Interior Health

Increasing evidences show plant growth-promoting rhizobacteria (PGPR) benefit legume-rhizobium symbiosis, and iron-based nanoparticles (FeNPs) act as rhizobia microenvironment stabilizers. However, few studies explored if their combination exerts synergistic effects on the symbiosis in legume. Here, we compared the effects of FeNPs, Pseudomonas rhizovicinus M30-35, and their co-application (Fe + M) on alfalfa growth, nitrogen fixation, root metabolites, and rhizosphere microbiome. Compared with FeNPs and M30-35, Fe + M increased shoot height, root length, root activity, chlorophyll content, and net photosynthetic rate (Pn) by 63.2% and 45.4%, 61.1% and 70.6%, 56.2% and 47.1%, 20.1% and 18.6%, and 41.1% and 30.6%, respectively; the nodule number, nitrogenase activity, ureide content, and leghemoglobin content rose by 29.6% and 31.4%, 58.5% and 78.7%, 20.4% and 15.1%, and 9.7% and 12.4%, respectively. Metabolomic analysis showed that Fe + M enhanced the accumulation of benzenoid compounds in roots, while microbial co-occurrence network analysis indicated reduced complexity and connectivity of rhizosphere bacterial and fungal communities. Importantly, core microbes, such as Hydrogenophaga, Nocardioides, unidentified_Mitochondria, and Scedosporium, were positively associated with benzenoid compounds, which contribute to nutrient cycling in the rhizosphere. Our findings demonstrate that FeNPs and PGPR strain together achieve synergistic effects on the nitrogen fixation in alfalfa.

Pharmacy residents are at risk of burnout, which can affect their well-being and performance and reduce their sense of satisfaction. Support interventions, specifically peer support, mentorship, and connectedness, may help to alleviate stress and improve well-being. To describe the current opportunities for and perceptions of support available to Canadian year 1 (Y1) pharmacy residents and to identify their interest in and desire for additional support opportunities. A cross-sectional national online survey of Canadian Y1 residents from the 2021/22, 2022/23, and 2023/24 residency years was conducted. A subset of survey respondents participated in an online focus group designed to further explore themes identified in the survey. A total of 109 residents participated in the survey, and 7 participated in the focus group. Participants reported that support was available to them in the forms of mentorship (n = 99, 90.8%), wellness or self-care opportunities (n = 45, 41.3%), and peer connection (n = 94, 86.2%). Mentorship and peer connection were highly valued, yet just over half of participants reported being satisfied with the level of mentorship and peer connection they experienced. Identified opportunities for improvement included formalizing mentorship programs, with clear roles, protected time, intentional matching, and paid training for mentors; enhancing access to health and wellness resources; and designating site-based support for residents. Mentorship and peer connection were the most commonly provided and highly valued supports for the Canadian Y1 pharmacy residents who participated in this study. Opportunities exist to enhance all forms of support offered to Y1 pharmacy residents, which ultimately may help to reduce resident burnout and improve resident well-being.

Study DesignHealth economic model.ObjectivesSignificant work has been done to estimate the cost of spinal cord injury (SCI) from a health system perspective. Most of this work, however, does not establish the true cost to the individual living with SCI. This study aimed to develop a cost calculator reflecting both initial health care costs as well as lifetime costs with direct input from people living with SCI.MethodsCosts were seperated into initial costs and lifetime costs. For initial costs, estimates were obtained from Canadian SCI health care data and the literature, and were then adjusted for inflation to 2024. For lifetime costs, input from individuals living with SCI and clinical input were collected. Initial and lifetime costs were integrated into a novel, user-friendly cost calculator.ResultsThe SCI Cost Calculator provides an estimated lifetime SCI cost ranging from $1.9M (older person living with incomplete SCI) to over $10 M 2024 Canadian dollars (younger person living with complete SCI) which is substantially higher than existing estimates. Initial costs can be as little as 3% of the lifetime cost for younger people or as high as 24% of the lifetime cost for older individuals.ConclusionCurrent cost estimates greatly understate the cost of living with SCI. To understand the support needed for persons living with SCI, an economic model that accurately reflects the costs of living with SCI is critical. Future work includes engaging the wider SCI community to enhance accuracy and validity of the cost domains identified.

