McMaster University

Latency-sensitive edge video analytics applications require rapid responses for real-time decision-making, driving the demand for efficient object detection pipelines. Conventional pipelines transmit and process full frames, overlooking redundancy in videos and leading to unnecessary resource consumption. Existing block-wise conditional execution methods mitigate this issue by processing only informative blocks. However, they treat all informative blocks equally and fail to further categorize these blocks. To address this limitation, we propose BlockHybrid, an edge video analytics framework designed to accelerate object detection pipelines by hybrid block-wise execution. Specifically, BlockHybrid classifies blocks into hard or easy blocks using a policy network. Hard blocks are transmitted and processed by a block-wise detector on the server, while easy blocks are handled by an efficient tracker locally on the camera, reducing redundant computation and communication. Extensive experiments demonstrate that BlockHybrid can achieve 8.8%31.5% higher local execution speed and comparable detection accuracy compared to state-of-the-art methods, and accelerate end-to-end processing—including camera-to-server communication—by 31.5%39.1% in a real-world testbed.

Objectives Equitable representation in research leadership is essential across all areas of medical science. In the context of HIV—where women are disproportionately affected—examining gender distribution in the leadership of HIV trials is essential to assess progress towards equity and identify persisting barriers. Methods We conducted a methodological study of trials from the CASCADE database, which evaluates interventions to improve the HIV care cascade. We extracted first and last authors' names and used Genderize.io to determine their gender, classifying authors as ‘women’ if the probability was 60% or greater. The primary outcome was the proportion of trials with women in leadership (first or last author), with secondary outcomes examining the proportions of trials with women as: first authors, last authors and in both roles. We also assessed associations with country income level, focus on women participants, study setting, pragmatism and team size. Results Gender for both authorship roles could be determined in 332 trials, of which 233/332 (70.2%) had a woman first or last author; 169/334 (50.6%) had a woman first author; 143/337 (42.4%) had a woman last author and 74/332 (22.3%) featured women in both roles. Women's leadership increased over time but was not associated with country income level, gender focus, study setting or impact factor. Effectiveness trials and those with fewer authors were more likely to have women in leadership. Conclusions Women's leadership in HIV trials has increased, reflecting progress in gender equity. However, smaller author teams appear to facilitate women's leadership, suggesting barriers in larger collaborations. Continued efforts are needed to ensure sustained progress and equitable representation.

From Vision to Publication: Navigating the Radiology Research Landscape as a Trainee

Integrating conductive nanomaterials with polymer substrates in a scalable and low‐cost way is crucial for developing flexible electronics. This work presents a scalable process for integrating high‐quality nanomaterials with polymer films to fabricate flexible electrical devices by combining simple yet effective techniques. Various conductive patterns on polymer substrates are successfully created by utilizing a combination of nanomaterial spraying, laser treatment, and adhesive delamination. The laser treatment embeds the sprayed nanoparticles onto the polymer surface by partially melting the polymer and significantly enhancing their adhesion selectively in places where it traces a path. This method incorporates single‐walled carbon nanotubes, graphene, and molybdenum disulfide onto polymers such as polypropylene, polyvinylidene fluoride, and nylon, achieving a minimum line width of 350 µm. The versatility of this technique is demonstrated by fabricating a range of devices, including microheaters, temperature sensors, chemiresistive sensors, and electrochemical sensors. The fabricated devices exhibit excellent durability and stable performance, addressing the limitations of integrating nanomaterials into polymer films. Additionally, this method allows for precise control of conductivity and pattern complexity, making it suitable for various applications. This work contributes to the advancement of flexible electronics, providing a scalable and adaptable method for creating high‐performance devices.

