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Item A Nutrition Education Intervention Positively Affects the Diet–Health-Related Practices and Nutritional Status of Mothers and Children in a Pulse-Growing Community in Halaba, South Ethiopia(Children, 2024-11) Lombamo, Getahun; Henry, Carol; Zello, GordonObjective: We conducted a six-month nutrition education intervention focused on the consumption of pulses and other foods to assess the effect on knowledge, attitude and practice (KAP) as well as the nutritional status of children and mothers from two pulse-growing communities in Halaba, south Ethiopia. Methods: About 200 mother–child pairs in each of two purposively selected communities participated in this intervention study. A six-month nutrition education programme, involving interactive monthly community meetings and home visits, was offered to one of the two communities and the other served as a control/comparison. This study incorporated the use of Health Belief Model constructs to assess the KAP/perceptions of mothers surrounding pulse and other food consumptions, as well as nutrition-related issues before and after the intervention. Objective measures included dietary diversity scores (DDSs), one-day weighed dietary intakes and nutritional status measures based on anthropometric information. Demographics and socioeconomic information were also collected at baseline and endline. Results: Significant improvements (p < 0.05) were found in the intervention group on the KAP and perceptions of pulse nutrition benefits among mothers, DDSs and pulse and animal source food consumption indexes for mothers and children and the mean body-mass-index-for-age Z-score and wasting among children. Conclusions: Community-based nutrition education interventions involving monthly interactive community meetings and home visits in pulse-growing communities from a resource-poor country like Ethiopia can be effective in improving mothers’ knowledge of pulse nutrition and consumption frequency, leading to improvements in the DDSs of children and mothers while decreasing child underweight and wasting.Item A theory-based model of cumulative activity(Scientific Reports, 2022-09) Phillips, Kole; Stanley, Kevin; Fuller, DanielEnergy expenditure can be used to examine the health of individuals and the impact of environmental factors on physical activity. One of the more common ways to quantify energy expenditure is to process accelerometer data into some unit of measurement for this expenditure, such as Actigraph activity counts, and bin those measures into physical activity levels. However, accepted thresholds can vary between demographics, and some units of energy measurements do not currently have agreed upon thresholds. We present an approach which computes unique thresholds for each individual, using piecewise exponential functions to model the characteristics of their overall physical activity patterns corresponding to well established sedentary, light, moderate and vigorous activity levels from the literature. Models are fit using existing piecewise fitting techniques and software. Most participants’ activity intensity profile is exceptionally well modeled as piecewise exponential decay. Using this model, we find emergent groupings of participant behavior and categorize individuals into non-vigorous, consistent, moderately active, or extremely active activity intensity profiles. In the supplemental materials, we demonstrate that the parameters of the model correlate with demographics of age, household size, and level of education, inform behavior change under COVID lockdown, and are reasonably robust to signal frequency.Item Acute stress, but not corticosterone, facilitates acquisition of paired associates learning in rats using touchscreen-equipped operant conditioning chambers(Elsevier, 2018) Roebuck, Andrew; Liu, Max; Lins, Brittney; Scott, Gavin; Howland, John G.Item ALF-Score++, a novel approach to transfer knowledge and predict network-based walkability scores across cities(Scientific Reports, 2022-08) Alfosool, Ali M. S.; Chen, Yuanzhu; Fuller, DanielWalkability is an important measure with strong ties to our health. However, there are existing gaps in the literature. Our previous work proposed new approaches to address existing limitations. This paper explores new ways of applying transferability using transfer-learning. Road networks, POIs, and road-related characteristics grow/change over time. Moreover, calculating walkability for all locations in all cities is very time-consuming. Transferability enables reuse of already-learned knowledge for continued learning, reduce training time, resource consumption, training labels and improve prediction accuracy. We propose ALF-Score++, that reuses trained models to generate transferable models capable of predicting walkability score for cities not seen in the process. We trained transfer-learned models for St. John’s NL and Montréal QC and used them to predict walkability scores for Kingston ON and Vancouver BC. MAE error of 13.87 units (ranging 0–100) was achieved for transfer-learning using MLP and 4.56 units for direct-training (random forest) on