Nonprofit organizations that serve the pediatric oncology community play a crucial role in disseminating quality information that can inform and support people living with childhood cancer, those that work in the field, and others who make key decisions or policies. These registered organizations can be challenging to locate, as the internet is flux with information and resources of varying quality, misinformation, and disinformation. There remains limited understanding of the knowledge mobilization landscape of these organizations in Canada.

This study will provide an overview of the pediatric oncology nonprofit organizational landscape and describe their knowledge mobilization efforts related to dissemination, highlighting existing strengths, gaps, and novel opportunities to strengthen and unite efforts.

A novel environmental scan methodology will be employed to search government and nonprofit organizations' databases. Independent reviewers will screen the websites of eligible organizations. Extracted data will be descriptively analyzed, geographically sorted, and presented in a tabular form with accompanying narrative.

This project received funding in 2024. We anticipate that preliminary results will be available by summer 2025. The search strategy for this study will be completed in the spring of 2025. One key project milestone for this environmental scan includes sharing drafts of the results from this strategy through expert consultations in the spring of 2025. After this milestone, a full set of preliminary results will be available by summer 2025, and the final manuscript will be submitted in fall 2025.

The environmental scan will explicate each step of our method to allow others the opportunity to garner understanding from our learnings. Findings will be disseminated to the broader community via social media, directly to the pediatric oncology network in Canada, and globally, through summaries, infographics, presentations, and traditional academic outputs. By doing so, the pediatric oncology community will have information pertinent to navigating these resources, and further steps can be devised to bolster the knowledge mobilization capacity in Canada.

DERR1-10.2196/76787.

Asthma is a debilitating disease, and its diagnosis and disease management remain imprecise. It continues to impose a major global burden on public health, medicine, and the economy. Asthma exhibits marked heterogeneity in clinical phenotypes, and environmental and genetic risk factors remain incompletely defined. Moreover, its significant geographical and ethnic variation limits diagnostic precision. They also hinder effective risk stratification and accurate prediction of disease exacerbations. To date, most asthma research and therapeutic development have focused on allergen-mediated immune responses. Conversely, the adverse effects of environmental chemical pollutants have received less attention. This imbalance has limited the development of a comprehensive understanding of asthma pathogenesis. It has also slowed progress toward truly precision-based therapies. Simultaneously, growing experimental and clinical evidence highlights causal links between environmental exposures and disease. The concepts of the exposome and exposomics have also emerged. These provide useful frameworks to study disease development and progression. In this review, we summarize recent multicenter studies on asthma. These studies show that environmental determinants of asthma are not uniform, as different asthma phenotypic clusters have distinct environmental exposure profiles. Moreover, environmentally driven metabolic reprogramming plays an important role, resulting in bioactive metabolites that also deserve careful attention. These factors are crucial for advancing precision environmental medicine.

Effective respiratory therapy relies heavily on inhaler device efficiency and patient technique. While device performance is well-documented in idealized induction ports, there remains a critical lack of data integrating patient-specific disease states to compare pressurized metered-dose inhaler (MDI) and valved holding chamber (VHC) efficiency against legacy dry powder inhaler (DPI) formulations. This study addresses this gap using Functional Respiratory Imaging (FRI) which combines high-resolution computed tomography (CT) scans with Computational Fluid Dynamics (CFD) to quantitatively assess aerosol deposition in asthma and Chronic Obstructive Pulmonary Disease (COPD) patient models. We evaluated the performance of MDIs alone and with various VHCs, against DPIs under optimal and sub-optimal inhalation profiles. Our results indicate that while MDIs alone require precise coordination, the addition of a VHC (AeroChamber Plus Flow-Vu) maintains high intrathoracic deposition and significantly minimizes oropharyngeal deposition, even with inhalation delays. Furthermore, the MDI/VHC combination demonstrated superior lung delivery compared to other tested VHCs and DPIs. Notably, the MDI/VHC system exhibited greater consistency across varying flow rates, whereas the DPIs tested showed higher sensitivity to sub-optimal maneuvers. Using FRI as tool for comparative inhaler assessment these results suggest that MDIs with appropriate VHCs provide the most consistent medication delivery for obstructive airway diseases.

Enterovirus D68 (EV-D68) has been implicated in clusters of acute flaccid myelitis (AFM) and severe respiratory illness; however, the magnitude and consistency of association across settings and over time remain uncertain. We quantified the association between EV-D68 detection and acute neurologic outcomes (particularly AFM) and explored design- and time-related heterogeneity. Following PRISMA 2020 and MOOSE guidance, we systematically identified observational studies reporting associations between EV-D68 detection and neurologic outcomes. Random effects meta-analysis was performed using REML with Knapp-Hartung adjustment; heterogeneity was summarised with τ² and I². Prespecified moderators were examined with meta-regression. Small-study effects were evaluated using contour-enhanced funnel plots, Egger and Peters tests, and PET-PEESE bias-adjusted models. PROSPERO registration: 1152300. Across 98 studies, the pooled odds ratio (OR) was 1.39 (95% CI 1.14-1.69), with high heterogeneity (I² = 98.9%; prediction interval 0.24-8.15). By design, respiratory surveillance studies showed stronger association (OR 1.59, 95% CI 1.35-1.86, k = 78) whereas AFM case-control studies did not (OR 0.86, 95% CI 0.40-1.86, k = 20). In multivariable meta-regression, study design and calendar year explained about 47% of inter-study variance. Predicted ORs declined from 2014 to 2022 across regions. Funnel asymmetry and small-study effects were suggested; PET-PEESE bias-adjusted estimates remained above the null. The EV-D68 outcome association is context-dependent and time-varying. Surveillance datasets enriched during outbreak waves drive the pooled signal, while AFM case-control designs yield attenuated estimates after adjustment. Standardising diagnostics and integrating design-specific surveillance will improve risk estimation and AFM preparedness.

