Canadian Research Research Articles

Consent and Inclusion of People Living with Dementia (PLWD) in Research: Establishing a Canadian Agenda for Inclusive Rights-Based Practices.

People living with dementia (PLWD) may want to participate in research, but the guidelines and processes enacted across various contexts may prohibit this from happening. Understanding the experiences of people with lived experiences of dementia requires meaningful inclusion in research, as is consistent with rights-based perspectives. Currently, the inclusion of PLWD in Canadian research is complex, and guidelines and conceptual frameworks have not been fully developed. This research note outlines a three-year proof-of-concept grant on the inclusion and consent of PLWD in research. It presents a brief report on some of the contradictions and challenges that exist in legislation, research guidelines, and research practices and raises a series of questions as part of an agenda on rights and inclusion of PLWD in research. It suggests conceptual, legal, and policy issues that need to be addressed and invites Canadian researchers to re-envision research practices and to advocate for law and policy reform that enables dementia research to align and respect the rights and personhood of PLWD.

Problematizing Dominant Assumptions about Unpaid Support through Exploring Case Study Profiles of Older Home Care Clients

Despite efforts to acknowledge diversity among unpaid caregivers, Canadian research, advocacy, practice, and policy tend to be based in and to reproduce dominant social and institutional expectations and assumptions about who provides unpaid support and why, and what this support looks like. The objective of thtudinal, qualitative research study. In that study, qualitative case study interviews were conducted with twelve home care clients, their identified family or friend caregiver, home care aide, case coordinator, and agency supervisor (129 interviews in total). Case study profiles compiled over time generated deeper information about the availability and capacity of informal sources of support for these clients, which prompted abductive analysis in relation to dominant assumptions typically made about caregivers in research, policy, and practice. Specifically, only one case (participant) had a caregiver whose profile closely matched dominant conceptualizations. In the remaining eleven cases, we found situations wherein: (a) caregivers grappled with physical or mental health challenges limiting their participation in care (sometimes meaning the client is themselves a caregiver, or the caregiver is also receiving home care services); (b) caregivers facing burnout sought to delimit their participation in care; (c) caregivers’ participation was limited by older adults’ reluctance to accept their help; (d) caregivers were largely unavailable, unreliable, or peripheral; or (e) client’s unpaid support networks were diffuse without a clearly central or identifiable “caregiver.” Findings are used to nuance and problematize widely held assumptions about caregivers, particularly their availability and capacity. Discussion highlights the need for research, policy, and programs related to unpaid caregiving to better reflect the lived realities of this support for older adults and often overlooked sources of diversity in caregiver circumstances and roles.

Dietary intake and food sources of calcium and vitamin D in young children in the Guelph Family Health Study

Canadian research on dietary intake of calcium and vitamin D in young children is limited. This cross-sectional analysis investigated dietary intake and food sources of calcium and vitamin D among 265 preschool-aged children (3.6 ± 1.2 years) in the Guelph Family Health Study via one 24-h dietary recall completed by their parents using the Automated Self-Administered 24-H Dietary Assessment Tool 2016-Canadian version. Median intakes of calcium and vitamin D were 827 mg d−1 [Interquartile range (IQR) = 522] and 4.0 μg d−1 (IQR = 3.6), respectively. The two most frequently consumed dairy food sources for both nutrients were fluid cow's milk (78%, n = 206) and cheese (60%, n = 160), whereas the most frequently consumed non-dairy food sources for calcium were fruits (92%, n = 243), bakery products (92%, n = 243), and water (92%, n = 243), and for vitamin D it was bakery products (74%, n = 196). Findings raise concern about low intakes of calcium and vitamin D in young Canadian children.

