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Youth exposure to unhealthy digital food marketing in relation to race/ethnicity and income adequacy in Canada
No full textAbstract Background Youth of racial/ethnic minority groups and lower-income households are disproportionately exposed to unhealthy food marketing on television; however, there is limited evidence concerning digital marketing. This study examined differences in Canadian youth’s exposure to digital food marketing by race/ethnicity and household income adequacy. Methods Frequency of food marketing exposure via digital platforms and digital food marketing techniques were self-reported by 996 youth in Canada aged 10–17 years. Proportional odds and logistic regression models explored differences between racial/ethnic (White vs. racial/ethnic minority) and income adequacy groups (low vs. medium vs. high), adjusted for sociodemographic and digital device usage variables. Results White participants had lower odds of more frequent exposure to digital marketing of sugary drinks (OR: 0.70; 95% CI: 0.52–0.94), sugary cereals (OR: 0.56; 95% CI: 0.42–0.76), fruits/vegetables (OR: 0.63; 95% CI: 0.45–0.87), salty/savoury snacks (OR: 0.63; 95% CI: 0.47–0.85), fast food (OR: 0.74; 95% CI: 0.55–0.99), and desserts/sweets (OR: 0.68; 95% CI: 0.50–0.91) than racial/ethnic minority youth. Compared to youth from low income adequacy households, those with medium income adequacy were less likely to report more frequent exposure to marketing of sugary drinks (OR: 0.67; 95 CI: 0.51–0.89), fast food (OR: 0.66; 95% CI: 0.50–0.87), and desserts/sweets (OR: 0.65; 95% CI: 0.49–0.87). White youth were less likely than racial/ethnic minority youth to report exposure to unhealthy food marketing on ≥ 1 social media platform(s) (OR: 0.45; 95% CI: 0.30–0.68) and gaming/TV/music streaming platform/website(s) (OR: 0.71; 95% CI: 0.51–0.99); no differences were observed between income groups. White youth were less likely than racial/ethnic minority youth to report exposure to marketing featuring incentives/premiums (OR: 0.72; 95% CI: 0.52–0.99) and cross-promotions (OR: 0.71; 95% CI: 0.51–0.99). Participants of higher (OR: 0.68; 95% CI: 0.49–0.95) and medium (OR: 0.69; 95% CI: 0.50–0.93) income adequacy were less likely to report exposure to marketing featuring celebrities than those with low income adequacy. Conclusions Youth of racial/ethnic minorities report more frequent exposure to digital food marketing, especially for unhealthy foods, than White youth in Canada. Differences were also observed between income groups. Comprehensive marketing regulations are needed to limit all youths’ exposure to unhealthy digital food marketing
Advancing Scope of Practice: A Policy Analysis of Advanced Sonographer Practitioners in Canada
No full textRising demand for healthcare services is outpacing capacity globally. This is felt most ardently in the digital imaging department, where a shortage of technical staff and radiologists alike has contributed to persistent backlogs, delaying initial diagnoses and subsequent image-dependent treatments. These delays compromise patient outcomes, increase avoidable hospitalizations, and lead to inefficient use of limited healthcare resources as patients seek interim care options.
