Search Results (5,661)

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse reactions to low-level environmental chemicals, often resulting in multisystem symptoms triggered by volatile organic compounds (VOCs) emitted from fragranced personal care and household products. The condition raises public health and accessibility concerns, as people with MCS may face barriers to accessing workplaces, healthcare settings, educational institutions, and other public environments. This descriptive cross-sectional study aimed to characterize the chemical exposures participants attributed to the onset of MCS and to subsequent symptom provocation, and to describe the associated symptom patterns. A cross-sectional survey was administered to Canadian residents aged 18 years or older, living with MCS for at least 1 year, with 18 questions assessing exposure history and onset of MCS and symptom provocation. A total of 119 participants completed the survey. Participants most frequently attributed the onset of MCS to the workplace (55%) or home (35%), with (61%) reporting ongoing exposures over time as the most frequently reported circumstance associated with onset. Fragranced products, including perfumes, air fresheners, cleaning products, disinfectants, construction materials, and laundry products, were the exposures most frequently reported in relation to both onset and subsequent symptom triggering. Symptoms involved multiple organ systems, with nearly one-third of participants reporting 11 or more symptoms; cognitive and respiratory symptoms were most prevalent. Nearly three-quarters of participants (74%) reported symptoms associated with third-hand exposure, and 51% reported discarding contaminated items, suggesting that third-hand exposure may represent an underrecognized pathway for symptom provocation. Full article

The rapid adoption of Generative Artificial Intelligence (GenAI) is transforming higher education by reshaping learning experiences, student engagement, and creativity. However, little is known about the mechanisms through which GenAI enhances creativity, particularly within tourism and hospitality education. Unlike prior studies that primarily examine students’ intention to adopt GenAI, this study explains how GenAI adoption translates into creativity through enhanced learning and learning engagement while accounting for ethical risks. Drawing upon contemporary learning and creativity literature, this study examined how students’ adoption of GenAI influences creativity through the mediating roles of enhanced learning and learning engagement, while also investigating the moderating effect of perceived ethical risks associated with GenAI use. Data were collected from 420 students enrolled in tourism and hospitality faculties and institutes across Egypt. The proposed research model was tested using Partial Least Squares Structural Equation Modeling (PLS-SEM). The findings reveal that enhanced learning and learning engagement are the principal mechanisms through which GenAI adoption improves students’ creativity, whereas perceived ethical risks significantly weaken these positive relationships. This study contributed to the emerging GenAI literature by moving beyond technology adoption perspectives to explain how GenAI shapes creativity outcomes in higher education. It further extends tourism and hospitality education research by providing one of the first empirical examinations of the mechanisms through which GenAI enhances student creativity while accounting for ethical concerns. The findings provide practical guidance for higher education institutions seeking to integrate GenAI responsibly while fostering creativity, engagement, and innovative learning environments. Full article

Background: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)—communication, therapeutic relationship, patient expectations, and environmental cues—are increasingly recognized yet remain inconsistently integrated into routine practice. Objective: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. Methods: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). Results: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. Conclusions: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains. Full article

Community-based leisure may support newcomer women’s well-being and belonging, yet its role within settlement practice remains underexamined. This manuscript presents findings from a larger community-based research project that explored Iranian newcomer women’s (aged 30–55) experiences navigating leisure, community life, and well-being during their settlement in Ottawa, Canada. In this manuscript, the discussion focuses on data collected from virtual feedback consultation sessions with two women who participated in co-designed leisure activities, and an executive from a non-profit settlement service organization serving Iranian and Farsi-speaking newcomers. Data coding, translation, verification and reflexive thematic analysis guided our qualitative methodological approach, and findings were interpreted within an intersectional feminist framework. Our findings revealed the challenges the participating women faced in balancing employment, caregiving, and household labour while acclimatizing to Canada. The women in this study described leisure as a vital interruption of their layered responsibilities and a chance to connect with others who shared their migration experience. Leisure did not replace formal settlement supports but addressed dimensions of settlement that 33 conventional indicators often miss, including identity loss, unfamiliarity with the city, and 34 the need for connection in a shared language and cultural setting. In this case, the settlement organization functioned as a cultural infrastructure that made participation in public and cultural life accessible for the women who took part. Full article