COVID-19 hospitalization, mortality and premature mortality by a history of immigration in Ontario, Canada: a population-based cohort study

Immigrants in high-income countries experienced inequities in COVID-19 severe outcomes. We examined hospitalization and death throughout the pandemic, and change during the vaccine era, in Ontario, Canada. We conducted a population-based study using linked immigration and health data, following two cohorts for 20 months from January 1, 2020 (pre-vaccine) and September 1, 2021 (vaccine era). We used multivariable Poisson generalized estimating equation regression to estimate adjusted rate ratios (aRR) with 95% confidence intervals (CI), accounting for age, sex and co-morbidities. We calculated age-standardized years of life lost (ASYRs) rates by immigrant category. Of 11,692,387 community-dwelling adults in the pre-vaccine era cohort and 11,878,304 community-dwelling adults in the vaccine era cohort, 21.6% and 21.4% of adults in each era respectively were immigrants. Females accounted for 57.9% and 57.8% of sponsored family, and 68.4% and 67.6% of economic caregivers, in each era respectively. Compared to other Ontarians in the pre-vaccine era cohort, hospitalization rates were highest for refugees (aRR [95% CI] 3.41 [3.39-3.44]) and caregivers (3.13 [3.07-3.18]), followed by sponsored family and other economic immigrants. Compared to other Ontarians, aRRs were highest for immigrants from Central America (5.00 [4.92-5.09]), parts of South Asia (3.95 [3.89-4.01]) and Jamaica (3.56 [3.51-3.61]) with East Asians having lower aRRs. Mortality aRRs were similar to hospitalization aRRs. In the vaccine era, all aRRs were attenuated and most were similar to or lower than other Ontarians, with refugees and a few regions maintaining higher rates. In the pre-vaccine era ASYRs were higher for all immigrant groups. ASYRs dropped in the vaccine era with only refugees continuing to have higher rates. Immigrants, particularly refugees, experienced greater premature mortality. aRRs for most immigrant groups dropped substantially after high vaccine coverage was achieved. Vaccine outreach and improvements in the social determinants of health are needed. Canadian Institutes of Health Research, Canada Research Chairs Program.

Assessing the impact of Canadian primary care research and researchers: Citation analysis.

To describe the citation impact and characteristics of Canadian primary care researchers and research publications. Citation analysis. Canada. A total of 266 established Canadian primary care researchers. The 50 most cited primary care researchers in Canada were identified by analyzing data from the Scopus database. Various parameters, including the number of publications and citations, research themes, Scopus h index, content analysis, journal impact factors, and field-weighted citation impact for their publications, were assessed. Information about the characteristics of these researchers was collected using the Google search engine. On average, the 50 most cited primary care researchers produced 51.1 first-author publications (range 13 to 249) and were cited 1864.32 times (range 796 to 9081) over 29 years. Twenty-seven publications were cited more than 500 times. More than half of the researchers were men (60%). Most were clinician scientists (86%) with a primary academic appointment in family medicine (86%) and were affiliated with 5 universities (74%). Career duration was moderately associated with the number of first-author publications (0.35; P=.013). Most research focused on family practice, while some addressed health and health care issues (eg, continuing professional education, pharmaceutical policy). Canada is home to a cadre of primary care researchers who are highly cited in the medical literature, suggesting that their work is of high quality and relevance. Building on this foundation, further investments in primary care research could accelerate needed improvements in Canadian primary care policy and practice.

A New Genetic Mouse Model of Lean NAFLD Uncovers a Sexual Dimorphism for Hepatic Damages and Cardiometabolic Impairments