To address these systemic inefficiencies, the United Kingdom introduced an Advanced Sonography Practitioner (ASP) position to allow experienced sonographers the authority to autonomously generate diagnostic reports. By enhancing sonographer autonomy and enhancing workflow efficiency, the U.K. model improved service delivery capacity, reduced role redundancies, and helped stabilize healthcare costs, while improving patient outcomes through expedited reporting and treatment planning. Other jurisdictions facing similar mounting healthcare pressures, such as Australia and New Zealand, have adopted elements of the U.K. model as a means of addressing system-wide health service pressures through scope of practice reform. This capstone analyzes the policy trajectories of the U.K., Australia, and New Zealand to explore how ASP models have supported healthcare efficiency and access. It evaluates the relevance of these reforms to the Canadian jurisdictional landscape and outlines implementation strategies focused on legislative reform, credentialing standards, and integration within regional healthcare
authorities
Enhancing provider adoption of patient-reported outcome measures (PROMs) through implementation science: insights from two international workshops
No full textAbstract Background Although the use of patient-reported outcome measures (PROMs) in practice is increasing, successful implementation is contingent on engaging healthcare providers (HCPs). Using Implementation Science (IS), we present the content of two workshops hosted at the International Society for Quality-of-Life annual conferences for individuals seeking to implement PROMs collection and use in their settings. Our goals were to provide workshop participants with knowledge, tools, and resources to prepare HCPs for PROM adoption and to demonstrate tailored strategies to meet context-specific needs. Methods An interdisciplinary team with diverse expertise in PROMs implementation delivered two workshops guided by the Capability, Opportunity, Motivation – Behavior (COM-B) model and the Theoretical Domains Framework (TDF). Using dotmocracy, participants were asked to consider, for their local context, the factors most important for changing HCPs’ behaviors to adopt PROMs in daily practice. Results The workshops incorporated IS theories, models, and frameworks (TMFs) to identify barriers faced by HCPs, support behavior change, and apply tailored theory-informed implementation strategies to prepare HCPs for PROM integration and evaluate adoption success. The factors rated the most important by workshop participants (n = 53) were woven into the discussions to illustrate the most common barriers encountered by HCPs adopting PROMs. Presenters drew on real-world practice and research experiences to identify promising implementation strategies, including education, training, behavioral modeling, persuasion, environmental restructuring, enablement, and audit and feedback to increase the capability, opportunity, and motivation of HCPs. Conclusions Given the increasing evidence base supporting the role of PROMs in patient-centered care, it is imperative to understand the mechanisms and best practices for increasing provider adoption of PROMs. This work offers a roadmap for understanding determinants more important to HCPs and systematically selecting theory-informed implementation strategies that may increase the likelihood of HCP adoption of PROMs. Offering tailored HCP training/education programs and implementation strategies can prepare HCPs for timely and effective PROM implementation.Plain Language summary Patient-reported outcome measures (PROMs) can make healthcare better in many ways. Yet not all healthcare providers (HCPs) use PROMs, and they sometimes face problems when trying to use PROMs in routine care. We held two workshops that looked at the problems often faced by HCPs and made suggestions to help them adopt and use PROMs on a regular basis. The workshops were guided by Implementation Science, a field that studies how to overcome barriers and improve practice. During the workshops, presenters focused on common issues faced by HCPs, like the lack of resources or support and low knowledge about PROMs. Participants and workshop facilitators then discussed best practices for addressing these issues. The findings from this work can guide future training with HCPs and efforts to increase PROM use in healthcare settings
Eye-XAI: an explainable artificial intelligence approach for eye disease detection using symptom analysis
