved family members regarding their experiences with EOL and bereavement practices, and how enacting compassionate care supported residents dying in LTC homes across Canada. Methods: This qualitative study was conducted across four LTC homes in Ontario, Manitoba, Saskatchewan, and Alberta. Using an interpretive qualitative design, we conducted semi-structured interviews with LTC nurses and bereaved family caregivers to examine how compassionate care is practiced in LTC settings. The analysis focused on how acts of compassion support both staff and family caregivers during the EOL process and contribute to the experience of a “good death” for residents. Results: A total of 26 family members and 13 LTC staff were interviewed. Three major themes emerged: (1) nurturing compassionate care within relationships, (2) integrating family as a team member to promote compassionate care, and (3) sustaining compassionate care practices in LTC. Several subthemes further elaborated on these core findings. Conclusion: Compassionate care is an essential and highly valued component of EOL care in LTC settings. Findings highlight the importance of supporting compassionate care as an integral part of a palliative approach to care, emphasizing the need for system wide initiatives to sustain and enhance such practices in LTC settings. Clinical trial: Not applicable.
Access status: Open Access ,
Parent coaching program for children with emerging developmental disabilities while on a waitlist for services: cost analysis from a family payer perspective
(BMC, 2026-03-07) Jia, Xiao Y.; Moretti, Myla E.; Ungar, Wendy J.; Wittmeier, Kristy; Filliter, Jillian H.; O’Donnell, Maureen; Khan, Faizan; Smith, Tamlyn; Zwicker, Jennifer; Majnemer, Annette
Background: Pre-school children with or at risk of developmental disabilities have diverse care needs in this critical period for neurodevelopment. Complexities in service delivery, wait times, and variable access can leave parents uncertain about how best to seek assistance for their children’s arising functional vulnerabilities. Despite higher costs, parents may resort to alternative private options to alleviate wait times for child development services. This study compared the services accessed and associated out-of-pocket (OOP) costs incurred by families in four Canadian provinces who engaged in a parent coaching intervention aimed at empowering parents in managing their child’s chronic disabilities with those who received usual care. Methods: The cost analysis was conducted alongside the BRIGHT Coaching randomized controlled trial in Quebec, British Columbia, Nova Scotia, and Manitoba. Families were randomized by a 1:1 allocation of intervention to control and clustered by provinces. Both groups could access health, education and community services. Parent-reported service utilization and costs were collected with the Resource Use Questionnaire at baseline, 8 months (post-coaching program), and 12 months (follow-up). From a family payer perspective, services were costed, encompassing OOP costs for parents and their children. Results: No statistically significant differences were observed in the median OOP costs per family between the control and intervention groups. Quebec had the highest mean OOP costs per child, while British Columbia had the highest for parents. The two-part model estimated the mean OOP costs per family over 12 months to be $2103.14 (95% CI: 1418.79, 2787.50), with the intervention group having, on average, $679.61 (p-value > 0.05, 95% CI: -479.00, 1838.22) higher costs than the control group; province, household income and parent education level were significant covariates. Conclusions: The results suggest that families of children with emerging developmental disabilities incur considerable OOP expenses. The findings highlight these families’ complex needs and financial challenges and may help inform policy decisions on improving support for this population. Trial registration: ClinicalTrial.gov NCT03880383 https//clinicaltrials.gov/study/NCT03880383. Registration Date 2019-03-19.
Access status: Open Access ,
Maternal and child healthcare coverage and trends: refugee vs. non-refugee districts in Uganda
(BMC, 2026-03-11) Nsubuga, Rogers; Kananura, Rornald M.; Wasswa, Ronald; Birabwa, Catherine; Ogwal, Jimmy; Dotse-Gborgbortsi, Winfred; Mwinnyaa, George; Abajobir, Amanuel; Kisozi, Julius; Nyandwi, Alypio; Boerma, Ties; Waiswa, Peter; Nilsen, Kristine
Background: Uganda hosts the largest refugee population in Africa, which exerts much pressure on the district health systems. While refugee-hosting districts (RH) receive targeted investments, the extent to which these influence maternal and child health (MCH) service coverage remains unclear. Using routine facility data, we examined differences in MCH coverage and trends between RH and non-refugee-hosting (non-RH) districts and also explored the effects of government health financing and health system performance on MCH coverage. Methods: We conducted a retrospective analysis utilizing routine health facility MCH data from the Uganda District Health Information System and district-level government Primary Healthcare (PHC) expenditure data from 2020 to 2023. MCH indicators were ANC1st trimester, ANC4, Institutional deliveries, mothers’ Post-natal care (PNC), Measles1 and DPT3 vaccination. We computed a composite coverage index (CCI), health systems performance z-score and compared trends across RH and non-RH districts. Mixed Effects Models assessed the association between government expenditure, RH-status, health system performance over the years. Results: RH districts consistently had modestly higher coverage of ANC1st trimester, ANC4, Institutional deliveries, PNC, Measles vaccination and CCI trends. Government expenditure was significantly higher in RH districts and refugee-dominant (RD) districts (p < 0.001 vs. p = 0.007). Refugee-dominant districts had higher but non-significant MCH coverage. Unadjusted models of MCH indicators and CCI were positively influenced by government financing and health systems performance z-score except for DPT3 and Measles, respectively. Adjusted models revealed that ANC4 coverage was 7.4% points higher in RH districts (7.42; 95% CI:0.753, 14.090; p = 0.029) and increased by 3.6% points for every unit increase in z-score (3.60; 95% CI: 0.729, 6.462; p = 0.014). CCI increased by 1.6% points and 2.3% points for every unit increased in the government expenditure and z-score respectively (1.55; 95% CI: 0.310, 2.788; p = 0.014) vs. (2.31; 95% CI: 0.642, 3.975; p = 0.007). Conclusion: Novel approach - leveraging routine facility data, revealed MCH coverage was modestly consistently higher in RH districts over the years and RH status influenced ANC4 coverage. Overall district-CCI depended on Government investment and health systems performance implying increase in PHC financing could be a key driver to universal district-level improvement.
