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 ,
Community acceptability of cardiovascular risk screening in faith centres in the Kassena-Nankana districts of Northern Ghana: a qualitative study
(BMC, 2025-11-05) Chatio, Samuel Tamti; Darko, Natalie; Zakariah- Akoto, Sawudatu; Willis, Andy; A Nonterah, Engelbert; R Jones, Ceri; Alale Aweeya, Joseph; Curtis, Ffion; Kunutsor, Setor K.; Seidu, Samuel; O Ansah, Patrick
Purpose: This study explored the community acceptability of a faith-based screening programme for cardiometabolic risk factors, specifically type 2 diabetes and hypertension, among faith congregation members in Northern Ghana. Methods: The research team conducted 18 in-depth semi-structured qualitative interviews and 10 focus groups, with a total of 123 participants, between October 2022 and February 2023 to discuss the acceptability of a proposed faith-based screening programme. Participants included faith leaders, congregation member nurses, and other congregation members from six religious organizations in the Kassena-Nankana East Municipality and West District in the Upper East Region of Northern Ghana. The study population ranged from 18 to 85 years old. The analytical process involved a combined inductive and deductive thematic analysis to identify key themes related to community acceptability of cardiovascular risk screening. Results: Participants’ comments on the acceptability of the proposed screening programme centred on four key themes: (1) Awareness and perception of type 2 diabetes and hypertension, (2) Perceptions of current screening services, (3) Challenges in Implementation, (4) Implementation strategies (what might work). All participants expressed a willingness to participate in the programme, though its success was deemed contingent on the provision of free screening services, access to treatment, and addressing certain challenges: stigma surrounding diagnosis, and concerns about treatment affordability. Solutions included support from congregation health professionals in delivering screenings, access to diabetes treatment, and assurances of maintaining patient confidentiality. Conclusions: The findings highlight community acceptability and willingness to participate in the screening programme, contingent upon addressing key challenges identified through both focus group discussions and in-depth interviews. These challenges included concerns about treatment affordability, the need for comprehensive community education, maintaining confidentiality, and ensuring screening services are convenient and time efficient. Participants emphasized the importance of leveraging congregation-based health professionals, providing pre- and post-screening counselling, and offering follow-up support for those diagnosed. These insights demonstrate that while faith-based centres present a promising platform for health interventions. The findings highlight the need for multi-sectoral collaboration to ensure equitable access, referral, and follow-up across health and community systems, addressing these barriers is crucial for successful implementation and sustainability.
Access status: Open Access ,
Evaluating the performance of five large language models in answering Delphi consensus questions relating to patellar instability and medial patellofemoral ligament reconstruction
(BMC, 2025-11-03) Vivekanantha, Prushoth; Cohen, Dan; Slawaska-Eng, David; Nagai, Kanto; Tarchala, Magdalena; Matache, Bogdan; Hiemstra, Laurie; Longstaffe, Robert; Lesniak, Bryson; Meena, Amit; Tapasvi, Sachin; Sillanpäa, Petri; Grzela, Patrick; Lamanna, Daniel; Samuelsson, Kristian; de SA, Darren
Purpose: Artificial intelligence (AI) has become incredibly popular over the past several years, with large language models (LLMs) offering the possibility of revolutionizing the way healthcare information is shared with patients. However, to prevent the spread of misinformation, analyzing the accuracy of answers from these LLMs is essential. This study will aim to assess the accuracy of five freely accessible chatbots by specifically evaluating their responses to questions about patellofemoral instability (PFI). The secondary objective will be to compare the different chatbots, to distinguish which LLM offers the most accurate set of responses. Methods: Ten questions were selected from a previously published international Delphi Consensus study pertaining to patellar instability, and posed to ChatGPT4o, Perplexity AI, Bing CoPilot, Claude2, and Google Gemini. Responses were assessed for accuracy using the validated Mika score by eight Orthopedic surgeons who have completed fellowship training in sports-medicine. Median responses amongst the eight reviewers for each question were compared using the Kruskal-Wallis and Dunn’s post-hoc tests. Percentages of each Mika score distribution were compared using Pearson’s chi-square test. P-values less than or equal to 0.05 were considered significant. The Gwet’s AC2 coefficient was calculated to assess for inter-rater agreement, corrected for chance and employing quadratic weights. Results: ChatGPT4o and Claude2 had the highest percentage of reviews (38/80, 47.5%) considered to be an “excellent response not requiring classification”, or a Mika score of 1. Google Gemini had the highest percentage of reviews (17/80, 21.3%) considered to be “unsatisfactory requiring substantial clarification”, or a Mika score of 4 (p < 0.001). The median ± interquartile range (IQR) Mika scores was 2 (1) for ChatGPT4o and Perplexity AI, 2 (2) for Bing CoPilot and Claude2, and 3 (2) for Google Gemini. Median responses were not significantly different between ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2, however all four statistically outperformed Google Gemini (p < 0.05). Inter-rater agreement was classified as moderate (0.40 > AC2 ≥ 0.60) for ChatGPT, Perplexity AI, Bing CoPilot, and Claude2, while there was no agreement for Google Gemini (AC2 < 0). Conclusion: Current free access LLMs (ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2) predominantly provide satisfactory responses requiring minimal clarification to standardized questions relating to patellar instability. Google Gemini statistically underperformed in accuracy relative to the other four LLMs, with most answers requiring moderate clarification. Furthermore, inter-rater agreement was moderate for all LLMs apart from Google Gemini, which had no agreement. These findings advocate for the utility of existing LLMs in serving as an adjunct to physicians and surgeons in providing patients information pertaining to patellar instability. Level of evidence: V
Access status: Open Access ,
National implementation of guided self-help family-based treatment for youth with eating disorders: a study protocol
(BMC, 2025-11-06) Couturier, Jennifer; Smith, Jeannine; Nicula, Maria; Nella, Ethan; Yanover, Tovah; Agostino, Holly; Annema, Stephanie; Boman, Jonathan; Bond, Jason; Coelho, Jennifer S.; Coolen, Anne-Marie; Datta, Nandini; Dimitropoulos, Gina; Ford, Catherine; Isserlin, Leanna; Johnson, Natasha; Jones, Shaleen; Katzman, Debra; Kelly, Brynn; Keshen, Aaron; Kimber, Melissa; Kumar, Sonia; Kurji, Ayisha; Lacroix, Emilie; Markland, Alison; Matheson, Brittany; McVey, Gail; McQuillan, Brittany; Norris, Mark; Obeid, Nicole; Phillips, Suzanne; Preskow, Wendy; Rodrigues, Allison; Smith, Sarah; Soroka, Chelcie; Spettigue, Wendy; Webb, Cheryl; Wournell, Jessica; Lock, James D.