Background/Objectives: Male hypogonadism affects 35–50% of men with type 2 diabetes mellitus (T2DM) and obesity. The relationship between testosterone deficiency and response to incretin-based therapies (GLP-1 and GIP receptor agonists) remains incompletely understood. This systematic literature review, conducted following PRISMA 2020 guidelines, examines whether male hypogonadism represents a risk factor for poor response to incretin therapy or, conversely, whether these agents offer therapeutic benefits for this population. Methods: A comprehensive systematic literature search was conducted on 31 December 2024, across PubMed/MEDLINE, Scopus, and Web of Science using three search domains: (1) hypogonadism and incretin therapy response; (2) testosterone deficiency and GLP-1/GIP receptor agonists; (3) incretin response and testosterone. Eligibility criteria included human studies (randomized controlled trials [RCTs], observational studies, cohort studies, cross-sectional studies, systematic reviews, and meta-analyses) in adult men reporting testosterone levels and/or incretin response. Animal studies, pediatric populations, case reports with n < 5, editorials, and letters without data were excluded. Study selection followed PRISMA 2020 guidelines with independent dual screening. Risk of bias was assessed using the Cochrane Risk-of-Bias 2.0 tool (ROB2) for RCTs, the Newcastle–Ottawa Scale (NOS) for observational studies, and AMSTAR-2 for systematic reviews and meta-analyses. Due to substantial heterogeneity in study designs, populations, interventions, and outcome measures, a meta-analysis was not feasible; therefore, a narrative synthesis was performed. Results: From 326 records identified, 29 studies were included after deduplication and screening (primary studies: 14; systematic reviews/meta-analyses: five; narrative reviews/expert opinion: 10). Risk-of-bias assessment revealed moderate-to-high overall risk: RCTs had small sample sizes (n = 12–42) and short follow-up (12–24 weeks), raising concerns about statistical power; observational studies were of fair-to-good quality (NOS 4–7 stars) but subject to confounding; and systematic reviews were of low-to-moderate confidence (AMSTAR-2). Primary evidence from RCTs and observational studies demonstrates that GLP-1 receptor agonists (GLP-1RAs)—particularly semaglutide and liraglutide—and the dual GIP/GLP-1 receptor agonist tirzepatide significantly increase total testosterone levels in men with obesity-related functional hypogonadism (mean increase 2.5–5.2 nmol/L). This effect is largely mediated by weight loss and improvement of insulin resistance rather than direct androgenic action. Evidence regarding whether baseline hypogonadism impairs glycemic or weight-loss response to incretin therapy is limited and indirect; no adequately powered comparative trials stratified by baseline testosterone status were identified. Conclusions: Incretin-based therapies, particularly GLP-1 receptor agonists and the dual GIP/GLP-1 receptor agonist tirzepatide, appear to improve testosterone levels in men with obesity-related functional hypogonadism, an effect that is largely mediated by weight loss and improvement of insulin resistance rather than a direct androgenic action. However, direct comparative evidence between hypogonadal and eugonadal men regarding glycemic or weight-loss response to incretin therapy remains insufficient to draw firm conclusions. The hypothesis that male hypogonadism does not impair incretin therapy response is biologically plausible but is currently supported only by indirect evidence. Prospective, adequately powered trials stratified by baseline testosterone status are needed to resolve this question. Full article

