Distribution-based sub-population selection (DSPS): A method for in-silico reproduction of clinical trials outcomes.

Diabetes presents a significant challenge to healthcare due to the short- and long-term complications associated with poor blood sugar control. Computer simulation platforms have emerged as promising tools for advancing diabetes therapy by simulating patient responses to treatments in a virtual environment. The University of Virginia Virtual Lab (UVLab) is a new simulation platform engineered to mimic the metabolic behavior of individuals with type 2 diabetes (T2D) using a mathematical model of glucose homeostasis in T2D and a large population of 6062 virtual subjects.

The Virtual DCCT: Adding Continuous Glucose Monitoring to a Landmark Clinical Trial for Prediction of Microvascular Complications.

Using a multistep machine-learning procedure, add virtual continuous glucose monitoring (CGM) traces to the original sparse data of the landmark Diabetes Control and Complications Trial (DCCT). Assess the association of CGM metrics with the microvascular complications of type 1 diabetes observed during the DCCT and establish time-in-range (TIR) as a viable marker of glycemic control. Utilizing the DCCT glycated hemoglobin data obtained every 1 or 3 months plus quarterly 7-point blood glucose (BG) profiles in a multistep procedure: (i) utilized archival BG traces to model interday BG variability and estimate glycated hemoglobin; (ii) trained across the DCCT BG profiles and associated each profile with an archival BG trace; and (iii) used previously identified CGM "motifs" to associate a CGM trace to a BG trace, for each DCCT participant.

Development of an organizational typology of interprofessional primary care teams in Quebec, Canada: A multivariate analysis.

Background: This study aimed to develop an organizational typology of Interprofessional Primary Care (IPC) teams in Quebec, Canada, by describing their organizational profiles and assessing the association between the characteristics of the populations served and the organizational profiles.

Methods: This cross-sectional study was carried out using a finite mixture model of the 2021 financial monitoring data from the Ministry of Health and Social Services of Quebec. The population consisted of all IPC teams in Quebec (N = 368).

Determinants associated with receiving a medical appointment through the Primary Care Access Points for unattached adults in Quebec: A cross-sectional study.

Canada is experiencing an unprecedented primary care crisis, with 6.5 million Canadians reporting lacking a family physician, including 31% of the Quebec population. To address this problem, the province of Quebec implemented Primary Care Access Points (GAPs) to help unattached patients navigate and access primary care services while awaiting attachment.

Reflective Tool on Advanced Access to Support Primary Healthcare Teams: Development and Validation of an Online Questionnaire.

Rationale: Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement.

Evaluation of an Automated Priming Bolus for Improving Prandial Glucose Control in Full Closed Loop Delivery.

Automated insulin delivery (AID) is widely available to people with type 1 diabetes (T1D), providing superior glycemic control versus traditional methods. The next generation of AID devices focus on minimizing user/device interactions, especially around meals ("full closed loop," [FCL]). Our goal was to assess the postprandial glycemic impact of the bolus priming system (BPS), an algorithm delivering fixed insulin doses based on the likelihood of a meal having occurred, in conjunction with UVA's latest AID.

Redirection of low-acuity emergency department patients to nearby medical clinics using an electronic medical support system: effects on emergency department performance indicators.

Background: Overcrowded emergency departments (EDs) are associated with higher morbidity and mortality and suboptimal quality-of-care. Most ED flow management strategies focus on early identification and redirection of low-acuity patients to primary care settings. To assess the impact of redirecting low-acuity ED patients to medical clinics using an electronic clinical decision support system on four ED performance indicators.

Enhancing interprofessional collaboration for unattached patients in primary care.

This project explored an interprofessional collaboration initiative at Clinique Indigo which aimed to improve comprehensive care for unattached patients in Quebec's primary care system. Throughout the project, physicians and non-physician health professionals alike became more actively engaged in the care of patients lacking a regular primary care provider. The project successfully demonstrated that defining a common vision for "well care" within the clinic and integrating diverse professionals could significantly improve quality of care for unattached patients, evidenced by an increase from 13% to 43% in comprehensive care provision.

Post Prandial Glucose Turnover Differs Between Adolescents & Adults with Type 1 Diabetes: Triple Tracer Mixed Meal Study.

Context: Insulin sensitivity (SI) varies with age in Type 1 diabetes (T1D).

Objective: To compare postprandial glucose turnover and insulin sensitivity between adolescents and adults with T1D.

Design: Cross-sectional comparison.

Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area.

Background: Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide.

