St Michaels Hospital

AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, version 2) and ROBIS are tools used to assess the methodological quality and the risk of bias in a systematic review (SR). We applied AMSTAR-2 and ROBIS to a sample of 200 published SRs. We investigated the overlap in their methodological constructs, responses by item, and overall, percentage agreement, direction of effect, and timing of assessments. AMSTAR-2 contains 16 items and ROBIS 24 items. Three items in AMSTAR-2 and nine in ROBIS did not overlap in construct. Of the 200 SRs, 73% were low or critically low quality using AMSTAR-2, and 81% had a high risk of bias using ROBIS. The median time to complete AMSTAR-2 and ROBIS was 51 and 64 minutes, respectively. When assessment times were calibrated to the number of items in each tool, each item took an average of 3.2 minutes per item for AMSTAR-2 compared to 2.7 minutes for ROBIS. Nine percent of SRs had opposing ratings (i.e., AMSTAR-2 was high quality while ROBIS was high risk). In both tools, three-quarters of items showed more than 70% agreement between raters after extensive training and piloting. AMSTAR-2 and ROBIS provide complementary rather than interchangeable assessments of systematic reviews. AMSTAR-2 may be preferable when efficiency is prioritized and methodological rigour is the focus, whereas ROBIS offers a deeper examination of potential biases and external validity. Given the widespread reliance on systematic reviews for policy and practice, selecting the appropriate appraisal tool remains crucial. Future research should explore strategies to integrate the strengths of both instruments while minimizing the burden on assessors.

SUMMARY Benthic animals live on or in the seafloor, a habitat known as the benthic zone. These bottom-dwelling organisms account for the largest fraction of animal diversity in our seas, playing vital roles in nutrient cycling, sediment stabilization and the broader food webs. Historically, the behavioral repertoire of benthic animals attached permanently to the sea floor has been considered as extremely limited (if at all present), reflecting an evolutionary adaptation to their sessile lifestyle and simplified nervous systems. Here, we overturn this view by studying the spontaneous and stimulus evoked behavioral repertoire of the basal chordate Ciona intestinalis which has a benthic sessile adult stage. We found that Ciona adults transition between three main postural engagement behavioral states. These are defined by different body part kinematics and postural dynamics characterised by changes in body shape configuration as opposed to locomotion. Transitions between states can occur probabilistically in spontaneously behaving animals suggesting that they can be internally generated by the simple brain of an adult Ciona. Importantly, using spatiotemporal embedding of postural features, we constructed a behavioral space for Ciona adults, which was divided into 18 stereotyped behavioral modes revealing the unappreciated richness of adult Ciona behaviors. Our analysis showed that Ciona adults can deploy in a selective manner these behavioral modules to elicit distinct responses to different mechanical stimuli, suggesting the presence of a sensory context dependent regulation of behavior in these benthic organisms. Our study raises the possibility that embodied postures is underlie the evolution of behavioral repertoires in sessile benthic animals.

ABSTRACT The world has changed since we conducted our first research study, in March of 2020, to understand the general public’s attitudes, needs, and perceptions about mental health and psychotherapy. The coronavirus pandemic, a significant growth in the demand for therapy, a renewed recognition of systemic racial and economic inequities, the massive expansion of telehealth, and the increasing presence of technology companies in the mental health space, have impacted the country and our field. We conducted a new research study in 2023, using the same methodology we used in 2020, as an attempt to “listen” to the public once again. We learned that people are struggling with a number of stressors and mental health challenges, while not receiving as much emotional support as they would have wanted. Overall, we were encouraged to learn that central elements of therapies of depth, insight, and relationship continue to have strong support and value for the public. People value getting to the root of what troubles them, recognize the importance of relational aspects of therapy, and believe that therapy is a worthwhile investment in themselves. Despite the prevalence of telehealth, the majority of people reported a preference for in-person treatment. Finally, a general perception of high costs remains the main declared barrier to accessing therapy. The framework we developed in 2020 for communication and engagement with the public remains valid based on what we heard from them in 2023. Main takeaways and implications for future action are provided.