Background: Fragrance-free policies are increasingly adopted to improve indoor air quality and reduce fragrance exposure linked to adverse health outcomes and accessibility barriers. This scoping review mapped the evidence on fragrance-free policies across sectors. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched five peer-reviewed databases and grey literature sources. Documents describing formal scent-free or fragrance-free policies or guidance in workplaces, healthcare, educational, or public settings were included. Data were charted on policy characteristics, enforcement mechanisms, implementation supports, and governance features. Results: Sixty-three documents were included. Findings revealed substantial variability in terminology, scope, and enforcement. Many policies relied on voluntary compliance and awareness-based strategies, with limited integration of structural supports such as procurement controls, staff training, and evaluation frameworks. Enforcement mechanisms were predominantly reactive, responsibilities were inconsistently defined, and consequences for non-compliance were limited. Although many policies referenced multiple chemical sensitivity or fragrance sensitivity, accommodation pathways and accountability structures were frequently lacking. Four key themes indicate that many fragrance-free policies function as accommodation tools rather than integrated environmental health interventions. Conclusions: Strengthening definitional clarity, institutional accountability, and structural integration may enhance effectiveness and support more consistent, equitable, and evidence-informed approaches to reducing fragrance-related exposures in indoor environments. Full article

High-solar-reflectivity cladding materials are widely promoted to reduce cooling demand and mitigate urban heat island effects. However, in cold and mixed climates, their overall energy and carbon performance remains uncertain due to potential winter heating penalties and embodied carbon trade-offs. This study presents a comparative evaluation of energy use, annual operational carbon emissions, and material-level embodied carbon for high-reflectivity cladding applied to commercial buildings across representative Canadian climate zones. Dynamic simulations were conducted in EnergyPlus using a standardized warehouse archetype in Montreal, Toronto, and Vancouver, representing cold continental, mixed continental, and marine climates. Roof and wall solar reflectivity (albedo) was varied from 0.2 (baseline) to 0.8 (high reflectivity), while other envelope properties remained constant. Increasing reflectivity reduced annual cooling demand by approximately 15% in Montreal and Toronto and 20% in Vancouver, with the largest reductions during peak summer periods. However, reduced winter solar heat gains produced heating penalties, increasing total annual energy use by 1% in Montreal, 0.5% in Toronto, and less than 0.5% in Vancouver. Operational greenhouse gas emissions were calculated by converting simulated annual electricity and natural gas use into CO₂-equivalent emissions using provincial grid emission factors and combustion factors consistent with Environment and Climate Change Canada reporting. The results demonstrate the strong influence of regional energy supply on operational carbon outcomes. A cradle-to-gate (A1–A3) life cycle assessment quantified embodied carbon of representative cladding materials using Environmental Product Declarations and North American databases. Embodied carbon varied considerably: product-specific steel cladding manufactured in low-carbon electricity regions showed global warming potential as low as 1.76 kg CO₂e/kg, compared with industry averages exceeding 2.4 kg CO₂e/kg. Rather than performing a complete whole-life carbon assessment, this study comparatively evaluates annual operational carbon emissions and material-level embodied carbon to improve understanding of the energy and carbon implications of high-solar-reflectivity cladding materials in representative Canadian climates. The results demonstrate that climate conditions, envelope thermal performance, regional energy supply, and manufacturing pathways influence the environmental performance of cool envelope strategies. Full article

Microwave-assisted recovery provides a potential approach for restoring fracture damage in asphalt mixtures, but previous studies have mainly focused on heating and curing conditions, while the role of the pre-heating fracture state remains less understood. This study investigated microwave-assisted fracture energy recovery from a damage-state regulation perspective by comparing a control asphalt mixture (CAM) with a basalt fiber-reinforced asphalt mixture (BFAM). Semi-circular bending (SCB) tests were combined with an L9 orthogonal design to evaluate three pre-heating conditions, target surface temperatures of 45–85 °C, and curing times of 6–24 h. Rather than directly enhancing binder recovery, basalt fiber reinforcement increased the initial fracture resistance and altered the relative fracture condition reached under a given external load. The recovery index RI ranged from 20.7% to 55.9% for CAM and from 35.2% to 82.3% for BFAM. Main-effects ANOVA showed that the pre-heating damage condition had the largest main-effect contribution within the adopted L9 framework, reaching 82.3% for CAM and 95.2% for BFAM, substantially exceeding those of target surface temperature and curing time. Under a comparable external load of approximately 2.5 kN, CAM reached the 70% P_max condition, whereas BFAM remained at the 40% P_max condition, with corresponding mean RI values of 42.8% and 76.9%. These results support a proposed conceptual damage-state regulation framework within the investigated material and experimental conditions, in which basalt fiber reinforcement preserves a more favorable pre-heating state and thereby greater recovery potential. The findings highlight the importance of improving fracture resistance and applying microwave-assisted treatment before extensive fracture development occurs, while broader validation is required before generalizing the proposed framework to other materials or field conditions. Full article

