Algorithms that support screening, triage, and treatment decisions depend on training data drawn from patient populations. Limited access to patient-level records across institutions and jurisdictions can reduce representation and contribute to uneven model performance across populations. Canada's federated health system, where provinces and territories manage separate datasets and privacy regimes, limits multicenter medical AI research. We conducted a scoping review to map how Canadian researchers share patient-level data in multicenter medical AI collaborations. We searched PubMed, IEEE Xplore, ACM Digital Library, Scopus, and Web of Science from 2018 to February 2025 and implemented a human-in-the-loop large language model process to support screening and extraction, with reviewer validation. Among 3100 included studies, 160 reported multicenter patient-level data collection. Centralized pooling dominated this subset, with 95% of studies using centralized storage and 5% (n = 8) reporting decentralized approaches, including federated learning, sequential model transfer, and distributed feature sharing. Governance requirements were frequently described as multi-site and sequential, and 81.8% of multicenter collaborations reported parallel ethics approvals from three or more institutional review boards. Only one decentralized collaboration operated entirely within Canada. International partnerships comprised 80% of multicenter studies, and many cohorts included non-Canadian sites or non-Canadian data. Our findings support adoption of distributed model development protocols and interoperable governance that limit central pooling while enabling consistent training, validation, and reporting across sites, as only 1 of 160 multicenter studies reported a decentralized approach with Canadian patient data only.
Emergency departments (EDs) play a critical role in caring for people who use non-prescribed opioids, but ED services for these patients vary widely across Canada. We sought to develop a Canadian checklist for EDs to use in serving people who use non-prescribed opioids based on existing literature, ED professional consensus, and input from people with lived and living experience of drug use. We applied a modified online Delphi approach with two rounds of web-based surveys. We identified participants from a Canada-wide collaborator meeting on the ED initiation of opioid agonist therapy, with additional participants recruited by collaborator suggestion. Initial items for review were generated from a literature review and input from ED clinicians and addiction physicians, and reviewed by people with lived and living experience. In Round 1, participants ranked the relative importance of recommendations within eight domains and suggested additional items. In Round 2, participants rated the retained recommendations and offered further feedback. Of 62 participants invited, 30 participated in Round 1 (June-July 2023) and 24 completed both rounds (Round 2: August-November 2023). Participants represented seven Canadian provinces and territories. In Round 1, 37 items were ranked, 15 retained, and 3 new added. In Round 2, 13 of 18 items were rated > 75/100 by at least 75% of participants, spanning six practice domains: ED services offered (n = 3); staffing (n = 2); education and training (n = 2); protocols and policies (n = 2); referrals from the ED (n = 3); and rural and remote services (n = 1). A Delphi process generated a 13-item evidence and consensus-informed checklist of ED practices to support caring for people who use non-prescribed opioids. Implementation of the checklist in Canadian EDs has the potential to standardize care and improve outcomes in this patient group. RéSUMé: OBJECTIF : Les services d’urgence (SU) jouent un rôle essentiel dans la prise en charge des personnes qui consomment des opioïdes non prescrits, mais les services de SU pour ces patients varient considérablement à l’échelle du Canada. Nous avons cherché à élaborer une liste de contrôle canadienne pour les SU à utiliser dans le service aux personnes qui utilisent des opioïdes non prescrits en fonction de la littérature existante, du consensus professionnel sur les SU et des commentaires des personnes ayant vécu et vivant l’expérience de la consommation de drogues. MéTHODES: Nous avons appliqué une approche Delphi en ligne modifiée avec deux séries d’enquêtes sur le web. Nous avons identifié des participants à une réunion de collaborateurs pancanadiens sur l’initiation au DE du traitement par agonistes opioïdes, avec d’autres participants recrutés sur suggestion du collaborateur. Les éléments initiaux à examiner ont été générés à partir d’une revue de la littérature et des commentaires des cliniciens du DE et des médecins spécialistes en toxicomanie, puis examinés par des personnes ayant vécu et vivant une expérience. Lors de la première ronde, les participants ont classé l’importance relative des recommandations dans huit domaines et suggéré d’autres éléments. Au cours de la deuxième ronde, les participants ont évalué les recommandations retenues et ont offert d’autres commentaires. RéSULTATS: Sur 62 participants invités, 30 ont participé à la première ronde (juin-juillet 2023) et 24 ont terminé les deux rondes (deuxième ronde : août-novembre 2023). Les participants représentaient sept provinces et territoires canadiens. Lors de la première ronde, 37 éléments ont été classés, 15 ont été retenus et 3 nouveaux ont été ajoutés. Au cours de la deuxième ronde, 13 des 18 éléments ont été cotés à plus de 75/100 par au moins 75 % des participants, dans six domaines de pratique : services offerts en DE (n = 3); dotation (n = 2); éducation et formation (n = 2); protocoles et politiques (n = 2); références de la DE (n = 3); et services ruraux et éloignés (n = 1). CONCLUSION: Un processus Delphi a généré une liste de vérification en 13 points, fondée sur le consensus, des pratiques de DE pour soutenir les soins aux personnes qui consomment des opioïdes non prescrits. La mise en œuvre de la liste de contrôle dans les SU canadiens a le potentiel d’uniformiser les soins et d’améliorer les résultats chez ce groupe de patients.
