Victoria Hospital is a public health care facility in Saint Lucia. It is located in Castries. The hospital opened in 1887.
Continuing Professional Development (CPD) (which includes Continuing Medical Education (CME) and Faculty Development (FD)) is essential for maintaining physician competency. However, participation in university-organized CPD at the University of Saskatchewan remains low, particularly among racialized physicians. Prior research identified racism, exclusion, and disconnectedness as barriers. This study revisits those findings through the lens of Belongingness and Social Identity Theories to examine how exclusion and identity-based harms shape CPD engagement. We conducted a theory-informed sub-analysis of interview and focus group transcripts (n = 34) with physician faculty across rural and urban Saskatchewan. Participants represented various specialties and backgrounds. Reflexive thematic analysis was used to explore how unmet needs for belonging and identity affirmation influenced CPD participation. Three key themes emerged: (1) CPD as a site of racialized othering and professional scrutiny; (2) tokenistic inclusion without recognition or meaningful support; and (3) withdrawal as a form of self-protection. Racialized physicians and International Medical Graduates (IMGs) often disengaged not from disinterest but due to psychological fatigue, identity invalidation, and exclusion. CPD participation is shaped by more than topic relevance or logistics, it is profoundly affected by emotional safety, institutional culture, and inclusion. Programs that fail to reflect diverse identities or foster inclusive environments risk reinforcing alienation. CPD must be reimagined as a relational, psychologically safe space. To foster equitable engagement, inclusion and representation must be embedded as foundational design principles, not treated as optional enhancements.
INTRODUCTION:Serum protein electrophoresis and serum free light chain (SFLC) assays are standard methods for monitoring patients with multiple myeloma (MM). However, patients with non-secretory MM often require invasive bone marrow biopsies to monitor treatment response and disease progression. Recently, serum soluble B-cell maturation antigen (sBCMA) has been proposed as an alternative biomarker for monitoring of MM, including non-secretory disease. We aimed to optimize the performance of and validate a serum sBCMA enzyme-linked immunosorbent assay (ELISA) from R&D Systems for research and eventual clinical use. METHODS AND RESULTS:A total allowable error of 25 % was used, with one-third (8.3 %) budgeted for imprecision, one-third for bias, and one-half (12.5 %) as the allowable deviation from linearity. For imprecision, the repeatability coefficient of variation (CV) was acceptable, but the within-laboratory CV was not. We were limited in our ability to assess accuracy, but recovery of the ELISA standards was acceptable, and the sBCMA concentrations determined in various patient populations compared well to previous publications. The sBCMA concentration also correlated significantly with the M-protein concentration and the involved/uninvolved SFLC ratio. The sBCMA ELISA was verified to be linear within the allowable deviation between 99.04-1179.36 pg/mL. We attempted to confirm stability of serum sBCMA stored at room temperature, 4 °C, and -20 °C for up to 50 weeks, but the assay reproducibility was too poor for this to be assessed adequately. CONCLUSION:Despite efforts to optimize the performance of the ELISA, the results were not reproducible enough over time to allow us to implement this sBCMA ELISA for clinical use.
BACKGROUND AND OBJECTIVES:Data on outcomes after minor stroke, especially lacunar stroke, are lacking or based on short follow-up. Outcome differences between lacunar and cortical stroke remain unclear but may provide insights into small vessel disease (SVD) etiology and prognosis. We report on dementia, death, recurrent stroke, and function up to 9 years after lacunar or minor cortical ischemic stroke. METHODS:In this 9-year longitudinal observational cohort study, we prospectively recruited participants presenting with mild, nondisabling lacunar or cortical ischemic stroke to Lothian Stroke Services in Edinburgh, United Kingdom. At baseline, we collected data on sociodemographics, vascular risk factors, dependence, cognition, and brain MRI. At 9 years, we used questionnaires (including items from the Stroke Impact Scale) and hospital/general practitioner records to assess dementia, recurrent stroke, death, cardiac diseases, vascular risk factors, dependence, recovery, and functionality. RESULTS:We recruited 264 participants; clinical data were available for 243 participants (92%) (baseline mean age 67 years (SD 12), 42% female, 44% with lacunar stroke) and self-reported functional data for 96 (36%) at a mean follow-up of 8.5 years (SD 0.57). Dementia was diagnosed in 9.4% of participants with lacunar stroke and 12.4% of those with cortical stroke, with risk increasing with age (odds ratio [OR] 1.08; CI 1.030-1.130). Recurrent stroke occurred in one-third of all participants; risk increased with the presence of vascular risk factors (OR 2.27; CI 1.287-4.032). Participants with cortical stroke were more likely to die compared with those with lacunar stroke (χ2 = 8.2; p = 0.004). Age (OR 1.09; CI 1.051-1.133), male sex (female OR 0.40, CI 0.196-0.818), and white matter hyperintensities (OR 1.36; CI 1.112-1.664) increased risk of death. Moderate/severe disability was reported by 12% of participants and cognitive concerns by 49%-55%. Affected limb recovery and balance were worse after lacunar stroke (W = 705.5, p = 0.00). DISCUSSION:Long-term outcomes after minor stroke were frequently suboptimal and varied by stroke subtype, highlighting the lasting impact of both lacunar and mild cortical ischemic strokes on quality of life. Improving long-term outcomes after mild stroke remains an important target for refining clinical care and shaping future research directions.
