Background: Guidelines recommend that adults with peripheral artery disease (PAD) take antiplatelets, statins, and antihypertensives. However, it is unclear how frequently clinicians do not prescribe these medications (ie, underprescription), how often patients fail to fill/refill their prescriptions (ie, nonadherence), which factors increase underprescription/nonadherence risk, and whether underprescription/nonadherence are associated with outcomes. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (January 1, 2006-to-February 18th, 2025) for studies reporting cumulative incidences/point prevalences of clinician underprescription and/or patient nonadherence to antiplatelets, statins, and/or antihypertensives; adjusted-risk factors for underprescription/nonadherence; and adjusted-outcomes associated with underprescription/nonadherence among adults with PAD. Two investigators independently screened citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Estimate certainty was communicated using GRADE. The study was registered on PROSPERO (CRD42022362801). Findings: Among 4206 citations identified, 125 studies (n = 14,681,801 participants; 37% female) were included. The pooled cumulative incidence of antiplatelet, statin, and antihypertensive (among those with PAD and hypertension) underprescription was 28% (95% confidence interval [CI] = 21-36%; moderate-certainty), 34% (95% CI = 31-38%; high-certainty), and 43% (95% CI = 33-53%; moderate-certainty), respectively. The cumulative incidence of antiplatelet, statin, and antihypertensive nonadherence was 27% (95% CI = 20-35%; moderate-certainty), 28% (95% CI = 24-33%; high-certainty), and 23% (95% CI = 22-24%; low-certainty), respectively. Underprescription was more common in population-based studies and those enrolling more females and past/current smokers while nonadherence was more common in studies enrolling more patients with diabetes. Underprescription risk factors included female sex, advanced age, malignancy history, and chronic limb-threatening ischemia (all moderate-certainty). Nonadherence risk factors included advanced age, comorbidity burden, and receiving specialist mental health care (all moderate-certainty). Underprescription was associated with increased major adverse cardiac events, all-cause mortality, and decreased amputation-free time (all moderate-certainty). Interpretation: One-quarter-to-one-half of adults with PAD are not prescribed antiplatelets, statins, and antihypertensives. Further, approximately one-quarter of these patients do not adhere to these medications after prescription. Funding: This research was supported by a 2024 Vanier Canada Graduate Scholarship (awarded to AMK and supervised by DJR), a Graham Farquharson Physician Services Incorporated Knowledge Translation Fellowship (awarded to DJR), and a Research Program Award, University of OttawaDepartment of Surgery Annual Competition (awarded to DJR).

Background: Artificial intelligence (AI) is increasingly integrated into health care, including psychiatry and psychology. In educational contexts, AI offers new possibilities for enhancing clinical reasoning, personalizing content delivery, and supporting professional development. Despite this emerging interest, a comprehensive understanding of how AI is currently used in mental health education, and the challenges associated with its adoption, remains limited. Objective: This scoping review aimed to identify and characterize current applications of AI in the teaching and learning of psychiatry and psychology. It also sought to document reported facilitators of and barriers to the integration of AI within educational contexts. Methods: A systematic search was conducted across 6 electronic databases (MEDLINE, PubMed, Embase, PsycINFO, EBM Reviews, and Google Scholar) from inception to October 2024. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies were included if they focused on psychiatry or psychology, described the use of an AI tool, and discussed at least 1 facilitator of or barrier to its use in education. Data were extracted on study characteristics, population, AI application, educational outcomes, facilitators, and barriers. Study quality was appraised using several design-appropriate tools. Results: From 6219 records, 10 (0.2%) studies met the inclusion criteria. Eight categories of AI applications were identified: clinical decision support, educational content creation, therapeutic tools and mental health monitoring, administrative and research assistance, natural language processing (NLP), program/policy development, students' study aid, and professional development. Key facilitators included the availability of AI tools, positive learner attitudes, digital infrastructure, and time-saving features. Barriers included limited AI training, ethical concerns, lack of digital literacy, algorithmic opacity, and insufficient curricular integration. The overall methodological quality of included studies was moderate to high. Conclusions: AI is being used across a range of educational functions in psychiatry and psychology, from clinical training to assessment and administrative support. Although the potential for enhancing learning outcomes is clear, its successful integration requires addressing ethical, technical, and pedagogical barriers. Future efforts should focus on AI literacy, faculty development, and institutional policies to guide responsible and effective use. This review underscores the importance of interdisciplinary collaboration to ensure the safe, equitable, and meaningful adoption of AI in mental health education.