Canada's federal government recently proposed allowing Health Canada to deem certain drug submission requirements met based on foreign regulatory decisions. Proponents frame this as a solution to delayed drug access. Yet the major contributors to delayed access to new drugs in Canada are manufacturers' late submissions and prolonged public reimbursement processes-not regulatory review times. This Policy Comment argues that the proposal targets the wrong stage of the access pipeline. We propose feasible alternatives - earlier filing incentives, enforceable reimbursement clocks, and a pan-Canadian listing default - that would meaningfully accelerate patient access to new therapies in Canada.
The effect of dietary intake on body weight may vary based on individual genetic differences. However, children are rarely used in such investigations. The aim was to identify possible genetic moderation through polygenic scores (PGS) for BMI, of the association between dietary intakes and BMI in children. The study sample included children who were part of a French-Canadian birth-cohort study. BMI data was available on seven occasions between ages 4 and 13 years. FFQ (juice and fruit drinks, sweets and snack foods, meats, and fruits and vegetables) and 24-h dietary recall (proteins, lipids, carbohydrates, total energy) data were available up to 4 years. Linear mixed models were used to account for repeated BMI measurements. The consumption of juice and fruit drinks (in girls), sweets and snack foods, fruits and vegetables, proteins, lipids, carbohydrates and total energy were associated with BMI. Associations with BMI increased with age (kg/m2 per year) for fruits and vegetables (β: -0.03, 95%CI: -0.06;-0.01), lipids (β: 0.11, 95%CI: 0.01;0.22), carbohydrates (β: 0.05, 95%CI: 0.01;0.08), and total energy (β: 0.07, 95%CI: 0.02;0.12), and with higher values of a PGS (kg/m2 per SD) for proteins (β: 0.54, 95%CI: 0.03;1.06), lipids (β: 0.63, 95%CI: 0.12;1.13), and total energy (β: 0.32, 95%CI: 0.06;0.58). Using longitudinal data, we showed that the associations between specific dietary intakes and BMI may vary depending on age and genetic susceptibility in childhood.
Severe tricuspid regurgitation (TR) causes high morbidity and recurrent heart failure hospitalizations (HFH). Transcatheter tricuspid valve replacement (TTVR) consistently eliminates TR, but real-world data on HFH reduction are limited. We therefore evaluated the impact of TTVR on HFH and clinical outcomes in a diverse cohort of compassionate-use and trial patients. This prospective, multicenter Canadian registry included 75 high-risk patients (STS score 8.2±5.9%) undergoing TTVR with the EVOQUE system. The primary endpoint was a composite of all-cause death or heart failure hospitalization (HFH) within one year after TTVR. Secondary endpoints included the annualized HFH rate 12 months before vs after TTVR, symptoms, quality of life (KCCQ-Kansas City Cardiomyopathy Questionnaire), and functional capacity. Procedural success was high (technical: 97.3%; device: 93.3%), with sustained TR reduction to ≤mild (94.3%), and a 6.7% one-year mortality. TTVR resulted in an 76.1% relative reduction in HFH (p<0.001). NYHA Class III/IV decreased from 76% to 10% (p<0.001). Significant improvements were observed in six-minute walk distance (260.8±104.7m to 334.5±103.5m, p<0.001) and KCCQ score (56.2±15.2 to 73.5±19.2 points, p=0.001). Multivariable analysis identified baseline NYHA IV (OR 3.96, p=0.003) and prior HFH (OR 2.31, p=0.033) as independent predictors of the composite endpoint (HFH/death). Comparative analysis showed that while compassionate-use patients (n=24) had a higher-risk profile than trial patients (n=51), both cohorts achieved comparable and significant clinical improvements. In a diverse, high-risk cohort, TTVR dramatically reduced HFH and significantly improved quality of life. These results reinforce the therapeutic benefits of TTVR in high-risk patients with severe TR.
