University of Manitoba Scholarship

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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 ,
5 Simple Prompts to Streamline the Evidence Synthesis Process
(14th International Congress on Medical Librarianship, 2026-07-16) Lê, Mê-Linh
Aim: The rapid development of readily available artificial intelligence (AI) has resulted in numerous tools and software that can streamline the evidence synthesis process. Depending on an information specialist's expertise, access to funds, and comfort, AI can be integrated into almost any stage of an evidence synthesis. But what about those who don’t have the time, training, or money to access the best models and tools? This presentation will introduce attendees to simple prompts that can be used in any freely available genAI tool (e.g., ChatGPT, Gemini) to easily and efficiently streamline repetitive tasks when creating and translating comprehensive search strategies, documenting search documentation, and drafting communication with team members. Methods: Using freely accessible models provided by OpenAI (ChatGPT), Google (Gemini), and Anthropic (Claude), prompts will be developed and tested that streamline repetitive tasks that are typically performed by information specialists as part of an evidence synthesis. Results: Testing on the prompts using different models is currently underway, and results will be fully available in early 2026. Preliminary use of the prompts in a single model has resulted in decreased time spent on search term development, modification of search syntax, and project administration. Discussion/Conclusion: The use of machine learning and generative artificial intelligence in evidence synthesis has spurred the development of numerous tools and applications. Research on how these technologies affect the work of information specialists is growing rapidly, sometimes to the point of feeling overwhelming or even concerning.1-3 Yet, because information specialists are often asked to contribute to more reviews than they can reasonably accept, AI offers an opportunity to streamline repetitive tasks and free time for higher-level work, whether that means supporting additional projects or focusing on the most complex aspects of a review. The prompts shared in this session can be readily incorporated into any information specialist’s toolkit to enhance efficiency and effectiveness in evidence synthesis.
Access status: Open Access ,
Trajectory of Kidney Function in T1D over Time: A Scoping Review
(Springer Nature, 2026-07-15) Co, Favian; Whitlock, Reid; Katta, Arvind; Aldworth, Carolina; Mares, Jon; Zheng, Zihe; Ferri, Mauricio; Askin, Nicole; Tangri, Navdeep
Introduction: Type 1 diabetes (T1D) is associated with chronic kidney disease (CKD) and major adverse cardiovascular events (MACE). Contemporary data on the natural history of kidney function decline and the effect of therapies on slowing disease progression in T1D-related CKD are limited. We conducted a scoping review to describe the natural trajectory of kidney function and its effects in individuals with T1D in the USA. Methods: In our scoping review of observational studies and grey literature, we searched EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL; Elton B. Stephens Company (EBSCO)], MEDLINE (Ovid), Scopus (Elsevier), Global Health (Ovid), and the Food and Drug Administration from inception to 25 April 2025. The study population included adults (age ≥ 18 years) with T1D in the USA. Our outcomes were change in estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), MACE (myocardial infarction, ischemic stroke, cardiovascular death, unstable angina, or heart failure hospitalization), and healthcare resource use (HCRU). We screened 6437 abstracts and selected 22 texts that matched our criteria. Results: In one cohort, more than 50.0% of individuals with T1D developed moderately increased albuminuria (UACR > 30–299 mg/g) after 20 years and two cohort studies in T1D observed a progressive annual eGFR decline of 3 mL/min/1.73 m2. Five cohort studies found higher proportions of individuals with T1D experienced MACE or kidney failure versus those without T1D. Cross-sectional studies estimated total annual cost of HCRU in the USA at $17–27.8 billion for those with T1D, with annual per-patient costs ranging from $73,534–$112,833 for kidney failure and $40,889–$86,417 for components of MACE. Conclusions: T1D is associated with a high burden of CKD, MACE, and healthcare costs. A clearer understanding of the trajectory of kidney function decline in T1D would help providers and policymakers understand the impact potential therapies to treat T1D-related CKD may have on reducing the risk of kidney failure, MACE, and HCRU.
Access status: Open Access ,
A population-based study on the impact of social determinants of health on time to treatment of stage I lung cancer in Ontario, Canada
(BMC, 2026-05-20) Hanna, Nader M.; Shakeel, Saad; Akhtar-Danesh, Gileh-Gol; Finley, Christian; Akhtar-Danesh, Noori
Background: Timely treatment of Stage I non-small cell lung cancer (NSCLC) is essential to improving outcomes, yet disparities persist in access to treatment across patient populations. This study aimed to assess the association between social determinants of health (SDOH) and time to treatment for patients with Stage I NSCLC in Ontario, Canada. Methods: We conducted a population-based retrospective cohort study using linked administrative databases. Adults diagnosed with Stage I lung cancer between 2007 and 2023 were included if they underwent either surgery or radiotherapy. Patients receiving chemotherapy, or surgery and radiotherapy were excluded. Flexible parametric models were used to evaluate associations between SDOH and time to treatment, stratified by treatment modality. Results: Among 10,734 patients with Stage I NSCLC, 7,366 (68.6%) received surgery only and 3,022 (28.2%) received radiotherapy only. Only 346 (3.2%) received both surgery and radiation. Increased time to treatment was significantly associated with advanced age (> 80 years: HR = 0.61, p < 0.001), higher comorbidity burden (> 5 comorbidities: HR = 0.80, p = 0.004), and being virtually rostered with a family physician (HR = 0.91, p = 0.001). Patients in the lowest neighbourhood income quintile had significantly longer time to treatment compared to higher quintiles (Q5: HR = 1.13, p < 0.001). Those living 50–100 km from a cancer centre experienced longer time to treatment (HR = 0.93, p = 0.011), as did patients treated in the Eastern region (HR = 0.79, p < 0.001) compared to those in the Central region. Time to treatment shortened over time, with improvements seen in 2015–2023 compared to 2007–2009. Conclusions: This study identifies age, comorbidity, socioeconomic status, geographic distance, and regional location as key SDOH associated with prolonged time to treatment for Stage I NSCLC in Ontario. These findings highlight ongoing inequities in cancer care and underscore the need for targeted policy and system-level interventions to improve timely treatment for vulnerable populations.
