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Background: The Rural Surgical Obstetrical Networks (RSON) project was developed in response to the persistent attrition of rural maternity services across Canada over the past two decades. While other research has demonstrated the adverse health and psychosocial consequences of losing local maternity services, this paper explores the impact of a program designed to increase the sustainability of rural services themselves, through the funding of four "pillars": increased scope and volume, clinical coaching, continuous quality improvement (CQI) and remote presence technology. Methods: We conducted in-depth, qualitative research interviews with rural health care providers and administrators in eight rural communities across British Columbia to understand the impact of the RSON program on maternity services. Researchers used thematic analysis to generate common themes across the dataset and interpret findings. Findings: Participants articulated six themes regarding the sustainability of maternity care as actualized through the RSON project: safety and quality through quality improvement opportunities, improved access to care through increased surgical volume and OR backup, optimized team function through innovative models of care, improved infrastructure, local innovation surrounding workforce shortages, and locally tailored funding models. Conclusion: Rural maternity sites benefited from the funding offered through the RSON pillars, as demonstrated by larger volumes of local deliveries, nearly unanimous positive accounts of the interventions by health care providers, and evidence of staffing stability during the study time frame. As such, the interventions provided through the Rural Surgical Obstetrical Networks project as well as study findings on the common themes of sustainable maternity care should be considered when planning core rural health services funding schemes. [ABSTRACT FROM AUTHOR]

Background: Providing access to pediatric healthcare services in British Columbia, Canada, presents unique challenges given low population densities spread across large geographic distances combined with a lack of availability of specialist providers in remote areas, leading to quality of care shortcomings and inequalities in care delivery. The study objective was to develop a framework that provides a common language and methodology for defining and planning child and youth healthcare services across the province.Methods: The framework was developed in two phases. In Phase 1, a literature and jurisdictional review was completed using the following inclusion criteria: (i) description of a framework focusing on organizing service delivery systems (ii) that supports health service planning, (iii) includes specialty or subspecialty services and (iv) has been published since 2008. In Phase 2, a series of meetings with key provincial stakeholders were held to receive feedback on the developed Tiers of Service framework versions that were based on the literature and jurisdictional review and adjusted to the British Columbian health care context. The final version was endorsed by the Child Health BC Steering Committee.Results: Ten medical articles and thirteen jurisdictional papers met the established selection criteria and were included in this study. Most frameworks were developed by the Australian national or state jurisdictions and published in jurisdictional papers (n = 8). Frameworks identified in the medical literature were mainly developed in Canada (n = 3) and the US (n = 3) and focused on maternity, neonatal, critical care and oncology services. Based on feedback received from the expert group, the framework was expanded to include community-based services, prevention and health determinants. The final version of the Tiers of Service framework describes the specific services to be delivered at each tier, which are categorized as Tier 1 (community services) through Tier 6 (sub-specialized services). Two consecutive steps were identified to effectively use the framework for operational and system planning: (i) development of a 'module' outlining the responsibilities and requirements to be delivered at each tier; and (ii) assessment of services provided at the health care facility against those described in the module, alignment to a specific tier, identification of gaps at the local, regional and provincial level, and implementation of quality improvement initiatives to effectively address the gaps.Conclusions: The benefits of the Tiers of Service framework and accompanying modules for health service planning are being increasingly recognized. Planning and coordinating pediatric health services across the province will help to optimize flow and improve access to high-quality services for children living in British Columbia. [ABSTRACT FROM AUTHOR]

This paper examines the consideration of climate change in environmental assessment (EA) in the liquefied natural gas (LNG) sector, British Columbia, Canada. Based on an analysis of recent EA applications, results show that climate change is considered, to some extent, in all phases of EA for most LNG projects. However, stakeholders indicate a dissatisfaction with practice – often based on expectations about EA that exceed what it can deliver as a project-based tool, and sometimes based on an incomplete understanding of existing climate change legislation and targets. Results also indicate inconsistent application of existing climate change requirements across project EAs. Notwithstanding proponents often addressing climate change in their EA applications, climate change tends to receive little attention in project decision and approval conditions. The paper concludes with recommendations for better practice climate change consideration in EA that is commensurate with the scope and scale of project-level issues, complemented by more strategic EA and economic instruments. [ABSTRACT FROM AUTHOR]

