What we are working on

To synthesize patient-level evidence on adeno-associated virus-associated thrombotic microangiopathy (AAV-TMA), describing presentation, timing, investigations, management, outcomes, and supporting an initial approach.

We conducted a systematic review (PROSPERO CRD420251150401) in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with the updated PRISMA 2020 statement. On 16 September 2025, searches were conducted in Medline, Embase, Global Health, Scopus, Web of Science, and CINAHL. We included reports of post-AAV patients with TMA-like presentations. Two reviewers independently screened records and extracted study- and patient-level data. Study quality was appraised using the Joanna Briggs Institute checklists.

We identified 656 records and included 12 records reporting 22 patients. Exposures were primarily onasemnogene abeparvovec (17/22) and fordadistrogene movaparvovec (3/22). Symptom onset clustered within the 5 to 10 days post-infusion window. Renal-predominant features were common (among cases with reporting: hypertension 15/17, oliguria/anuria 13/17, proteinuria 15/16, hematuria 9/9). Schistocytes were present in 16/16 cases, and thrombocytopenia was severe (median 17×10³/µL). ADAMTS13 activity was reported in 9/22, and none were severely deficient. Most patients received corticosteroids; PLEX was used in 6/17 cases and C5 inhibitors in 10/21 cases. ICU admission occurred in 8/10 cases, renal replacement therapy in 7/22, and mortality in 2/22.

Post-systemic AAV-TMA onset clustered in a narrow period with prominent renal involvement. These findings support phenotype- and ADAMTS13-informed triage, balancing thrombotic thrombocytopenic purpura (TTP) coverage with consideration of complement-directed therapy in severe presentations.

Lithium-ion battery fires in electric micromobility devices are an emerging source of burn and inhalation injury. Clinical reports describe prevention strategies related to charging practices, storage, product safety, and regulation. Similar guidance is also produced by fire services, regulators, consumer safety agencies, public health bodies, and manufacturers. This study compared prevention recommendations from the clinical literature with grey-literature guidance to identify where these sources overlap and where non-clinical guidance adds prevention priorities not commonly captured in clinical reports.

A systematic review was conducted in accordance with the Cochrane Handbook and PRISMA 2020 and registered prospectively in PROSPERO (CRD420261341238). Prevention recommendations from a systematic review of micromobility battery fire injuries were used as the clinical reference set. A targeted grey-literature search was conducted across manufacturer guidance, fire service recommendations, regulatory bulletins, consumer safety reports, and public health advisories. Recommendations were extracted, consolidated by meaning, grouped using the review's thematic categories, and compared with the clinical recommendations.

Seventeen grey-literature sources were reviewed. Preliminary mapping showed close overlap for consumer-facing recommendations, including supervised charging, avoidance of overnight or unattended charging, use of manufacturer-approved chargers and batteries, avoidance of damaged or overheating batteries, safe storage away from exits and combustible materials, and product certification. Grey-literature sources placed additional emphasis on certification marks, e-bike conversion kits, battery disposal and recycling, product registration, recall communication, manufacturer and distributor responsibilities, and building-level charging infrastructure.

Clinical and grey-literature recommendations overlapped most clearly on individual behaviours, especially charging practices and product certification. Grey-literature guidance more often addressed structural measures, including regulation, product supply, building-level controls, recall systems, and battery end-of-life handling. Comparing clinical and grey literature prevention discourse identifies areas where clinical recommendations may be strengthened by incorporating structural and policy-level strategies.

Lithium-ion battery fires involving electric mobility devices have been reported; however, their frequency and clinical characteristics have not been well summarized. Burn and inhalation injuries associated with these events, along with their incident characteristics, acute management, and outcomes, were captured in this review.

A systematic review was conducted in accordance with the Cochrane Handbook and PRISMA 2020 and registered prospectively in PROSPERO (CRD420261341238). MEDLINE, Embase, Scopus, Web of Science Core Collection, and CINAHL were searched up to 2026. Backward and forward citation searching and targeted Google Scholar and Google web searches were also performed. Human studies reporting extractable original data on injuries associated with lithium-ion battery fires or explosions involving electric mobility devices were eligible.

Eleven records comprising 334 patients or casualties from seven countries were included. Most were case reports, case series, or observational reports in adults from burn centres. The most severe cases usually followed indoor micromobility fires, often during charging. Across the most directly comparable hospital-based reports, inhalation injury ranged from 33% to 88%, operative management from 40% to 78%, and mortality from 0% to 11%. Reported burn severity was substantial, with mean total body surface area values ranging from 14.5% to 27.5% in the major cohorts. In contrast, one pediatric short-circuit series described uniformly minor hand burns managed non-operatively without mortality.

Lithium-ion battery fires involving electric mobility devices occur predominantly in adults following an indoor battery fire, often during charging. Fires result in combined burn and inhalation injuries, frequent surgeries, prolonged hospitalizations, and mortality. Prevention efforts should focus on certified devices and chargers and on reducing indoor overnight charging.

Temporary emergency department (ED) service disruptions in Alberta are publicly posted by Alberta Health Services (AHS), but their cumulative burden has not been systematically reconstructed. We aimed to quantify publicly documented ED disruption burden in Alberta using archived public records.