Background Although taxes that raise retail tobacco prices and industry-initiated price increases have been shown to decrease tobacco consumption, the scarcity of studies in Latin America and the Caribbean using household- or individual-level data in existing reviews limits their policy relevance. Objective To conduct a systematic review and meta-analysis to assess the association between prices and taxes and the use of tobacco products in Latin America and the Caribbean. Methods We searched six electronic bibliographic databases, two online search engines, two working paper repositories, and hand-searched seven journals. We included all quantitative studies that used any measures of individual or household tobacco use as an outcome, written in English, Portuguese or Spanish. We used random-effects meta-analyses to pool results across studies. Results We found consistent evidence that in Latin American countries, higher cigarette prices were associated with lower cigarette smoking participation, consumption and initiation and that effect sizes were large enough to be policy meaningful. Pooled own-price elasticities indicate that higher prices were associated with a less than proportional decrease in tobacco use (pooled own-price elasticities, participation: –0.14 [95%CI –0.22, –0.06]; consumption: –0.54 [95%CI –0.75, –0.34]; total: -0.75 [95%CI -1.14, -0.36]). We found no consistent evidence that socioeconomic status, age, sex, rurality, or geographic regions affected price responsiveness. Conclusions Our review confirms that taxes that raise tobacco prices can effectively lower tobacco use. Moreover, raising tobacco prices through increased taxes is anticipated to boost tax revenue due to the inelastic nature of the demand for tobacco.

Context: Organizational leadership is essential for adequate and stable financing, strong governance across jurisdictions and sectors, and a competent public health workforce for effective and resilient public health systems. While there have been some efforts to characterize leadership competencies at the individual level, more focus is needed to understand effective governance of public health organizations and systems through the lens of leadership competencies at the organizational level. Objective: To identify organizational level leadership competencies for effective and equitable public health governance. Design: This scoping review included published academic literature from Scopus, Web of Science, Medline, and ProQuest and grey literature from Google Scholar, Canadian Government websites, Trove, FedSys, and Open Grey, published between 2004 and 2023. The search strategy focused on the concepts of governance, leadership, and pub-lic health organizations. An inductive-deductive approach informed the analysis using reflexive thematic analysis and a framework outlining the six functions of public health governance. Results: A total of 35 records were included for analysis; 22 academic and 13 grey literature records. This review identified 9 themes describing organizational leadership competencies for public health governance: 1) Systems thinking 2) Public policy development, implementation and evaluation, 3) Partnership and collaboration, 4) Equity and justice 5) Organizational learning, 6) Oversight, 7) Resource stewardship, 8) Legal authority, 9) Organizational ethics. Conclusions: This scoping review contributes to our understanding of the leadership competencies needed to enact and sustain effective governance at an organizational level. These identified themes and associated competencies can facilitate the creation of organizational culture and values that align with effective governance tenets in public health. Additional research is needed to further apply and contextualize these competencies in different countries and public health settings.

