The transition from breastmilk to solid foods (weaning) is a critical stage in infant development and plays a decisive role in the maturation of the complex microbial community inhabiting the human colon. Diet is a major factor shaping the colonic microbiota, which ferments nutrients reaching the colon unabsorbed by the host to produce a variety of microbial metabolites influencing host physiology(1). Therefore, making adequate dietary choices during weaning can positively modulate the colonic microbiota, ultimately contributing to health in infancy and later life(2). However, our understanding of how complementary foods impact the colonic microbiota of weaning infants is limited. To address this knowledge gap, we employed a metagenome-scale modelling approach to simulate the impact of complementary foods, either combined with breastmilk or with breastmilk and other foods, on the production of organic acids by colonic microbes of weaning infants(3). Complementary foods and combinations of foods with the greatest impact on the in silico microbial production of organic acids were identified. These foods and food combinations were further tested in vitro, individually or in combination with infant formula. Fifty-three food samples were digested using a protocol adapted from INFOGEST to mimic infant digestion and then fermented with faecal inoculum from 6 New Zealand infants (5-11 months old). After 24h of fermentation, the production of organic acids was measured by gas chromatography. Differences in organic acid production between samples were determined using the Tukey Honestly Significant Difference test to account for multiple comparisons. The microbial composition was characterised by amplicon sequencing of the V3-V4 regions of the 16S bacterial gene. Taxonomy was assigned using the DADA2 pipeline and the SILVA database (version 138.1). Bioinformatic and statistical analyses were conducted using the R packages phyloseq and ANCOM-BC2, with the Holm-Bonferroni adjustment to account for false discovery rates in differential abundance testing. Blackcurrant and raspberries increased the production of acetate and propionate (Tukey’s test, p<0.05) and the relative abundance of the genus Parabacteroides (Dunnett’s test, adjusted p<0.05) compared to other foods. Raspberries also increased the abundance of the genus Eubacterium (Dunnett’s test, adjusted p<0.05). When combined with infant formula, black beans stood out for increasing the production of butyrate (Tukey’s test, p<0.05) and the relative abundance of the genus Clostridium (Dunnett’s test, adjusted p<0.05). In conclusion, this study provides new evidence on how complementary foods, both individually or in combination with other dietary compounds, influence the colonic microbiota of weaning infants in vitro. Insights generated by this research can help design future clinical trials, ultimately enhancing our understanding of the relationship between human nutrition and colonic microbiota composition and function in post-weaning life.

Micronutrient deficiencies (MND) are a significant global health issue, particularly affecting children’s growth and cognitive potential and predisposing to adverse health outcomes for women of reproductive age (WRA).(1) Over half of global MND cases occur in Sub-Saharan Africa (SSA), with 80% of women estimated to be deficient in at least one of three micronutrients(2). Large-scale food fortification is a cost-effective strategy recommended for combatting widespread MND and has been effectively implemented in many developed countries(3). In developing countries such as SSA, socio-economic barriers and a fragmented food processing industry hinders effective implementation of food fortification(4). As a result, countries with fortification programmes face significant challenges, including low coverage of fortified food in the population and poor compliance with fortification standards by food producers(5) The contribution of food fortification to nutrient intakes of WRA in SSA have yet to be fully assessed. This study sought to evaluate mandatory food fortification programmes in SSA and estimate the contribution of fortified food consumption to micronutrient intakes and requirements of WRA. We utilised multi-national fortification data from the global fortification data exchange, which includes data on country fortification standards and the estimated level of compliance to fortification requirements. Data on the supply and consumption of fortifiable food was also included from the FAO. We calculated the potential nutrient intake from fortified food consumption for each nutrient using country fortification standards and food availability. We adjusted the estimated intake for each nutrient by multiplying with the estimated compliance percentage. We also assessed what proportion of women’s requirements for essential micronutrients, folate, iron, iodine, vitamin A, and zinc, are met through fortified food consumption using RNI values from WHO/FAO for WRA. Between 2019 and 2021, we estimated that mandatory fortification of wheat and maize flour, oil and salt in SSA contributes a median of 138µgDFE of folic acid, 217µg of iodine, 43µg RAE of vitamin A and 2.1mg and 2.0mg of iron and zinc respectively to the intakes of WRA daily. These intakes represent 12.8% (0.0-49.2) of iron, 27.5% (0.0-83.2) of zinc, 55.0% (0.0-245.0) of folate, 8.8% (0.0-37.2) of vitamin A and 228.2% (98.2-358.6) of iodine requirements respectively, taking into consideration the lower bioavailability of iron and zinc from cereal-based diets of SSA populations. In reality, compliance with fortification requirements in SSA is low, estimated at a median of 22% (0.0 - 83.4) for maize flour, 44% (0.0 - 72.0) for vegetable oil and 83% (0.0 - 100.0) for wheat flour fortification and is a major factor limiting the overall contribution of fortification to micronutrient intakes. Inadequate regulatory monitoring to ensure compliance with fortification requirements in SSA have resulted in lower-quality fortified foods, limiting women’s potential to achieve adequate micronutrient intake through fortified food consumption.