Beta-hemolytic streptococci (BHS) are responsible for a large proportion of skin and soft tissue infections. Since the 1940s, studies evaluating BHS resistance to trimethoprim-sulfamethoxazole (TMP-SMX) have produced inconsistent results, limiting the use of this agent for these infections. To our knowledge, the true resistance profile of BHS to TMP-SMX has not been assessed in Canada for many years. Our primary objective was therefore to describe the contemporary susceptibility of BHS isolates to TMP-SMX in our mixed urban-rural region served by a tertiary care center in Quebec, Canada. Susceptibility to tetracycline, levofloxacin, erythromycin, and clindamycin was also assessed. BHS isolates from various clinical specimens were identified at our tertiary care hospital laboratory, which serves as the reference laboratory for the region, between December 30th, 2024, and January 30th, 2025. Antibiotic susceptibility was assessed using disk diffusion according to Clinical and Laboratory Standards Institute (CLSI) standards for tetracycline, levofloxacin, erythromycin, and clindamycin (including testing for inducible resistance - D-test), and according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards for TMP-SMX. Among 151 BHS isolates identified in January 2025, 99% of isolates were susceptible to TMP-SMX, 98% to levofloxacin, 74% to tetracycline, and 72% to clindamycin. In vitro susceptibility of BHS isolates to TMP-SMX at our institution in January 2025 was 99%. The clinical (in vivo) effectiveness of TMP-SMX for proven or suspected BHS infections remains to be determined.
The Innovation and Entrepreneurship in Surgical Training (INVEST) curriculum was developed to introduce surgical residents to basic concepts of innovation and entrepreneurship. The INVEST curriculum involves a series of 4 academic sessions teaching pillars of surgical innovation and entrepreneurship: identifying needs, value assessment, exploring feasibility, and telling a story. We prospectively examined participant perceptions before and after the INVEST curriculum. This longitudinal survey study included consecutive surgical trainees in their first year of training across 9 surgical specialties who partook in the INVEST curriculum at McMaster University. The primary outcome was change in perceived ability to succeed in achieving meaningful contributions to surgical innovation. Change in willingness to complete future training in surgical innovation was a secondary outcome. We used McNemar tests and Wilcoxon matched-pairs signed-rank tests to analyze differences in pre- and postcourse data. Forty-seven residents attended the INVEST sessions and 36 completed both the pre- and post-INVEST surveys (76.6%). The mean age of respondents was 27.0 years and 53.2% were female. Resident confidence in health care innovation and entrepreneurship knowledge improved 2.2-fold (14.9% to 33.3%, p < 0.01) following completion of the INVEST curriculum. The curriculum sparked interest in further education among 17% of participants, while reducing interest in 14%. Participants' self-perceived ability to partake in entrepreneurial exploits increased following completion of the INVEST curriculum. Similar to training curricula in research, entrepreneurship education sparked interest in some, while decreasing interest in others. Early exposure to entrepreneurship in surgical training may help residents identify opportunities for investment of time.