Background: Guided self-help family-based treatment (GSH-FBT) is emerging as a promising, more efficient alternative to traditional family-based treatment (FBT). The present study is designed to examine the real-world implementation of GSH-FBT at pediatric treatment sites across nine provinces in Canada. Methods: Implementation teams at each site consisting of a GSH-FBT coach, a medical provider, and a program administrator will be formed. Clinician coaches will be trained in this new modality and supported with weekly GSH-FBT consultation. Each site will recruit ten families with an adolescent with anorexia nervosa and the parents will undergo ten virtual GSH-FBT sessions. The implementation approach will be evaluated using qualitative and quantitative methods. Outcomes of interest include (1) treatment fidelity, (2) treatment wait times, (3) change in adolescent symptoms and parent/caregiver self-efficacy, (4) change in provider readiness, attitudes, and confidence towards the intervention, and (5) the overall experience of the implementation of the intervention from the perspective of the provider teams, and participant families. Discussion: The findings of this study will help to identify factors important to the acceptability and implementation of GSH-FBT in real-world clinical settings. Trial registration: This study was first registered with clinicaltrials.gov (registration # NCT06851273) on February 12, 2025 (url: https://clinicaltrials.gov/study/NCT06851273?id=NCT06851273&rank=1 ).
Access status: Open Access ,
A randomised controlled trial comparing epinephrine and dexamethasone to placebo in the treatment of infants with bronchiolitis (BIPED study): a statistical analysis plan
(BMC, 2025-11-12) Heath, Anna; Rios, David; Vogel, Kristina I.; Rowe, Tremaine; Wills-Ibarra, Natasha; Oakley, Ed; Offringa, Martin; Pechlivanoglou, Petros; Klassen, Terry P.; Dalziel, Stuart R.; Plint, Amy C.
Background: Bronchiolitis is a common lung infection that affects infants and young children. While most children can be treated at home, some require hospitalisation where supportive care, such as fluids and oxygen, is the suggested treatment. Bronchiolitis is the leading cause of infant hospitalisation in developed countries and exerts a significant burden on the healthcare system. The aim of the Bronchiolitis in Infants Placebo Versus Epinephrine and Dexamethasone (BIPED) study is to evaluate the effects of a combination of epinephrine and dexamethasone, given during initial presentation at the emergency department, on hospitalisation for bronchiolitis. This article outlines the statistical analysis plan (SAP) for the BIPED study. The BIPED study is a Phase III, multi-centre, randomised, controlled, double-blinded superiority, placebo-controlled trial to determine whether the combination of epinephrine and dexamethasone is successful in reducing hospitalisation for bronchiolitis up to 7 days following presentation at an emergency department with bronchiolitis. The secondary outcomes include hospital admissions for bronchiolitis at the emergency department enrolment visit, and all-cause hospital admissions, health care provider visits and health care-related costs in the 21 days following enrolment. The safety outcomes are gastrointestinal bleeding, serious bacterial infection, severe varicella and death. Discussion: The BIPED study will provide evidence on whether a combination of epinephrine and dexamethasone reduces hospitalisation in infants following presentation to the emergency department with bronchiolitis. These data will be analyzed using this SAP, submitted before the data became available for analysis, to reduce the risk of bias in our reported outcomes. Trial registration: ClinicalTrials.gov NCT03567473. Registered on June 25, 2018.