Background/Objectives: Since 2021, indeterminate thyroid nodules have been routinely assessed using molecular testing through Quebec’s provincial ThyroSeq v3 pilot project. The primary objective of our study was to compare the molecular and clinicopathological characteristics of Bethesda III and Bethesda IV thyroid nodules evaluated through the pilot project. The secondary objective was to assess the program’s economic impact. Methods: This retrospective study included 934 patients (mean age 55.7 ± 14.3 years; 79.3% female; mean nodule size 2.2 ± 0.8 cm) from two McGill University teaching hospitals in Quebec, comprising 593 Bethesda III and 341 Bethesda IV nodules that underwent molecular testing between 2021 and 2025. Eligible nodules were TI-RADS 3 or 4, measured 1–4 cm, and Bethesda III nodules required two consecutive cytology results before testing. Clinicopathological characteristics, histopathological diagnoses, molecular findings, and mutational profiles were analyzed. A projected 10-year cost analysis was also performed. Results: Of the 934 nodules tested, 280 demonstrated a genetic alteration. The risk of malignancy among surgically resected ThyroSeq v3-positive Bethesda III and IV nodules was 68% and 78%, respectively. Compared with Bethesda III nodules, Bethesda IV nodules demonstrated significantly greater vascular invasion (p = 0.029) and prevalence of oncocytic carcinomas (p = 0.010). Molecular testing was associated with an estimated reduction of 1.49 million Canadian dollars in healthcare costs over 10 years. Conclusions: Although Bethesda IV nodules exhibited more oncocytic carcinomas and invasion, molecular mutation class distribution and the prevalence of aggressive pathological features were similar between Bethesda categories. Together with the demonstrated economic savings, these findings support continued implementation of publicly funded ThyroSeq v3 testing to improve management of indeterminate thyroid nodules while reducing unnecessary surgery. Full article

Background: Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with Multiple Chemical Sensitivity (MCS). Methods: Using a qualitative-dominant mixed-methods design, we examined IAQ accessibility barriers and explored perceived implementation and accessibility gaps in existing fragrance-free policies among sixty individuals with MCS and related IAQ exposures across ten focus groups. Qualitative and quantitative data were collected in parallel, with thematic analysis conducted in NVivo. A structured IAQ and policy survey was administered to quantify reported experiences and policy impacts. Results: Approximately 63.3% of focus group participants reported dissatisfaction with the indoor environments they encountered. Qualitative findings highlighted indoor environments as inaccessible, inadequately controlled, and associated with ongoing exposure to fragranced products as well as other indoor pollutants. These findings indicate that current approaches often fail to ensure accessibility, leaving individuals with MCS exposed and excluded from full participation in workplaces, healthcare settings, and other public spaces. Conclusions: Comprehensive fragrance-free policies incorporating source control, education, ventilation, and accountability mechanisms may reduce exposure while improving accessibility and inclusion across the built environment. Full article

Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. To our knowledge, this is the first national Canadian study to examine accommodation request outcomes across both employment and housing among adults with MCS, combining quantitative and qualitative data. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants’ experiences of disclosure, and accommodation outcomes. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). Findings should be interpreted in light of the cross-sectional design, self-reported data, and community-based recruitment, which may limit generalizability. The findings suggest that inconsistent institutional recognition of MCS can function as a barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires clarified guidance on the duty to accommodate multiple chemical sensitivity, proactive scent-free and lowest-emission policies in workplaces and housing, and improved healthcare provider education to support accommodation documentation. Full article