This economic evaluation study assessed the cost-effectiveness of six treatment strategies for non-displaced osteoporotic femoral neck fractures (NDFNFs) in older adults using a Markov cohort model from the Ontario, Canada, public payer perspective. A probabilistic Markov chain Monte Carlo decision analysis model was developed to compare six strategies: 1) cemented femoral fixation total hip arthroplasty (THA; hybrid, cemented femoral component/uncemented cup - 'cemented THA'); 2) cementless THA; 3) cemented hip hemiarthroplasty (HHA); 4) cementless HHA; 5) internal fixation (IF); and 6) conservative treatment. The base case cohort consisted of Canadian patients presenting with a NDFNF aged 65 years, modelled with a lifetime horizon. Outcomes included quality-adjusted life-months (QALMs), lifetime costs (discounted at 1.5% annually), net monetary benefits (NMBs), and incremental cost-effectiveness ratios (ICERs). All costs are presented in Canadian dollars (CAD, $). The cost-effectiveness threshold (λ) was $4,166.67 per QALM. The primary outcome measure was expected NMBs, and the preferred strategy was the one with the highest expected NMBs over the lifetime horizon. The estimated mean costs were $6,054 (IF), $11,995 (cemented THA), $11,011 (cemented HHA), $11,854 (cementless HHA), $15,405 (cementless THA), and $7,617 (conservative treatment). Cemented THA yielded the highest QALMs (192.7). Cemented THA had the highest NMB ($790,784). Cementless THA, cementless HHA, and conservative treatment were absolutely dominated while cemented HHA was extendedly dominated. After excluding dominated strategies, the ICER for cemented THA compared with IF was $127.5 per QALM, indicating that cemented THA is cost-effective relative to IF. At a λ of $4,166.67 per QALM, cemented THA was the most cost-effective strategy in 48.7% of simulations, followed by cemented HHA (31.2%) and IF (17.9%). Cemented femoral fixation THA is the most preferred strategy (highest expected NMB at λ) for NDFNFs in 65-year-old patients. When evaluated against a λ of $4,166.67 per QALM, cemented THA outperforms cementless THA, HHA, IF, and conservative treatment.
Phytoplasmas are cell wall-less bacteria that are transmitted by phloem-feeding insects. In Canada, insect vectors of this pathogen are leafhoppers (Hemiptera: Cicadellidae), and they can contribute to significant economic losses. As climate change alters the composition and movement of insect communities, migratory species such as the potato leafhopper (Empoasca fabae, Harris 1841), one of the most abundant leafhoppers in Québec affecting berries, may play an emerging role in phytoplasma transmission. Although E. fabae is not currently confirmed to act as a vector, its frequent presence and abundance in fields, along with its potential to acquire phytoplasmas, deserve further investigation. In this study, we tested DNA from E. fabae collected in strawberry fields for the presence of 'Candidatus Phytoplasma' using a highly validated nested PCR assay. The amplicon from positive insects were cloned and 46 of those clones were sequenced to identify phytoplasma groups and subgroups. Our findings confirmed the presence of multiple Aster Yellows (16SrI-related) subgroups in E. fabae, based on phylogenetic analysis, restriction fragment length polymorphism (RFLP) profiling, and single-nucleotide polymorphism (SNP) profiles. However, although phytoplasma was detected in a new generation of leafhoppers reared under controlled conditions in disease-free alfalfa plants, the ability of E. fabae to transmit the pathogen remains unknown. Overall, these findings highlight the importance of monitoring common pests such as E. fabae as early indicators of phytoplasma diversity in Eastern Canadian agricultural systems.
An emerging strategy to alleviate healthcare system pressures are prehospital treat and discharge directives, allowing paramedics to manage patient care in the community without transporting to an emergency department (ED). In Ontario, Canada, three discharge directives apply to patients with resolved seizures, resolved hypoglycemia, and resolved supraventricular tachycardia. Our objective was to describe how these directives were utilized in practice and to characterize associated operational metrics and downstream ED utilization among eligible patients. We conducted a retrospective cohort study using paramedic records from southwestern Ontario between June 1, 2023, and November 15, 2024. All 9-1-1 calls were screened using objective criteria in the medical directives to identify patients who may have been eligible for paramedic discharge. Patient records were categorized into groups by directive, then classified by their call outcome (transported, discharged by paramedics, patient refusal of transport). Where established linkages existed, transported patient records were linked to their ED visits. We examined paramedic scene times and call durations across groups, and ED metrics of length of stay (LOS), wait time for physician assessment, visit outcome, and visit costs. Of 1,596 patients identified as potentially eligible for discharge, 1,085 (68.0%) were transported to an ED, 474 (29.7%) patients refused transport, and 35 (2.2%) were discharged by paramedics. Paramedic discharged patients had half the median call duration (45 minutes) of ED transported patients (87 minutes). Patients with hypoglycemia had a high rate of transport refusal (58.9%), while the cohort of patients with seizure had the highest rate of transport (72.0%). Among 494 patients with linked ED data, the mean ED LOS was 6 hours and 20 minutes. Most were discharged (70.2%) or left before completing care (13.4%). The average ED visit cost was $461 in Canadian dollars (not including physician billing), and the mean wait time for physician assessment exceeded 1.5 hours. Paramedic-initiated discharge was used infrequently, but cases in which it was applied were associated with shorter call durations and avoided subsequent ED utilization. These descriptive findings suggest potential operational advantages worthy of further evaluation, though additional research is needed to determine safety, and system-level impact.
