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Influence of Frailty on Clinical and Radiological Outcomes in Patients Undergoing Transforaminal Lumbar Interbody Fusion—Analysis of a Controlled Cohort of 408 Patients
Full text linkBackground/Objectives: The concept of frailty has been recognized as an important issue which can influence postoperative outcomes. We aimed to investigate the influence of frailty on clinical and radiological outcomes in patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease. Methods: A single-center, retrospective cohort study was conducted involving 408 patients in whom 506 expandable interbody devices were implanted. The patients were grouped into vulnerable/frail versus well/fit according to the Canadian Frailty Index. Results: The frail patients were older and had a larger number of fused segments (3.0 vs. 2.4 segments, p = 0.009). In the univariate analysis, the frail patients were more likely to experience a postoperative adverse event (AE) until discharge (OR 1.89, 95% CI 1.22–2.92; p = 0.004), three (OR 1.57, 1.07–2.3; p = 0.021), and 12 months postoperatively (OR 3.77, 1.96–7.24; p < 0.001). Following the multivariable logistic regression analysis, frailty remained an independent risk factor for postoperative AEs at 12 months (OR 3.44, 95% CI 1.69–6.99; p = 0.001). Conclusions: Frailty negatively influenced the rate of AEs until 12 months, while the odds of having a favorable outcome at any time remained unaffected in patients undergoing posterior spinal fusion with TLIF. Future efforts are needed to evaluate whether preoperative medical optimization or prehabilitation may positively impact patient outcomes
Emulsion-Based Encapsulation of Fibrinogen with Calcium Carbonate for Hemorrhage Control
Full text linkHemorrhage, particularly non-compressible torso bleeding, remains the leading cause of preventable death in trauma. Self-propelling hemostats composed of thrombin-calcium carbonate (CaCO3) particles and protonated tranexamic acid (TXA+) have been shown to reduce blood loss and mortality in severe bleeding animal models. To further enhance both hemostatic and self-propelling properties, this study was to investigate fibrinogen-CaCO3 particles prepared via a water-oil-water (W/O/W) emulsion method. The particles were characterized using light and fluorescence microscopy, gel electrophoresis, rotational thromboelastometry (ROTEM), and video motion tracking. The method produced spherical micrometer-sized particles with various yields and fibrinogen content, depending on the preparation conditions. The highest yield was achieved with sodium carbonate (SC), followed by ammonium carbonate (AC) and sodium bicarbonate (SBC). AC and paraffin generated smaller particles compared to SC and heptane, which were used as the carbonate source and oil phase, respectively. Fibrinogen incorporation led to an increase in particle size, indicating a correlation between fibrinogen content and particle size. Fluorescence microscopy confirmed successful fibrinogen encapsulation, with various amounts and hemostatic effects as assessed by gel electrophoresis and ROTEM. Combining fibrinogen-CaCO3 particles with TXA+ and thrombin-CaCO3 particles showed synergistic hemostatic effects. All fibrinogen-encapsulated particles exhibited self-propulsion when mixed with TXA+ and exposed to water, regardless of fibrinogen content. This study advances current hemostatic particle technology by demonstrating enhanced self-propulsion and fibrinogen incorporation via the W/O/W emulsion method. Further optimization of the encapsulation method could enhance the effectiveness of fibrinogen-CaCO3 particles for hemorrhage control
Promoting fast-growing species sawlog plantations by smallholder farms: evidence from a choice experiment study in Vietnam
Full text linkSmallholders’ planting fast-growing trees for pulpwood production has substantially contributed to forest rehabilitation, wood production and rural incomes worldwide. Government incentive programs have attempted to increase the productivity and value of such plantations and enhance sawlog supply to the furniture industry. Designing effective incentive programs to encourage sawlog plantations requires a deeper understanding of smallholder preferences and socio-economic characteristics. This study examines preferences for different designs of incentive programs, including technical support, rotation length, financial subsidy, committed area and timber insurance. A scale-adjusted latent class model is used to investigate preference heterogeneity using data on 300 smallholders in the Central Highland and Northern Upland regions, representing two development stages of plantation forestry in Vietnam. The analysis identified four preference classes, which value attributes differently. Preference for sawlog plantation programs depends on individual characteristics and psychological factors such as perception of benefits, obstacles and risks. The longest rotation preferred by a significant proportion of smallholders for sawlog-oriented plantations is a medium rotation of 8-10 years. Our study further determines feasible incentive programs that meet smallholder preferences and government budget constraints, draws important policy implications for promoting the value of smallholder plantations and livelihoods.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
Using Qualitative Geospatial Methods to Explore Physical Activity in Children with Developmental Disabilities: A Feasibility Study
