bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differing Realties among Assisted Living Residents with Dementia: Understanding Care Partner Responses
Authors: Kemp Candace L , Anglin Emerald , Morgan Jennifer Craft , Perkins Molly M , Burgess Elisabeth O 
Published: February 2025

Abstract

Background and Objectives
Persons living with dementia can experience confusion in terms of orientation to time, place, and scenario. The ways care partners respond are apt to shape quality of life and care experiences. With a focus on assisted living (AL) residents with dementia, we seek to: 1) examine differing realities and care partner responses and 2) identify influential resident and care partner factors, other contributing contextual conditions, and response outcomes.

Research Design and Methods
We present analysis of qualitative data gathered from a grounded theory (GT) study involving eight diverse AL communities each studied for a one-year period between 2019 and 2023. Researchers followed 73 residents with dementia and 103 care partners (family, friends, AL staff, external workers, volunteers), conducting interviews (n=236) and participant observation (980 visits and 2,676 hours), and reviewing resident participants’ AL records. Guided by principles of GT, analysis was iterative, involved initial, axial, and selective coding, and led to the identification of the core category, “reality management.”

Results
Most residents experienced dementia-related confusion. In response, care partners engaged in a process of “reality management,” which involved strategies that invalidated or validated realities and emotions; these included: ignoring, dismissing, correcting, redirecting, and joining. The nature, types and expression of confusion, and resident and care partner characteristics and capacities, influenced responses and outcomes.

Discussion and Implications
Findings reinforce the value of person- and situation-specific responses and have implications for practice and underscore the need for additional research.
Killing It Softly: The ILC’S Articles on State Responsibility
Authors: Douglas Zachary 
Published: February 2025

Abstract
By preferring tautologies supplied by the theory of objective responsibility over general principles of liability derived from comparative law, the ILC’s Articles on State Responsibility cannot assist in operationalising the general and opentextured treaty standards for State conduct that are commonplace in many fields of international law, particularly in environmental law. Moreover, the one-size-fits-all approach to defining the secondary consequences of a wrongful act in the ILC’s Articles rests upon a conception of outright prohibition of the conduct in question and a community interest in securing the cessation of that conduct, whereas many primary obligations, if transgressed, should be properly seen as generating a duty of compensation only without the other secondary consequences that automatically follow in the ILC’s scheme of responsibility.
A1 BACTERIAL LYSOPHOSPHATIDYLCHOLINE (LPC) AND LYSOPHOSPHATIDIC ACID (LPA) INDUCE VISCERAL HYPERSENSITIVITY THROUGH TRANSIENT RECEPTOR POTENTIAL CANONICAL 5 (TRPC5) AND LYSOPHOSPHATIDIC ACID RECEPTOR 1 (LPAR1) AND 3 (LPAR3) DEPENDENT-MECHANISMS
Authors: Pujo J , De Palma G , Lu J , Rueda G H , Vicentini F A , Hall-Bruce M , Nardelli A , Verdu E , Reed D E , Vanner S J , Collins S , Bercik P 
Published: February 2025

Abstract

Background
Abdominal pain is the key symptom in Irritable Bowel Syndrome (IBS). Its pathophysiology is not fully understood, but low-grade inflammation and gut microbiota-diet interactions have been implicated. LPC and LPA are phospholipids generated by inflammatory processes in mammals, which are known to induce neurogenic pain through multiple channels and G-protein-coupled receptors. It is unknown whether bacteria can produce LPC/LPA and through which pathways they signal to the host.

Aims
To investigate whether bacterial LPC and LPA induce visceral hypersensitivity and identify the underlying mechanisms.

Methods
Germ-free NIH Swiss and Swiss Webster mice (n=117) were colonized for 5 weeks with fecal microbiota from IBS patients with either low or high fecal LPC/LPA levels, or microbiota from healthy controls. The mice were fed either regular chow or a diet enriched with phosphatidylcholine (PC) (2g/kg) a precursor of LPC and LPA. Visceral sensitivity was assessed by visceromotor responses (VMRs) to colorectal distension. Dorsal root ganglion (DRG) neurons from C57BL/6 mice were pretreated with a TRPC5 inhibitor (AC1903; 30 μM), an LPAR1 antagonist (AM095; 10 μM), or an LPAR1 and LPAR3 antagonist (Ki16425; 10 μM) or their vehicle (0.1% DMSO), and then treated with LPC (10 μM) or LPA (10 μM), respectively. Calcium mobilization was measured by a Cytation C10 imaging reader using a fluorescent probe Fluo-4 (1 mM). C57BL/6 mice received intracolonic infusion with a vehicle or a mix of LPC (600 μM) /LPA (25 μM), one group of mice was pretreated with AC1903 (30 μM) and Ki16425 (10 μM) prior to LPC/LPA administration, CRD was performed 90 minutes later.