The efficiency of oil contaminated pulp and paper mill sludge (PPMS) stabilization by Eisenia fetida strongly depends on optimal temperature conditions for nutrient recovery and organic pollutant reduction. In Western Newfoundland, Canada, fluctuations in environmental temperature (< 0 °C to 20 °C), limit the year-round viability of vermicomposting. Therefore, PPMS (TS) and PPMS amended cow manure (TSC) were vermicomposted over a 70-day period at three controlled temperatures (12 °C, 17 °C, and 22 °C) to assess the effects of thermal conditions on PPMS stabilization, and vermiremediation efficiency, and population dynamics of E. fetida. While pH remained stable at 17 °C and 22 °C, it decreased significantly at 12 °C (p < 0.000), whereas electrical conductivity increased significantly across all treatments (p < 0.000). The biodegradability coefficient was significantly higher (p < 0.008) in TS at 17 °C and 22 °C while maximum carbon (C) loss and nitrogen (N) enrichment occurred in TSC at 22 °C, resulting in a reduced C:N (<20) by day 56. Oil degradation was faster in TSC compared to TS at 17 °C and 22 °C. A significant increase in macronutrients (P, Na, K, Ca, Mg) and micronutrients (B, Mn, Fe, Al) were observed at 17 °C and 22 °C with the highest enrichment in TSC, followed by TS (p < 0.001). A slight increase in potentially toxic elements (As, Co) was detected in TSC, whereas Zn and V were more prominent in TS at 12 °C. TS exhibited higher levels of Cd, Cu, Ni, and Cr, while Pb and Mo were elevated in TSC at 22 °C. However, all remained below Canadian Council of Ministers of the Environment (CCME) guideline limits. Growth and reproduction of E. fetida and vermicompost production were significantly enhanced (p < 0.0001) at 17 °C and 22 °C, peaking on day 42 while lower at 12 °C. Overall, temperature between 17 °C and 22 °C optimized PPMS vermicomposting and are feasible from late spring to mid fall in Corner Brook, Newfoundland and Labrador, Canada.
Liver transplantation from donors following medical assistance in dying (MAiD) is a novel practice with emerging Canadian outcomes data. We sought to compare donor and recipient outcomes after liver transplantation following donor MAiD, circulatory death (DCD), or brain death (DBD). We conducted a scoping review and a single-centre retrospective cohort study. The 5 retrospective studies identified found comparable short-term liver graft and patient survival between MAiD, DCD, and DBD liver recipients, with no differences in vascular complications or primary nonfunction. One study noted higher biliary complications among MAiD liver recipients. Our single-centre retrospective cohort reporting included 177 liver transplant recipients between 2018 and 2024 (19 MAiD, 14 DCD, and 144 DBD donors). Among donors, MAiD (mean age 59 yr) and DBD (mean age 57 yr) donors were older than DCD donors (mean age 37 yr; p < 0.001) and had lower median body mass index than other donors (MAiD 20, DCD 22, DBD 26; p < 0.001). Cold ischemia times were longest for DBD grafts (6.6 h v. 6.2 h DCD and 5.8 h MAiD; p = 0.02), with no other intraoperative differences. Rates of mortality within 90 days (p = 0.7), complications (Clavien-Dindo grade ≥ 3; p = 0.4), and retransplant (p = 0.6) were comparable across groups. Biliary strictures affected 42% MAiD, 35% DCD, and 13% DBD livers (p = 0.005), mostly extrahepatic and anastomotic strictures. Kaplan-Meier analysis found no significant difference in graft survival between donor groups (p = 0.7), Cox regression identified portal vein thrombosis (hazard ratio [HR] 23.98, 95% confidence interval [CI] 2.41 to 238.15), hepatic artery thrombosis (HR 8.14, 95% CI 1.72 to 38.54), and biliary complications (HR 11.93; 95% CI 2.31 to 61.76) as independent predictors of graft loss. Liver transplantation from donors who underwent MAiD was not associated with higher graft loss or mortality than in those who underwent DCD or DBD. Its continued use is safe, and larger multicentre studies are warranted for validation.