Access status: Open Access ,
ERVK activity in CD8+ T cell immune cell compartment in patients with ALS
(BMC, 2026-05-23) Sharma, Snigdda; Cortés-Pérez, Claudia; Bird, Sasha; Di Curzio, Domenico; Vandenakker, Alex; Schellenberg, Kerri; Douville, Renée N.
Endogenous retrovirus-K (ERVK) expression has been associated with Amyotrophic Lateral Sclerosis (ALS), and its viral proteins can be detected in affected brain and spinal cord tissues. Despite confirmation of ERVK load in the blood of patients with ALS, few studies have examined ERVK protein expression in immune cells. ERVK produces an enzyme called integrase (IN), which can cause DNA damage during the integration of viral DNA into the host genome. Given that genomic instability is a hallmark of ALS, we hypothesized that the ERVK IN enzyme may also be expressed in lymphoid and myeloid-derived immune cells of patients. Peripheral blood mononuclear cells (PBMC) were isolated from blood specimens using Ficoll isolation, and either flash-frozen for western blot analyses or affixed onto slides using the cytospin technique for subsequent confocal microscopy analysis. Image analysis of confocal micrographs revealed that ERVK IN expression was significantly elevated in CD3+CD8+ T cells from a subset of patients with ALS as compared to controls. CD3+CD8+ T cells in ALS exhibit enhanced number and size of ERVK IN puncta within the nucleus and at the plasma membrane. The DNA damage load, as measured by marker γH2AX, was strongly associated with ERVK IN levels in both controls and patients with ALS. Stratification of molecular data based on clinical parameters showed an association of elevated ERVK IN load in CD8+ T cells from patients with ALS with lower ALSFRS-R and higher King’s scores, as well as a significant decline in lung function metrics. In bulk PBMC from patients with ALS, ERVK IN was associated with expression of immune checkpoint marker PD-1, but not T cell exhaustion marker TOX. ERVK IN in CD14+CD11b+ myeloid cells was also elevated, with ERVK+ cells exhibiting notable membrane ruffling typical of immune cell activation and increased expression of HLA-DR. However, ERVK IN expression in monocytes was not correlated with clinical metrics in patients with ALS. This work points to the use of ERVK IN in CD8+ cytotoxic T cells as a blood biomarker for ALS clinical trials, especially those focused on testing the efficacy of antivirals as a therapeutic strategy for ALS. Graphical Abstract
Access status: Open Access ,
Correction: From chromosomal protein disorder to chromatin phase separation
(BMC, 2026-07-30) Davie, James; Ausió, Juan
Access status: Open Access ,
Prevalence, semiology and neuroimaging of movements in comatose adults at risk of death by neurologic criteria: a prospective cohort study
(BMC, 2026-05-14) Neves Briard, Joel; English, Shane W.; Fergusson, Dean A.; dhanani, sonny; Lauzier, François; Turgeon, Alexis F.; Ball, Ian; Darvesh, Sultan; Titova, Polina; Lebrasseur, Martine; Couillard, Philippe; Kramer, Andreas; D’Aragon, Frédérick; Hannouche, Mathew; Burns, Karen E. A.; Boyd, J. G.; Binnie, Alexandra; Wang, Han T.; Shemie, Sam; Shankar, Jai J. S.; Chassé, Michaël
Purpose: In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion. Methods: In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites. Results: We included 282 participants with a median [IQR] age of 60 [47—69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22—32%) and 12% (95% CI: 9—16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63—2.05; aOR for MUO: 1.36, 95% CI: 0.61—3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77—2.68; aOR for MUO: 1.75, 95% CI: 0.77—3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC. Conclusions: SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion. Trial registration: Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017. Graphical abstract
Access status: Open Access ,
Resource availability and anthropogenic disturbance alter how wolves move and feed: comparing two populations
(BMC, 2026-05-22) Prokopenko, Christina M.; Kingdon, Katrien A.; Dupont, Daniel L. J.; Carswell, Brendan M.; Naaykens, Taylor; Prokopenko, John; Turner, Julie W.; Zabihi-Seissan, Sana; Wal, Eric V.
Animals behave ‘optimally’ when they minimize their costs while maximizing their energetic gain. Optimal foraging theory predicts that with decreasing resource abundance, animals will increase 1) niche breadth, 2) territory size and movement distance, and 3) time spent at resource patches. We used optimal foraging as a guiding framework to test what drives differences in behaviour of GPS collared wolves in two predator populations. As expected, niche breadth and territory sizes were larger, movement rates were greater and cluster durations were longer in the study area with relatively lower resource abundance Our comparative test through the lens of optimal foraging theory led to some unexpected discoveries. Specifically, differences in these responses were not explained by the density of the large primary prey (moose) but instead anthropogenic disturbance (linear feature density) was a ubiquitous influence on wolf behaviours. Wolves in higher linear feature density responded by reducing their cluster residency and increased step lengths and territory sizes with increases in linear feature density. Our work provides evidence that large carnivores can mediate changes in resources by adjusting their space use and time budgets in a way that corresponds with optimal behaviour - maximizing their energy gain and minimizing costs.
Access status: Open Access ,
Disrupting power hierarchies: applying a trauma- informed, intersectional, reflexive engagement strategy
(BMC, 2026-07-01) Brown, Cara; Thille, Patricia; Ganann, Rebecca; Allison, Teresa; Moorhouse, Simone; Pelletier, Gail C.; Rawsthorne, Patricia E.; El-Alawi, Aya
People with lived experience in health care, like patients and their family and/or friend caregivers, are important to include in the research process to improve impact and relevance of research. However, these lived experience researchers (LERs) can be harmed if this engagement is done poorly, especially though tokenization, or through the reliving of health care related traumatic experience. Five LERs joined a research team that collaboratively developed a research proposal through seven workshops. The research topic was of care transitions from hospital to home, of which all five LERs had lived experience as patients or caregivers. To mitigate harm for the LERs, the project was designed with a trauma-informed, intersectional and reflexive approach, with a focus on disrupting historical power structures inherent in research and health care systems. The engagement design was planned a priori and uniquely incorporated regular feedback mechanisms and strategies to support reflexivity for all team members. This engagement strategy had some success in disrupting standard power hierarchies that persist in research teams and can impede meaningful LER engagement. Ultimately the LERs felt heard and understood by the team and developed strong relationships with the principal investigator (PI) and project coordinator, and they contrasted this experience with other health and research experiences where they perceived their input to have less weight. The reflexive approach revealed what aspects of the engagement were going well, and which continued to be plagued by historical power and hierarchies inherent in academic and health systems. While the continual feedback process did not allow the team to completely overcome these hierarchies, it brought them to light so that they could be addressed as much as possible within the context of the project, and we share three examples in this commentary. We hope that this detailed description of developing a research proposal using a power-focused framework with a team with multiple LERs helps to address the gap in the literature about how researchers can support the reduction of power hierarchies when engaging LERs.
Access status: Open Access ,
Co-design in action: lessons learned from transplant patient and family engagement in an integrated knowledge translation strategy during the COVID-19 pandemic
(BMC, 2026-07-23) Cameranesi, Margherita; Logan, Sherrie; de Vries, Rienk; Escoto, Manuel; Hébert, Marie-Josée; Kabbani, Dima; Piotrowski, Caroline; West, Lori; Gongal, Patricia
Background: The COVID-19 pandemic significantly impacted immunocompromised individuals, particularly transplant recipients. Despite their vulnerability, national- and international-level research often lacks direct input from this community. In response, the Canadian Donation and Transplantation Research Program (CDTRP) implemented an integrated knowledge translation (iKT) strategy that involved patient, family, and donor (PFD) partners as co-leads and decision makers throughout the research process. Methods: Beginning in 2022, CDTRP adapted a co-engagement model to identify research priorities and inform study design, conduct, and knowledge mobilization related to COVID-19 issues for transplant recipients. Diverse stakeholders, including researchers, clinicians, policymakers, trainees, transplant-focused organizations, and PFD partners, collectively co-developed the TREAT-COVID research project. In 2022–2023 CDTRP hosted a series of four national forums that were co-designed and co-facilitated by PFD co-leads, enabling shared decision making and iterative refinement of research priorities and strategies. This paper provides an overview of the iKT strategy implemented, including objectives, engagement processes, outputs, resulting study adaptations, and lessons learned. Results: Each forum generated new insights and actionable changes. Forum 1 identified research priorities, including clinical therapeutics, psychosocial needs, quality of life, economic burden, and recovery-related supports. Forum 2 emphasized mental health and support for transplant recipients and their caregivers. Forum 3 identified the distinct but complementary priorities of transplant recipients and their caregivers, such as clinical care and mental wellness, respectively. Forum 4 addressed barriers to recruiting study participants and refined communication strategies. These forums collectively shaped the TREAT-COVID research project by informing study priorities, data collection tools, recruitment strategies, and knowledge mobilization. Conclusions: This paper details the iKT strategy implemented by the CDTRP to engage diverse stakeholders in COVID-19-related research for transplant communities. Meaningful and structured patient and family involvement in national health research during a public health emergency was prioritized. By involving patient and family partners in governance, facilitation, study refinement, recruitment, and dissemination, CDTRP advanced a collaborative and equity-driven iKT model. The paper contributes an operational example of national-scale patient and family co-leadership in time-sensitive research.