personalized clusters.Item ALF–Score—A novel approach to build a predictive network–based walkability scoring system(PLoS One, 2022) S. Alfosool, Ali M.; Chen, Yuanzhu; Fuller, DanielWalkability is a term that describes various aspects of the built and social environment and has been associated with physical activity and public health. Walkability is subjective and although multiple definitions of walkability exist, there is no single agreed upon definition. Road networks are integral parts of mobility and should be an important part of walkability. However, using the road structure as nodes is not widely discussed in existing methods. Most walkability measures only provide area–based scores with low spatial resolution, have a one–size–fits–all approach, and do not consider individuals opinion. Active Living Feature Score (ALF–Score) is a network–based walkability measure that incorporates road network structures as a core component. It also utilizes user opinion to build a high–confidence ground–truth that is used in our machine learning pipeline to generate models capable of estimating walkability. We found combination of network features with road embedding and points of interest features creates a complimentary feature set enabling us to train our models with an accuracy of over 87% while maintaining a conversion consistency of over 98%. Our proposed approach outperforms existing measures by introducing a novel method to estimate walkability scores that are representative of users opinion with a high spatial resolution, for any point on the road.Item An economic analysis of the health-related benefits associated with bicycle infrastructure investment in three Canadian cities(PLoS One, 2021-02-08) Whitehurst, David; DeVries, Danielle N; Fuller, Daniel; Winters, MeghanObjectives Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020). Method The World Health Organization’s Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016–2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: ‘no change’, ‘moderate change’ (a 2% increase), and ‘major change’ (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs. Results Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28–69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9–18 premature deaths prevented and a reduction of 87–142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19–43 premature deaths prevented and 209–349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs. Conclusion Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.Item Associations between gentrification, census tract-level socioeconomic status, and cycling infrastructure expansions in Montreal, Canada(SSM - Population Health, 2024-02) Kiani, Behzad; Thierry, Benoit; Apparicio, Philippe; Firth, Caislin; Fuller, Daniel; Winters, Meghan; Kestens, YanBackground: Cycling infrastructure investments support active transportation, improve population health, and reduce health inequities. This study examines the relationship between changes in cycling infrastructure (2011–2016) and census tract (CT)-level measures of material deprivation, visible minorities, and gentrification in Montreal. Methods: Our outcomes are the length of protected bike lanes, cyclist-only paths, multi-use paths, and on-street bike lanes in 2011, and change in total length of bike lanes between 2011 and 2016 at the CT level. Census data provided measures of the level of material deprivation and of the percentage of visible minorities in 2011, and if a CT gentrified between 2011 and 2016. Using a hurdle modeling approach, we explore associations among these CT-level socioeconomic measures, gentrification status, baseline cycling infrastructure (2011), and its changes (2011–2016). We further tested if these associations varied depending on the baseline level of existing infra- structure, to assess if areas with originally less resources benefited less or more. Results: In 2011, CTs with higher level of material deprivation or greater percentages of visible minorities had less cycling infrastructure. Overall, between 2011 and 2016, cycling infrastructure increased from 7.0% to 10.9% of the road network, but the implementation of new cycling infrastructure in CTs with no pre-existing cycling infrastructure in 2011 was less likely to occur in CTs with a higher percentage of visible minorities. High-income CTs that were ineligible for gentrification between 2011 and 2016 benefited less from new cycling infrastructure implementations compared to low-income CTs that were not gentrified during the same period. Conclusion: Montreal’s municipal cycling infrastructure programs did not exacerbate socioeconomic disparities in cycling infrastructure from 2011 to 2016 in CTs with pre-existing infrastructure. However, it is crucial to pri- oritize the implementation of cycling infrastructure in CTs with high populations of visible minorities, particularly in CTs where no cycling infrastructure currently exists.Item Building CapaCITY/É for sustainable transportation: Protocol for an implementation science research program in healthy cities(BMJ Open, 2024) Winters, Meghan; Fuller, Daniel; Cloutier, Marie-Soleil; Harris, M