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Scale measuring the construct of “health security in chronic illness” (HSCI) was piloted in Canadian cardiac device patients (N = 176) enrolled in a remote-monitoring study at 2 timepoints. Analysis revealed a 2-factor solution, labeled as “support” and ”certainty”. Patients reported receiving less support over time, but consistent health certainty. Patients with implantable cardioverter defibrillators felt less secure over time and reported lower levels of health security in chronic illness than pacemaker patients. Résumé: Une échelle mesurant le concept de la « sécurité en matière de santé en présence d’une maladie chronique » a fait l’objet d’un projet pilote auprès de patients canadiens porteurs de dispositifs cardiaques (N = 176) inscrits dans une étude de télésurveillance comportant deux évaluations. L’analyse a révélé une solution à deux facteurs, soit le soutien et la certitude. Les patients ont déclaré qu’ils recevaient moins de soutien au fil du temps, mais que la certitude quant à leur santé était constante. Les porteurs d’un défibrillateur cardioverteur implantable se sentaient moins en sécurité au fil du temps et signalaient de plus bas niveaux de sécurité en matière de santé, relativement à leur maladie chronique, que les porteurs d’un stimulateur cardiaque.

Background: Colchicine is an anti-inflammatory therapy with a low associated cost that has been shown in 2 large studies to reduce cardiovascular (CV) events, but its use is associated with side effects. The main objective for this analysis is to determine whether colchicine therapy is cost-effective for the prevention of recurrent CV events in patients who have suffered a myocardial infarction (MI). Methods: A decision model was developed to estimate the healthcare costs in Canadian dollars and the clinical outcomes among patients who have suffered an MI and are treated with colchicine. Probabilistic Markov modelling was used in combination with Monte Carlo simulation to derive expected lifetime costs and quality-adjusted life-years, which permitted the calculation of incremental cost-effectiveness ratios. Models were derived for both short-term (20 months) and long-term (lifelong) colchicine use in this population. Results: Long-term colchicine use was dominant over standard of care, with lower average lifetime costs per patient (CAD$91,552.80 vs $97,085.84) and a higher average number of quality-adjusted life-years per patient (19.92 vs 19.80). Short-term colchicine use also dominated over standard of care. Results were consistent over a range of scenario analyses. Conclusions: Based on 2 large randomized controlled trials, treatment of patients post-MI with colchicine appears cost-effective, compared to the standard of care at the current price. Based on these studies and currently accepted willingness-to-pay thresholds in Canada, healthcare payers could consider funding long-term colchicine therapy for CV secondary prevention while we await results from ongoing trials. Résumé: Contexte: La colchicine est un traitement anti-inflammatoire peu coûteux qui, selon deux grandes études, réduit le taux d’événements cardiovasculaires (CV), mais son utilisation est également associée à des effets secondaires. L’objectif principal de cette analyse était de déterminer si le traitement par la colchicine présente un rapport coût-efficacité intéressant en prévention des événements CV récurrents chez les patients ayant subi un infarctus du myocarde (IM). Méthodologie: Un modèle décisionnel a été mis au point pour estimer les coûts des soins de santé en dollars canadiens et les issues cli-niques chez les patients qui ont subi un IM et qui sont traités par la colchicine. Un modèle probabiliste de Markov a été utilisé en association avec une simulation de Monte-Carlo pour obtenir le coût attendu pendant la vie et le nombre d’années de vie ajustées en fonction de la qualité, données qui ont permis de calculer les rapports coût-efficacité différentiels. Les modèles ont été adaptés pour l’utilisation de la colchicine à court terme (20 mois) et à long terme (à vie) dans la même population. Résultats: L’utilisation de colchicine à long terme donnait de meilleurs résultats que le traitement de référence, avec un coût moyen à vie par patient plus faible (91 552,80 $ CA c. 97 085,84 $ CA) et un plus grand nombre moyen d’années de vie ajustées selon la qualité (19,92 c. 19,80). L’utilisation à court terme de la colchicine donnait aussi de meilleurs résultats que le traitement de référence. Ces résultats ont été observés pour un éventail de scénarios analysés. Conclusions: Selon deux grands essais randomisés contrôlés, le traitement par la colchicine des patients ayant subi un IM semble avoir un meilleur rapport coût-efficacité que le traitement de référence en fonction des coûts actuels. Selon ces études et les seuils de propension à payer actuellement acceptés au Canada, les payeurs pourraient envisager de financer le traitement à long terme par la colchicine en prévention d’événements CV secondaires, jusqu’à l’obtention des résultats des essais en cours.

Background Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient‐informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. Methods and Results Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient‐piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self‐management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short‐ and longer‐term follow‐up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. Conclusions This early‐stage, pretrial research has important implications for the acute and long‐term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient‐oriented research.

Recovering nitrogen (N) from municipal wastewater is a promising approach to prevent nutrient pollution, reduce energy use, and transition toward a circular N bioeconomy, but remains a technologically challenging endeavor. Existing N recovery techniques are optimized for high-strength, low-volume wastewater. Therefore, developing methods to concentrate dilute N from mainstream wastewater will bridge the gap between existing technologies and practical implementation. The N-rich biopolymer cyanophycin is a promising candidate for N bioconcentration due to its pH-tunable solubility characteristics and potential for high levels of accumulation. However, the cyanophycin synthesis pathway is poorly explored in engineered microbiomes. In this study, we analyzed over 3,700 publicly available metagenome assembled genomes (MAGs) and found that the cyanophycin synthesis gene cphA was ubiquitous across common activated sludge bacteria. We found that cphA was present in common phosphorus accumulating organisms (PAO) Ca. ‘Accumulibacter’ and Tetrasphaera, suggesting potential for simultaneous N and P bioconcentration in the same organisms. Using metatranscriptomic data, we confirmed the expression of cphA in lab-scale bioreactors enriched with PAO. Our findings suggest that cyanophycin synthesis is a ubiquitous metabolic activity in activated sludge microbiomes. The possibility of combined N and P bioconcentration could lower barriers to entry for N recovery, since P concentration by PAO is already a widespread biotechnology in municipal wastewater treatment. We anticipate this work to be a starting point for future evaluations of combined N and P bioaccumulation, with the ultimate goal of advancing widespread adoption of N recovery from municipal wastewater.

