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Heat is a leading weather-related cause of death worldwide and heat waves are increasing globally in terms of frequency, duration, and intensity. Global heat-related deaths could quadruple by midcentury. As with many environmental hazards, numerous factors impact how heat might affect any given person and there are significant gaps in our understanding related to indoor heat and its effect on health. Despite growing interest in establishing standards and guidelines, there is currently no clear consensus on a safe maximum upper limit for indoor temperature. There is conclusive evidence of links between high outdoor temperatures and human health yet research on this correlation does not typically explicitly consider indoor heat exposure. Considerably more research has been completed on healthy, active individuals than for more heat-susceptible populations and the impacts of moderate heat stress on the health of large populations are not well understood. We conducted a literature review on the impact of indoor thermal conditions on health, recognizing that air temperature alone cannot describe thermal exposure. We introduce the concept of a standardized maximum safe indoor temperature, defined for still air conditions, 50% relative humidity and mean radiant temperature equal to air temperature. Equivalent temperatures with respect to the thermal load on the body can then be calculated for various air velocities, humidities or mean radiant temperatures using the standard effective temperature (SET) model. For U.S. policymakers, we propose adopting a standardized maximum safe indoor temperature of 28 °C. We recognize that the adoption of standardized maximum safe indoor temperatures may vary around the world, but the framework we propose to adjust the standardized upper limit for humidity, air motion, and radiant temperature could be used globally. We also identify important knowledge gaps to guide future research on the relationships between heat and health that could support informed cost-benefit analyses.

AimThis study intended to explore associations of reverse triiodothyronine (rT3) with emotional disturbances and health-related quality of life (HRQoL) after experiencing acute ischemic stroke (AIS).Materials and methodsSerum samples from individuals with AIS were collected on admission to three Lithuania stroke centers and investigated for free tetraiodothyronine, free triiodothyronine (fT3), rT3, and thyroid stimulating hormone levels. At discharge, emotional disturbance was evaluated using the Hospital Depression and Anxiety Scale (HADS), and HRQoL using the EQ-5D-5L scale.ResultsAnalyses included 159 individuals (59.7% male and 40.3% female; mean (SD) aged 66.4 [10.3] years), 52.83% of which showed increased rT3 levels upon admission. After adjustment for age, sex, National Institutes of Health Stroke Scale scores, previous stroke, modified Rankin Scale before AIS ≤ 2, and diabetes mellitus, multivariable linear regression revealed negative associations of rT3 with HADS total score (β = −0.163; p = 0.046) and HADS-D subscale score (β = −0.187; p = 0.019). Analyses supported a positive relationship between the fT3 ratio to rT3 with HADS-D score (β = 0.157; p = 0.046) and rT3, rT3 × fT3 product with EQ-5D index score (β = 0.157; p = 0.044 and β = 0.179; p = 0.023, respectively).ConclusionWe found that individuals who experienced AIS and had higher levels of rT3 at hospital admission had less emotional disturbance and better HRQoL when discharged.

This study investigated the effect of incorporating small amounts of carbonaceous materials in cement paste and mortar systems at a low dosage. The materials studied include industrial graphite, natural graphite, carbon black, activated charcoal, and decolorized charcoal. The effect of this material on cement hydration through different techniques such as compressive strength mortar, TGA, SEM, isothermal calorimetry, rheology, and calcium isotherm adsoprtion. These tests studied the influence of carbonaceous materials’ properties on cement hydration. With the exception of industrial graphite G1, the carbonaceous materials showed an acceleration of setting after 1 day by favoring the nucleation of hydrates, reducing the porosity, and improving the mechanical properties. On the other hand, traces of this acceleration are no longer visible beyond 28 days. The accelerating effect of different carbons sources appears to be less dependent of crystallinity, mineralogy, or particle size, but rather on surface chemistry and the quality of particle dispersion.