Background: The prevalence of non alcoholic fatty liver disease (NAFLD) is ~30% higher in the obese population. However, among patients living with NAFLD, 40% are not obese and half of them are lean. Although being mostly studied in obese individuals, the progression of NAFLD in lean patients may involve cardiac manifestations as well. Our hypothesis states that lean NAFLD patients also develop cardiac complications, independently of pre-existent metabolic disruptions, mechanisms of which remain to be fully understood, especially when considering the sexual dimorphism of the disease. Method: To address the underlying mechanisms of the progression of NAFLD independently of obesity, we used a murine model of hepatic mitochondrial deficiency, achieved through a hepato-specific knockout (KO) of Lrpprc. KO mice thus develop microvesicular steatosis without obesity in both sexes which was extensively characterized at the molecular and metabolic level in liver, plasma and heart. Our results unveiled a sex-dependent hepatic and cardiac phenotypic remodeling. KO male mice, to a greater extent than females, showed sustained fasting hypoglycemia and increased insulin sensitivity. Males also showed a more inflammatory hepatic profile characterized by a significant increase of F4/80 staining in immunohistological analyses (3-fold). Furthermore, only males exhibited an increase in the circulating hepatokine FGF21 (1.74-fold) and an increase in VLDLs lipoproteins while HDLs lipoproteins were decreased. In contrast, KO females showed a modest and global decrease of the lipoprotein profile. As such, sex differences occurred also in the heart since only males showed diastolic dysfunction while females’ cardiac function remained unaffected despite mitochondrial defects such as impairments in mitochondrial biogenesis, dynamics and oxidative capacities. Noteworthy, we also observed a significant and inverse correlation between glycemia and an index for cardiac relaxation only in males. Conclusion: Overall, this study underscores the value of this model for NAFLD without obesity where sex-dependent damage in the liver, the plasma and the heart are highlighted. Canadian Institutes of Health Research (CIHR), Montreal Heart Institute Foundation, Heart and Stroke Foundation of Canada, Cardiometabolic Health, Diabetes and Obesity Research Network. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Regulation of the mitochondrial integrated stress response and ATF4 by acute contractile activity in mouse muscle

In the context of energetically demanding conditions, such as exercise, skeletal muscle relies on mitochondria to support its metabolic requirements. Maintenance of mitochondria and their bioenergetic availability is thus critical to sustain the metabolic flexibility of muscle. The quality of the organelle network is highly regulated by the coordination of mitochondrial quality control (MQC) processes. One MQC pathway that has garnered recent interest is the integrated stress response (ISR), which is activated in response to a variety of stimuli. The transcription factor ATF4, denoted as the main effector of this response pathway, serves to ameliorate cellular stress by upregulating a plethora of cytoprotective genes, such as CHOP and ATF5. Current literature has shown that the ISR is activated upon mitochondrial stress/perturbations to restore optimal organelle function and health. However, the precise mechanism that constitutes the activation of ISR and thus the response of ATF4 following acute exercise-induced stress is unknown. Therefore, our objective is to determine the extent of ISR/ATF4 induction in vivo and to test whether this pathway is required for the maintenance of muscle function. To investigate this, a mouse in situ hindlimb protocol was utilized to acutely stimulate muscles at 0.25-1 tetani/per second for 9 mins, followed by a 1-hour recovery period. The kinases, CAMKIIα and JNK2, were robustly phosphorylated/activated 6-fold immediately following the protocol. The initial stage of ISR activation, reflected in the ratio of phosphorylated to total-eIF2α protein levels, was also increased in response to acute contractile activity, evident in the recovery phase. Downstream of ISR activation, the total protein expression of ATF4 remained unchanged, however, contractile activity induced an increase in the localization of ATF4 to the nucleus. Robust 2-fold increases in the mRNA expression of ATF4 and CHOP were also observed and enhanced following the recovery period. Changes in ATF4 mRNA appeared to be independent of transcriptional activation, as assessed using an ATF4 promoter-reporter plasmid. An in vitro cell free mRNA decay assay revealed an increase in ATF4 mRNA stability post-stimulation, possibly as a result of cellular compartmental changes in the RNA binding proteins, HuR and CUGBP1. RNA sequencing analyses also confirmed the observed increase in related ISR genes following an exhaustive bout of exercise. These data suggest that acute contractile activity is indeed suffcient to induce mitochondrial stress and activate the ISR, corresponding to the induction of ATF4. Future work will reveal the underlying mitochondrial signal responsible for activating this pathway, as well as the downstream consequences for the regulation of MQC processes in maintaining mitochondrial homeostasis. This work was supported by funds from the Canadian Institutes for Health Research (CIHR). Victoria C. Sanfrancesco is the recipient of the CIHR Frederick Banting and Charles Best Canada Graduate Scholarship-Master's (CGS-M). David A. Hood is the holder of a Canadian Research Chair in Cell Physiology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Impact of chronic muscle use and disuse on innate immune signaling in skeletal muscle