Abstract Background Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. Methods We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. Discussion Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

Abstract Hydrogel-encapsulated catalysts are an attractive tool for low-cost intensification of (bio)-processes. Polyvinyl alcohol-sodium alginate hydrogels crosslinked with boric acid and post-cured with sulfate (PVA-SA-BS) have been applied in bioproduction and water treatment processes, but the low pH required for crosslinking may negatively affect biocatalyst functionality. Here, we investigate how crosslinking pH (3, 4, and 5) and time (1, 2, and 8 h) affect the physicochemical, elastic, and process properties of PVA-SA-BS beads. Overall, bead properties were most affected by crosslinking pH. Beads produced at pH 3 and 4 were smaller and contained larger internal cavities, while optical coherence tomography suggested polymer cross-linking density was higher. Optical coherence elastography revealed PVA-SA-BS beads produced at pH 3 and 4 were stiffer than pH 5 beads. Dextran Blue release showed that pH 3-produced beads enabled higher diffusion rates and were more porous. Last, over a 28-day incubation, pH 3 and 4 beads lost more microspheres (as cell proxies) than beads produced at pH 5, while the latter released more polymer material. Overall, this study provides a path forward to tailor PVA-SA-BS hydrogel bead properties towards a broad range of applications, such as chemical, enzymatic, and microbially catalyzed (bio)-processes.

Background: The primary goal of this study was to determine the time spent completing moderate-to-vigorous intensity physical activity (MVPA) among adults with atrial fibrillation (AF). Secondary aims examined MVPA and sitting time (ST) by AF subtypes (ie, paroxysmal, persistent, long-standing persistent, and permanent) and associations between MVPA or ST and knowledge, task self-efficacy, and outcome expectations. Methods: An observational study was conducted in the Champlain region of Ontario, Canada. AF patients completed a survey to determine MVPA and ST using the Short-Form International Physical Activity Questionnaire. Results: A total of 619 patients (66% male; median age 65 years [95% CI 64-67 years]) completed the survey. Median MVPA and ST were 100 (60-120) min/wk and 6 (5-6) h/d; 56% of patients were not meeting the Canadian 24H Movement Guidelines. Most patients (54%) did not know/were unsure of the MVPA recommendations, yet 72% thought physical activity should be part of AF management. Positive correlations were found between higher MVPA levels and the following: (i) speaking to a healthcare professional about engaging in physical activity for managing AF (ρ = 0.108, P = 0.017); (ii) greater confidence regarding ability to perform physical activity and muscle-strengthening exercise (ρ = 0.421, P < 0.01); and (iii) patient agreement that AF would be better managed if they were active (ρ = 0.205, P < 0.01). Conclusions: Many AF patients do not meet the MVPA recommendations, which may be due to lack of physical activity knowledge. Exercise professionals may help educate patients on the benefits of physical activity, improve task-self efficacy, and integrate MVPA into patient lifestyles. Résumé: Introduction: Le principal objectif de la présente étude était de déterminer le temps consacré à faire de l’activité physique modérée à vigoureuse (APMV) chez les adultes atteints de fibrillation auriculaire (FA). Les objectifs secondaires visaient à examiner l’APMV et le temps en position assise (TA) selon les sous-types de FA (c.-à-d. paroxystique, persistante, persistante de longue durée et permanente) et les associations entre l’APMV ou le TA et les connaissances, le sentiment d’auto-efficacité et les attentes de résultats. Méthodes: Nous avons réalisé une étude observationnelle dans la région de Champlain, en Ontario, au Canada. Les patients atteints de FA ont rempli une enquête pour déterminer l’APMV et le TA à l’aide du questionnaire court International Physical Activity Questionnaire (IPAQ). Résultats: Un total de 619 patients (66 % d’hommes; âge médian de 65 ans [IC à 95 % 64-67 ans]) a rempli l’enquête. L’APMV et le TPA médians étaient de 100 (60-120) min/sem et de 6 (5-6) h/j; 56 % des patients ne répondaient pas aux Directives canadiennes en matière de mouvement sur 24 heures. La plupart des patients (54 %) ne connaissaient pas les recommandations d’APMV ou n’étaient pas certains de les connaître, mais 72 % pensaient que l’activité physique devrait faire partie de la prise en charge de la FA. Nous avons observé des corrélations positives entre les degrés plus élevés d’APMV et ce qui suit : (i) le fait de parler à un professionnel de la santé de la pratique de l’activité physique pour prendre en charge la FA (ρ = 0,108, P = 0,017); (ii) la confiance accrue quant à la capacité de faire de l’activité physique et les exercices de renforcement musculaire (ρ = 0,421, P < 0,01); (iii) l’accord du patient sur le fait que la pratique de l’activité physique contribuerait à une meilleure prise en charge de la FA (ρ = 0,205, P < 0,01). Conclusions: Plusieurs patients atteints de FA ne répondaient pas aux recommandations d’APMV, possiblement en raison du manque de connaissances concernant l’activité physique. Les professionnels de l’activité physique peuvent contribuer à l’éducation des patients afin de leur faire connaître les avantages de l’activité physique, améliorer leur auto-efficacité et intégrer l’APMV à leur mode de vie.

Background: Cardiovascular (CV) disease is a condition with high levels of morbidity and mortality. Canakinumab is a novel monoclonal antibody therapy that has been shown to reduce CV events but is associated with side effects and high cost. The main objective for this analysis is to determine whether canakinumab use is cost-effective for the prevention of recurrent CV events. Methods: A decision model was developed to estimate the direct costs and outcomes among patients who have suffered a myocardial infarction and are treated with canakinumab. A lifetime study horizon was used to analyze the base-case costs and utilities from the perspective of the Canadian publicly funded healthcare system. Markov modeling was used in combination with Monte Carlo simulation to derive expected values for costs and quality-adjusted life years (QALYs), permitting the calculation of incremental cost-effectiveness ratios. Results: Canakinumab was associated with higher average lifetime costs per patient ($457,982 vs $82,565) and higher average QALYs per patient (14.90 vs 14.20), compared with standard of care. Thus, the incremental cost per QALY gained for canakinumab treatment vs standard-of-care therapy was $535,365. The probability that canakinumab treatment is cost-effective was 0%. Results were consistent over a range of scenario analyses. Conclusions: Treatment of patients post–myocardial infarction with canakinumab is not cost-effective, compared with standard-of-care therapy at the current price. Based on currently accepted willingness-to-pay thresholds in Canada, a reduction in price of 91% is required to yield a cost per patient that would be considered appropriate. Résumé: Introduction: La maladie cardiovasculaire (CV) est une affection à forts taux de morbidité et de mortalité. Le canakinumab est un nouveau traitement par anticorps monoclonaux qui s’est avéré diminuer les événements CV, mais qui est associé à des effets secondaires et des coûts élevés. Le principal objectif de la présente analyse est de déterminer si l’utilisation du canakinumab est rentable dans la prévention des événements CV récidivants. Méthodes: Nous avons élaboré un modèle de prise de décision pour estimer les coûts directs et les résultats chez les patients qui ont souffert d’un infarctus du myocarde et qui sont traités par canakinumab. Nous avons utilisé un horizon d’étude sur la vie entière pour l’analyse coût-utilité de référence selon la perspective du système de soins de santé du Canada financé par l’État. La modélisation de Markov qui a été utilisée en combinaison avec la simulation Monte Carlo pour obtenir les valeurs attendues des coûts et des années de vie ajustées en fonction de la qualité (AVAQ) a permis le calcul des ratios coûts-efficacité différentiels. Résultats: Le canakinumab a été associé à des coûts moyens sur la vie entière plus élevés par patient (457 982 $ vs 82 565 $) et une AVAQ moyenne plus élevée par patient (14,90 vs 14,20) que le traitement selon la norme de soins. Par conséquent, le coût différentiel par AVAQ obtenu avec le traitement par canakinumab vs le traitement selon la norme de soins était de 535 365 $. La probabilité que le traitement par canakinumab soit rentable était de 0 %. Les résultats étaient cohérents dans un éventail d’analyses de scénarios. Conclusions: Le traitement des patients après un infarctus du myocarde par canakinumab n’est pas rentable comparativement au traitement selon la norme de soins au prix actuel. Selon les seuils de propension à payer actuellement acceptés au Canada, une réduction du prix de 91 % est requise pour obtenir un coût par patient qui serait considéré comme approprié.

Abstract Background Systematic reviews are the cornerstone of evidence-based medicine. However, systematic reviews are time consuming and there is growing demand to produce evidence more quickly, while maintaining robust methods. In recent years, artificial intelligence and active-machine learning (AML) have been implemented into several SR software applications. As some of the barriers to adoption of new technologies are the challenges in set-up and how best to use these technologies, we have provided different situations and considerations for knowledge synthesis teams to consider when using artificial intelligence and AML for title and abstract screening. Methods We retrospectively evaluated the implementation and performance of AML across a set of ten historically completed systematic reviews. Based upon the findings from this work and in consideration of the barriers we have encountered and navigated during the past 24 months in using these tools prospectively in our research, we discussed and developed a series of practical recommendations for research teams to consider in seeking to implement AML tools for citation screening into their workflow. Results We developed a seven-step framework and provide guidance for when and how to integrate artificial intelligence and AML into the title and abstract screening process. Steps include: (1) Consulting with Knowledge user/Expert Panel; (2) Developing the search strategy; (3) Preparing your review team; (4) Preparing your database; (5) Building the initial training set; (6) Ongoing screening; and (7) Truncating screening. During Step 6 and/or 7, you may also choose to optimize your team, by shifting some members to other review stages (e.g., full-text screening, data extraction). Conclusion Artificial intelligence and, more specifically, AML are well-developed tools for title and abstract screening and can be integrated into the screening process in several ways. Regardless of the method chosen, transparent reporting of these methods is critical for future studies evaluating artificial intelligence and AML.

Abstract Background Smoking cessation interventions implemented in emergency department (ED) settings have resulted in limited success, owing to factors such as lack of time, motivation, and incentives. A dynamic yet simple and effective approach that addresses the fast-paced nature of acute-care ED settings is needed. This study proposes a multi-center randomized controlled trial (RCT) to compare the effectiveness of an easy to deliver proactive, multi-component tobacco treatment intervention to usual care in the ED setting. Methods This will be a prospective four-site, single-blind, blinded-endpoint (PROBE) RCT. Participants will be recruited directly in the ED and will be approached strictly in order of arrival time. Those randomized to the Quit Card Intervention (QCI) group will receive a “quit kit” which will include: a “Quit Card” worth $300 that can be used at any Canadian pharmacy to purchase any form of nicotine replacement therapy (NRT); a self-help booklet; and proactive enrolment in 6 months of telephone follow-up counseling. The usual care (UC) group will receive a “quit kit” which will include a brochure for a local smoking cessation program. Quit kits for both groups will be delivered in opaque, sealed envelopes, and identical in size and weight so to conceal group allocation from the blinded research coordinator. Randomization will be stratified by site and by the Canadian Triage Acuity Scale (CTAS), a value assigned to each ED patient based on the severity of the condition. An equal number of quit kits will be prepared for each CTAS level. The primary outcome will be bio-chemically verified smoking abstinence at 26 weeks. Secondary outcomes include smoking behavior at weeks 4, 52, and 104 as well as mortality and health care utilization outcomes. Investigators, outcome assessors, and data analysts will be blinded to group allocation until after primary analyses are completed. It is hypothesized that the QCI group will have higher a abstinence rate, improved health outcomes, and decreased healthcare utilization. Discussion There are few examples of hospital EDs in Canada that systematically initiate tobacco cessation interventions for patients who smoke. Given the high smoking prevalence among ED patients and the relation of tobacco smoking to the majority of ambulatory care sensitive conditions, EDs are a missed opportunity in the initiation of tobacco treatment interventions. We have designed and will test an evidence-based tobacco treatment intervention that is simple and highly scalable. Trial registration ClinicalTrials.gov NCT04163081 . Registered on November 14, 2019