Access status: Open Access ,
Evaluating primary suicide prevention in adolescents with risk factors (ESPAIR): study protocol for a cluster-randomized controlled trial
(BMC, 2025-11-24) Baggio, Stéphanie; Bailey, Eleanor; Edan, Anne; Heller, Patrick; Kapp, Carole; Lambert, Nadejda; Michaud, Laurent; Mundt, Adrian P.; Nsingi, Neslie; Perez, Sophia; Peregalli, Santiago; Piguet, Camille; Piotrowski, Caroline; Prutyanova, Yekaterina; Rumley, Mathias; Sapin, Marlène; Urben, Sébastien; Iglesias, Katia
Background: Suicide is the leading cause of death among young people. Because it is preventable, suicide prevention has become a critical public health priority worldwide. Current evidence suggests that primary suicide prevention interventions are effective in promoting suicide awareness and reducing suicidal thoughts among adolescents. However, scarce research has been conducted in vulnerable populations who may be at increased risk of suicidal behaviour. This project aims to test the effectiveness of a primary suicide prevention intervention on suicide awareness, knowledge of suicide and local resources, suicidal thoughts, psychological distress, and safety. Methods: This study is an open-label, multi-centre, superiority, cluster-randomized controlled trial with two parallel arms (randomization 1:1 in at least 8 study sites) of a primary suicide prevention intervention based on psychoeducation versus an art-based control intervention. Four groups of youth aged 14–25 with high suicide risk will be recruited (in total, n = 240), including those (1) detained in juvenile detention centres, (2) disconnected from school, (3) in treatment for psychiatric disorders, (4) belonging to a sexual or gender diversity, (5) affected by chronic conditions, and (6) with relational/familial problems. Participants will be randomly assigned to the suicide prevention or control intervention. The primary outcome is suicide awareness measured on a validated scale. Secondary outcomes include knowledge of suicide, knowledge of local resources, suicidal behaviour, psychological distress, access to primary suicide prevention, and safety. Measures will be collected at baseline, at 1-week, and 3-month follow-ups. Analyses will be conducted as intention-to-treat using mixed-effects models. Discussion: We expect that a brief primary suicide prevention intervention (psychoeducation) will be effective and safe in vulnerable adolescents. Trial registration: ClinicalTrials.gov NCT06551038. Registered on August 13, 2024.
Access status: Open Access ,
Recommendations for the diagnosis and management of eosinophilic esophagitis in adults and children in Canada: a Delphi consensus project
(BMC, 2025-11-07) Avinashi, Vishal; Gupta, Milli; Payne, Beth A.; Amhaz, Haneen; Temirova, Alisha T.; Afif, Waqqas; Ashok, Dhandapani; Barkey, Janice; Burnett, David; Bush, Jonathan W.; Cameron, Scott; Carr, Stuart; Demellawy, Dina E.; Erdle, Stephanie; Huynh, Hien Q.; Griffin, Jennifer; Grover, Samir C.; Grzywacz, Kelly; Jeimy, Samira; Ko, Hin H.; Lacuesta, Gina; Marcon, Margaret; Mayrand, Serge; Petropolis, Harrison; Rodrigues, David; Sherlock, Mary; Song, Christine; Tardio, Natacha; Vander Leek, Timothy K.; Vurzinger, Meagan; Williams, Brock A.; Xenodemetropoulos, Ted; Ma, Christopher; Chan, Edmond S.
Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that effects both pediatrics and adult patients in Canada and is increasing in prevalence. No Canadian focused best practice recommendations currently exist to guide clinical practice. Methods: The study used a modified Delphi technique to develop evidence and expert opinion-based recommendations for providing care for patients with EoE. The Delphi process consisted of 3 rounds of quantitative surveys and qualitative consensus meetings. Experts were included in the Delphi if they had experience caring for EoE patients in Canada within one of the following professional groups: allergist, adult gastroenterologists, pathologists, pediatric gastroenterologists, and dieticians. Results: Delphi rounds were completed between May 1, 2024, and June 30, 2024. A total of 31 experts in EoE care from across Canada were recruited to participate in the Delphi consensus process. All participants completed all three rounds of Delphi surveys. The final statement includes 38 recommendations for the care of patients with EoE organized into three sections: definition, diagnosis, and management. A Table of research gaps is provided to stimulate further knowledge development on this topic. Conclusion: This consensus statement includes actionable recommendations to support quality care of patients with EoE at any age across Canada. We encourage EoE centers in Canada to come together in a multi-disciplinary form to not only provide clinical care but also do much needed research on Canadian specific topics and gaps in EoE care.
Access status: Open Access ,
Venetoclax in Combination with Obinutuzumab in Previously Untreated Fit Patients with Chronic Lymphocytic Leukemia: A Canadian Cost-Utility Analysis
(Springer Nature, 2025-11-07) van de Wetering, Gijs; Owen, Carolyn; Banerji, Versha; Gosselin, Ariane; Kamdar, Shivani; Roc, Nancy P.; Bakker, Lytske; Ratnaparkhi, Gargi; Barakat, Stephane; Vicente, Colin; Manzoor, Beenish S.