Full text linkChildren with developmental disabilities (DDs) experience barriers to physical activity (PA) participation. Greater contextual information regarding their PA behaviors is needed for effective PA promotion. We investigated the feasibility of using activity trackers and Global Positioning Systems (GPS) devices with follow-up interviews to explore PA behaviors in children with DDs. Fifteen children with DDs (aged 10 ± 2 years) wore an activity tracker and GPS device for 7 days. Data were time-aligned to measure PA and identify PA locations. Maps were created to guide follow-up semi-structured interviews with the children and their parents/guardians to understand PA contexts and perceptions of daily PA. The children took 8680 ± 4267 steps/day across 6 ± 1 days. The children provided preferences for PA locations and the parents/guardians gave context by expressing how DDs affect PA and identifying environmental factors in PA locations. The children with DDs who lived near parks, participated in PA that leveraged the strengths of their individual skillsets, and had parents/guardians who provided social support had more positive PA experiences. Combining activity tracking and GPS data with follow-up map-based interviews is feasible to explore PA behaviors and the experiences of children with DDs. This methodology may provide novel insight into daily PA in children with DDs, which can inform how future interventions can support them to be more active and have positive experiences while being active
Sensor-Based Rock Hardness Characterization in a Gold Mine Using Hyperspectral Imaging and Portable X-Ray Fluorescence Technologies
Full text linkRock hardness significantly impacts comminution efficiency, one of mining’s most energy-intensive processes. Accurate, rapid, and non-invasive hardness characterization can enhance mine-to-mill optimization and energy management. This study investigates sensor-based technologies, hyperspectral imaging, and portable X-ray fluorescence (pXRF) integrated with machine learning (ML) algorithms for characterizing rock hardness in open-pit gold mining contexts. A total of 159 rock samples from two Canadian open-pit gold mines were analyzed through Leeb rebound hardness (LRH), short-wave infrared (SWIR) hyperspectral imaging, and a pXRF analyzer for chemical characterization. The most critical spectral features of SWIR images were extracted using a novel and automated feature extraction approach and further refined by applying a recursive feature elimination (RFE) algorithm to reduce the dimensionality of the spectral feature space. Three ML algorithms, including Random Forest Regressor (RFR), Adaptive Boosting (AdaBoost), and Multivariate Linear Regression (MLR), were applied to develop predictive hardness models considering three scenarios: using chemical features, using refined spectral features, and their combination. The findings underscore the potential of advanced sensor integration and analytics in remotely characterizing rock hardness, which could contribute to enhancing efficiency and sustainability in modern mining operations
Going National: Lessons Learned from Opening Up Submissions to Authors Across Canada
Full text linkSlides presented at Student Journal Forum, February 18-20, 2025.
Presenting journal: The iJournal
Session recording is available at: https://play.library.utoronto.ca/watch/178572cbf77c19edf12193ad992eac6dIn 2023, The iJournal opened its call for submissions to students and recent graduates across Canada for the first time. Previously, it had accepted and published submissions only from students at its home faculty, the Faculty of Information at the University of Toronto. In this presentation, The iJournal team will reflect on the two years since expanding their scope for submissions, share challenges and successes, and give tips for journals considering an expansion themselves. This presentation will address the big-picture questions to consider: does expanding your submission scope make sense for your journal? Does it fit your journal’s mission? The presentation will also offer practical, strategic advice, such as the importance of clarifying your eligibility criteria and identifying which schools and programs to reach out to. Editors at The iJournal will share their experiences communicating and working with authors based in different geographic and academic contexts. They will also share submission and publication data, revealing the outcomes of two years of expanded submissions and discussing how these results have begun to inform an evolving strategy for their journal. Accepting submissions from across Canada has certainly come with challenges for The iJournal, including an increased volume of submissions and inquiries, and needing to orient its reviewers to a broader, national context. But the expansion has also led to valuable network-building and the publication of even stronger research. The iJournal hopes to start a dialogue exploring these benefits and challenges with other student journals considering expanding their submission scope
Assessment of Inter-Reader Reliability of Fazekas Scoring on Magnetic Resonance Imaging of the Brain in Adult Patients with Sickle Cell Disease
Full text linkBackground/Objectives: Cerebral white matter disease is a common finding in patients with sickle cell that has been linked to cognitive impairment. However, there is no standardized approach for quantification of the cerebral disease burden. The Fazekas score is widely used to quantify the burden of white matter disease in chronic small vessel disease. However, its utility in sickle cell disease, specifically the inter-rater variability, has not been established. Methods: A patient cohort was compiled for the purpose of a research ethics board (REB)-approved retrospective study of adult patients with sickle cell disease, each of whom underwent MRI/MRA between the years 2017 and 2019. A total of 90 such patients were captured. All MRI/MRA studies were performed on three Tesla MRIs. Two independent neuroradiologists assessed the axial FLAIR MRI brain sequence (see image 1) for each of the 90 patients, with the sole focus of assigning a Fazekas score (0–3) to each study as a means of quantifying the burden of ischemic white matter lesions. The neuroradiologists were blinded to the scoring assigned by their counterpart and to the clinical information. After the initial assessment was completed, studies with discrepant Fazekas scores were documented and discussed by both readers. A consensus Fazekas score was then assigned to each of these studies. Results: Cohen’s weighted kappa was used as a measure of agreement between readers. The expected agreement was 74.65%, with an observed agreement of 94.44% between readers, with a kappa of 0.7808. Conclusions: We conclude on the basis of our study that there is good inter-reader reliability of Fazekas scoring on axial FLAIR MRI brain sequence in patients with sickle cell disease. The Fazekas is a promising measure that could easily be integrated in systematic evaluation of cerebrovascular lesions of adults with sickle cell disease
