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Type d'Item : Item , Vancomycin optimised dosing regimens for critically ill patients receiving renal replacement therapy(2026-08-04) Ulldemolins, Marta; Lipman, Jeffrey; Liu, Xin; Abdul-Aziz, Mohd-Hafiz; Baptista, João P.; Bilgrami, Irma; Bitker, Laurent; Boidin, Clement; Brinkmann, Alexander; Cheng, Vesa; Choi, Gordon; Cole, C. Louise; De Waele, Jan J.; Deans, Renae; Eastwood, Glenn M.; Escobar, Leslie; Frey, Otto R.; Garreau, Romain; Goutelle, Sylvain; Gresham, Rebecca; Hernandez-Mitre, Maria P.; Jamal, Janattul A.; Joynt, Gavin M.; Kanji, Salmaan; Kielstein, Jan T.; Kluge, Stefan; König, Christina; Koulouras, Vasilios P.; Lassig-Smith, Melissa; Laterre, Pierre-Francois; Lee, Anna; Lefrant, Jean-Yves; Lei, Katie; Leung, Patricia; Mat-Nor, Mohd-Basri; Mudaliar, Yugan; Ostermann, Marlies; Paul, Sanjoy K.; Peake, Sandra L.; Rello, Jordi; Richard, Jean-Christophe; Richards, Brent; Roberts, Darren M.; Roberts, Michael S.; Roehr, Anka C.; Roger, Claire; Seoane, Leonardo; Shekar, Kiran; Sinnollareddy, Mahipal; Sousa, Eduardo; Spring, Anna; Starr, Therese; Stephens, Dianne; Taccone, Fabio S.; Thomas, Jane; Turnidge, John; Valkonen, Miia; Wallis, Steven C.; Williams, Tricia; Wittebole, Xavier; Wright, Daniel F. B.; Zikou, Xanthi T.; Roberts, Jason A.Abstract Background Optimal dosing of vancomycin in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to high pharmacokinetic variability. We aimed to develop individualised vancomycin dosing recommendations that optimise efficacy while minimising toxicity. Methods Prospective, international, pharmacokinetic study enrolling critically ill patients treated with vancomycin and various RRT modalities. A population pharmacokinetic model was developed, externally validated and applied to perform Monte Carlo dosing simulations. We calculated the probability of each dosing regimen to achieve the efficacy target against methicillin-resistant Staphylococcus aureus (ratio of the area under the concentration–time curve to the minimum inhibitory concentration (AUC0-24 h/MIC) ≥ 400) without exceeding the toxicity threshold (AUC0-24 h ≥ 700 mg.h/L). Results We enrolled 65 critically ill patients from 6 countries receiving continuous RRT (50.8%) or sustained low-efficiency dialysis (49.2%). The model was developed using 1318 pre- and post-filter plasma and effluent concentrations and validated with a new dataset (19 critically ill patients, 124 pre-filter plasma concentrations), with 47.4% patients concomitantly treated with extracorporeal membrane oxygenation. Predictive performance was high (median prediction error =—13.4%). Simulations showed that dosing requirements were dependent on actual body weight and RRT intensity and duration (p < 0.05). An optimised dosing nomogram was subsequently developed considering these clinical characteristics. Conclusions Actual body weight and RRT intensity and duration are the main determinants of vancomycin dosing requirements in critically ill patients treated with RRT. Efficacious, non-toxic dosing may be guided by the optimised nomogram.Type d'Item : Item , Advancing palliative medicine training in adolescent and young adult care: a needs assessment study(2026-06-22) Bakhsh, Abdulaziz; Srikanthan, Amirrtha; Cleyn, Sarah; van Zanten, Stephanie C. V.; Tutelman, Perri; Krueger-Naug, Anne M.; Parsons, Henrique; Lapenskie, Julie; Ruller, Sydney; Halman, Samantha; Downar, James; Abdelaal, MohamedAbstract Background Adolescents and young adults (AYAs), defined as individuals aged 15–39 years, face unique medical, psychosocial, and existential challenges when living with life-limiting illness. Despite evidence supporting early palliative care integration, Canadian adult palliative care curricula lack formalized AYA-specific competencies. Healthcare providers consistently report insufficient preparation in this area. Methods A descriptive cross-sectional needs assessment survey was administered nationally to physicians who completed Canadian adult palliative care residency training between 2019 and 2024. A multidisciplinary steering committee of experts in AYA palliative care and medical education, alongside a patient partner, guided the development of the bilingual 25-item questionnaire guided by an established framework for medical education survey design. The questionnaire assessed clinical exposure, self-rated knowledge across 20 competency areas, comfort