What we are working on

Lithium-ion battery fires involving electric micromobility devices can cause severe burn and inhalation injury. Clinical reports and public safety organizations both make prevention recommendations, but their emphasis may differ. This study compared prevention messages in the clinical and grey literature.

Clinical recommendations were drawn from a prospectively registered systematic review (PROSPERO CRD420261341238). A targeted grey-literature review examined 16 source groups from consumer-safety agencies, fire services, regulators, standards organizations, and manufacturers. Key source pages were rechecked through August 7, 2026. Recommendations were grouped by theme and compared descriptively.

Eleven clinical records were included. Clinical and grey literature overlapped on supervised charging, manufacturer-approved batteries and chargers, damaged-battery warning signs, safe storage, avoiding battery modification, product certification, regulation, injury surveillance, public education, and charging infrastructure. Grey literature additionally addressed professional e-bike conversions, disposal and recycling, product registration and recalls, incident reporting, producer and distributor responsibilities, and building-level fire-safety controls. Health-system preparedness for multiple-casualty incidents was identified in the clinical literature but not as an explicit recommendation in the reviewed grey sources.

Clinical reports and public guidance generally reinforce the same immediate safety messages, while grey literature extends prevention into regulatory, product-life-cycle, and building-level measures. Together, they provide complementary targets for prevention messaging. This comparison describes recommendation content and does not assess intervention effectiveness.

Complete local obstetric service unavailability may require patients to seek care outside their community. We characterized the duration of publicly posted complete obstetric service unavailability in Alberta and the proximity of affected sites to another currently listed maternity-related service.

Using Alberta Health Services archived disruption snapshots and news or notice postings, we reconstructed intervals from August 1, 2021, to June 30, 2026, during which all local obstetric services or obstetric coverage were reported as unavailable. Repeated captures were reconciled, recurring schedules were expanded, and overlapping intervals were unioned within each site and calendar year. For each affected site, road distance and estimated driving time to the nearest other facility matching predefined maternity-related terms were calculated using a local OSRM automobile-routing matrix based on the Geofabrik Alberta OpenStreetMap extract and an AHS directory reviewed July 26, 2026.

Thirty-six sites contributed 262,232 cumulative site-hours, representing 67.2% of reconstructed maternity-disruption site-hours. The median road distance to another currently directory-listed maternity-related facility was 77.7 km (IQR 41.2–89.7), corresponding to 61.5 driving minutes (IQR 34.2–72.7). Six sites were at least 100 road km away, and Slave Lake and Wabasca were at least 120 driving minutes away. Sundre, Rimbey, Three Hills, and Westlock contributed 157,896 site-hours (60.2%) but were 38.0–62.4 road km from another currently listed maternity-related facility.

Duration burden and geographic separation were distinct dimensions of publicly documented obstetric-service instability. Most cumulative hours were concentrated at four sites with shorter estimated driving times, whereas several lower-burden communities were more geographically isolated. Distances based on the current AHS directory provide geographic context only and do not establish historical service availability, actual patient travel, or clinical suitability.

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.

Immersive virtual reality (iVR) is increasingly used for technical surgical-skills training. As iVR technology and applications have evolved, it remains unclear how evidence has progressed in methodological rigor, assessment beyond the virtual environment, and relevant outcomes. We characterized the contemporary evidence base and identified evidence gaps.

We included studies evaluating interactive iVR delivered through a head-mounted display for technical surgical-skills training in medical students, surgical trainees, fellows, or surgeons. Studies published before January 2021 were compared with those from January 2021 onward. We extracted study design, sample size, assessor blinding, assessment setting, retention, implementation reporting, study-quality characteristics, and outcome domains. Findings were synthesized descriptively to characterize evidence maturity.

Thirty-six studies met eligibility criteria, including 16 published before January 2021 and 20 thereafter. Contemporary studies were more frequently randomized (19/20, 95% vs 10/16, 63%) and assessed performance beyond the iVR environment (19/20, 95% vs 12/16, 75%). However, assessment in cadaveric or operating-room settings remained uncommon (5/20, 25% vs 6/16, 38%). Delayed retention was assessed in one study and no contemporary studies, while no study evaluated patient outcomes. Contemporary studies assessed technical performance, accuracy, errors, or completion time.