When it comes to advancing equity, across the health sciences, efforts repeatedly target interventions on those most burdened by inequities rather than the systems or structures that give rise to inequities. This mismatch, in and of itself, is an important determinant of equity. While many conceptual models draw collective attention to deeper, structural causes (e.g., social, political, and commercial determinants of health) as the 'what', inattention to questions of 'how'–or the collective practices that serve to connect what is known with what is done–are like a wedge holding this gap in place. In this article, we use an exaggerated metaphor of mismatched task-and-tool to provoke critically reflective dialogue about collective attachment to scholarship and practices incoherent with our own body of knowledge. We offer a set of five practices easily integrated in any aspect of work related to advancing equity, through everyday actions anyone (anywhere) can take to purposefully act from an evidence and equity-informed position.

Despite self-congratulatory rhetoric, Canada compromised COVID-19 vaccine equity with policies impeding a proposed global waiver of vaccine intellectual property (IP) rules. To learn from Canada’s vaccine nationalism we explore the worldview – a coherent textual picture of the world – in a sample of Government of Canada communications regarding global COVID-19 vaccine sharing. Analysed documents portray risks and disparities as unrelated to the dynamics and power relations of the Canadian and international economies. Against this depoliticised backdrop, economic growth fueled by strict IP rules and free trade is advanced as the solution to inequities. Global vaccine access and distribution are pursued via a charity-focused public-private-partnership approach, with proposals to relax international IP rules dismissed as unhelpful. Rather than a puzzling lapse by a good faith ‘middle power’, Canada’s obstruction of global COVID-19 vaccine equity is a logical and deliberate extension of dominant neoliberal economic policy models. Health sector challenges to such models must prioritise equity in global pandemic governance via politically assertive and less conciliatory stances towards national governments and multilateral organisations. Mobilisation for health equity should transform the overall health-damaging macroeconomic model, complementing efforts based on specific individual health determinants or medical technologies.

This report describes the case of a frail 36-year-old patient who underwent an endovascular treatment of a right subclavian artery pseudoaneurysm (SAP) associated with an arteriovenous fistula secondary to a traumatic central venous catheter insertion. The deployment of a covered stent from the innominate to the right common carotid artery combined with coiling of the SAP and the internal mammary artery was performed. Two additional covered stents were deployed from the vertebral artery to the distal subclavian artery to preserve right upper extremity circulation. This case highlights the feasibility of an endovascular treatment of a complex SAP in a candidate unsuitable for open surgery.

Abstract Introduction The importance of including people affected by research (e.g., community members, citizens or patient partners) is increasingly recognized across the breadth of institutions involved in connecting research with action. Yet, the increasing rhetoric of inclusion remains situated in research systems that tend to reward traditional dissemination and uphold power dynamics in ways that centre particular (privileged) voices over others. In research explicitly interested in doing research with those most affected by the issue or outcomes, research teams need to know how to advance meaningful inclusion. This study focused on listening to voices often excluded from research processes to understand what meaningful inclusion looks and feels like, and asked what contributes to being or feeling tokenized. Methods In this deliberative dialogue study, 16 participants with experience of navigating social exclusions and contributing to research activities reflected on what makes for meaningful experiences of inclusion. Using a co‐production approach, with a diversely representative research team of 15 that included patient and community partners, we used critically reflective dialogue to guide an inclusive process to study design and implementation, from conceptualization of research questions through to writing. Results We heard that: research practices, partnerships and systems all contribute to experiences of inclusion or exclusion; the insufficiency or absence of standards for accountability amplifies the experience of exclusion; and inclusive practices require intention, planning, reflection and resources. Conclusions We offer evidence‐informed recommendations for the deeply relational work and practices for inclusivity, focused on promising practices for cultivating welcoming systems, spaces and relationships. Patient or Public Contribution This work reflects a co‐production approach, where people who use and are affected by research results actively partnered in the research process, including study design, data‐generating activities, analysis and interpretation, and writing. Several of these partners are authors of this manuscript.