Background: Sexual and gender minorities (SGMs) are at an increased risk for developing mental health disorders due to their socially stigmatized identities. Minority stress (i.e. discrimination, identity nondisclosure, internalized stigma) has been shown to impact mental health outcomes among SGMs. Both distal and proximal minority stressors may serve as potentially morally injurious events (PMIEs), which may lead to moral injury and trauma/stressor-related symptoms. Critically, minority stress-related moral injury among SGMs has never before been explored using a mixed-methods approach.Methods: Thirty-seven SGM participants with diverse minority identities participated in the study. Using a convergent parallel mixed-methods design, we conducted semi-structured qualitative interviews, performed clinical assessments, and administered a comprehensive battery of quantitative measures. Here, we modified the Moral Injury Event Scale (MIES) for use with SGMs. Qualitative themes were extracted and then converged with MIES scores to investigate differential thematic presentations based on the quantitative intensity of SGM-related PMIEs.Results: Data analysis indicated four core themes related to moral injury among SGMs: shame (internalizing stigma), guilt, betrayal/loss of trust, and attachment injuries (rejection, altered sense-of-self, and social cognition). The qualitative presentation of these themes differed depending on MIES severity. Attachment injuries emerged as a unique core feature of moral injury among SGMs, whereby the remaining core themes align with previous moral injury research. Furthermore, quantitative analyses revealed that the level of exposure to and intensity of minority stress-related PMIEs was positively associated with hazardous alcohol use and trauma-related symptoms.Conclusions: This is the first mixed-methods study to investigate minority stressors as PMIEs, highlighting how these experiences may contribute to symptoms of moral injury among SGMs. Moral injury may serve as a valuable framework for better understanding trauma-related symptoms and mental health disparities among SGMs. These findings have the potential to inform novel treatment interventions aimed at addressing mental health burdens among SGMs.

Despite most Canadians preferring to die at home, over 50% die in hospitals, a setting often discordant with patient-centered end-of-life care and environmentally harmful. This article argues that healthcare policies unintentionally “nudge” patients and providers towards the medicalization of death, contributing to low-value care and significant greenhouse gas emissions. We analyze how inaccessibility to primary and palliative care, default “full code” status, overspecialization, and inadequate home-care supports perpetuate hospital deaths. Using an illustrative case, we demonstrate how these policies influence care trajectories from outpatient to hospital admission and disposition planning. Our aim is to highlight these underrecognized downstream effects to inform health leaders about opportunities to improve end-of-life care quality, align with patient preferences, and secondarily, benefit planetary health.

Background Clinicians, health care organizations, and families demand better and more accessible children's mental health services with greater patient engagement. The I-InTERACT-North program was developed for children following traumatic brain injury and adapted for a transdiagnostic neurological and neurodevelopmental focus, with a recent transition to a stepped-care model. To date, the program has been exclusively provided within research studies; however, demand for its clinical use is growing. Implementation frameworks provide essential guidance regarding facilitators and barriers of clinical implementation under real-world conditions. Similarly, intersectionality evaluation can provide insights to develop equitable and inclusive health care practices. Informed by the Consolidated Framework of Implementation Research 2.0 (CFIR) and recent intersectionality supplement, the objectives were to examine the perspectives of parents/caregivers and clinical partners involved in the I-InTERACT-North program to identify (a) facilitators and barriers to inform the scale and spread of the program, and (b) equity, diversity, and inclusion (EDI) considerations to integrate in future clinical implementation. Method This study used a qualitative descriptive design with focus group methodology. Participants included parents/caregivers and clinical partners. Semi-structured focus groups were conducted virtually. Focus group data were coded inductively and deductively using CFIR 2.0. The team reflected on intersectionality in the data, coding results, and broader context of the program's history. Results Positive perceptions of the innovation's relevance and adaptability were echoed across focus groups. Prominent facilitators included the program's adaptability, personalized, flexible format, and knowledge dissemination. Barriers included geography, technological accessibility, and workflow, with participants stressing the importance of tailoring to culture, language, and neurodiversity. Feedback from participants aligned with 10 reflective prompts highlighted within the CFIR intersectionality supplement pertaining to families’ intersecting categories, diverse intervention experiences, and information access. Conclusions Identified facilitators of I-InTERACT-North implementation extended across program knowledge sharing and recruitment. Recommendations included directions for clinical and system integration to facilitate scalability.

