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OBJECTIVES: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients. METHODS: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019. Patients >18 years old with grade I or II splenic injury due to blunt trauma with CB on CT were included. The primary outcome was the failure of NOM requiring angioembolization/operation. We determined the failure rate of NOM for grade I versus grade II splenic injuries. We then performed bivariate comparisons of patients who failed NOM with those who did not. RESULTS: A total of 145 patients were included. Median Injury Severity Score was 17. The combined rate of failure for grade I-II injuries was 20.0%. There was no statistical difference in failure of NOM between grade I and II injuries with CB (18.2% vs 21.1%, p>0.05). Patients who failed NOM had an increased median hospital length of stay (p=0.024) and increased need for blood transfusion (p=0.004) and massive transfusion (p=0.030). Five patients (3.4%) died and 96 (66.2%) were discharged home, with no differences between those who failed and those who did not fail NOM (both p>0.05). CONCLUSION: NOM of grade I-II splenic injuries with CB fails in 20% of patients. LEVEL OF EVIDENCE: IV.

Abstract Background Participation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff. Methods The scoping review framework by Arksey and O’Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search. Results Of the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce. Conclusion This review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.

Abstract Background Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15–26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma. Methods To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach. Results Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics. Conclusions These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Abstract Metallic microfluidic devices made from powder-bed additive manufacturing systems have received increasing attention, but their feasible channel geometry and complexity are often limited by lack of an effective approach to removing trapped powder particles within the channels or conduits of the sintered parts. Here, we present an innovative approach to fabricating long serpentine, high-aspect-ratio submillimeter channels made of stainless steel 316L (SS) by binder jet printing (BJP) and liquid-phase sintering. We leverage the unique nature of the BJP process, that is printing and consolidation steps are decoupled, enabling us to join two or more parts during the sintering step. Instead of constructing the channel device as a single part, we print multiple parts for easy powder removal and later join them to form enclosed channels. The key innovation lies in adding sintering additives like boron nitrides (BN) to the SS stock powder—at the SS/BN interfaces, liquid phase is locally generated at temperature much lower than the SS melting temperature, facilitating the bonding of the multiple parts as well as the consolidation of parts for near-full density. We systematically vary the sintering temperature to show how it affects the joining quality and the channel shape distortion. The joining quality such as the fracture strengths of the joined samples is measured by a pull test while the shape distortion is characterized by various imaging techniques. The feasibility of the proposed approach is demonstrated by fabricating a 400-mm-long, fully enclosed serpentine channel with a rectangular cross-section of 0.5 mm in width and 1.8 mm in height. The pressure drop across this 3D-printed SS serpentine channels is measured for air flow and compared to a standard gas flow model, showing that the device is free of leakage or clogs.

ABSTRACTBackground Aboriginal and Torres Strait Islander youth are vulnerable to racism, trauma and Lateral Violence (LV) where negative feelings and behaviours are directed towards members within their own oppressed group. Conversely, Lateral Empowerment (LE) is the collective prevention and repair of the effects of LV and promotes resilience and strength. There is limited peer reviewed literature directly relating to LV and LE.Objective This review focuses on grey literature to gain greater insight into the understanding and experiences of LV/LE among Aboriginal and Torres Strait Islander young people within Australia.Method This grey literature scoping review identified N = 38 documents between January 1980 and September 2023 related to LV or LE to gain a greater insight into the understanding of LV and LE among the Aboriginal and Torres Strait Islander community outside of published publications.Results The results elucidated that the experience of LV for Aboriginal and Torres Strait Islander youth is largely based upon internalised racism pertaining to Aboriginal identity. Strength-based gender-specific approaches which focus upon positive cultural experiences, the use of lived experience mentors and the inclusion of family were identified as the foundation for LE.Conclusion The grey literature review highlights that the Aboriginal and Torres Strait Islander community are taking an active role in addressing and preventing LV through culturally informed practices and approaches based upon the truth telling of Australia’s colonial history. There remains the need for specific approaches directed at Aboriginal and Torres Strait Islander youth to help prevent and address LV/LE.