Results
Mice with fecal microbiota from IBS patients with high fecal LPC/LPA displayed visceral hypersensitivity compared to mice with microbiota from healthy controls or from patients with low fecal LPC/LPA. These increased responses were seen only in mice fed PC-enriched diet, but not with regular chow. Both LPC and LPA administration increased the percentage of responding DRG neurons compared to the vehicle. The pretreatment with AC1903, AM095 or Ki16425 decreased the percentage of responding neurons when treated with LPC or LPA, respectively, compared to the vehicle. Intracolonic administration of LPC and LPA induced a significant increase in visceral sensitivity compared to the vehicle-treated mice. This increase was prevented in mice pretreated with an intracolonic injection of AC1903 and Ki16425.

Conclusions
Bacterial LPC and LPA induce neuronal activation and visceral hypersensitivity through TRPC5 and LPAR1/LPAR3-dependent mechanisms, respectively.

Funding Agencies
CIHRWeston Family Foundation
A3 CELIAC DISEASE AUTOIMMUNITY INCREASING AMONG VARIOUS PEDIATRIC SUBGROUPS IN ALBERTA, CANADA
Authors: King J A , Coward S , Godley J , Metcalfe A , Ronksley P , Kaplan G G , Williamson T 
Published: February 2025

Abstract

Background
Celiac disease (CeD) autoimmunity, defined as elevated tissue transglutaminase (TTG) levels with or without biopsy confirmation, is rising among children in Canada; however, further investigation is needed to understand if this varies across pediatric subpopulations.

Aims
To evaluate incidence and trends in CeD autoimmunity among different pediatric subgroups.

Methods
Using population-based administrative data, we identified individuals under 15 years old during their first positive TTG test in Alberta from April 2015 to March 2024. Based on the year of test, we determined socioeconomic status by matching patient postal code to census level dissemination area (which translate to material and social deprivation quintiles) and geographic residence. Incidence per 100,000 person-years (PY) and 95% confidence intervals (CIs) were calculated for subgroups (sex, age, rurality, material and social deprivation) within time periods (pre-pandemic [2015–2019], pandemic [2020–2022], and post-pandemic [2023–2024]). Incidence rate ratios (IRRs) were estimated to compare pre-pandemic and post-pandemic rates.

Results
A total of 5,141 children with incident CeD autoimmunity were identified. The highest incidence was observed post-pandemic (92 per 100,000 PY), particularly among those aged 5–9 years (135 per 100,000 PY), those living in the least materially deprived areas (117 per 100,000 PY), and females (113 per 100,000 PY). All subgroups saw significantly higher rates in the post-pandemic period relative to the pre-pandemic period, except for those most materially deprived (IRR = 1.1 [95% CI: 0.9, 1.4]). A larger increase in rates was seen in those most materially privileged (IRR = 1.7 [95% CI: 1.5, 2.0]). A change in incidence was also more pronounced among children in rural (IRR = 1.7 [95% CI: 1.5, 1.9]) compared to those in urban areas (IRR = 1.3 [95% CI: 1.2, 1.4]).

Conclusions
Although rates of CeD autoimmunity vary between pediatric subpopulations, most groups are experiencing significant increases over time. This includes populations historically experiencing lower rates (e.g., those in rural areas), indicating a mounting burden of CeD for the future.
Incidence rates for CeD autoimmunity across subgroups and time

*comparing post-pandemic to pre-pandemic

Funding Agencies
CIHRTRIANGLE (Training a new generation of researchers in gastroenterology and liver)
A7 THERAPEUTIC DIETARY INTERVENTION IN ADULT CROHN’S DISEASE PATIENTS: EFFECTS ON REMISSION MARKERS, QUALITY OF LIFE, AND PHYSICAL ACTIVITY
Authors: Toews B R , Lu C , Raman M , Reimer R 
Published: February 2025

Abstract

Background
Current evidence recognizes diet and physical activity as important factors in influencing the natural history of Crohn’s disease (CD); however, the relationship between dietary components and disease relapse remains unclear. Patients with active CD have a lower quality of life (QoL) compared to healthy controls.

Aims
The aims of this study were threefold: 1) to explore the effect of a CD specific therapeutic dietary intervention (CD-TDI) upon clinical and biochemical remission in adults with active, mild luminal CD, 2) to investigate outcomes related to patient-reported health QoL, and 3) to investigate the relationship between IBD parameters and physical activity. We hypothesized that a CD-TDI would be more effective when compared to conventional management (CM) to induce clinical and biochemical remission and improve patient-reported QoL in symptomatic and asymptomatic patients with active, mild luminal CD.