Mitochondria exhibit high levels of adaptability to various stimuli such as chronic muscle use (i.e. exercise) or disuse, such as immobilization or denervation. These changes in the mitochondrial network ultimately affect the health and functioning of skeletal muscle, which contributes to whole-body metabolism, locomotion, and postural stability. It is now acknowledged that mitochondrial dysfunction can activate inflammatory pathways through the recognition of damage-associated molecular patterns (DAMPs). The objective of this study was to examine how changes in mitochondria brought about by either chronic muscle inactivity or chronic exercise training affect innate immune system activation. We hypothesized that an inverse relationship between mitochondrial content and innate immune signaling would be evident in skeletal muscle. To investigate this, skeletal muscle from the hindlimbs of mice was collected after 7 days of sciatic muscle denervation, or after 4.5 weeks of endurance swim training involving 240 minutes of daily exercise. We analyzed the expression of the NLRP3 inflammasome, innate immune system signaling proteins, mitochondrial markers, and mitochondrial DNA (mtDNA) content using western blotting, cytochrome C oxidase (COX) activity, ELISA and qPCR. Following 7 days of denervation, there was a significant decrease in both COX-IV protein and COX activity, indicating a reduction in mitochondrial content. This was accompanied by an increase (p<0.05) in NLRP3, procaspase-1, gasdermin-D (GSDMD) and its active N-terminal fragment, GSDMD-N, as well as a notable increase in IL-1β. In addition, other possible converging pathways were also upregulated including cGAS-STING, and gasdermin-E. In comparison, following exercise training, there was a significant increase in mitochondrial content, apparent through increases in COX-IV protein, COX activity and mitochondrial RNA content. This was associated with decreases in procaspase-1 and caspase-1 protein expression alongside reduced STING activation. These findings highlight an inverse relationship between mitochondrial content and the activation of several inflammatory pathways that possibly converge upon NLRP3 inflammasome activation and pyroptotic cell death, leading to detriments in skeletal muscle health. This work aims to further the understanding of innate immune signaling pathways within muscle which can potentially highlight therapeutic targets to regulate its activation under divergent metabolic conditions. This work was supported by funds from the Natural Science and Engineering Research Council (NSERC). Priyanka Khemraj is the holder of an Ontario Graduate Scholarship. David A. Hood is the holder of a Canadian Research Chair in Cell Physiology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Activation of the Nrf-2 pathway improves the mitochondrial phenotype in skeletal muscle cells

