Research Initiatives Research Articles

Finding Common Ground a comparison between coastal nature-based solutions in the Netherlands and British Columbia, Canada

Many coastal communities worldwide are facing challenges caused by increasing sea levels. However, urban development, population growth and industrialisation in low-lying delta regions persists. This includes the Netherlands and British Columbia, Canada. Both regions explore new and innovative flood risk and adaptation strategies by initiating nature-based solutions (NBS) pilot projects and integrating research and community initiatives. The aim of this paper is to learn from the experiences with these NBS pilots and support practitioners with insights and knowledge about the prospectives and implementation process of NBS. Our study takes a bird's eye view by diving into four NBS case study projects that try to enhance flood defence and quality of life while considering ecosystems and community values simultaneously. To better understand current initiatives on NBS, we first describe the historical trajectories of flood risk management and climate adaptation policy in both countries. Then we analyse two urban and two suburban case studies to identify and compare enablers and barriers that surround the implementation of NBS. We use the Pilot Paradox as a framework to reflect on the enablers and barriers, and to formulate recommendations for barriers that are common ground. We found that upscaling of the pilots forms an important challenge in both countries. We also found that Canada is interested in exchanging technical knowledge, experiences, and insights with other countries through the involvement of international researchers, consultants, and students in projects. Such collaboration between countries, communities, practitioners, and academics could accelerate the development of innovative climate adaptation strategies worldwide.

The Memphis SOUND Project: The Development of a Community-Based Research Project to Address Hearing Health Disparities Among Black Adults Who Qualify for Cochlear Implants.

The objective of this article is to introduce the concept of community-based participatory research as a means to understand barriers to cochlear implant access racially minoritized populations. Black adults living in the United States experience unique barriers to cochlear implantation. Community-based research approaches can be used to understand and address these barriers. The Memphis SOUND Project is a community-based research initiative that seeks to address hearing health disparities by examining utilization of hearing healthcare among Black adults. Preliminary findings introduce motivators and barriers related to CI intervention in this population. This Memphis SOUND Project provides valuable insights to the benefits of community-based research in understanding and addressing CI utilization disparities.

What is effective physiotherapy for dementia and how do we get there: a qualitative study.

Dementia is a leading cause of disability. Physiotherapists play a crucial role in caring for people with dementia. However, previous research has found that physiotherapists have low knowledge and confidence working with people with dementia. To determine: 1) What are the components of effective physiotherapy care for people with dementia; and 2) What can be done to facilitate the provision of effective physiotherapy care. This was a qualitative study using an interpretive description approach. Sixteen physiotherapists experienced in dementia care participated in semi-structured interviews. Researchers analyzed data using thematic analysis. Two themes were created for each research objective. The themes explaining the components of effective physiotherapy care were: 1) engaging the person with dementia (subthemes: knowing the person with dementia; using knowledge to adapt the approach to successfully deliver physiotherapy treatments; optimizing the physical environment) and 2) collaborative care (subthemes: working with care partners; working as an interdisciplinary team). The themes describing how to facilitate provision of effective care were: 1) Physiotherapists require "greater opportunity for mentoring and education on dementia care" and 2) Physiotherapists must "advocate for the role of physiotherapy in dementia care." These findings provide important information regarding the components of effective dementia care for physiotherapists and will help guide clinical practice, inform future dementia education, research, and professional organization advocacy initiatives.

MPOX (Monkeypox): Current Epidemiology, Clinical Manifestations, and Advances in Treatment and Prevention Strategies

MPOX (formerly known as monkeypox) has emerged as a significant public health concern in recent years, necessitating a comprehensive understanding of its epidemiology, clinical manifestations, treatment options, prevention strategies, and global health impact. This literature review synthesizes the latest data on the spread and incidence of MPOX, with a focus on geographic distribution, affected populations, and emerging trends in transmission. The clinical presentation of MPOX, including symptoms, disease progression, and complications, is explored, with particular attention to variations across different demographics. Recent advances in the treatment of MPOX are analyzed, covering current antiviral therapies, the role of supportive care, and the potential of new treatments under investigation. Prevention strategies are also examined, highlighting the effectiveness of vaccination efforts, public health measures, and containment and control strategies. The review further considers the broader impact of MPOX on global health, discussing its implications for public health policy and pandemic preparedness. Through this comprehensive analysis, the review aims to provide a robust foundation for understanding MPOX and inform future research, clinical practice, and public health initiatives.