Access status: Open Access ,
Unpacking Credit: Gender and Contribution Statements in Health Library Scholarship
(14th International Congress on Medical Librarianship, 2026-07-16) Monnin, Caroline; Lê, Mê-Linh; Fuhr, Justin
AIM: Health librarians are important advocates for promoting awareness and compliance with best practices in scholarly communication, in addition to producing their own research. In this role, they also emphasize transparency and equity when it comes to authorship and contributions. Journal article contributor statements, such as the Contributor Roles Taxonomy (CRediT), assign contributorship to authors using standardized vocabularies. CRediT is the most well-known statement and is used by over forty large publishers and research organizations. An ongoing study looking at research in library and information science (LIS) research found that contributor statements are used in only 6% of LIS journals. This presentation measures its usage in health science librarianship research, and we anticipate that due to health librarians' contributions to evidence synthesis research, the rate of contributor statements will be higher compared to LIS scholarship. This research also investigates whether the gender of health library authors influences which CRediT roles they are assigned. While all CRediT roles are important, some align more closely with principal investigator responsibilities (e.g., supervision) while others are more supportive in nature (e.g., project administration). METHODS: This research will identify all scholarly journal articles from ten peer-reviewed health science library journals published in the first issues of 2023, 2024, and 2025. Information on contributor statements, roles, and author names will be extracted. We will use WikiGenderSort to assign gender, allowing us to analyze gender and contributor roles. Using contributor statements in each article, we will collect data on compliance with journal requirements, rates of authors providing statements when not required, and/or the lack of contributor statements altogether. RESULTS: Our analysis is ongoing, and full results will be available by January 2026. DISCUSSION: This is the first study that analyzes author contribution statements and gender in health librarianship. Attendees will reflect on their own approach to author contribution statements, analyze gender dynamics in health library research, and consider strategies to ensure research contributors receive proper credit. They will develop a deeper understanding of the benefits and challenges of using contributor statements in academic publishing, and how to promote their use among co-authors and journal editors.
Access status: Open Access ,
Timeliness, continuity or travel time: results of a choice-based analysis exploring public preferences for access to primary care in Canada
(BMC, 2026-03-27) Kiran, Tara; Daneshvarfard, Maryam; Beyer, Alexander; Martin, Danielle; Breton, Mylaine; McCracken, Rita K.; Lavergne, M. R.; Kovacina, Neb; Katz, Alan; Pinto, Andrew D.; Kay, Jasmin; MacLeod, Peter; van der Linden, Clifton
Background: Access and continuity are two pillars of primary care that are often in tension. While both are important to patients, it is unclear which they prioritize. This study examines public preferences for timeliness, continuity, and travel time to primary care in Canada using a discrete choice experiment. Methods: The experiment was embedded in a national online survey of adults in Canada. Respondents were randomly assigned to one of four clinical scenarios (worsening depression, new sore throat, new sexually transmitted infection, or worsening diabetes) and completed a discrete choice experiment selecting between two hypothetical primary care options. Each option varied in timeliness (same/next day, 2–7 days, 1 week–1 month), continuity (regular provider, unknown provider with or without access to records), and travel time (≤ 10 min, 10–30 min, > 30 min). We estimated marginal means (MM) to assess attribute preferences and conducted stratified analyses by socio-demographic characteristics. Responses were weighted to be demographically representative of the Canadian population. Results: We analyzed data from 9276 survey respondents. All three primary care attributes significantly impacted decision-making, with timeliness and continuity being more important for decision-making than travel time. For example, for depression, 75% of participants (95% CI 73%-77%) opted for healthcare options that offered the quickest appointment, 66% (95% CI 64%-68%) opted for care with their regular clinician, and 56% (95% CI 54%-58%) favored the shortest travel time less than 10 min. Including the third level of each care attribute in a healthcare option significantly reduced the likelihood of selecting that option. Preferences did not vary substantially by socio-demographic characteristics. Conclusions: Both attributes of access and continuity were consistently prioritized by respondents, with preferences remaining stable across respondent characteristics. Our findings highlight the need for care models that offer timely access with familiar clinicians, or alternatives that maintain informational continuity.