Access status: Open Access ,
Barriers and facilitators to data-informed care planning in long-term care in Nova Scotia, Canada: a qualitative study
(BMC, 2026-03-05) Nasiri, Nazanin; Kalu, Michael; Veras, Mirella; Ghanouni, Parisa; Hirdes, John P.; Iaboni, Andrea; Iduye, Steve; Moody, Elaine; Norman, Kathleen; Searle, Sam; Theou, Olga; Turcotte, Luke A.; Verlinden, Linda; Weeks, Lori; McArthur, Caitlin
Background: Long-term care (LTC) homes in Canada provide essential care for individuals requiring ongoing support. While data-informed care planning is increasingly advocated for, its implementation remains inconsistent, limiting its potential to enhance resident-centered care. The interRAI long-term care facilities assessment (LTCF) and real-time location systems (RTLS) are two sources of routinely collected data that can inform care planning. However, how they are currently used to inform care planning and what hinders or supports their use remains unclear. We describe the current use of routinely collected data in LTC and identify barriers and facilitators to informing care planning from the perspectives of staff, residents, and family caregivers in Nova Scotia, Canada. Methods: We employed Sally Thorne’s Interpretive Description qualitative design with purposeful sampling: 10 LTC residents, 14 family members, and 22 staff (12 nurses, 2 nursing assistants, 2 physiotherapy/occupational therapy assistants, plus one administrator, one recreational/music therapist, and one dietitian). Data collection occurred in two stages: initial interviews (individual or focus group) followed by care observations, with additional interviews as needed after observation. Each session, lasting for one hour, was audio recorded, transcribe verbatim for analysis. Data were analyzed using thematic analysis by multiple coders. Results: Findings revealed that while interRAI LTCF and RTLS data were available, their integration into care planning was inconsistent due to outdated admission records, data interpretation challenges, communication gaps, and staff shortages. Residents and families often lacked awareness of care plans, limiting their engagement in decision-making. However, facilitators such as incorporating residents’ social histories, leveraging RTLS to track activity patterns, ensuring regular data updates, and fostering interdisciplinary collaboration improved data utilization. Enhanced training, structured implementation strategies, and tailored communication methods were identified as essential to strengthening data-informed care planning. Conclusions: Although routinely collected data have the potential to enhance resident-centered care planning, systemic barriers hinder their effective use in LTC settings. Addressing these challenges through targeted interventions, improved staff training, and knowledge user engagement can optimize data-driven decision-making and improve resident outcomes. Future efforts should focus on integrating digital health tools and structured implementation frameworks to maximize the benefits of data-informed care planning in LTC homes. Clinical Trial Number: Not applicable.
Access status: Open Access ,
Using web-based CBT-I to improve sleep to prevent depression and anxiety in adolescents at high risk: a randomized controlled trial protocol
(BMC, 2026-02-26) Spiropoulos, Athina; Vincent, Norah; Tomfohr-Madsen, Lianne; Brost, Angelica; Schmidtler, Hayley; MacKinnon, Anna L.; Kopala-Sibley, Daniel C.
Background: Among adolescents, internalizing disorders are a leading cause of the global burden of disability and death due to suicide. There is a critical need to prevent first-lifetime onsets of internalizing disorders, particularly among high-risk adolescents. Insomnia and poor sleep have been robustly linked to internalizing disorders in adolescents. The present trial will examine if brief, web-based Cognitive Behavioral Therapy for Insomnia (CBT-I) reduces insomnia symptoms, improves sleep quality, and improves subthreshold internalizing symptoms in never-clinically depressed or anxious adolescents with sleep problems (insomnia severity scores indicating subthreshold insomnia or higher) who are at risk for internalizing disorders due to a parental history of these disorders. Methods: This trial uses a two-arm, single-blinded, parallel group randomized controlled design (N = 50). Participants in the treatment group will complete a web-based CBT-I intervention (return2sleep) that is comprised of 7 sessions (six adolescent sessions and one parent session). Participants in the control group will receive a psychoeducational pamphlet and be encouraged to continue treatment (if any) as usual. Insomnia severity, sleep quality, and depressive and anxiety symptoms will be assessed at three time points (baseline, immediately post-treatment, and three months post-treatment). Additionally, clinically significant internalizing disorders in adolescents will be assessed using diagnostic interviews. Discussion: Web-based CBT-I is a non-invasive, economical, and easily administered intervention targeting sleep which is a potentially modifiable risk factor for the onset of depression and anxiety. Results from this trial will inform larger-scale effectiveness trials to examine whether, via interventions to improve sleep, it is possible to prevent currently healthy, but high-risk, adolescents with sleep problems from developing internalizing disorders for the first time in their lives, thereby preventing a lifelong cascade of adverse psychosocial outcomes. Trial registration: ClinicalTrials.gov NCT06358495 . Registered on April 15, 2024.
Access status: Open Access ,
The International/Canadian hereditary angioedema guideline
(BMC, 2026-01-28) Betschel, Stephen; Binkley, Karen; Borici-Mazi, Rozita; Chapdelaine, Hugo; Hébert, Jacques; Kanani, Amin; Keith, Paul K.; Lacuesta, Gina; Waserman, Susan; Yang, William; Palda, Valerie; Lang-Robertson, Kelly; Aygören-Pürsün, Emel; Banerji, Aleena; Bernstein, Jonathan A.; Caballero, Teresa; Farkas, Henriette; Grumach, Anete S.; HIDE, Michihiro; Katelaris, Connie; Longhurst, Hilary J.; Magerl, Markus; Riedl, Marc; Zanichelli, Andrea; Zuraw, Bruce; Adatia, Adil; Boursiquot, Jean-Nicolas; Connors, Lori; Cook, Victoria; Cooper, Michelle; Fu, Lisa; Gill, Parwinder; Goodyear, Dawn; Jagdis, Amanda; Jeimy, Samira; Kalicinsky, Chrystyna; Kamra, Palinder; Kan, Manstein; Kim, Harold; Laramée, Benoît; Lee, Erika; Leith, Eric; Marois, Louis; McCusker, Christine; O’Keefe, Andrew; Othman, Ibraheem; Poon, Man-Chiu; St-Pierre, Charles; Stepaniuk, Peter; Tsai, Ellie; Uminski, Kelsey
This update to the 2019 Canadian Hereditary Angioedema (HAE) Guideline broadens its focus to include the management of patients with HAE worldwide, building on its established international framework. It has been developed through a collaboration of Canadian and international HAE experts and patient groups, coordinated by the Canadian Hereditary Angioedema Network. The objective is to provide evidence-based recommendations, using the Grading of Recommendations Assessment, Development and Evaluation system, for the management of patients with HAE. These include recommendations for the treatment of attacks, short-term prophylaxis, and long-term prophylaxis, as well as recommendations for self-administration, individualized therapy, health-related quality of life, and comprehensive care. New to the 2024 edition are specific recommendations for the treatment of angioedema attacks in individuals with HAE who are breastfeeding/lactating, as well as a dedicated section on shared decision-making. HAE results in spontaneous and often unpredictable attacks of painful swelling, typically affecting the extremities, bowel mucosa, genitals, face, and upper airway. These attacks are associated with significant functional impairment, reduced health-related quality of life, and in the case of laryngeal attacks, a high risk of mortality. Managing HAE is complex, and patient care in Canada, similar to many other countries, remains inconsistent and suboptimal. Care delivery lags behind nations that have implemented more structured management models for HAE, and offer broader access to a wider range of approved therapies. This guideline is intended to be used to optimize HAE management, highlight the importance of individualized care, and provide guidance to healthcare providers, policymakers, patients, and advocates. Primary target users include healthcare providers who are managing patients with HAE, as well as emergency and intensive care physicians, primary care physicians, gastroenterologists, dentists, otolaryngologists, pediatricians, hematologists, dermatologists, and gynecologists who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.