The growing proportion of women in veteran communities internationally highlights a rising need for veteran support services tailored to their unique experiences. Despite this, support services remain predominantly designed for men, leading to underutilization and dissatisfaction among women veterans. This scoping review aimed to provide a comprehensive international review of the current state of knowledge regarding the experiences of women veterans in accessing and engaging with veteran-specific support services. This study followed the Joanna Briggs Institute scoping review methodology. Five databases were searched for papers published from 2000 onwards. Studies reporting on barriers and/or facilitators to access and experiences of engaging with veteran-specific support services reported by women veterans were included. There were no limitations on study methodology or country of origin, and all publications reporting primary research were included. A total of 117 studies were included in the review. This research originated predominantly from the US (n = 109), with seven UK papers, and one Canadian. Eleven themes were identified across the literature, highlighting gendered barriers and facilitators of accessing veteran-specific support for women. Women veterans report feelings of discomfort, exclusion, and discrimination within veteran services, which are perceived as being set up and designed for men. Women report experiencing stigma in help-seeking compounded by a perception of feminine weakness experienced during military service. Some women didn't want to access services they saw as military-adjacent, due to gendered adverse experiences during military service, including discrimination, harassment, and sexual violence. A lack of identification with the term 'veteran' further hinders women's engagement with veteran-specific services. Enablers of access include care that is sensitive to women's needs, trauma-informed service user-provider relationships, and peer support. The reviewed evidence suggests women experience unique challenges and needs in accessing veteran-specific services. Support services should focus on developing care that is, culturally competent, trauma-informed and sensitive to the needs of women, to address gendered barriers to engagement. More research is needed to confirm these research findings outside of the US context, and incorporating an intersectional lens in future research will be essential for improving the support systems for women veterans internationally.
Canada is committed to supporting internationally educated nurse (IEN) integration into the healthcare system, as a strategy to address post-pandemic nursing shortages. The province of Nova Scotia has emerged as a Canadian exemplar with the development of NICHE (Nova Scotia's International Community of Healthcare Workers Engagement) programme, which anchors intersectoral collaboration between the government, the nursing regulator and healthcare systems in service of streamlining IEN integration. We conducted a province-wide realist evaluation of the integration of IENs into the Nova Scotia healthcare system and community. We collected data from interviews with 24 participants, comprised of IENs and stakeholders at meso- and micro-healthcare system levels. We used a theory-driven approach to data analysis which utilised elements of content analysis, reflective dialogue and the construction of CMOCs (context-mechanism-outcome configurations). We constructed three main CMOCs which highlight facilitators for IEN integration related to (1) the development of adaptive programme pathways for IENs, (2) the critical role of IEN allies and advocates within healthcare systems, and (3) the shift in focus from recruitment to retention. The study findings describe the contextual factors and key mechanisms that promote 'successful' IEN integration which may be useful for leaders and policymakers integrating IENs into their local health human workforce. The findings raise important questions about supporting IEN retention, consistent with the vision for a healthy and sustainable nursing workforce. The findings from this study underscore the need for further evaluation research in on the topic of IENs.