Background/Objective: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder diagnosed in Canada and is associated with a significant economic burden. This study evaluates the cost effectiveness of fixed-treatment duration venetoclax plus obinutuzumab (VEN + O) for previously untreated, fit CLL patients in Canada, for whom this therapy is not universally reimbursed provincially. Methods: A three-state partitioned survival model was developed using data from the CLL13 trial and a Bayesian network meta-analysis. Health states included progression-free, progressed disease, and death. A lifetime horizon (40-year) was used and a 1.5% discount rate was applied to costs and effects. Costs included drug acquisition, administration, monitoring, adverse events, subsequent treatment, and terminal care. Utility values were derived from previous NICE technology appraisals in CLL. Extensive sensitivity and scenario analyses were conducted. Results: VEN + O was associated with lower total costs and higher quality-adjusted life years and thus dominant compared with ibrutinib, zanubrutinib, and fludarabine plus cyclophosphamide plus rituximab. Compared with acalabrutinib and venetoclax plus ibrutinib, the incremental cost-utility ratios (ICURs) were in the south-west quadrant and substantially above a CA$50,000/QALY willingness-to-pay threshold, meaning VEN + O was cost effective versus these comparators. VEN + O was cost effective versus bendamustine plus rituximab. Extensive sensitivity and scenario analyses confirmed the robustness of these results. Conclusions: This analysis demonstrates that VEN + O, a 12-month fixed duration treatment, is a cost-effective option for previously untreated fit CLL patients in Canada. VEN + O offers potential health benefits and cost savings when compared with relevant comparator treatments.
Access status: Open Access ,
Clinical trials of L1 (Deferiprone) at the Hospital for Sick Children in Toronto: a review of facts and circumstances
(1999-01) Naimark, Arnold; Knoppers, Bartha Maria; Lowy, Frederick H.
The Board of Trustees of the Hospital for Sick Children, prompted by the current controversy involving Dr. Nancy Olivieri, The Hospital for Sick Children and Apotex Inc. , wished to have its policies, procedures and practices subjected to an independent external review. The Board decided that the review should proceed in two phases. The mandate for the initial phase of external review was established by resolution of the Board of Trustees at a meeting on September 8, 1998. The resolution states: Be it resolved that the mandate for Part 1 of the Independent External Review authorized by the Board of Trustees be as follows: Part 1: L1 Clinical Trials To conduct an independent review to determine the facts and circumstances giving rise to the current controversy involving Dr. Nancy Olivieri, The Hospital for Sick Children and Apotex Inc. including matters pertaining to the following: • Patient Safety at The Hospital for Sick Children • Conflicts of Interest • Release and Publication of Research Information Upon completion of the Review which is expected by November 30, 1998, the Reviewer will report his findings to the Board of Trustees. The report of his findings will then be made public by the Board.
Access status: Open Access ,
A Review of Chemically Induced Intercalation and Deintercalation in Battery Materials
(Wiley, 2023-01-03) Odetallah, Mariam; Kuss, Christian
Intercalation is the fundamental process underlying lithium-ion batteries and related technologies. While intercalation is electrochemically induced in batteries, it can also be performed with chemical redox agents. In principle, the two processes are equivalent, although there can be differences, such as rate control, side reactions, and charge transfer mechanisms. Chemically induced intercalation can be used where electrochemical methods are impractical or impossible and continues to inspire innovative applications. This chemistry is important in synthesis and pretreatment of intercalation materials, with novel impactful applications emerging that range from lithium recycling to intercalation material-based redox flow batteries. This review summarizes the use of chemical intercalation and serves as a resource for selecting and optimizing methods specific to material and application. Covering the whole life cycle of intercalation materials: development, synthesis, use, and finally recycling, it can be expected that these reactions will continue to have great impact on the path toward efficient and cheap energy storage.
Access status: Open Access ,
In-utero exposure to maternal diabetes and DNA methylation alterations in the Next Generation birth cohort
(BMC, 2025-10-03) Salama, Ola E.; Rawal, Yash; Irabor, Priscilla; Kassim, Haziqa; Pylypjuk, Christy; Sellers, Elizabeth ; Wicklow, Brandy A.; Jones, Meaghan
Introduction: The incidence of type 2 diabetes (T2D) in youth is increasing and in-utero exposure to maternal diabetes is a known risk factor, with higher risk associated with pregestational T2D exposure compared to gestational diabetes mellitus (GDM) exposure. We hypothesize this differential risk is reflected in DNA methylation (DNAm) changes induced by differential timing of in-utero exposure to maternal diabetes, and that exposure to diabetes throughout pregnancy (T2D) compared to exposure later in development (GDM), induces different DNAm signatures and different T2D risk to offspring. This study presents an epigenome-wide investigation of DNAm alterations associated with in-utero exposure to either maternal pregestational T2D or GDM, to determine if the timing of prenatal diabetes exposure differentially alters DNAm. Methods: We performed an epigenome-wide analysis on cord blood from 99 newborns exposed to pregestational T2D, 70 newborns exposed to GDM, and 41 unexposed to diabetes in-utero from the Next Generation birth cohort. Associations were tested using multiple linear regression models while adjusting for sex, maternal age, BMI, smoking status, gestational age, cord blood cell type proportions and batch effects. Results: We identified 27 differentially methylated sites associated with exposure to GDM, 27 sites associated with exposure to T2D, and 9 common sites associated with exposure to either GDM or T2D (adjusted p value < 0.05 and effect size estimate > 0.01). One site at CLDN15 and two unannotated sites were previously reported as associated with obesity. We also identified 87 differentially methylated regions (DMRs) associated with in-utero exposure to GDM and 69 DMRs associated with in-utero exposure to T2D. We identified 23 DMR sites that were previously associated with obesity, three with T2D and five with in-utero exposure to GDM. Furthermore, we identified six CpG sites in the PTPRN2 gene, a gene previously associated with DNAm differences in blood of youth with T2D from the same population. Conclusion: Our findings support that in-utero exposure to maternal diabetes is associated with DNAm alterations in offspring. Moreover, the timing of maternal diabetes in-utero exposure (GDM or T2D) produces overlapping but distinct DNAm patterns, suggesting that the window of exposure to maternal diabetes produces different molecular modifications and may reflect, at least in part, the difference in risk for youth-onset T2D in offspring. We also identified sites in this study that have been previously associated with T2D or obesity, which may serve as potential early-life biomarkers of exposure and/or risk, warranting further investigation in longitudinal studies.
