The CLSA is a national data platform for aging research that used epidemiology-based sampling methods and explicitly excluded people living on First Nations Reserves and other provincial First Nations settlements as possible CLSA participants. As such, the CLSA research approach did not use Indigenous community engagement. Nevertheless, the CLSA sample includes a sizeable subsample of participants who self-identified as First Nations, Métis, or Inuit. This project seeks to describe the self-identified Indigenous subsample of the CLSA from the baseline data collection and interpret that description with the aid of an Elder Advisory Circle. We conducted a descriptive analysis of the self-identified Indigenous subsample of the CLSA from the baseline data collection. The analysis was presented to an Elder Advisory Circle for consultation. The lack of community-engaged approaches to Indigenous research and sampling approaches appears to have resulted in a sociodemographic profile of older Indigenous Peoples that does not match the lived experience of the Elder Advisory Circle and contrasts with other data available on Indigenous Peoples in Canada. We feel the existing CLSA data does not reflect the sociodemographic profile of older Indigenous Peoples. We use this community consultation process to provide recommendations for the appropriate use of the Indigenous-identified data in the CLSA, and we conclude by recommending great caution when using the data from the Indigenous subsample in the CLSA data.

The average global life expectancy is predicted to increase to approximately 80years by 2040 [1]. Cancer is an ageing-related disease, and its prevalence will also increase with this ageing of the population [2]. This rise in older adults living with cancer will demand innovation in service delivery, multidisciplinary collaboration, and a renewed focus on compassionate, patient-centred care. We are therefore compelled to rethink how we approach cancer diagnosis, treatment, and survivorship. This white paper explores the potential realities and challenges through a multidimensional lens, addressing the intersection of demographic shifts, rapid technological advancements, and the evolving needs of older adults living with cancer. Key areas examined include the integration of precision medicine and digital health tools, the adaptation of healthcare delivery models, and the implications for workforce training and resource allocation. The discussion highlights disparities in care, the importance of personalised interventions, and strategies to enhance quality of life for older adults with cancer. By anticipating these developments, the paper offers critical insights for policymakers (who set the rules and goals and allocate funding), health system leaders (who manage the day-to-day operations), clinicians and allied health professionals (who are patient-facing), and patients and caregivers, aiming to promote equity, innovation, quality and resilience in the care of older adults with cancer as we approach the next decade. The paper seeks to consolidate and clarify the diverse issues and opportunities that will emerge as the global population ages and the burden of cancer among older adults rises. With average life expectancy predicted to approach 80years by 2040, and cancer recognised as a disease closely linked to ageing [3], the paper brings together expert perspectives to provide a sector-wide synthesis of the impending challenges. Its purpose is not to offer a conventional systematic review, but rather to serve as a strategic resource for policymakers, health system leaders, clinicians, allied health professionals, patients, and caregivers, informing the response to demographic shifts, technological advances and evolving patient needs. By consolidating insights on disparities in care, the necessity for personalised interventions, and strategies to enhance quality of life, the paper aims to inform and inspire innovation, equity and resilience in geriatric oncology as we approach the next decade.

Craniosynostosis is characterized by the early fusion of cranial sutures, leading to abnormal skull shapes, potentially increased intracranial pressure (ICP), and, in some cases, neurocognitive challenges. Craniosynostosis may occur in isolation or as part of a genetic syndrome, with the majority of cases being nonsyndromic. Genetic mutations, such as those affecting the FGFR and TWIST genes and numerous signaling pathways, play a pivotal role in the etiopathogenesis of craniosynostosis. Secondary craniosynostoses related to systemic diseases and bone dysplasia are also common. Imaging is integral to the evaluation of craniosynostosis, allowing accurate diagnosis, differentiating mimics, facilitating surgical planning, and enabling postoperative monitoring. Technical advances in US, low-dose CT, and black bone MRI have enhanced diagnostic accuracy while minimizing pediatric patients' exposure to radiation. Surgical intervention is often required to ensure deformity correction, maintain adequate intracranial volume for early brain development, and prevent immediate and delayed complications. Timely intervention and systematic follow-up are critical for better long-term outcomes and decrease the risk of repeat surgeries in pediatric patients with craniosynostosis. The authors provide a comprehensive overview of craniosynostosis, beginning with the embryologic development and anatomic organization of cranial sutures. The multifactorial causes and the classification of this disorder are discussed, with an emphasis on syndromic and nonsyndromic craniosynostoses. Critical imaging findings and a structured presurgical imaging approach are described and illustrated. In addition, surgical planning, timing, and techniques; postoperative imaging appearances; and long-term follow-up considerations critical to multidisciplinary care are reviewed. ©RSNA, 2026 Supplemental material is available for this article.