Access status: Open Access ,
Development of a personalized, modular intervention to promote dignity, meaning and mindfulness in palliative patients in a swiss acute-care hospital
(BMC, 2026-04-10) Klatte, Katharina; Seiler, Annina; Schweighoffer, Reka; Meinlschmidt, Gunther; Walter, Silke; Mai, Sandra S.; Jenewein, Josef; Chochinov, Harvey; Rodin, Gary; Schaefert, Rainer; Eckstein, Sandra
Background: Patients with serious, life-limiting diseases often experience substantial emotional and spiritual distress, death anxiety, depressive symptoms, and loss of dignity. Fostering dignity and meaning and relieving psychological distress have been identified as core objectives of palliative care. To address the individual needs of palliative patients, a personalized, modular intervention approach may be advantageous. Aim: Based on previous work, we aimed to develop a personalized, modular approach to improve dignity, meaning, and mindfulness in palliative care patients. Methods: An expert panel of international specialists in palliative care, dignity therapy, psychotherapy, clinical psychology, psychiatry, and psychosomatic medicine was convened to develop the proposed modular approach. Intervention development is described following the “Template for Intervention Description and Replication” TIDieR guidance and is based on results from a literature search on previous work on dignity, meaning-centered therapy, and mindfulness-based interventions, as well as on in-depth needs assessments. Results: Based on the expert consensus, a three-modular approach was formulated, with evidence-based modules providing Dignity Therapy, Managing Cancer and Living Meaningfully (CALM) therapy, and mindfulness-based interventions, each addressing complementary aspects. Conclusion: A personalized, modular intervention to promote dignity, meaning, and mindfulness in palliative care patients was developed by a panel of international experts using existing dignity-fostering end-of-life interventions. The resulting modular approach was designed with the aim to address patients’ individual needs.
Access status: Open Access ,
Model-based algorithms to ascertain smoking in administrative health data: a registry-based validation study
(BMC, 2026-03-29) Haque, Md Ashiqul; Nickel, Nathan C.; Turgeon, Maxime; Lix, Lisa
Background: Accurate measurement of smoking in population-based administrative health data (AHD) poses challenges due to the indirect nature of smoking-related information collection. While most studies use rule-based algorithms (RBAs) based on diagnosis codes, model-based algorithms (MBAs) utilizing machine learning (ML) with diverse data features might have better sensitivity and accuracy. We developed ML model-based algorithms (MBAs) for ascertaining smoking in AHD and compared them to RBAs. Methods: We conducted a retrospective cohort study using AHD (hospital abstracts, medical claims, and prescription drug records) from April 1, 2012, to March 31, 2020, from Manitoba, Canada. The study included adults (≥ 18 years) from a clinical registry containing self-reported current smoking. Clinical data were linked with up to five years of hospital records, physician billing claims, and prescription medication records. RBAs were based on diagnosis codes for tobacco use and nicotine dependence medication. MBAs, constructed using Random Forest (RF) and Least Absolute Shrinkage and Selection Operator (LASSO) models, included smoking indicators, comorbid condition, and sociodemographic factors. Training and test datasets were used to develop and evaluate the MBAs, respectively. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), balanced accuracy, and their 95% confidence intervals (CIs) were estimated. Results: The cohort comprised 24,718 individuals (88.6% female); prevalence of current smokers was 10.0%. A comprehensive RBA had sensitivity 23.3% (95% CI: 20.3–26.5), specificity 98.9% (95% CI: 98.7–99.2), and PPV 70.9% (95% CI: 65.1–76.1). An MBA based on RF had sensitivity 66.8% (95% CI: 63.3–70.2), specificity 77.8% (95% CI: 76.8–78.8), and PPV 25.1% (95% CI: 23.8–26.4). NPV was consistently above 90.0%. MBAs had higher balanced accuracy than RBAs. Stratified analyses by sex and residence location revealed differences in estimates for MBAs and the RBAs. The number of years of AHD did not affect the MBA results. While MBAs had better sensitivity, RBAs had better specificity. Conclusions: Our study highlights the potential of comprehensive data integration and ML methods to improve the sensitivity and accuracy of smoking identification in AHD. Balancing accurate smoker identification with the risk of false positives is crucial when choosing an algorithm to ascertain current smokers using AHD.
Access status: Open Access ,
A novel algorithm for the continuous determination of individualized intracranial pressure (iICP) thresholds using a multi-window weighted approach
(BMC, 2026-04-07) Stein, Kevin Y.; Froese, Logan; Sainbhi, Amanjyot S.; Vakitbilir, Nuray; Bergmann, Tobias; Silvaggio, Noah; Hasan, Rakibul; Herath, Isuru; Hayat, Mansoor; Moon, Jaewoong; Zeiler, Frederick A.
Abstract Background Individualized intracranial pressure (iICP) thresholds, defined as the function intersectionality between intracranial pressure (ICP) and cerebrovascular reactivity (CVR), represent a promising potential approach to personalized medicine in neurocritical care. However, current iICP derivation methods fail to account for the variable quality of iICP estimates and rely on entire recording periods, limiting their use to retrospective, post-hoc calculations and thereby limiting clinical applicability. Therefore, the goal of this study was to develop an automated, continuous iICP derivation algorithm that provides accompanying quality metrics, evaluate the algorithm’s performance, and identify patient-related factors influencing derivation yields. Methods A custom algorithm employing a multi-window weighted approach was developed for the continuously updating derivation of iICP. The algorithm was designed to concurrently generate quality metrics alongside iICP outputs, which grade key characteristics of the underlying ICP-CVR curves. The algorithm was tested on a cohort of 131 moderate-to-severe traumatic brain injury (TBI) patients from the Winnipeg Acute TBI Database. Multiple iterations of the algorithm, with varying parameter settings, were tested to assess algorithm performance. Subgroup analyses were performed to identify demographic-, admission-, and treatment-related factors that may influence derivation yields. Results Algorithm performance varied significantly with parameter selection, including modeling method, CVR index-threshold combination, and update frequency. The best performing iteration achieved a median derivation yield of 66.1%. The use of modeling methods in conjunction, the use of the pressure reactivity index and thresholds of + 0.20 and + 0.25, and the use of higher update frequencies were shown to be associated with superior algorithm performance. Time-based subgroup analyses revealed lower yields during the early phases post-injury, while demographic-, admission-, and treatment-related factors showed minimal influence on algorithm performance. Conclusion This study demonstrates the feasibility of deriving iICP thresholds in a continuously updating fashion. While promising, further optimization is needed to improve derivation yields and enable bedside implementation. Moreover, comprehensive outcome and physiologic analyses are needed to clarify the relationships of iICP with long-term outcomes and cerebral physiologic insult burden.