We conducted a retrospective archive-based descriptive study of AHS temporary service disruption postings from inception (August 6, 2021) to May 31, 2026. ED-related records were identified from two public archive streams: dated snapshot pages of service disruptions and the AHS news/notice archive. Source records were treated as events before within-source deduplication and as episodes after repeated postings referring to the same underlying disruption were collapsed. Closure intervals were reconstructed from public wording, clipped to the study window, and merged within site-year to estimate total disruption hours. Notice-derived episodes underwent cross-source reconciliation against the snapshot-derived corpus, with manual fixed intervals applied where supported by source text. Disruption hours parsed from all episodes were manually reviewed by one author, with targeted review of a subset performed by a second author.

The final analytic file contained 1,175 episode-years, representing 1,033 unique episodes. Publicly documented ED disruptions accounted for an estimated 154,074.7 unioned disruption hours. Annual burden was 6,155.0 h in the partial 2021 period, 27,866.0 h in 2022, 38,896.3 h in 2023, 36,280.2 h in 2024, 31,088.2 h in 2025, and 13,789.0 h in the partial 2026 period. Across all years, the highest-burden sites were Consort, Hardisty, Boyle, Grimshaw, and Two Hills.

Publicly documented ED service disruptions in Alberta represent a substantial and recurrent loss of emergency care access, with the burden concentrated in a limited number of communities. These findings support routine province-wide surveillance of ED disruptions, more transparent reporting of service interruptions, and targeted workforce stabilization efforts in communities experiencing repeated disruption burden.

Local maternity care depends on linked hospital capabilities, including labour and delivery coverage, cesarean section capability, anesthesia support, epidural access, and obstetrical backup. In rural and regional communities, temporary loss of any one of these capabilities may alter where and how patients can safely deliver. Alberta Health Services publicly posts many temporary hospital service disruptions, but the cumulative pattern of maternity capability instability has not been systematically described. We aimed to characterize publicly posted maternity-related capability disruptions in Alberta using archived public records.

We performed a retrospective archive-based descriptive study of Alberta Health Services temporary service disruption postings from August 1, 2021, to May 31, 2026. Records were drawn from dated snapshot pages of active disruptions and the Alberta Health Services news/notice archive. Eligible records included postings explicitly affecting local maternity capability, including obstetrical service disruptions, loss of labour and delivery availability, loss of cesarean section or epidural capability, and mixed-service disruptions involving obstetrics when delivery care or maternity backup was explicitly affected. Records were standardized by site, deduplicated into episodes, categorized by affected capability, and reconstructed into disruption intervals. Intervals were merged within site-year to estimate disruption hours.

The analytic file contained 984 unique episodes and 1,292 episode-year records across 45 sites. Broad maternity-related disruption signals accounted for 384,779.2 disruption hours. Annual disruption burden was 26,871.0 h in the partial 2021 period, 92,570.5 h in 2022, 85,798.5 h in 2023, 76,257.5 h in 2024, 74,182.8 h in 2025, and 29,099.0 h in the partial 2026 period. The conservative obstetrics/labour and delivery unavailable layer accounted for 257,504.8 h. Capability-associated disruption hours included operative/cesarean section capability unavailable, 176,594.0 h; epidural unavailable, 30,994.7 h; and other named maternity disruption, 13,448.5 h. The highest-burden sites were Sundre, Rimbey, Three Hills, Slave Lake, and Westlock.

Publicly posted maternity service disruptions in Alberta demonstrate recurrent instability in local delivery capability across multiple rural and regional sites. These disruptions often involve partial loss of specific clinical capabilities rather than complete loss of all maternity care. Capability-based reporting may better capture the practical access implications of maternity service instability and identify communities where targeted workforce, anesthesia, and operative-delivery stabilization may be needed.

Wildfires can disrupt hospital operations through direct fire exposure, smoke intrusion, infrastructure strain, evacuation risk, and regional patient redistribution. Existing reviews have focused more broadly on wildfire-related emergency department impacts, emergency medical services response, or hospital evacuation across hazards, rather than specifically on how hospitals and acute-care systems preserved service continuity during wildfire-related disruption. This review synthesised peer-reviewed and selected gray-literature evidence on evacuation, transfer, surge response, and early recovery strategies used to maintain acute-care access during wildfire events.

We conducted a systematic review of studies and operational reports describing wildfire- or bushfire-related disruption to hospitals and acute-care services. We searched MEDLINE, Embase, CINAHL, and Scopus using controlled vocabulary and text words related to wildfires, hospital and critical care settings, and evacuation, transfer, continuity, and recovery processes. We also undertook targeted gray-literature searching using structured Google web searches and searches of relevant hospital, health-system, emergency-preparedness, and government websites. Eligible records included hospital- or system-level reports of evacuation, transfer, service continuity, operational response, or early recovery during real wildfire events. Two reviewers independently screened records and extracted data on setting, disruption type, operational strategies, and reported outcomes. Given expected methodological heterogeneity, findings were synthesised narratively.