Advancing clinical MRI exams with artificial intelligence: Japan's contributions and future prospects.

In this narrative review, we review the applications of artificial intelligence (AI) into clinical magnetic resonance imaging (MRI) exams, with a particular focus on Japan's contributions to this field. In the first part of the review, we introduce the various applications of AI in optimizing different aspects of the MRI process, including scan protocols, patient preparation, image acquisition, image reconstruction, and postprocessing techniques. Additionally, we examine AI's growing influence in clinical decision-making, particularly in areas such as segmentation, radiation therapy planning, and reporting assistance. By emphasizing studies conducted in Japan, we highlight the nation's contributions to the advancement of AI in MRI. In the latter part of the review, we highlight the characteristics that make Japan a unique environment for the development and implementation of AI in MRI examinations. Japan's healthcare landscape is distinguished by several key factors that collectively create a fertile ground for AI research and development. Notably, Japan boasts one of the highest densities of MRI scanners per capita globally, ensuring widespread access to the exam. Japan's national health insurance system plays a pivotal role by providing MRI scans to all citizens irrespective of socioeconomic status, which facilitates the collection of inclusive and unbiased imaging data across a diverse population. Japan's extensive health screening programs, coupled with collaborative research initiatives like the Japan Medical Imaging Database (J-MID), enable the aggregation and sharing of large, high-quality datasets. With its technological expertise and healthcare infrastructure, Japan is well-positioned to make meaningful contributions to the MRI-AI domain. The collaborative efforts of researchers, clinicians, and technology experts, including those in Japan, will continue to advance the future of AI in clinical MRI, potentially leading to improvements in patient care and healthcare efficiency.

Key challenges in developing a gene therapy for Usher syndrome: machine-assisted scoping review.

Despite compelling empirical evidence demonstrating its efficacy, gene therapies for usher syndrome (USH) are not yet available for the patient's usage. This scoping review assessed the current scenario and analysed the challenges in implementing gene therapies for USH. A literature search was conducted using PubMed and Google Scholar through an artificial intelligence (AI) tool, MaiA, focusing on relevant publications from the last 10 years. We followed the methodological guidance of the Joanna Briggs Institute (JBI) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) checklist. Of 517 records, 51 reports were considered for final analysis. It identified and categorized challenges across four key areas: preclinical, clinical, economic, and regulatory. Of all, many reports (30) highlighted the preclinical challenges where the USH gene development process encountered roadblocks. Specifically, preclinical challenges included the lack of suitable in-vivo models and effective delivery methods. Clinical challenges focused on establishing clear endpoints and long-term safety and efficacy. Economic challenges addressed diagnostic issues and manufacturing hurdles, while regulatory challenges focused on expedited evaluation processes and guidance for clinical development. Our analysis uncovered key barriers to clinical translation of USH gene therapy and strategies to address them. Researchers are employing innovative approaches, including novel delivery methods such as minigenes and nanoparticles, inventive clinical trial designs, cohesive regulatory frameworks, strategic market assessments, and collaborative research initiatives. These efforts hold promise for impactful disease-cure and modifying interventions ultimately enhancing the quality of life for USH patients.

Addressing social norms for adolescent timing and spacing of pregnancy in low and middle-income countries: Developing a global research agenda.

Social norms shape adolescent sexual and reproductive health behaviours contributing to contraceptive and pregnancy outcomes. No global research agendas exist to guide research on adolescent social norms shifting in low- and middle-income countries (LMICs). We developed a social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs. We adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method. A group of researchers guided the process, and consulted with diverse experts to develop a list of 21 research questions for global stakeholders to score via an online survey. Survey participants scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession. We received 185 survey responses. Participants were, on average, 44 years old, 64% were women, 70% were from LMICs and 47% were implementers. The RPS ranged from 52 to 81% (74% median) and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective norm-shifting interventions (NSIs) strategies, processes and indicators to NSIs, and NSI adaptation and scale-up. Using a collaborative and rigorous process with diverse representation from LMICs and implementers, we reached consensus on five priority research questions to guide future adolescent social norms research to improve healthy timing and spacing of pregnancy in LMICs.