With an increasingly political environment developing in western, industrialized resource sectors, the purpose of this paper is to explore Indigenous governments' ability to assert sovereignty over their territory as it pertains to resource development. Utilizing a relational self-determination framework, we present a case study of the Stk'emlupsemc te Secwépemc Nation and their role in governance over mineral development in their unceded traditional territory located in the interior of British Columbia, Canada. This article adds to the growing case examples that suggest that First Nations governments in Canada are exerting their selfdetermination strategically, transitioning the role of negotiated agreements from an Impact-Benefit transaction to gain greater participation in resource extraction decision-making. Utilizing tools such as cultural heritage studies, legal action, and developing community-based processes of consent, First Nations governments are gaining more negotiating leverage and influence over decision-making processes for resource development projects. These insights are particularly relevant for Indigenous communities that are considering their options regarding resource development as a path to autonomy and self-governance over their territory, resources, and economies. [ABSTRACT FROM AUTHOR]

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. Results: We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. Discussion: These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care. [ABSTRACT FROM AUTHOR]

This paper presents the various tools and data sources in British Columbia (Canada) that can be used by environmental consultants to assess the potential of cross-contamination between shale gas formation fluids and shallow aquifers from hydraulic fracturing and related oil and gas activities. A systematic approach for evaluating the potential of cross-contamination using these data sources is applied to a specific case study at an undisclosed location in the northeastern part of the province. This approach includes defining and then evaluating the basic criteria for assessing the potential of cross-contamination. These criteria are: a leak source; a driving force such as buoyancy or head differential and a leakage pathway. This study has revealed that there is a potential of cross-contamination due to hydraulic fracturing activities and wellbore integrity issues. Wellbore integrity can be compromised by induced seismic events or by unintentional communication with offset hydraulic fractured wells. Induced seismicity is linked to the activity of hydraulic fracturing as well as to the deep disposal of wastewater. • A shale gas database in Canada is investigated for wellbore integrity. • Wellbore leakage and cross-contamination can occur with shale gas extracting wells. • Induced seismicity from hydraulic fracturing and disposal wells can damage wellbores. [ABSTRACT FROM AUTHOR]

In 1999, BC Hydro installed optical fibers in the fluid channel of 525 kV self-contained fluid-filled submarine cables originally installed in the 1980s that connect substations in the Vancouver area of British Columbia, Canada, for the purposes of monitoring temperatures. In combination with this work, a real-time monitoring was used to collect load data and measured temperatures in an effort to optimize the ratings of the cables. The dynamic thermal circuit rating system developed by the Electric Power Research Institute was applied to the 525 kV cables as part of a project to modify the system for support of the unique characteristics of the cable system installation. Specifically, the submarine cables utilize a parallel pipe water cooling system for the shore zones. This paper describes the software modifications that were implemented to enhance the dynamic rating system to model the unique characteristics of the 525 kV cable system and discusses how recorded data collected over several seasons were used to verify and refine the cable rating model. The resulting evaluation showed good agreement of the dynamic rating system calculations with measured results and helped the utility better understand the ratings on these circuits and permitted the utility to perform simulations to evaluate various loading conditions. [ABSTRACT FROM AUTHOR]

Precarious employment is a labour practice characterized for employers by flexibility and economic efficiencies and for workers by vulnerability and uncertainty as to job duration, scheduling, benefits, and pay. It is increasingly common in Canada and can result in physical, mental, financial, and social strain for people who experience it. In libraries, it can have negative effects on individual workers, organizational health, and service quality. However, literature on precarious library work is scarce, and it is unclear how it affects the library field or how its effects compare to those described in the broader literature. The purpose of this study was to gather information about library workers' perceptions and experiences of precarious employment and to see how it played out in library settings. Thirteen library workers both with and without experiences of precarious employment in British Columbia participated in semi-structured interviews, which were synthesized into a narrative summarizing their thoughts and experiences. Results indicated that precarious work mainly benefited library organizations from scheduling and financial standpoints, while negative outcomes were more numerous, more salient, and affected both individuals and organizations. Participants also identified opportunities and challenges for future changes to precarious employment situations. Awareness of such perceptions and experiences may help to spark conversations and increase support for those experiencing negative effects from precarious work, and it can serve to reduce or eliminate factors leading to those effects. However, failure to address them can result in negative outcomes for library workers and organizations, such as stress, marginalization, burnout, turnover, leaving the field, reduced service quality, and more. Accordingly, this paper provides some of the first qualitative information on precarious employment in libraries and can be used to support broader discussions about the topic. [ABSTRACT FROM AUTHOR]