Background: Premature or rapid battery depletion may compromise the performance and reliability of an implantable cardioverter defibrillator (ICD), potentially resulting in harm or death to patients. We sought to describe the outcomes and clinical management of devices included in the Abbott ICD Premature Battery Depletion Advisory, using data from a Canadian registry. Methods: This prospective observational study includes patients with an Abbott device subject to the advisory, from 9 centres in Canada. The incidence and outcomes related to device revision owing to premature battery depletion were identified and adjudicated by a committee. Results: There were 2678 patients enrolled with a device subject to the advisory. Devices were implanted between 2010 and 2017; follow-up time was 5.7 ± 0.7 years. Device revision occurred in 222 patients (8.3%). Revision for premature battery depletion occurred in 43 patients (1.6%). Devices were revised at physician discretion on notice of the advisory in 16 patients (0.6%), and at patient request in 5 patients (0.2%). A total of 63 (2.4%) devices reached routine end of battery life. A further 95 (3.5%) patients underwent revision for other reasons. There were no reported major complications or adverse events with device revision owing to the advisory. There were no deaths attributed to premature battery depletion. Conclusions: The rate of premature battery depletion associated with the Abbott ICD Premature Battery Depletion Advisory is low. There were no clinically adverse events identified that were associated with the battery performance of devices under advisory. Résumé: Contexte: L’épuisement prématuré ou rapide de la pile pourrait compromettre le rendement et la fiabilité d’un défibrillateur cardioverteur implantable (DCI), et risque d’être dommageable ou mortel pour les patients. Nous avons voulu décrire les issues et la gestion clinique des dispositifs mentionnés dans l’avis d’Abbott sur l’épuisement prématuré de la pile de DCI, en utilisant des données tirées d’un registre canadien. Méthodologie: L’étude observationnelle prospective a été menée auprès de patients porteurs d’un dispositif Abbott faisant l’objet de l’avis, dans neuf établissements au Canada. La fréquence des révisions de dispositif dues à l’épuisement prématuré de la pile et les issues qui y sont associées ont été recensées et évaluées par un comité. Résultats: Ont été inscrits à l’étude 2 678 patients porteurs d’un dispositif faisant l’objet de l’avis. Les dispositifs avaient été mis en place entre 2010 et 2017; la durée du suivi avait été de 5,7 ± 0,7 ans. Une révision de dispositif a été effectuée chez 222 patients (8,3 %). Elle a été motivée par un épuisement prématuré de la pile chez 43 patients (1,6 %). Une révision de dispositif a été faite à la discrétion du médecin, après réception de l’avis, chez 16 patients (0,6 %) et à la demande de cinq patients (0,2 %). Au total, la pile de 63 (2,4 %) dispositifs avait atteint la fin de sa durée de vie habituelle. D’autres raisons ont entraîné une révision chez 95 autres patients (3,5 %). Aucune complication majeure et aucun effet indésirable n’ont été signalés avec les dispositifs révisés par suite de l’avis. Il n’y a eu aucun décès attribué à un épuisement prématuré de la pile. Conclusions: Le taux d’épuisement prématuré de la pile de DCI associé à l’avis d’Abbott est faible. Il n’y a pas eu d’incidents cliniques jugés liés au rendement de la pile des dispositifs faisant l’objet de l’avis.

Abstract Background Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. This failure rate has prompted investigation into methods of determining physiologic procedural success before and after treatment, before clinically apparent outcomes occur such as gangrene. The aim of this systematic review is to evaluate if in patients undergoing endovascular surgery for lower extremity atherosclerotic peripheral arterial disease, do changes in physiologic measures of perfusion during surgery correlate with clinical outcomes. Methods We registered and designed a study protocol for a systematic review. Literature searches will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977 onwards). Grey literature will be identified through OpenGrey and clinical trial registries, and supplemented by citation searches. We will include randomized controlled trials, quasi-experimental trials, and observational (cohort, case-control) studies conducted in human adults (age 18 or older) who received elective arterial angioplasty for atherosclerotic peripheral vascular disease. The primary outcome of interest will be major adverse limb events. Two investigators will independently screen all citation, full-text articles, and abstract data. The study quality (risk of bias) will be appraised appropriate tools. Data analysis and synthesis will be qualitative; no meta-analysis is planned, as the anticipated homogeneity of measurement and outcome reporting standardization is low. Discussion The treatment of peripheral arterial disease is unique in that the tissue of the ischemic leg is easily accessible for direct monitoring during procedures. This is contrasted with cardiac and neurologic monitoring during cardiac and cerebral procedures, where indirect or invasive measures are required to monitor organ perfusion. Currently synthesized evidence describing limb perfusion focuses on static states of ischemia, and does not evaluate the value of change in perfusion measurement as an indicator of endovascular treatment success. These methods could potentially be applied to optimize procedural outcomes by guiding perfusion-based decision-making during surgery. Systematic review registration PROSPERO CRD42019138192

Abstract Background As systematic reviews’ limited coverage of the medical literature necessitates decision-making based on unsystematic review, we investigated a possible advantage of systematic review (aside from dataset size and systematic analysis): does systematic review avoid potential bias in sampling primary studies from high impact factor journals? If randomized controlled trials (RCTs) reported in higher-impact journals present different treatment benefits than RCTs reported in lower-impact journals, readers who focus on higher-impact journals for their rapid literature reviews may introduce bias which could be mitigated by complete, systematic sampling. Methods We randomly sampled Cochrane Library (20 July 2005) treatment reviews that measured mortality as a binary outcome, published in English or French, with at least five RCTs with one or more deaths. Our domain-based assessment of risk of bias included funding source, randomness of allocation sequence, blinding, and allocation concealment. The primary analysis employed logistic regression by a generalized linear model with a generalized estimating equation to estimate the association between various factors and publication in a journal with a high journal impact factor (JIF). Results From the 29 included systematic reviews, 189 RCTs contributed data. However, in the primary analyses comparing RCT results within meta-analyses, there was no statistically significant association: unadjusted odds of greater than 50% mortality protection in high-JIF (> 5) journals were 1.4 (95% CI 0.42, 4.4) and adjusted, 2.5 (95% CI 0.6, 10). Elements of study quality were weakly, inconsistently, and not statistically significantly correlated with journal impact factor. Conclusions Journal impact factor may have little to no association with study results, or methodological quality, but the evidence is very uncertain.