Remarkable records of jaguars and Andean bears in northwestern Ecuador: Implications for human-wildlife conflicts

Jaguar populations (Panthera onca) on the Ecuadorian coast are critically endangered, with only a few dozen individuals remaining in the region. In some areas, no records have been documented for decades. Between November 2023 and January 2024, independent camera trap monitoring in northwestern Ecuador yielded evidence of the presence of a jaguar, marking a significant recovery after seven years of absence in Manduriacu and at least 15 years in Junín. The jaguar was observed moving through an area of approximately 25 km, traversing forested and human-altered zones. Furthermore, additional evidence from the Ecominga Foundation and the Cielo Verde community indicated the occurrence of livestock attacks, which aligns with the typical predatory patterns observed in jaguar behavior. The attack site was located approximately 8 km from where the jaguar was initially recorded, suggesting that both events refer to the same individual. In response, local authorities inspected the area and organized community workshops. Furthermore, an Andean bear was recorded in Manduriacu during the same sampling period, confirming the co-occurrence of both species in the area. The documented movement of this jaguar, along with the presence of other species, underscores the imperative need to continue research and conservation initiatives in the region. These initiatives will ensure the protection and coexistence of wildlife and human populations in this highly biodiverse region.

Assessment of Medical Pancreatology Fellowship Training in the United States: A Collaborative Alliance for Pancreatic Education and Research (CAPER) initiative

Assessment of Medical Pancreatology Fellowship Training in the United States: A Collaborative Alliance for Pancreatic Education and Research (CAPER) initiative

The Current State of Leadership Research: Identifying Key Trends through Natural Language Processing and Machine Learning Analysis

The impact of leadership on organizational performance and success is a well-established theme, leading to a significant expansion in related scientific studies. This has made identifying and understanding the current state of literature challenging. Most studies focus on specific aspects of leadership, offering a fragmented view of the field. This study employs Natural Language Processing (NLP) techniques and a machine learning approach to analyze 19,429 research papers from Web of Science and Scopus. We aimed to identify and interpret current trends in leadership research, providing a comprehensive overview of the leadership domain, highlighting five key research trends: (1) Leadership and Digital Transformation Research (LDTR); (2) Leadership and Organizational Performance Research (LOPR); (3) Educational Leadership Research (ELR); (4) Leadership Practices and Development Research (LPDR); and (5) Gender and Diversity Leadership Research (GDLR). This overview not only delineates current trends but also aids researchers in identifying significant gaps in existing literature, thereby facilitating the development of innovative research projects and initiatives.

Linking green supply chain management practices with perceived environmental performance: A mediated moderation model

AbstractThis empirical study intends to identify the relationships between three green supply chain management practices (GSCMPs) [green purchase (GP1), green production (GP2) and employee green orientation (EGO)]; and perceived environmental performance (PEP) based on stakeholder theory. The study also included one mediator, perceived social responsibility (PSR) to test its mediating effects in three direct relationships and one moderator, perceived regulatory pressure (PRP), to test the moderation in the relationship between PSR and PEP. The study used a deductive methodology based on a cross‐sectional survey design. IBM SPSS 29 was used for descriptive analysis and a variance‐based partial least square structural equation modelling (PLS‐SEM) (through PLS 4.0) was used for testing the hypothesised relationships. The study found that, first of all, all the three independent constructs have significant positive relationships with the dependent variable, PEP. Second, GP2 and EGO have significant positive relationships with the mediator, PSR while GP1 has an insignificant relationship with PSR. Third, the mediator (PSR) is positively related to PEP. Fourth, regarding the mediating effects, the study identified that PSR partially mediates the relationships between GP2 and PEP as well as between EGO and PEP while PSR does not mediate the relationship between GP1 and PEP. Finally, the study identified that PRP strengthens the positive relationship between PSR and PEP. It is strongly anticipated that this empirical study will spark further theoretical research and empirical experiments on GSCMP‐oriented environmental performance. The study incorporated two unique variables as mediator and moderator that can open a new avenue for the upcoming research initiatives. Furthermore, the study's findings can serve as a foundation for the policymakers and/or managers working on the formulation and implementation of green supply chain management‐related policies and strategies.