Requisition storage and retrieval are an integral part of the outpatient laboratory testing process. It is frequently necessary to review an original requisition to confirm the ordering physician, patient demographics, diagnostic information, and requested tests. Manual retrieval of a paper requisition is time-consuming and tedious. Although commercial solutions exist for the scanning and archiving of barcoded paper requisitions, the tools to accomplish this are freely available from the open source software community. We present a simple dedicated piece of software, Reqscan, for scanning patient laboratory requisitions, finding all barcode information, and saving the requisition as a portable document format named according the barcode(s) found. This Python application offers a simple solution to patient requisition digitization. Reqscan has been successfully tested and implemented into routine practice for storage and retrieval of outpatient requisitions at St. Paul's Hospital, Department of Pathology and Laboratory Medicine in Vancouver, British Columbia, Canada. [ABSTRACT FROM AUTHOR]

The opioid overdose crisis in Canada has dramatically worsened during the current COVID-19 pandemic. People who use opioids are dying at unprecedented rates, and a rapid expansion of available treatments for opioid use disorder (OUD) is needed. Injectable opioid agonist therapy (iOAT) is an evidence-based treatment for OUD with a superior retention rate. However, iOAT is currently only available in seven specialized clinics across British Columbia, and many people who may benefit from iOAT cannot access it. In this commentary paper, we discuss evidence behind iOAT, outline barriers preventing greater access, and make suggestions around how to improve access to iOAT. [ABSTRACT FROM AUTHOR]

The deformation of rock slopes is associated with the formation and accumulation of internal and external features (such as tension cracks, rock mass bulging and dilation, rockfall, etc.) that can be comprehensively referred to as "slope damage". In this paper, we use a 3D distinct element numerical modelling approach to investigate the role of shear zone morphology and groundwater pressure on the displacement and slope damage accumulation at the Downie Slide, a large, extremely slowly moving rockslide in British Columbia (Canada). First, we briefly review the external slope damage features that can be observed in an airborne laser scanner (ALS) dataset, allowing four slope damage domains (upper, central, northern, and southern domain) to be interpreted within the slide area, based on the orientation and type of features. Using the same ALS dataset we construct a 3D model of the present-day slope, explicitly including the two shear zones along which displacements occur, in order to investigate their role in the later stage of the landslide evolution. We assign a strain-softening constitutive model to the slide body, in order to account for the decrease in material properties due to damage accumulation. Virtual inclinometers are also implemented in the model, allowing for the comparison of simulated and observed displacement direction along the shear zones. The progressive deformation and failure of the slope is then simulated both assuming dry and wet conditions, in order to examine the role of pore water pressure, and the morphology of the upper and lower shear zones on the magnitude, orientation, and distribution of displacements. For each numerical model, the simulated slope damage features are recorded, by analyzing the zone volumetric strain and failure state, and compared with the type and orientation of features observed in each of the interpreted slope damage domains, thus allowing the numerical results to be better constrained and validated. It is clearly demonstrated that the orientation and distribution of slope damage and displacements observed in both the surface ALS and the subsurface borehole inclinometer data can be well reproduced in the 3D numerical models. Numerical modelling results show that the principal factor controlling the spatial distribution of slope damage at the Downie Slide is the morphology of the lower shear zone, whereas a negligible role is played by the upper shear zone morphology. We also observe that models incorporating a groundwater table display larger displacements, without significant effects on the orientation and distribution of simulated slope damage. This paper demonstrates that an analysis of slope damage is very important for understanding the mechanisms underlying the behavior of large landslides and should be a fundamental step in the comprehensive characterization of any major slope failure. • Slope damage features form as a result of deformation in rock slopes. • Characterizing slope damage provides insights on the failure mechanism and process. • The Downie Slide (BC, Canada) was investigated using a 3D distinct element approach. • Slope damage features can be used to constrain numerical modelling results. • Slope damage formation at the Downie Slide is controlled by shear zone morphology. [ABSTRACT FROM AUTHOR]

Storm surges and waves are key climate-driven parameters affecting the design and operation of ports and other infrastructure on the coast. Reliable predictions of future storm surges and waves are not yet available for the west coast of Canada, and this data gap hinders effective climate risk assessment, planning and adaptation. This paper presents numerical simulations of storm surges and waves in British Columbia coastal waters under a future climate (Representative Concentration Pathway) scenario (RCP8.5). The numerical models were first forced by wind and surface pressure fields from the ERA-5 global reanalysis, and calibrated and validated using historical wave and water level records. The models were then driven by atmospheric data from four regional climate models (RCMs) to investigate potential changes in the frequency and magnitude of storm surges and extreme waves over the 21st century. The model outputs were analyzed to determine the potential impacts of climate change on storm surges and wave effects at key ports and transportation assets in western Canada. The study is the first of its kind to utilize unstructured, computational models to simulate storm surges and waves for the entire western Canada coastal region, while maintaining the high spatial resolution in coastal sub-basins needed to capture local dynamic responses. [ABSTRACT FROM AUTHOR]

• Two new advanced configurations for CO 2 capture in pulp mill was investigated. • A rate-based model in ProMax® 4.0 was used for modeling the CO 2 capture process. • Techno-economic assessment was analyzed for the new advanced configurations. • The combined effect of carbon tax and CO 2 sales price on the NBSK price was analyzed. • CO 2 capture plant in pulp mill only led to a slight increase in the NBSK pulp price. This project study involves the techno-economic assessment of two new advanced configurations for amine-based carbon dioxide capture from a pulp mill. The newly proposed advanced configurations include advanced rich amine four split (ARA4S), and advanced rich amine three split with desorber inter-heating (ARA3S-DI) which is aimed at reducing carbon capture cost and carbon emissions. The rate-based model in ProMax® 4.0 was used for the simulation study while the flue gas was provided by a 365,000 air dry tonne of pulp (ADt Pulp) per annum pulp mill in British Columbia, Canada. Comparative analysis revealed that the Capture Cost (US$/tCO 2 and US$/ADt Pulp) of the 5 kmol/m3 MEA system was lowest for the conventional configuration, while for the 2 kmol/m3 AMP-3 kmol/m3 MEA blend it was lowest for the advanced rich amine 3-split with desorber inter-heating configuration. In addition, the Capture Costs of the MEA solution with a conventional configuration system is 8.7% higher than the AMP-MEA blend with advanced rich amine three split with desorber inter-heating configuration. Sensitivity analysis revealed that the combined effect of a carbon tax (US$ 40/tCO 2), CO 2 sales price (US$ 40/tCO 2) and advanced configuration only led to a slight increase (2.6% for MEA and 2.1% for AMP-MEA blend) in the price of the northern bleached softwood kraft pulp. With an even better-performing solvent system and process configuration, the price of NBSK pulp may not be affected given the indicated CO 2 tax and CO 2 price regime. [ABSTRACT FROM AUTHOR]

Recent studies have shown that Canada will not achieve its 2030 emission reduction targets outlined in the Paris Agreement. Canadian energy decision makers are now at a crossroad between making sound fiscal decisions and ramping up efforts to meet emission reduction commitments. Approximately 195,000 people are living in off-grid Canadian communities, with most of these communities relying on fossil-fuel based energy generation. Hybrid renewable energy systems provide a novel solution to address the high costs of off-grid energy and Canada's emission reduction targets. To address the competing stakeholder priorities in off-grid energy planning (e.g., economic, environmental, and system performance), the authors of this paper employed a generalizable combinatorial-based alternative ranking method. Alternative energy technology combinations were simulated to calculate key performance indicator values. The framework allows decision makers to identify the most feasible energy system based on their priorities. A case study was performed with the developed framework for a small off-grid community in British Columbia, Canada. The results show that feasibility of energy system configurations vary greatly based on differing decision-making priorities. The case study also confirmed that hybrid renewable energy systems have better environmental performance compared to their fossil fuel counter parts, but at a significantly higher cost. The study further confirms that the balance between environmental and economic performance of off-grid energy systems can be improved through proper component sizing, management practices, and the integration of energy storage. • Life cycle impacts need to be considered in off-grid hybrid renewable energy systems planning. • Hybrid renewable energy systems incur lower environmental impacts at higher costs. • Combining fossil fuel generators and battery banks reduces emissions at a lower cost. • Decision makers' priorities has a high impact in the ranking of energy system configurations. • The developed method accounts for different priorities in energy system feasibility assessment. [ABSTRACT FROM AUTHOR]

Background: Reducing harms of youth substance use is a global priority, with parents identified as a key target for efforts to mitigate these harms. Much of the research informing parental responses to youth substance use are grounded in abstinence and critiqued as ineffective and unresponsive to youth contexts. Parental provision of substances, particularly alcohol, is a widely used approach, which some parents adopt in an attempt to minimize substance use harms; however, research indicates that this practice may actually increase harms. There is an absence of research exploring youth perspectives on parental approaches to substance use or the approaches youth find helpful in minimizing substance use-related harms. Methods: This paper draws on interviews with youth aged 13–18 (N = 89) conducted within the Researching Adolescent Distress and Resilience (RADAR) study in three communities in British Columbia, Canada. An ethnographic approach was used to explore youth perspectives on mental health and substance use within intersecting family, social, and community contexts. This analysis drew on interview data relating to youth perspectives on parental approaches to substance use. A multisite qualitative analysis (MSQA) was conducted to examine themes within each research site and between all three sites to understand how youth perceive and respond to parental approaches to substance use in different risk environment contexts. Results: Within each site, youths' experiences of and perspectives on substance use were shaped by their parents' approaches, which were in turn situated within local social, geographic, and economic community contexts. Youth descriptions of parental approaches varied by site, though across all sites, youth articulated that the most effective approaches were those that resonated with the realities of their lives. Zero-tolerance approaches were identified as unhelpful and unresponsive, while approaches that were aligned with harm reduction principles were viewed as relevant and supportive. Conclusions: Youth perspectives illustrate that parental approaches to substance use that are grounded in harm reduction principles resonate with young people's actual experiences and can support the minimization of harms associated with substance use. Evidence-based guidance is needed that supports parents and young people in adopting more contextually responsive harm reduction approaches to youth substance use. [ABSTRACT FROM AUTHOR]

Background: Since the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC).Objectives: This paper examines whether hospitalization for Ambulatory Care Sensitive Conditions (1) can be used as a proxy measure for the organization of PHC in First Nations reserve areas; and (2) is associated with premature mortality rates.Methods: In this descriptive correlational study, we used administrative data available through Population Data BC, including demographic and ecological information (i.e. geo-codes indicating location of residence). We used two different measures of hospitalization: rates of episodic hospital care and rates of length of stay. We correlated hospitalization rates with premature mortality rates and the level of care available in First Nations communities, which depends on a federal funding formula based upon community size and, more specifically, the level of isolation from a provincial point of care.Results: First Nations communities in BC that have local 24/7 access to PHC services have similar rates of hospitalization for ACSC to those living in urban centres. This is demonstrated by the similarities in the strengths of the correlation between premature mortality rates and rates of avoidable hospitalization for conditions treatable in a PHC setting. This is not the case for communities served by a Health Centre (weaker correlation) and for communities serviced by a Health Station or with no on-reserve point of care (no correlation).Conclusions: Improving access to PHC services in First Nations communities can be associated with a significant reduction in avoidable hospitalization and premature mortality rates. The method we tested is an important tool that could serve health care planning decisions in small communities. [ABSTRACT FROM AUTHOR]