Access status: Open Access ,
Clinical, social, and home-level factors associated with the quality of life of residents living with dementia in Canadian nursing homes: a cross-sectional, multi-province study
(BMC, 2026-04-18) Dusing, Gabriel J.; Corbett, Kyle; Dymchuk, Emily; O’Rourke, Hannah M.; Chamberlain, Stephanie A.; Doupe, Malcolm B.; Kelly, Christine; Keefe, Janice; Aubrecht, Katie; Beeber, Anna S.; Arya, Amit; Banerjee, Sube; Jarrett, Pam; Estabrooks, Carole A.; Shrestha, Shovana; Devkota, Rashmi; Ristau, Melissa; Hoben, Matthias
Abstract Background Quality of life (QoL) is a central priority in dementia care, yet most nursing homes (NHs) in Canada rely on clinical indicators that do not capture the emotional and social dimensions of residents’ well-being. Little is known about how clinical, social, and NH factors jointly shape QoL for residents living with dementia. This study examined the associations of resident social characteristics, clinical conditions, and NH factors with resident QoL. Methods This cross-sectional study included publicly funded NHs in the Canadian provinces of Alberta, British Columbia, Manitoba, Nova Scotia, and Ontario. QoL was measured using staff-proxy interviews to complete the DEMQOL-CH. Staff also provided information about resident social characteristics. Clinical data were obtained from routinely collected, standardized resident assessments. NH characteristics were reported by administrators. We used linear regression with robust standard errors to assess associations of social, clinical, and NH variables with resident QoL. Multiple imputation addressed missing data, and model fit was compared using the Akaike Information Criterion. Results The final sample included 2,950 residents in 67 NHs. Older age was also associated with lower QoL (-0.009 per standard-deviation increase in age, 95%CI: −0.016; −0.002). Clinical factors that were significantly associated with lower QoL were: depressive symptoms (coefficient=-0.066, 95%CI: -0.082; -0.050), responsive behaviours (-0.034, 95%CI: -0.054; -0.015), and health instability (-0.027, 95%CI: -0.045; -0.010). More severe cognitive impairment was associated with higher staff-rated QoL (0.039, 95%CI: 0.023; 0.055). Compared with Ontario, residents in British Columbia (− 0.059, 95%CI: −0.079; −0.040) and Manitoba (− 0.039, 95%CI: −0.061; −0.017) had lower QoL. Living in a large NH was associated with lower quality-of-life scores relative to small homes (− 0.034, 95%CI: −0.051 to − 0.016). The combined model, which incorporated social, clinical, and facility factors, had the best fit. Conclusions QoL in Canadian NHs appears to be shaped primarily by resident clinical conditions and facility environments rather than individual social characteristics. Interventions that address mental health, behavioural symptoms, and environmental stressors may yield the greatest improvements in resident well-being.
Access status: Open Access ,
Minosin Kikiwa
(CCPA-Manitoba, 2024-10) Bruce, Lucille; Mason, Joanne; Sansregret, Rachel; Summer, Ursula; Simmons, Gisele; Brock, Carolyn; Cameron-Munroe, Lorraine; Morrison, David; Mallett, Kathy; Luo, Hai; Funk, Laura; Dunsmore, Rachel; Disbrowe, Malcolm; Villeneuve-Monias-Braun, Lynsie
In the fall of 2022, two local Indigenous community leaders, Lucille Bruce and Joanne Mason, formed our Indigenous Seniors Research Committee. We wanted to learn from Indigenous seniors in Winnipeg to understand their housing and care experiences, needs, and preferences. We also wanted to bring people together to think about different models of housing and support and use this research to advocate for better living conditions and quality of life, from a holistic, culturally-informed perspective. In 2023, we spoke with 48 Indigenous older adults (aged 55+) living in Winnipeg, through individual interviews or discussion based focus circles. As part of this first step of the research, we also spoke with nine community knowledge-keepers. In the second step of the project, findings were used to prompt further reflection and discussion at a larger focus circle held with 29 participants (either new or returning) in January 2024.