What Is New in Altitude- and Cold-Related Illnesses of Travel: Appraisal and Summary of the Updated Guidelines from the Wilderness Medical Society
Full text linkWilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, the Wilderness Medical Society (WMS) has aggregated research findings and created guidelines on prevention measures and therapeutic options for acute altitude illness, frostbite injuries, and avalanche and non-avalanche snow burials. As new research emerges, some guidelines have been updated to reflect the most current and sound scientific conclusions. In this review, we have synthesized the evidence-based guidelines and have reviewed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. Further research efforts can expand the scope of evidence-based practice in travel medicine and ideally standardize the implementation of recommendations within both pre-travel and post-travel medical practices
The Municipal Role in Mental Health
No full textThis paper is part of the IMFG Who Does What series. For a full list of papers, please visit https://bit.ly/WhDWUnder the Canadian constitution, provincial governments bear primary responsibility for the delivery of health care and often develop their own strategies to address mental health and addiction. In practice, however, local governments shoulder much of the burden of front-line service delivery, often with limited fiscal resources. With rising rates of mortality due to opioid addictions, and the substantial costs of mental illness – not just to the health care system but also to the social and economic well-being of Canadians – urgent coordinated action is needed.
The two essays in this paper set out the municipal role in harm reduction and mental well-being and provide recommendations for action. They argue that while municipalities have a lead role to play, cooperation with other local agencies and other orders of government is essential.
Municipalities
R. Marcus Hammond, Barb Fornssler, and Elaine Hyshka examine how municipalities can effectively respond to substance-related harm through a harm reduction approach. They argue that Canadian municipalities are well positioned to implement harm reduction policies, programs, and practices across key governance domains and through enhanced intergovernmental cooperation. They provide recommendations for organizational policies and procedures, zoning and land use planning, direct service delivery, and drug policy and enforcement reform that municipalities can adopt to reduce morbidity and mitigate impacts on people, families, and communities.
Kwame McKenzie, Rishika Wadehra, Sophie Baker, and Jesse Rosenberg note that municipalities have a front-line role in, and unique perspective on, many social factors that can impact mental health and well-being, including housing and homelessness, racism, climate change, substance use and addictions, and public safety. They recommend that municipalities, as the order of government that knows their context and populations best, bring leaders and communities together and leverage their networks, including community organizations and health-care providers, to develop effective approaches – and they offer a practical blueprint for doing so. McKenzie et al. also provide case studies of cities which have taken leadership roles in well-being.
Provincial governments
Hammond, Fornssler, and Hyshka note that policy support across provinces and territories is variable. Their recommendations include advocating for harm reduction policies and funding from provincial and federal governments; developing local substance strategies with provincial and community partners; and establishing communications and data-sharing mechanisms with all orders of government over the long term to ensure timely release of policies and health data.
McKenzie et al. suggest that all orders of government must widen their focus to consider both population and risk-reduction approaches, including not only making targeted interventions but acting on the structural and social determinants of health to foster greater well-being. Given that many policy and funding levers are provincial in jurisdiction, municipalities can advocate for policy and funding changes to drive progress. This paper also points to the role provinces can play in collecting and providing additional data and making it accessible.
Federal government
Hammond, Fornssler, and Hyshka note that a harm reduction approach to enforcement and drug policy reform should prioritize connecting people to services rather than punishing them. Accordingly, they recommend decriminalization for minor drug offences alongside other harm reduction approaches, while noting this policy has been controversial to date in areas where it has been tried.
McKenzie et al. recommend that the federal government provide funding directly to municipalities and civil society groups to lead efforts on well-being.
Intergovernmental Cooperation
In both essays in this report, the authors strongly recommend intergovernmental cooperation in a range of areas, including in policy areas that are not within (or solely within) municipal jurisdiction (e.g., criminal justice, income supports, schools, job training). Both essays also argue that enhanced intergovernmental cooperation in the areas of data sharing, funding, and service delivery is needed to more effectively reduce harm and improve mental well-being.Institute on Municipal Finance and GovernanceInstitute on Municipal Finance and Governanc
Reply to Cosio et al. Glycation of Nail Proteins as a Risk Factor for Onychomycosis. Comment on “Gupta et al. Diabetic Foot and Fungal Infections: Etiology and Management from a Dermatologic Perspective. J. Fungi 2024, 10, 577”
Full text linkWe find the comment on the article titled “Diabetic Foot and Fungal Infections: Etiology and Management from a Dermatologic Perspective” informative and wish to thank the authors for their added insight on this complex topic [...