Thoracic back pain is an understudied clinical entity, and few evidence-based guidelines exist for its evaluation. Pulmonary embolism can present atypically with referred pain to the thoracic region if the visceral pleura becomes involved.

A patient presented to the interventional pain clinic with 6 weeks of worsening multifocal back pain. Conservative management addressed his cervical and lumbar pain but did not improve his thoracic symptoms. A pulmonary embolism was incidentally found while evaluating unrelated intraabdominal complaints. Anticoagulation fully resolved the thoracic component of his pain.

Pulmonary embolism is a major cause of death and disability worldwide, and delays in diagnosis are associated with poorer outcomes. Atypical cases like this one highlight the need for clinical practice guidelines on the diagnosis and management of thoracic back pain.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has elucidated various extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2, including endocrine complications that affect the hypothalamic-pituitary-adrenal axis. Efforts to diagnose adrenal insufficiency in critically ill patients are challenging due to overlapping symptoms such as hypotension and fatigue. This challenge is amplified in patients with renal comorbidities, among whom classic electrolyte derangements of adrenal insufficiency (eg, hyperkalemia) may be masked by acute kidney injury (AKI) and renal replacement therapy. CASE REPORT A 46-year-old man with chronic kidney disease and an ileostomy presented with fatigue, abdominal pain, high ileostomy output, and hypotension. Evaluation revealed COVID-19 with concomitant AKI, metabolic acidosis, and hyperkalemia. Initial management via hemodialysis and remdesivir corrected the acidosis and electrolyte abnormalities. However, after renal recovery and discontinuation of dialysis, the patient developed recurrent, refractory hypotension, hyperkalemia, and hypoglycemia, prompting assessment for adrenal dysfunction. Morning cortisol levels were critically low. A subsequent cosyntropin stimulation test showed a blunted cortisol response, confirming adrenal insufficiency. Hydrocortisone and fludrocortisone treatments resulted in hemodynamic stabilization and resolution of the electrolyte abnormalities. CONCLUSIONS This case highlights the "masking" effect of dialysis on the clinical presentation of adrenal insufficiency. Clinicians must maintain a high index of suspicion for adrenal insufficiency in patients with COVID-19 who display recurrent hypotension or hyperkalemia despite renal recovery. Furthermore, the presence of hyperkalemia in a patient with high ileostomy output is paradoxical and should prompt immediate evaluation for mineralocorticoid deficiency.

Blood pressure (BP) management following successful reperfusion after endovascular thrombectomy (EVT) is critical in achieving favorable clinical outcomes. Individualized BP management using predictive modeling by machine learning may further improve prediction of functional outcomes. This study was a retrospective analysis of data from the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, a randomized controlled trial comparing between intensive and conventional BP management during the 24 h after successful recanalization by EVT from June 18, 2020, to November 28, 2022. The trial was conducted across 19 centers in South Korea. Machine learning models were developed to predict functional independence (90-day modified Rankin Scale 0 to 2). Model performance was compared between clinical variables only and systolic blood pressure (SBP) metrics in addition to clinical variables. In addition, the Shapley additive explanations (SHAP) analysis was performed to provide model explanation and understand the importance of SBP metrics. A total of 288 patients (61.1% men, median age 75 years [interquartile range, 65-81]) were included. Among the six algorithms, the deep neural network model incorporating SBP metrics performed best on validation, achieving an area under the curve of 0.86 (95% confidence interval, 0.76-0.92) which was significantly better than the model using only clinical variables (area under the curve 0.80 [95% confidence interval, 0.69-0.88], P = .037). Among SBP metrics, SHAP analysis identified time rate of SBP and minimum SBP as important features, with time rate showing greater influence in the intensive group and minimum SBP in the conventional group. Integrating SBP metrics with clinical variables significantly improved machine learning performance in predicting functional outcomes after successful EVT. Explainable artificial intelligence (AI) identified time rate and minimum SBP as key predictors of outcome. Trial Registration Information: ClinicalTrials.gov (NCT04205305; registered December 17, 2019).