A patient's ethnicity and culture need to be considered prior to male facial rejuvenation. Here, we describe the most important factors across ethnicities that affect the analysis, treatment, and postoperative considerations of commonly performed procedures.There are some traits commonly associated with certain ethnicities that differ from each other. These span skeletal structure, skin characteristics, predisposition to poor scarring, periorbital and nasal anatomy, and hair qualities.As they pertain to the described differences in traits, certain variations exist within procedures to accommodate non-Caucasian patients. This is to make results more natural, fitting to a patient's ethnicity and goals, and to account for differences in postoperative healing.An integral part of every patient encounter is to listen to the patient's perspective and goals prior to developing a treatment plan. Their facial analysis should subsequently be performed in the context of their ethnicity. The management of non-Caucasian facial rejuvenation patients should not be taught as a variation of the norm but rather as unique considerations to modify known surgical techniques for each individual ethnicity and culture. Training needs to emphasize and popularize these differences.

Acute kidney injury (AKI) is a known immune-related adverse event of cancer immune checkpoint inhibitor (ICI) therapy. Further population-based data on AKI incidence, risk factors and practice patterns post-ICI therapy are needed. We measured the cumulative incidence of AKI among advanced cancer patients while receiving ICI therapy and non-ICI systemic therapy in Ontario, Canada (2012-18). An increase in serum creatinine was used to define AKI and graded according to event severity. Time to event modeling was used to compare the risk of developing AKI, pre-disposing factors and survival outcomes. We studied 16 425 patients with advanced cancer receiving either ICI or non-ICI systemic therapy. Among 4380 patients receiving ICI therapy, the overall crude 4-year incidence of AKI (any stage) was 29% and severe AKI (stage ≥2) was 7%. Characteristics associated with a higher risk of AKI included male sex, genitourinary (versus other) malignancy, the presence of hypertension, diabetes or chronic kidney disease, and prescription of a non-steroidal anti-inflammatory drug. The risk of experiencing AKI was significantly lower among patients treated with ICI versus non-ICI systemic therapy [adjusted hazards ratio (aHR) 0.80, 95% confidence interval (CI) 0.74-0.86, P-value <.0001]. Among the 587 patients who experienced an AKI and were both alive and discontinued ICI therapy within 30days, 54 (9%) were re-challenged with ICI in the following 6months and 24 (44%) had a recurrent AKI event. Patients who were re-challenged with ICI therapy had improved overall survival as compared with patients that received other non-ICI systemic therapy (aHR 0.38, 95% CI 0.22-0.67, P-value <.001). Our real-world study demonstrates a modest risk for severe AKI among cancer patients receiving ICI therapy, lower than with exposure to other systemic cancer therapies. Among patients who developed AKI and stopped ICI therapy, re-challenge was uncommon but may warrant consideration for select patients.

Inherited retinal dystrophies (IRDs) are a genetically diverse group of vision loss disorders with over 360 implicated genes. However, 30-50% of cases remain unresolved after panel-based clinical testing and may benefit from exome or genome sequencing for a genetic diagnosis. To manage the extensive and analytically demanding datasets generated by genome sequencing, we developed ReDGAP (Retinal Degeneration Genome Analysis Pipeline), a phenotype-guided, semi-automated genome analysis pipeline that integrates clinical phenotyping with flexible variant scoring to prioritize variants of interest (https://github.com/vincentlab-la/ReDGAP). The pipeline supports the joint analysis of multiple variant classes, using an evidence-weighted scoring system informed by in silico predictors. Validation in eleven previously solved IRD cases achieved a 100% re-identification rate. Application to five unsolved cases yielded diagnoses in four (80%), including intronic variants in CRB1 and HGSNAT, a tandem duplication in OAT, and a 5'UTR deletion affecting a retina-specific promoter of RPGRIP1. Functional validation confirmed transcript-level disruptions in three variants, while computational analysis demonstrated regulatory impact in the fourth. Integrating phenotypic data with broad variant analysis offers a tailored model for improving IRD diagnostics, enabling timely molecular diagnoses and informing eligibility for emerging gene-targeted therapies. This positions ReDGAP as a tailored, clinically relevant model for investigating rare diseases within the evolving landscape of precision health.