Abstract Background Laboratory tests are increasingly important for diagnosing multiple sclerosis (MS). Cerebrospinal fluid (CSF) laboratory testing, including detection of CSF oligoclonal bands (OCB), aids in the diagnosis of MS but significant variability in reporting practices across Canadian clinical laboratories has been shown. To address this issue, the Harmonized CSF Analysis for MS Investigation (hCAMI) subcommittee of the Canadian Society of Clinical Chemists (CSCC) Reference Interval Harmonization (hRI) Working Group was formed. Methods The hCAMI subcommittee, comprised of clinical chemists and neurologists, identified key areas of CSF laboratory testing for MS investigation that require harmonization and formulated specific questions for targeted recommendations. The subcommittee comprehensively reviewed the literature, surveyed clinical chemists regarding current practices and neurologists on reporting preferences, and conducted studies to answer these questions. Recommendation statements were drafted and will undergo the Delphi process for refinement to ultimately generate evidence-based consensus statements. Results Six key areas for harmonization were identified: (1) quality control practices, (2) timing considerations for matched CSF and serum sample collection, (3) reporting protocols for band counts, (4) interpretation and follow-up for other patterns (i.e., monoclonal gammopathy, inflammatory response), (5) handling of matched band intensity variations, and (6) defining panel components and reference intervals/decision limits. Literature and data were reviewed for each key area. Draft recommendations were developed and will undergo iterative refinement via the Delphi process. Conclusion Harmonized laboratory reporting recommendations will lead to consistency and alignment of CSF laboratory testing for diagnosis of MS across Canada. This subcommittee’s efforts will promote evidence-based standardized reporting practices to improve diagnostic accuracy and patient care.

Improving the outcomes for high-need, high-cost (HNHC) patients requires accurately predicting who will become an HNHC patient. The objectives of this study are to: (1) develop models to predict individuals at risk of becoming future HNHC patients, and (2) compare the performance of predictive models with and without patient-reported data. We used data from two patient-reported surveys datasets from British Columbia, Canada (inpatient and emergency department (ED) surveys) and linked administrative data. Our outcome was being an HNHC patient in the year following survey completion (i.e., incurring costs in the top 5% of the population). We compared two predictor sets, including a standard set (demographic, clinical, and resource use/cost) and an enhanced set (which included patient-reported data), across five model types. We assessed performance using measures of discrimination (c-statistic, and cost capture) calibration (calibration curve), and clinical usefulness (decision curve analysis). Our final sample size was 11,964 for the inpatient survey and 11,144 for the ED survey. Models exhibited good discrimination and calibration. The addition of patient-reported data improved discrimination as measured by the c-statistic (from 0.83, 95% CI: 0.77-0.86 to 0.85, 95% CI: 0.80-0.88 for the logistic regression model from the ED survey), and cost capture (from 0.52, 95% CI: 0.40-0.67 to 0.62, 95% CI: 0.48-0.76). The decision curve analysis demonstrated that the enhanced models provided the highest net benefit across a range of thresholds. Patient-reported data improved the discriminative performance of models to predict HNHC patients, particularly for those with the highest health care costs.