Intraventricular hemorrhage (IVH) is a severe complication in premature neonates, occurring in 25%-30% of cases and often leading to posthemorrhagic hydrocephalus (PHH). When blood clots in the cerebrospinal fluid (CSF), preventing permanent shunt placement, temporary interventions are considered. Ventriculosubgaleal shunt (VSGS) utilizes the subgaleal space to absorb and drain excess CSF, reducing infection risk and allowing hydrocephalus control until the neonate reaches an appropriate weight and CSF clarity. This systematic review and meta-analysis evaluate the safety and efficacy of VSGS in treating neonatal PHH. A systematic review was conducted using Medline, Embase, and Web of Science following Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 neonates. The primary outcomes analyzed were VSGS-related infection, VSGS revision, VSGS catheter migration, catheter obstruction, VSGS-related CSF leakage, permanent ventriculoperitoneal shunt (VPS) placement, overall mortality, and procedure-related mortality. A total of nineteen studies, encompassing 562 neonates, were included in our analysis. The pooled VSGS-related infection rate was 9% (95%CI: 5% to 12%). The need for VSGS revision was observed in 4% of cases (95%CI: 0% to 8%). The catheter obstruction rate was 2% (95% CI: 0% to 5%), while VSGS catheter migration occurred in 1% of cases (95%CI: 0% to 5%). VSGS-related CSF leakage was reported in 6% of neonates (95%CI: 3% to 9%). Permanent VPS placement was required in 75% of patients (95%CI: 67% to 82%). The overall mortality rate was 10% (95%CI: 4% to 16%), and the procedure-related mortality rate was 1% (95%CI: 0% to 2%). This systematic review and meta-analysis identified VSGS as a safe and effective option for treating hydrocephalus caused by IVH in premature neonates.

Heart failure (HF) is a global burden and, irrespective of age, sex, race, nationality, and geography, affects individuals across the world. Several reports mentioned that, globally, more than 64 million people, which accounts for 1% to 3% of the total global population, are living with HF. In the United States, approximately 6.7 million people older than 20 years have some form of HF, and it is expected to rise to 8.5 million (approximately 3% of the US population) by 2030. HF was linked to 85,037 deaths in 2021, which was 45.8% higher than in 2011. The direct and indirect healthcare costs to treat and manage HF keep increasing both in the United States and around the world. There are several different classes of therapeutic agents available to treat HF. The current recommended therapies include the following drug classes: renin-angiotensin-aldosterone system inhibitors, angiotensin receptor-neprilysin inhibitor, diuretics, β-blockers, and sodium-glucose cotransporter inhibitors. The present article reviews the pathophysiology of HF and focuses on the Food and Drug Administration-approved HF therapeutic agents and insights from corresponding clinical studies.

People living with HIV have an increased risk of cardiovascular disease, but data on the development and consequences of hypertension remain limited. Using data from REPRIEVE, a global randomised trial of pitavastatin for primary cardiovascular prevention among people with HIV, we evaluated whether pitavastatin reduces the incidence of hypertension among participants without hypertension at baseline and whether incident hypertension is associated with subsequent major adverse cardiovascular events (MACE).

We conducted a prespecified secondary analysis of participants without evidence of hypertension at REPRIEVE entry (baseline). REPRIEVE (NCT02344290) was a global, randomised, double-blind, placebo-controlled trial that enrolled adults with HIV aged 40-75 years at low-to-moderate atherosclerotic cardiovascular risk, receiving stable antiretroviral therapy. The primary outcome in this secondary analysis was incident hypertension based on clinical diagnosis according to standard criteria. Included participants were those without hypertension at baseline; excluded were those with documented hypertension, antihypertensive treatment use, systolic blood pressure of 140 mm Hg or higher, or diastolic blood pressure of 90 mm Hg or higher. The association between incident hypertension and a secondary outcome of MACE was evaluated in a time-updated analysis. Analyses used both Cox and Fine-Gray proportional hazards models and Poisson regression.

Of 7769 participants enrolled in REPRIEVE, 4989 (64%) without hypertension at baseline were included (2496 assigned to pitavastatin and 2493 to placebo) in this secondary analysis. The median age was 49 years (IQR 45-54); 1464 (29%) were women and 3525 (71%) men; and the median systolic and diastolic blood pressures at baseline were 102 mm Hg and 76 mm Hg, respectively. Over a median follow-up of 5·0 years (IQR 4·4-5·8), 668 (13%) participants developed hypertension. Participants randomly assigned to pitavastatin showed a modestly lower incidence of hypertension (24·7 per 1000 person-years vs 29·6 per 1000 person-years), corresponding to a 17% relative risk reduction (cause-specific hazard ratio [HR] 0·83, 95% CI 0·71-0·97; p=0·017). Risk factors of incident hypertension included old age, high BMI, metabolic syndrome, reduced estimated glomerular filtration rate (eGFR), and Black race in high-income regions. Among participants with incident hypertension, 581 (87%) initiated antihypertensive therapy. Of 213 who initiated antihypertensive therapy after diagnosis of hypertension, 159 (74·6%) were controlled 4 years after diagnosis. Incident hypertension was associated with a higher risk of MACE during follow-up (subdistribution HR 2·16, 95% CI 1·32-3·52) in modelling adjusted for baseline cardiovascular risk score.

These findings suggest additional cardiovascular benefits of pitavastatin on hypertension among people with HIV targeted for primary cardiovascular prevention.

National Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, ViiV Healthcare, Instituto de Salud Carlos III, and the European Regional Development Fund.