Objective: This scoping review investigates the potential of 6G technology in healthcare, particularly in smart city settings, focusing on its enhanced data capabilities, AI's role in healthcare optimization, infrastructure support, interoperability, quality standards, and privacy and security concerns. Patients and methods: The scoping review followed the Arksey and O'Malley framework, with Levac et al.'s methodological advancements. The review team searched academic databases like PubMed/Medline, SCOPUS, Embase, Web of Sciences, and IEEE Xplore. They also explored grey literature sources like Google Scholar, OpenGrey, and Web of Science Conference Proceedings. A search strategy was developed, and 145 studies were selected from an initial pool of 9835 records from 2010 to 2025. The review categorized 145 studies into three phases, focusing on deploying 6G technology in healthcare, the infrastructure required, and ethical considerations related to the technology's ethical implications. Result: Phase one focused on advancements like real-time imaging, performing medical procedures remotely, using predictive tools to analyze data, and providing care tailored to individual patients. Phase two examined how the next generation of wireless technology (6G) could interact with communication systems, including techniques to handle large amounts of data (massive MIMO) and using extremely high-frequency signals (terahertz communications) to transfer information faster. Phase three explored ethical concerns about applying 6G technology, such as systems that make decisions based on user intentions (intent-driven management) and organizing information around data-based designs (data-driven architecture). The review highlights how 6G technology could revolutionize patient care and medical services by enabling faster data transfers, reducing delays, increasing system capacity, and incorporating artificial intelligence. Conclusion: The scoping review shows the capability of the transformative potential of 6G technology, particularly in healthcare and urban development, emphasizing its enhanced data transfer speeds, reduced latency, and increased capacity that can significantly improve patient care through better remote monitoring, security, and telemedicine services. It stresses the vital role of policymakers in guiding the development of 6G infrastructure, ensuring effective spectrum allocation, and implementing robust security measures while addressing health and electromagnetic exposure concerns. Policymakers are urged to adopt security-by-design principles, adhere to international standards, and foster collaboration among academia, industry, and government to drive innovation and ensure the responsible deployment of 6G technology. By stimulating research and establishing clear performance metrics, they can facilitate continuous improvement and adaptation, ultimately benefiting society as a whole. The review concludes that strategic policy formulation is essential for maximizing the advantages of 6G technology, leading to more intelligent, productive, and sustainable societal frameworks.

Abstract Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent - and how - subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.

Individuals born with Trisomy 21 may be more susceptible to experiencing nutrition-related conditions and diseases throughout their lifespan. Seven studies conducted outside of Canada that investigated the impact of nutrition interventions in individuals of different ages (mostly children and youth) born with Trisomy 21 reported mixed results. Furthermore, Canadian clinical nutrition practice guidelines for the provision of care to individuals born with Trisomy 21 tend to be general in nature and may be based on a body of evidence that was not representative of this population. There is a need for well-designed inclusive nutrition research studies to determine the nutritional needs of individuals born with Trisomy 21 and to better understand how to provide person-centred nutrition and healthcare services that achieve nutrition and health equity for these individuals and improve their overall nutritional status and health.

Background: Enhanced recovery after cesarean delivery protocols include evidence-based interventions designed to improve patient experience, pregnancy, and neonatal outcomes while reducing healthcare-related costs. This is the first update of the Enhanced Recovery After Surgery Society guidelines for antenatal and preoperative care before cesarean delivery after the original publication in 2018. Methods: Interventions were selected based on expert consensus using the Delphi method. An updated literature search was conducted in September 2024 using the Embase, PubMed, MEDLINE, EBSCO CINAHL (Cumulative Index of Nursing and Allied Health Literature), Scopus, and Web of Science databases. Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 Enhanced Recovery After Surgery Society guidelines publication, which evaluated each antenatal and preoperative enhanced recovery after cesarean delivery intervention, focusing on randomized clinical trials and large observational studies (≥800 patients) to maximize search feasibility and relevance. Following a review of the evidence, a consensus was reached regarding the quality of evidence and the strength of recommendation for each proposed intervention according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: The 6 recommended enhanced recovery after cesarean delivery interventions are (1) antenatal pathway patient education for scheduled caesarean delivery (evidence low to very low, recommendation strong); (2) multidisciplinary medical and surgical staff education regarding enhanced recovery after cesarean delivery support, intervention implementation, and measurement (evidence low, recommendation strong); (3) optimization of the medical care for pregnant patients with comorbid conditions, such as anemia, obesity, hypertension, prepregnancy and gestational diabetes, smoking (tobacco, cannabis, vaping), congenital heart disease, epilepsy, autoimmune disease, and asthma (evidence moderate, recommendation strong); (4) abdominal skin preparation with chlorhexidine gluconate impregnated cloth (evening before scheduled cesarean delivery) (evidence moderate; recommendation weak); (5) the duration of preoperative fasting based on the content intake (evidence low, recommendation weak); (6) the use of a preoperative, nonparticulate carbohydrate drink (evidence low-moderate, recommendation strong). Conclusion: The first 3 recommendations are for use in the antenatal period (10-38 weeks of gestation), which allow for the optimization of patient comorbidities, whereas the remaining 3 recommendations are for preoperative interventions (skin preparation, preoperative fasting directives, and preoperative carbohydrate supplementation). Educational tools for cesarean delivery with well-designed shared decision-making focus on comorbidity management should be developed. These management tasks are viewed as routine care; however, the measurable success and impact have clinical variance. The enhanced recovery after cesarean delivery goal for patients who are undergoing a scheduled caesarean delivery is to maximize the quality of the pregnant patient's recovery and the fetal-neonatal outcome.