Access status: Open Access ,
“I think of it as planting seeds”: challenging patient-provider discussions about COVID-19 vaccination: a qualitative study
(BMC, 2025-10-28) Driedger, S. Michelle; Maier, Ryan; Metge, Colleen; Katz, Alan; Singer, Alexander
Background: Vaccination has been essential in mitigating the worst effects of the COVID-19 pandemic in Canada. Healthcare providers can play a crucial role in promoting COVID-19 vaccination by discussing immunization, addressing patients’ questions, and providing them with relevant information. However, some segments of the public remained hesitant towards COVID-19 vaccination during the pandemic, reflecting an information environment crowded with misinformation and political polarization. This study examines challenging clinical discussions that healthcare providers had with patients hesitant about COVID-19 vaccines. It focuses on obstacles to fruitful conversations and strategies to overcome them, which can extend into ongoing vaccine-related conversations outside a pandemic context. Methods: Researchers conducted individual interviews with ten healthcare providers during the pandemic (January-May 2022) in the province of Manitoba, Canada. Participants were recruited using invitations distributed via professional organizations and networks. The recruited sample included primary care physicians, nurse practitioners, and a specialist provider who had recently discussed the COVID-19 vaccine with patients. Study participants were asked about their challenging conversations regarding the COVID-19 vaccine with patients and how they navigated these experiences. The resulting data were analyzed using NVivo12 to capture and organize salient themes. Results: Healthcare providers reported that COVID-19 vaccines have prompted new forms of vaccine hesitancy and resistance compared to existing vaccines, particularly due to concerns about the integrity of the vaccine (e.g., vaccine novelty, ingredients) or related public policy (i.e., vaccine mandates). Providers reported a significant rise in hostility from patients who were staunchly hesitant and experienced moral injury, burnout, and an emotional toll from witnessing disregard for public health. Participants indicated that they attempted to employ motivational interviewing strategies and shared decision-making and voiced desires for further training in such approaches. Some participants found mixed success with using decision aids or used improvised strategies to facilitate discussions. Conclusion: Motivational interviewing and shared decision-making strategies proved valuable to healthcare providers in navigating challenging discussions, addressing/acknowledging patient concerns, and preserving relationships. Healthcare providers need to be better supported with training in these strategies and in navigating the moral/emotional/physical consequences of experiencing a global health crisis in clinical settings.
Access status: Open Access ,
Effects of silver diamine fluoride on oral bacteriome and mycobiome: a randomized clinical trial
(BMC, 2025-10-21) Manerkar, Mayura; de Jesus, Vivianne C.; Mittermuller, Betty-Anne; Lee, Victor H. K.; Singh, Sarbjeet; Bertone, Mary; Chelikani, Prashen; Schroth, Robert
Background: Silver diamine fluoride (SDF) is a simple and non-invasive agent used to arrest early childhood caries (ECC). This study aimed to investigate potential changes to the oral microbiome in children with ECC who were treated with SDF and sodium fluoride (NaF) varnish at three different frequency regimens. Methods: Forty-five children (n = 15 per group) with ECC were recruited from community-based dental clinics in Winnipeg, Canada into an open-label, parallel-group, randomized clinical trial testing three different treatment frequency regimens of SDF. A total of 195 carious lesions were treated with two applications of 38% SDF and 5% NaF varnish (and assessed over three study visits one month, four months, or six months apart. Dental plaque samples were collected at each visit. Sequencing of the V4-16 S rRNA and ITS1 rRNA genes were used to study the supragingival plaque microbiome. Results: Microbial diversity analyses showed no significant differences in the overall microbiome after SDF treatment. However, significant changes in the abundance of specific bacteria and fungi, particularly Lactobacillus spp., Bifidobacterium spp., and Candida spp., were observed after treatment. Furthermore, overabundance of Streptococcus mutans and Candida dubliniensis at baseline was observed in children who had at least one caries lesion not arrested after one SDF application, compared to those who had 100% arrest rates. The overall arrest rates for treated carious lesions were 75.9% at the second visit and 92.8% at the third visit. Arrest rates were higher for all lesions after two applications of SDF with NaF varnish, and applications one month and four months apart had higher arrest rates (95.9% and 98.5%) than six months (81.1%) apart. Conclusions: Applications of SDF with NaF varnish were an effective modality for arresting ECC, with higher arrest rates after two SDF applications. No loss of diversity but changes in the abundance of specific bacteria and fungi were observed after SDF treatment. Trial registration: ClinicalTrials.gove NCT04054635 (first registered 13/08/2019).