Anne; Howard, Andrew; Kestens, Yan; Kirk, Sara; Macpherson, Alison; Moore, Sarah; Rothman, Linda; Shareck, Martine; Tomasone, Jennifer R; Laberee, Karen; Stephens, Zoé Poirier; Sones, Meridith; Ayton, Darshini; Batomen , Brice ; Bell, Scott; Collins, Patricia; Diab, Ehab; Giles, Audrey R; Hagel, Brent E; Harris, Mike S; Harris, Patrick; Lachapelle, Ugo; Manaugh, Kevin; Mitra, Raktim; Muhajarine, Nazeem; Myrdahl, Tiffany Muller; Pettit, Christopher J; Pike, Ian; Skouteris, Helen; Wachsmuth, David; Whitehurst, David; Beck, BenIntroduction: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. Methods and analysis: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. Ethics and dissemination: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.Item Cancer Cell’s Achilles Heels: Considerations for Design of Anti-Cancer Drug Combinations(International Journal of Molecular Sciences, 2024-12) Gahramanov, Valid; Vizeacoumar, Frederick Sagayaraj; Morales, Alain Morejon; Bonham, Keith; Sakharkar, Meena K.; Kumar, Santosh; Vizeacoumar, Franco; Freywald, Andrew; Sherman, MichaelLoss of function screens using shRNA (short hairpin RNA) and CRISPR (clustered regularly interspaced short palindromic repeats) are routinely used to identify genes that modulate responses of tumor cells to anti-cancer drugs. Here, by integrating GSEA (Gene Set Enrichment Analysis) and CMAP (Connectivity Map) analyses of multiple published shRNA screens, we identified a core set of pathways that affect responses to multiple drugs with diverse mechanisms of action. This suggests that these pathways represent “weak points” or “Achilles heels”, whose mild disturbance should make cancer cells vulnerable to a variety of treatments. These “weak points” include proteasome, protein synthesis, RNA splicing, RNA synthesis, cell cycle, Akt-mTOR, and tight junction-related pathways. Therefore, inhibitors of these pathways are expected to sensitize cancer cells to a variety of drugs. This hypothesis was tested by analyzing the diversity of drugs that synergize with FDA-approved inhibitors of the proteasome, RNA synthesis, and Akt-mTOR pathways. Indeed, the quantitative evaluation indicates that inhibitors of any of these signaling pathways can synergize with a more diverse set of pharmaceuticals, compared to compounds inhibiting targets distinct from the “weak points” pathways. Our findings described here imply that inhibitors of the “weak points” pathways should be considered as primary candidates in a search for synergistic drug combinations.Item Changes in physical activity after joining a bikeshare program: A cohort of new bikeshare users(International Journal of Behavioral Nutrition and Physical Activity, 2022-10) Auchincloss, Amy; Michael, Yvonne L.; Niamatullah, Saima; Li, Siyu; Melly, Steven J; Pharis, Meagan L; Fuller, DanielBackground There are hundreds of bikeshare programs worldwide, yet few health-related evaluations have been conducted. We enrolled a cohort of new bikeshare members in Philadelphia (Pennsylvania, USA) to assess whether within-person moderate and vigorous physical activity (MVPA) increased with higher use of the program and whether effects differed for vulnerable sub-groups. Methods During 2015–2018, 1031 new members completed baseline and one-year follow-up online surveys regarding their personal characteristics and past 7-day MVPA minutes per week (minutes per week with- and without walking). Participants were linked to their bikeshare trips to objectively assess program use. Negative binomial (for continuous outcomes) and multinomial (for categorical outcomes) regression adjusted for person characteristics (socio-demographics, health), weather, biking-infrastructure, and baseline biking. Results Participant median age was 30, 25% were of Black or Latino race/ethnicity, and 30% were socioeconomically disadvantaged. By follow-up, personal bike ownership increased and 75% used bikeshare, although most used it infrequently. Per 10 day change in past year (PY) bikeshare use, non-walking MVPA min/wk increased 3% (roughly 6 min/wk, P < 0.014). More days of bikeshare was also associated with change from inactive to more active (odds ratio for ≥ 15 days in PY vs. no bikeshare use 1.80, CI 1.05–3.09, P < 0.03). Results were consistent across vulnerable sub-groups. In general, impacts on MVPA were similar when exposure was personal bike or bikeshare. Conclusions Bikeshare facilitated increases in cycling, slightly increased non-walking MVPA, and showed potential for activating inactive adults; however, for larger program impact, members will need to use it more frequently.Item Changes in physical activity among Canadian adults more than 6 months into the COVID-19 pandemic: a secondary analysis of the INTERACT cohort study(BMJ Open, 2024-09) Sturrock, Shelby; Gesink, Dionne; Winters, Meghan; Kestens, Yan; Stanley, Kevin; Moineddin, Rahim; Woodruff, Sarah; Fuller, DanielObjective: To estimate the effect of (a) the COVID-19 pandemic and (b) COVID-19 restriction stringency on daily minutes of device-measured moderate-to-vigorous physical activity (MVPA). Design Physical activity data were collected from theINTerventions, Equity, Research and Action in Cities Team (INTERACT) cohorts in Montreal, Saskatoon and Vancouver before (May 2018 to February 2019, ‘phase 1’) and during the pandemic (October 2020 to February 2021, ‘phase 2’). We estimated the effect of the two exposures by comparing daily MVPA measured (a) before vs during the pandemic (phase 1 vs phase 2) and (b) at different levels of COVID-19 restriction stringency during phase 2. Separate mixed effects negative binomial regression models were used to estimate the association between each exposure and daily MVPA, with and without controlling for confounders. Analyses were conducted on person-days with at least 600min of wear time. Effect modification by gender, age, income, employment status, education, children in the home and city was assessed via stratification. Setting: Montreal (Quebec), Saskatoon (Saskatchewan) and Vancouver (British Columbia), Canada. Main outcome measure: Daily minutes of MVPA, as measured using SenseDoc, a research-grade accelerometer device. Results: Daily minutes of MVPA were 21% lower in phase 2 (October 2020 to February 2021) compared with phase 1 (May 2018 to February 2019), controlling for gender, age, employment status, household income, education, city, weather and wear time (rate ratio=0.79, 95%CI 0.69, 0.92). This did not appear to be driven by changes in the sample or timing of data collection between phases. The results suggested effect modification by employment, household income and education. Restriction stringency was not associated with daily MVPA between October 2020 and February 2021 (adjusted rate ratio=0.99, 95%CI 0.96, 1.03). Conclusions: Between October 2020 and February 2021, daily minutes of MVPA were significantly lower than 2 years prior, but were not associated with daily COVID-19 restriction stringency.Item Chronic maternal hyperglycemia induced during mid-pregnancy in rats increases RAGE expression, augments hippocampal excitability, and alters behavior of the offspring(Elsevier, 2015) Chandna, Andrew; Kuhlmann, Naila; Bryce, Courtney; Greba, Quentin; Campanucci, Veronica; Howland, John GItem Clozapine, relapse, and adverse events: a 10-year electronic cohort study in Canada(The British Journal of Psychiatry, 2024-09) Balbuena, Lloyd; Halayka, Shawn; Lee, Andrew; AHMED, AG; Hinz, Tamara; Kolla, Nathan; Pylypow, JennaBackground Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings. Aims To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts. Method Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics. Results In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively. Conclusions Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.Item Clozapine, Relapse, and Adverse Events: A 10-Year Electronic Cohort Study in Canada: Commentary, Author Response(2024) Halayka, Shawn; Balbuena, LloydWe agree with Kikuchi that the diversity of diagnoses may have obscured clozapine’s risk-benefit balance in our paper (1). Hence, our findings may have reflected the lower range of the overall benefit of clozapine. Table 1 shows the expected count of rehospitalization events stratified by index diagnosis in adult patients. These were calculated using flexible survival models implemented in the STPM3 Stata package (2). The above figures show that clozapine had fewer relapse events compared to other drugs in patients with schizophrenia and schizoaffective disorders. In patients with bipolar disorder, the relapse events were the same, but clozapine had higher adverse events. The reverse was true in schizoaffective disorder patients: lower relapse events for clozapine but the same adverse event counts as other drugs. The child and youth cohort could not be stratified by diagnosis because of low numbers. We agree with Kikuchi that the adverse events analysis was tilted in favor of other antipsychotics. Suicide attempts and deaths were not available in the data, so clozapine’s benefit is probably underestimated (3) while adverse events more specific to other drugs are probably underestimated. The decision to exclude unmedicated periods was deliberate, since our objective was a head-to-head comparison of medications. In a previous paper (4) we found that over a five-year period, schizophrenia patients, on average, spent 11 months without medication and only 17 days in clozapine. Within-person analysis was considered, but this technique discards the records of people who did not switch from other drugs to clozapine or vice-versa. In our data, these patients made up the majority. In summary, our register-based study shows that clozapine is an effective medication, with benefits and risks that require balancing.Item Comment on Bisson et al. Novel Approach to Proficiency Testing Highlights Key Practice Variations in Cancer Biomarker Delivery. J. Mol. Pathol. 2024, 5, 1–10(MDPI, 2024-06-27) Torlakovic, Emina; Normanno, NicolaItem Cross-sectional study evaluating the effectiveness of the Mozambique–Canada maternal health project abstraction tool for maternal near miss identification in Inhambane province, Mozambique(BMJ Publishing Group, 2024) Muosieyiri, Maud; Forsyth, Jessie; Andre, Fernanda; Adoni, Ana Paula Ferrão da Silva; Muhajarine, NazeemObjectives The objectives of this study are to determine whether the additional clinical criteria of the Mozambique maternal near miss abstraction tool enhance the effectiveness of the original WHO abstraction tool in identifying maternal near miss cases and also evaluate the impact of sociodemographic factors on maternal near miss identification. Design Cross-sectional study. Setting Two secondary referral hospitals in Inhambane province, Mozambique from 2021 to 2022. Participants From August 2021 to February 2022, 2057 women presenting at two hospitals in Inhambane Province, Mozambique, were consecutively enrolled. Eligible participants included women admitted during pregnancy, labour, delivery, or up to 42 days post partum. Selection criteria focused on women experiencing obstetric complications, while those without complications or with incomplete medical records were excluded. Primary and secondary outcome measures The primary outcome was identifying maternal near miss cases using the original WHO Disease criterion and the additional clinical criteria from the Mozambique-Canada Maternal Health Project abstraction tool. Secondary outcomes included the association between sociodemographic factors and maternal near miss identification. All outcomes were measured as planned in the study protocol. Results The new Mozambique-Canada abstraction tool identified more maternal near miss cases (28.2% for expanded disease and 21.1% for comorbidities) compared with the original WHO tool (16.2%). Hypertension and anaemia from the newer criteria were strongly associated with the original WHO Disease criterion (p<0.001), with kappa values of 0.58 (95% CI 0.53 to 0.63) and 0.21 (95% CI 0.16 to 0.26), respectively. Distance to health facilities was significantly associated, with women living over 8 km away having higher odds (OR=2.47, 95% CI 1.92 to 3.18, p<0.001). Type of hospital also influenced identification, with lower odds at Vilankulo Rural Hospital for Expanded Disease criterion (OR=0.70, 95% CI 0.57 to 0.87, p=0.001), but higher odds for comorbidities criterion (OR=3.13, 95% CI 2.40 to 4.08, p<0.001). Finally, older age was associated with higher odds of identification under the comorbidities criterion, particularly for women aged 30–39 (OR=3.06, 95% CI 2.15 to 4.36) as well as those 40 years or older (OR=4.73, 95% CI 2.43 to 9.20, p<0.001). Conclusions The Mozambique-Canada Maternal Health Project tool enhances maternal near miss identification over the original WHO tool by incorporating expanded clinical criteria, particularly for conditions like hypertension and anaemia. Sociodemographic factors, including healthcare access, hospital type and maternal age, significantly impact near miss detection. These findings support integrating the expanded criteria into the WHO tool for improved identification of maternal near misses in Mozambique and similar low-resource settings. Future research should examine the tool’s effectiveness across varied healthcare contexts and populations.Item Development of a chest X-ray machine learning convolutional neural network model on a budget and using artificial intelligence explainability techniques to analyze patterns of machine learning inference(JAMIA Open, 2024-07) Stephen, LeeObjective Machine learning (ML) will have a large impact on medicine and accessibility is important. This study’s model was used to explore various concepts including how varying features of a model impacted behavior. Materials and Methods This study built an ML model that classified chest X-rays as normal or abnormal by using ResNet50 as a base with transfer learning. A contrast enhancement mechanism was implemented to improve performance. After training with a dataset of publicly available chest radiographs, performance metrics were determined with a test set. The ResNet50 base was substituted with deeper architectures (ResNet101/152) and visualization methods used to help determine patterns of inference. Results Performance metrics were an accuracy of 79%, recall 69%, precision 96%, and area under the curve of 0.9023. Accuracy improved to 82% and recall to 74% with contrast enhancement. When visualization methods were applied and the ratio of pixels used for inference measured, deeper architectures resulted in the model using larger portions of the image for inference as compared to ResNet50. Discussion The model performed on par with many existing models despite consumer-grade hardware and smaller datasets. Individual models vary thus a single model’s explainability may not be generalizable. Therefore, this study varied architecture and studied patterns of inference. With deeper ResNet architectures, the machine used larger portions of the image to make decisions. Conclusion An example using a custom model showed that AI (Artificial Intelligence) can be accessible on consumer-grade hardware, and it also demonstrated an example of studying themes of ML explainability by varying ResNet architectures.Item Development of a ParticipACTION App–Based Intervention for Improving Postsecondary Students’ 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping(JMIR Research Protocols, 2023) Flood, Stephanie M; Thompson, Brooke; Faulkner, Guy; Vanderloo, Leigh M; Blackett, Beth; Dolf, Matt; Latimer-Cheung, Amy E; Duggan, Mary; Di Sebastiano, Katie M; Lane, Kirstin N; Brouwers, Melissa C; McKenna, Julia; Chulak-Bozzer, Tala; Fuller, Daniel; Ruissen, Geralyn R; Sturrock, Shelby L; Tomasone, JenniferRBackground: The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students’ movement behaviors. Objective: We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. Methods: The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app–based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. Results: Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. Conclusions: Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app–based intervention targeting postsecondary students’ movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app–based interventions. Should the forthcoming evaluation demonstrate the intervention’s acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students’ movement behaviors and mental well-being.Item Development of a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease(British Thoracic Society, 2018-01-30) Ospina, Maria; Michas, Marta; Deuchar, Lesly; Leigh, Richard; Bhutani, Mohit; Rowe, Brian; Marciniuk, Darcy; Goodridge, Donna; Dechman, Gail; Bourbeau, Jean; Balter, Meyer; Camp, Pat; Hernandez, Paul; Goldstein, Roger; Stickland, MichaelIntroduction: Hospital and emergency department discharge for patients with chronic obstructive pulmonary disease (COPD) is often poorly organised. We developed a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbations of COPD. Methods: A purposeful sample of clinicians and patients were invited to participate in a two-round Delphi study (July–November 2015). In round 1, participants rated on a seven-point Likert scale (1=not at all important; 7=extremely important) the importance of 29 unique COPD care actions. Round 2 comprised items selected from round 1 based on consensus (>80%endorsement for Likert values 5–7). A list of 18 care items from round 2 was discussed in a face-to-face nominal group meeting. Results: Seven care items were included in the COPD discharge bundle based on clinician and patient input: (1) ensure adequate inhaler technique is demonstrated; (2) send discharge summary to family physician and arrange follow-up; (3) optimise and reconcile prescription of respiratory medications; (4) provide a written discharge management plan and assess patient’s and caregiver’s comprehension of discharge instructions; (5) refer to pulmonary rehabilitation; (6) screen for frailty and comorbidities; and (7) assess smoking status, provide counselling and refer to smoking cessation programme. Conclusion: We present a seven-item, patient-centred, evidence-based and consensus-based discharge bundle for patients with acute exacerbations of COPD. Alignment with clinical practice guidelines and feasibility of local adaptations of the bundle should be explored to facilitate wide applicability and evaluation of the effectiveness of the COPD discharge bundle.Item The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation(BioMed Central, 2017-11-28) Rotter, Thomas; Plishka, Christopher; Hansia, Mohammed Rashaad; Goodridge, Donna; Penz, Erika; Kinsman, Leigh; Lawal, Adegboyega; O'Quinn, Sheryl; Buchan, Nancy; Comfort, Patricia; Patel, Prakesh; Anderson, Sheila; Winkel, Tanya; Lang, Rae Lynn; Marciniuk, DarcyIntroduction Hospital and emergency department discharge for patients with chronic obstructive pulmonary disease (COPD) is often poorly organised. We developed a patient-centred, evidence-based and consensusbased discharge care bundle for patients with acute exacerbations of COPD. Methods A purposeful sample of clinicians and patients were invited to participate in a two-round Delphi study (July–November 2015). In round 1, participants rated on a seven-point Likert scale (1=not at all important; 7=extremely important) the importance of 29 unique COPD care actions. Round 2 comprised items selected from round 1 based on consensus (>80%endorsement for Likert values 5–7). A list of 18 care items from round 2 was discussed in a face-to-face nominal group meeting. Results Seven care items were included in the COPD discharge bundle based on clinician and patient input: (1) ensure adequate inhaler technique is demonstrated; (2) send discharge summary to family physician and arrange follow-up; (3) optimise and reconcile prescription of respiratory medications; (4) provide a written discharge management plan and assess patient’s and caregiver’s comprehension of discharge instructions; (5) refer to pulmonary rehabilitation; (6) screen for frailty and comorbidities; and (7) assess smoking status, provide counselling and refer to smoking cessation programme. Conclusion We present a seven-item, patient-centred, evidence-based and consensus-based discharge bundle for patients with acute exacerbations of COPD. Alignment with clinical practice guidelines and feasibility of local adaptations of the bundle should be explored to facilitate wide applicability and evaluation of the effectiveness of the COPD discharge bundle.