Objectives: The rapid integration of artificial intelligence (AI) in healthcare requires robust legal safeguards to ensure safety, privacy and non-discrimination, crucial for maintaining trust. Yet, unaddressed differences in disciplinary perspectives and priorities risk impeding effective reform. This study uncovers convergences and divergences in disciplinary comprehension, prioritisation and proposed solutions to legal issues with health-AI, providing law and policymaking guidance. Methods: Employing a scoping review methodology, we searched MEDLINE (Ovid), EMBASE (Ovid), HeinOnline Law Journal Library, Index to Foreign Legal Periodicals (HeinOnline), Index to Legal Periodicals and Books (EBSCOhost), Web of Science (Core Collection), Scopus and IEEE Xplore, identifying legal issue discussions published, in English or French, from January 2012 to July 2021. Of 18 168 screened studies, 432 were included for data extraction and analysis. We mapped the legal concerns and solutions discussed by authors in medicine, law, nursing, pharmacy, other healthcare professions, public health, computer science and engineering, revealing where they agree and disagree in their understanding, prioritisation and response to legal concerns. Results: Critical disciplinary differences were evident in both the frequency and nature of discussions of legal issues and potential solutions. Notably, innovators in computer science and engineering exhibited minimal engagement with legal issues. Authors in law and medicine frequently contributed but prioritised different legal issues and proposed different solutions. Discussion and conclusion: Differing perspectives regarding law reform priorities and solutions jeopardise the progress of health AI development. We need inclusive, interdisciplinary dialogues concerning the risks and trade-offs associated with various solutions to ensure optimal law and policy reform.

Social media can be an important source of clinical neuroscience information for healthcare users (e.g., patients, healthcare providers, the general public). This systematic review synthesized evidence on the effectiveness of social media strategies in translating knowledge and disseminating clinical neuroscience information to healthcare users. A systematic review of six electronic databases up to July 29, 2024 was conducted. Original, peer-reviewed articles examining the effectiveness of YouTube, Facebook, LinkedIn, Twitter, social media messaging apps, or a combination of these platforms in translating clinical neuroscience information to healthcare users (e.g., patients, healthcare providers, caregivers, and the general public) were eligible for inclusion. Several proxies (e.g., change in uptake of research, change in awareness, change in knowledge, change in understanding, behaviour change, and/or change in social media metrics) were considered as outcomes of knowledge translation (KT) effectiveness. Two independent reviewers screened articles and assessed risk of bias. The protocol was registered on PROSPERO (ID: CRD42021269034). A total of six studies were included in this review. The included studies used YouTube, Facebook, Twitter, or a combination of social media platforms aimed at healthcare users. Most social media strategies used to disseminate clinical neuroscience information in the included studies (N = 5/6) resulted in improved indicators of KT. However, due to the high risk of bias among the included studies, these results must be interpreted with caution. Disseminating clinical neuroscience information via Facebook, Twitter, YouTube, or a combination of these platforms may achieve the goals of KT. However, there is currently a gap in the literature about clinical neuroscience KT via social media, both in the quantity of studies and quality of evidence. Future research should aim to minimize the risk of bias by controlling for important confounding factors and use objective measures of KT to complement subjective measures.