The evidence base has expanded and methodological rigor has improved, but relevant validation remains limited.

Contemporary iVR research demonstrates progress in study design and assessment beyond the virtual environment, while evidence for durable skill retention, operative transfer, implementation, and patient benefit remains insufficient. Future studies should prioritize rigorous comparative designs and relevant outcomes.

Lithium-ion battery fires involving electric mobility devices have been reported, but 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 may limit access to emergency care, but their cumulative burden and distribution across Alberta have not been summarized at the system level. We quantified publicly posted ED disruption hours, timing, stated reasons, and geographic context.

We retrospectively reconstructed Alberta Health Services (AHS) temporary ED disruption postings from August 1, 2021, through July 31, 2026. We reconciled archived service-listing snapshots with the AHS news and notice archive, collapsed duplicate captures, and converted posted wording into dated intervals. Recurring schedules were expanded, intervals were clipped to the study period, and overlapping intervals within each site were merged. We summarized burden by year and site, stated reasons, time of week, timing structure, distance and drive time to the nearest listed ED, and concurrent disruption at that ED. One reviewer checked every reconstructed interval against its source, and a second reviewer audited 200 intervals. Analyses were descriptive.

Forty-nine EDs contributed 160,798.7 unioned disruption hours. Annual burden was highest in 2023 (38,896.3 h) and remained high in 2024 (36,280.2 h) and 2025 (31,088.2 h). The five highest-burden EDs accounted for 93,307.5 h (58.0%). Workforce-shortage wording was linked to 128,902.0 h (80.2%). Reason categories were not mutually exclusive. Night accounted for 83,195.5 h (51.7%) of disruption hours, compared with 37.5% of study-period time, a 1.38 concentration ratio. Scheduled, Sustained, and Intermittent intervals accounted for 52.1%, 32.5%, and 15.4% of hours, respectively. Median road distance to the nearest listed ED was 49.6 km (IQR 40.6–76.9), and median estimated drive time was 40.6 minutes (IQR 34.1–61.3). Seventeen of 49 affected EDs (34.7%) had at least one period of documented concurrent disruption at their nearest listed ED.

Publicly posted disruptions were recurrent, concentrated at a small number of EDs, and often scheduled or sustained. Nighttime disruption was overrepresented, and 17 of 49 affected EDs had documented overlap with their nearest listed ED. These findings reflect public postings and do not establish actual service availability, patient travel, or patient outcomes. More consistent reporting of disruption timing, service level, and stated reason would improve surveillance.

Temporary hospital disruptions can affect local delivery care, caesarean capability, epidural access, and maternity backup. Alberta Health Services (AHS) publicly posts these changes, but their cumulative burden is not available in a single system-level dataset. We characterized publicly documented maternity-related hospital capability disruptions across Alberta using archived records.

We conducted a retrospective descriptive reconstruction of AHS temporary service-disruption postings from August 1, 2021, through July 31, 2026. We included postings explicitly affecting maternity care, labour and delivery, caesarean or operative maternity capability, epidural access, or maternity backup. Snapshot and notice records were standardized by site, deduplicated, and reconstructed into dated intervals. Reopening notices and subsequent postings were used only when they provided source-supported evidence of a changed endpoint. Overlapping intervals at the same site were unioned to estimate unique site-level disruption hours. Capability layers overlap and are therefore not additive.

Across 45 sites, 520 reconstructed disruption periods contributed 394,216.2 unioned disruption hours. Annual burden was highest in 2022 at 92,570.5 h and remained substantial in 2023 (85,798.5 h), 2024 (76,257.5 h), and 2025 (74,182.8 h). 38,536.0 h were recorded through July 31, 2026. The highest cumulative burdens occurred in Sundre, Rimbey, Three Hills, Slave Lake, and Westlock. Disruptions affecting all obstetric services and caesarean, epidural, or surgical backup capability were common, but layer-specific hours are non-additive.

Publicly posted AHS records show recurrent and sustained loss of maternity-related hospital capability across Alberta. Several high-burden sites reflect long posted suspensions, including intervals already active at the archive start and therefore left-censored. Capability-specific reporting better reflects operational changes that may affect local delivery access, while these public records do not establish real-time availability, patient outcomes, or a formal rurality classification.

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.