ABSTRACT Background Youth have been uniquely affected by the COVID‐19 pandemic. Despite high rates of COVID‐19 infection, youth had one of the lowest vaccine uptake rates. Certain characteristics can affect vaccine uptake, such as mental health and substance use, but it is important to understand uptake for an effective response to pandemics. Objective This study examined the perspectives of youth with mental health or substance use concerns on COVID‐19 vaccine confidence, hesitancy and overall COVID‐19 vaccine perspectives. Methods Using photovoice, a community‐based participatory research method, a sample of 27 youth aged 14−24 years participated in a series of photography workshops and focus groups. Participants submitted final photographs for discussion. Focus groups were recorded, transcribed and thematically analysed. Results Four themes were generated: (1) Youth deciphered the vaccine discourse in a changing information landscape; (2) mixed perspectives of families, friends and loved ones influenced the vaccine journey; (3) complex societal influences affected views and decisions around the COVID‐19 vaccine; and (4) youth navigated their vaccine journeys through first‐ and second‐hand experiences. The four themes and subthemes highlight the evolution of youth's journeys with the COVID‐19 vaccine over the course of the pandemic and into the late‐pandemic period. Conclusions Youth with mental health or substance use challenges navigated a complex environment during the COVID‐19 pandemic. The wide variety of factors influencing vaccine perspectives should be taken into account in public health messaging and future research on youth vaccine uptake. Youth‐led and youth‐engaged research can help solicit rich and meaningful perspectives of young people on important public health issues. Patient or Public Contribution This was a youth‐led study. A youth research analyst conducted the study activities together with the support of a youth advisory group, an adult photographer with lived experience, and a scientific team.

Aims This systematic review aims to identify and synthesise the publicly available research testing treatments for mental health, cognition and psychological well-being in long COVID.Methods The following databases and repositories were searched in October–November 2023: Medline, Embase, APA PsycINFO, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Internet, WANFANG Data, Web of Science’s Preprint Citation Index, The Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform. Articles were selected if they described participants with long COVID symptoms at least 4 weeks after SAR-CoV-19 infection, reported primary outcomes on mental health, cognition and/or psychological well-being, and were available with at least an English-language summary. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed.Results Thirty-three documents representing 31 studies were included. Seven tested psychosocial interventions, five pharmaceutical interventions, three natural supplement interventions, nine neurocognitive interventions, two physical rehabilitation interventions and five integrated interventions. While some promising findings emerged from randomised controlled trials, many studies were uncontrolled; a high risk of bias and insufficient reporting were also frequent.Conclusions The published literature on treatments for mental health, cognition and psychological well-being in long COVID show that the interventions are highly heterogeneous and findings are inconclusive to date. Continued scientific effort is required to improve the evidence base. Regular literature syntheses will be required to update and educate clinicians, scientists, interventionists and the long COVID community.

Mitochondrial creatine kinase (mtCK) regulates the “fast” export of phosphocreatine to support cytoplasmic phosphorylation of ADP to ATP which is more rapid than direct ATP export. Such “creatine-dependent” phosphate shuttling is attenuated in several muscles, including the heart, of the D2.mdx mouse model of Duchenne muscular dystrophy at only 4 weeks of age. However, the degree to which creatine-dependent and -independent systems of phosphate shuttling progressively worsen or potentially adapt in a hormetic manner throughout disease progression remains unknown. Here, we performed a series of proof-of-principle investigations designed to determine how phosphate shuttling pathways worsen or adapt in later disease stages in D2.mdx (12 months of age). We also determined whether changes in creatine-dependent phosphate shuttling are linked to alterations in mtCK thiol redox state. In permeabilized muscle fibres prepared from cardiac left ventricles, we found that 12-month-old male D2.mdx mice have reduced creatine-dependent pyruvate oxidation and elevated complex I-supported H2O2 emission (mH2O2). Surprisingly, creatine-independent ADP-stimulated respiration was increased and mH2O2 was lowered suggesting that impairments in the faster mtCK-mediated phosphocreatine export system resulted in compensation of the alternative slower pathway of ATP export. The apparent impairments in mtCK-dependent bioenergetics occurred independent of mtCK protein content but were related to greater thiol oxidation of mtCK and a more oxidized cellular environment (lower GSH:GSSG). Next, we performed a proof-of-principle study to determine whether creatine-dependent bioenergetics could be enhanced through chronic administration of the mitochondrial-targeting, ROS-lowering tetrapeptide, SBT-20. We found that 12 weeks of daily treatment with SBT-20 (from day 4–∼12 weeks of age) increased respiration and lowered mH2O2 only in the presence of creatine in D2.mdx mice without affecting calcium-induced mitochondrial permeability transition activity. In summary, creatine-dependent mitochondrial bioenergetics are attenuated in older D2.mdx mice in relation to mtCK thiol oxidation that seem to be countered by increased creatine-independent phosphate shuttling as a unique form of mitohormesis. Separate results demonstrate that creatine-dependent bioenergetics can also be enhanced with a ROS-lowering mitochondrial-targeting peptide. These results demonstrate a specific relationship between redox stress and mitochondrial hormetic reprogramming during dystrophin deficiency with proof-of-principle evidence that creatine-dependent bioenergetics could be modified with mitochondrial-targeting small peptide therapeutics.

