Brantford Energy (Canada)

Diabetic foot infections (DFIs) are a serious complication of diabetes, leading to high rates of hospital admission, amputation, and early death-particularly in persons living in resource-limited communities. Although the updated International Working Group on the Diabetic Foot guidelines in 2024 provide well-laid-out strategies for managing DFIs, these tend to be better suited for use in well-resourced centers. This case-based review discusses and applies these guidelines for an approach to DFI in real-world scenarios. It focuses on supporting health care providers working in community and resource-limited settings. The review explores how to recognize and diagnose DFI, including the use of imaging modalities, and how to distinguish soft tissue infection from bone infection or noninfectious entities. Management strategies are detailed regarding antibiotic considerations and approaches, including in resource-limited settings, and when other interventions or surgical referral may be important. Practical clinical cases are used to illustrate key points, emphasizing how care may be adapted based on the context. The authors also consider health equity aspects by identifying barriers that may be faced by patients who are from racialized backgrounds and live in resource-limited settings. The review aims to equip frontline wound clinicians with a pragmatic approach to managing DFIs that is grounded in up-to-date evidence framed in a real-world context.JOURNAL/aswca/04.03/00129334-202604000-00004/figure1/v/2026-03-10T151712Z/r/image-jpeg GENERAL PURPOSE: To provide clinicians with an evidence-based approach to the diagnosis and management of diabetic foot infections (DFIs). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:Analyze evidence-based clinical and laboratory findings to accurately diagnose (DFIs) and diabetic foot osteomyelitis.Evaluate patient-specific clinical data to select evidence-based management strategies for patients with (DFIs) and diabetic foot osteomyelitis.

Alzheimer's disease and related dementias (ADRD) remain underdiagnosed early due to reliance on costly, invasive, and time-intensive assessments, prompting development of the Memory Sync Booth, an AI-assisted walk-in screening tool for older adults. The booth delivers accessible, automated, and secure tablet-based evaluations which include orientation, attention, naming, picture description, voice analysis, and clock drawing, then processed using NLP, speech recognition, and computer vision for consistent scoring. Grounded in Responsible AI and Digital Health Innovation, it enables equitable deployment across senior community spaces and long-term care settings, with optional direct result-sharing to family doctors and automated alerts for cognitive decline. Tested with 20 volunteers aged 60+, the pilot demonstrated feasibility and potential for earlier MCI detection, reduced clinical wait times, and more proactive dementia management.

This dissertation contributes to both a theoretical and an empirical understanding of the reciprocal associations between autonomy and relatedness across key social contexts—family, peers, and school—during the school transitions over time. Grounded in Self-Determination Theory (SDT), this research examined how adolescent autonomy, both in its general form and in domain-specific expressions (i.e., behavioral and academic autonomy), interacts with relatedness within three critical micro-level social environments: the family (i.e., parental warmth, conflict, parental autonomy granting, parental academic pressure), peers (e.g., friend support, peer victimization), and the school setting (i.e., perceived teacher-student relationships, school relatedness). By employing longitudinal designs at daily and six-month intervals, this work provides a nuanced understanding of development by distinguishing within-individual fluctuations from stable between-individual differences. This approach offers a dynamic perspective on how these constructs co-develop over time, which challenges traditional static developmental models. Specifically, the findings suggest that autonomy across different domains and relatedness in various contexts are closely interconnected at the same time point. In terms of within-person lagged associations, in the family context, parental warmth and general autonomy showed a bidirectional association, with changes in one predicting changes in the other the following day. Additionally, an increase in general autonomy predicted a decrease in parental psychological control over a six-month period. In the school context, greater school-relatedness predicted higher intrinsic academic motivation six months later. Furthermore, the developmental trajectories of parental academic pressure were positively associated with the trajectories of controlled academic motivation, while the developmental trajectories of perceived negative relationships with teachers were negatively associated with the trajectories of autonomous academic motivation. In sum, autonomy and relatedness should not be viewed as competing needs but as intertwined forces that, when nurtured appropriately, reinforce each other. By fostering environments that support both autonomy and relatedness, we can better equip adolescents to navigate the challenges of school transitions and beyond, ultimately promoting their well-being and success.

Benign osseous metaplasia of the breast is an extremely rare breast lesion. This is a report of a 79-year-old woman who presented with a right breast lesion. The lesion was found incidentally on computed tomography (CT) scan examination of the chest. Subsequent mammogram showed coarse calcification within a round circular area measuring approximately 12 mm in size. Ultrasound examination showed an ill-defined 9 × 9 × 9 mm hypoechoic lesion with calcification and internal vascularity. Histologic examination of the excised lesion showed features of benign osseous metaplasia. There was no evidence of atypia and malignancy. The subsequent immunohistochemistry confirmed the diagnosis. The immunohistochemical staining for epithelial markers—pancytokeratin (AE1/AE3), Cam 5.2, HMWCK (34Be12), and CK5—was negative in the stromal component, which ruled out a metaplastic carcinoma. Osseous metaplasia occurs in association with a wide variety of benign and malignant breast lesions. However, primary benign osseous metaplasia in the absence of breast disease is an extremely rare entity. The case presented here is a reminder that osseous metaplasia can occur in the breast in isolation. The case also emphasizes the value of thorough histopathological examination in making the diagnosis, as clinical and imaging studies cannot differentiate between neoplastic and non-neoplastic lesions as well as benign and malignant neoplasms with certainty.

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.

Abstract Fusobacterium nucleatum (FN) is enriched in human colorectal tumors [1] and its presence is correlated with poor prognosis [2]. Bacteriophages ("phages") are naturally occurring, self-amplifying viruses that are highly specific for particular bacterial species and strains and are recognized to have a high intrinsic safety. They offer a promising treatment strategy to both target FN associated with colorectal cancer (CRC) and, by phage engineering, to deliver an anti-tumoral immune-stimulating payload that may enhance the effectivity of other anti-cancer therapies such as checkpoint inhibitors in unresponsive colorectal cancer patients. The major challenge in engineering phages that target FN is the optimization of the eukaryotic payloads for high expression in this bacterial host. Since no data is available about codon usage and non-coding genetic sequences in the genome of FN bacteria, two computational approaches were used to optimize the codon usage for elevated payload expression of the first selected payload, murine IL-15. These approaches involved identifying ribosome binding sites and elongation speeds to optimize codon usage. Following design of an IL-15 expression vector, expression of this eukaryotic payload in FN bacteria was tested in vitro. For phage engineering, a plasmid containing the designed payload sequence was used to introduce the selected IL-15 encoding sequences into the phage genome. FN phage was successfully engineered to deliver a payload encoding the sequence of murine cytokine IL-15. Targeting of FN with engineered phage resulted in IL-15 protein expression in phage-infected bacteria in vitro. Given the specificity of FN for CRC tumors and the ability to locally express a eukaryotic protein by using FN targeting phage to deliver a payload, phage therapy may offer novel treatment approaches for patients with CRC. Citation Format: Lihi Ninio-Many, Yael Zigelman, Nufar Buchshtab, Yifat Elharar, Gal Eylon, Eliya Gidron, Dikla Berko-Ashur, Julian Nicenboim, Lior Zelcbuch, Einav Safyon Gartman, Sharon Kredo-Russo, Noga Kowalsman, Ilya Vainberg Slutskin, Iddo Weiner, Inbar Gahali-Sass, Naomi Zak, Sailaja Puttagunta, Merav Bassan. Novel engineering of therapeutic Fusobacterium nucleatum phage for colorectal cancer treatment [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P064.

Patients of endoscopists with lower adenoma detection rates (ADR) are more likely to die from missed colorectal cancers. Measuring ADR is challenging at the system level as pathology results are generally reported in unstructured electronic medical records. Natural language processing (NLP) can be used to extract relevant information from text-based records. At Cancer Care Ontario (CCO), we developed and validated a NLP algorithm to identify colorectal adenomas in unstructured electronic pathology reports available in CCO’s Electronic Mapping Reporting and Coding (eMaRC) data. We identified pathology reports from colonoscopies in eMaRC as those with specimen type ‘biopsy’ and anatomic site ‘colon’. The sampling period was restricted to 2015–16 and patients older than 50 years. From this sampling frame, two random samples of 450 and 1,000 reports were selected as the test and validation sets. Expert clinicians reviewed and classified reports as adenoma or other. The test set was used to develop an NLP algorithm to identify adenomas using Base SAS 9.4. Statistical analyses, including sensitivity (recall), specificity, precision (positive predictive value) and F1 score of the NLP algorithm compared to clinician review were determined. A significant proportion of Ontario colonoscopists, patologists and laboratories were represented in the examined validation sets. The sensitivity of the NLP algorithm was approximately 100% (95 %CI: 98.51–100) and 99.81% (95 %CI: 98.97–100) in the test and validation sets, respectively. Similarly, the specificity was 99.08% (95 %CI: 94.99–99.98) and 100% (95 %CI: 99.21–100). The CCO NLP algorithm was highly accurate in identifying colorectal adenomas in eMaRC data across many institutions in Ontario,. This lays the groundwork to measure ADR at the system-level in Ontario Cancer Care Ontario

Transition from the neonatal intensive care unit (NICU) to home is challenging for caregivers of complex surgical infants. A prospective, observational cohort pilot study using telemedicine to improve transition was implemented in a quaternary level IV NICU. (1) To assess, identify, and resolve patient care concerns in the immediate postdischarge period. (2) To improve caregiver knowledge and care practices. Caregivers of medically complex infants participated in telemedicine visits with neonatal providers within 1 week of discharge. Providers reviewed infant health, equipment use, and outpatient follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers completed a postvisit satisfaction survey. Ninety-three visits were performed from May 2015 to March 2017. Seventy-six percent of visits were postsurgery patients. Seventy-eight postdischarge issues were identified: medication administration (13%), respiratory (19%), feeding (33%), and surgical site (35%). Fifty percent of caregivers reported that telemedicine visits prevented an additional call or visit to a clinician; 12% prompted an earlier visit (n = 93). Caregiver satisfaction rating was high. Median estimation of total mileage saved by respondents was 1755 miles. Postdischarge telemedicine visits with complex surgical NICU graduates identify clinical issues, provide caregivers with support, and save travel time. Advanced practice nurses are instrumental in patient recruitment, with patient visits, and in providing postdischarge continuity of care. Barriers to implementation were identified. A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts.