Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.

Residents of rural areas are underrepresented in research. The aim of this narrative review was to explore studies describing the effectiveness of community engagement strategies with rural communities to promote participant recruitment and participation in clinical research. Following PRISMA guidelines, this narrative review was conducted in June 2020. Our search strategy was built around keywords that included community-engaged research, rural community, and recruitment strategies into clinical research. Content-related descriptive statistics were summarized. The selected articles were distributed into categories of levels of community engagement: inform, consult, involve, collaborate, or co-lead. The search resulted in 2,473 identified studies of which forty-eight met inclusion criteria. Of these, 47.1% were randomized controlled trials. The most common levels of engagement were consultation (n = 24 studies) and collaboration (n = 15), while very few focused on informing (n = 2) and co-leadership (n = 2). Strategies, limitations, and findings are discussed for each level of community engagement. This narrative addressed a gap in knowledge regarding participant recruitment in rural communities in relation to assistance from community members. Community engagement contributed to the success of the research, especially in recruitment, participation, and building trust and partnership.

Magnetic resonance imaging T1 values in Alzheimer's disease (ATD) were similar to age-matched controls although frontal T1 values tended to increase intraindividually with progression of the dementia. T1 values were raised, in both cortical grey and white matter, in Korsakoff's syndrome and multi-infarct dementia. T1 values appear of little value in studying the neuropathological changes in ATD in relationship to the neuropsychological deficits, but can assist in the differential diagnosis of pre-senile dementia.

This article examines the theological and ecological significance of the International Pastoral Letter on the Columbia River Watershed issued by the U.S. and Canadian Bishops in 2001. It argues that through its inclusive, participatory process, its emphasis on the watershed as a significant locus for theological reflection, and its strong moral, spiritual vision regarding what a watershed is and can be, the Letter makes a significant contribution to Catholic teaching on the environment. However, the article also claims that due to its generalizing rhetorical style, its weak vision of spirituality and its lack of a critical, prophetic edge, the Letter fails to realize its full potential. The article poses questions about the central meaning and purpose of such pastoral letters and about what the Roman Catholic community can learn from the present Letter that might strengthen future attempts to address environmental or other pressing concerns.

This was not a journey I wanted to make. One of my oldest and dearest friends, Donald Nicholl, was dying of cancer in England. Travelling there to see him meant, I knew, saying goodbye. And this was something I did not want to do. I did not want to face up to the stark fact of his impending death. I did not want to consider how I would live with the immense hole that I knew his passing would create. Somehow, from a distance, I had been able to sustain the illusion that he would not die, that his disease would go into remission, that we would again walk the Pennines together, talking excitedly of our latest discoveries, of our hopes for the future. But now, handing my ticket to the stewardess and boarding the plane, I no longer harboured such illusions. Embarking on this journey brought home to me the harsh reality I had so far been evading: my friend was dying. In doing so, it also wakened me in a new way to Donald's journey, to his struggle, amidst much physical pain and loneliness, to make his way along the narrow, steep path toward death, toward God.

This was a path in many ways unimaginable to me. Certainly, I have faced up to the reality of death, struggled with it in my own way. But to be on the edge of death, to know that the end of life is near? No, I have not known that reality. But perhaps this was one of the reasons for my journey to see Donald in England: to be brought into the presence of this mystery in a way that I never would have discovered on my own. It is strange to consider this.

This essay is an attempt to sketch a preliminary map of the emerging dialogue between spirituality and the contemporary literature of nature. This includes: (1) a consideration of their distinctive approaches to the mapping of the sacred landscape; (2) an exploration of some of the ambiguities and tensions within the literature of nature toward matters of religion; (3) an outline of recent developments within the discipline of spirituality that enable scholars in that field to respond more thoughtfully to questions raised by nature writers; (4) a description of the genres found in the burgeoning literature of nature writing and the themes that make it a useful resource and conversation partner for spirituality; (5) an evaluation of three prominent themes of contemporary nature writing—relationship, mystery, and moral responsibility—of particular importance for developing a contemporary spirituality of nature.