Abstract Background Prior research has showed the importance of providing integrated support services to prevent and reduce youth not in education, employment, or training (NEET) related challenges. There is limited evidence on NEET youth’s perspectives and preferences for employment, education, and training services. The objective of this study was to identify employment, education and training service preferences of NEET youth. We acknowledge the deficit-based lens associated with the term NEET and use ‘upcoming youth’ to refer to this population group. Methods Canadian youth (14–29 years) who reported Upcoming status or at-risk of Upcoming status were recruited to the study. We used a discrete choice experiment (DCE) survey, which included ten attributes with three levels each indicating service characteristics. Sawtooth software was used to design and administer the DCE. Participants also provided demographic information and completed the Global Appraisal of Individual Needs–Short Screener. We analyzed the data using hierarchical Bayesian methods to determine service attribute importance and latent class analyses to identify groups of participants with similar service preferences. Results A total of n=503 youth participated in the study. 51% of participants were 24–29 years of age; 18.7% identified as having Upcoming status; 41.1% were from rural areas; and 36.0% of youth stated that they met basic needs with a little left. Participants strongly preferred services that promoted life skills, mentorship, basic income, and securing a work or educational placement. Three latent classes were identified and included: (i) job and educational services (38.9%), or services that include career counseling and securing a work or educational placement; (ii) mental health and wellness services (34.9%), or services that offer support for mental health and wellness in the workplace and free mental health and substance use services; and (iii) holistic skills building services (26.1%), or services that endorsed skills for school and job success, and life skills. Conclusions This study identified employment, education, and training service preferences among Upcoming youth. The findings indicate a need to create a service model that supports holistic skills building, mental health and wellness, and long-term school and job opportunities.

Abstract Background Stillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016. Methods All restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs). Results A total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41–4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16–2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50–2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12–2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19–2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20–1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98–7.23), birthing age 35–40 years (aOR, 1.92; 95% CI, 1.02–3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12–3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17–6.16) and unemployment (aOR, 4.06; 95% CI, 1.41–11.73). Conclusion Factors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority.

Abstract Pancreatic ductal adenocarcinoma (PDAC) develops through step-wise genetic and molecular alterations including Kras mutation and inactivation of various apoptotic pathways. Here, we find that development of apoptotic resistance and metastasis of Kras G12D -driven PDAC in mice is accelerated by deleting Plk3, explaining the often-reduced Plk3 expression in human PDAC. Importantly, a 41-kDa Plk3 (p41Plk3) that contains the entire kinase domain at the N-terminus (1-353 aa) is activated by scission of the precursor p72Plk3 at Arg354 by metalloendopeptidase nardilysin (NRDC), and the resulting p32Plk3 C-terminal Polo-box domain (PBD) is removed by proteasome degradation, preventing the inhibition of p41Plk3 by PBD. We find that p41Plk3 is the activated form of Plk3 that regulates a feed-forward mechanism to promote apoptosis and suppress PDAC and metastasis. p41Plk3 phosphorylates c-Fos on Thr164, which in turn induces expression of Plk3 and pro-apoptotic genes. These findings uncover an NRDC-regulated post-translational mechanism that activates Plk3, establishing a prototypic regulation by scission mechanism.

Abstract Chronic kidney disease (CKD) causes skeletal muscle wasting, resulting in reduced function and inability to live independently. This systematic review critically appraised the scientific literature regarding the effects of full‐body resistance training on clinically‐relevant functional capacity measures in CKD. The study population included studies of people with Stage 4 or 5 CKD and a mean age of 40+ years old. Eight databases were searched for eligible studies: Pubmed, Embase, Cochrane, CINAHL, Scopus, Web of Science, MEDLINE, and AGELINE. MeSH terms and keyword combinations were used for screening following the PRISMA conduct. Inclusion criteria were based on PICO principles and no date of publication filter was applied. The intervention was training 2 days/week of structured resistance exercises using major upper and lower muscle groups. Minimum intervention period was 7 weeks. Comparison groups maintained their habitual activity without structured exercise training. Outcome measures of interest were: 6‐min walk test, grip strength, timed up‐and‐go test, and sit‐to‐stand. Eight randomized controlled trials and one nonequivalent comparison‐group study fulfilled the inclusion criteria and underwent data extraction. All studies were of hemodialysis patients. The evidence indicates that full‐body resistance exercise significantly improved grip strength, timed up and go and sit to stand tests; metrics associated with enhanced quality and quantity of life.

A 9-year-old boy was suspected of having acute myocardial infarction and emergency coronary angiogram was performed. No signs of flow limitation in either coronary artery was detected. We performed intravascular ultrasonography from the ascending aorta, which showed a ridge on the left main trunk acting like a valve, resulting in significant stenosis. Percutaneous coronary intervention with stent deployment was performed with good result.

Abstract Protein arginine methyltransferase 5 (PRMT5) is a well-known epigenetic regulatory enzyme. However, the role of PRMT5-mediated arginine methylation in gene transcription related to cardiac fibrosis is unknown. Here we show that fibroblast-specific deletion of PRMT5 significantly reduces pressure overload-induced cardiac fibrosis and improves cardiac dysfunction in male mice. Both the PRMT5-selective inhibitor EPZ015666 and knockdown of PRMT5 suppress α-smooth muscle actin (α-SMA) expression induced by transforming growth factor-β (TGF-β) in cultured cardiac fibroblasts. TGF-β stimulation promotes the recruitment of the PRMT5/Smad3 complex to the promoter site of α-SMA. It also increases PRMT5-mediated H3R2 symmetric dimethylation, and this increase is inhibited by Smad3 knockdown. TGF-β stimulation increases H3K4 tri-methylation mediated by the WDR5/MLL1 methyltransferase complex, which recognizes H3R2 dimethylation. Finally, treatment with EPZ015666 significantly improves pressure overload-induced cardiac fibrosis and dysfunction. These findings suggest that PRMT5 regulates TGF-β/Smad3-dependent fibrotic gene transcription, possibly through histone methylation crosstalk, and plays a critical role in cardiac fibrosis and dysfunction.

Abstract Introduction Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. Methods and analysis We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. Ethics and dissemination Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.

Over the years, the field of forensic anthropology has become more diverse, bringing unique perspectives to a previously homogeneous field. This diversification has been accompanied by recognizing the need for advocacy and activism in an effort to support the communities we serve: marginalized communities that are often overrepresented in the forensic population. As such, forensic anthropologists see the downstream effects of colonialism, white supremacy, inequitable policies, racism, poverty, homophobia, transphobia, gun violence, and misogyny. Some argue that advocacy and activism have no place in forensic anthropological praxis. The counterarguments for engaging in advocacy and activism uphold white, heterosexual, cisgender, and ableist privilege by arguing that perceived objectivity and unbiased perspectives are more important than personally biasing experiences and positionality that supposedly jeopardize the science and expert testimony. Advocacy and activism, however, are not new to the practice of anthropology. Whether through sociocultural anthropology, archaeology, or other areas of biological anthropology, activism and advocacy play an important role, using both the scientific method and community engagement. Using a North American approach, we detail the scope of the issues, address how advocacy and activism are perceived in the wider discipline of anthropology, and define ways in which advocacy and activism can be utilized more broadly in the areas of casework, research, and education.

