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Recent Submissions

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    A qualitative study to refine and finalize the MedManageSCI prototype: A web-based toolkit to support medication self-management in adults with spinal cord injury/dysfunction
    (Public Library of Science, 2025-10-22) Cadel, Lauren; El-Kotob, Rasha; Hitzig, Sander L.; McCarthy, Lisa M.; Hahn-Goldberg, Shoshana; Packer, Tanya L.; Patel, Tejal; Ho, Christopher H.; Cimino, Stephanie R.; Lofters, Aisha K.; Guilcher, Sara J. T.
    Adults with spinal cord injury/ dysfunction (SCI/D) commonly take multiple medications for a variety of secondary conditions, and have described challenges with medication self-management. To help support medication self-management, a web-based toolkit, MedManageSCI, was co-designed by our team of researchers and adults with SCI/D, caregivers, and healthcare providers (www.medmanagesci.ca). Together, we co-developed the content areas to include in MedManageSCI, along with the design and brand considerations, to create an initial prototype of the toolkit. To finalize the prototype prior to implementation, the primary objective of this qualitative study was to further refine MedManageSCI by examining the clarity, comprehensiveness, relevance, and delivery of the toolkit modules. Cognitive interviews were conducted virtually between July 2024 and September 2024 with adults with SCI/D (N = 16). A concurrent verbal probing approach using scripted and spontaneous probes was followed. Data were coded using a pre-established coding matrix that aligned with the scripted probes. Participants provided 193 specific modifications to improve the clarity, comprehensiveness, relevance, or delivery of the MedManageSCI toolkit, which were categorized as: Comprehension, Design, and Web-based Delivery. The Comprehension category contained three subcategories: Written Refinements, Ensuring Accessibility, and Revamping Resources. The Design category contained three subcategories: Formatting Content, Streamlining Function, and Enhancing Visuals. Participants perceived the website as an ideal way to deliver the toolkit, noting several benefits of a web-based delivery in comparison to a paper-based toolkit. Overall, participants found the modules to be comprehensive and highly relevant. Further, we discuss the application of cognitive interviews for further refining the MedManageSCI prototype, recommendations to improve the comprehensibility, and the advantages of a web-based toolkit for the SCI/D population. Involving individuals with SCI/D in the development and refinement of self-management materials will help ensure that the content and resources are tailored and appropriate; thereby elevating its likelihood of uptake and dissemination during implementation.
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    Human dimensions in water crisis management: Gender bias in water manager appraisals and implications for water decision-making
    (Public Library of Science, 2025-11-19) Smith, Lauren Keira Marie; Begsieker, Hilary B.; Wolfe, Sarah Elizabeth
    Climate change increases water crises’ frequency and intensity, requiring more effective solutions and water management. Environmental scholars have found gender-diverse teams make more sustainable, efficient, and equitable solutions. However, women remain under-represented in water management, hindering effective decision-making. Further, water crisis communications carry inextricable mortality reminders: In a water crisis, access to a life-sustaining resource is threatened. Terror Management Theory stipulates that these mortality reminders activate predictable human responses to assuage the anxiety from thinking about our own demise, responses that include strengthening ingroup identities and distancing from outgroups. These responses may exacerbate gender biases already present in homogeneous management contexts, potentially limiting effective water management outcomes. We empirically tested effects of (a) a standard mortality reminder, (b) a water crisis reminder, and (c) a painful but non-life-threatening control reminder on judgements of same- or different-gender water managers. Ambivalent sexism (a framework consisting of hostile and benevolent sexism subcategories) was included as a moderator variable, revealing significant interacting effects based on participants’ benevolent sexism levels. Benevolent sexism (BS) stems from the belief that women need to be protected by men, creating prejudiced behaviours that may appear protective but in actuality harm gender equity. We found (a) water crisis reminders evoked responses similar to the standard mortality reminders and (b) significant interacting effects emerged regarding existential threat, benevolent sexism, and decision-makers’ gender. Specifically, control group males rated the water manager more positively, regardless of gender; male participants higher in BS rated the woman water manager more positively, regardless of reminder condition; and female participants lower in BS rated the woman water manager less positively in the threat reminder conditions. Reasons for these outcomes are explained alongside implications for effective water management. Thus, water crisis communications, mortality reminders, and sexism can influence gender bias in water management, negatively influencing sustainable water outcomes.
