University of Manitoba

The computation of one or more probability distributions or measures is required for a number of problems in statistics and data science. Optimal experimental design, or more particularly, optimal approximate design, is one example. Other examples include parameter estimation, adaptive design, stratified sampling and image processing.

Objectives To evaluate cochlear implant (CI) performance in recipients with an intact electrode array compared to a subset with one or more electrodes deactivated to examine differences in speech perception outcomes. Methods A review of a single CI centre database of adult recipients using an Advanced Bionics HiRes Mid‐Scala electrode was performed. Comparisons between recipients with a fully functioning (“intact”) array and recipients with one or more electrodes deactivated included aided thresholds and sentence recognition scores (AzBio). Results Forty‐eight of 164 recipients (29%) had one or more electrodes deactivated (mean = 2.5, median = 2.0, SD = 1.4). Reasons included sound quality concerns (n = 22), lack of percept (n = 16), non‐auditory stimulation (n = 4), incomplete insertion (n = 3), and abnormal loudness growth (n = 3). There were no significant differences in pre‐operative status or demographics between the cohorts (p > 0.05). Analyses found small (~5 dB) yet significant differences in aided thresholds between cohorts across most frequencies (p < 0.05). At 1 year post activation, the mean AzBio score for the intact cohort was 68%. Individuals with deactivated electrodes owing to poor sound quality (55%) or incomplete insertion (39%) scored significantly worse than the intact cohort (p < 0.05). Individuals with two or more deactivated electrodes scored significantly worse (48%) than the intact cohort (p < 0.05). Comparison of a subset of individual scores pre‐deactivation (32%) and post‐deactivation (57%) revealed a significant individual improvement following deactivation (p = 0.02). Conclusion Electrode deactivation is a common occurrence and is associated with higher individual, but lower average group, speech perception scores. Level of Evidence: 3.

Background This study determined if cycling-specific active transportation (AT) was sensitive to the behavioural economics heuristic “The Fresh Start Effect”, with the beginning of a work week being temporal landmark for cycling to work. Methods We triangulated data from five sources to test the study hypothesis. First, publicly available cycling traffic data collected from May to September between 2014 and 2019 using electromagnetic counters (EcoCounter Inc, Montreal Qc.) were used to categorize 5 urban trails as “AT” or “leisure” based on hourly cycling traffic patterns. Linear regression model with repeated measures, compared daily trends in cycling traffic over the course of a work week along the different trail types and then compared with daily trends in occupational bicycle parking (n = 56,307 counts), vehicular traffic (n = 6.2 M counts), and sales from a local coffee shop (n = 166,753 counts) over the same time frame. Effect sizes were compared to daily trends in fitness centre attendance (n = 563,290 counts), a positive control for the Fresh Start Effect. Results We found a significant ~ 22% decline in daily cycling traffic on both AT (-147 cyclists/day; 95% CI: -199.0 to -95 cyclists/day) and leisure trails (-22 cyclists/day; 95% CI: -59 to + 15 cyclists/day) over the course of a work week. The relative decline over the work week in AT-based cycling traffic was similar to the decline in daily parking (~ 14%; -12 cyclists/day; 95% CI: -17 to -7 cyclists/day). The relative effect size of this trend was nearly identical to the decline in fitness centre attendance over the work week (~ 21%; -592 visits/day; 95% CI: -759 visits/day to -425 visits/day), replicating the original Fresh Start Effect. In contrast to the decline in AT-based cycling traffic, daily vehicular traffic (+ 2248 cars/day; 95% CI: 2022 to + 3674 cars/day) and coffee sales (+ 31 units/day; 95% CI: +22 to + 42 units/day) increased ~ 7% from the beginning to the end of a work week. Conclusions The weekly patterns of AT-based cycling are sensitive to the Fresh Start Effect. This observation could be used to inform policies for increasing cycling rates in urban centres.

This study is aimed at describing preferences for eHealth parent-focused programming among parents/caregivers of young children diagnosed with neurodevelopmental disorders (NDDs) and/or mental health (MH) disorders using an online survey. We also examined differences in preference based on parents of children with no diagnosis, 1 diagnosis, and 2 + diagnoses of NDD/MHs. Using the Technology Acceptance Model, we focused on preference of content, program length, delivery methods, and barriers to accessing eHealth-based programs. Parents/caregivers of children aged 0 to 5 completed an anonymous survey via the crowdsourcing platform, AskingCanadians. The survey asked participants about their preferences in eHealth services for supporting their children. Parents were also requested to report on their perceived social support, recent stressors, and barriers and motivators to accessing online resources. Out of 606 surveyed parents/caregivers, 26.4% had a child diagnosed with a NDD or MH disorder, self-reported by the parents/caregivers. There were many differences in preferences for eHealth services between parents of children with one NDD/MH disorder, multiple NDDs/MH disorders, and no diagnoses. Parents of children with multiple NDDs/MH disorders preferred a mix of peer- and expert-driven programs and more structured and asynchronous program formats compared to the other groups, who preferred simply expert-driven programs. Tailoring eHealth parent-focused programs based on parents of children with NDDs’/MH disorders’ preferences could enhance eHealth program effectiveness, reduce dropout rates, and improve program development.