BackgroundDespite growing literature, few studies have explored the implementation of policy interventions to reduce maternal and perinatal mortality in low- and middle-income countries (LMICs). Even fewer studies explicitly articulate the theoretical approaches used to understand contextual influences on policy implementation. This under-use of theory may account for the limited understanding of the variations in implementation processes and outcomes. We share findings from a study exploring how a health system-level policy intervention was implemented to improve maternal and child health outcomes in a resource limited LMIC.MethodsOur qualitative multiple case study was informed by the Normalization Process Theory (NPT). It was conducted across eight districts and among ten health facilities in Uganda, with 48 purposively selected participants. These included health care workers located at each of the cases, policy makers from the Ministry of Health, and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews to understand uptake and use of Uganda's maternal and perinatal death surveillance and response (MPDSR) policy and were inductively and deductively analyzed using NPT constructs and subconstructs.ResultsWe identified six broad themes that may explain the observed variations in the implementation of the MPDSR policy. These include: 1) perception of the implementation of the policy, 2) leadership of the implementation process, 3) structural arrangements and coordination, 4) extent of management support and adequacy of resources, 5) variations in appraisal and reconfiguration efforts and 6) variations in barriers to implementation of the policy.Conclusion and recommendationsThe variations in sense making and relational efforts, especially perceptions of the implementation process and leadership capacity, had ripple effects across operational and appraisal efforts. Adopting theoretically informed approaches to assessing the implementation of policy interventions is crucial, especially within resource limited settings.

Studying prosociality in rodents can provide insight into brain mechanisms potentially related to neurodevelopmental disorders known to impact social behaviors (e.g., autism spectrum disorder). While many studies have been published suggesting promising models, current knowledge remains scattered, including potential factors mediating prosocial behaviors in rodents. Prosocial behavior is characterized by an action done to benefit another or promote their well-being. The goal of this scoping review is to characterize current findings regarding prosocial paradigms in rodents, highlight current gaps in reporting, and identify factors shown to be important in mediating prosocial responses in rodents. Five databases were consulted in search of relevant studies published between 2000 and 2020 (APA PsycInfo, Embase, MEDLINE, Scopus, Web of Science). An update using a semi-supervised machine learning approach (ASReview) was then conducted to collect studies from 2021-2023. In total, 80 articles were included. Findings were the following: (1) Three categories of prosocial paradigm were extracted: cooperation, helping, and sharing tasks, (2) Rodents showed the ability to perform prosocial actions in all three categories, (3) Significant gaps in reported methodologies (e.g., failure to report animals' characteristics, housing conditions, and/or experimental protocol) and mediating factors (e.g., sex, strain, housing, food restriction) were found, and (4) Behaviors are determinant when investigating prosociality in rodents, however many studies omitted to include such analyses. Together these results inform future studies on the impact of mediating factors and the importance of behavioral analyses on the expression of prosocial behaviors in rodents.

BackgroundCannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. ObjectiveRecognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients’ preferences supporting harm reduction interventions, we developed a mobile app–based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm–reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. MethodsThis pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use–related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. ResultsRecruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. ConclusionsCHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. Trial RegistrationClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275 International Registered Report Identifier (IRRID)DERR1-10.2196/53094

BackgroundScaling effective primary care innovations to benefit more people is of interest to decision makers. However, we know little about how promising innovations are being scaled “spontaneously,” that is, without deliberate guidance. ObjectiveWe aim to observe, document, and analyze how, in real-life conditions, 1 primary care innovation spontaneously scales up across Quebec, Canada. MethodsWe will conduct a participative study using a descriptive single-case study. It will be guided by the McLean and Gargani principles for scaling and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Informed by an integrated knowledge translation approach, our steering committee will include patient users throughout the project. Inspired by the Quebec College of Family Physician’s “Dragons’ Den” primary care program, we will identify a promising primary care innovation that is being or will be scaled spontaneously. We will interview the innovation team about their scaling experiences every month for 1 year. We will conduct interviews and focus groups with decision makers, health care providers, and end users in the innovation team and the target site about their experience of both scaling and receiving the scaled innovation and document meetings as nonparticipant observers. Interview transcripts and documentary data will be analyzed to (1) compare the spontaneous scaling plan and implementation with the McLean and Gargani principles for scaling and (2) determine how it was consistent with or diverged from the 4 McLean and Gargani guiding principles: justification, optimal scale, coordination, and dynamic evaluation. ResultsThis study was funded in March 2020 by the Canadian Institutes of Health Research. Recruitment began in November 2023 and data collection began in December 2023. Results are expected to be published in the first quarter of 2024. ConclusionsOur study will advance the science of scaling by providing practical evidence–based material about scaling health and social care innovations in real-world settings using the 4 guiding principles of McLean and Gargani. International Registered Report Identifier (IRRID)PRR1-10.2196/54855