International migration is contributing to changes in the sociocultural and the economic landscapes of many cities in the world. As part of the changes in cities, we are witnessing an increased use of community gardens as spaces for wellbeing restoration, for social connection, and for addressing the challenge of food insecurity, particularly cultural food insecurity. Cultural food security is one major under-recognized issue, yet is pivotal to address given its role in positively supporting immigrants' settlement and health. However, there is lack of comprehensive evidence of how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Our scoping review explored evidence from existing literature on how neighborhoods are changing to accommodate community gardens (CG) as a novel means to address cultural food insecurity among immigrant communities and support place-making and resettlement. Our literature search identified several areas of transformations including the different kinds of community gardens that have emerged, the associated physical, social, cultural, environmental, economic, and policy changes that have been reported in other countries in the Global North. The review also identified multifold benefits of CG in this regard, including benefits to health and wellbeing - the physical (i.e. nutrition and physical activity), mental (e.g., a place for healing for immigrants fleeing war-torn countries, domestic violence, trauma; fostering a connection to the land in new environments via place-making), and social (e.g., fostering community connections and cultural knowledge exchange). Despite the known benefits of community gardens to immigrants' health and wellbeing, there remains a lack of comprehensive evidence in Canada on how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Such studies will serve as sources of evidence for novel ideas to address the cultural food needs and food insecurity of immigrant communities, which is becoming a growing public health concern.

Objectives: The charge of the newly formed Society of Critical Care Medicine Sustainability Task Force is to describe actionable items supporting environmental stewardship for ICUs, to discuss barriers associated with sustainability initiatives and outline opportunities for future impact. Data sources: Ovid Medline, EBSCOhost CINAHL, Elsevier Embase, and Scopus databases were searched through to March 2024 for studies reporting on environmental sustainability and critical care. Study selection: Systematic reviews, narrative reviews, quality improvement projects, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed. Data extraction: Data regarding environmental sustainability initiatives that aimed to quantify, manage, or mitigate pollution and/or carbon emissions with a focus on ICUs, barriers to change, and opportunities for development were qualitatively assessed. Data synthesis: ICUs are resource-intensive and as such, methods to attenuate carbon emissions and waste can play a substantial role in mitigating the sizable burden of healthcare-related pollution and greenhouse gas emissions. Several initiatives and strategies exist for clinicians and providers to engage in environmental stewardship, with specific attention to avoiding low-value care while maintaining or improving patient safety and high-quality care. Increased focus on sustainability can be met with resistance to change, including institutional, financial, and behavioral barriers. Collaboration and innovative thinking create valuable opportunities for clinicians, patients, families, and policymakers to advocate for patient and planetary health. Conclusions: Within the healthcare system, ICUs are well positioned to lead sustainability action, policy, and practice. Critical care teams have the capability and the moral responsibility to mitigate the negative impact of critical care medicine upon our environment and become change agents promoting sustainable healthcare for the benefit of human health.

Objective: To apply an intersectional lens to explore how the interconnected social identities of women across global settings impact access experiences for gender-based violence (GBV) supports. Design: A scoping review. Data sources: We systematically searched seven databases to identify studies published in English from the database inception to January 2023. Inclusion criteria: We included peer-reviewed studies with a primary objective of examining the access experiences of populations who self-identify as women (aged 15 years or older) who have experienced GBV, have intersecting identities (ie, racialisation, poverty, etc) that can further contribute to marginalisation and utilised or sought support services. Methods: Two reviewers independently completed title/abstract, full-text screening and data charting. Integrating intersectionality theory and the McIntyre access framework, we analysed support service access and utilisation across social identities, axes of marginalisation and geographic contexts. Results: 210 papers (195 distinct studies) met the inclusion criteria. Most studies (60%) were published since 2015 and used qualitative methods (63%). Findings reflected intersectional differences in women's experiences of accessing GBV services across contexts and lived experiences. Common findings indicate that seeking GBV support was motivated and enabled by informal supports and positive prior experiences in accessing services. However, findings highlight that structural and systemic constraints in existing support systems (in all study settings) impact access to necessary support services and their alignment with women's needs. Few studies examined health and non-health outcomes associated with unhindered access to care. Conclusions: Women's experiences with GBV support systems in different geopolitical contexts highlight barriers across axes of racialisation, poverty, multidimensional violence and other systemic factors, which are often eclipsed in generic one-size-fits-all models of support. This research can inform transformational policy development and tailored interventions to improve outcomes for all women who experience GBV and thus advance gender equality and equity goals.

Objectives: Primary care attachment represents an inclusive, equitable and cost-effective way of enhancing health outcomes globally. However, the growing shortage of family physicians threatens to disrupt patient-provider relationships. Understanding the consequences of these disruptions is essential for guiding future research and policy. The objectives of this study were to map the existing evidence on the impacts of changes in primary care attachment, identify research gaps and recommend areas for further investigation. Design: Scoping review following Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Two researchers conducted all stages of screening, and study quality was assessed using JBI critical appraisal tools. Key themes included causes of attachment change, direction of change and outcomes aligned with the quintuple aim framework. Both qualitative and quantitative findings were synthesised narratively. Eligibility criteria: Peer-reviewed, English-language articles published between 1999 and 2024 on primary care attachment changes. Information sources: PubMed, Scopus and Web of Science. Results: Of 2045 studies screened, 31 met inclusion criteria, with 60% published after 2020. Most studies originated from high-income countries, particularly the USA (35%) and Canada (29%). Attachment losses and transfers were the most frequently studied, while attachment and unattachment durations were less explored. These changes in attachment were consistently shown to impact patients, providers, clinics and the healthcare system, influencing all aims of the quintuple aim framework, including clinical outcomes, healthcare utilisation, costs, equity and patient experience. Commonly assessed outcomes included clinical impact (68%), health equity (48%), patient experience (32%) and costs (23%), with no study assessing provider experience. Conclusions: This scoping review maps the published literature on changes in primary care attachment and introduces clarifying terminology. Key research gaps include geographical diversity (lack of studies from low- and middle-income countries), attachment gain (limited research on strategies to reconnect unattached patients), attachment duration (insufficient evidence on long-term health outcomes), economic implications (underexplored costs of physician turnover and disruption), provider experiences (lack of studies on how changes in primary care attachment impact provider burnout, job satisfaction and workload) and patient health outcomes (focus on healthcare utilisation rather than direct health outcomes). These findings underscore the need for further research and offer valuable insights for future studies and policy development.