Access status: Open Access ,
Finding maximum common contractions between phylogenetic networks
(BMC, 2025-10-01) Marchand, Bertrand; Tahiri, Nadia; Fard, Shohreh G.; Tremblay-Savard, Olivier; Lafond, Manuel
In this paper, we lay the groundwork on the comparison of phylogenetic networks based on edge contractions and expansions as edit operations, as originally proposed by Robinson and Foulds to compare trees. We prove that these operations connect the space of all phylogenetic networks on the same set of leaves, even if we forbid contractions that create cycles. This allows to define an operational distance on this space, as the minimum number of contractions and expansions required to transform one network into another. We highlight the difference between this distance and the computation of the maximum common contraction between two networks. Given its ability to outline a common structure between them, which can provide valuable biological insights, we study the algorithmic aspects of the latter. We first prove that computing a maximum common contraction between two networks is NP-hard, even when the maximum degree, the size of the common contraction, or the number of leaves is bounded. We also provide lower bounds to the problem based on the Exponential-Time Hypothesis. Nonetheless, we do provide a polynomial-time algorithm for weakly galled trees, a generalization of galled trees.
Access status: Open Access ,
What actually happens in partnered health research? A concordance analysis of agreement on partnership practices in funded Canadian projects between academic and knowledge user investigators
(BMC, 2025-10-06) Sibley, Kathryn; Crockett, Leah K.; Tittlemier, Brenda; Graham, Ian D.
Background: Collaborations involving partnerships between academic researchers and knowledge users can improve the relevance and potential adoption of evidence in health care practices and decision-making. However, descriptions of partnering practice characteristics are often limited to self-report from the lead academic researcher, with no comparison among team members. The primary objective of this study was to determine the extent to which nominated principal investigator (NPI) respondents of a questionnaire about funded Canadian partnered health research projects agreed with other team researchers and knowledge users (KU) on partnership practices. Methods: We conducted secondary analysis of a subset of data from 106 respondents from 53 partnered Canadian health research projects funded between 2011 and 2019. We organized projects into NPI-researcher and NPI-KU dyads, and analyzed 23 binary variables about types of knowledge users involved and approaches for involving knowledge users in the project. We calculated Kappa scores and examined if agreement varied by dyad type and time across three blocks of years of project funding using a two-way ANOVA. We also explored how agreement varied by question type (independent t-test) and by variable (Pearson Chi-Square). Results: Overall agreement on partnership practices was minimal (mean Kappa = 0.38, SD 0.27). NPI- researcher dyads had higher Kappa scores than NPI-KU dyads (p = 0.03). There were no significant differences across funding year blocks (p > 0.05). Agreement on the types of knowledge users engaged in the project was weak (mean Kappa = 0.43, SD 0.32), and there was no difference by dyad type. Agreement was minimal on the approaches for involving knowledge users the project (mean Kappa = 0.28, SD 0.31), and NPI-researcher dyads had significantly higher Kappa scores than NPI-KU dyads (p = 0.03). Variable-level agreement ranged between 47 and 98%. Conclusions: The overall low level of agreement among team members responding about the same project has implications for the continued study and practice of partnered health research. These findings highlight the caution that must be used in interpreting retrospectively assessed self-report practices. Moving forward, prospective documentation of partnered research practices offers the greatest potential to overcome the limitations of recall-based retrospective analyses.
Access status: Open Access ,
HIV vaulnerability among people who inject drugs (PWID): findings from the Bangladesh integrated biological and behavioural surveillance (IBBS) study 2020
(BMC, 2025-10-21) Srivastava, Jessica; Karim, Md. N.; Haseen, Fariha; Hasan, Md.; Rabbani, Md. G.; sultana, Farhana; Alam, Md. S.; Fatima, Sibgha; Munshi, Saif U.
Introduction: People who inject drugs (PWID) contribute significantly to the global HIV burden. Various individual and contextual factors exacerbate the risk of HIV among PWID, this problem is particularly acute in low- and middle-income countries, where resource constraints impede effective prevention and treatment efforts. Although Bangladesh is classified as a low HIV prevalence country, and despite national efforts, including surveillance through the Integrated Biobehavioural Survey (IBBS), gaps in evidence and actionable insights persist. This study aims to analyse the latest IBBS 2020 data to identify risk factors associated with HIV vulnerability among PWID in Bangladesh, informing culturally relevant and targeted harm reduction strategies to mitigate these risks. Method: This study analysed data from IBBS, which used a two-stage cluster sampling and Time Location Sampling methods to recruit participants. Data were collected across four domains: (1) Sociodemographic characteristics, (2) Drug and Injection-Related Behaviours, (3) Sexual Behaviours, and (4) Co-infections, with blood samples collected for HIV, hepatitis-C, and syphilis serological testing. Sample weights were applied to adjust for the complex survey design. Descriptive statistics summarized participant characteristics and risk behaviours. Two binary logistic regression models were used to identify HIV risk factors: The Fully Adjusted Model, which included all plausible confounders and used the Wald backward elimination method to determine significant predictors, and the Partially Adjusted Model, which controlled for age, gender, and education to explore intermediate factors through adjusting confounding or mediation. Result: Overall, the prevalence of HIV among PWID was 4.1%. Social exclusion (AOR: 1.71, 95% CI 1.1, 2.7). Hepatitis C infection (AOR: 2.57, 95% CI 1.6, 4.0), drug use of more than 10 years (AOR: 3.74, 95% CI 1.3, 10.8), injecting once or more daily (AOR: 5.23, 95% CI 2.6, 10.7), having multiple injecting partners (AOR: 3.11, 95% CI 1.8, 5.3) sharing injecting accessories (AOR: 2.55, 95% CI 1.5, 4.4) and engaging with a commercial sex partner (AOR: 1.80, 95% CI 1.1, 2.9) emerged as significant predictors of HIV risk among PWID patients. Conclusion: This study reveals the heightened HIV risk among PWID in Bangladesh, driven by intertwined social, behavioural, biological, and structural factors. It underscores the urgent need for tailored, holistic interventions combining harm reduction, structural reforms, and biomedical strategies to address vulnerabilities, reduce high-risk behaviours, and improve healthcare access for this marginalized group.