Factors associated with patients' experience of access to their multidisciplinary primary health care clinic: A multilevel analysis.

Background: Understanding patients' experiences accessing primary health care (PHC) is necessary to improve service organisation. This study aims to examine individual, organisational, and contextual factors associated with patients' experience of accessing the multidisciplinary PHC clinic to which they are attached.

Methods: This cross-sectional study builds on survey data collected in multidisciplinary PHC clinics located in 14 regions in the province of Quebec (Canada).

Use of diabetes technology in children.

Children with type 1 diabetes and their caregivers face numerous challenges navigating the unpredictability of this complex disease. Although the burden of managing diabetes remains significant, new technology has eased some of the load and allowed children with type 1 diabetes to achieve tighter glycaemic management without fear of excess hypoglycaemia. Continuous glucose monitor use alone improves outcomes and is considered standard of care for paediatric type 1 diabetes management.

Life cycle assessment of alternative pulp mill sludge treatment methods in Finland.

Proper management of wastewater treatment plant side streams in pulp and paper mills is a matter of great interest. This study evaluates the environmental impact of different strategies in the management of biosludge from pulp and paper mills in Finland through a Life Cycle Assessment methodology. The base industrial standard practice, biosludge incineration for energy recovery and ash landfill disposal (Scenario 1), was compared to the alternative process of hydrothermal carbonization.

Efficacy of LSVT LOUD on Phonatory Control and Voice Quality in Patients with Primary Progressive Apraxia of Speech: Case Studies.

Primary progressive apraxia of speech (PPAOS) is a neurodegenerative syndrome characterized by the progressive and initially isolated or predominant onset of difficulties in the planning/programming of movements necessary for speech production and can be accompanied by dysarthria. To date, no study has used an evidence-based treatment to address phonation control in patients with PPAOS. The aim of this study was to evaluate the feasibility and efficacy of LSVT LOUD as a treatment for phonatory control in speakers with PPAOS.

Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey.

Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care.

Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022.

Perception of the compatibility of Quebec residency program characteristics with the advanced access model: a cross-sectional study.

Background: The advanced access (AA) model is among the most recommended innovations for improving timely access in primary care (PC). AA is based on core pillars such as comprehensive planning for care needs and supply, regularly adjusting supply to demand, optimizing appointment systems, and interprofessional collaborative practices. Exposure of family medicine residents to AA within university-affiliated family medicine groups (U-FMGs) is a promising strategy to widen its dissemination and improve access.

Validation of the UVA Simulation Replay Methodology Using Clinical Data: Reproducing a Randomized Clinical Trial.

Computer simulators of human metabolism are powerful tools to design and validate new diabetes treatments. However, these platforms are often limited in the diversity of behaviors and glycemic conditions they can reproduce. Replay methodologies leverage field-collected data to create ad hoc simulation environments representative of real-life conditions.

Development of a Patient-Reported Experience Measure Tool for Ambulatory Patients With Acute Unexpected Needs: The APEX Questionnaire.

The aim of this study was to develop a patient-reported experience measure (PREM) for comparing the experience of care received by ambulatory patients with acute unexpected needs presenting in emergency departments (EDs), walk-in clinics, and primary care practices. The Ambulatory Patient EXperience (APEX) questionnaire was developed using a 5-phase mixed-methods approach. The questionnaire was pretested by asking potential users to rate its clarity, usefulness, redundancy, content and face validities, and discrimination on a 9-point scale (1 = strongly disagree to 9 = strongly agree).

Patient perspectives on the vital primary care role of community pharmacists in Nova Scotia, Canada: qualitative findings from the PUPPY Study.

Objectives: Community pharmacists play an important role in primary care access and delivery for all patients, including patients with a family physician or nurse practitioner ("attached") and patients without a family physician or nurse practitioner ("unattached"). During the COVID-19 pandemic, community pharmacists were accessible care providers for unattached patients and patients who had difficulty accessing their usual primary care providers ("semi-attached"). Before and during the pandemic, pharmacist services expanded in several Canadian provinces.

Age-related differences in perception and coding of attractive odorants in mice.

Hedonic perception deeply changes with aging, significantly impacting health and quality of life in elderly. In young adult mice, an odor hedonic signature is represented along the antero-posterior axis of olfactory bulb, and transferred to the olfactory tubercle and ventral tegmental area, promoting approach behavior. Here, we show that while the perception of unattractive odorants was unchanged in older mice (22 months), the appreciation of some but not all attractive odorants declined.