BACKGROUND:Pedicle screw loosening is a clinically-relevant failure mode following spinal fusion procedures, resulting from damage and compaction to the surrounding bone with loading of the bone-implant interface. Current in vitro tests for investigating pedicle screw loosening commonly apply uniaxial loading (e.g. screw pullout or toggle testing). However, these methods do not replicate multiaxial spinal loading associated with activities of daily living. The goals of this study were to (1) develop and assess a novel test method for inducing pedicle screw loosening under multiaxial loading conditions, and (2) compare this approach to uniaxial toggle testing. METHODS:Eight osteoporotic human lumbar vertebrae (L2-L4, 70.1 ± 5.5 years old) underwent testing to compare volumetric bone damage and screw displacement under uniaxial and multiaxial loading. Load magnitudes were incrementally increased in a step-wise fashion after 1000 and 2000 cycles, with the final load step continuing until the screw head displaced more than 6 mm. Post-test computed tomography (CT) imaging was used to quantify volumetric bone damage. FINDINGS:Multiaxial loading accelerated bone damage leading to earlier implant loosening (p < 0.001). Failure predominantly occurred in the inferior direction (p = 0.06). Medial (p = 0.07) and lateral (p < 0.001) screw displacement were greater under multiaxial loading. CT imaging showed greater volumetric bone deformation with multiaxial loading (p = 0.01). INTERPRETATION:This study demonstrated that physiologically-derived multiaxial loading accelerates volumetric bone damage and pedicle screw loosening. Further, the increased bone deformation in the medial and lateral directions suggests that spinal movements involving these loads may accelerate risk of screw loosening.
Aims Postoperative periprosthetic femoral fractures (POPFF) are a recognized complication following total hip arthroplasty (THA). The primary aim of this study was to compare the survivorship and POPFF rate of a composite beam (CB) femoral component with a polished taper slip (PTS) femoral component as part of THA. Methods Between January 2008 and December 2013, 3,198 consecutive THAs were performed using either the Exeter V40 (PTS, n = 2,177) or the Lubinus SP II (CB, n = 1,021) femoral compo nent within two separate arthroplasty centres. Patient demographic details and operative details were collected prospectively. Patient records and radiological archives were reviewed at minimum ten years following surgery to identify subsequent revision surgery, dislocation, or POPFF.- Results At a median 12-year follow-up (IQR 11.1 to 12.7), 2,214 patients (2,214/3,198) remained alive. The mean patient age at surgery was 67.6 years (SD 11.2). Analysis of all-cause THA failure demonstrated PTS femoral component survivorship of 96.6% (95% CI 95.8 to 97.4) while CB femoral component survivorship was 99.5% (95% CI 98.7 to 100) (log rank (Mantel Cox) p = 0.001) at ten years. POPFF accounted for 13% of reoperations in the CB group (n = 2/16) compared with 48% of reoperations (n = 34/71) in the PTS group (p = 0.001), where 85% of POPFFs underwent ORIF. Multivariate analysis found that PTS femoral components (hazard ratio (HR) 5.17, p = 0.003) and older patient age at surgery (HR 3.18, p = 0.002) were associated with an increased risk of POPFF. Risk of dislocation was higher in the CB group (relative risk 2.1, 95% CI 1.0 to 4.3; p = 0.030). Conclusion PTS femoral components were associated with a significantly higher risk of POPFF. When including patients treated with open reduction and internal fixation (ORIF), this resulted in reduced PTS survivorship compared with CB femoral components at follow-up. This should be considered alongside the established benefits of PTS femoral components when used in THA.