Access status: Open Access ,
Correlates of residential detoxification completers and non-completers in Alberta
(BMC, 2025-10-10) Mekonnen, Abreham; Lee, Bonnie K.; Pijl, Em; Larouche, Richard
Objectives: We aimed to identify factors correlated with completion, non-completion and cycling between completion and non-completion among clients admitted to Alberta Residential Withdrawal Management Services. Methods: The study included data on clients from a provincial database (N = 20,020) admitted to residential withdrawal management units across Alberta between April 1, 2015, and March 31, 2022. We collapsed admission-level data into client-level data, where each individual's information is captured as a unique record. Multinomial logistic regression was performed to investigate correlates of completion, non-completion, and multiple cycles of completion and non-completion. Clients in these three categories were compared in their socio-demographics, primary substance of concern, and other program variables of admission count, length of stay, transition to treatment, facilities utilized, days of discharge, and years of admission. Results: The study sample included 39,952 admissions, with an average of two per client. Overall, 55.8% (n = 11,170) of discharged clients completed the program, 25.5% (n = 5,106) were non-completed, and 18.7% (n = 3,744) cycled between completion and non-completion. Regression analysis indicated that clients who used a single substance, primarily alcohol, cocaine and marijuana, completed post-secondary education, were employed or had unstable employment, and were married had lower odds of non-completion. Other variables related to higher odds of completion were urban residence, multiple admissions to a facility, and longer lengths of stay. Conversely, clients who primarily used amphetamines, barbiturates, crystal meth, opiates, and tranquillizers had higher odds of non-completion. Female gender, being discharged on Saturday and Sunday, using detoxification as a standalone service without transitioning to residential treatment and admission to two or more facilities also correlated with higher odds of non-completion. Conclusion: Results indicated that the type of substances, gender, education, marital status, employment, place of residence, and transition to residential services were associated with detoxication outcomes. These findings can inform the customization and allocation of services, targeted support, service intensity and areas requiring additional attention and investment to improve treatment outcomes.
Access status: Open Access ,
Evaluating the efficacy of a novel home-based oral food challenge protocol for pediatric food protein induced enterocolitis syndrome
(BMC, 2025-10-30) Morris, Emily G.; Huan, Peter W.; Protudjer, Jennifer; Li, Lucy; Rondilla, Natalie; Abraham, Jeevan; Kim, Harold
Background: Oral food challenges (OFCs) are considered the gold standard for diagnosis of food protein–induced enterocolitis syndrome (FPIES), a non-immunoglobulin E mediated gastrointestinal food allergy characterized by delayed, repetitive vomiting, lethargy, and sometimes diarrhea, primarily affecting infants and young children. Our modified approach to OFCs involves smaller, gradually increased doses to mitigate the risk of severe reactions. We aimed to measure the successful completion of this OFC protocol. Methods: In a retrospective chart review, patients age < 18 years, who had 1 + episode of acute FPIES between 2015 and 2023 were identified using an allergy clinic database. Patients underwent OFCs with home up dosing every 2–4 weeks. Steps included 1%, 2%, 5%, 10%, 20%, 30%, 40%, 60%, 80%, and 100% of the final serving amount. The primary outcome was successful completion, i.e. absence of severe reactions during the OFC protocol and 1 year after. Data were analysed using logistic regression and reported as odds ratios (OR) and 95% confidence intervals (95% CI). Results: were adjusted for multiple allergic comorbidities, age of FPIES onset, and biological sex. Results Among 47 patients who began the OFC protocol, 38 (80.85%) completed it without significant reactions. Of the 9 (19.14%) who did not complete the protocol, 4 (44.4%) paused due to reactions, and 5 (55.6%) paused due to non-FPIES symptoms. The 4 reactors paused due to mild-to-moderate reactions; there were no severe reactions during the protocol. There were no significant associations identified between OFC completion and severity of symptoms (OR 1.05; 95% CI 0.24–4.71; p = 0.94); age at onset of symptoms (OR 0.99; 95% CI 0.94–1.02; p = 0.58); or age of starting OFC (OR 1.00; 95% CI 0.98–1.02; p = 0.90). Patients who reacted to milk tended to be less likely to complete the protocol than those reacting to other foods (OR 0.28; 95% CI 0.07–1.06; p = 0.06). Conclusions: This study supports the potential for a home-based gradual approach to OFCs in FPIES, evidenced by a high completion rate and no severe reactions.
Access status: Open Access ,
Optimal cerebrovascular reactivity thresholds for the determination of individualized intracranial pressure thresholds in traumatic brain injury: a CAHR-TBI cohort study
(BMC, 2025-10-06) Stein, Kevin; Griesdale, Donald; Sekhon, Mypinder; Bernard, Francis; Gallagher, Clare; Thelin, Eric P.; Raj, Rahul; Aries, Marcel; Froese, Logan; Kramer, Andreas H.; Zeiler, Frederick A.
It has been demonstrated that patient-specific intracranial pressure (ICP) thresholds are possible to derive using the function intersectionality between ICP and cerebrovascular reactivity (CVR). Such individualized ICP (iICP) thresholds represent a potential personalized medicine approach to neurocritical care management. However, it is currently unknown how various CVR thresholds compare in regard to deriving iICP. Here we attempt to identify the CVR thresholds that are best suited for iICP derivation. Leveraging 365 patient data sets from the CAnadian High-Resolution TBI (CAHR-TBI) Research Collaborative, iICP was derived using three ICP-based CVR indices: the pressure reactivity index (PRx); the pulse amplitude index (PAx); and the RAC index, and thresholds ranging from − 1 to + 1, in 0.05 increments. Patients were dichotomized based on 6-month outcome scores into Alive vs. Dead and Favorable vs. Unfavorable outcome. 2 × 2 tables were created for each threshold, grouping patients by outcome and whether their mean ICP was greater or less than their calculated iICP. Chi-squares were calculated for each table and subsequently plotted. The thresholds that produced the largest Chi-square values were identified as those able to derive the iICP with the greatest ability to predict outcomes. Next, Spearman rank correlation testing was used to evaluate associations between iICP, for each threshold, and measures of cerebral physiologic insult burden. With consideration of yield data, ability to predict outcome, and association with cerebral physiologic insult burden, a threshold of + 0.05 was identified for PRx. No optimal threshold could be identified for PAx or RAC.
Access status: Open Access ,
Shaping written corrective feedback perspectives and practices: comparing novice and experienced instructors of English for academic purposes in Bangladesh
(SpringerOpen, 2025-10-11) Alam, Md Zahangir
This qualitative study examined the key influences on the beliefs and approaches concerning written corrective feedback (WCF) of teachers of English for academic purposes (EAP) in Bangladesh. It fills a significant research gap concerning how Bangladeshi EAP teachers—particularly across experience levels—perceive and practice WCF, especially in relation to their understanding of writing instruction within a diverse and resource-limited higher education context. Through six interviews with experienced and novice teachers, the study explored how teacher experience affects perspectives and practices related to WCF. The findings suggest that teaching experience significantly affects beliefs about WCF because experienced teachers benefit from professional development and extensive professional networks. Furthermore, teacher education programmes and professional development opportunities do not benefit all teachers equally; novices have fewer chances, which affects their development differently from their more experienced peers. Experienced teachers—initially exposed to direct grammar-focused WCF as students—have evolved to prefer providing indirect feedback that targets broader aspects, such as content and organisation. Instead, novice teachers focus on providing direct feedback on sentence-level issues, such as grammar and spelling. Finally, it emphasises that context-aware training, institutional support, and resources are key to improving WCF and academic writing in Bangladeshi EAP programmes, with broader relevance for equitable language teaching in similar low-resource settings.
Access status: Open Access ,
Reducing undergraduate students’ trust of commercial contract cheating websites with an academic support literacy intervention
(BMC, 2025-10-14) Kreitz, Sydney; Stoesz, Brenda M.
The acquisition of products and services from the commercial contract cheating industry has an extensive history, with the industry experiencing significant growth during the COVID-19 pandemic. Since then, these commercial entities have added generative artificial intelligence (genAI) to their websites to ensure continued use of their services by postsecondary students. Cheating providers use various other persuasive features (e.g., assurance of quality work, use of the words ‘guarantee’ and ‘secure’) to convince students to trust them and become customers. To counter the efforts of commercial cheating services, education about the cheating industry and academic integrity should reduce any trust that students have in them. We developed an academic support literacy module about appropriate (e.g., university assistance, legitimate tutors) and inappropriate (e.g., contract cheating services) academic support. Before and after the module, 39 introductory psychology students rated how much they trusted various websites using a 12-item consumer trust scale. Although a drop in trust after viewing the module was significant for all three types of academic support websites, it was greatest for contract cheating websites. Significant correlations were also found between the non-planning aspects of impulsiveness (as measured by the Barratt Impulsiveness Scale [BIS-11]; Patton et al. J Clin Psychol 51(6):768–774, 1995) and reputation ratings given for the contract cheating websites. Further study of perceptions (using objective and subjective measures) of contract cheating websites and how aspects of impulsiveness on website perceptions is necessary for the continued development of educational interventions to reduce temptations to engage with the industry. Our study findings contribute to the literature on the promotion of academic integrity and prevention of academic misconduct, particularly contract cheating, through education.

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