Abstract Background Menthol (MEN) mouth rinsing (MR) has gained considerable interest in the athletic population for exercise performance; however, the overall magnitude of effect is unknown. Objective The aim of this systematic review and meta-analysis was to determine the efficacy of menthol MEN MR and the impact it has on exercise capacity and performance. Methods Three databases were searched with articles screened according to the inclusion/exclusion criteria. Three-level meta-analyses were used to investigate the overall efficacy of MEN MR and the impact it has on exercise capacity and performance. Meta-regressions were then performed with 1) mean VO2peak, 2) MEN swilling duration; 3) the MEN concentration of MR solution, 4) the number of executed swills throughout a single experiment, 5) the use of flavoured sweetened, non-caloric, or non-flavoured neutral solutions as controls, 6) mean environmental temperature at the time of exercise tests, and 7) exercise type as fixed factors to evaluate their influence on the effects of MEN MR. Results Ten MEN MR studies included sufficient information pertaining to MEN MR and exercise performance and capacity. MR with MEN resulted in no significant change in capacity and performance (SMD = 0.12; 95% CI − 0.08, 0.31; p = 0.23, n = 1, tau21

Abstract Background Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. Methods Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. Results Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. Conclusions Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders’ perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.

Abstract Background Engaging people with lived experience of mental health or substance use challenges and family members (PWLE) improves the quality and relevance of the associated research, but it can be challenging to include them meaningfully and authentically in the work. Knowledge mobilization events After reviewing the literature on the science of lived experience engagement, we held two knowledge mobilization events to translate the findings to relevant partners and collect their feedback to guide our future research. A total of 55 people attended, bringing the perspective of people with lived experience, family members, research staff, research trainees, and scientists, as well as attendees holding multiple roles. We presented the scoping review findings, then held discussions to solicit feedback and encourage the sharing of perspectives. Attendee perspectives Through small and large group discussion activities, we found that our scoping review findings resonated with the attendees’ personal experiences with engagement in mental health and substance use research. Among the gaps highlighted in the discussions, the two that were most emphasized were the critical importance of improving diversity in engagement work in mental health and substance use, and the importance of addressing gaps around communication, relationships, rapport, and power dynamics in engagement spaces. Conclusions Diversity, communication, relationships, and power dynamics emerge as key areas of work needed in the near future to advance the science of PWLE engagement in mental health and substance use research. We commit to pursuing the work that is considered of greatest need by a range of partners this research engagement sphere. We call on researchers in this area to continue this line of work, with a focus on the areas of research identified by attendees.

Introduction: Hypophosphatemia occurs commonly in inflammatory bowel disease (IBD) patients and can cause considerable morbidity. The differential diagnoses in IBD include nutritional causes and hypophosphatemia induced by some formulations of intravenous iron infusions. Case Presentation: We present the case of a 37-year-old man with active Crohn’s disease, presenting with difficulty walking and fractures of the vertebrae and calcaneus. He had long-standing hypophosphatemia. Nutritional causes for hypophosphatemia were considered in the first instance given the presence of chronic diarrhea and vitamin D deficiency; however, there was minimal response to appropriate supplementation with oral phosphorous and vitamin D. Iron infusion-induced hypophosphatemia was then considered, but the nadir phosphate level preceded any iron infusion. Therefore, work-up was undertaken for less common causes. He was ultimately diagnosed with tumor-induced osteomalacia, caused by excess fibroblast growth factor 23 (FGF23) secretion from a phosphaturic mesenchymal tumor about the knee. He had complete resolution of symptoms and biochemical abnormalities following successful resection of the tumor. Conclusion: This case illustrates the approach to investigation of hypophosphatemia in IBD patients. If the time course and response to phosphate supplementation are not as expected for nutritional or iron infusion-induced hypophosphatemia, less common causes should be considered.