Aging muscle displays a reduction in mitochondrial content, along with elevated reactive oxygen species (ROS) emission and reduced levels of antioxidant enzymes. These characteristics enhance tissue susceptibility to oxidative damage, facilitating sub-optimal cellular metabolism and subsequent muscle atrophy. While these perturbations to metabolic homeostasis are a natural course of the aging process, there has been ongoing research investigating how to implement interventions to reduce this decline in muscle health. Regular exercise is one possible treatment modality, however this may be unsuitable for some populations who are unable to participate due to their health status. The objective of this study was to examine the activation of the Nrf-2 pathway using the nutraceutical Sulforaphane (SFN) and evaluate its role as a potential exercise mimetic. We hypothesized that SFN would act through similar pathways activated with chronic exercise to improve mitochondrial content, respiration, and ROS emission. To address our objective, C2C12 myotubes were treated with SFN for various timepoints basally, and in the presence of the Complex-I inhibitor rotenone to induce oxidative stress. Western blotting revealed an 8-fold increase in Nrf-2 nuclear localization following 24hrs of SFN treatment, which subsequently led to the upregulation of antioxidant enzymes NQO1, Heme Oxygenase-1, catalase, glutathione reductase and Glucose-6-Phosphate Dehydrogenase by 2-to 3-fold. These protein changes, were accompanied by dramatic reductions in both total cellular and mitochondrial ROS emission with SFN, detected with CellROX Green and MitoSOX Red respectively. Interestingly, this led to an increase in mitochondrial membrane potential, detected via MitoTracker Red (MTR), despite rotenone-induced oxidative stress. Western blotting revealed TFAM upregulation at 24hrs, suggesting an increase in mitochondrial DNA (mtDNA) replication and transcription. This was corroborated by an increase in COX subunit I protein, a mitochondrially-encoded subunit of cytochrome c oxidase, as well as MitoTracker Green and MTR staining by 48hrs. Mitochondrial respiration was evaluated using Seahorse analysis, demonstrating a marked increase in ATP production as well as basal and maximal respiration. Together these data suggest that activation of the Nrf-2 pathway via SFN may lead to adaptations similar to chronic exercise. Additionally, SFN may have applications in disorders characterized by mitochondrial loss and high ROS emission. To fully elucidate the precise mechanisms underlying this agent, SFN will be combined with chronic contractile activity to determine if these two interventions operate through independent pathways. This work was supported by funds from the Natural Science and Engineering Research Council (NSERC). Sabrina Champsi is the recipient of the NSERC Alexander Graham Bell Canada Graduate Scholarship-Master’s (CGS-M). David A. Hood is the holder of a Canadian Research Chair in Cell Physiology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Does ovariectomy exacerbate the cardiorespiratory and metabolic consequences of moderate intermittent hypoxia in female rats?

Intermittent hypoxia (IH) is a major consequence of sleep apnea (SA). IH causes respiratory dysfunction and contributes to numerous co-morbidities of SA including hypertension and obesity. The fact that menopause increases the prevalence of SA and related diseases in women indicates the importance of loss of ovarian function in the pathophysiology. Here, we determined whether experimental loss of ovarian function (ovariectomy; OVX) exacerbates the cardiorespiratory and metabolic consequences of IH. We explored neuroendocrine changes by assessing hormones known to be involved in energy balance, respiratory control, and stress responses (leptin, ACTH and corticosterone). We subjected adult (8 weeks) Sprague Dawley female rats to bilateral OVX (n = 13) or sham operation (n = 14). Rats were housed in pairs, and after two weeks of recovery, animals were exposed to room air (control; n = 16) or to a 7-day moderate IH protocol (n = 11). Within their cage, rats intermittently received a nitrogen-enriched hypoxic mixture, followed by room air for reoxygenation. Each bout of hypoxia lasted 30 seconds (nadir FIO2 = 0.10) and was followed by 5-minutes of reoxygenation (10 cycles/h, for 8hrs between 10h-18h). Apnea frequency, acute responses to hypoxia (FIO2 = 0.12; 120 sec) and hypercapnia (FICO2 = 0.05; 10 min) were measured by whole-body plethysmography. Blood pressure was assessed by the tail cuff method, and body weight was followed throughout the protocol. Plasma corticosterone and leptin were measured by multiplex assays. OVX increased apneic events, whereas IH reduced them; with the highest frequency observed in OVX females maintained in normoxia. Ventilatory responses (hypoxia and CO2) and blood pressure were not affected by IH or OVX. Over the course of the protocol, OVX increased weight gain whereas IH induced weight loss. OVX (but not IH) increased ACTH and corticosterone. IH (but not OVX) reduced leptin. Correlation matrix analysis showed that weight gain was the best predictor of apnea frequency (r = 0.759; p = 0.03). We conclude that loss of ovarian function and related weight gain have the greatest impact on respiratory function during sleep. Additionally, OVX-related activation of the stress pathways may contribute to this process. These results fail to demonstrate a role for OVX in exacerbating the cardiorespiratory and metabolic consequences of IH. Lack of weight gain following IH likely contributes to this finding. This study is supported by operating grants from the Canadian Institutes of Health Research (RK and VJ). NJM is supported by a Sentinel North Partnered Research Chair in Sleep Pharmacometabolism and a Canada Research Chair in Metabolism and Sleep Neurobiology. MG received a doctoral scholarship from the Fonds de Recherche du Québec — Santé (FRQS). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Key Learnings from 'Seniors of Canada': A Community Project Aimed to Disrupt Ageism.