Abstract Background Aortic arch surgery remains the only viable life-saving treatment for aortic arch disease. However, the necessity for cessation of systemic blood flow with hypothermic cardiac arrest carries substantial risk of morbidity and mortality, including poor neurological outcomes and kidney failure. While uncontrolled studies have suggested the safety of operating at warmer temperatures, significant variables remain un-investigated, supporting the need for a randomized clinical trial (RCT) to produce evidence-based guidelines for perfusion strategies in aortic surgery. This study proposes a multi-center RCT in order to compare outcomes of warmer hypothermic strategies during aortic hemiarch surgery on a composite endpoint of neurologic and acute kidney injury (AKI). Methods/design This is a prospective multi-center, single-blind two-arm RCT comparing mild (32 °C) versus moderate (26 °C) hypothermic cardiac arrest in patients (n = 282) undergoing hemiarch surgery with antegrade cerebral perfusion (ACP). The primary endpoint is a composite of neurological injury (incidence of transient ischemic attack and/or stroke) and Kidney Disease Improving Global Outcomes (KDIGO) stage 1 or higher AKI. Secondary outcomes include death, cardiopulmonary bypass time, bleeding, transfusion rates, prolonged mechanical ventilation, myocardial infarction, length of stay, and quality of life measures. Patients will undergo 1:1 block randomization to each treatment arm on day of surgery. Sequence of operation will be at the surgeon’s discretion with mandatory guidelines for temperature and ACP administration. Perioperative management will occur as per enrolling center standard of care. Neurocognitive function will be assessed for neurological injury using validated neurological screening tests: NIHSS, MOCA, BI, and MRS throughout patient follow-up. Diagnosis and classification of AKI will be based on rising creatinine values as per the KDIGO criteria. Study duration for each patient will be 60 ± 14 days. Discussion It is hoped that performing hemiarch surgery using mild hypothermia (32 °C) and selective ACP will result in a 15% absolute risk reduction in the composite outcomes. The potential of this risk reduction will translate into improved patient outcomes, survival, and long-term financial savings to the health care system. In addition, the results of this trial will be used to create the first-ever guidelines for temperature management strategy during aortic surgery. Trial registration This trial is registered on ClinicalTrials.gov with the registration number NCT02860364. Registration date August 9th, 2016.

Abstract Objective Angioplasty is a fundamental treatment for atherosclerotic disease and may be performed as the sole therapy in small vessel disease. However, the ideal duration of balloon inflation has not yet been identified. Our study investigated whether prolonged inflation of at least 1-min duration, when compared with brief inflation, affects residual stenosis after arterial angioplasty. Data sources and methods Two independent reviewers conducted a systematic review of EMBASE, MEDLINE, CENTRAL, trial registries and grey literature, using pre-specified search syntax. Data abstraction and quantitative analysis was performed independently, according to pre-specified criteria. The primary outcome was residual stenosis after initial angioplasty, in addition to other pre-specific clinical and radiographic outcomes. All analyses were stratified by coronary, cerebrovascular, and peripheral territory. The study protocol is published and registered on PROSPERO (CRD42018092702). Results Six relevant articles were identified, of which one investigated peripheral vascular angioplasty and five investigated coronary artery angioplasty, encompassing 1496 procedures. The studies were at moderate risk of bias. Minimal heterogeneity within coronary studies allowed for subgroup meta-analysis. Prolonged inflation was significantly associated with lower risk of residual stenosis post-inflation in the pooled coronary trials (RR 1.76 [95% CI 1.46–2.12], I2 = 0%, p

Abstract Background Angioplasty is a fundamental treatment for atherosclerotic disease in the cardiac, cerebrovascular, and peripheral vascular beds. However, the optimal duration of balloon inflation has not been identified. Our study will investigate whether prolonged angioplasty balloon inflation of at least 1 min duration, when compared with brief inflation, affects residual stenosis after arterial angioplasty. Methods In compliance with PRISMA, two independent reviewers will conduct a systematic review of EMBASE, MEDLINE, CENTRAL, trial registries, grey literature, and ancestry and citation search. Data abstraction, quantitative, and quantitative meta-analysis will be performed according to pre-specified criteria. The primary outcome is residual stenosis immediately after initial angioplasty; however, secondary outcomes will include multiple short and long term pre-specific clinical and radiographic outcomes. Risk of bias, subgroup analyses, and sensitivity analyses are planned. Discussion Despite the ubiquitous use of angioplasty in atherosclerotic disease and multiple trials investigating the ideal balloon inflation duration, there are no systematic reviews evaluating prolonged angioplasty balloon inflation. Currently synthesized evidence is insufficient to confidently direct clinical decision-making, and the current variation in operator preference of balloon angioplasty duration suggests ongoing clinical equipoise. Given the known availability of current primary evidence, our study intends to synthesize the evidence and guide future clinical decision making and investigation. Systematic review registration PROSPERO CRD42018092702

Abstract Background Low back pain is one of the most common and disabling health problems in Canada and internationally. In most cases, low back pain is a benign, self-limiting condition that can be managed with little diagnostic investigation or treatment. Yet contrary to clinical practice guideline recommendations, diagnostic imaging (here meaning X-ray, MRI, CT) is commonly used in the assessment of low back pain. Diagnostic imaging is of limited value in most cases, exposing patients to unnecessary radiation and leading to increased health services use and worse patient health outcomes. The Choosing Wisely campaign has highlighted the need to reduce diagnostic imaging for low back pain; however, no clinical decision rules are available. Methods This project will develop a clinical decision support tool for appropriate use of diagnostic imaging for patients with low back pain in the emergency department. We will conduct a prospective cohort study at five Canadian emergency departments. The study will follow recommendations for prediction model development and testing. The study population will be 4000 patients presenting to the emergency department with low back pain. We will assess potential clinical indications of emergent-cause (i.e., “red flag” items), including clinical characteristics and past history. Our outcome, emergent-cause for low back pain such as fracture, cancer, infection, or cauda equina syndrome, will be assessed at discharge and at 1-, 3-, and 12-month follow-up periods using information from self-report and health administrative data. We will construct and assess the performance of a multivariable prediction model that has strong measurement properties, presented as a clinical decision support tool acceptable to knowledge users. Discussion Practice guidelines describe “red flags” for which diagnostic imaging is likely appropriate. However, recommendations across guidelines are discordant, and few studies have evaluated these criteria to determine which characteristics best predict emergent etiology that warrant diagnostic imaging. A clinical decision support tool, that recommends diagnostic imaging where appropriate, has the potential to improve clinical care and patient outcomes and reduce costs associated with managing low back pain patients.

Abstract Background Older adults are more likely to access the emergency department, which suffers from overcrowding and congestion, for conditions that could potentially be treated in other settings. Older adults living in long-term care centers have access to healthcare resources in their residence, and several programs have been created with the intent of treating medical conditions on-site. The aim of this study is to identify and systematically review programs and interventions at long-term care centers that aim to treat patients on-site, avoiding unscheduled transportation to the emergency department. Methods We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We will perform a comprehensive search of Embase, MEDLINE, CINAHL, ClinicalTrials.gov, PROSPERO, and the Cochrane Central Registry of Controlled Trials using a broad search strategy. Two independent reviewers will assess titles and abstracts against inclusion criteria, and we will further evaluate relevant full-text articles for inclusion. We will assess the risk of bias using the Newcastle-Ottawa scale for included non-randomized studies and the Cochrane Risk of Bias tool for randomized trials. We will present a narrative synthesis of results and complete a meta-analysis only if enough homogeneity is found. We will create funnel plots to evaluate possible reporting bias and use The Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology to assess the confidence in cumulative evidence. Discussion As pressure on the healthcare system continues to rise, many areas are looking for alternative models of care. Several programs have been put in place in long-term care centers that seek to avoid transportation to the emergency department by providing enhanced care on-site. These programs are quite variable, and, to date, there is no standardized program or model of care. Systematic review registration PROSPERO (CRD42018091636)

Abstract Background Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide. Objectives To use individual participant data network meta‐analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers. Search Methods We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews. Selection Criteria We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection. Data Collection and Analysis We conducted NMA with individual participant data (IPD), using a frequentist approach for random‐effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest. Results We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence). Authors' Conclusions This analysis reinforces the case against mass deworming at a population‐level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.

Abstract Health research has documented disparities in health and health outcomes within and between populations. When these disparities are unfair and avoidable they may be referred to as health inequities. Few trials attend to factors related to health inequities, and there is limited understanding about how to build consideration of health inequities into trials. Due consideration of health inequities is important to inform the design, conduct and reporting of trials so that research can build evidence to more effectively address health inequities and importantly, ensure that inequities are not aggravated. In this paper, we discuss approaches to integrating health equity-considerations in randomized trials by using the PROGRESS Plus framework (Place of residence, Race/ethnicity/culture/language, Occupation, Gender, Religion, Education, Socio-economic status, Social capital and “Plus” that includes other context specific factors) and cover: (i) formulation of research questions, (ii) two specific scenarios relevant to trials about health equity and (iii) describe how the PROGRESS Plus characteristics may influence trial design, conduct and analyses. This guidance is intended to support trialists designing equity-relevant trials and lead to better design, conduct, analyses and reporting, by addressing two main issues: how to avoid aggravating inequity among research participants and how to produce information that is useful to decision-makers who are concerned with health inequities.

This review evaluates the effects of mass deworming for soil‐transmitted helminths on growth, educational achievement, cognition, school attendance, quality of life and adverse effects in children in endemic helminth areas. Mass deworming for soil‐transmitted helminths probably has little to no effect on weight, height, school attendance, cognition measured by short‐term attention, or mortality. There are no data on short‐term quality of life and little evidence of adverse effects. Mass deworming for schistosomiasis alone may slightly increase weight but probably has little to no effect on height and cognition. The evidence does not support indirect benefits for untreated children from being exposed to treated children. One moderate quality long term study showed an increase in economic productivity (hours worked) and increase in educational enrollment 10 years later of mass deworming and hygiene promotion. But, it is uncertain whether these effects are due to the deworming or the combined hygiene intervention. Findings are consistent for various groups of the population by age, gender, worm prevalence, baseline nutritional status, compliance, impact on worms, infection intensity, types of worms, risk of bias, and study characteristics. Deworming for children who screened positive for schistosomiasis or soil‐transmitted helminths results in larger gains in weight but no difference in effect on height, cognition or school attendance. Also, one low to moderate quality study showed long‐term benefit on school enrolment of sanitation improvement combined with screening and treating people for hookworm infection. Abstract Background Soil‐transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by the World Health Organization (WHO), affect more than a third of the world's population, with varying intensity of infection. There is debate about the effectiveness and cost‐effectiveness of mass deworming of children as a strategy to improve child health in endemic areas. Objectives The objective of this review was to evaluate the effects of mass deworming for soil‐transmitted helminths with or without deworming for schistosomiasis or co‐interventions on growth, educational achievement, cognition, school attendance, quality of life and adverse effects in children inendemic helminth areas. We also aimed to assess possible effect modifiers using pre‐planned subgroup analysis of age, sex, prevalence of worms and baseline nutritional status. Search strategy Our librarian scientist designed a search strategy that was reviewed by the Campbell Collaboration librarian for the following 11 electronic databases: MEDLINE, CINAHL, LILACS, EMBASE, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts, up to May 13, 2015. We also searched websites and clinical trial registers, other systematic reviews, and contacted authors and experts in the field. Study selection criteria We included studies if they included children aged six months to 16 years, carried out mass deworming for soil‐transmitted helminths (alone or in combination with other drugs or child health interventions), reported one of our primary outcomes of growth, school attendance, school performance, cognitive processing or development, well‐being, or adverse events, and included a comparator to a control or active comparator. We included randomized trials, quasi‐randomized trials, controlled before after studies, interrupted time series and quasi‐experimental studies that used statistical methods of analysis to match participants with non‐participants, or statistical methods to account for confounding and sample selection bias. Data collection and analysis We screened titles and abstracts in duplicate, as well as the full texts of those considered eligible at level 1. We used a pre‐tested data extraction form to collect details on participants, interventions, outcomes, study methods and setting, and extracted data in duplicate. We conducted random effects pairwise meta‐analysis for all primary outcomes. If heterogeneity was acceptable (I290,000 children. These studies were conducted in 23 low and middle income countries (L&MICs), in areas where prevalence of worms ranged from 0.5 per cent to 99 per cent infected. Most of the studies consisted of deworming twice per year or more frequently, with only two studies deworming once per year. Overall risk of bias was moderate. Mass deworming for soil‐transmitted helminths compared to controls probably has little to no improvement in weight (0.09 kg, 95%CI: ‐0·04 to 0·2; 35,430 participants, 11 trials), height (0.07 cm, 95% CI:‐0.1 cm to 0.24 cm); 6,839 participants, nine trials) or attendance (1% higher, 95% CI: ‐1% to 3%; >30,000 participants, seven trials) (moderate certainty evidence). Mass deworming for soil transmitted helminths leads to little to no difference in proportion stunted (eight per 1000 fewer‐from 48 fewer to 32 more; 4,286 participants, four trials), cognition measured by short‐term attention (‐0·23 points on 100 point scale, 95%CI ‐0·6, 0·14; 4,078 participants, three trials), or mortality (1 per 1000 fewer, 95%CI: ‐3 to 1 per 1000; >1 million participants, six trials) (high certainty evidence). We found no data on short‐term quality of life and little evidence of adverse effects. Mass deworming for schistosomiasis alone may slightly increase weight (0·4 kg, 95%CI: ‐0·2, 1·0) and has little to no effect on height (low certainty evidence) and cognition (moderate certainty evidence). Our analyses do not support indirect benefits for untreated children, from being exposed to treated children in the community (low certainty evidence). There may be increase in long‐term economic productivity (1.58 hours more per week, 95%CI: ‐0.46 to 3.62) and school enrolment (0.29 years, 95%CI 0.01 to 0.58), little to no effect on height (‐0.11 cm, 95%CI: ‐0.64 to 0.42) and self‐reported health (0.04 units, 95%CI: 0.0 to 0.08) of mass deworming when combined with hygiene education, however, it is uncertain whether these effects are due to deworming alone or hygiene or the combination (very low certainty). We are uncertain about long‐term effects on math or English at school and cognitive development due to very low certainty evidence.. Results were congruentacross sensitivity and subgroup analyses by age, sex, worm prevalence, baseline nutritional status, impact on worms, infection intensity, types of worms (ascaris, hookworm or trichuris), risk of bias, cluster vs. individual trials, high compliance and low attrition bias. Deworming for children who screened positive for schistosomiasis or soil‐transmitted helminths resulted in larger gains in weight and no difference in effect on height, cognition or school attendance. Implications for policy and programmes This independent analysis reinforces the case against mass deworming. These findings suggest that in addition to a reconsideration of mass deworming programmes in their current form, additional policy options need to be explored to improve child health and nutrition in worm‐endemic areas. These include the needs for investing in interventions to address basic determinants of worm infestations such as poverty, living conditions, sanitation and inequities. Decisions on public health approaches in such settings need to be taken on the basis of human rights, ethics and evidence‐based, sustainable cost‐effective approaches. For schistosomiasis, the policy implication is that mass deworming may be effective at improving weight. Implications for research Since all analyses of effect modification are limited by aggregate level data which may hide individual level differences, we propose that future research should assess which subset of children does benefit from mass deworming, if any, using individual patient data meta‐analysis. This analysis and other work could focus on whether it is feasible to develop a case‐finding tool with clinical data that could identify children and settings that would benefit from treatment. Plain Language Summary Mass deworming programmes have little or no effect on most welfare outcomes. The Campbell review in brief The effectiveness and cost‐effectiveness of mass deworming of children to improve child health and other outcomes is debated. This independent analysis reinforces the case against mass deworming, finding little or no effect on most welfare outcomes. What is this review about? Soil‐transmitted helminthiasis and schistosomiasis affect more than a third of the world's population. There is debate about the effectiveness and cost‐effectiveness of mass deworming of children to improve child health and other outcomes in endemic areas. This review evaluates the effects of mass deworming for soil‐transmitted helminths on growth, educational achievement, cognition, school attendance, quality of life and adverse effects in children in endemic helminth areas. What studies were included? Included studies examine out mass deworming for soil‐transmitted helminths (alone or in combination with other drugs or child health interventions) for children aged 6 months to 16 years, and report at least one of the following outcomes: growth, school attendance, school performance, cognitive processing or development, well‐being, or adverse events. Included study designs are randomized trials, interrupted time series and non‐experimental studies that used statistical methods of analysis to match participants with non‐participants, or statistical methods to account for confounding and sample selection bias. Sixty‐five studies are analyzed in the review, with a treatment duration from 4 months to 5 years, covering 1,092,120 children, including five long‐term studies 8‐10 years after mass deworming programs with over 90,000 children. These studies were conducted in 23 low and middle income countries. Most programmes studied conduct deworming twice per year or more frequently, with only two studies of programmes deworming just once per year. Does deworming improve child health and other welfare outcomes? Mass deworming for soil‐transmitted helminths probably has little to no effect on weight, height, school attendance, cognition measured by short‐term attention, or mortality. There are no data on short‐term quality of life and little evidence of adverse effects. Mass deworming for schistosomiasis alone may slightly increase weight but probably has little to no effect on height and cognition. The evidence does not support indirect benefits for untreated children from being exposed to treated children. One moderate quality long term study showed an increase in economic productivity (hours worked) and increase in educational enrollment 10 years later of mass deworming and hygiene promotion. But, it is uncertain whether these effects are due to the deworming or the combined hygiene intervention. Findings are consistent for various groups of the population by age, gender, worm prevalence, baseline nutritional status, compliance, impact on worms, infection intensity, types of worms, risk of bias, and study characteristics. Deworming for children who screened positive for schistosomiasis or soil‐transmitted helminths results in larger gains in weight but no difference in effect on height, cognition or school attendance. Also, one low to moderate quality study showed long‐term benefit on school enrolment of sanitation improvement combined with screening and treating people for hookworm infection. What are the implications of this review for policy makers and decision makers? This independent analysis reinforces the case against mass deworming. In addition to a reconsideration of mass deworming programs in their current form, additional policy options need to be explored to improve child health and nutrition in worm‐endemic areas. For schistosomiasis, policy implications are that mass deworming may be effective at improving weight. What are the research implications of this review? Future research should assess which subset of children benefit from mass deworming using individual‐level meta‐analysis. This analysis could explore whether it is feasible to develop a case‐finding tool to identify children and settings which will benefit from treatment.

The Java programming language provides a comprehensive set of multithreading programming techniques but currently lacks interprocess communication (IPC) facilities, other than slow socket-based communication mechanisms (which are intended primarily for distributed systems, not interprocess communication on a multicore or multiprocessor system). This is problematic due to the ubiquity of modern multicore processors, and the widespread use of Java as a programming language throughout the software development industry. This work aimed to address this problem by utilising Microsoft Windows’ native IPC mechanisms through a framework known as the Java Native Interface. This enabled the use of native C code that invoked the IPC mechanisms provided by Windows, which allowed successful synchronous communication between separate Java processes. The results obtained illustrate the performance dichotomy between socket-based communication and native IPC facilities, with Windows’ facilities providing significantly faster communication. Ultimately, these results show that there are far more effective communication structures available. In addition, this work presents generic considerations that may aid in the eventual design of a generic, platform-independent IPC system for the Java programming language. The fundamental considerations include shared memory with semaphore synchronisation, named pipes and a socket communication model.