Background The rising prevalence of dementia necessitates a scalable solution to cognitive screening. Paper-based cognitive screening examinations are well-validated but minimally scalable. If a digital cognitive screening examination could replicate paper-based screening, it may improve scalability while potentially maintaining the performance of these well-validated paper-based tests. Here, we evaluate the Rapid Online Cognitive Assessment (RoCA), a remote and self-administered digital cognitive screening examination. Objective The objective of this study was to validate the ability of RoCA to reliably evaluate patient input, identify patients with cognitive impairment relative to the established tests, and evaluate its potential as a screening tool. Methods RoCA uses a convolutional neural network to evaluate a patient’s ability to perform common cognitive screening tasks: wireframe diagram copying and clock drawing tests. To evaluate RoCA, we compared its evaluations with those of established paper-based tests. This open-label study consists of 46 patients (age range 33-82 years) who were enrolled from neurology clinics. Patients completed the RoCA screening examination and either Addenbrooke’s Cognitive Examination-3 (ACE-3, n=35) or Montreal Cognitive Assessment (MoCA, n=11). We evaluated 3 primary metrics of RoCA’s performance: (1) ability to correctly evaluate patient inputs, (2) ability to identify patients with cognitive impairment compared to ACE-3 and MoCA, and (3) performance as a screening tool. Results RoCA classifies patients similarly to gold standard paper-based tests, with a receiver operating characteristic area under the curve of 0.81 (95% CI 0.67‐0.91; P <.001). RoCA achieved sensitivity of 0.94 (95% CI 0.80‐1.0; P <.001). This was robust to multiple control analyses. Approximately 83% (16/19) of the patient respondents reported RoCA as highly intuitive, with 95% (18/19) perceiving it as adding value to their care. Conclusions RoCA may act as a simple and highly scalable digital cognitive screening examination. However, due to the limitations of this study, further work is required to evaluate the ability of RoCA to be generalizable across patient populations, assess its performance in an entirely remote manner, and analyze the effect of digital literacy.

In this study, our aims were to (a) examine the associations between adverse childhood experiences (ACEs; i.e., childhood maltreatment, household challenges, and peer victimization) and resilience, adjusting for sociodemographic variables, and (b) test the moderating effect of emotional regulation on the association between childhood maltreatment ACEs and resilience in Royal Canadian Mounted Police (RCMP) cadets. Study data were from the RCMP Study. Participants were Cadets (N = 597, 75.0% men) who underwent a full assessment before the Cadet Training Program (CTP). Logistic regression models were used to estimate the associations between ACEs and resilience while adjusting for sociodemographic variables and to test the moderating effect of emotional regulation; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. Several childhood maltreatment ACEs were associated with decreased resilience among cadets after adjustment for sociodemographic covariates: physical abuse, aOR = 0.26, 95% CI [0.10, 0.68]; emotional abuse, aOR = 0.28, 95% CI [0.10, 0.79]; neglect, aOR = 0.22, 95% CI [0.09, 0.55]; exposure to intimate partner violence, aOR = 0.18, 95% CI [0.04, 0.73]; and peer victimization, aOR = 0.30, 95% CI [0.12, 0.76]. The interaction between exposure to any childhood maltreatment ACE and emotional suppression, as assessed using the Emotion Regulation Questionnaire, was significantly associated with low resilience scores, aOR = 0.94, 95% CI [0.89, 0.99]. The current results underscore the critical importance of mitigating the adverse impact of childhood maltreatment ACEs on resilience processes among cadets before the CTP.

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 Within the context of cancer care, access to timely, high-quality care is closely correlated with better health outcomes and quality of life. Yet in Canada, research continues to show that inequities in access to cancer care persist across the cancer continuum, particularly among people experiencing structural marginalization. Although some Canadian research has explored barriers accessing cancer care, little research has explicitly focused on barriers arising from organizational and health systems contexts. Our objective was to explore barriers to accessing cancer services within the health system and organizations delivering cancer services across the cancer continuum for people experiencing structural marginalization. Methods This study drew on critical ethnographic methods, employing a participatory, integrated knowledge translation approach. Data collection included interviews with health and social service providers (n = 24) and key informants (n = 7), interviews and focus groups with individuals with lived experience of significant health and social inequities (n = 29), and 40 h of observations with service providers working in clinical oncology settings. Guided by social justice, critical and intersectional theoretical perspectives, data analysis followed an interpretive descriptive approach. Results Four interrelated themes were developed through our analysis, with the overarching thread of a ‘mismatch evident throughout: (1) the design of cancer services does not always account for social contexts and structural determinants of health; (2) discourses of operational efficiency are competing with equity-oriented care; (3) the physical spaces of cancer care matter; and (4) experiences of stigma and discrimination are incompatible with accessing cancer care. Our findings suggest that the ways in which cancer services across the continuum are designed, including the types of services available, how care activities are structured, what activities take priority, and how services are experienced, create barriers that particularly impact people experiencing structural marginalization. Conclusions Our findings highlight the mismatches between how cancer services are currently designed and delivered, and the specific needs of people experiencing health and social inequities. These findings also point to organizations delivering cancer services as potential sites for transformation toward more equitable access to cancer care. Equity-oriented healthcare may offer a framework for service design and delivery to improve access to cancer care and experiences of care.

Hostility toward members of opposing political parties is at record levels. To address this hostility and polarization, we test theory outlined in the political affiliation model (PAM), including constructive replication and extensions with the variables of identification, disidentification, perceived similarity, and liking. We also replicate the role of suspicion as it fits in PAM, and examine the effect of party versus candidate effects on expected counterproductive workplace behaviors (CWBs), expected influence on coworker attitudes, and expected turnover in. Finally, we further test and strengthen our findings by incorporating experimental manipulations of suspicion and liking (via causal chain analysis). Results of three studies provide support for most of the presumed key relationships in PAM. In general, liking is a key mediator to positive behaviors such as expected task, OCB, and coworker attitudes while suspicion is a key mediator for negative expected behaviors such as CWBs and expected turnover. Overall, PAM receives substantial support via replications and extensions to new variables that include expected CWBs, turnover, and recommendations to interview to help understand how political forces influence judgments in the workplace.

Study Design Biomechanical study. Objective Determine the effect of screw thread pitch, trajectory, and purchase depth on the screw pull-out strength in lateral mass fixation constructs. Summary of Background Data Fusion of the cervical spine is routinely performed with lateral mass screw fixation. It is imperative to optimize the lateral mass fixation construct strength to minimize the risk of hardware failure and subsequent complications and reoperations. Methods Biomechanical testing was performed using bicortical artificial bone models to replicate the lateral mass of the cervical spine. Cortical and cancellous screws of 3.5 mm diameter were compared at 3 purchase depths: unicortical, bicortical, and bicortical backed-out to unicortical, and 2 trajectories: Roy-Camille (RC) and Magerl. In a second construct, bicortical 3.5 mm screws were replaced with unicortical 4.0 mm screws. Both thread pitches and trajectories were also compared. Results Fixation with the RC technique was stronger than with Magerl in all constructs. Roy-Camille fixation using cortical screws was stronger than cancellous screws in all purchase depths. Magerl fixation using cancellous screws was stronger in all purchase depths but only statistically significant for the group where the bicortical screw was backed-out to unicortical. The construct where the bicortical 3.5 mm screw was replaced with a 4.0 mm unicortical screw was stronger than when the screw was backed-out to a unicortical depth. This was significant for cortical screws in both trajectories but only significant for cancellous screws using the RC technique. Conclusions Biomechanical strength of cervical lateral mass fixation was shown to be directly influenced by thread pitch, depth, and trajectory. Thus, spine surgeons should be cognizant of their fixation constructs and any changes made to their components.