Visual representations of aging have historically relied upon binarized clichés: idealized youthfulness versus frailty and illness. To challenge these oversimplified depictions, graduate students developed a community outreach project titled 'Seniors of Canada'. The aim of this project was twofold: (1) share images and stories of people in later life; and (2) challenge dominant narratives and stereotypes of aging. In this note, we outline the prevailing discourse of what aging 'looks like', how we collected stories and images, and implications for knowledge mobilization and research in Canada. This article highlights insights gained since the inception of the project, including three key learnings: (1) Building bridges across academia and community, (2) Intergenerational connection and digital tools, and (3) The power of visual storytelling. We provide a practical overview of a successful knowledge mobilization/community outreach project and showcase the power of bridging academia and community for social change.

Early adopter insights on physical impact mill technology for harvest weed seed control in Canada

The evolution and spread of herbicide resistance among the weed community has increased interest in alternative weed management strategies such as harvest weed seed control. Western Canadian producers have begun adopting physical impact mills as an additional weed management strategy. A survey of early adopters of physical impact mill technology in Canada was conducted to better understand the motivations behind producers adopting, initial experiences, and research needs. Ten producers responded to the survey, accounting for 18 out of an estimated 30 impact mills in use in Canada, believed to be located primarily in the Canadian Prairies. These producers were mainly from larger farms (>4000 ha), equipped the majority of their combines (75% average) and used the mills in essentially all crops grown. The majority of respondents were located in Saskatchewan, with two mills being used in Alberta. Wild oat ( Avena fatua L.) (60%) and kochia ( Bassia scoparia (L.) A.J. Scott) (50%) were the weeds most frequently mentioned as specific motivators of impact mill adoption. Average increased fuel cost from the mill was estimated at CAD$3.46 ha−1, with average annual maintenance costs of about $1500 per impact mill. Producers relied on information from mill companies and other early-adopting farmers primarily, followed by extension talks and social media. Research needs were also identified by producers that could inform the future direction of harvest weed seed control research in Canada. Future research should focus on confirming efficacy, optimizing combine settings, and looking at integrated systems with precision agriculture technologies.

Furthering Deceased Donor Intervention Research in Canada and the United Kingdom.

Furthering Deceased Donor Intervention Research in Canada and the United Kingdom.

A Better Estimate of Internally Generated Intangible Capital

Internally developed intangibles are not included in reported assets under U.S. generally accepted accounting principles. The omission of this increasingly important class of assets reduces the usefulness and relevance of financial statement analysis, conducted with reported values of equity and assets. Recent studies overcome this deficiency by capitalizing research and development (R&D) expenses to estimate the value of knowledge capital and by capitalizing selling, general, and administrative (SG&A) expenses to estimate the value of organization capital. Those two estimates are then added to reported values for financial statement analysis. For convenience, many studies rely on two rules of thumb and assume them to be equally applicable in all instances: (1) 30% of SG&A and 100% of R&D expenses are investments, and (2) the useful life of SG&A and R&D investments is three and five years, respectively. We propose a more flexible approach by estimating the capitalization and amortization parameters on an industry–year–specific basis. Our modified values of total assets and equity, inclusive of the value of capitalized intangibles, exhibit greater association with future returns and investments compared with as-reported values and values estimated with uniform rules of thumb. We provide a better estimate of intangible capital for the consumers of financial statements. This paper was accepted by Ranjani Krishnan, accounting. Funding: A. Srivastava and R. Zhao acknowledge financial support from the Social Sciences and Humanities Research Council of Canada. A. Srivastava acknowledges financial support from the Canada Research Chairs Program of the Government of Canada. A. Iqbal acknowledges financial support from the Canadian Securities Institute Research Foundation and Chartered Professional Accountants (Alberta) Education Foundation. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2022.01703 .