Background: Our prior six-year review (n=2165) revealed 24% of patients undergoing posterior decompression surgeries (laminectomy or discectomy) sought emergency department (ED) care within three months post-surgery. We established an integrated Spine Assessment Clinic (SAC) to enhance patient outcomes and minimize unnecessary ED visits through pre-operative education, targeted QI interventions, and early post-operative follow-up. Methods: We reviewed 13 months of posterior decompression data (n=205) following SAC implementation. These patients received individualized, comprehensive pre-operative education and follow-up phone calls within 7 days post-surgery. ED visits within 90 days post-surgery were tracked using provincial databases and compared to our pre-SAC implementation data. Results: Out of 205 patients, 24 (11.6%) accounted for 34 ED visits within 90 days post-op, showing a significant reduction in ED visits from 24% to 11.6%, and decreased overall ED utilization from 42.1% to 16.6% (when accounting for multiple visits by the same patient). Early interventions including wound monitoring, outpatient bloodwork, and prescription adjustments for pain management, helped mitigate ED visits. Patient satisfaction surveys (n=62) indicated 92% were “highly satisfied” and 100% would recommend the SAC. Conclusions: The SAC reduced ED visits after posterior decompression surgery by over 50%, with pre-operative education, focused QI initiatives, and its individualized, proactive approach.

Leader exemplification involves implicit and explicit claims of high moral values made by a leader. We employed a 2 × 3 experimental design with samples of 265 students in Study 1 and 142 working adults in Study 2 to examine the effects of leader exemplification (exemplification versus no exemplification) and ethical conduct (self-serving, self-sacrificial, and self-other focus) on perceived leader authenticity, trust in leader, and organizational advocacy. In Study 1, we found that exemplification produced elevated levels of perceived authenticity, trust, and advocacy in the form of employment and investment recommendations. We also showed that leader ethical conduct moderated this effect, as ratings were highest following a leader’s self-sacrificial conduct, lowest for self-serving conduct, and moderate for conduct reflecting self-other concerns. In Study 2, we replicated these findings for perceived authenticity and trust, but not organizational advocacy, which yielded mixed results. The leadership implications and future research directions are discussed.

During 2016–2022, Medicare part D beneficiaries filled 8,674,460 clotrimazole-betamethasone dipropionate prescriptions. Annual rates were stable (30.9 prescriptions/1,000 beneficiary-years in 2022, enough for one in every 33 beneficiaries). Diagnostic testing was infrequent, particularly among internal medicine, family medicine, and general practitioners, suggesting potential opportunities to improve diagnostic and prescribing practices.

In December 2018, an outbreak of Salmonella Enteritidis infections was identified in Canada by whole-genome sequencing (WGS). An investigation was initiated to identify the source of the illnesses, which proved challenging and complex. Microbiological hypothesis generation methods included comparisons of Salmonella isolate sequence data to historical domestic outbreaks and international repositories. Epidemiological hypothesis generation methods included routine case interviews, open-ended centralized re-interviewing, thematic analysis of open-ended interview data, collection of purchase records, a grocery store site visit, analytic comparison to healthy control groups, and case–case analyses. Food safety hypothesis testing methods included food sample collection and analysis, and traceback investigations. Overall, 83 cases were identified across seven provinces, with onset dates from 6 November 2018 to 7 May 2019. Case ages ranged from 1 to 88 years; 60% (50/83) were female; 39% (22/56) were hospitalized; and three deaths were reported. Brand X profiteroles and eclairs imported from Thailand were identified as the source of the outbreak, and eggs from an unregistered facility were hypothesized as the likely cause of contamination. This study aims to describe the outbreak investigation and highlight the multiple hypothesis generation methods that were employed to identify the source.

An investigation into an outbreak of Salmonella Newport infections in Canada was initiated in July 2020. Cases were identified across several provinces through whole-genome sequencing (WGS). Exposure data were gathered through case interviews. Traceback investigations were conducted using receipts, invoices, import documentation, and menus. A total of 515 cases were identified in seven provinces, related by 0–6 whole-genome multi-locus sequence typing (wgMLST) allele differences. The median age of cases was 40 (range 1–100), 54% were female, 19% were hospitalized, and three deaths were reported. Forty-eight location-specific case sub-clusters were identified in restaurants, grocery stores, and congregate living facilities. Of the 414 cases with exposure information available, 71% (295) had reported eating onions the week prior to becoming ill, and 80% of those cases who reported eating onions, reported red onion specifically. The traceback investigation identified red onions from Grower A in California, USA, as the likely source of the outbreak, and the first of many food recall warnings was issued on 30 July 2020. Salmonella was not detected in any tested food or environmental samples. This paper summarizes the collaborative efforts undertaken to investigate and control the largest Salmonella outbreak in Canada in over 20 years.

This editorial summarises the clinical relevance of ‘chronopsychiatry’, defined as the interface between circadian science and mental health science. Chronopsychiatry represents a move towards time-variable perspectives on neurobiology and symptoms, with a greater emphasis on chronotherapeutic interventions.

Rift propagation, rather than basal melt, drives the destabilization and disintegration of the Thwaites Eastern Ice Shelf. Since 2016, rifts have episodically advanced throughout the central ice-shelf area, with rapid propagation events occurring during austral spring. The ice shelf's speed has increased by ~70% during this period, transitioning from a rate of 1.65 m d−1 in 2019 to 2.85 m d−1 by early 2023 in the central area. The increase in longitudinal strain rates near the grounding zone has led to full-thickness rifts and melange-filled gaps since 2020. A recent sea-ice break out has accelerated retreat at the western calving front, effectively separating the ice shelf from what remained of its northwestern pinning point. Meanwhile, a distributed set of phase-sensitive radar measurements indicates that the basal melting rate is generally small, likely due to a widespread robust ocean stratification beneath the ice–ocean interface that suppresses basal melt despite the presence of substantial oceanic heat at depth. These observations in combination with damage modeling show that, while ocean forcing is responsible for triggering the current West Antarctic ice retreat, the Thwaites Eastern Ice Shelf is experiencing dynamic feedbacks over decadal timescales that are driving ice-shelf disintegration, now independent of basal melt.

Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.

The early and sensitive detection of microbial contamination of kaolinite slurries is needed for timely treatment to prevent spoilage. The sensitivity, reproducibility, and time required by current methods, such as the dip-slide method, do not meet this challenge. A more sensitive, reproducible, and efficient method is required. The objective of the present study was to develop and validate such a method. The new method is based on the measured growth kinetics of indigenous kaolinite-slurry microorganisms. The microorganisms from kaolinite slurries with different contamination levels were eluted and quantified as colony-forming units (CFUs). Known quantities of E. coli (ATCC 11775) were inoculated into sterilized kaolinite slurries to relate kaolinite-slurry CFUs to true microbial concentrations. The inoculated slurries were subsequently incubated, re-extracted, and microbial concentrations quantified. The ratio of the known inoculated E. coli concentration to the measured concentration was expressed as the recovery efficiency coefficient. Indigenous microbial communities were serially diluted, incubated, and the growth kinetics measured and related to CFUs. Using the new method, greater optical densities (OD) and visible microbial growth were measured for greater dilutions of kaolinite slurries with large microbial-cell concentrations. Growth conditions were optimized to maximize the correlation between contamination level, microbial growth kinetics, and OD value. A Standard Bacterial Unit (SBU) scale with five levels of microbial contamination was designed for kaolinite slurries using the experimental results. The SBU scale was validated using a blind test of 50 unknown slurry samples with various contamination levels provided by the Imerys Company. The validation tests revealed that the new method using the SBU scale was more time efficient, sensitive, and reproducible than the dip-slide method.