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IntroductionFirst Nations communities in Canada are disproportionately impacted by prenatal opioid exposure (POE) and neonatal abstinence syndrome (NAS). In response, we developed a research partnership with 13 First Nations communities in Ontario. Phase I of the research project, initiated in 2018, included the development of mixed-methods reports on the impact of POE for each community. This protocol outlines the evaluation of phase II, during which nine communities individually co-designed and implemented community-specific knowledge mobilisation (KMb) plans informed by findings from phase I. The evaluation aims to assess advisory working group engagement, KMb implementation and perceived community-level impacts.Methods and analysisThis mixed-methods evaluation integrates survey and qualitative data to assess First Nations-led KMb products and activities. The Public and Patient Engagement Evaluation Tool, a validated survey instrument, will be administered to advisory group members and analysed descriptively. Focus groups and interviews will be conducted to explore advisory working group members’ experiences and analysed using phenomenological methods. Qualitative findings will be mapped to the Engage with Impact framework to assess outcomes across engagement domains.Ethics and disseminationEthics approval has been granted by Vancouver Island University. All community contacts and advisory working group members will provide informed consent prior to data collection. Phase II activities are governed by formal community agreements. In alignment with First Nations Principles of OCAP (Ownership, Control, Access and Possession), First Nations community partners retain ownership of their KMb products and are actively involved in the design, implementation and dissemination of the project evaluation. Results will be shared through peer-reviewed publications, community reports and knowledge-sharing events.

Goal: Efficient patient flow is critical at Tampa General Hospital (TGH), a large academic tertiary care center and safety net hospital with more than 50,000 discharges and 30,000 surgical procedures per year. TGH collaborated with GE HealthCare Command Center to build a command center (called CareComm) with real-time artificial intelligence (AI) applications, known as tiles, to dynamically streamline patient care operations and throughput. To facilitate patient flow for our neuroscience service line, we partnered with the GE HealthCare Command Center team to configure a Downgrade Readiness Tile (DRT) to expedite patient transfers out of the neuroscience intensive care unit (NSICU) and reduce their length of stay (LOS). Methods: As part of an integrated NSICU performance improvement project, our LOS reduction workgroup identified the admission/discharge and transfer process as key metrics. Based on a 90%-plus average capacity, early identification of patients eligible for a downgrade to lower acuity units is critical to maintain flow from the operating rooms and emergency department. Our group identified clinical factors consistent with downgrade readiness as well as barriers preventing transition to the next phase of care. Configuration of an AI-powered model was identified as a mechanism to drive earlier downgrade and reduce LOS in the NSICU. A multidisciplinary ICU LOS reduction steering committee met to determine the criteria, design, and implementation of the AI-powered DRT. As opposed to identifying traditional clinical factors associated with stability for transfer, our working group asked, \"What are clinical barriers preventing downgrade?\" We identified more than 76 clinical elements from the electronic medical records that are programmed and displayed in real-time with a desired accuracy of over 95%. If no criteria are present, and no bed is requested or assigned, the DRT will report potential readiness for transfer. If three or more criteria are present, the DRT will suggest that the patient is not eligible for transfer. Principal Findings: The DRT was implemented in January 2022 and is used during multidisciplinary rounds (MDRs) and displayed on monitors positioned throughout the NSICU. During MDRs, the bedside nurses present each patient's key information in a standardized manner, after which the DRT is used to recommend or oppose patient transfer. Six months postimplementation period of the DRT and MDRs, the NSICU has seen a 7% or roughly eight-hour reduction in the ICU length of stay (4.15-3.88 days) with a more than three-hour earlier placement of a transfer order. Unplanned returns to the ICU (or bouncebacks) have remained low with no change in the preimplementation rate of 3% within 24 hours. As a result of this success, DRTs are being implemented in the medical ICUs. Practical Applications: This work is uniquely innovative as it shows AI can be integrated into traditional interdisciplinary rounds and enable accelerated decision-making, continuous monitoring, and real-time alerts. ICU throughput has traditionally relied on direct review of a patient's clinical course executed during clinical rounds. Our methodology adds a dynamic and technologically augmented touchpoint that is available in real time and can prompt a transfer request at any time throughout the day.

Background Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). Methods This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3–6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3–6 months after the procedure. Results Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n  = 360, DAPT-T n  = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p  = 0.97) and no difference in any of the secondary safety outcomes. Conclusions Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.

Objectives: The current research aimed to gain an understanding of women’s experiences of FGM to develop an evidence based holistic conceptual framework for professionals dealing with the impact of FGM and responses required for survivors and their children. Method: Using a grounded theory approach, qualitative semi-structured interviews were carried out with 20 women survivors of FGM. Results: Participant’s related culture, religion, role of men, lack of education, female identity and deception as the major factors influencing their understanding and the impact of FGM. Their experiences of FGM, as well as being influenced by their conceptualisation of the practice, led to effects on their emotional life, relationships, identity, and physical body. The fear resulting from FGM that women described affected their ability to enhance their resilience. All the core categories of emotional, relational, identity, and physical impact, as well as resilience, were further influenced by the key stages of womanhood; including menstruation, marriage and childbirth. Women voiced their views that all the above issues were compounded by their needs not being met and the lack of meaningful and effective service responses. Conclusions: There are complex systems and relationships that influence the psychological and social impact of FGM. These have core implications for clinical and policy in relation to maternity and healthcare services.

Background: Harmful traditional practices (HTPs) are deeply entrenched behaviours or actions that violate the human rights of affected individuals. They have negative consequences on the physical and psychological health, social rights and political equality of affected individuals and their communities. Despite legislation making HTPs illegal in many countries, these practices continue today, causing considerable health risks to women and girls. Whilst studies have sought to understand factors perpetuating different HTPs, a paucity of reviews synthesises these findings. Aims: The aim of this review is to consider son preference, female genital mutilation, and child marriage in relation to their persistence, including the underlying and other factors that facilitate resistance and control mechanisms. Method: Using PRISMA guidelines, a systematic literature review of 21 research studies. Results: Women of practising communities identified educational status of women, residential location, economic status, and a family history of practising HTPs as socio-economic factors perpetuating HTPs. Negative physical health consequences and women's autonomy were identified as facilitating resistance to HTPs, whilst religion and patriarchy were identified as mechanisms that prevented resistance to HTPs. Policy implications are considered. Keywords: Son preference, female genital mutilation, child marriage, systematic review, Africa/Asia

Ehlers-Danlos type IV is a major concern to vascular surgeons because it is often associated with spontaneous hemorrhage from arteries containing decreased type Ill collagen. Five members of a family with Ehlers-Danlos type IV and a review of another family of five with Ehlers-Danlos type IV are reported. Evaluation of the recent family included clinical evaluation as well as assay of collagen production. The age range of the three involved females and two males was 7 to 52 years. The father of the affected family had a spontaneous colon perforation at age 39. His son, at age 27, had a spontaneous rupture of the iliac artery. Revascularization was accomplished with difficulty. His daughter had a large cerebral bleed. Two granddaughters, ages 7, have not had any bleeding or aneurysmal events. The amount of type Ill collagen was only 10% of normal in the patient with the iliac artery rupture. The three females all exhibited similarly low levels of type Ill collagen. The father's type Ill collagen level was not sufficiently low to confirm Ehlers-Danlos type IV, although he had a spontaneous colon perforation. In the other Ehlers-Danlos type IV family of five, the three surviving members had type Ill collagen levels as low as 5% of normal. Two family members died after spontaneous iliac rupture at ages 24 and 33. Both families exhibited an autosomal dominant inheritance pattern. Ehlers-Danlos type IV remains a challenging problem for vascular surgeons. It is transmitted as an autosomal dominant inheritance with a high degree of penetrance. Spontaneous arterial and intestinal perforations should alert the clinician to the possibility of Ehlers-Danlos type IV. Patients should be evaluated noninvasively. Arterial repairs may not be successful in these patients because the vessels are extremely friable. Assays of collagen production are advisable in establishing the diagnosis.

Gender-based harmful traditional practices (HTP) are prevalent in many countries across the world and have a severely negative impact on the physical and psychological health of women and girls. This thesis informs understanding of the factors that both perpetuate and inhibit resistance to HTPs. It further provides understanding of the psychological impact of female genital mutilation (FGM) informing both clinical and policy action. Chapter one is a critical review of both quantitative and qualitative literature exploring factors that perpetuate and facilitate resistance to HTPs. Following both database and manual searches, 21 studies were included and reviewed. Women who had experienced or carried out harmful traditional practices of son preference, FGM or child marriage, relate educational status, residential location, economic status, and family history of practising FGM as sociological facets that perpetuate HTPs. Negative health implications and female autonomy are considered factors that facilitated resistance to HTPs, and religion, tradition and patriarchy serve as control mechanisms that inhibit resistance to HTPs. Chapter two is a qualitative research study that explores women survivors’ experiences of FGM and the resultant psychological impact. The development of a theoretical model shows women related lack of knowledge, female identity, religion, culture, role of men, and deception as reasons for the practice of FGM. Experiencing FGM impacted on the physical, identity, emotional, and relational aspects of women’s lives. All of these factors, in addition to women’s resilience, were influenced by key stages of their life including menstruation, sexual intimacy, and having a child, as well as by fear and unmet needs due to insufficient service provision. Chapter three is a reflective account, exploring the challenges encountered throughout the research process, as well as reflecting on issues of counter-transference between the researcher and the participants, their impact, and their management.

U.S. presidents regularly speak at commencement ceremonies of colleges and universities of all sizes, and these addresses are often used for broader message dissemination. This study suggests that the tone and content of the speeches can be predicted well before the delivery. It found that across the board, presidents used their first-term speeches to advance their policy agendas, and their second-term speeches for focusing on legacy building while continuing to push their policy agendas. Democratic presidents used their second-term speeches for policy advocacy more than Republican presidents. In an age of increased presidential commencement addresses, insight into how a president is likely to use a commencement address, as demonstrated by the findings of this study, will be useful to institutions considering presidential speakers.