Introduction The cuff leak test (CLT) is hypothesised to help optimise extubation by assessing for laryngeal oedema which, if unrecognised and untreated, could lead to post-extubation stridor, post-extubation airway obstruction, and reintubation. However, the diagnostic accuracy of the CLT to detect post-extubation stridor (and hence potentially airway obstruction) remains uncertain. Given the equipoise that exists surrounding the CLT, we are conducting a pilot randomised clinical trial (RCT) examining the CLT as part of the pathway to extubation. Herein, we report the protocol for the C uff Leak Test and Airway O b s truction in M echanically Ventilated IC U Patients (COSMIC): a Pilot Feasibility Randomized Clinical trial (RCT). Methods and analysis This is a multicentre, international, parallel-group, pragmatic, pilot RCT. We will enrol 100 mechanically ventilated patients in the intensive care unit (ICU) who are deemed ready for extubation and have at least one risk factor for laryngeal oedema. In the intervention arm, respiratory therapists will perform a qualitative CLT before extubation. If a patient passes the CLT (suggesting no laryngeal oedema), extubation will be performed in keeping with standard care. If the patient fails the CLT (suggesting laryngeal oedema), extubation will be delayed allowing for administration of dexamethasone, consideration of diuresis, and the CLT will be repeated in 12–24 hours. In the control arm, patients will be extubated without completing a CLT, without steroid administration, and without delay. Randomization will be by a 1:1 allocation, stratified by centre. The primary feasibility outcomes will include recruitment and protocol adherence. Secondary outcomes will include post-extubation stridor, reintubation within 72 hours, emergency surgical airway within 72 hours, and ICU and hospital mortality within 30 days. Ethics and dissemination This trial has been approved by Clinical Trials Ontario, Hamilton Integrated Research Ethics Board, State of Kuwait Ministry of Health, University of Texas Health Committee for the Protection of Human Subjects and Brant Community Health Systems Research Ethics Committee. The trial has received a No Objection Letter from Health Canada. Trial results will be disseminated via publication in peer-reviewed journals. Trial registration number NCT05456542 .

Alzheimers disease (AD) is characterized by progressive cognitive deterioration. Besides the pathological features of amyloid-beta plaques and tau tangles, emerging research implicates impaired adult hippocampal neurogenesis (AHN) in the dentate gyrus as a contributing factor. Impaired AHN in AD is marked by reduced neural stem cells activation, diminished progenitor cell proliferation, and abnormal neuronal maturation. This review explores the role of AHN in AD, delves into the disrupted molecular mechanisms underlying AHN dysfunction in AD, while assesses potential therapeutic strategies aimed at restoring neurogenesis to treat AD. Understanding AHNs role in AD could inform future diagnostic and therapeutic approaches.

Purpose The INTREPID trial showed that once-daily single-inhaler triple therapy (SITT) using fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) offers clinical benefits versus non-ELLIPTA multiple-inhaler triple therapy (MITT) for the management of chronic obstructive pulmonary disease (COPD) in real-world clinical practice. This analysis evaluated the cost-effectiveness of SITT with FF/UMEC/VI versus non-ELLIPTA MITT for treating symptomatic COPD from a German healthcare perspective. Patients and Methods Data from the INTREPID trial, including baseline characteristics, treatment effects (forced expiratory volume in 1 second and St. George’s Respiratory Questionnaire score [derived from exploratory COPD assessment test score mapping]), and discontinuation rates, along with German healthcare resource and drug costs (2023 Euros), were used to populate the GALAXY COPD model. The analysis was conducted over a lifetime horizon, with outcomes including life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-utility ratios. The robustness of the analysis was assessed using scenario, one-way sensitivity, and probabilistic analyses. Results Improved lifetime outcomes were predicted for FF/UMEC/VI versus non-ELLIPTA MITT, providing additional LYs of 0.174 (95% range: 0.065, 0.322) and QALYs of 0.261 (0.186, 0.346) per patient, together with cost savings of €2,850 (€3,517, €2,220). Additionally, patients receiving FF/UMEC/VI were predicted to experience a reduction in exacerbations (−0.063), highlighting its dominance as the preferred treatment option. These findings remained consistent across one-way sensitivity, scenario, and probabilistic analyses, highlighting the robustness of FF/UMEC/VI as a cost-effective solution for COPD management in Germany. Conclusion FF/UMEC/VI offers clinical benefits and cost savings compared with non-ELLIPTA MITT, suggesting that it may reduce the burden of COPD in Germany and warranting consideration as a preferred treatment option by physicians.