Methods
This was a randomized controlled trial whereby 51 participants were randomly allocated in a 2:1 ratio to the intervention group (CD-TDI) or CM for 13 weeks. Patients receiving the CD-TDI, an anti-inflammatory diet developed specifically for CD with foundational principles rooted in the Mediterranean diet, were offered patient-centered counseling by a Registered Dietitian for 12 weeks. QoL was measured using the 12-item short form health survey (SF-12). Physical activity was measured using ActivPAL® inclinometers (PAL Technologies, Glasgow). The Harvey Bradshaw Index (HBI) and fecal calprotectin (mcg/g) were used to assess clinical and biochemical remission.

Results
The CD-TDI group experienced both significant decreases in HBI from baseline to week 13 (Wk0: 3.0, IQR:1.0-5.3; Wk13: 2.0, IQR:0-3.0; p=0.05) and FCP from 130 ug/g (IQR: 38-411) at baseline to 72 ug/g (IQR:3-153) at week 13 (p= 0.01). The CM group saw no change in HBI and there was an increase in FCP by 337 ug/g or 55% from baseline to week 13. The SF-12 yielded two summary scores, the mental component score (MCS-12) and physical component score (PCS-12). The CD-TDI group experienced an increase in both the PCS-12 from 46.9 (SEM: 2.0) to 50.0 (SEM: 1.6) (p=0.10) and the MCS-12 from 49.2 (SEM: 1.8) to 50.9 (SEM: 1.8) (p=0.17), moving both scores to the mean healthy population score of 50, but the changes were not significant. Linear modelling revealed that both FCP (F(1, 58), p&lt;0.001) and CRP (F(1, 62), p&lt;0.001) act as significant predictors of the MCS-12 change score from baseline to week 13. There was no significant change in step count (p=0.41) within the CD-TDI group from baseline to week 13.

Conclusions
It can be concluded that the CD-TDI group experienced a significant decrease in gut inflammation and improved symptoms. Deeper analysis is underway to examine the influence of physical activity parameters on QoL.

Funding Agencies
CIHRNSERC CREATE, University of Calgary
A15 THERAPEUTIC POTENTIAL OF THE GLYCOCAGE TARGETED DELIVERY SYSTEM FOR IMPROVING INFLAMMATORY BOWEL DISEASE TREATMENT
Authors: Ma W , Menzies S , Wang C , Kothandapani J , Brumer H , Sly L M 
Published: February 2025

Abstract

Background
Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is marked by chronic inflammation along the gastrointestinal tract (GIT). IBD cases are rising globally, with Canada having one of the highest prevalance rates. Thus, there is a critical need for more effective treatments. Current IBD therapy includes orally administered small molecule anti-inflammatory drugs, such as corticosteroids and JAK inhibitors. However, their use is limited by the high doses required due to systemic uptake, and consequently, negative off-target effects. To improve delivery of these drugs to the inflamed tissue in the lower GIT for better efficacy, our GlycoCaged prodrug technology links the drug to a plant carbohydrate for targeted release by gut bacterial glycosidases at the disease site. To demonstrate proof-of-principle, we used dexamethasone (DEX), a potent corticosteroid that is not used in IBD treatment due to inherent side effects. We showed that “GlycoCaging’‘ Dex improves its efficacy (10-X lower doses required) and reduces systemic side effects as compared to free DEX in the SHIP-/- model of CD-like ileitis.
We hypothesize that Glycocaging IBD drugs will increase drug efficacy and reduce off-target effects by delivering drugs to the site of intestinal inflammation.

Aims
1) Investigate the location of prodrug decaging in the GIT using SHIP-/- mouse model. 2) Evaluate GlycoCaged dexamethasone in the T cell transfer model of colitis.

Methods
To delineate the location of decaging activity in vivo, SHIP+/+ and SHIP-/- mice were orally gavaged with 3 mg/kg of DEX or the molar equivalent of GlycoCaged DEX and collected sections of intestinal tissues for LC-MS/MS analysis at multiple timepoints post oral gavage. To assess the GlycoCage system in another mouse model of IBD, T cell transfer model of colitis is established by injecting (i.p) CD4+CD25-CD45RBhigh T cells (isolated from CD45.1 mice by FACS) into age- and sex-matched Rag-/- mice. A dose titration was performed from 3mg/kg/d for 5 weeks of DEX or the molar equivalent of caged DEX to determine and compare their minimal effective doses. Treatment effects were assessed with histology, flow cytometry and multiplexed cytokine assay.