Abstract Introduction: The combination of CDK4/6 inhibitor+endocrine therapy (CDK4/6i+ET) is standard 1st-line (1L) systemic treatment for patients with ER+/HER2-negative metastatic breast cancer (MBC). Numerous agents are available / in development for subsequent lines of treatment. Circulating tumor DNA (ctDNA) via liquid biopsy presents a promising, non-invasive approach for blood-based tumor genotyping, patient stratification and response assessment with the potential to enhance biomarker-driven strategies and aid in development of new therapeutics. Experimental Procedures: IND.241 is a master protocol platform design consisting of independent substudies monitoring patients with ER+/HER2- MBC prior to progression (PD) on CDK4/6i+ET and investigating novel agents or drug combinations in 2nd/3rd lines (2L, 3L) after progression on CDK4/6i+ET. The primary objective of the novel drug/combination substudies is to centrally interrogate ctDNA (Tempus xF+, a 523-gene liquid biopsy panel) and evaluate whether biomarker selection improves ORR or CBR (RECIST 1.1). Secondary objectives include safety and toxicity profile, PFS, and OS. The monitoring substudy (Substudy A) enrolls patients currently on CDK4/6i+ET treatment and aims to characterize molecular profile, clinical features, and ctDNA dynamics of acquired resistance. This platform trial enables creation and maintenance of a tissue and data bank including clinical data, genomics, and radiomics to evaluate surrogates of treatment outcomes and potential biomarkers of response, resistance, and disease progression. Results: Patients with specific biomarkers detected in ctDNA will be enrolled to corresponding biomarker positive cohorts of substudies. Patients with no substudy-specific biomarkers are randomized to biomarker negative cohorts of available substudies. Treatment substudies follow a 2-stage design. Currently, the monitoring substudy A is actively accruing. Substudy B is evaluating lunresertib (PKMYT1 inhibitor) + gemcitabine in patients +/-CCNE1 overexpression / amplification. Substudy C is evaluating niraparib (PARP inhibitor) + fulvestrant (ET) in patients +/- alterations in BRCA1/2 (germline/somatic) or PALB2 (germline). These latter two substudies have now closed to accrual, with efficacy and safety evaluation ongoing. Substudy D, recently added, is evaluating lunresertib + camonsertib (ATR inhibitor) in patients +/- CCNE1 overexpression/amplification, FBXW7 or PPP2R1A alterations. Additional substudies are in development for this platform trial. Conclusions: IND.241 employs a biomarker-driven platform trial designed to evaluate CDK4/6i resistant ER+/HER2- MBC, using non-invasive ctDNA tumor genotyping to select patients for biomarker-driven substudies with the goal of defining the ctDNA landscape across 1L to 3L treatments. Citation Format: Moira Rushton, Dave W. Cescon, Nathalie Levasseur, Michelle B. Nadler, Daniel Rayson, Brooke E. Wilson, Sara K. Taylor, Rossanna Pezo, Arif Awan, Zahi Mitri, Vikaash Kumar, Jennifer Melvin, John Hilton, Stephen Chia, Philippe L. Bedard, Spencer Finn, Wei Tu, Courtney Coschi, Philippe Jamme, Elia Aguado-Fraile, Lesley Katie Seymour, Laura Pearce. IND.241: A Canadian cancer trials group liquid-biopsy informed platform trial to evaluate treatment in CDK4/6-inhibitor resistant ER+/HER2- metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr CT239.

Clinical laboratories are facing severe shortages of qualified medical laboratory technologists (MLT). Given the vital role of the laboratory within the healthcare system, patient care in acute care settings, especially within emergency departments, are at risk if there are insufficient MLTs available to staff hospital laboratories. To mitigate this human resource challenge and reduce the overall risk to laboratory operations, clinical laboratories are exploring novel strategies to ensure continuous services that are crucial to patient care. One strategy being employed is leveraging medical laboratory assistant (MLA) staff to perform certain laboratory testing under the direction of MLTs. Options include testing in the central laboratory and point of care testing (POCT). Here, several recommendations have been developed by consensus of the authors, who are several clinical biochemists from across Canada and members of the Canadian Society of Clinical Chemists (CSCC) POCT Special Interest Group, with expertise in central laboratory and POCT oversight. These recommendations are aimed at clinical laboratory and healthcare system clinical and administrative leaders who are exploring alternative staffing models. The recommendations refer to two models of testing performed by MLAs, one whereby MLAs perform a menu of lower complexity tests within the central laboratory and one in which MLAs perform POCT outside of the laboratory in a true point of care setting.

Urine drug testing (UDT) is a critical tool used in medical, forensic, and occupational settings, but interpreting results can be challenging. We performed a study to assess the ability of health care professionals to interpret UDT results accurately. In total, 911 clinical and laboratory professionals in the United States and Canada responded to a survey with questions gauging expertise in UDT interpretation. Responses were analyzed to identify knowledge gaps. Toxicologists and laboratory PhD scientists performed well, with means of 4.82 and 4.63 questions answered correctly (out of 6 possible), respectively. Physicians specializing in pathology, emergency medicine, primary care, and internal medicine, however, displayed concerning knowledge gaps, as did laboratorians with nondoctoral degrees. Experience and training correlated with interpretation accuracy. Identification of simulated compliance as well as understanding opioid exposure, metabolism, and immunoassay cross-reactivity were among the most clinically significant knowledge gaps. More than 30% of survey respondents indicated that they would seek UDT information from the internet or peers rather than clinical or laboratory experts. The study highlighted the need for targeted education and better collaboration between clinical and laboratory experts and other health care professionals to ensure that when physicians order UDT, they can accurately interpret results and reduce harm.

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