Access status: Open Access ,
Association between neurofilament light chain concentrations and outcomes in patients with moderate to severe traumatic brain injury: a systematic review and meta-analysis
(BMC, 2026-05-04) Bouras, Marwan; Pageau, Mathieu; Gagnon, Marc-Aurèle; Costerousse, Olivier; Demers, Karolane; Grenier-Gagnon, Anouk; Isaac, Chartelin J.; Torkomyan, Tomas H.; Lauzier, François; Zarychanski, Ryan; Francoeur, Charles L.; Gerges, Peter; Abiala, Godwill; Moore, Lynne; Englis, Shane W.; Turgeon, Alexis F.
Background: Moderate to severe traumatic brain injury (TBI) is associated with high rates of mortality and long-term disability. Accurate biomarkers are needed to predict longterm neurological outcomes and guide decision-making early after TBI. Neurofilament light chain (NfL), a structural protein of neurons, has emerged as a promising candidate, but its association with outcomes in this population remains uncertain. Methods: We conducted a systematic review and meta-analysis to assess the association between blood or cerebrospinal fluid NfL concentrations and outcomes in adults with moderate to severe TBI. We searched MEDLINE, Embase, Cochrane CENTRAL and Web of Science from inception to October 2025. Eligible studies included cohort studies or randomized controlled trials reporting NfL levels measured during the acute phase and reporting at least one outcome of interest. Our primary outcome was long-term neurological function, defined as the latest available Glasgow Outcome Scale (GOS) or Glasgow Outcome Scale–Extended (GOS-E) score, dichotomized into unfavorable (GOS ≤ 3 or GOS-E ≤ 4) and favorable (GOS > 3 or GOS-E > 4). Mortality, at any time point, was a secondary outcome. Risk of bias was assessed using an adapted scale from the QUADAS-2 tool, and certainty of evidence was evaluated using GRADE criteria. Results: Fourteen studies (2,905 participants) were included, with ten (n = 1,648) contributing to the meta-analysis for our primary outcome. Higher NfL concentrations were associated with unfavorable neurological outcomes, with moderately higher levels in patients with poor outcomes compared with those with favorable outcomes (SMD 0.45, 95% CI 0.33–0.56; I² = 12%). Six studies (n = 483) assessed mortality; higher NfL concentrations were associated with increased mortality (SMD 0.71, 95% CI 0.04–1.39; I² = 82%), with a more consistent association when NfL was measured within 24 h after injury (I² = 0%). The certainty of evidence was graded as very low for both outcomes, reflecting risk of bias and, for mortality, additional inconsistency and imprecision. Conclusions: Higher NfL concentrations were associated with unfavorable neurological outcomes after moderate-to-severe TBI. The association with mortality was more uncertain and should be interpreted with caution given the substantial heterogeneity across studies. Its incremental prognostic value beyond known predictors remains uncertain. Trial registration: PROSPERO CRD42022332110, 22 May 2022.
Access status: Open Access ,
Impact of risk mitigation measures on oral fluoroquinolone prescribing: a multi-site population-based Canadian cohort study
(BMC, 2026-03-25) Lix, Lisa; Dahl, Matthew; St-Jean, Audray; Golandouz, Hassan M.; Ling, Vicki; Janzen, Donica; Ronksley, Paul E.; Scory, Tayler D.; Dutton, Daniel J.; Manning, Devin; Carney, Greg; Perras, Christine; Ernst, Pierre
Background: Use of fluoroquinolones (FQs), broad-spectrum antibiotics, has been linked to adverse health outcomes and resulted in safety warnings by regulatory agencies worldwide. We tested the effect of Canadian risk mitigation measures (RMMs) introduced in January 2017 on FQ prescription rates. Methods: We conducted a retrospective multi-site cohort study using administrative data from six Canadian provinces. The cohort included adults (18 + years) with outpatient prescriptions for four oral systemic FQs (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin) between 2008 and 2022. Overall FQ prescription rates and percentage of FQ prescriptions for three antibiotic indications (acute bacterial sinusitis [ABS], acute exacerbation of chronic obstructive pulmonary disease [AECOPD], urinary tract infection [UTI]) were assessed before and after RMMs were introduced. Segmented generalized linear models were applied to monthly prescription rates and percentages for: (1) pre-RMM (January 2008-December 2016; reference), (2) post-RMM pre-COVID (January 2017-Feburary 2020), and (3) post-RMM within-COVID (March 2020-December 2022) segments. We estimated province-specific relative rates (RR) for the post-RMM segments and slope coefficients for pre- and post-RMM segments and their 95% confidence intervals (CIs) and pooled them using random-effects models. Results: Crude annual FQ prescription rates decreased from 107.5 to 45.0 per 1,000 population over the study period; in the pre-RMM segment, age- and sex-adjusted rates decreased an average of 0.30 per 1,000 population per month (95% CI: 0.19–0.41); province-specific estimates of decrease ranged from 0.16 to 0.48. The pooled RR for the post-RMM pre-COVID segment was 0.50 (95% CI: 0.43–0.59); the post-RMM within-COVID segment pooled RR was similar (RR = 0.38; 95% CI: 0.29–0.50). The decline in percentage of FQ prescriptions post-RMM pre-COVID was largest for UTI (pooled RR = 0.32, 95% CI: 0.25–0.41), followed by ABS (RR = 0.41, 95% CI: 0.34–0.51) and AECOPD (RR = 0.51, 95% CI: 0.37–0.69), although there was variation across provinces. Conclusions: Canadian RMMs for FQ use were associated with a decrease in prescription rates overall and for three indications, although rates had begun to decline before RMMs were introduced and the magnitude of decrease varied across provinces. Safety warnings tailored to specific indications and regional practices may be needed to address variation in FQ prescribing. Trial registration: HMA-EMA catalogue of real-world data studies (Study ID: 108,049).