Sepsis, the body's life-threatening response to infection, is associated with significant morbidity and mortality. In 2017, the World Health Assembly passed a resolution urging member states to recognize sepsis as a public health priority. Our objective was to identify and describe sepsis policies, guidelines, and health professional training standards in Canada. We conducted a scoping review and an environmental scan, including systematic searches of published and grey literature. Policies, guidelines, or training standards related to identifying, managing, or reporting sepsis, published since 2010 and available in English/French, were included. We extracted data on the organization(s) involved in the development, information on the source, including the target patient population, measures of inclusive engagement, and whether the source considered at-risk, equity-denied, and/or Indigenous communities. We identified 32 sources of evidence, including sepsis policies or guidelines for 38% (5/13) of provinces and territories, the inclusion of sepsis as a training competency in 16% (11/67) of the Royal College of Canada medical specialties/subspecialties competency standards, and two Canadian Hospital Accreditation Standards. Only 6% (2/32) of the sources considered the role of social determinants of health, and 13% (4/32) engaged individuals with lived sepsis experience or members of the public. We identified existing sepsis policies, guidelines, and standards that reveal significant gaps across provinces and territories, particularly the lack of attention to social determinants of health and the exclusion of individuals with lived experience. Coordinated national policy efforts are urgently needed to reduce the burden of sepsis in Canada.
Sustaining agricultural productivity while maintaining ecological integrity requires understanding the spatial dynamics of ecosystem services (ES). In the Canadian prairies-an intensively modified agricultural region-the degradation of natural habitats has impacted ES flows crucial for food security. We investigated how landscape structure, acting as a structural proxy for potential internal ES flows, mediated by landscape structure, influence crop yield at the Soil Landscape of Canada (SLC) scale, an ecologically meaningful delineation based on natural features. Our primary objective was to determine the relative importance of landscape composition versus configuration in predicting agricultural productivity. We conducted a biophysical assessment of key ES (pollination, carbon storage, habitat quality, soil erosion control) for the year 2020. We quantified landscape composition and configuration metrics at the SLC scale to represent the structural potential for ES flow pathways. Generalized additive models (GAMs) were used to analyze the non-linear effects of these variables on a composite crop yield index. Our findings reveal that landscape configuration-notably connectivity (positive linear effect) and crop diversity (complex non-linear effect)-significantly predicts crop yield, often exerting greater influence than the mere amount of natural habitat. A secondary analysis showed that yield in specific crops like canola, which depends on pollination, responded positively to natural habitat extent. The models explained a substantial portion of yield variance (Adjusted R2 ≈ 0.66-0.67). Our analysis highlights that agricultural output is not solely a function of field-level inputs but is deeply embedded within, and responsive to the landscape matrix at SLC scale and the ecological processes it mediates. Strategically enhancing landscape cohesion and crop diversity may therefore offer greater yield benefits than focusing on increasing isolated natural habitat, guiding a shift towards spatially explicit, multifunctional landscape planning. The online version contains supplementary material available at 10.1007/s10980-026-02333-y.
Medical assistance in dying (MAiD) became a legal end-of-life option on December 10, 2015, in Québec, and on June 17, 2016, in the rest of Canada. Since its legalization, there has been a steady increase in the number of MAiD requests and provisions. Across permissive jurisdictions, Québec now has the highest rate of assisted death. Despite the growing use of MAiD, research examining the factors driving this increase remains limited and fragmented. Existing studies offer partial and sometimes contradictory explanations, with little integration of legal, institutional, societal, and individual dimensions. Further research is needed to better understand the determinants of MAiD requests and practices, particularly in the Canadian and Québec contexts. This research aims to understand the factors influencing changes in MAiD requests and administrations in Québec by examining laws, practices, societal perspectives, organization of care and services, and individual characteristics of those requesting MAiD, as well as their interrelationships. We present the protocol developed by the Consortium interdisciplinaire de recherche sur l'aide médicale à mourir, an interdisciplinary research consortium, including an international advisory committee, set up for this research. The design of this protocol is multimethods and convergent mixed methods, including (1) an international cross-thematical approach with 4 main research methods (a scoping review, key informant interviews, focus groups with health care professionals, and a population-based survey) chosen to partially answer research questions across the entire study and to compare with other jurisdictions and (2) 11 theme-specific methods (including community forums, media coverage analysis, comparative legal analyses, case studies of triads, individual interviews, and system mapping) to enrich and complement findings from the cross-thematical approach. When this 3-year funded study started in July 2024, several research methods not requiring ethics committee approval (because no human participants were involved) were initiated, including scoping and systematic reviews, media coverage analysis, and comparative legal analyses. By August 2025, interviews with key informants were completed, and analyses took place in September. Concurrently, other subteams started data collection (focus groups December 2025) or are getting ready to seek ethics approval for their protocols and data collection processes involving human participants: case studies of triads, individual interviews, and community forums. Findings from the international cross-thematical approach and theme-specific methods will provide a comprehensive understanding of the factors influencing the use of MAiD in Québec. This study has strengths, including the use of a specific theoretical framework, a variety of complementary methods, and an integrated knowledge mobilization strategy. As for its limitations, we foresee challenges with the comparison of jurisdictions in terms of language, culture, and legal systems, as well as access to data about MAiD cases, since reporting systems may differ between jurisdictions. DERR1-10.2196/83549.