No full textAbstract The early and accurate detection of eye diseases play a pivotal role in preventing vision loss and improving patients’ quality of life. It is therefore important to search for methods for improving this detection. It turns out that Artificial Intelligence (AI) has shown great promise for the detection task. However, AI models are often opaque and complex and as a result there has been a slow adoption for these models in clinical settings. In this paper Eye-XAI is introduced which provides an effective approach to the detection combining Explainable Artificial Intelligence (XAI) techniques with symptom analysis to enhance the transparency and interpretability of eye disease detection models. Our results demonstrate that Eye-XAI not only achieves high accuracy (99.11%) for eye disease detection but also provides transparent and interpretable insights into the diagnostic process. The adoption of Eye-XAI can therefore significantly enhance the early detection and management of eye diseases while empowering clinicians with a deeper understanding of its AI-based diagnostic recommendations. Furthermore, this approach promotes patient engagement by facilitating communication and trust between patients and their healthcare providers. Eye-XAI represents a major step towards the integration of XAI in ophthalmology, unlocking new possibilities for improved eye disease diagnosis and treatment
Personalised and precision mental health in eating disorders: why routine outcome measurement is key
No full textAbstract For over a decade, the mental health field has been interested in precision treatment using psychopharmacological interventions. More recently, this interest has expanded to include psychotherapy, which is the primary treatment modality for eating disorders. Personalised medicine and precision treatment are also seen as priorities for the eating disorder field by those with lived experience and carers, clinicians and researchers. However, precision treatment necessitates the collection of large amounts of clinical data. Three frameworks exist or have been proposed for the purpose of gathering large-scale routine clinical outcomes in eating disorder services: The International Consortium for Health Outcomes Measurement (ICHOM) eating disorder set, the Australia national minimum dataset, and the Eating Disorders Clinical Research Network. Despite the emergence of these frameworks, challenges exist with implementation. This paper outlines the rationale for the collection of routine outcome data in eating disorder treatment settings, the three existing frameworks proposed, and considerations for implementation and scaling. These include clinical and practice applications, technical aspects, statistics, and contextual factors. We invite attention to our recommendations and collaborative approaches to facilitate progress towards precision treatment in eating disorders.Plain English summary Precision treatment, also known as precision medicine, involves tailoring treatment to the individual characteristics of each patient. Precision treatment for eating disorders is seen as a priority by individuals with lived experience, their carers, clinicians and researchers. However, precision treatment depends on large amounts of clinical data being collected. Currently, eating disorder services do not collect the same information from or about patients. There is no large clinical database to inform precision medicine decisions. Three main frameworks have been proposed to support largescale and consistent data collection in eating disorder services: The International Consortium for Health Outcomes Measurement (ICHOM) eating disorder set, the Australian national minimum dataset, and the UK Eating Disorders Clinical Research Network. These frameworks hold promise but there are challenges with applying them. This paper summarises why collecting routine outcome data is important, the three main frameworks proposed, and the factors which may help to progress data collection and precision treatment for eating disorders. We consider clinical, practical, technical, statistical and contextual factors. It is important that progress in this area is collaborative and involves individuals with lived experience, carers, clinicians and researchers
Ethical Issues Encountered by Registered Nurses Caring for Adult Patients Requiring Extracorporeal Membrane Oxygenation
No full textBackground: Extracorporeal Membrane Oxygenation (ECMO) is a life-extending and potentially life-saving technology. However, the literature is clear that its use may generate ethical issues for the healthcare providers caring for patients receiving ECMO. Registered Nurses (RNs) caring for ECMO patients and their families may experience these ethical issues more acutely than other healthcare providers, as RNs are consistently with the patient and family members. It is important to identify potential ethical issues affecting RNs, as in some cases, ethical distress and burnout may ensue. Aim: The primary aim of this study was to identify the ethical issues experienced by RNs caring for adult ECMO patients in a single-centre Cardiovascular Intensive Care Unit (CVICU). A secondary aim that emerged during data analysis was to describe how RNs experience and respond to the emotional challenges associated with these ethical issues and the strategies they use to mitigate them. Methods: A qualitative descriptive design was used. Data were collected through individual semi-structured interviews with 10 RNs who had experience caring for adult ECMO patients. Interviews were conducted either in person or via Zoom, audio-recorded, and transcribed verbatim. Data were analyzed using conventional content analysis. Findings: The findings were organized into three categories. Ethical Issues (Category 1) addressed the primary research question and included the subcategories: futility of treatment, time to decide, allocation of resources, nonmaleficence, beneficence, consent, and operating within the RN’s scope of practice. Emotional Challenges for Nurses (Category 2a) emerged in relation to the ethical issues described by participants and included end-of-life care (process and patient appearance), futility, and time to decide. Strategies to Help Mitigate Ethical Issues and Respond to Emotional Consequences (Category 2b) described how nurses managed these challenges and included education and support, understanding the plan of care, and collaborative team dynamics. Conclusion: These findings highlight the ethical issues faced by RNs caring for adult ECMO patients, particularly around end-of-life decisions and uncertainties regarding patient outcomes. These findings align with existing literature on the importance of clear communication, team support, and ongoing education in reducing distress and enhancing nurse well-being in critical care
The role of human–pig interactions in modulating gut microbiota, stress, and performance
No full textAbstract Background The microbiota‒gut‒brain axis modulates pigs’ stress response, behavior, and overall welfare. Stressful management practices can disrupt gut microbiota (GM), negatively impacting pigs' health and welfare. This study evaluated how the quality of human handling influences stress-related physiological responses, productive performance, and gut microbiota (GM) composition in pigs during the nursery phase. Results Female pigs (n= 36, 21 days old) were randomly assigned to three experimental groups (12 pigs/group, four pens per treatment): positive human handling (PHH), negative human handling (NHH), and a control group (CG). The PHH group experienced gentle tactile interactions, whereas the NHH group was subjected to chronic intermittent stress through acute stressors, and the CG group received minimal handling for routine practices. Hair cortisol concentrations were measured as an indicator of chronic stress (days 15 and 64). Productive performance was assessed through body weight (BW), average daily gain (ADG), average daily feed intake (ADFI), and feed conversion (FC). Fecal samples were collected at baseline (T0, day 16), mid-study (T1, day 37), and end of the study (T2, day 65) and analyzed using 16S rRNA gene amplicon sequencing to assess GM changes over time. Pigs in the PHH group showed a significant reduction in cortisol levels from baseline to post-treatment (P < 0.0001), while no significant changes were observed in the NHH group (P = 0.26). A smaller but significant decrease was also detected in the CG group (P = 0.001). PHH pigs had higher BW (P = 0.0009) and ADG (P = 0.03) during the later growth phase compared to NHH pigs. At T2, PHH pigs exhibited greater diversity and richness compared to NHH pigs, indicating a restorative effect on GM composition. Differential abundance analyses identified four bacterial genera that distinguished treatment groups: Blautia, Megasphaera, and Subdoligranulum were enriched in PHH pigs, while Terrisporobacter was enriched in NHH pigs. Additionally, bacterial interaction networks exhibited the least complex network in the NHH group, with ecological associations primarily involving Clostridium and Terrisporobacter. Conclusions The quality of human handling influenced stress physiology, performance, and gut microbiota in pigs. Positive handling reduced cortisol levels, improved growth, and promoted microbial diversity, while negative handling was linked to decreased performance and reduced microbial network complexity. These results highlight the potential of positive interactions to enhance welfare and productivity, and identify specific bacterial genera as potential biomarkers differentiating negative and positive handling conditions
Development of Asphaltene Derived Carbon Fiber Reinforced Thermoset Composites for Structural Applications
No full textCarbon fiber is renowned for its outstanding specific strength and stiffness, excellent thermal stability, corrosion resistance, and superior fatigue performance, making it an ideal reinforcement material for polymer composites in both structural and functional applications. In this study, carbon fibers were synthesized from a low-cost precursor, asphaltene, a heavy fraction derived from Alberta oil sands bitumen. The performance of these asphaltene derived carbon fibers (ACFs) was evaluated in thermoset resin composites to explore their potential for structural use. In the first chapter, two grades of ACFs were developed to target different application needs: one carbonized at 1200°C (ACF-1200) with a tensile modulus of approximately 35 GPa and an elongation of 1.4%, and another carbonized at 600°C (ACF-600) with a tensile modulus of about 12 GPa and an elongation of 2.3%. Both fiber types without sizing were incorporated into a thermoset epoxy matrix in a unidirectional configuration via compression molding with a 40wt% fiber content. Mechanical tests were carried out to evaluate the reinforcing efficiency of ACFs. Tensile, flexural and impact properties were tested for the composite structures. Incorporation of