Exploring child welfare worker wellbeing, organizational social context, and staff recommendations for change: a mixed method case study

ABSTRACT Unpacking evidence-based practice in social work education: a scoping review Child welfare workers are the link between families and the system and are tasked with assessing and mitigating child maltreatment. While US-based research suggests that organizations are prime for child welfare workers to experience poor overall wellbeing, there is a dearth of research in Canada. This mixed method case study explored workers’ levels of burnout, secondary trauma, and compassion satisfaction, and the organizational social context. Qualitative recommendations to promote wellbeing include, Help us help families, Listen to me and appreciate me, Give us time to breathe, Give me my independence, We want to connect, and We are fighting the system.

Predictors of Self-Efficacy for Inclusive Education: A Comparison of Canada and Germany

This study investigated group and individual differences in beginning secondary school teachers’ self-efficacy for the inclusive classroom in Canada and Germany. This research complements previous Canadian and German research that compared the self-efficacy of pre-service teachers in each country, as well as those experiences that contributed to their self-efficacy. In the current study, 110 Canadian and 90 German beginning teachers completed the Teacher Efficacy for Inclusive Practice scale and the Beliefs About Learning and Teaching Questionnaire and described their experience with diverse populations. As a group, Canadian teachers were higher in their self-efficacy for implementing inclusive instruction and for engaging in collaboration with families and colleagues. The groups did not differ on self-efficacy for managing behaviour, though males felt more efficacious than females. Overall, country accounted for 18% and 11% of the variance in self-efficacy for inclusive instruction and for collaboration, respectively. Additional individual differences in self-efficacy for instruction and for managing behaviour were accounted for by participants’ experiences with diverse populations. Finally, participants’ beliefs that aligned with student-centred approaches accounted for unique variance in self-efficacy for inclusive instruction and collaboration. Results are discussed in the context of prior research and possible considerations for teacher education programs.

Refocusing on Patient Safety.

Patient safety provides an important foundation for high-quality care. Research in Canada and elsewhere has identified substantial levels of harm in hospitals and other settings; these results spurred the development and spread of safety practices, along with strategies to strengthen organizational training, incident reporting and analysis and a host of resources intended to reduce the burden of harm. Yet, despite these efforts, 20 years after the publication of the Canadian Adverse Event study (Baker et al. 2004) and other studies, many leaders believe progress in patient safety has stalled (NEJM Catalyst 2023). Indeed, some recent studies indicate that the levels of harm have increased. One notable study by David Bates and colleagues (2023), building on approaches used in earlier studies, identified at least one adverse event in 23.6% of a random sample of patients in Massachusetts hospitals in 2018. Among 978 events, 22.7% were judged preventable and one-third required at least substantial intervention or prolonged recovery.

Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network.