OBJECTIVE: To assess the feasibility and potential effectiveness of a modified version of the Ottawa Model for Smoking Cessation in an outpatient respirology clinic.

Background: As part of needs assessment processes, our Faculty of Medicine (FOM) continuing professional development office investigated the differences between physicians who do and those who do not frequently participate in planned group learning to gain insight into their interest in new forms of continuing professional development (CPD). Method: We sent a 19 item questionnaire to 485 randomly selected physicians of the 1050 family physicians in Eastern Ontario. The questionnaire examined present participation and satisfaction with CPD activities and perceptions regarding the potential impact of those; and appetite for new opportunities to meet their learning needs. Results: Of the 151 (31%) physicians responding, 61% reported attending at least one FOM group learning program in the past 18 months (attenders) and 39% had not (non-attenders). Non-attenders indicated less satisfaction (p = 0.04) with present opportunities and requested development in newer approaches such as support for self-learning, on-line opportunities, and simulation. Conclusions: Although there are high levels of satisfaction with the present CPD system that predominantly offers large group learning options, a substantial number of physicians expressed interest in accessing new options such as personal study and on-line resources.

OBJECTIVE: The aim was to describe how selected health research funding agencies active in low- and middle-income countries promote the translation of their funded research into policy and practice. METHODS: We conducted inductive analysis of semi-structured interviews with key informants from a purposive sample of 23 national and international funding agencies that fund health research in Brazil, Colombia, India, the Philippines, South Africa and Thailand. We also surveyed web sites. FINDINGS: We found a commitment to knowledge translation in the mandate of 18 of 23 agencies. However, there was a lack of common terminology. Most of the activities were traditional efforts to disseminate to a broad audience, for example using web sites and publications. In addition, more than half (13 of 23) of the agencies encouraged linkage/exchange between researchers and potential users, and 6 of 23 agencies described "pull" activities to generate interest in research from decision-makers. One-third (9 of 23) of funding agencies described a mandate to enhance health equity through improving knowledge translation. Only 3 of 23 agencies were able to describe evaluation of knowledge translation activities. Furthermore, we found national funding agencies made greater knowledge translation efforts when compared to international agencies. CONCLUSION: Funding agencies are engaged in a wide range of creative knowledge translation activities. They might consider their role as knowledge brokers, with an ability to promote research syntheses and a focus on health equity. There is an urgent need to evaluate the knowledge translation activities of funding agencies.

BackgroundPrevious studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care. Little has been done to determine the comparative impact of different telemedicine options for a specific population such as individuals with heart failure (HF).Methods and findingsSystematic reviews (SR) of randomized controlled trials (RCTs) that examined telephone support, telemonitoring, video monitoring or electrocardiographic monitoring for HF patients were identified using a comprehensive search of the following databases: MEDLINE, EMBASE, CINAHL and The Cochrane Library. Studies were included if they reported the primary outcome of mortality or any of the following secondary outcomes: all-cause hospitalization and heart failure hospitalization. Thirty RCTs (N = 10,193 patients) were included. Compared to usual care, structured telephone support was found to reduce the odds of mortality(Odds Ratio 0.80; 95% Credible Intervals [0.66 to 0.96]) and hospitalizations due to heart failure (0.69; [0.56 to 0.85]). Telemonitoring was also found to reduce the odds of mortality(0.53; [0.36 to 0.80]) and reduce hospitalizations related to heart failure (0.64; [0.39 to 0.95]) compared to usual post-discharge care. Interventions that involved ECG monitoring also reduced the odds of hospitalization due to heart failure (0.71; [0.52 to 0.98]).LimitationsMuch of the evidence currently available has focused on the comparing either telephone support or telemonitoring with usual care. This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.ConclusionsCompared to usual care, structured telephone support and telemonitoring significantly reduced the odds of deaths and hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little has been done to directly compare these two interventions against one another. Further research into their comparative cost-effectiveness is also warranted.

IntroductionNetwork meta-analyses (NMAs) are complex methodological approaches that may be challenging for non-technical end-users, such as policymakers and clinicians, to understand. Consideration should be given to identifying optimal approaches to presenting NMAs that help clarify analyses. It is unclear what guidance researchers currently have on how to present and tailor NMAs to different end-users.MethodsA systematic review of NMA guidelines was conducted to identify guidance on how to present NMAs. Electronic databases and supplementary sources were searched for NMA guidelines. Presentation format details related to sample formats, target audiences, data sources, analysis methods and results were extracted and frequencies tabulated. Guideline quality was assessed following criteria developed for clinical practice guidelines.ResultsSeven guidelines were included. Current guidelines focus on how to conduct NMAs but provide limited guidance to researchers on how to best present analyses to different end-users. None of the guidelines provided reporting templates. Few guidelines provided advice on tailoring presentations to different end-users, such as policymakers. Available guidance on presentation formats focused on evidence networks, characteristics of individual trials, comparisons between direct and indirect estimates and assumptions of heterogeneity and/or inconsistency. Some guidelines also provided examples of figures and tables that could be used to present information.ConclusionsLimited guidance exists for researchers on how best to present NMAs in an accessible format, especially for non-technical end-users such as policymakers and clinicians. NMA guidelines may require further integration with end-users' needs, when NMAs are used to support healthcare policy and practice decisions. Developing presentation formats that enhance understanding and accessibility of NMAs could also enhance the transparency and legitimacy of decisions informed by NMAs.

INTRODUCTION: Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders. OBJECTIVE: To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics. METHODOLOGY AND RESULTS: We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs. CONCLUSION: Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices.

Making sense of rapidly evolving evidence on genetic associations is crucial to making genuine advances in human genomics and the eventual integration of this information in the practice of medicine and public health. Assessment of the strengths and weaknesses of this evidence, and hence the ability to synthesize it, has been limited by inadequate reporting of results. The STrengthening the REporting of Genetic Association studies (STREGA) initiative builds on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and provides additions to 12 of the 22 items on the STROBE checklist. The additions concern population stratification, genotyping errors, modelling haplotype variation, Hardy-Weinberg equilibrium, replication, selection of participants, rationale for choice of genes and variants, treatment effects in studying quantitative traits, statistical methods, relatedness, reporting of descriptive and outcome data, and the volume of data issues that are important to consider in genetic association studies. The STREGA recommendations do not prescribe or dictate how a genetic association study should be designed but seek to enhance the transparency of its reporting, regardless of choices made during design, conduct, or analysis.