The g-ratio of a myelinated axon is defined as the ratio of the inner-to-outer diameter of the myelin sheath and modulates conduction speed of action potentials along axons. This g-ratio can be mapped in vivo at the macroscopic scale across the entire human brain using multi-modal MRI and sampled along white matter streamlines reconstructed from diffusion-weighted images to derive the g-ratio of a white matter tract. This tractometry approach has shown spatiotemporal variations in g-ratio across white matter tracts and networks. However, tractometry is biased by partial volume effects where voxels contain multiple fiber populations. To address this limitation, we used the Convex Optimization Modeling for Microstructure Informed Tractography (COMMIT) framework to derive tract-specific axonal and myelin volumes, which are used to compute the tract-specific aggregate g-ratio. We compare our novel COMMIT-based tract-specific g-ratio mapping approach to conventional tractometry in a group of 10 healthy adults. Our findings demonstrate that the tract-specific g-ratio mapping approach preserves the overall spatial distribution observed in tractometry and enhances contrast between tracts. Additionally, our scan-rescan data show high repeatability for medium to large caliber tracts. We show that short and large caliber tracts have a lower g-ratio, whereas tractometry results show the opposite trends. This technique advances tract-specific analysis by reducing biases introduced by the complex network of crossing white matter fibers.

Background Although commonly used to evaluate health interventions, cluster randomized trials raise difficult ethical issues. Recognizing this, the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, published in 2012, provides 15 recommendations to address ethical issues across seven domains. But due to several developments in the design and implementation of cluster randomized trials, there are new issues requiring guidance. To inform the forthcoming update of the Ottawa Statement, we aimed to identify any gaps in the Ottawa Statement discussed within the literature. Methods We searched Google Scholar, Scopus, and Web of Science using the ‘cited by’ function on 11 November 2022.We included all types of publications, including articles, book chapters, commentaries, editorials, ethics guidelines, theses and trial-related publications (i.e., primary reports, protocols, and secondary analyses), that cited and engaged with the Ottawa Statement, the Ottawa Statement précis, or one or more of its four background papers. Data were extracted by four reviewers working in rotating pairs. Reviewers captured relevant text verbatim and recorded whether it reflected a gap relating to one or more of the Ottawa Statement domains. Using a thematic analysis approach, semantic coding was used to summarize the content of the data into distinct gaps within the Ottawa Statement domains, which was subsequently expanded in an inductive manner through discussion. Results The qualitative analysis of the text from 53 articles resulted in the identification of 24 distinct gaps in the Ottawa Statement: 4 gaps about justifying the cluster randomized design; 2 gaps about research ethics committee review; 3 gaps about identifying research participants; 4 gaps about obtaining informed consent; 3 gaps about gatekepeers; 6 gaps about assessing benefits and harms; 1 gap about protecting vulnerable participants; and 1 gap about equity-related issues in cluster randomized trials. Conclusion Identifying 24 gaps reveals a need to update the Ottawa Statement. Alongside additional gaps identified in ongoing empirical work and through engagement with our patient and public partners, the gaps identified through this citation analysis should be considered in the forthcoming Ottawa Statement update.

Objective We aimed to understand data‐driven dietary patterns in Canadian preschoolers and their impact on obesity development among male and female individuals. Methods In the prospective, population‐based Canadian pregnancy cohort, the CHILD Cohort Study (N = 2219), dietary intake was assessed at age 3 years using a previously developed 112‐item food frequency questionnaire. At age 5 years, we measured height, weight, and waist circumference and calculated BMI and waist circumference z scores. Obesity was defined as BMI z score > 2. We used principal components analysis to derive dietary patterns and multivariable‐adjusted regression analyses to determine dietary patterns' associations with BMI and waist circumference z scores, as well as obesity status. Results Among Canadian preschoolers, we identified three dietary patterns: “Prudent” (high in vegetables, fruits, legumes, and fish); “Western‐like” (high in fast foods, red/processed meats, and carbonated drinks); and “Refined Grain‐Snack” (high in refined grains, dairy, and salty snacks). At age 5 years, 4.7% of the children were living with obesity (3.1% male individuals and 1.6% female individuals). Females adhering to the Refined Grain‐Snack pattern had higher waist circumference z scores (β = 0.14; 95% CI: 0.03–0.25) and 2.74‐fold odds of living with obesity (95% CI: 1.29–5.85). No significant associations were observed among male individuals or with other dietary patterns and obesity outcomes among female individuals. Conclusions Preschool dietary patterns are associated with sex‐biased obesity development, highlighting the need for further research to explore these differences and inform targeted obesity prevention strategies during this important developmental period.

Introduction The widespread use of antimicrobials in the livestock industry has raised global concerns regarding the emergence and spread of antimicrobial resistance genes (ARGs). Comprehensive databases of ARGs specific to different farm animal species can greatly improve the surveillance of ARGs within the agri-food sector and beyond. In particular, defining the association of ARGs with mobile genetic elements (MGEs)—the primary agents responsible for the spread and acquisition of resistant phenotypes among bacterial populations—could help assess the transmissibility potential of clinically relevant ARGs. Recognizing the gut microbiota as a vast reservoir of ARGs, we aimed to generate a representative isolate collection and genome database of the swine gut microbiome, enabling high-resolution characterization of ARGs in relation to bacterial host range and their association with MGEs. Results We generated a biobank of bacteria from different sections of the gastrointestinal tracts of four clinically healthy pigs housed at a research farm in Ontario, Canada. The culturing was performed under anaerobic conditions using both selective and general enrichment media to ensure the capture of a diverse range of bacterial families within the swine gut microbiota. We sequenced the genomes of 129 unique isolates encompassing 44 genera and 25 distinct families of the swine gut microbiome. Approximately 85.3% (110 isolates) contained one or more ARGs, with a total of 246 ARGs identified across 38 resistance gene families. Tetracycline and macrolide resistance genes were the most prevalent across different lineages of the swine gut microbiota. Additionally, we observed a wide range of MGEs, including integrative conjugative elements, plasmids, and phages, frequently associated with ARGs, indicating that the swine gut ecosystem is conducive to the horizontal transfer of ARGs. High-throughput alignment of the identified ARG-MGE complexes to large-scale metagenomics datasets of the swine gut microbiome suggests the presence of highly prevalent and conserved resistome sequences across diverse pig populations. Conclusion Our findings reveal a highly diverse and relatively conserved reservoir of ARGs and MGEs within the gut microbiome of pigs. A deeper understanding of the microbial host range and potential transmissibility of prevalent ARGs in the swine microbiome can inform development of targeted antimicrobial resistance surveillance and disease control programs.

Background Food deserts—communities with limited access to healthy food—have been linked with poor surgical outcomes; however, their impact on orthopaedic trauma outcomes remains unknown. The aims of this study were to determine the prevalence of food desert residency among orthopaedic trauma patients and to investigate the impact of food desert residency on the rate of unplanned reoperation with use of a large, high-quality, prospectively collected dataset with adjudicated outcomes. We hypothesized that orthopaedic trauma patients would reside in food deserts at a higher rate than the general U.S. population and that living in a food desert would be independently associated with an increased rate of unplanned reoperation. Methods We included all patients from the Aqueous-PREP and PREPARE trials who had documented ZIP codes. The primary outcome was unplanned reoperation within 1 year, and the secondary outcomes included the reasons for reoperation. Residing in a food desert was the independent variable and was defined by the United States Department of Agriculture (USDA). Census tracts were converted to ZIP codes in order to assign food access for an individual’s residence with use of the USDA Food Access Research Atlas. Results Of the 2,607 patients included, 1,453 (55.7%) lived in a ZIP code containing a food desert compared with 49% of the U.S. population. Patients residing in a food desert were 42% female, 26.6% non-White, and 64% employed prior to injury, whereas patients not residing in a food desert were 41% female, 15% non-White, and 63% employed prior to injury, all of which was collected via patient self-report. Multivariable analysis demonstrated that living in a food desert was independently associated with 40% higher odds of unplanned reoperation (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.06 to 1.85; p = 0.019). This was driven by reoperation for delayed union or nonunion (OR, 1.75; 95% CI, 1.19 to 2.57; p = 0.004) and reoperation for a wound-healing complication (OR, 1.60; 95% CI, 1.01 to 2.54; p = 0.044). Conclusions This study found a strong association between residing in a ZIP code containing a food desert and an increased rate of unplanned reoperation, which was primarily driven by delayed union or nonunion and wound-healing complications. Addressing nutritional deficiencies in this population may help to effectively triage the use of health-care resources. Further research should focus on clarifying specific deficiencies and assessing the effectiveness of targeted interventions. Level of Evidence Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background Skin antisepsis remains a vital component in prophylaxis against surgical site infection (SSI); however, for open fractures, it is unclear whether alcohol-based or aqueous solutions should be preferred. The purpose of this study was to compare the use of alcohol-based and aqueous skin antisepsis solutions, using data from the 2 PREP-IT trials, with respect to the risks of SSI and unplanned reoperation following surgery for an open fracture. Methods Individual patient data from the 2 cluster-randomized, crossover clinical trials were combined to create a single data set of patients undergoing surgery for an open fracture. A regression model was used to analyze the effects of an alcohol-based versus an aqueous solution, as well as for potential interaction with the use of chlorhexidine or iodine as the primary agent. The primary outcome was SSI within 90 days. Results A total of 3,338 participants undergoing surgery for an open fracture were included in the final analysis, with 1,700 receiving an alcohol-based solution and 1,638 receiving an aqueous solution. Overall, the use of an alcohol-based skin antiseptic solution, compared with an aqueous solution, did not reduce the risk of SSI at 90 days (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.66 to 1.48; p = 0.95), or the risk of unplanned reoperation at 1 year (OR, 0.98; 95% CI, 0.75 to 1.28; p = 0.88). Planned subgroup analyses also found no significant difference in the risk of SSI or unplanned reoperation when participants were stratified by Gustilo-Anderson type, fracture location, or the primary ingredient of the skin preparation solution (chlorhexidine versus iodophor). Conclusions This analysis found no difference in the risk of SSI or reoperation when comparing alcohol-based and aqueous skin preparation solutions. Furthermore, this analysis demonstrated no harm with use of an alcohol-based solution for open fractures, and the PREPARE trial found that skin preparation with 0.7% iodine povacrylex in 74% isopropyl alcohol was associated with a reduced risk of SSI for closed fractures. Given these findings, surgeons may wish to consider streamlining their policy by treating all fractures with a single skin antiseptic, 0.7% iodine povacrylex in 74% isopropyl alcohol. Level of Evidence Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.