Human research islet cell culture outcomes at the Alberta Diabetes Institute IsletCore.

Human islets from deceased organ donors have made important contributions to our understanding of pancreatic endocrine function and continue to be an important resource for research studies aimed at understanding, treating, and preventing diabetes. Understanding the impacts of isolation and culture upon the yield of human islets for research is important for planning research studies and islet distribution to distant laboratories. Here, we examine islet isolation and cell culture outcomes at the Alberta Diabetes Institute (ADI) IsletCore (n = 197). Research-focused isolations typically have a lower yield of islet equivalents (IEQ), with a median of 252,876 IEQ, but a higher purity (median 85%) than clinically focused isolations before culture. The median recovery of IEQs after culture was 75%, suggesting some loss. This was associated with a shift toward smaller islet particles, indicating possible islet fragmentation, and occurred within 24 h with no further loss after longer periods of culture (up to 136 h). No overall change in stimulation index as a measure of islet function was seen with culture time. These findings were replicated in a representative cohort of clinical islet preparations from the Clinical Islet Transplant Program at the University of Alberta. Thus, loss of islets occurs within 24 h of isolation, and there is no further impact of extended culture prior to islet distribution for research.

A multidimensional tool to measure farm stressors: development and initial validation of the farmer stress assessment tool (FSAT).

BACKGROUND: Farming is a stressful occupation, and a growing body of research shows that farm stressors are associated with poor mental health. To date, there are few methodologically sound surveys that assess farm stressors, and none have been validated for the Canadian context. Our study aimed to: (a) investigate the types of stressors experienced by farmers, (b) develop a farm stress assessment tool and test its factor structure and internal consistency, and (c) assess its criterion-related validity to self-reported levels of anxiety, depression, burnout, and resilience among farmers. METHODS: We developed a 20-item survey based on a review of the literature, examining existing farm stress surveys, and consulting 10 farmers and agricultural industry experts. Then, a convenience sample of farmers living in Alberta, Canada (Sample 1, N = 354) completed a questionnaire containing the 20-item farm stress survey and four validated measures that assessed depression, anxiety, burnout, and resilience. Sample 1 was used to assess the factor structure using exploratory factor analysis (EFA), internal consistency, and criterion-validity of the survey. Next, a convenience sample of farmers living outside of Alberta (Sample 2, N = 138) was used to evaluate the factor structure of the survey using confirmatory factor analysis (CFA). RESULTS: The results of the EFA revealed five underlying dimensions of farm stressors: Unexpected work disruptions, Agricultural hazards, Farm and financial planning, Isolation, and Regulations and public pressure. The subscales accounted for 61.6% of the variance, and the internal consistency (Cronbach's alpha) ranged from 0.66 to.75. Subscale correlations were below 0.44, indicating evidence of discriminant validity. Correlations between the five subscales and the four mental health outcome variables supported the criterion-related validity of the survey. The results of the CFA indicated that the data fit the model, and fit was further improved by correlating one pair of error terms. CONCLUSIONS: Preliminary analysis of our Farmer Stress Assessment Tool (FSAT) suggests it is a reliable and valid instrument for measuring a range of stressors farmers face. Implications for policy and community-based mental health interventions that help farmers manage the enduring stressors of agriculture is discussed.

Perceived Parental Distraction by Technology and Mental Health Among Emerging Adolescents.