Access status: Open Access ,
Laying the foundation in food allergy education: CSACI food allergy educator program
(BMC, 2026-04-10) Protudjer, Jennifer; Mack, Douglas P.; Connors, Lori; Lidington, Jasmin; Kim, Harold
In Fall 2023, the Canadian Society of Allergy and Clinical Immunology (CSACI) introduced an evidence-based, participant-informed food allergy educator program for physicians and allied health professionals working in allergy. Herein, we aimed to provide an overview and evaluation of the first four cohorts of the foundational course. The 8-weeks foundational course in food allergy, the content of which was delivered by world leaders in food allergy, included topics ranging from food allergy epidemiology, diagnosis and management to the psychosocial burden of food allergy. Learners completed a pre-test and a post-test, one week prior to the course, and one week following the course, respectively. We operationalized the passing grade for the post-test as a minimum of 75%. Data were analysed descriptively with comparisons made using a paired t-test (Stata Version 19.0, College Station, TX). To date, four cohorts, including 34 learners, have completed the foundational course. The pre-test and post-test mean scores were 72.5% (range 30.0–96.0%) and 84.5% (range 65.0–97.5%), respectively, which corresponds to a significant improvement in food allergy knowledge from the pre-test (p < 0.0001). in the first four cohorts of the CSACI Food Allergy Educator Program Foundational Course, food allergy knowledge significantly improved among learners. The foundational course will continue to be offered at least once yearly. An advanced practice course is also being developed.
Access status: Open Access ,
Canadian Treat-to-Target Practice Survey of Real-World Interventions and Strategies in Psoriasis (CAN TARGET PSORIASIS)
(Springer Nature, 2026-04-16) Yeung, Jensen; Grewal, Parbeer; Lansang, Perla; Vender, Ron; Wiseman, Marni; Zeinab, Rami A.; Barakat, Maxime; Prajapati, Vimal H.
Introduction: Treat-to-target (T2T) strategies have been proposed to support decision-making in chronic plaque psoriasis care, but their use in Canadian clinical practice has not been well studied. Methods: This retrospective chart review examined how Canadian T2T criteria are applied for adult patients with moderate-to-severe plaque psoriasis and whether treatment decisions reflect treatment target achievement in clinical practice. Charts from 438 adults who initiated or modified biologic therapy and completed two visits 3–8 months apart were included. Treatment target achievement at visit 2 was assessed using predefined major and minor criteria, which included Psoriasis Area and Severity Index (PASI), body surface area (BSA), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI) outcome measures. Results: Of the 438 patients, 321 (73.3%) met the treatment target and 98.4% of these continued their current biologic therapy. Among the 117 patients who did not meet the treatment target, 48.7% of remained on their current biologic therapy. Treatment target achievement was associated with lower PASI, BSA, PGA, and DLQI scores. DLQI influenced treatment modification even when treatment targets were unmet. Switching between interleukin (IL)-17 and IL-23 inhibitors was the most frequent treatment modification strategy. Conclusion: Findings support the clinical value of Canadian T2T criteria, while highlighting the importance of shared decision-making. Many patients who did not meet treatment targets remained on their current biologic therapy, emphasizing the role of patient input, quality of life, and physician judgment. These results reinforce the importance of balancing treatment targets with individualized care in real-world plaque psoriasis management.
Access status: Open Access ,
Quantization of KLT matrices using a GMRF model for image blocks with application to adaptive transform coding
(Springer Open, 2026-01-08) Boragolla, Rashmi; Yahampath, Pradeepa
Forward adaptive transform coding of images requires a codebook of transform matrices from which the best transform can be chosen for each macroblock. Codebook construction is a problem of designing a quantizer for Karhunen–Lóeve transform (KLT) matrices estimated from sample image blocks. We present a novel method for KLT matrix quantization based on a finite-lattice non-causal homogeneous Gauss–Markov random field (GMRF) model with asymmetric Neumann boundary conditions for blocks in natural images. The matrix quantization problem is solved in the GMRF parameter space, simplifying the harder problem of quantizing a large matrix subject to an orthonormality constraint to a low-dimensional vector quantization problem. Typically used GMRF parameter estimation methods such as maximum-likelihood (ML) do not necessarily maximize the coding performance of the resulting transform matrices. To this end we propose a method for GMRF parameter estimation from sample image data, which maximizes the high-rate transform coding gain. We also investigate the application of GMRF-based transforms to variable block-size adaptive transform coding.
Access status: Open Access ,
Personal Research Agendas for Librarians: Beyond the Project to the Bigger Picture
(2026-05-15) Babb, Maureen
Slides from a webinar presentation delivered for the American Library Association's Library Research Round Table (ALA LRRT). Webinar Abstract: Research agendas are a regular part of the scholarly grey literature in fields outside of Library and Information Studies (LIS), but are not nearly so common within. When discussed in the LIS literature, research agendas tend to be described for the field, rather than for the individual, with the intent of identifying areas where further research is needed, and to suggest to librarian-researchers that these would be areas of study worth pursuing. In other academic disciplines, developing a personal research agenda is a fairly standard component of becoming or developing as a researcher – they may even be an expected part of job interviews, performance reviews, or the process of setting up a programme or laboratory. Though not generally a required item for librarians, we too can benefit from the creation of a personal research agenda, especially in roles where research is expected, such as academic librarianship. A great deal of research in librarianship is practice-based, tied directly to projects that the researching librarian is undertaking at their institution – there is no doubt such research is valuable, but there may be a desire to take such practice-based research further, or to conduct research in other areas that is not so closely linked to practice. The creation of a personal research agenda would be of particular relevance to librarians interested in changing their research style from solely one-off, short-term research projects to a broader research focus, and to multi-project research interests. Research agendas are living documents, designed to help you understand and navigate your desires and needs as a researcher, and may include not only your research interests and projects you hope to complete, but considerations of how you hope to develop as a researcher and how you might achieve those goals. This webinar will take attendees through a discussion of personal research agendas, covering what they are, how to create one, and how they can help you develop and proceed along your research journey.
Access status: Open Access ,
Supplementary Material for Not your average dairy farmer: Clustering dairy farmers of Western Canada and Ontario based on management practices and well-being
(Elsevier, 2026-02-09) Tambadou, Halimatou
Survey Questions for article abstract: A wide array of operational and management practices characterizes the dairy farming landscape in Canada. This heterogeneity poses challenges in understanding the full range of dairy farming systems, which can lead to incomplete representations and less effective interventions aimed at improving the well-being of dairy farmers. This study aimed to holistically explore the relationship between dairy farmers' well-being and farm management practices. A multiple factorial analysis was used to group dairy farmers based on various factors, including demographic characteristics, mental and physical health outcomes, farming responsibilities, work-life balance, social environment and support, animal housing and management, and concerns about various dairy-related stressors. The analysis identified 4 distinct clusters of farmers defined by 66 significant variables. Key factors influencing the differences among the surveyed dairy producers included age, concern about finances, drought, public perceptions of the dairy industry, policies and regulations, farm responsibilities, satisfaction with professional relationships (such as those with veterinarians and feed representatives), and mental health outcomes. Despite the variations among the clusters, a common theme emerged: most participants selected finding more time for enjoyable activities and reducing their workload as ways to improve their well-being. The findings suggest that the nature of dairy farming and its associated responsibilities may often hinder farmers from achieving a healthy work-life balance. Furthermore, this study highlights the distinct challenges faced by various groups of dairy farmers. The typologies established in this research offer a promising foundation for providing tailored resources and support.
Access status: Open Access ,
A class of complementary sequences of integers
(1959) Connell, Ian; Jonsson, Wilbur; Mendelsohn, Nathan Saul
A pair of sequences {Un} , {Vn} for n= 1,2,3,... are called complementary sequences if together they contain the positive integers without repetition or omission. This paper deals exclusively with Beatty sequences which are complementary sequences of the form Un=[n(1+1/∝)], Vn=[n(1+∝)] where ∝>o is irrational. The pairs (Un, Vn) for particular values of ∝ are winning pairs in a generalization of Wythoff's game. The generalized game is defined and the complete solution given. The particular values of ∝ give rise to a generalization of the Fibonacci numbers; arithmetical properties of these numbers are discussed. The subscript rules give explicit values for Upn and VQn where Pn/Qn is a continued fraction convergent to ∝. The property Uvn=Un + Vn, n = 1,2,3,..., called reduplication, is enjoyed by only a discrete set of values of ∝ . These special values are determined and the allied problem: for what values of ∝ >o can [[n(1+∝)]/∝]=[n(1+∝)/∝] be true for every positive integer n is completely solved. Reduplication leads to the idea of continued subscripts which is developed in detail. Beatty sequences can be split into r-fold complementary sequences. For example the sequence {Un} can be split into the two sequences {Uun} and {Uvn} . The number of r-fold sequences is determined. The Eames representation leads to an algorithm for determining the Beatty sequences from the continued fraction for ∝ and conversely. A class of Beatty sequences is discussed which is found to be related to Fan sequences. Van der Waerden’s theorem for Beatty sequences leads to an interesting conjecture. Finally, a brief description of the work of several other writers in the subject is given.