Results
Free DEX is absorbed early in the proximal GIT, while the GlycoCage prodrug system protects the DEX to be released starting in the distal small intestine and cecum, closer to the inflamed sites. Caged DEX ameliorated colonic inflammation in the T cell transfer model of colitis at lower doses than free DEX.

Conclusions
Our results highlight a novel microbiome-cleavable glycoconjugate drug delivery platform that has the potential to improve the therapeutic indices of diverse drugs for treating IBD. In the future, we will evaluate the efficacy of other GlycoCaged drugs.

Funding Agencies
CAG, CIHRTRIANGLE
A34 EVALUATION OF GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) EFFICACY IN A SINGLE CANADIAN CENTER
Authors: Maniere T , Kaufman D 
Published: February 2025

Abstract

Background
Endoscopic Submucosal Dissection (ESD), developed in Japan, is a minimally invasive method for resecting large superficial gastric lesions. It allows high en-bloc resection rates, reducing local recurrence and enabling complete histological assessment, overcoming the limitations of Endoscopic Mucosal Resection (EMR). Although well-studied in Asia, ESD’s evaluation in North America remains limited due to lower gastric cancer incidence.

Aims
The aim of our study is to evaluate gastric ESD’s effectiveness and assess peri-procedural complications

Methods
This retrospective cohort study included 75 patients who underwent ESD for gastric adenocarcinoma, neuroendocrine tumors, high-grade and low-grade dysplasia at Charles Le Moyne Hospital between 2017 and 2024. Data collected included patient demographics, procedural details, and pathology outcomes. Primary outcomes were en-bloc and R0 resection rates, while secondary outcomes included complications like perforation and hemorrhage. Five patients were excluded from the R0 and curative resection analysis due to non-evaluable pathology:piece meal resection (1), unconclusive margins (2), failure of resection(2).

Results
A total of 75 patients were included, with a mean age of 73 years (), and 64% were men. Polyp characteristics based on Paris classification were: 0-IIa+c (21%), 0-IIa (20%), 0-Is (17%), 0-IIB (9%), 0-Ip (4%), 0-Is+IIa (4%), 0-IIc (4%), 0-Isp (3%), 0-IIa+b (3%), and 0-IIb+c (1%). Lesions were located in antrum (32), body (25) GE junction (14), angulus (5) and gastro-jejunum anastomosis (1). One patient had two polyps resected concurrently (0-Ip + 0-Is). Paris class identification was missing in 13% of cases. The mean maximum endoscopic size visual estimation was 24 mm (5-90), while the mean maximum pathology specimen size was 40 mm (8-75). Pathology results showed: 25% invasive adenocarcinoma, 18% intra-mucosal adenocarcinoma, 18% high-grade dysplasia, 20% low-grade dysplasia, 11% hyperplastic polyps, 3% neuroendocrine tumors (grades 1-2), and 2% had no pathology due to complications. The mean procedural time was 117 minutes (40-412). Perforations occurred in 17% (13/76) of patients, with successful endoscopic closure in 92% (12/13) of cases. One patient required surgical repair. En-bloc and R0 resection rates were 80% and 73%, respectively, with curative resections in 67% of cases.

Conclusions
ESD demonstrated high en-bloc and R0 resection rates, confirming its effectiveness for managing gastric lesions. These results are consistent with North American studies. Though complications like perforation occurred, most were managed endoscopically. This provides preliminary evidence for ESD as a safe and effective option for gastric lesion resection in Canada.

Funding Agencies
None
A37 OPTIMIZING ENDOSCOPIC SCHEDULING USING THE SMSA SCORE FOR ENDOSCOPIC MUCOSAL RESECTION.
Authors: Maillet D , Chapelle N , Martel M , Menard C 
Published: February 2025

Abstract

Background
Colonoscopies prevent colorectal cancer (CRC) by detecting and removing neoplastic polyps. Complex polyps (CP) pose many challenges. While endoscopic mucosal resection (EMR) is the standard treatment, its procedure time is unpredictable, leading to scheduling inefficiencies. The SMSA (Size, Morphology, Site, Access) score helps classify CP and predict clinical risks but has never been used as a predictor of procedural time. A tool to predict EMR duration is needed to improve efficiency in resource-limited settings.

Aims
We aim to assess if the SMSA and SMSA+ scores can predict procedural time and to determine whether the specific domains of the score, as well as additional pre-procedure factors, are associated with increased procedural duration.