Risk assessment is critical for managing health threats at the human–animal–environment interface, yet sector-specific approaches can result in fragmented actions. To address this gap, the Joint Risk Assessment Operational Tool (JRA OT), an operational tool of the Tripartite Zoonoses Guide, was developed by the Food and Agriculture Organization of the United Nations, the World Health Organization, and the World Organization for Animal Health. The JRA OT provides a structured framework for joint qualitative risk assessments that integrate multisectoral expertise to identify risk pathways, assess likelihood and impact, and develop consensus-based risk management and communication options. Surveillance systems play a critical role in this process by providing the multisectoral data needed to inform risk assessments, while the JRA process helps identify information gaps and guide the strengthening of integrated One Health surveillance. Implemented in at least 52 countries, the JRA OT has informed national mandates in Indonesia, Viet Nam, and Tanzania, regional strategies in West Africa, and adaptations in Canada. Cascade training has been used to build subnational capacity to facilitate roll out. Sustained leadership commitment, multisectoral coordination, routine applications, local adaptation, and capacity building remain essential for global implementation. Full article

Bone loss represents a significant clinical burden that has driven the development of improved orthopedic graft substitutes. Although current grafting options, including autografts, allografts, and xenografts, have demonstrated considerable therapeutic potential, their widespread application is constrained by limitations such as donor scarcity, limited availability, and associated clinical risks. Consequently, biologically derived materials, including avian eggshells and marine bivalve shells, have emerged as promising alternative sources to produce bone precursor materials and next-generation bone graft substitutes. This review summarizes recent advances in avian eggshell- and marine shell-derived calcium carbonate (CaCO₃) materials for bone regeneration and examines their preclinical evaluation in diverse animal models, including critical-size defects in calvarial, femoral, radial and mandibular bone. Relevant studies published over the past ten years were systematically analyzed, focusing on natural calcium carbonate systems derived from avian eggshell and marine shells, including oyster, mussel, clam, scallop, cockle, and sea urchins. A structured literature search was conducted using PubMed, Scopus, and Google Scholar to identify studies published between 2015 and 2025 investigating eggshell- and aquatic-derived biomaterials for bone repair and regeneration. Eligible studies were screened, and data were comparatively analyzed with respect to biomaterial source, scaffold fabrication, physicochemical characteristics, mechanical performance, biocompatibility, osteogenic potential, and the use of preclinical animal studies. Eggshell-derived biomaterials currently show the strongest translational evidence, while aquatic shell-derived biomaterials remain promising but underexplored for bone regeneration. Furthermore, this review critically examines the scientific, manufacturing, and regulatory challenges that must be addressed before clinical implementation. Full article

Nonadherence to medications for psychosis is a major challenge in the management of schizophrenia and is associated with an increased risk of relapse, hospitalization, functional deterioration, and premature death. Although long-acting injectable (LAI) medications for psychosis improve treatment continuity, important differences exist among LAIs regarding initiation regimen, attainment of therapeutic blood level exposure, and steady state, dosing, and switching. Risperidone ISM^® is an intramuscular LAI administered every four weeks, designed to provide rapid and sustained therapeutic exposure without the need for loading doses or oral supplementation. This narrative review translates the pharmacokinetic (PK) and pharmacodynamic (PD) profile of risperidone ISM^® into expert-informed guidance for treatment initiation, dose optimization, switching, and ongoing schizophrenia management. Risperidone ISM^® achieves therapeutic exposure within hours of administration and maintains plasma concentrations and dopamine D2 receptor occupancy at levels associated with antipsychotic efficacy throughout the dosing interval, supporting continuous antipsychotic coverage and stability. Its PK profile, as characterized in clinical studies, and simplified initiation regimen may facilitate clinical decision-making across treatment settings, including transitions from oral risperidone or other medications for psychosis and continuity of care following hospitalization or relapse, while supporting symptom stability, functioning, and patient engagement. By translating PK/PD characteristics into practical clinical implications, this review aims to support clinicians in optimizing the use of risperidone ISM^® as part of individualized, recovery-oriented care in the short- and long-term management of people living with schizophrenia across settings. The recommendations presented reflect expert interpretation of the available PK/PD, clinical trial, observational, and product-label evidence, supplemented by clinical experience. Full article