Importance: The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents' attention to cues necessary for supporting children's mental health. Objective: To explore whether there are directional prospective associations between perceived parental technoference and emerging adolescents' mental health symptoms (anxiety, depression, inattention, and hyperactivity). Design, Setting, and Participants: This cohort study assessed a general population of mothers and emerging adolescents in Calgary, Alberta, Canada. Women were recruited during pregnancy between May 3, 2008, and December 13, 2010, with convenience sampling and repeated follow-up; eligible women were 18 years or older, spoke English, had a gestational age of at least 24 weeks, and received local prenatal care. Data collection for the present study took place when emerging adolescents were aged 9 (May 20 to July 15, 2020), 10 (March 4 to April 30, 2021), and 11 (November 22, 2021, to January 17, 2022) years. Mothers provided consent for their child to participate, and emerging adolescents provided assent. Data were analyzed from December 1 to 31, 2023, using random-intercept cross-lagged panel models. Exposure: Perceived parental technoference. Main Outcomes and Measures: Emerging adolescents completed questionnaires about their perception of parental technoference and their mental health symptoms (depression, anxiety, hyperactivity, and inattention) at the 3 study times. This study did not rely on statistical significance, but instead on the magnitude of effect sizes to determine meaningful effects. Results: Participants included 1303 emerging adolescents (mean [SD] age, 9.7 [0.8] years at time 1; of the 1028 reporting information, 529 [51.5%] were girls). Cross-sectional associations indicated correlations between perceptions of parental technoference and emerging adolescents' mental health (r range, 0.17-0.19). Higher levels of anxiety at 9 and 10 years of age were prospectively associated with higher parental technoference scores at 10 (ß = 0.11 [95% CI, -0.05 to 0.26]) and 11 (ß = 0.12 [95% CI, 0.001-0.24]) years of age, with small magnitudes of effect size. Higher parental technoference scores at 9 and 10 years of age were prospectively associated with higher hyperactivity at 10 (ß = 0.07 [95% CI, -0.07 to 0.22]) and 11 (ß = 0.11 [95% CI, -0.02 to 0.24]) years of age and inattention at 11 years of age (ß = 0.12 [95% CI, 0.001-0.24]), with small magnitudes of effect size. No gender differences were identified. Conclusions and Relevance: In this 3-wave longitudinal birth cohort study, perceived parental technoference was associated with emerging adolescents' mental health. The findings speak to the need to discuss digital technology use and mental health with parents and emerging adolescents as a part of routine care.

Perceptions of breast cancer screening programs and breast health among immigrant women: Qualitative study in Alberta.

OBJECTIVE: To examine how women who have emigrated from the Middle East and North Africa (MENA) region perceive breast cancer risk and screening in Canada and how they approach breast health, and to explore barriers to breast cancer screening in this population. DESIGN: Focused ethnography. SETTING: Edmonton, Alta. PARTICIPANTS: Women who were born in MENA countries (eg, Egypt, Iraq, Lebanon, Libya, Saudi Arabia, Somalia, Sudan, and Syria) and had immigrated to Canada less than 5 years prior to study recruitment and lived in Edmonton, Alta. METHODS: Six focus groups were conducted over a 6-week period in July and August 2018 with 6 participants in each group (N=36); results were analyzed thematically. MAIN FINDINGS: Three broad themes were identified: knowledge about breast health, cancer risk, and screening services; barriers to maintaining breast health and to screening; and potential solutions for overcoming these barriers. Findings indicated participants have limited knowledge about breast cancer screening practices in Alberta and that multiple barriers to screening remain. CONCLUSION: This study can help inform the development of culturally appropriate interventions to overcome barriers and to motivate women from MENA countries to use breast cancer screening.

Associations between specialized dementia care, COVID-19 and central nervous system medication use in assisted living: a population-based repeated cross-sectional study.

BACKGROUND: Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use. METHODS: We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics. RESULTS: On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2-4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14-1.27 vs. adjPR 1.09, 95% CI 1.02-1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10-1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed. CONCLUSIONS: The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.

The effect of rhizosphere pH on removal of naphthenic acid fraction compounds from oil sands process-affected water in a willow hydroponic system.

The extraction and processing of bitumen from the oil sands in northern Alberta, Canada generates large volumes of oil sands process-affected water (OSPW). OSPW contains a complex mixture of inorganic and organic compounds, including naphthenic acid fraction compounds (NAFCs) that are of particular concern due to their toxicity to aquatic organisms. Phytoremediation is a cost-effective, scalable approach that has the potential to remove NAFCs from OSPW and reduce OSPW toxicity. Environmental pH influences the chemical form and bioavailability of NAFCs. However, little is known about the influence of pH on the uptake of NAFCs in plant systems. This study sought to elucidate the impact of rhizosphere pH on the uptake of NAFCs using a sandbar willow (Salix interior) hydroponic system. To mimic and maintain the naturally low pH conditions of the root, OSPW solutions in these systems were adjusted to a low pH level (pH 5.0) and their NAFC uptake from solution was compared to that of OSPW at native pH (pH 8.0). Our findings revealed that the lower pH hydroponic systems demonstrated enhanced NAFC removal from solution as determined by LC-MS analysis, where up to 26% of NAFCs were removed from OSPW over 72 h at pH 5.0 compared to 8% removed at pH 8.0. Similarly, analysis of spike-in 13C-labeled NAs demonstrated that the OSPW hydroponic system rapidly removed a relatively labile NA (13C-cyclohexane carboxylic acid) from solution at both pH levels, whereas near complete removal of a recalcitrant NA (13C-1-adamantane carboxylic acid) was observed in pH 5.0 solutions only. These results provide insight into the importance of rhizosphere pH on efficient NAFC uptake by plant root systems. Further research will determine whether OSPW phytoremediation efficiency can be enhanced using field treatment conditions that promote low rhizosphere pH levels.

Mammal responses to human recreation depend on landscape context.

Rapid growth in outdoor recreation may have important and varied effects on terrestrial mammal communities. Few studies have investigated factors influencing variation in observed responses of multiple mammal species to recreation. We used data from 155 camera traps, in western Alberta (Canada), and a hierarchical Bayesian community modelling framework to document 15 mammal species responses to recreation, test for differential responses between predators and prey, and evaluate the influence of local context. Factors characterizing context were trail designation (i.e., use by motorized vs non-motorized), management type, forest cover, landscape disturbance, and season. We used three measures to characterize variation in recreation pressure: distance to trail, trail density, and an index of recreation intensity derived from the platform Strava. We found limited evidence for strong or consistent effects of recreation on mammal space use. However, mammal space use was better explained by an interaction between recreation and the influencing factors than by either on their own. The strongest interaction was between trail density and management type; mammals were more likely to avoid sites near a higher density of trails in areas with more restrictive management. We found that responses to recreation varied with the trail designation, although there were not clear or consistent differences between responses to trails designated for motorized vs. non-motorized use. Overall, we found that responses were species- and context-dependent. Limiting the density of trails may be important for reducing negative impacts to mammals within conservation areas. We show that using multiple measures of recreation yields more insight into the varied effects of human disturbances on wildlife. We recommend investigating how different characteristics of recreation (noise, speed, and visibility) influence animal behaviors. Multispecies monitoring and modelling across multiple landscapes that vary in recreation pressure can lead to an adaptive management approach to ensuring outdoor recreation coexistence with wildlife.

Pediatric antibody responses to SARS-CoV-2 after infection and vaccination in Calgary, Canada.

BACKGROUND: There are few reports of longitudinal serologic responses in children following Sars-CoV-2 infection and vaccination. This study describes longitudinal SARS-CoV-2 antibody responses following infection, vaccination, or both (hybrid immunity) in a cohort of Canadian children. The objectives of our study were to compare antibody levels following SARS-CoV-2 infection, vaccination, and hybrid immunity and to examine antibody decline after final antigen exposure. METHODS: The Alberta Childhood COVID-19 Cohort (AB3C) study was a prospective longitudinal cohort study conducted from July 2020 to September 2022 with repeat sampling across 5 visits. Children under 18 years of age were enrolled for serial measurement of antibody responses to SARS-CoV-2 virus vaccine and infection. RESULTS: The final sample size was 919; participants were 50.5% female, 48.2% were > 12 years and 88.5% were white ethnicity. The median peak spike IgG level of those with only infection was not different from those with no vaccination or infection (233 AU/mL (IQR: 99-944 AU/mL) vs. 3 AU/mL (IQR: 1-5 AU/mL; P = 0.1765). Participants with infections after vaccination had higher IgG levels than those where infection preceded vaccination (median: 36,660 (IQR: 22,084 - 40,000 AU/mL) vs. 17,461 AU/mL (IQR: 10,617 - 33,212 AU/mL); P < 0.0001). In a linear mixed methods model, children with infection-only had low levels of antibody that stayed stable over the study duration without further antigen exposures. Those with infection after vaccination had the slowest rate of antibody decline over time at 4% (95%CI: 2-5%) per week, compared with children where infection preceded vaccine 7% (95%CI: 6-8%) per week. CONCLUSIONS: Children with hybrid immunity conferred through vaccination (2 + doses) followed by a SARS-CoV-2 infection had the highest and longest lasting antibody levels, compared to children who had an infection followed by vaccination, vaccination-only, or infection-only. The longer-term clinical importance of these findings, related to prevention of repeated infections and severe outcomes and need for further vaccine doses, is not yet known.

What role does compassion have on quality care ratings? A regression analysis and validation of the SCQ in emergency department patients.

OBJECTIVE: To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients' reported experiences of compassion in the emergency department differed between sociodemographic groups. METHODS: Provincial data for this cross-sectional study were collected from 03/01/2022 to 09/05/2022 from 14 emergency departments in Alberta, Canada. Data from 4501 emergency department patients (53.6% women, 77.1% White/European) were analyzed. The primary outcome was patients' overall quality care ratings during their most recent ED visit. Measures included in the hierarchical stepwise regression included demographics, and those drawn from the Emergency Department Patient Experience of Care (EDPEC) questionnaire: single and multi-item measures of patient information (e.g., patient perceptions health) and patient experience (e.g., physician communication), and compassion (e.g., Sinclair Compassion Questionnaire; SCQ-ED). RESULTS: Data from 4501 ED patients were analysed. Stepwise hierarchical linear multiple regression indicated that of 21 included variables, compassion most strongly predicted overall quality care ratings (b=1.61, 95% CI 1.53-1.69, p<.001, f2=.23), explaining 19% unique variance beyond all other measures. One-way ANOVAs indicated significant demographic differences in mean compassion scores, such that women (vs. men) reported lower compassion (MD=-.15, 95% CI=-.21, -.09, p<.001), and Indigenous (vs. White) patients reported lower compassion (MD=-.17, 95% CI =-.34, -.01, p=.03). CONCLUSIONS: Compassion was identified as a key contributor to ED overall quality care ratings, and experiences of compassion varied as a function of demographics. Patient-reported compassion is an indicator of quality care that needs to be formally integrated into clinical care and quality care assessments.

The Impact of the COVID-19 Pandemic on Pattern of Antibiotic and Opioid Prescriptions by Dentists in Alberta, Canada.

OBJECTIVES: After the shutdown of most dental services during the COVID-19 lockdown, the oral health community was concerned about an increase in prescribing opioids and antibiotics by dentists due to patients' limited access to dental offices. Therefore, the objective of this study was to investigate the impact of COVID-19 pandemic on the pattern of antibiotic and opioid prescriptions by dentists in Alberta, Canada. METHODS: Data obtained from the Tracked Prescription Program were divided into antibiotics and opioids. Time periods were outlined as pre-, during-, and postlockdown (phase 1 and 2). For the number of prescriptions and average supply, each monthly average was compared to the corresponding prelockdown monthly average, using descriptive analysis. Time series analyses were conducted using regression analyses with an autoregressive error model. Data were trained and tested on monthly observations before lockdown and predicted for during- and postlockdown. RESULTS: A total of 1.1 million antibiotics and 400,000 opioids dispense were tracked. Decreases in the number of prescriptions during lockdown presented for antibiotics (n = 24,933 vs. 18,884) and opioids (n = 8892 vs. 6051). Average supplies (days) for the antibiotics (n = 7.10 vs. 7.55) and opioids (n = 3.92 vs. 4.05) were higher during the lockdown period. In the trend analyses, the monthly number of antibiotic and opioid prescriptions showed the same pattern and decreased during lockdown. CONCLUSION: The COVID-19 pandemic altered the trends of prescribing antibiotics and opioids by dentists. The full impact of COVID-19 pandemic on the population's oral health in light of changes in prescribing practices by dentists during and after lockdown warrants further investigation.

Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing: A Randomized Clinical Trial.

Importance: Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae. Objective: To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF. Design, Setting, and Participants: This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada. Pharmacists identified patients 65 years or older with 1 additional stroke risk factor and known, untreated AF (OAC nonprescription or OAC suboptimal dosing) or performed screening using a 30-second single-lead electrocardiogram to detect previously unrecognized AF. Patients with undertreated or newly diagnosed AF eligible for OAC therapy were considered to have actionable AF. Data were analyzed from April 3 to November 30, 2023. Interventions: In the early intervention group, pharmacists prescribed OAC using guideline-based algorithms with follow-up visits at 1 and 3 months. In the delayed intervention group, which served as the usual care control, the primary care physician (PCP) was sent a notification of actionable AF along with a medication list (both enhancement over usual care). After 3 months, patients without OAC optimization in the control group underwent delayed pharmacist intervention. Main Outcomes and Measures: The primary outcome was the difference in the rate of guideline-concordant OAC use in the 2 groups at 3-month follow-up ascertained by a research pharmacist blinded to treatment allocation. Results: Eighty patients were enrolled with actionable AF (9 [11.3%] newly diagnosed in 235 individuals screened). The mean (SD) age was 79.7 (7.4) years, and 45 patients (56.3%) were female. The median CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack) score was 2 (IQR, 2-3). Seventy patients completed follow-up. Guideline-concordant OAC use at 3 months occurred in 36 of 39 patients (92.3%) in the early intervention group vs 23 of 41 (56.1%) in the control group (P < .001), with an absolute increase of 34% and number needed to treat of 3. Of the 23 patients who received appropriate OAC prescription in the control group, the PCP called the pharmacist for prescribing advice in 6 patients. Conclusions and Relevance: This randomized clinical trial found that pharmacist OAC prescription is a potentially high-yield opportunity to effectively close gaps in the delivery of stroke risk reduction therapy for AF. Scalability and sustainability of pharmacist OAC prescription will require larger trials demonstrating effectiveness and safety. Trial Registration: ClinicalTrials.gov Identifier: NCT03126214.

Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?

BACKGROUND: COVID-19 and resulting health system and policy decisions led to significant changes in healthcare use by nursing homes (NH) residents. It is unclear whether healthcare outcomes were similarly affected among older adults in assisted living (AL). This study compared hospitalization events in AL and NHs during COVID-19 pandemic waves 1 through 4, relative to historical periods. METHODS: This was a population-based, repeated cross-sectional study using linked clinical and health administrative databases (January 2018 to December 2021) for residents of all publicly subsidized AL and NH settings in Alberta, Canada. Setting-specific monthly cohorts were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. Monthly rates (per 100 person-days) of all-cause hospitalization, hospitalization with delayed discharge, and hospitalization with death were plotted and rate ratios (RR) estimated for period (pandemic wave vs historical comparison), setting (AL vs NH) and period-setting interactions, using Poisson regression with generalized estimating equations, adjusting for resident and home characteristics. RESULTS: On March 1, 2020, there were 9,485 AL and 14,319 NH residents, comparable in age (mean 81 years), sex (>60% female) and dementia prevalence (58-62%). All-cause hospitalization rates declined in both settings during waves 1 (AL: adjusted RR 0.60, 95%CI 0.51-0.71; NH: 0.74, 0.64-0.85) and 4 (AL: 0.76, 0.66-0.88; NH: 0.65, 0.56-0.75) but unlike NHs, AL rates were not significantly lower during wave 2 (and increased 27% vs NH, January 2021). Hospitalization with delayed discharge increased in NHs only (during and immediately after wave 1). Both settings showed a significant increase in hospitalization with death in wave 2, this increase was larger and persisted longer for AL. CONCLUSIONS: Pandemic-related changes in hospitalization events differed for AL and NH residents and by wave, suggesting unique system and setting factors driving healthcare use and outcomes in these settings in response to this external stress.

Acute and chronic complication profiles among patients with chronic kidney disease in Alberta, Canada: a retrospective observational study.

BACKGROUND: Chronic kidney disease (CKD) poses a substantial burden to individuals, caregivers, and healthcare systems. CKD is associated with higher risk for adverse events, including renal failure, cardiovascular disease, and death. This study aims to describe comorbidities and complications in patients with CKD. METHODS: We conducted a retrospective observational study linking administrative health databases in Alberta, Canada. Adults with CKD were identified (April 1, 2010 and March 31, 2019) and indexed on the first diagnostic code or laboratory test date meeting the CKD algorithm criteria. Cardiovascular, renal, diabetic, and other comorbidities were described in the two years before index; complications were described for events after index date. Complications were stratified by CKD stage, atherosclerotic cardiovascular disease (ASCVD), and type 2 diabetes mellitus (T2DM) status at index. RESULTS: The cohort included 588,170 patients. Common chronic comorbidities were hypertension (36.9%) and T2DM (24.1%), while 11.4% and 2.6% had ASCVD and chronic heart failure, respectively. Common acute complications were infection (58.2%) and cardiovascular hospitalization (24.4%), with rates (95% confidence interval [CI]) of 29.4 (29.3-29.5) and 8.37 (8.32-8.42) per 100 person-years, respectively. Common chronic complications were dyslipidemia (17.3%), anemia (14.7%), and hypertension (11.1%), with rates (95% CI) of 11.9 (11.7-12.1), 4.76 (4.69-4.83), and 13.0 (12.8-13.3) per 100 person-years, respectively. Patients with more advanced CKD, ASCVD, and T2DM at index exhibited higher complication rates. CONCLUSIONS: Over two-thirds of patients with CKD experienced complications, with higher rates observed in those with cardio-renal-metabolic comorbidities. Strategies to mitigate risk factors and complications can reduce patient burden.

Long-awaited evidence on back blows versus abdominal thrusts.

This is a commentary on the study conducted by Dunne et al. from Alberta, Canada, which retrospectively analyzed data from patients with foreign body airway obstruction (FBAO) in the region. By linking the region's prehospital data with hospital data, the authors were able to report not only the FBAO relief of each intervention, but also patient survival outcomes and complications associated with the interventions. By analyzing the 709 patient encounters that received BLS interventions from bystanders, paramedics, or both, and adjusting for potential confounders, the study showed that abdominal thrusts and chest compressions were associated with decreased odds of FBAO relief compared to back blows as the first intervention. The commentary summarizes the study findings and discusses the importance of the study in the context of FBAO research, which has been choked for too many years.

Dose optimization of pancreatic enzyme replacement therapy is essential to mitigate muscle loss in patients with advanced pancreatic cancer and exocrine pancreatic insufficiency.

BACKGROUND & AIMS: Exocrine pancreatic insufficiency (EPI) contributes to malnutrition, marked by muscle loss during chemotherapy for advanced pancreatic cancer (aPC). Pancreatic enzyme replacement therapy (PERT) is recommended for patients with EPI; however, it's efficacy for attenuating muscle loss has not been demonstrated. We aimed to delineate the impact of PERT dose on muscle loss using a 7-year population-based cohort with aPC who were provided PERT at the discretion of their oncologist or dietitian according to clinical indications of EPI. METHODS: All patients treated with chemotherapy for aPC from 2013 to 2019 in Alberta, Canada (population ∼4.3 million) were included if they had computed tomography (CT) scans both prior to and 12 ± 4 weeks after chemotherapy initiation. Change in muscle area (cm2) was measured at 3rd lumbar level on repeated CT scans. Muscle loss was defined by measurement error (loss >2.3 cm2). Clinical and pharmaceutical data were retrieved from provincial registries. For patients who were dispensed PERT -8 to +6 weeks from chemo start (PERT users), estimated dose consumed per day was calculated as: (total dose dispensed) / (days, first to last dispensation). PERT users were categorized as high dose or low dose users according to the median estimated dose consumed. Non-users were classified as No PERT. Association between PERT use and muscle loss was analyzed with multivariable logistic regression. RESULTS: Among 210 patients, 81 (39%) were PERT users. Median estimated dose consumed per day of 75 000 USP lipase units defined the cutoff between low dose and high dose uses. There were no significant differences in baseline characteristics between high dose and low dose groups. Muscle loss was more prevalent among low dose compared to both high dose and No PERT groups (88% vs. 58% and 67%, p < 0.05). In the multivariable model predicting muscle loss, low dose PERT was independently associated with greater odds of muscle loss (OR 5.4, p = 0.004) vs. high dose, independent of tumour response, disease stage, and chemotherapy regimen. CONCLUSION: In patients with clinical indications of EPI during chemotherapy for aPC, low doses of PERT were insufficient to prevent muscle loss. Patients with EPI consuming higher doses of PERT had similar odds of muscle maintenance to patients without clinical indications of EPI. Provider education for optimal PERT dosing in patients with EPI should be prioritized, and resources must be allocated to support dose titration.

Contribution of emissions from the oil sands activities in Alberta, Canada to atmospheric concentration and deposition of nitrogen and sulfur species at a downwind site.

Oil sands activities in the Athabasca Oil Sands Region in Alberta, Canada, are large sources of atmospheric NOx and SO2. This study investigated the impact of oil sands emissions on the atmospheric deposition of nitrogen and sulfur species at a downwind site, about 350 km from the oil sands facilities. Measurement data are from the Canadian Air and Precipitation Monitoring Network (CAPMoN) from 2015 to 2019, including ambient concentrations of HNO3, pNO3-, NO2, pNH4+, NH3, SO2, pSO42- and base cations, as well as concentrations of NO3-, SO42-, NH4+, and base cations in precipitation. Sector analysis of air mass back trajectories was conducted to distinguish measurements with different air mass origins. Median atmospheric concentrations and dry deposition fluxes of HNO3, pNO3-, NO2, pNH4+, pSO42-, and SO2 on days when the air masses came from the oil sands sector were significantly greater than those with the "Clean" sector by 34-67%, whereas the difference in NH3 concentration was not significant. Contributions of the oil sands emissions to dry deposition fluxes of these species ranged from 3.8 to 13.1%. The precipitation-weighted mean concentrations of NO3-, SO42-, and NH4+ in samples with the oil sands sector were 76 %, 65 % and 81 % greater than those with the "Clean" sector, respectively. Contributions of the oil sands emissions to wet deposition of NO3-, SO42-, and NH4+ were 12.5 ± 8.9 %, 8.7 ± 4.4 %, and 6.0 ± 3.3 %, respectively. The annual total deposition of nitrogen and sulfur were 1.9 kg-N ha-1 and 0.74 kg-S ha-1, respectively, of which 8.0 ± 3.5 % and 8.7 ± 3.6 % were from oil sands emissions. The total deposition of sulfur and nitrogen did not exceed the critical loads (CL) of acidity, but nitrogen deposition exceeded the CLs of nutrient nitrogen in the region.

Real-world evidence of sotrovimab effectiveness for preventing severe outcomes in patients with COVID-19: A quality improvement propensity-matched retrospective cohort study of a pan-provincial program in Alberta, Canada.

OBJECTIVES: Post-marketing surveillance of sotrovimab's effect during implementation in the Canadian population is limited. METHODS: The study used a propensity score-matched retrospective cohort design. Follow-up began between the periods of December 15, 2021 and April 30 2022. The study assessed any severe outcome defined as all-cause hospital admission or mortality within 30 days of a confirmed COVID-19-positive test. Covariate-adjusted odds ratios between sotrovimab treatment and the severe outcome was conducted using logistic regression. RESULTS: There were 22,289 individuals meeting the treatment criteria for sotrovimab. There were 1603 treated and 6299 untreated individuals included in the analysis. The outcome occurrence in the study was 5.49% (treated) and 4.21% (untreated), with a median time from diagnosis to treatment of 1.00 days (interquartile range 2.00 days). In the propensity-matched cohort, sotrovimab was not associated with lower odds of a severe outcome (odds ratio 1.20, 95% confidence interval 0.91-1.58), adjusting for confounding variables. CONCLUSIONS: After adjusting for confounding variables, sotrovimab treatment was not associated with lower odds of a severe outcome within 30-days of COVID-19-positive date.

Selenium bioaccumulation in Daphnia pulex via aqueous and dietary exposure.

Pit lakes are currently being investigated as a way to store and reclaim waste materials in the Alberta Oil Sands (AOS) region, Canada. Lake Miwasin (LM) is a pilot-scale pit lake consisting of treated fine tailings overlayed with oil sands process-affected water (OSPW) blended with fresh surface water. In October 2021, the surface water contained a mean concentration of 1.33 ± 0.04 µg/L dissolved selenium (Se), slightly above the Canadian Council of Ministers of Environment water quality guideline for long-term protection of aquatic life (1 µg Se/L). This study assessed the bioaccumulation of Se by the cladoceran Daphnia pulex under laboratory conditions through both aqueous and dietary exposure routes for comparison to field-collected specimens. In 12-day semi-static tests, lab-cultured D.pulex were exposed to water, and algae grown in media spiked with selenate. Results showed that Se bioaccumulation by lab-cultured D. pulex increased in all exposure treatments from days 5 to 12, with maximum Se concentrations of 3.08-3.47 µg/g dry weight (dw) observed within the exposure range tested. Interestingly, lower Se bioaccumulation concentrations (1.26-1.58 µg/g dw) were observed in the highest dissolved Se and dietary Se treatments, suggesting potential internal regulatory mechanisms. In addition, native D. pulex (LM) collected from Lake Miwasin and cultured in-house were exposed in 8-day semi-static tests to Lake Miwasin surface water and algae cultured in Lake Miwasin surface water. Selenium bioaccumulation in native D. pulex (LM) ranged from 2.00 to 2.04 µg/g dw at day 8 and was not significantly different (p > 0.05) compared to Se concentrations in D. pulex collected from Lake Miwasin (2.15 ± 0.28 µg/g) in summer 2022.

Toxicity Evaluation of Water and Pore Water from a Pilot-Scale Pit Lake in the Alberta Oil Sands Region to Daphnia Species.

Significant amounts of tailings and oil sands process-affected water (OSPW) are generated by bitumen extraction in the Alberta Oil Sands region. These by-products are potentially toxic to aquatic organisms and require remediation. The study site was Lake Miwasin, a pilot-scale pit lake integrated into broader reclamation efforts. It consists of treated tailings overlaid with blended OSPW and freshwater, exhibiting meromictic conditions and harboring aquatic communities. This study assessed the potential toxicity of Lake Miwasin surface water (LMW) and pore water (LMP) using saline-acclimated Cladocera, including lab strains of Daphnia magna and Daphnia pulex and native Daphnia species collected in brackish Humboldt Lake (HL) and Lake Miwasin (LM). The pore water evaluation was used to represent a worst-case water quality scenario during pond stratification. Additionally, the inclusion of native organisms incorporated site-specific adaptations and regional sensitivity into the toxicity evaluation. Our results showed that LMW did not display acute or chronic toxicity to lab species and native Daphnia sp. (HL). Conversely, LMP was acutely toxic to both lab species and native D. pulex (LM). In chronic tests (12 days exposure), LMP negatively affected reproduction in D. pulex (lab), with reductions in the number of offspring. Limited ability to acclimated organisms to the high salinity levels of LMP resulted in a shortened exposure duration for the chronic toxicity test. In addition to salinity being identified as a stressor in LMP, toxicity identification evaluation (TIE) phase I findings demonstrated that the observed toxicity for D. magna (lab) and D. pulex (LM, native) might be attributed to ammonia and metals in LMP. Further investigations are required to confirm the contributions of these stressors to LMP toxicity.

Particle size distribution of total suspended sediments in urban stormwater runoff: Effect of land uses, precipitation conditions, and seasonal variations.

Understanding particle size distribution (PSD) of total suspended sediments in urban runoff is essential for pollutant fate and designing effective stormwater treatment measures. However, the PSDs from different land uses under different weather conditions have yet to be sufficiently studied. This research conducted a six-year water sampling program in 15 study sites to analyze the PSD of total suspended sediments in runoff. The results revealed that the median particle size decreased in the order: paved residential, commercial, gravel lane residential, mixed land use, industrial, and roads. Fine particles less than 125 µm are the dominant particles (over 75%) of total suspended sediments in runoff in Calgary, Alberta, Canada. Roads have the largest percentage of particles finer than 32 µm (49%). Gravel lane residential areas have finer particle sizes than paved residential areas. The results of PSD were compared with previous literature to provide more comprehensive information about PSD from different land uses. The impact of rainfall event types can vary depending on land use types. A long antecedent dry period tends to result in the accumulation of fine particles on urban surfaces. High rainfall intensity and long duration can wash off more coarse particles. The PSD in spring exhibits the finest particles, while fall has the largest percentage of coarse particles. Snowmelt particles are finer for the same land use than that during rainfall events because the rainfall-runoff flows are usually larger than the snowmelt flows.