HPB SO37 - GTN Patch for Medical Relaxation of the Sphincter of Oddi: “A Safe and Effective Pre-ERCP Treatment for Controlled Bile Leak Post-Cholecystectomy"

Abstract Background Bile leak is a frequent complication following laparoscopic total, subtotal cholecystectomy, and bile duct exploration (BDE) with an incidence up to 2.8%. It can contributing significantly to postoperative morbidity and mortality. GTN has demonstrated efficacy in reducing papillary muscle contraction and Sphincter of Oddi pressure. Similarly GTN might promote healing and closure of bile leaks post total or subtotal cholecystectomy. This study aims to assess the safety and effectiveness of GTN in treating bile leaks post total, subtotal cholecystectomy or bile duct exploration. Method Data was prospectively collected from patients who developed bile leaks after total or subtotal cholecystectomy between June 2020 and June 2024. Inclusion criteria were patients with a bile leak post-surgery during this period. Exclusion criteria included unstable patients, uncontrolled bile leaks, the presence of biliary obstruction, or major bile duct injuries. Suitable patients were treated with a GTN patch as first line management before potential ERCP. A 5 mg GTN skin patch was applied every 24 hours, starting at least 48 hours post-surgery if drain output exceeded 100 ml/hour. Patients were consented about side effects including hypotension and headache. Results Seven patients were treated with GTN, with mean age of 51 years, four were females. Four cases were emergencies and four had subtotal cholecystectomies, one in the elective group. Bile leaks occurred after biloma drainage and one after removal of trans-cystic drain post trans-cystic BDE. All patients experienced significant drain output reduction the day after starting GTN. There were no complications during or after treatment. One required ERCP two months later for persistent low-volume bile leak of 5-10 ml per day. Headaches occurred in two cases, treatment was discontinued in one. The average time to GTN treatment was 3.4 days. Conclusion This study demonstrates GTN treatment's safety and effectiveness for managing bile leaks following total, subtotal cholecystectomy or BDE. We recommend GTN as the primary therapy for controlled bile leaks, barring biliary obstruction or major injury. Response can be evaluated within 24-48 hours through significant output reduction. Implementing local protocols can minimize variations in GTN treatment initiation times. GTN should be prioritized over ERCP to prevent complications like perforation, pancreatitis, and bleeding. We aim for this study to underscore GTN's efficacy to surgeons and promote multicentre research initiatives.

Sustainability in European luxury tourism companies: an analysis of practices and managerial perspectives

Purpose This paper aims to present findings from a preliminary study aimed at investigating sustainability practices and managerial perceptions within European luxury tourism companies. The study addressed two key research questions: What is the present state of sustainability practices in the luxury tourism sector? What are the managers' perspectives and the prevailing trends in the adoption of sustainable approaches? Design/methodology/approach The study used a mixed methods approach to gather data from a diverse range of European luxury tourism companies. The survey and the interview of companies’ representatives encompassed various organisational types engaged in different tourism activities, allowing for a comprehensive exploration of sustainability practices within the sector. Organisational characteristics, such as size, turnover and location, were considered to ensure a representative sample. Findings The findings of the study reveal a robust commitment to environmental, social and economic sustainability across the luxury tourism industry. Despite variations in organisational characteristics, including size, turnover and location, the study identified a lack of significant differences in sustainability practices, indicating a noteworthy homogeneity within the sector. The findings also show that a high percentage of companies hold sustainability certifications and share an emphasis on authenticity, local engagement and economic profitability. Research limitations/implications The study's sample size may limit the generalisability of the findings. A larger sample size would enhance the study's robustness and allow for more comprehensive insights into sustainability practices within the luxury tourism sector. The study's focus on European luxury tourism companies may limit its applicability to other regions or contexts. Originality/value This study contributes to the existing literature by providing insights into sustainability practices and managerial perspectives within the European luxury tourism sector. The study offers original insights into the current state of sustainability in luxury tourism and highlights opportunities for further research and refinement of sustainability initiatives within the sector.

The use of generative AI for coding in academia

Abstract In a recent Perspective Piece, Cooper et al. (2024) highlight the benefits that large language models (LLM) bring to the coding process and offer some guidance around the use of LLM‐generated code in academic publications. Whilst we broadly support the stance taken by the authors, we offer a slightly different perspective from our experience of using both artificial intelligence (AI) generated code and more traditional resources such as Stack Overflow. We highlight how the integration of generative AI tools such as ChatGPT holds immense promise for advancing academic research, revolutionising coding education and practices, promoting inclusivity, and facilitating knowledge dissemination. However, we also acknowledge that researchers must navigate the ethical and methodological challenges inherent in harnessing AI technologies, prioritising transparency, validation, and critical inquiry to ensure the integrity and credibility of research initiatives.

Abstract 4139196: Long-term effectiveness and safety of mavacamten in a real-world, multi-center, global study: Preliminary results of COLLIGO-HCM from a diverse cohort in the United States

Introduction: The mavaCamten ObservationaL evIdence Global cOnsortium in hypertrophic cardiomyopathy (COLLIGO-HCM; ClinicalTrials.gov ID NCT06372457) is a multinational, multicenter observational research initiative aiming to describe the real-world outcomes of mavacamten for the treatment of obstructive HCM. Aims: Describe the real-world effectiveness and safety of mavacamten, measured by echo measurements and NYHA class. Methods: This retrospective study used data from medical records from two participating HCM centers in the US. Patient-level data was extracted to assess the effectiveness and safety of mavacamten post-treatment initiation through 60 weeks. Patient characteristics and outcomes were described, including echocardiogram measurements, New York Heart Association (NYHA) functional class, and safety. Results: A total of 93 patients were treated with mavacamten (mean age 60.6 ± 13.9 years, 23.7% black, 57.0% female, and 77.4% NYHA class III at baseline) with a mean follow-up of 37.0 ± 28.1 weeks ( Table ). From baseline to week 60, 3 (3.2%) patients experienced temporary treatment discontinuation, and 3 (3.2%) discontinued mavacamten due to left ventricular ejection fraction (LVEF) <50%. By week 12, 77.1% of patients had improved by ≥1 NYHA class. The percentage increased to 89.5% by week 24 and remained stable through week 60. Mean changes from baseline in resting and Valsalva left ventricular outflow tract gradients were 31.8 ± 32.8 and 57.3 ± 47.3 mmHg, respectively, at week 24, and remained similar through week 60. Mean change in LVEF from baseline was 4.1 ± 7.1% at week 12 and remained largely unchanged through week 60 (Figure) . Conclusions: This study demonstrated the early and sustained effectiveness of mavacamten with one of the longest follow-ups to date, in a real-world population with a higher racial diversity and disease burden than those in the clinical trials. This data further substantiates the effectiveness and safety profile of mavacamten.

Hydrochemical characterization and sustainability assessment of Ismailia canal water, Eastern Nile Delta, Egypt: implications for human health and environmental safety

Surface freshwater systems globally face severe stresses due to overpopulation and associated waste. The Ismailia Canal, a crucial freshwater source in the eastern Nile Delta, Egypt, serves multiple purposes and is endangered by various environmental activities. This study characterizes the canal’s water using physicochemical parameters to evaluate its suitability for different uses. Water samples were collected twice in winter and summer seasons of the year 2018 from eight sites distributed along the course of Ismailia Canal. A comprehensive chemical analysis of the samples was carried out. Water chemistry was graphically and statistically assessed. Water qualities were evaluated using WHO guidelines, water quality index (WQI), Pollution indices of metals (PIm) and long- and short-term effect of trace elements on irrigation. Results show that the water is slightly alkaline and moderately hard, with higher salinity in winter than summer. Major cations and anions are higher in winter, whereas NO₃ is higher in summer. The canal water is primarily of the Ca(Mg)-HCO₃ type, influenced mainly by rock-water interactions. While most physicochemical parameters meet drinking water standards, Al, Sb, As, Cd, Fe, Pb, and Tl exceed limits, with significant impacts from Al and Tl year-round, and seasonal impacts from As, Pb, Cd, and Fe. For irrigation, water quality is generally unaffected in winter, but Mo and Se have slight impacts in summer for long-term use. This research is vital for informing sustainable water management practices, which are crucial for Egypt’s research initiatives, economic stability, and environmental sustainability.