Objective: To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery. Design: Systematic review with network and component network meta-analyses of randomised controlled trials. Data sources: Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science were initially searched 1 March 2022, and updated on 25 October 2023. Certainty in findings were assessed using the Confidence in Network Meta-Analysis (CINeMA) approach. Main outcome measures: To compare treatments and to compare individual components informed by partnership with patients, clinicians, researchers, and health system leaders using an integrated knowledge translation framework. Eligible studies were any randomised controlled trial including adults preparing for major surgery who were allocated to prehabilitation interventions or usual care, and where critical outcomes were reported. Results: 186 unique randomised controlled trials with 15 684 participants were included. When comparing treatments using random-effects network meta-analysis, isolated exercise (odds ratio 0.50 (95% confidence interval (CI) 0.39 to 0.64); very low certainty of evidence), isolated nutritional (0.62 (0.50 to 0.77); very low certainty of evidence), and combined exercise, nutrition, plus psychosocial (0.64 (0.45 to 0.92); very low certainty of evidence) prehabilitation were most likely to reduce complications compared with usual care. Combined exercise and psychosocial (-2.44 days (95% CI -3.85 to -1.04); very low certainty of evidence), combined exercise and nutrition (-1.22 days (-2.54 to 0.10); moderate certainty of evidence), isolated exercise (-0.93 days (-1.27 to -0.58); very low certainty of evidence), and isolated nutritional prehabilitation (-0.99 days (-1.49 to -0.48); very low certainty of evidence) were most likely to decrease length of stay. Combined exercise, nutrition, plus psychosocial prehabilitation was most likely to improve health related quality of life (mean difference on Short Form-36 physical component scale 3.48 (95% CI 0.82 to 6.14); very low certainty of evidence) and physical recovery (mean difference in meters on the six min walk test 43.43 (95% CI 5.96 to 80.91); very low certainty of evidence).When comparing individual components using component network meta-analysis, exercise and nutrition were the individual components most likely to improve all critical outcomes. The certainty of evidence for all comparisons across all outcomes was generally low to very low due to trial level risk of bias and imprecision; however, results for exercise and nutritional prehabilitation were robust with exclusion of high risk of bias trials. Conclusions: Consistent and potentially meaningful effect estimates suggest that exercise prehabilitation, nutritional prehabilitation, and multicomponent interventions including exercise may benefit adults preparing for surgery and could be considered in clinical care. However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation's efficacy. Registration: International prospective registry of systematic reviews CRD42023353710.

Polymeric nanoparticles are among the most widely used nanocarriers for delivering therapeutic molecules. However, their synthesis processes often generate undesirable impurities that could be toxic and challenging to eliminate. In this study, we compared three purification techniques - centrifugation, dialysis, and tangential flow filtration (TFF) - to evaluate their efficacy in removing residual drug, surfactant, and solvent while preserving the nanoparticles' physicochemical features (hydrodynamic size, zeta potential, polydispersity index). Centrifugation excels in eliminating unencapsulated drug and residual surfactant but significantly affects the nanoparticles' physicochemical properties, such as colloidal stability and size homogeneity. On the other hand, dialysis is a gentler technique effective in removing residual solvent but less so for residual surfactant and unencapsulated drug. TFF emerges as a balanced approach, offering a compromise between the two but none of these techniques achieves satisfactory purification at lab-scale alone. While each technique has its merits, none can meet all requirements independently. The optimal purification strategy often involves a combination of techniques, determined on a case-by-case basis considering factors like purity levels, time, costs, and the preservation of critical properties such as drug loading and colloidal stability. This study underscores the need for a nuanced approach in selecting purification strategies for polymeric nanoparticles in drug delivery applications.

Introduction: Alternative transportation programs are widely promoted as a viable strategy for prevention of alcohol-impaired driving (AID) and crashes, with ride-sharing and safe-ride being two major approaches. The scientific literature on these programs frequently uses the terms "ride-sharing" and "safe-ride" interchangeably, though their meaning is not synonymous. This critical review set out to clarify the main characteristics of these programs to advance research, dissemination of the findings, and knowledge transfer in the alternative transportation field for AID and crash prevention. Method: A systematic literature search of six databases using the PRISMA-S checklist identified studies of ride-sharing and safe-ride programs to prevent AID or crashes. Inclusion criteria comprised studies published in academic and gray literature between 1980 and 2023. A six-step thematic analysis of included studies identified the defining characteristics of each program. Results: The 32 included studies evaluated for-profit ride-sharing/ride-hailing programs (n = 21) and safe-ride programs (n = 11). No studies on non-profit ride-sharing programs were identified. Analyses revealed two main themes. Operational strategies were most important for distinguishing between for-profit ride-sharing and safe-ride programs, with differences in these subthemes: purpose (revenue generation vs. AID reduction), management (private vs. private plus other strategies), funding (self-financing vs. external), and promotion (convenient transportation vs. dangers of AID). Service offerings, the second theme, highlighted differences in program costs, availability, accessibility, service capacity, coverage, and types of vehicles used. Discussion: The scientific literature on ride-sharing was limited to for-profit ride-sharing, suggesting that referring to them as "ride-hailing" in future studies would be more accurate. Both operational strategies and service offerings highlight the advantages and disadvantages of ride-hailing and safe-ride programs in the context of AID. Some programs referred to as ride-sharing programs have the same operational strategies as safe-ride programs, suggesting these be classified as safe-ride programs for conceptual coherence.