Access status: Open Access ,
Mapping policies, regulations, and practice supports for medical office assistants in primary care: a scoping review
(BMC, 2026-02-20) Shuldiner, Jennifer; Ragunathan, Apira; Mohammed, Jawairia; Katz, Alan; Andiappan, Meena; Barber, David; Condon, Amanda; Garber, Gary; Kiran, Tara; Hysong, Sylvia; Schoon, Jill; Martin, Danielle; Wong, Sabrina T.; Ivers, Noah
Importance: Medical Office Assistants (MOAs) are non-clinicians who carry out critical tasks in primary care settings. Despite their central roles as the first point of contact for patients or at the front desk, there are no reviews of policies, supports or interventions that could help support MOAs within complex primary care clinics. Objective: We systematically scoped the literature to identify interventions, regulations, policies, practice supports, or resources targeting MOAs in primary care. Evidence review: Searches were conducted in Pubmed, EMBASE, Web of Science, and grey literature sources (Google, Google Scholar, and Duckduckgo), for items set in high-income countries and reported in English or French, from January 2000 to December 2024. We additionally searched for references for all articles through Scopus. Articles, reports, papers, or other online materials or articles were included if they reported anything about supporting MOAs in primary care clinics. Data analysis involved descriptive numerical summaries and content analysis. Findings: Sixty articles were included, covering team building or reconfiguration of the team (18/60; 30%), education/counselling/health coaching (15/60; 25%), navigator or care management of patients (10/60; 17%), training or credentials for MOAs (8/60; 13%), screening activities (6/60; 10%), and advanced rooming (3/60; 5%). Articles were primarily set in the United States (47/60; 78%). Workforce well-being was the most common positive outcome (26/60; 43%). Equity outcomes were rarely reported (5/60; 8%). Commonly identified barriers to implementing interventions included time and resource constraints, staffing challenges, inadequate training, and lack of provider buy-in. Involving MOAs in planning, offering role flexibility, and fostering leadership support were important for success. Furthermore, strong leadership, collaborative relationships, and fair compensation were key components of an environment conducive to change. Conclusion and relevance: This review reveals gaps in supporting MOAs as members of the primary care team. Most of the literature focuses on clinic-level changes, with limited evidence on MOA training and/or career growth. Given their strong impact on primary care access and experience for patients, more focus on MOAs in health system reform is warranted.
Access status: Open Access ,
Transferability of a 10-week remotely delivered Virtual Physical Activity Seated Exercise (V-PASE) program on post-stroke functional mobility: study protocol for a multisite randomized controlled trial
(BMC, 2026-02-06) Mackie, Paul; Ashe, Maureen C.; Barclay, Ruth; Bayley, Mark T.; Donkers, Sarah J.; Fleet, Jamie L.; Mortenson, W. B.; Peters, Sue; Pollock, Courtney L.; Pooyania, Sepideh; Quigley, Adria; Sakakibara, Brodie M.; Schneeberg, Amy; Sheehy, Lisa; Stelling, Sally; Yao, Jennifer; Eng, Janice J.
Background: Seated exercises may reduce the need for in-person support during home-based exercise programs in people with balance impairments. However, it is uncertain if these exercises can transfer to improved lower extremity function and mobility. Thus, the objective is to investigate the effects of a remotely delivered 10-week seated exercise intervention on functional mobility, compared with control, in individuals living with a chronic stroke who have balance impairments. Methods: The study is a multi-site, assessor blinded, randomized controlled trial that will recruit across five provinces in Canada using the CanStroke Recovery Trials platform. A total of 100 adults living with a chronic stroke (≥ 6 months post-stroke) and mobility impairment (using a walking aid) will be recruited. Participants will be randomized (1:1) to the 10-week Virtual Physical Activity Seated Exercise (V-PASE) or control group. All exercise sessions will be delivered one-on-one through videoconferencing by a trained instructor. Sessions will be 60 min in duration and completed 3 times/week at a moderate intensity (40%–60% Heart Rate Reserve). The primary outcome measure is the 30s Sit-To-Stand score at the end of the 10-week intervention. Secondary outcome measures will be mobility, balance, quality of life, stroke-related quality of life, cognition, fatigue, anxiety, depression, and blood profiles (glucose and lipids). Discussion: Exercises completed in a chair have the potential to transfer to improved functional mobility in people with balance impairments, such as individuals with stroke. The stability of the seated position may improve safety during home-based exercises and thus increase participation. Trial registration: ClinicalTrials.gov NCT05724823. Registered on February 13th, 2023.
Access status: Open Access ,
Based on the gut–heart axis: Polygonum capitatum improves atherosclerosis by modulating gut microbiota and TMAO, supporting MCPIP1/p53-associated endothelial protection
(BMC, 2026-03-09) Wang, Yunpei; Tian, Weiyi; Ye, Zi; Liao, Yuanzhu; Huang, Chunhua; Qi, Dake; Wang, Yuhui; Chen, Yajie; Zhou, Yixia
Polygonum capitatum (PC), known as “Tou Hua Liao” (Chinese name), is an essential source of Hmong medicinal plants, which has been used for treating various human diseases. This study examined whether PC has lipid-lowering and anti-atherosclerotic effects and explored the underlying mechanisms. We focused on PC’s influence on gut microbiota–derived metabolites. First, we analyzed animal-derived serum containing PC components and the botanical compounds of PC by UPLC-MS/MS to identify potential bioactive constituents. Second, we treated high-fat diet–fed hamsters with PC to determine whether the treatment improved plasma lipids and attenuated atherosclerosis progression. We then assessed PC’s effects on the gut microbiota by 16S rDNA sequencing and performed fecal microbiota transplantation in hamster models. Finally, we used human umbilical vein endothelial cells (HUVECs) to probe molecular mechanisms by which PC might inhibit oxidative stress and apoptosis. In a diet-induced atherosclerotic hamster model, PC treatment reduced atherosclerosis by decreasing lipid accumulation, oxidative stress, and apoptosis, and it restored gut microbiota balance while markedly lowering the abundance of TMAO-producing bacteria. PC also exerted antioxidant and anti-apoptotic effects and inhibited endothelial apoptosis via an MCPIP1-dependent mechanism. Together, these results indicate that PC suppresses atherosclerosis through two likely pathways: reduction of gut microbiota–derived TMAO production and inhibition of oxidative stress–driven endothelial apoptosis. Network pharmacology analysis of PC-specific blood-absorbed components supports these findings.
Access status: Open Access ,
Sex differences in disease severity and immune responses in murine and human inflammatory arthritis
(BMC, 2026-02-07) Hemshekhar, Mahadevappa; O’Neil, Liam J; Kahia, Nyambura; Marshall, Courtney L.; Singh, Tamarah; Navarrete, Mario; El-Gabalawy, Hani; Mookherjee, Neeloffer; Arsenio, Janilyn
Background: Rheumatoid Arthritis (RA), a systemic autoimmune disorder of unknown etiology, disproportionately affects females at a 3:1 ratio compared to males. While biological sex differences in the immune system exist, sex-related differences in inflammatory and immune mediators of RA disease severity are undefined. Our objective was to characterize sex-related differences in immune responses in a murine collagen-induced arthritis (CIA) model and in human RA patients. Methods: In CIA compared to saline control mice, inflammatory disease severity was assessed using standardized clinical scores. Anti-collagen antibodies, neutrophil elastase, calprotectin/ S100A8/A9 heterodimer, CRAMP, MMP3, and MMP9 were quantified by ELISA in the sera and joint tissues. Cytokine/chemokine levels in sera and joints were assessed using a Luminex based-44-Plex Discovery Assay® Array. Immunophenotyping of mouse splenic T cells analysis was performed by flow cytometry. Proteomic profiling of serum samples from an established RA cohort (72 female and 19 male that were at least 84% ACPA+) was performed using an aptamer-based SomaScan platform. Results: We identified distinct sex-related differences in disease severity and pro-inflammatory profiles in the sera and joint tissues of CIA mice, with inflammatory responses that were male-skewed in the sera and female-skewed in the joints. Furthermore, we demonstrated heightened neutrophil activation markers and CD4+ T cell-mediated inflammatory responses in female CIA mice. Similar sex-related differences in neutrophil activation and leucocyte migration were identified in RA patients. Conclusions: Our study demonstrates novel sex differences in pro-inflammatory mediators and activities of neutrophils and CD4+ T cells associated with disease severity in CIA mice, and in human RA patients. These findings provide new insights into sex-related differences in immunological pathways associated with inflammatory arthritis, which may contribute to the sex disparity in RA pathogenesis.
Access status: Open Access ,
Identifying the knowledge needs and preferences of parents of children with rare diseases regarding clinical trials: a scoping review protocol
(BMC, 2026-02-05) Mabbott, Annie P.; Knisley, Lisa; Scott, Shannon D.
Background: Rare diseases (i.e., incidence of <1/2000) are individually uncommon, but collectively these 10,000 conditions affect an estimated 473 million people globally, and approximately 70% of rare diseases manifest in childhood. Despite this global impact, 90% of rare diseases lack effective treatment. Treatments for rare diseases are often identified through clinical trials. Identifying parents’ knowledge needs and preferences regarding pediatric rare disease clinical trials is an important aspect of empowering parents, improving clinical research practices, and potentially improving recruitment to these vital trials. The aim of the scoping review is to determine the extent, range, and characteristics of the evidence on the knowledge needs and preferences of parents regarding pediatric rare disease clinical trials. Methods: A scoping review will be conducted to identify sources of literature on the topic. A systematic search strategy co-developed with a research librarian will be conducted in six databases (Medline, EMBASE, CINAHL, Scopus, Web of Science, and PsycINFO). Gray literature will be searched via Google, Perplexity AI, the ProQuest Dissertations & Theses Global database, and relevant rare disease organizational websites. Abstract and full-text screening will be conducted by two reviewers independently. Studies in English will be included regardless of study design, date of publication, or location of study/publication. Study quality will be appraised using the Mixed Methods Appraisal Tool. Data will be extracted including study characteristics, population, phenomena under investigation, and knowledge needs and preferences identified. Analysis will involve a descriptive numerical summary and qualitative content analysis. Findings will be presented in evidence tables, and patterns, themes, and gaps across the data will be reported using a narrative approach. Discussion: This review will provide an overview of the existing literature regarding parents’ knowledge needs and preferences about pediatric rare disease clinical trials. The findings of this review will inform future research and the development of knowledge translation resources for parents of children with rare diseases. Systematic review registration: This protocol has been registered in Open Science Framework (registration: https://doi.org/10.17605/OSF.IO/QXR8G ).
Access status: Open Access ,
Lessons Learned: Defining the Right Specifications for Diagnostics in Outbreak Situations
(Springer Nature, 2026-03-26) Beutler, Markus; Bonvehí, Pablo; Chu, May; Duong, Veasna; Peeling, Rosanna; Schmidt-Chanasit, Jonas; Jochum, Simon; Sticha-Kaiser, Christoph; Castelletti, Noemi; Strobl, Matthias; Wieser, Andreas
Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic significantly changed the development and use of infectious disease diagnostics, emphasizing the need for rapid implementation, access equity, and revealing challenges in evaluation and licensing from unclear guidelines. Methods: An international expert panel was convened by Roche Diagnostics, Fraunhofer Institute for Translational Medicine and Pharmacology (Immunology, Infection and Pandemic Research division), and Ludwig Maximilians University to address these challenges. The panel aimed to develop parameters for designing minimal viable products and consequence-centered diagnostic strategies, focusing on the broader implications of test results for public health interventions and disease control rather than individual test performance. Results: Key findings included the need to tailor target product profiles to outbreak scenarios, considering socioeconomic factors and outbreak phases. Prioritizing rapid, cost-effective, and widely accessible tests, even at the expense of lower sensitivity was highlighted. Using such tools was effective during the SARS-CoV-2 pandemic because they were wider-reaching and identified more cases, especially in low-/middle-income countries where highly sensitive molecular tests had limited availability. Conclusion: Modeling different testing strategies allows outbreak control programs to quantify the impact of trade-offs between accessibility, affordability, and speed of diagnosis in different outbreak settings.
Access status: Open Access ,
Advancing family wellbeing through a Massive Online Open Intervention: the LightBEAM program protocol for randomized waitlist control trial {1a}
(BMC, 2026-02-02) Sitka, Madissen; Simpson, Kaeley; Paton, Allyson; MacKinnon, Anna; afifi, tracie; Cameron, Emily E.; Hai, Tasmia; Stewart-Tufescu, Ashley; Gonzalez, Andrea; Toombs, Elaine; Unger, Jo Ann; Giuliano, Ryan; Mushquash, Aislin; Archibald, Mandy; Tomfohr-Madsen, Lianne; Roos, Leslie E.
While early childhood remains a formative period for healthy child development, it is simultaneously a time when parents experience increased mental health challenges. Such increased challenges (e.g., heightened parental stress, anxiety, depression, etc.) can lead to a variety of adverse child outcomes, including increased risk of externalizing and internalizing disorders. Despite the well-documented effects of parental mental health on child development, Canadian families face a plethora of barriers to accessing services in a timely manner, and as such, low-barrier, accessible mental health supports are needed. In an effort to increase available services to Canadian families, the current study translates the BEAM program (Building Emotional Awareness and Mental Health; thebeamprogram.com), a previously established online parenting and mental health app, into LightBEAM a massive open online intervention (MOOI). By translating an efficacious intervention into a MOOI format, we hope to increase accessibility, scalability, and reach of the program in an effort to better support Canadian families. To investigate the efficacy of translating BEAM into LightBEAM, a pilot waitlist control design will be utilized. Canadian families who are parenting a child between the ages of 1.5 and 8 years old and who are experiencing elevated symptoms of parenting stress, anxiety, depression, and/or anger will be recruited. When moving through the intervention arm of the trial, participants will have access to an app that houses 12 weeks of parenting and mental health videos, a group forum, and weekly exercises to reinforce key skills learned. A combination of Multilevel modeling and mediation models will be utilized to assess changes in participants' elevated mental health scores across the 12-week program and the 6-month follow-up period. Additionally, post-program focus groups will be conducted to further explore the feasibility and acceptability of the program. The translation of BEAM into LightBEAM, a national MOOI, has the potential to increase the scalability of this intervention to ensure that Canadian families have access to timely mental health and parenting supports. Results will be used to inform future iterations of the program. This trial was retrospectively registered with ClinicalTrial.gov NCT07026838 on June 10th, 2025{4}. Protocol Version 1, August 2025 {2}.

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