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    Pathways for accountability in intergovernmental water-climate conferences
    (Public Library of Science, 2025-12-01) Jones-Crank, J. Leah; Bayoumi, Moustafa; Jacobs-Mata, Inga; Klimes, Martina; Samel, Matus
    Water and climate are inextricably linked [1,2], and integrating water and climate goals together can lead to win-win actions [3]. Most global multilateral conferences devoted to climate change do feature water actions. Likewise, most global conferences devoted to water systems do feature climate change impacts. At water and climate intergovernmental negotiation meetings, here called simply multilateral conferences, participants—including nation states, multilateral bodies, and other organizations—set targets, develop strategic plans, and commit to action. These targets, plans, and commitments are what we call the conference “outcomes” that guide future action. These conferences must strive towards greater integration of water and climate to address cross-sectoral challenges. At present, we see promising shifts towards integrating water and climate. For example, the Water for Climate Pavilion (WfCP) at the United Nations (UN) Climate Change Conference of Parties (COP) meetings brings together over 70 stakeholders to highlight how water management can offer vital yet often overlooked climate solutions. Additionally, the United Arab Emirates (UAE), which hosted COP28 in 2023, realized the centrality of water for meaningful climate action and will now co-host, with the Republic of Senegal, the upcoming 2026 UN Water Conference, embedding climate-related challenges and solutions into the water agenda.
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    SARS-CoV-2 detection is independent of microbiome composition on surfaces in a major Ontario hospital
    (Public Library of Science, 2025-12-04) George, Nikhil A.; Bradford, Lauren; Hinz, Aaron; El Kadi, Marita; Xing, Lydia; Doukhanine, Evgueni; MacFadden, Derek R.; Nott, Caroline; Fralick, Michael; Kassen, Rees; Wong, Alex; Hug, Laura A.
    The SARS-CoV-2 pandemic has resulted in considerable mortality in hospital settings. Built environment surveillance can provide a non-invasive indicator of SARS-CoV-2 status in hospitals, but we have a limited understanding of SARS-CoV-2’s microbial co-associations in the built environment, including any potential co-occurrence dynamics with pathogenic and antimicrobial-resistant microorganisms. Here we examine the microbial communities on floors and elevator buttons across several locations in two major tertiary-care Ontario hospitals during a surge in SARS-CoV-2 cases in 2020. Total microbial community composition, prevalence and type of detected antimicrobial resistance genes, and virulence factor distributions were governed by sample source rather than SARS-CoV-2 detection status. Fifteen microorganisms were identified as indicator species associated with positive SARS-CoV-2 signal, including three opportunistic pathogens (i.e., two Corynebacterium sp. and a Sutterella sp). Key clinically relevant antimicrobial resistance genes showed varying prevalence across sites within the hospital, suggesting that our workflow could inform resistance burden in hospitals. Overall, these results indicate limited or only weak interactions between microbiome composition and SARS-CoV-2 detection status in the hospital built environment.
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    Barriers and facilitators to antibiotic stewardship in Nigeria's private healthcare sector: A qualitative interview study with national health and regulatory interest holders
    (Public Library of Science, 2026-01-06) Mahdi, Aaya; Detchaptche, Sarah Pascale Ngassa; Klinton, Joel Shyam; Eriobu, Nnakelu; Uche, Blessing; Maredia, Nawal; Oga-Omenka, Charity; Sulis, Giorgia
    Antimicrobial resistance (AMR) poses a growing global health concern, particularly in low- and middle-income countries (LMICs) such as Nigeria, where stewardship efforts have largely overlooked the private healthcare sector. Given that most Nigerians seek care from private providers, understanding the barriers and opportunities for implementing antibiotic stewardship programs in this setting is critical. We conducted a qualitative study consisting of semi-structured interviews with 14 interest holders from national health and regulatory organizations in Nigeria. Participants were purposively selected for their expertise and leadership roles related to antibiotic use and regulation in Nigeria, ensuring representation from professional associations, federal agencies, and technical bodies. Interviews were conducted virtually between August and December 2024, transcribed verbatim, and thematically analyzed using Braun and Clarke’s six-step framework. Codes were grouped into four thematic domains reflecting the roles of key actors (private sector, practitioners, government and health systems, and patients), and mapped to the Social-Ecological Model (SEM) to reflect individual, organizational, and policy-level influences. Participants identified multiple barriers to stewardship implementation in the private sector, including inconsistent prescribing practices, limited access to diagnostics, weak regulatory enforcement, and knowledge gaps among practitioners and patients. System-level constraints such as workforce shortages and fragmented AMR surveillance infrastructure were also cited. However, participants did highlight several facilitators, including licensing-linked training requirements, institutional partnerships, and openness within the private sector to adopt stewardship initiatives. Recommended strategies included standardized training programs, development of prescribing guidelines and protocols, performance-based incentives, and community-based public awareness campaigns. This study underscores the urgent need for targeted, context-sensitive stewardship strategies tailored to Nigeria’s private healthcare sector. Engagement with interest holders revealed both systemic challenges and actionable opportunities to strengthen antibiotic stewardship and support broader AMR control efforts.