Objective To understand how surgeons improve the quality of breast cancer surgery. Background Between 2007 and 2021, breast cancer surgeons in Manitoba, Canada, participated in national initiatives to build a local capacity for quality improvement (QI) in cancer surgery. Key aspects of these initiatives include audit and feedback reports using data from synoptic operative reports and communities of practice. Surgeon engagement in breast cancer surgery QI in Manitoba has not been evaluated since the initiatives were concluded in 2021. Methods We conducted 60-minute virtual semi-structured qualitative interviews with surgeons who performed breast cancer surgery in Manitoba, Canada, between 2021 and 2024. The interviews were guided by the theoretical domain framework. The thematic analyses were performed by 2 independent researchers. Results Twelve surgeons were interviewed. Surgeons were motivated to ensure timely care close to home, with excellent oncological, surgical, and aesthetic outcomes. They felt capable of monitoring and improving their surgical quality by tracking their own metrics, collaborating with multidisciplinary colleagues, engaging in continuous professional development, and advocating for improvement. Audit and feedback reports were not perceived to improve the quality of surgery. They felt limited opportunities to sustain improvement strategies. Resource constraints and leadership support within the healthcare system were major barriers to achieving their ideal quality of care. Conclusion Surgeons performing breast cancer surgery in Manitoba were motivated and capable of improving the quality of breast cancer surgery. However, they perceive limited opportunities and barriers within the healthcare systems to doing so. Future research will provide information on broader contextual factors affecting breast cancer surgery QI.

Setting The GetYourBenefits! Project began as an attempt to convince physicians that it is important to diagnose and treat poverty. Intervention The academics worked with community agencies and physician organizations to communicate about the government benefits for which individuals with low incomes and/or disabilities are eligible. The Project Manager and Outreach Officer met with and gave talks to community groups. The Financial Literacy and Empowerment Program Coordinator, Community Financial Counselling Services (CFCS), who leads Manitoba’s free tax filing clinics, led the development of the Get Your Benefits booklet. The authors decided communicating about the project was important. The project was funded by the Winnipeg Foundation with the collaboration of the Manitoba government and is being continued by CFCS. Outcomes This paper describes how information on accessing benefits has been communicated to physicians, health care providers, and those who work in public health. Over 170,000 booklets were distributed. By the final year of the project (2023), over 85 websites had linked to the project website, a major growth over the nine websites linked in the first year of the project. Several updates a year were sent advising on opportunities for accessing benefits, with more than 270 individuals and organizations receiving these in the last year of the project. Implications Accessing these benefits has brought and could bring additional millions of unclaimed federal dollars to eligible individuals across Canada. There is still much to be done.

Objectives To describe the prevalence, incidence, factors associated with pain-related disabilities, and experiences of limitations due to pain among First Nations, Inuit, and Métis peoples in Canada. Methods We conducted a scoping review of the literature. The search strategy, developed with a health sciences librarian, included Indigenous-specific and health peer-reviewed databases, and grey literature for studies from inception to May 23, 2023. We included epidemiological, qualitative, and mixed-methods studies assessing pain-related disability outcomes among First Nations, Inuit, and Métis peoples in Canada. Synthesis We screened 5902 citations from the peer-reviewed databases, of which 86 were screened as full-text items, and 49 were screened separately from grey literature sources. Two relevant items were retrieved. In 2017, an epidemiological study reported point prevalence estimates of pain-related disability lasting 6 months or more as follows: 11.4% among Inuit, 20.7% among Métis, and 22.2% among off-reserve First Nations people, with higher prevalence in women than in men. In 2002, a qualitative study highlighted emergent themes related to “difficulty coping with pain” and “suffering” among Cree adults with disabilities from the Mushkegowuk Territory. No studies reported on the incidence or factors associated with pain-related disability. Conclusion Our scoping review found two studies on pain-related disabilities among Indigenous peoples in Canada. Continued collaboration with Indigenous partners is required to contextualize these findings and determine appropriate next steps.

Poor website accessibility and usability with credible website/information sources can create barriers to the equitable uptake of vaccines. Scarce research investigates how intended users interact with and perceive official COVID-19 websites. We examine how people in Canada interact with official COVID-19 vaccine websites and how they use information to inform their choices regarding COVID-19 vaccinations. Using a qualitative design and talk-aloud (also called ‘think-aloud’) method, we conducted interviews with 50 general population individuals residing in 3 provinces in Canada in July-December 2021, during which they navigated specific government websites and attempted to find information on various aspects of COVID-19. During the interviews, participants were given specific tasks (e.g. searching for specific information on the websites) and asked to ‘think aloud’ while performing them. Thematic content was used to identify positive and negative elements regarding the websites that were stated by participants as they navigated the websites. Our analysis demonstrated that participants appreciated websites that featured user-friendly and aesthetically pleasing designs, had local and updated information, offered links to reputable sources, and dispelled misconceptions. Participants also critiqued sites for using technical jargon, presenting seemingly insufficient information, and potentially having conflicts of interest. These findings underline the need for health authorities to prioritize web-based communication and understand the information needs of their audience. Ignoring user preferences raises potential risks of poor communication, such as leaving their citizens seeking information elsewhere.