To evaluate a new compartment pressure monitor reporting continuous pressures and its contribution to Acute Compartment Syndrome (ACS) diagnosis. Design: Multicenter, non-randomized, prospective study. Six Level-I Trauma Centers. Enrolled were patients with acute long bone fractures (OTA 11-13, 2R, 2U, 31-33, and 41-43) where the Micro Electric Mechanical Sensor (MEMS) device was inserted either pre- or post-operatively into the compartment most likely to develop ACS, as deemed by the surgeon. Intracompartmental pressures (ICP) were continuously measured for up to 18 hours (as indicated by the FDA and Health Canada); clinical signs were simultaneously assessed for canonical compartment syndrome signs. The primary measurement outcomes were ease of use, accuracy, and safety of the device across all participating sites. Ease of use was assessed through surveys completed by surgeons, which evaluated their confidence in the device's functionality and usability. Accuracy was determined by analyzing patient outcomes, using surgical findings and clinical resolution as the gold standards, to assess whether the device's results corresponded to true positive and true negative cases of compartment syndrome. Feasibility was defined as the device's ability to integrate into the clinical workflow, operate reliably under typical conditions, and provide actionable data for ACS diagnosis. The secondary outcomes included continuous intracompartmental pressure (ICP) measurements and their diagnostic value. Sensitivity and specificity were evaluated by comparing continuous ICP data with clinical assessments based on the "6 P's" (pain, pallor, paresthesia, pulselessness, poikilothermia, and paralysis) to determine their combined utility in diagnosing ACS. A total of 100 patients, 68 males and 32 females with an average age of 42 years old (17-80 years old), were enrolled. All of the patients had suffered a fracture, 25 proximal tibias (OTA/AO-41), 40 midshaft tibias (OTA/AO42), 13 distal tibias (OTA/AO43), 11 forearms (OTA/AO 2R.2U), 6 femurs (OTA/AO31-33), 5 humerus (OTA/AO 11-13). Eighty-nine patients received the MEMS device post-operatively and 11 patients pre-operatively. 93% of participating surgeons reported confidence in the device's function and ease of use. Pressures were measured on average for 16h36 (3h-18h). No complications were reported. Post-operative ICPs (25.4 mmHg) were higher (p =0.0462) on average than pre-operative ICPs (18.9 mmHg). Patients that did not develop Compartment Syndrome had their post-operative pressures trend down after 4 hours (23.8mmHg). Sensitivity and specificity analyses of ICP alone, delta P alone, pressure trends alone, or a combination of the three metrics were conducted using patient outcomes as the gold standard for diagnostic accuracy. The trend of the curve in continuous monitoring pressure measurements proved more reliable than a single absolute pressure value in aiding in the correct diagnosis of ACS deviating from standard ACS diagnosis literature The MEMS device allowed earlier diagnosis of ACS by 4 hours (. When continuous pressure measurement was combined with standard clinical examination, the sensitivity and specificity reached 100%. The MEMS-based device reliably enabled continuous compartment pressure monitoring in all the study institutions. Further examination of continuous trends and accompanying perfusion pressure could allow surgeons the clinical adjunct to diagnose ACS many hours earlier than clinical signs alone. Level II - Prospective study.

BackgroundIn critically ill patients, acceleration of liberation from mechanical ventilation is important in order to reduce the risk of complications and to improve long-term outcomes. Whether the use of proportional-assist ventilation with load-adjustable gain factors (PAV+) results in a shorter time to successful liberation from mechanical ventilation than pressure-support ventilation (PSV) is unclear.MethodsIn this international clinical trial, we randomly assigned adult patients who had been receiving mechanical ventilation for at least 24 hours and were able to undergo partial ventilatory support with PSV but were not yet ready for liberation from ventilation to undergo PAV+ (which targeted normal work of breathing) or PSV (which targeted a normal respiratory rate and tidal volume). The primary outcome was the time from randomization to successful liberation from mechanical ventilation.ResultsAcross 23 centers in seven countries, 722 patients were enrolled, and 573 underwent randomization and were included in the analysis. The median time to successful liberation from mechanical ventilation was 7.3 days (95% confidence interval [CI], 6.2 to 9.7) in the PAV+ group and 6.8 days (95% CI, 5.4 to 8.8) in the PSV group (P=0.58). The median number of ventilator-free days, the incidence of reintubation and tracheostomy, and the incidence of death by day 90 (29.6% in the PAV+ group and 26.6% in the PSV group), all of which were secondary outcomes, were similar in the two groups. With respect to sedative drugs, the mean (±SD) difference in the midazolam-equivalent dose at day 28 relative to the baseline dose was −1.51±3.28 mg per kilogram of body weight in the PAV+ group and 0.04±0.97 mg per kilogram in the PSV group. Serious adverse events occurred in 31 patients (10.8%) in the PAV+ group and in 28 patients (9.8%) in the PSV group (P=0.79).ConclusionsThe time to liberation from mechanical ventilation did not differ significantly between the group that underwent PAV+ and the group that underwent PSV. (Funded by the Canadian Institutes of Health Research and others; PROMIZING ClinicalTrials.gov number, NCT02447692.)

To evaluate the effectiveness of traditional code stroke orientation versus with addition of e-learning videos in reducing anxiety among non-neurology residents.

N-acetyl-aspartate (NAA) and myo-inositol (mI) are neurometabolites reflecting neuronal viability and astrocyte activity, respectively. These are quantified using proton magnetic resonance spectroscopy (1H-MRS) and may be biomarkers for Alzheimer's disease dementia (AD). Our objectives were: 1) Compare dorsolateral prefrontal cortex (DLPFC) NAA and mI levels between AD and cognitively healthy control participants (HC) 2) assess if NAA/mI ratio can distinguish groups, and 3) explore the relationship between metabolites and cognition. The study included 64 participants over 55, 41 with AD. Bilateral DLPFC NAA and mI levels were quantified using 3T 1H-MRS and normalized to H2O. NAA and NAA/mI ratio were lower in AD vs. HC. mI was unchanged. The NAA/mI ratio at a cut-off value of 1.69 showed 59% sensitivity and 87% specificity at distinguishing AD from HC. NAA was associated positively with cognition. In conclusion, DLPFC metabolite changes suggest altered mitochondrial function in AD. NAA/mI ratio shows good specificity in distinguishing AD from HC, suggesting its role in complementing other biomarkers. Future studies should evaluate NAA/mI ratio with other disease specific biomarkers.

Mechanical thrombectomy (MT) is a fundamental intervention for acute ischemic stroke (AIS), enhancing clinical outcomes through rapid reperfusion. While MT techniques like stent‐retriever thrombectomy (SRT), direct aspiration thrombectomy (DAT), and combined approaches are effective for large vessel occlusions (LVO) and distal/medium vessel occlusions (DMVO), the impact of stroke etiology on these techniques is underexplored. Clot composition, influenced by stroke etiology, may affect recanalization achievement. This study assesses the efficacy and safety of SRT, DAT, and combined thrombectomy in DMVO AIS across stroke etiologies.