INNV-17. SAME-DAY DISCHARGE AFTER LASER INTERSTITIAL THERMAL THERAPY: A PROSPECTIVE COHORT PILOT STUDY WITH A MATCHED CONTROL GROUP

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for intracranial pathologies, offering precision and control over tissue damage. With implementation of enhanced recovery after surgery (ERAS) protocols within neurosurgery, identifying patients amenable for same-day discharge (SDD) is an important step towards streamlining perioperative care following LITT, and correspondingly, we aim to summarize our initial experience. METHODS We conducted a prospective study at the University of Miami Hospital of 7 patients who underwent LITT for intracranial pathologies and were discharged on the same day of ablation (post-ablation day 0, PAD0). We then performed a retrospective case-control study against a historic matched PAD1 cohort comparing categorical and continuous variables for statistical significance. RESULTS The mean age of the PAD0 cohort was 55 years with 71% males. Preoperative neurological status and comorbidities did not differ significantly between the PAD0 and PAD1 cohorts for KPS (median [IQR]: 80 [80-90] vs. 90 [80-90], p=0.40), mFI-5 (median [IQR]: 1 [1.5] vs. 0 [1], p=0.54), and mFI-11 (median [IQR]: 1 [1.5] vs. 1 [1], p=0.52). PAD0 outcomes demonstrated no immediate complications, neurosurgical readmissions, or significant neurological deficits within 6 months post-procedure and were non-significantly different than PAD1 patients. No PAD0 patient experienced intracranial hemorrhage or vasogenic edema following LITT that necessitated further intervention. CONCLUSIONS Our study demonstrates the safety and feasibility of same-day discharge following LITT for intracranial pathologies in the appropriately selected patient. Through meticulous patient selection and optimized perioperative protocols, expedited recovery without compromising patient outcomes was achieved. This approach holds potential for substantial cost savings and resource optimization within healthcare systems. Further research and quality improvement initiatives are warranted to refine patient selection criteria and maximize the benefits of same-day discharge in LITT practice.

SoIR: a comprehensive Solanaceae information resource for comparative and functional genomic study.

The Solanaceae family, which includes economically important crops such as tomatoes, potatoes and peppers, has experienced a rapid expansion in genomic data due to advancements in sequencing technologies. However, existing databases are limited by incomplete species representation, a lack of comprehensive comparative genomic tools and the absence of systematic pan-genomic analyses. To address these gaps, we developed the Solanaceae Information Resource (SoIR, https://soir.bio2db.com), a comprehensive genomics database for the Solanaceae family. SoIR integrates genomic data from 81 species and transcriptomic data from 41 species, encompassing a total of 3908408 gene annotations derived from Gene Ontology, nonredundant protein, Pfam, Swiss-Prot and TrEMBL databases. The resource also includes 3437115 CRISPR guide sequences, 212395 transcription factorsand 19086 genes associated with methylation modification. In addition to species-specific analyses, SoIR provides extensive bioinformatics tools for investigating gene family evolution, phylogenetic relationships and karyotype reconstruction across 25 fully sequenced genomes. With advanced tools such as Blast, Synteny and Sequence Alignment, the platform provides users with interactive and intuitive visualizations for conducting cross-species comparative genomics. As the first comprehensive pan-genomic resource for the entire Solanaceae family, SoIR facilitates in-depth cross-species analysis, supporting global research initiatives in plant evolution, functional genomics and crop improvement.

Management of opioid use disorder: 2024 update to the national clinical practice guideline.

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters. For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation-Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline. From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care. This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.

Research agenda for ending preventable maternal deaths from postpartum haemorrhage: a WHO research prioritisation exercise

IntroductionPostpartum haemorrhage (PPH) remains the leading cause of maternal death. Yet there is a lack of clarity around what research is needed to determine what works and how best to...