Postoperative length of stay (LOS) significantly contributes to healthcare costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for degenerative conditions of the cervical spine. The secondary objectives were to examine the variability in LOS and institutional practices used to decrease LOS. This was a multicenter observational retrospective cohort study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective anterior cervical discectomy and fusion (ACDF) (1-3 levels) or posterior cervical fusion (PCF) (between C2 and T2) with/without decompression for degenerative conditions of the cervical spine. Prolonged LOS was defined as LOS greater than the median for the ACDF and PCF populations. The principal investigators at each participating CSORN healthcare institution completed a survey to capture institutional practices implemented to reduce postoperative LOS. In total, 1228 patients were included (729 ACDF and 499 PCF patients). The median (IQR) LOS for ACDF and PCF were 1.0 (1.0) day and 5.0 (4.0) days, respectively. Predictors of prolonged LOS after ACDF were female sex, myelopathy diagnosis, lower baseline SF-12 mental component summary score, multilevel ACDF, and perioperative adverse events (AEs) (p < 0.05). Predictors of prolonged LOS after PCF were nonsmoking status, education less than high school, lower baseline numeric rating scale score for neck pain and EQ5D score, higher baseline Neck Disability Index score, and perioperative AEs (p < 0.05). Myelopathy did not significantly predict prolonged LOS within the PCF cohort after multivariate analysis. Of the 8 institutions (57.1%) with an enhanced recovery after surgery (ERAS) protocol or standardized protocol, only 3 reported using an ERAS protocol specific to patients undergoing ACDF or PCF. Patient and clinical factors predictive of prolonged LOS after ACDF and PCF are highly variable, warranting individual consideration for possible mitigation. Perioperative AEs remained a consistent independent predictor of prolonged LOS in both cohorts, highlighting the importance of preventing intra- and postoperative complications.

A Primer on Artificial Intelligence for Healthcare Administrators.

Healthcare administrators steer their organizations' strategic direction with an emphasis on quality, value and efficiency, aiming to improve patient outcomes and ensure operational sustainability. Artificial intelligence (AI) has become a transformative force in healthcare in the past decade, with Canadian health systems and research institutions investing in AI solutions to address critical healthcare challenges. This primer delivers a fundamental guide to essential AI concepts in healthcare and provides practical guidance to prepare organizations for AI readiness.

Preoperative expectations of patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

BACKGROUNDDespite an abundance of literature on degenerative cervical myelopathy (DCM), little is known about preoperative expectations of these patients. PURPOSEThe primary objective was to describe patient preoperative expectations. Secondary objectives included identifying patient characteristics associated with high preoperative expectations and to determine if expectations varied depending on myelopathy severity. STUDY DESIGNThis was a retrospective study of a prospective multicenter, observational cohort of patients with DCM. PATIENT SAMPLEPatients who consented to undergo surgical treatment between January 2019 and September 2022 were included. OUTCOMES MEASURESAn 11-domain expectation questionnaire was completed preoperatively whereby patients quantified the expected change in each domain. METHODSThe most important expected change was captured. A standardized expectation score was calculated as the sum of each expectation divided by the maximal possible score. The high expectation group was defined by patients who had an expectation score above the 75th percentile. Predictors of patients with high expectations were determined using multivariable logistic regression models. RESULTSThere were 262 patients included. The most important patient expectation was preventing neurological worsening (40.8%) followed by improving balance when standing or walking (14.5%), improving independence in everyday activities (10.3%), and relieving arm tingling, burning and numbness (10%). Patients with mild myelopathy were more likely to select no worsening as the most important expected change compared to patients with severe myelopathy (p<.01). Predictors of high patient expectations were: having fewer comorbidities (OR -0.30 for every added comorbidity, 95% CI -0.59 to -0.10, p=.01), a shorter duration of symptoms (OR 0.92, 95% CI 0.35–1.19, p=.02), no contribution from “failure of other treatments” on the decision to undergo surgery (OR 1.49, 95% CI 0.56–2.71, p=.02) and more severe neck pain (OR 0.19 for 1 point increase, 95% CI 0.05–0.37, p=.01). CONCLUSIONSMost patients undergoing surgery for DCM expect prevention of neurological decline, better functional status, and improvement in their myelopathic symptoms. Stopping neurological deterioration is the most important expected outcomes by patients.