Canadian researchers have made significant contributions to the advancement of organ transplantation globally. The COVID-19 pandemic made transparent the importance of reflecting on our accomplishments and the current and future challenges that limit the lives of our patients and to celebrate individual and collective achievement. On October 6, 2025, thought leaders in the field of organ transplantation assembled in Vancouver to recognize the contributions of Paul Keown, a clinician scientist and translational researcher, whose work has directly impacted thousands of transplant recipients worldwide. This article summarizes the invited speaker presentations and represents a unique opportunity to celebrate the past and to focus on current challenges and future opportunities to advance the field of organ transplantation. Les chercheurs canadiens ont largement contribué à l’essor mondial de la transplantation d’organes. La pandémie de COVID-19 a rappelé l’importance de faire le point sur nos réalisations, d’anticiper les défis actuels et futurs qui affectent la vie de nos patients et de célébrer les accomplissements individuels et collectifs. Le 6 Octobre 2025, des figures marquantes du domaine de la transplantation d’organes se sont réunies à Vancouver pour souligner les contributions de Paul Keown, clinicien-chercheur et spécialiste de la recherche translationnelle, dont les travaux ont eu des retombées directes pour des milliers de transplantés à travers le monde. Cet article résume les présentations des conférenciers invités et constitue une occasion unique de célébrer le chemin parcouru et d’orienter la réflexion vers les défis et opportunités à venir dans le domaine de la transplantation d’organes.
Alterations of the gut microbiome have been reported in central nervous system demyelinating diseases. While the gut microbiome in pediatric multiple sclerosis (MS) has been studied, the role of the gut microbiome in other pediatric-onset acquired demyelinating syndromes (ADS) remains unknown. We compared the gut microbiome composition between myelin oligodendrocyte glycoprotein antibody-positive (MOG+) and antibody-negative (MOG-) participants with pediatric-onset ADS. Participants aged ≤21 years enrolled in the Canadian Pediatric Demyelinating Disease Network microbiome study (2015-2018) with a single episode or relapsing non-MS, non-neuromyelitis optica spectrum disease attacks of demyelination with symptom onset <18 years were included. Stool sample-derived DNA underwent 16S rRNA (V4) sequencing. Serum MOG-IgG antibodies were tested within 30 days of first attack onset. Alpha-diversity (Shannon, Margalef's index, Chao1) and beta-diversity (weighted UniFrac) were analysed. Phylum/genus-level taxa were assessed using negative binomial models with false discovery rate correction. Rate ratios were sex- and age-adjusted (aRR). Forty-six participants (18 MOG+/28 MOG-) were included. Mean age at stool sample collection (MOG+/MOG-) was 14.7/17.2 years. Alpha-/beta-diversities did not differ between MOG+/MOG- participants (p > 0.3). At the phylum level, the relative abundance of Proteobacteria was lower in MOG+ than MOG- participants (aRR:0.22;95%CI:0.07-0.69;q = 0.03). At the genus level, the relative abundance of Escherichia/Shigella was lower in MOG+ than MOG- participants (aRR:0.01;95%CI:0.001-0.07;q = 0.001), CONCLUSIONS: While alpha/beta-diversities did not differ between MOG+/MOG- participants, taxa-level differences were observed. Our findings suggest that the gut microbiome composition may differ by MOG serostatus among pediatric-onset ADS participants. Future work is warranted, utilizing larger cohorts and longitudinal follow-up.