levels across 21 competency areas, training needs and barriers, and preferred learning formats. Responses were anonymous. Descriptive statistics were used for analysis. Results Of 71 responses received, 55 met eligibility criteria for analysis (response rate 35%, eligibility rate 77%). Only 31% of participants received AYA-specific training during residency. Most participants (82%) reported low comfort when caring for the youngest AYA age group (15–18 years). The greatest knowledge gaps were in pediatric-to-adult care transitions (69%), sexual health and fertility concerns (62%), and social support navigation (39%). Top training priorities were AYA developmental and psychosocial factors (75%), grief and bereavement support (65%), and care transitions (60%). The most common training barriers were limited clinical exposure (78%), lack of mentors (65%), and absence of AYA-specific programs (61%). Conclusions Our findings revealed substantial gaps in training, knowledge, and comfort levels in providing AYA palliative care among recent graduates from the adult palliative care programs in Canada. This may represent an initial step towards the development of a competency-based AYA-focused residency training curriculum.Type d'Item : Item , Complexity of medical needs and primary care attachment shape patient experiences with episodic virtual primary care: a mixed methods study in two Canadian provinces(2026-06-24) Correia, Rebecca H.; Hasan, Emran; Gallant, François; Doucet, Shelley; Kiran, Tara; Lapointe-Shaw, Lauren; MacNeill, A. L.; Thelen, Rachel; Welton, Stephanie; Easley, Julie; Grudniewicz, Agnes; Hedden, Lindsay; Lavergne, M. R.Abstract Background Episodic virtual care (EVC) offers patients rapid access to virtual primary care services but lacks relational continuity with a primary care clinician or team. We investigated patients’ experiences with EVC and examined differences based on access to a regular primary care clinician and self-reported complexity of medical needs. Methods In this convergent parallel mixed methods study, we conducted a descriptive and exploratory survey of EVC users’ health service access, self-reported medical needs, EVC use, and demographics. Participants included adults (aged ≥ 18) living in Nova Scotia or New Brunswick who self-reported using EVC in the past year. We used descriptive statistics to summarize numeric and ordinal data of patient experience and stratified findings by having a regular primary care clinician and medical complexity. We conducted inductive content analysis of free-text survey responses. We integrated quantitative and qualitative data at the interpretation phase. Results We identified mixed experiences among EVC users, with quantitative data portraying virtual care experiences more favourably than free-text responses. Most users felt EVC met their health needs, although those without a regular primary care clinician and with greater medical complexity tended to rate experiences less favourably. In free-text responses, some participants expressed concerns with the technological aspects of virtual visits and voiced preferences for in-person care. Patients with a regular primary care clinician tended to access EVC for short-term health concerns, whereas those without a regular primary care clinician sought care for ongoing/chronic problems and prescription renewals. Conclusions EVC is helping to address some gaps in access, particularly for patients without a regular primary care clinician, by providing care where there might otherwise be none. However, EVC often falls short of meeting ongoing and more comprehensive care needs, underscoring the importance of improving access to longitudinal primary care.Type d'Item : Item , Reimagining Community Youth Sport Events: Relational Lessons from the Arctic Winter Games(Université d'Ottawa / University of Ottawa, 2026-09-04) Alavi, Salman; Dallaire, ChristineThis thesis examines the Arctic Winter Games (AWG) as a community youth sport event that offers important lessons for reimagining such events around relationality. While sport events are often evaluated through economic, competitive, or performance-oriented outcomes, this thesis shifts attention to their relational significance. It asks how the AWG creates conditions for meaningful relational experiences, what kinds of relational encounters participants describe during and after the event, and what this case can teach us about the social possibilities of community youth sport events. Drawing on qualitative secondary data analysis, this thesis analyzes materials from two broader research projects on the AWG, including interviews, open-ended survey responses, organizational documents, and observation notes. The analysis is primarily informed by Hartmut Rosa's theory of resonance and Victor Turner's concepts of liminoid and communitas, along with related concepts of relationality. Together, these theoretical perspectives allow the thesis to examine not only how significant relationships emerge during the AWG, but also how particular event conditions may increase the possibility of meaningful relational encounters. Across three article-based analysis, this thesis develops a layered understanding of relationality in the AWG. The first article examines the AWG as a potential space of social resonance, showing how organizational, spatial, temporal, and psychological conditions can support meaningful connection while also illustrating key elements of resonance, such as affection and response, and its preconditions, such as openness and curiosity. The second article considers the pressures that may inhibit resonance in youth sport events, including hyper-competition, sportification, and instrumental rationality, while showing how the AWG may soften these pressures. The third article explores the AWG as a liminoid configuration in which participants experience various forms of relationality, including friendship, networking, belonging, emotional and cultural resonance, enchantment, communitas, and continued involvement after the Games. Taken together, this thesis argues that the AWG can be understood not simply as a youth sport competition, but as an illustrative case for reimagining community youth sport events around relationality. Its significance lies less in producing relationships automatically than in showing how a community-oriented philosophy, sociocultural programming, festive atmosphere, emphasis on northern and Indigenous values, and broader developmental values can create conditions in which relational encounters become more likely.Type d'Item : Item , The Impact of Omega-3 Polyunsaturated Fatty Acids on Skeletal Muscle Regeneration in Aged Mice(Université d'Ottawa / University of Ottawa, 2026-09-04) Chabert, Cassandra; Dort, JunioSkeletal muscle regeneration is a tightly regulated process mediated by the immune system and muscle stem cells (MuSCs). In aged skeletal muscle tissue, chronic low-grade inflammation drives maladaptive tissue remodeling. Currently, there are no approved therapies to attenuate age-related skeletal muscle disorders, leaving the elderly susceptible to loss of muscle mass/function, fragility, and a decline in quality of life. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are bioactive lipids with anti-inflammatory properties, primarily stemming from their metabolites. In this study, we have shown that n-3 PUFAs have a direct effect on myoblasts in vitro, and we have shown the effect of an enriched n-3 PUFA diet on skeletal muscle regeneration in vivo using a cardiotoxin injury model. Our results suggest that an enriched n-3 PUFA diet may increase anti-inflammatory markers in the blood, but the effect on inflammation in the tissue is limited, with the exception of inter-fiber lipid deposition. -- La régénération du muscle squelettique est un processus impliquant l'interaction entre le système immunitaire et les cellules souches musculaires (MuSC). En vieillissant, ce processus délicat se dérégule à cause de l'inflammation chronique. Actuellement, il n'existe aucun traitement approuvé pour atténuer les troubles musculo-squelettiques liés à l'âge, ce qui rend les personnes âgées vulnérables à une perte de masse et de fonction du muscle. Les acides gras polyinsaturés omega-3 (n-3 PUFAs) sont des lipides bioactifs qui produisent des effets anti-inflammatoires qui proviennent principalement de leurs métabolites (SPMs). Dans cette étude, nous avons démontré que les n-3 PUFAs ont un effet direct sur les myoblasts in vitro et nous avons démontré l'effet d'un régime enrichi en n-3 PUFAs sur la régénération du muscle squelettique in vivo. Nos résultats suggèrent qu'un régime riche en n-3 PUFAs augmente les marqueurs antiinflammatoires sanguins, mais son effet sur l'inflammation tissulaire est limité, à l'exception d'une réduction du dépôt lipidique interfibre.