unsized ACF-1200 significantly enhanced the mechanical performance of the epoxy composites, with tensile strength and modulus increasing by approximately 82% and 227%, while flexural strength and modulus improved by around 80% and 243%, respectively, compared to neat epoxy. The incorporation of 40 wt% unsized ACF-600 (2.3% elongation) also improved the impact resistance of epoxy composites by 77% relative to neat epoxy. When used in hybrid laminates with commercial carbon fiber (CCF) mats, ACFs further enhanced the impact performance of CCF composites by 19%. In the second chapter, a commercial epoxy compatible sizing was applied to the ACF-1200 surface to enhance the interfacial compatibility with the resin matrix. I optimized the sizing level and performed Fourier Transform Infrared Spectroscopy (FTIR) and contact angle (CA) to test the effectiveness of sizing. Dynamic mechanical analysis (DMA) confirmed higher stiffness, improved thermal stability, and better fiber–matrix interfacial compatibility. Furthermore, surface sizing treatment provided additional improvements, with flexural strength and modulus increasing by 11% and 7%, and interlaminar shear strength (ILSS) showing an 18% enhancement. I also observed less fiber pull outs and interfacial gap for the SEM images of fractured surfaces of composites as compared to unsized ACF-1200 composites which reflects the effectiveness of the sizing application. Overall, these results demonstrate that asphaltene, an abundant byproduct of oil sands processing, can serve as a sustainable and cost-effective precursor for carbon fiber production. The resulting ACFs show strong potential for lightweight, high-performance composite applications across structural and functional sectors
Measuring person-centred care in the mission, vision, and core value statements of Canadian healthcare organizations
No full textAbstract Background Person-centred care (PCC) has been shown to improve health outcomes. The inclusion and incorporation of person-centredness in care has been a growing priority for healthcare organizations across Canada. Methods Person-Centred Care Quality Indicators (PC-QI) evaluate to what extent various PCC elements have been integrated into healthcare organizations. Using the first PC-QI, content analysis was performed on the mission, vision, and core value statements of 54 healthcare organizations to assess whether PCC is being included as a strategic and decision-making priority in the Canadian healthcare system. Results Fifty-three healthcare organizations (98%) included at least one domain of PCC in their statements. The three most frequent were compassionate care (85%), trusting relationship with providers (70%), and co-designed care (56%). There was no presence of affordable care. Conclusion Canadian healthcare organizations are working towards promoting and implementing a culture that prioritizes some elements of PCC in the care of patients
Characterizing Behavioural Measures of Age-Related Physical Decline in Wild White-Faced Capuchins (Cebus imitator)
No full textAging research in animals promotes better understanding of the biology of aging and evolution of life history traits including longevity. It can also inform interventions that support physical functioning into advanced ages. Nonhuman primates are excellent models for human aging, but research is biased toward a few species in captivity. While capuchins are of enduring interest given their convergent evolution with humans, their aging patterns are poorly known. In this thesis, I led a cross-sectional study of behavioural aspects of physical aging in wild white-faced capuchins (Cebus imitator) at Santa Rosa, Costa Rica, asking whether age is associated with differences in the activity budget, posture and locomotion, microhabitat use, and food intake rates and preferences among adults; I also explored sex differences in these relationships. Using generalized additive mixed models to analyze 13 months of behavioural data collected from adults in five social groups (44 females and 25 males aged 6-30 years), I found partial support for my hypothesis that aging-associated physical declines decrease activity levels and abilities to engage in physically demanding behaviours. Older adults were more likely to rest and use the upper canopy but less likely to cling, run, suspend, and use vertical supports than younger adults. They also demonstrated shorter leap distances, lower intake rates of overall invertebrates, and reduced feeding preferences for extracted invertebrates. However, age was not significantly associated with frequencies of foraging, socializing, traveling, climbing, leaping, or ground use; intake rates for extracted invertebrates, mobile invertebrates, overall fruits, or encased fruits; or feeding preferences for mobile invertebrates or encased fruits. Across all behaviours, there were no significant sex differences in age patterns. This study is the first to report detailed behavioural patterns across adulthood in wild white-faced capuchins, establishing non-invasive measures of physical function for subsequent work on socioecological modifiers of the pace of biological aging in this system. Moreover, this research expands the taxonomic breadth of primate datasets for comparative aging research to include a remarkably long-lived platyrrhine