Abstract Background Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community‐driven health technology solutions. The purpose was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement. Methods Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to identify and integrate technological solutions towards rural health equity from community stakeholders in three steps: (1) idea generation; (2) sorting and rating feasibility/importance and (3) group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities. Results Overall, 34 rural community stakeholders from western Canada (76% female, mean age = 55.4 years) participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multidimensional scaling and cluster analysis resulted in a six‐cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make health care more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas that were rated as equally important and feasible. Key themes included organizational and individual‐level solutions and connecting patients to newly developed technologies. Conclusions Overall, the grouping of solutions revealed that technological applications require not only access but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity. Patient or Public Contribution Rural community stakeholders were involved in the generation and interpretation of technological solutions towards rural health equity in a three‐step process: (1) individual brainstorming of ideas, (2) sorting and rating all ideas generated and (3) collective interpretation and group consensus on final results.

Introduction Misinformation refers to inadvertent misleading information that the public may be exposed and share without intent to cause harm, and can delay or prevent effective care, affect mental health, lead to misallocation of health resources and/or create or exacerbate public-health crises. There are many strategies to address misinformation, but there is a need to evaluate their effects. Our objective is to synthesise and routinely update evidence to assess the impact of strategies to mitigate health-related misinformation in diverse settings, and populations.Methods and analysis We will search seven databases in May 2023 with planned updates at 6 and 9 months, which will be supplemented with searches for grey literature and reference lists of included studies and contacting experts. Two reviewers will independently screen all search results for studies that evaluate one or more approaches to addressing health-related misinformation. One researcher will conduct data extraction and risk of bias assessments, which will be reviewed by a second reviewer for accuracy. We will include experimental, quasi-experimental and observational studies for any populations, settings and diseases without language or publication restrictions. We will conduct quantitative analysis if meta-analytical pooling is possible. If pooling is not possible, we will synthesise quantitative data according to outcomes and interventions addressed, and present a narrative summary of findings disaggregated by sex and/or gender, irrespective of whether differences were found.Ethics and dissemination There are no individuals or protected health information involved and no safety issues identified. Results will be published through the Global Commission on Evidence and COVID-END websites, in a peer-reviewed journal, as well as through plain-language materials.PROSPERO registration number CRD42023421149.

The search for environmentally friendly and low-carbon-footprint construction materials continues progressively. Researchers are now interested in innovative materials that connect with the principles of sustainable construction, and materials such as hemp concrete prove to be promising. This article presents the results of a study that aimed to evaluate the hygrothermal performance of hemp concrete integrated into the building envelope using the hygrothermal tool WUFI Pro 6.2. The simulation model was compared and verified with existing models before its utilization for this study. The results of this verification were in good agreement, which gave us more confidence in its application for further parametric studies of building envelopes in hot climate zones. Three wall systems were simulated: (i) a wall system with hemp concrete, (ii) a compressed earth block wall, and (iii) a cement block wall. The most important variables used in the simulations were the hygrothermal properties of the materials or wall components and the incident solar radiation. The simulation results showed that hemp concrete has good thermal performance and temperature and humidity regulation capabilities of the building envelope. The interior surface temperatures of the hemp concrete walls were between 22.1 °C and 24.6 °C compared to the compressed earth block and cement block walls, where the surface temperatures were between 22.0 °C and 27 °C and between 21.2 °C and 28.7 °C, respectively, and between 23 °C and 45 °C for the exterior temperatures. These values remain the same with the increase in exterior temperatures for hemp concrete walls. In conclusion, hemp concrete could be a great alternative material for use in construction for hot climate zones.