Access status: Open Access ,
Development of risk prediction model for chronic pain after knee replacement surgery: protocol for an individual patient data meta-analysis
(BMC, 2026-03-19) Sadeghirad, Behnam; Khalili, Malahat; Busse, Jason W.; Abdelkader, Wael; Foroutan, Farid; Mbuagbaw, Lawrence; Gilron, Ian; Khan, James; Madden, Kim; Tushinski, Daniel; Bohm, Eric; Gademan, Maaike G. J.; Poolman, Rudolf W.; Adili, Anthony; Perruccio, Anthony V.; Rampersaud, Y. R.; Righolt, Christiaan; Shanthanna, Harsha; Khaled, Maram; Gabbott, Ben; Marcucci, Maura; Zalzal, Paul; Griffin, Xavier; Schemitsch, Emil; Iorio, Alfonso
Background: Chronic post-surgical pain (CPSP) impacts approximately one in four patients following total knee arthroplasty (TKA) and is associated with reduced function and quality of life. We will conduct a systematic review of prospective studies to identify eligible data and establish an international repository of individual patient data (IPD) on prognostic factors for chronic pain after TKA. This repository will be then used to develop and validate a prediction model for CPSP following TKA. Methods: We will identify eligible studies through a search of MEDLINE, CINAHL, EMBASE, and Cochrane CENTRAL from January 2005 to August 2025. We will include prospective studies that: (1) enrolled adults undergoing elective TKA, (2) assessed perioperative risk factors for CPSP, and (3) measured knee pain longitudinally at least 3 months post-surgery. Pairs of reviewers will independently screen titles and abstracts of retrieved citations and review the full texts of potentially eligible studies. We will reach out to principal investigators or authors of eligible studies to notify them of our initiative and request to receive their IPD into a secured repository, based on a data sharing agreement. We will use a one-stage approach for IPD meta-analysis of factors associated with CPSP following TKA, and development of a risk prediction model. Discussion: We will use anonymized de-identified data for our IPD meta-analysis. This protocol was reviewed and approved by the Hamilton Integrated Research Ethics Board (HiREB). We will develop an online calculator to support our risk assessment model for research and clinical use. This IPD meta-analysis will facilitate the development of a robust prognostic model to guide clinical decisions or enrolment in interventional studies, with the ultimate goal of identifying pathways to effective CPSP prevention strategies after TKA. Trial registration: CRD42024591329.
Access status: Open Access ,
Lessons learned: challenges in recruiting and engaging people with heavy cannabis use for online interventions in Canada
(BMC, 2026-04-16) Rysen, Karli K.; Mackenzie, Corey S.; Carusone, Julian M.; Schaub, Michael P.; Wenger, Andreas; Wallbridge, Harold; Edgerton, Jason D.; Kruk, Richard; Keough, Matthew T.
Background: People who seek treatment often disengage between completing screening and starting treatment. Among those who begin treatment, many have low completion of program content and are lost to follow up. Currently, little is known about predictive factors of treatment initiation and engagement. The aims of this secondary analysis of the Canadian CANreduce program were to discuss the practicality of a randomized controlled trial for online heavy cannabis use treatment and to examine predictors of treatment initiation and engagement in the Canadian CANreduce program. Method: The CANreduce intervention was pre-registered on clinicaltrials.gov for traceability (ID: NCT04965012). Statistical models were organized into three conceptual predictor groupings using baseline data: individual cannabis-specific factors, mental health and other substance use factors, and treatment belief factors. Binary logistic regressions examined which factors predicted treatment initiation in the CANreduce treatment program and multiple regression analyses examined which factors predicted percentage of the CANreduce program modules completed among participants who initiated treatment. Results: Despite following the core elements of published treatment retention protocols, challenges in recruitment were evident. Of 928 people who created a profile on the website and began screeners, 86.3% (n = 801) completed screeners. Of the 801 who completed screeners, 31.3% (n = 251) were eligible for the program. Of those eligible and assigned to active treatment, 54.3% (n = 51) assigned to the therapist condition and 45.7% (n = 43) assigned to the research assistant condition initiated treatment. Treatment initiation predictors included higher cannabis use problems score, lower family history density, increased alcohol use frequency, and more positive attitudes towards treatment. Treatment engagement (percentage of program completed) predictors included increased social motives for cannabis use and more positive attitudes towards treatment. Discussion: This secondary analysis shifts the focus from treatment efficacy to pre-treatment attrition and early engagement in an online cannabis intervention. Substantial recruitment and initiation challenges were observed, highlighting vulnerabilities in the treatment-seeking pathway before content is accessed. By identifying predictors of treatment initiation and module completion, this study offers practical “lessons learned” to inform recruitment and engagement strategies in future online cannabis trials.

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