Introduction: Vedolizumab is a gut-selective anti-lymphocyte trafficking biologic indicated for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) and Crohn's disease (CD) in Canada. Objective: The objective of this study was to evaluate the cost effectiveness of treatment sequencing for UC and CD from a public healthcare payer perspective, leveraging new real-world evidence from the literature and the EVOLVE study, a retrospective chart review. Methods: Using separate decision tree/Markov models to assess cost effectiveness for UC and CD, two sequencing approaches were estimated for adult patients (≥ 18 years) diagnosed with UC or CD who were biologic-naïve: vedolizumab as first-line biologic followed by anti-tumor necrosis factor (TNF)-α versus first-line anti-TNFα followed by vedolizumab. Treatment effectiveness (response and remission), surgery rates, dose escalation and regain of response and safety inputs were estimated from EVOLVE, a retrospective chart review of real-world data, and evidence synthesis from the literature, whereas costs and utilities were estimated from health technology assessment reports, clinical trials, and the literature. Biosimilar costs were used for anti-TNFα. Both models simulated a 5-year time horizon and discounted costs and outcomes at 1.5%. Probabilistic base-case analyses (n = 10,000) reported total costs (2023 Canadian dollars) and quality-adjusted life-years (QALYs). Several scenario analyses were conducted to explore robustness of results. Results: In UC, vedolizumab as a first-line biologic followed by anti-TNFα resulted in an incremental gain of 0.09 QALYs (2.46 vs. 2.55) and saved $7179 ($134,028 vs. $126,848), making this a dominant strategy compared with first-line anti-TNFα followed by vedolizumab. In CD, use of vedolizumab as a first-line biologic resulted in an incremental gain of 0.04 QALYs (3.35 vs. 3.39) at an incremental cost of $50,631 ($89,850 vs. $140,381) versus first-line anti-TNFα followed by vedolizumab (incremental cost-effectiveness ratio of $1,265,775 per QALY). Conclusions: Based on this analysis, sequencing vedolizumab as a first-line biologic prior to anti-TNFα in UC and CD provided additional clinical benefit to patients. In UC, vedolizumab as a first-line biologic also saved healthcare system costs compared with anti-TNFα, whereas in CD, vedolizumab provided incremental benefit at an incremental cost, which was not considered cost effective at a threshold of $50,000/QALY.

In response to emerging challenges that intersect humans, animals, and environments, there is growing international exigent need to adopt 'One Health' approaches. While One Health efforts are emerging in British Columbia in Canada, there are still challenges to overcome in the adoption of a One Health approach in policymaking. We conducted a comparative analysis of One Health policies in Asia, specifically, Singapore, Hong Kong, Bangladesh, and Thailand, which have well-established and sophisticated One Health approaches, to determine good practices in the implementation of One Health that could be considered for adoption in British Columbia. We conducted a literature review and scan of public-facing One Health websites, strategic action plans, and health databases, complemented by 13 semi-structured interviews with researchers, educators, service providers, human and animal health experts, and policymakers in our chosen Asian jurisdictions and British Columbia. While there was diversity in the One Health approaches taken by four jurisdictions, three key characteristics were present in policymaking processes in all of them: a national One Health strategic action plan, inter-ministerial coordination, and flexibility in the working relationships of public servants. One Health presents an opportunity for British Columbia to take a novel approach to public health policymaking, the one that is more holistic and effective at addressing shared health challenges.

Objectives: The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research. Design: This study took the form of a scoping review. Data sources: Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024. Eligibility criteria: All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA. Data extraction and synthesis: Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis. Results: Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively. Conclusions: By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.