Hip arthroscopy is an increasingly common outpatient surgical procedure where postoperative pain can be severe. Peripheral nerve blocks have been evaluated for analgesia following hip arthroscopy; however, there is no consensus on an optimal technique that provides effective local anesthetic-based postoperative analgesia without motor blockade. We hypothesized that the pericapsular nerve group (PENG) block would provide effective motor-sparing analgesia following ambulatory hip arthroscopy. We conducted a randomized placebo-controlled double-blind trial comparing an ultrasound-guided PENG block with 20 mL of 0.5% ropivacaine to a control with a sham injection. Our primary outcomes were cumulative opioid consumption (oral morphine equivalent) and quality of recovery (QoR-15) scores at 24 hours postoperatively. Secondary outcomes included pain, postoperative opioid consumption, time to first analgesic request, postanesthesia care unit (PACU) length of stay, and opioid and block-related side effects. 94 patients were included (47 per group). QoR was similar between groups at 24 hours as measured by the QoR-15 (range 0-150, higher scores indicate better recovery): mean SD 96.8±20.9 in the PENG group versus 101.0±20.9 in the control group (mean difference -4.2; adjusted p=0.414). Opioid consumption at 24 hours was also similar between groups. In adjusted analyses, the PENG group required less opioid analgesia in the PACU (mean difference -9.5 MME; p=0.039) and had a shorter PACU stay (mean difference -20.5 min; p=0.027). Pain scores at rest and on movement decreased over time in both groups, with no consistent differences in overall pain trajectories. Opioid consumption at 48 hours, opioid-related adverse effects and block-related complications were similar between groups. When administered preoperatively, the PENG block provides only modest early perioperative benefits without improving overall postoperative analgesia or QoR in patients undergoing ambulatory hip arthroscopy. Based on these findings, routine preoperative use of the PENG block for ambulatory hip arthroscopy cannot be recommended beyond standard multimodal analgesia, although it may be considered selectively to facilitate early PACU recovery in carefully chosen patients. The potential role of postoperative PENG block as a rescue intervention warrants further investigation. NCT03449680; https://clinicaltrials.gov/study/NCT03449680.

The current lack of clarity with what public health budgets are spent on globally impedes research and informed resource allocation. This study aimed to examine the extent to which disaggregated public health expenditures data is publicly reported and determine which core public health functions are funded in three countries. A targeted search of government websites was conducted to identify datasets of disaggregated public health expenditures at timepoints before and during the COVID-19 pandemic. Public health expenditures datasets (including financial statements and budgets) were searched for at national, subnational, and local levels in three high-income countries with comparable public health systems: Australia, Canada, and England. Expenditures were then categorized into the five WHO Core Essential Public Health Operations to enable comparison across jurisdictions. No current disaggregated public health expenditures were publicly available in Australia. Disaggregated public health expenditures data were limited in public availability in Canada, available only at the federal level, in one province (Quebec), and one local Public Health Unit (Toronto). In England, local authorities’ disaggregated public health expenditures are standardized and reported by the Ministry of Housing, Communities, and Local Government, and the (now dissolved) national public health agency (Public Health England) budgets were published until 2020-21. Public health expenditures covered all five Essential Public Health Operations in both countries. When combining all levels of governments’ expenditures on public health, England focused most of its resources on one category (Health Promotion), while Canada spent more evenly across different categories (Health Protection, Health Promotion, and Disease Prevention). Expenditures on Response to Health Threats functions increased sharply during the pandemic. Public health functions also seem to be divided to some extent between levels of government. Our analysis suggests that it is difficult to know which programs are funded by public health expenditures, with England and Quebec’s publicly reported standardized datasets as the exception. Improved public reporting and standardization of disaggregated public health expenditures however is critical to informed resource allocation and should be conducted in close collaboration with public health practitioners to ensure accurate representation of public health activities.