Methods
We conducted a retrospective cohort study at a tertiary-care center in Sherbrooke, Canada, involving consecutive adult patients who underwent EMR for CP between November 2020 and August 2024. The primary outcome is to evaluate if the SMSA and SMSA+ scores can estimate procedure duration. Secondary outcomes include identifying variables associated with procedure time. Data on demographics, polyp characteristics, procedure details, and adverse events were collected and analyzed using descriptive statistics and regression models.

Results
A total of 100 patients were included (mean age: 67.9 ± 9.3, 53% female, Charlson score: 3.62 ± 1.98), The distribution of SMSA scores was as follows: Score 1: 0%; Score 2: 10.0% (mean time: 48.1 ± 15.3 mins); Score 3: 37.0% (mean time: 54.1 ± 15.7), and Score 4: 53.0% (mean time: 74.2 ± 30.5). The SMSA+ was distributed as score 0: 16.3% (mean time: 56.3 ± 16.4) and score 1: 83.7% (mean time: 66.3 ± 28.6). A mean of 2.3 ± 2.3 additional cold snare polypectomies were performed during the procedure with a similar distribution across all scores. Regression model indicated that both the SMSA score (P=13.3, t=3.0, p&lt;0.01) and intra-procedural complications (P=29.9, t=3.9, p&lt;0.01) were significant predictors of procedure time. Age, sex, Charlson score, fibrosis, fragmented specimen, and EMR technique did not significantly contribute to procedural time. Further analysis revealed that only the size domain of the SMSA score was associated with procedural duration (P=4.45, t=3.3, p&lt;0.01). The SMSA+ score was not predictive of procedural time.

Conclusions
The SMSA score, especially the size domain, is a useful predictor of EMR procedural time, while the SMSA+ score does not predict duration. These findings suggest that incorporating the SMSA score into clinical practice could enhance scheduling efficiency. However, further studies using multicenter data is needed to explore additional factors.

Funding Agencies
None
A40 INITIAL OUTCOMES FOLLOWING THE LAUNCH OF A PERORAL ENDOSCOPIC MYOTOMY (POEM) PROGRAM FOR ACHALASIA: A SINGLE-CENTRE EXPERIENCE IN CANADA
Authors: Tsai C H , Woo M , Gupta M , Schieman C , Belletrutti P J 
Published: February 2025

Abstract

Background
Peroral endoscopic myotomy (POEM) has gained prominence as a minimally invasive therapeutic option for achalasia. Despite its growing adoption worldwide, the establishment of POEM programs in Canada is relatively recent, and local data on clinical outcomes remain limited.

Aims
This study aims to assess the short-term outcomes of patients undergoing POEM for achalasia including symptom improvement, complication rates, and detailing the endoscopic and hospital resources necessary to sustain a POEM program.

Methods
A retrospective chart review was conducted to collect procedural and clinical outcome data for patients who underwent POEM and completed follow-up assessments from the inception of the program in October 2023 to September 2024 at the Foothills Medical Centre in Calgary, Alberta. The Eckardt symptom score was used to objectively evaluate symptoms pre-operatively and one-month post-POEM.

Results
A total of 20 patients, with a mean age of 59.2 (± 13.4) years, completed a one-month postoperative assessment after POEM. Each procedure was performed jointly by a gastroenterologist and a thoracic surgeon in the operating room. Most patients (16/20) were classified as ASA category II. The median Charlson Comorbidity Index was 2. 65.0% of patients had prior endoscopic interventions for achalasia, including pneumatic dilation or botulinum toxin injection. The pre-procedural mean integrated relaxation pressure at the lower esophageal sphincter was 25.8 ± 11.4 mmHg. The mean POEM procedural time was 110.5 (± 33.6) minutes, with an average of 6.5 endoscopic clips used per case for tunnel closure. The esophageal myotomy lengths were 4.79 (± 0.38) cm for type I and type II achalasia, and 9.0 (± 0.89) cm for type III achalasia. The postoperative length of stay was a median of 1 day. Postoperative complications occurred in 2 patients, both of which were managed conservatively, with no procedure-related deaths. The mean pre-POEM Eckardt score was 7.00 (± 1.79), which decreased to a mean of 1.00 (± 0.89) at one-month post-POEM (p &lt; 0.001) [Figure 1].

Conclusions
POEM is a safe and effective treatment option for patients with symptomatic achalasia. We demonstrate marked initial symptom improvement and a low complication rate. However, POEM is resource- and time-intensive. Further studies are warranted to evaluate long-term outcomes and complications such as gastroesophageal reflux disease (GERD) and Barrett’s esophagus.

Figure 1: Total Eckardt symptom score before and after POEM. Each line represents data from an individual patient.
Funding Agencies: