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Combined paper mill biosolids (PB) and forest-derived liming by-products improve soil properties, but their residual effects following several years of application have hardly been investigated. A 13-year (2009–2021) field study was initiated at Yamachiche, QC, Canada, to assess the residual effects of PB and liming materials on the properties of a loamy soil. The PB was applied during nine consecutive years (2000–2008) at 0, 30, 60, and 90 Mg wet·ha−1, whereas the 30 Mg PB·ha−1 rate also received one of three liming materials (calcitic lime, lime mud, wood ash) at 3 Mg wet·ha−1. No amendment was applied during residual years. Past liming materials continued to increase soil pH but their effect decreased over time; meanwhile, past PB applications caused a low increase in residual soil NO3-N. Soil total C, which represented 40% of added organic C when PB applications ceased, stabilized to 15% after six years. Soil Mehlich-3-extractable contents declined over the thirteen residual years to be not significant for P, K, and Cu, while they reached half the values of the application years for Zn and Cd. Conversely, Mehlich-3 Ca was little affected by time. Therefore, land PB and liming material applications benefited soil properties several years after their cessation. [ABSTRACT FROM AUTHOR]

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada. [ABSTRACT FROM AUTHOR]

Based upon qualitative interviews with 54 women and men living with HIV across Ontario, Canada, this paper examines the impact of HIV criminalization on the sexual and romantic relationships of people living with HIV. This research highlights the navigation strategies people living with HIV create and employ to both navigate and protect themselves from the law. Through a thematic and intersectional analysis, this study shows how adoption of these strategies is unequal, with access to navigation strategies varying along lines of gender, race, and sexual orientation. As a result, women and racialized people living with HIV face more difficulties navigating the impact of the law. HIV criminalization in Canada fuels and validates HIV stigma and produces vulnerability both within and outside of the relationships of people living with HIV. This paper seeks to understand HIV criminalization from the perspective of those governed by the law, in hopes of producing knowledge which will contribute to legal reform, inform policy, and support the development of efficacious secondary prevention initiatives. [ABSTRACT FROM AUTHOR]

This paper focuses on the methodological and empirical challenges researchers encounter when accessing government open data through the case study of Canada's Open Government Action Plan, with a specific emphasis on datasets hosted by the House of Commons. To address these challenges, we have created an R package designed to streamline the retrieval process of datasets, that are not-so-user-friendly, from the House of Commons website. Furthermore, we have made complete datasets available in both French and English, which are the official languages of Canada, and in multiple formats to improve accessibility. Our package aims to be an invaluable resource for researchers interested in Canadian politics or conducting comparative research. Therefore, a portion of this paper is allocated to showcase the potential utility of our package. Through our research, we highlighted three crucial lessons: firstly, the heterogeneous nature of datasets requires flexibility and adaptability; secondly, open data curators encounter various challenges in addressing user-reported issues; and thirdly, there is a nuanced understanding of "openness" in government datasets. In conclusion, we reflect on the potential scalability of open data initiatives while advocating for a nuanced approach that considers the complex challenges associated with open data accessibility. [ABSTRACT FROM AUTHOR]

This paper investigates the possibilities and challenges of using mass timber as a sustainable alternative for retrofitting existing buildings in Canada. To create the knowledge foundation on which to devise a holistic framework tailored to the specific characteristics of Canada's built environment, a detailed analysis of the types, geographical distribution, structural, and energy features of the local building stock is first presented. Then, previous strategies for enhancing and upgrading existing buildings with engineered timber are reviewed, classified, and evaluated. Finally, to explore economic and environmental implications, a detailed assessment of available life-cycle cost–benefit analysis approaches is conducted alongside their adaptation to Canada's building context. The findings of this paper can inform policymakers, builders, and designers in developing more sustainable building retrofit practices, design, and regulations, in line with Canada's efforts toward net zero emissions. [ABSTRACT FROM AUTHOR]

Background: Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open. Results: Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes. Conclusions: This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health. [ABSTRACT FROM AUTHOR]

Introduction: This study presents a global research scenario in the broad domain of osteoarthritis (OA) research, using quantitative and qualitative publication and citation indicators. Methods: The study is based on 45,368 global publications, sourced from the Scopus bibliographical database, covering three decades (1994–2023). We studied the performance of the top 12 developed and top 12 developing countries. The key countries, organizations and authors at national and international levels were identified. The broad subject areas and key journals contributing to global OA research were delineated, besides identifying the broad characteristics of highly cited papers in the field. Results: The United States and China were the most productive countries, while the Netherlands and Canada made the largest citation impact. Harvard Medical School and the University of Sydney made the most contribution, while Boston University and Pfizer Inc., USA registered the highest citation impact. Hunter DJ and Guermazi A were the most productive authors, while Lohmander LS, and Hochberg MC registered the highest citation impact. Osteoarthritis and Cartilage (n = 4879) and Annals of the Rheumatic Diseases (n = 786) published the maximum papers, while Arthritis and Rheumatism and Nature Reviews Rheumatology registered the largest citation impact. The highly cited papers with 100 or more citations constituted 6.25% of the total publications. Conclusions: There has been a systematic growth of publications on OA. The research on OA was mainly done in developed countries, with the maximum publications coming from the United States of America, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the United States of America. [ABSTRACT FROM AUTHOR]

This paper studies a distributionally robust multi-item newsvendor problem, where the demand distribution is unknown but specified with a general event-wise ambiguity set. Using the event-wise affine decision rules, we can obtain a conservative approximation formulation of the problem, which can typically be further reformulated as a linear program. In order to efficiently solve the resulting large-scale linear program, we develop a column generation-based decomposition scheme and speed up the computational efficiency by exploiting a special column selection strategy and stopping early based on a Karush-Kuhn-Tucker condition test. Focusing on the Wasserstein ambiguity set and the event-wise mean absolute deviation set, a computational study demonstrates both the computational efficiency of the proposed algorithm, which significantly outperforms a commercial solver and a Benders decomposition method, and the out-of-sample superiority of distributionally robust solutions relative to their sample average approximation counterparts. History: Accepted by Nicola Secomandi, Area Editor for Stochastic Models & Reinforcement Learning. Funding: This work was supported by the Natural Sciences and Engineering Research Council of Canada [492997-2016, RGPIN-2016-05208], the National Natural Science Foundation of China [71972012], Alliance de recherche numérique du Canada, and Canada Research Chairs [CRC-2018-00105]. It was also supported by Groupe d'études et de recherche en analyse des décisions (GERAD). Finally, this research was enabled in part by support provided by Digital Research Alliance of Canada (https://alliancecan.ca/en). Supplemental Material: The software that supports the findings of this study is available within the paper and its supplemental information (https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2022.0010) as well as from the IJOC GitHub software repository (https://github.com/INFORMSJoC/2022.0010). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer affects the mouth and throat areas. It is a major cause of death for older people in developed countries. This review looked at how living in rural areas influences oral cancer trends in these countries. The studies from these countries showed increasing rates of oral cancer in rural areas of the US, Australia, Canada, and Europe. Older people are more affected by these cancers than younger groups. The main risk factors are tobacco use, alcohol consumption, and HPV infections. People in rural areas often do not know much about HPV-related cancers. They also tend to use more tobacco and alcohol than city dwellers. Even in developed countries, living in rural areas can lead to shorter lifespans for oral cancer patients. This is mainly because it is harder for them to access specialized cancer treatment centres and advanced medical care. In summary, where people live can significantly impact their chances of surviving oral cancer, even in wealthy nations. Oral cancer is the general term used to describe cancers of the oral cavity and oropharyngeal region. These cancers are one of the leading causes of death in elderly residents within the Organisation for Economic Co-operation and Development (OECD) member countries in the 21st century. This scoping review was carried out to assess the influence of rurality on oral cancer trends and patterns among OECD member countries. Four online databases (Medline, PubMed, Scopus, and CINAHL) were searched for studies that reported on oral cancer trends in rural and remote areas in OECD member countries. A total of 1143 articles were obtained initially; among them, 995 papers were screened to include 18 articles for this scoping review. Studies have reported increasing incidence and prevalence in the United States, Australia, Canada, and European countries wherein risk factors such as tobacco, alcohol, and human papilloma virus (HPV) infections were associated with oral and oropharyngeal cancers. Awareness among people living in rural areas about HPV-related cancers was very low, while rates of tobacco and alcohol abuse were noted to be rising more rapidly than among their urban counterparts. Furthermore, the ageing population was most affected compared to the younger age groups of people with oral and oropharyngeal cancer that are prevalent in these regions. Overall, despite living in developed countries, rurality was noted to be a significant factor in the lower life expectancy of oral cancer patients, mainly due to the limited accessibility to tertiary cancer care centres and advanced medical care. [ABSTRACT FROM AUTHOR]

Background: Previous Canadian reviews of physician, pharmacist, and dentist disciplinary action have noted differences in discipline outcomes across professions and provinces. The objective of this study was to compare the disciplinary action process across provinces and professions, and to describe the perspectives of health professional regulatory bodies on the disciplinary action process. Methods: Participation from medicine, pharmacy, nursing, and dentistry registrars or complaints directors from 10 Canadian provinces was sought. One-on-one, semi-structured interviews were conducted by telephone or video call. Results: Nineteen interviews with regulators were conducted--8 pharmacy, 5 nursing, 5 medicine, and 1 dentistry. Complaints and discipline processes followed a similar overall pathway with some differences. Differences in process were largely due to differences in health regulation legislation and were noted across professions, across provinces, and within a province. Participants tended to be more aligned with regulators within their province rather than regulators of the same profession across the country. Conclusion: To our knowledge, this paper is the first to describe Canadian health professional regulatory body perspectives on the complaints and discipline process. More research is needed to better understand the factors that affect discipline outcomes and to ultimately improve complaints and discipline processes. [ABSTRACT FROM AUTHOR]

Background: The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. Methods: Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019–2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. Results: Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. Conclusions: This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians. [ABSTRACT FROM AUTHOR]

From July 2022 to December 2022, the World Data System (WDS) International Technology (ITO) and International Program (IPO) Offices conducted a review of strategic plans and technical roadmaps of all current WDS members and the set of Canadian repositories that participated in the Digital Research Alliance of Canada's CoreTrustSeal Certification Support and Funding Pilotv (Digital Research Alliance of Canada, 2022). In this paper, we describe how a new organizational assessment method was designed and utilized to identify the needs and challenges faced by the WDS and Canadian CTS Pilot members. Our method relied on reviewing public-facing documentation provided by the repositories, with a priority on strategic plans and technical road maps. In total, we reviewed 95 sources of information, including 33 strategic plans and 3 technical roadmaps describing a total of 95 out of the original 147 target organizations. In this paper, we also describe our assessment tool and the overarching challenges and goals we identified through the usage of this tool. Finally, we will describe the limitations of our methodology and provide recommendations from the World Data System on how best to assist the WDS members and the cohort of Canadian data repositories based on our findings. [ABSTRACT FROM AUTHOR]

Social scientists, geographers, criminologists, and health scientists are often tasked with finding data to best capture the impact of "community context" on individual outcomes, including residential services, physical resources, and social institutions. One outlet for such data in Canada is Digital Map Technologies Inc. (DMTI) Spatial, which offers a national repository of over one million businesses and recreational points of interest. The database is generated through CanMap Streetfiles, which includes geocodes of each point's precise location. These data are available to researchers from their university data library and Esri Canada, but primarily available to private sector and government markets. That said, the goal of the current paper is to encourage researchers to access this rich yet under‐utilized data source. Each service, business, or resource in the DMTI Spatial database is assigned to a respective category using Standard Industrial Classification codes and North American Industrial Classification System codes. It is not clear, however, which is the more reliable coding criteria. We provide an overview of our review of DMTI Spatial data and take‐away suggestions for using this valuable resource for future research on meso‐level residential markers. Key messages: The goal of this paper is to outline existing data source(s) and measures from DMTI Spatial that might help capture meso‐level residential institutions.We recommend "best practices" for using DMTI Spatial data in researchers' own work to capture neighbourhood resources/amenities, or the social infrastructure of the community using either Standard Industrial Classification codes or North American Industrial Classification System codes.We conclude that Standard Industrial Classification codes in DMTI Spatial enhanced points of interest data are more complete—and more accurate—than North American Industrial Classification System codes. [ABSTRACT FROM AUTHOR]

The current strategy reports a simple, rapid and precise paper spray ionization mass spectrometry method for trace determination of lutein in matrices of different complexities. The established method was based upon optimization of the applied, cone and RF voltages and mobile phase. Under the optimized parameters, a linear concentration range (1.0–50 μg/g) of lutein was successfully achieved with low limits of detection (3σ/ b) and quantification (10σ/ b) of 0.5 and 1.665 μg/mL, respectively. The proposed method was successfully applied for trace determination of lutein residues in fresh and commercial foods (green and black tea, and tomato paste) purchased from local markets in Canada. The measured concentration of lutein in green bean was 2.76 ± 0.11 μg/g while the highest level (51.5 ± 0.05 μg/g) of lutein was found in the mint stems. • A rapid and low cost paper spray ionization mass spectrometry protocol for lutein analysis was developed. Ii. An acceptable accuracy and recovery for lutein assay have been achieved. Ii. Excellent lower limits of detection (0.50 μg/mL) and quantification (1.67 μg/mL) were achieved. Iv. The proposed PSI/MS protocol was successfully applied for analysis of lutein in food stuffs. [ABSTRACT FROM AUTHOR]

In this article, Dr. Rÿser recounts the key events and strategies that led to the successful Indigenous movement to safeguard Indigenous rights during the Canadian Patriation. He tracks the movement's development from the 1969 "White Paper," in which Prime Minister Pierre Trudeau and Minister of Indian Affairs Jean Chrétien proposed eliminating the special status of Indigenous peoples in the new constitution, to Grand Cheif George Manuel's 1980 initiative, the "Constitution Express," in which he organized more than 600 Indigenous activists to travel across Canada by train to demand that the rights guaranteed in their Indigenous treaties with the British be upheld by the new Canadian Constitution. [ABSTRACT FROM AUTHOR]

Background: Fentanyl test strips (FTS) are lateral flow immunoassay strips designed for detection of ng/mL levels of fentanyl in urine. In 2021, the US Centers for Disease Control and the Substance Abuse and Mental Health Administration stated that federal funds could be used for procurement of FTS for harm reduction strategies approved by the government such as drug checking. The market for FTS has expanded rapidly in the US and Canada. However, there is no regulatory oversight by either government to ensure proper function of FTS that are being marketed for drug checking. Main body: Many brands of FTS have rapidly entered the harm reduction market, creating concerns about the reproducibility and accuracy of their performance from brand to brand and lot to lot. Some examples are provided in this Comment. Similar problems with product quality were observed in the mid 2000's when lateral flow immunoassays for malaria were funded in many countries and again in 2020, when COVID-19 tests were in huge demand. The combination of high demand and low levels of regulation and enforcement led some manufacturers to join the goldrush without adequate field testing or quality assurance. We argue that the harm reduction community urgently needs to set a lot checking program in place. A set of simple protocols for conducting the tests and communicating the results have been developed, and are described in the following Perspectives paper in this issue. Conclusion: In the absence of governmental regulation and enforcement, the harm reduction community should implement a FTS lot checking program. Based on previous experience with the malaria diagnostic lot checking program, this inexpensive effort could identify products that are not suitable for harm reduction applications and provide valuable feedback to manufacturers. Dissemination of the results will help harm reduction organizations to ensure that FTS they use for drug checking are fit for the purpose. [ABSTRACT FROM AUTHOR]

Simple Summary: The current approach to breast cancer screening, which is based on a person's age, overlooks individual-level differences in breast cancer risk. As a result, many people are over- or under-screened according to their actual risk of breast cancer. Risk-stratified breast screening may overcome the limitations of age-based screening, but there are still many knowledge gaps regarding how best to implement it in the population setting. This study will generate the first Canadian evidence on the adoption of breast cancer risk assessment in the population setting, to support the future implementation of risk-stratified breast cancer screening. This study demonstrated that, while risk assessment for risk-stratified screening at the population level is feasible, an equity lens must be considered in implementation to ensure cancer-screening disparities are not widened. Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. A prospective cohort study was undertaken within the PERSPECTIVE I&I project, which will generate the first Canadian evidence on multifactorial breast cancer risk assessment in the population setting to inform the implementation of risk-stratified screening. Recruited females aged 40–69 unaffected by breast cancer, with a previous mammogram, underwent multifactorial breast cancer risk assessment. The adoption of multifactorial risk assessment, the effectiveness of methods for collecting risk factor information and the costs of risk assessment were examined. Associations between participant characteristics and study sites, as well as data collection methods, were assessed using logistic regression; all p-values are two-sided. Of the 4246 participants recruited, 88.4% completed a risk assessment, with 79.8%, 15.7% and 4.4% estimated at average, higher than average and high risk, respectively. The total per-participant cost for risk assessment was CAD 315. Participants who chose to provide risk factor information on paper/telephone (27.2%) vs. online were more likely to be older (p = 0.021), not born in Canada (p = 0.043), visible minorities (p = 0.01) and have a lower attained education (p < 0.0001) and perceived fair/poor health (p < 0.001). The 34.4% of participants requiring risk factor verification for missing/unusual values were more likely to be visible minorities (p = 0.009) and have a lower attained education (p ≤ 0.006). This study demonstrates the feasibility of risk assessment for risk-stratified screening at the population level. Implementation should incorporate an equity lens to ensure cancer-screening disparities are not widened. [ABSTRACT FROM AUTHOR]

Climate change increases the risk of illness through rising temperature, severe precipitation and worst air pollution. This paper investigates how monthly excess mortality rate is associated with the increasing frequency and severity of extreme temperature in Canada during 2000-2020. The extreme associations were compared among four age groups across five sub-blocks of Canada based on the datasets of monthly T90 and T10, the two most representative indices of severe weather monitoring measures developed by the actuarial associations in Canada and US. We utilize a combined seasonal Auto-regressive Integrated Moving Average (ARIMA) and bivariate Peaks-Over-Threshold (POT) method to investigate the extreme association via the extreme tail index χ and Pickands dependence function plots. It turns out that it is likely (more than 10%) to occur with excess mortality if there are unusual low temperature with extreme intensity (all χ > 0.1 except Northeast Atlantic (NEA), Northern Plains (NPL) and Northwest Pacific (NWP) for age group 0-44), while extreme frequent high temperature seems not to affect health significantly (all χ ≤ 0.001 except NWP). Particular attention should be paid to NWP and Central Arctic (CAR) since population health therein is highly associated with both extreme frequent high and low temperatures (both χ = 0.3182 for all age groups). The revealed extreme dependence is expected to help stakeholders avoid significant ramifications with targeted health protection strategies from unexpected consequences of extreme weather events. The novel extremal dependence methodology is promisingly applied in further studies of the interplay between extreme meteorological exposures, social-economic factors and health outcomes. [ABSTRACT FROM AUTHOR]

With the continuous improvement of shale oil and gas recovery technologies and achievements, a large amount of geological information and data have been accumulated for the description of shale reservoirs, and it has become possible to use machine learning methods for "sweet spots" prediction in shale oil and gas areas. Taking the Duvernay shale oil and gas field in Canada as an example, this paper attempts to build recoverable shale oil and gas reserve prediction models using machine learning methods and geological and development big data, to predict the distribution of recoverable shale oil and gas reserves and provide a basis for well location deployment and engineering modifications. The research results of the machine learning model in this study are as follows: ① Three machine learning methods were applied to build a prediction model and random forest showed the best performance. The R2 values of the built recoverable shale oil and gas reserves prediction models are 0.7894 and 0.8210, respectively, with an accuracy that meets the requirements of production applications; ② The geological main controlling factors for recoverable shale oil and gas reserves in this area are organic matter maturity and total organic carbon (TOC), followed by porosity and effective thickness; the main controlling factor for engineering modifications is the total proppant volume, followed by total stages and horizontal lateral length; ③ The abundance of recoverable shale oil and gas reserves in the central part of the study area is predicted to be relatively high, which makes it a favorable area for future well location deployment. [ABSTRACT FROM AUTHOR]

Municipal water supply through truck-to-cistern systems is common in northern Canada. Household satisfaction and concerns about water services likely impact user preferences and practices. This case study explores household perspectives and challenges with regard to domestic access to water in a decentralized truck-to-cistern system. A case study was conducted in the Northern Village of Kangiqsualujjuaq, Nunavik (Quebec, Canada). A paper-based questionnaire was completed by 65 households (one quarter of the population). Many households (37%) reported not drinking tap water from the truck-to-cistern system. Chlorine taste was a frequently reported concern, with those households being significantly less likely to drink water directly from the tap (p = 0.002). Similarly, households that reported a water shortage in the previous week (i.e., no water from the tap at least once) (33%) were more likely to express dissatisfaction with delivered water quantity (rs = 0.395, p = 0.004). Interestingly, 77% of households preferred using alternative drinking water sources for drinking purposes, such as public tap at the water treatment plant, natural sources or bottled water. The study underscores the importance of considering household perspectives to mitigate the risks associated with service disruptions and the use of alternative sources for drinking purposes. [ABSTRACT FROM AUTHOR]

For most of Canada’s approximately 40-year debate on medically assisted death, euthanasia and assisted suicide were considered distinct issues. Yet in 2016 their ethical, psychological, and practical differences were effectively disregarded when the two acts were grouped together in the legislation under the umbrella term “Medical Assistance in Dying” (MAiD). The lack of distinction under the law of the two terms ignores important ethical considerations from the MAiD practitioners’ perspective. Although the principle of respect for autonomy must remain central to the assessments of MAiD eligibility, it cannot be the only consideration. This paper examines the ethical considerations and principles that underlie decisions to provide MAiD through an analysis of the progress, and results, of the 40-year debate on assisted suicide and euthanasia. [ABSTRACT FROM AUTHOR]

The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has caused millions of deaths globally, with vulnerable populations such as people experiencing homelessness (PEH) at higher risk. This systematic review and meta-analysis aims to identify the prevalence and key factors contributing to vaccine acceptance experienced by PEH. Methods: The protocol of this study was registered in PROSPERO (CRD42023391659). We included studies that reported relevant information about vaccine acceptance or vaccine hesitant/refusal among PEH. Eight databases were systematically searched in January 2023. Meta-analysis was conducted for the prevalence of vaccine acceptance, vaccine uptake, and factors associated with vaccine acceptance. Attitudes toward vaccines were combined into bar charts. Result: A total of 29 papers were included in this systematic review and 19 papers were included for meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance among PEH was 66% (95%CI: 58%-73%). Our meta-regression showed vaccine acceptance was significantly increased over time. Moreover, subgroup meta-analysis showed that PEH were more likely to accept the COVID-19 vaccine after June 2021 (78%, 95%CI: 65%-86%) compared with earlier period (56%, 95%CI: 54%-59%). Subgroup meta-analysis also revealed that women and participants without underlying medical condition (chronic diseases) were significantly less likely to accept the COVID-19 vaccine, compared to men and those with medical conditions, respectively. Conclusion: The study emphasizes the need for targeted public health interventions aimed at increasing vaccine acceptance among PEH, especially at the early stage of the pandemic, among females, those without underlying medical conditions, being Black (in Canada and the USA), and young people. These interventions should address the common concerns of vaccine safety, adverse effects, effectiveness, and distrust in health care systems. In addition to offering vaccinations in different areas convenient to them, education programs could be established to increase vaccine acceptance among PEH. [ABSTRACT FROM AUTHOR]

Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [ABSTRACT FROM AUTHOR]

Background: Indigenous populations in Canada and the United States (US) have maintained reciprocal relationships with nature, grounded in respect for and stewardship of the environment; however, disconnection from traditional food systems has generated a plethora of physical and mental health challenges for communities. Indigenous food sovereignty including control of lands were found to be factors contributing to these concerns. Therefore, our aim was to conduct a scoping review of the peer-reviewed literature to describe Indigenous disconnection from Indigenous food systems (IFS) in Canada and the US. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-SR) and Joanna Briggs Institute guidelines, we searched MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and Bibliography of Native North Americans. Data was extracted from 41 studies and a narrative review completed based on study themes. Results: The overarching theme identified in the included studies was the impact of colonization on IFS. Four sub-themes emerged as causes for Indigenous disconnection from traditional food systems, including: climate change; capitalism; legal change; and socio-cultural change. These sub-themes highlight the multiple ways in which colonization has impacted Indigenous food systems in Canada and the US and important areas for transformation. Conclusions: Efforts to reconnect Indigenous knowledge and values systems with future food systems are essential for planetary health and sustainable development. Traditional knowledge sharing must foreground authentic Indigenous inclusion within policymaking. Highlights: • The main theme identified amongst the SR literature was the lasting impacts of colonization on Indigenous food systems in Canada and the US, which is described through four key areas: climate change; capitalism; legal changes; and socio-cultural changes. • Less than 20% of included papers report author positionality, with only 7% of included papers reporting Indigenous authorship, emphasizing an opportunity for more reporting and Indigenous engagement in the future. • Loss of cultural knowledge and practices was highlighted by many articles reviewed. • Revitalisation of IFS must include authentic Indigenous engagement, support Indigenous knowledge frameworks, community sharing networks, education programs and co-management. [ABSTRACT FROM AUTHOR]

Background: In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. Methods: The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. Results: Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. Conclusions: Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that – despite small – the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised. [ABSTRACT FROM AUTHOR]

The mean square synchronization problem of the complex dynamical network (CDN) with the stochastic link dynamics is investigated. In contrast to previous literature, the CDN considered in this paper can be viewed as consisting of two subsystems coupled to each other. One subsystem consists of all nodes, referred to as the nodes subsystem, and the other consists of all links, referred to as the network topology subsystem, where the weighted values can quantitatively reflect changes in the network's topology. Based on the above understanding of CDN, two vector stochastic differential equations with Brownian motion are used to model the dynamic behaviors of nodes and links, respectively. The control strategy incorporates not only the controller in the nodes but also the coupling term in the links, through which the CDN is synchronized in the mean-square sense. Meanwhile, the dynamic stochastic signal is proposed in this paper, which is regarded as the auxiliary reference tracking target of links, such that the links can track the reference target asymptotically when synchronization occurs in nodes. This implies that the eventual topological structure of CDN is stochastic. Finally, a comparison simulation example confirms the superiority of the control strategy in this paper. [ABSTRACT FROM AUTHOR]

In this paper, a review of Indigenous engagement in renewable energy projects is conducted and the main elements of energy partnerships between stakeholders and Indigenous partners are discussed. In recent years, Canada has witnessed more significant Indigenous involvement in economic and energy development projects than ever before. For large-scale energy partnerships, the focus is on engagement, financial capital, community buy-in (readiness, and entrepreneurial and business skills), and benefits-sharing with community partners. Equity-ownership, reconciliation, and self-determination intersect with and impact the benefits and sustainability of energy projects, as they are interrelated in the framework of most energy partnerships. This paper illustrates policy disconnects in connection with partnership-making, social outcomes, and decision-making among Indigenous communities. Furthermore, findings from relevant literature explore the nuanced discourse on social implications and capacity challenges that interlink with climate adaptation and reconciliation when promoting large-scale renewable energy partnerships with Indigenous communities. Through a systematic review and a meta-analysis of the literature, we found 80 relevant studies during the screening process, of which 33 were selected for the synthesis. Findings demonstrate that the Crown, energy companies, and community partners need to coordinate and collaborate closely to achieve energy security and sustainable renewable energy. The review suggests that Indigenous engagement in energy partnerships supports positive outcomes for social development and environmental protection among Indigenous communities. The literature suggests that when government and industry mentor in the project implementation process, important positive impacts on energy transitions, and self-sufficiency can be realized. [ABSTRACT FROM AUTHOR]

Since Canada legalized medical assistance in dying (MAID) in 2016, it has become one of the most permissive regimes in the world for euthanasia and assisted suicide. The number of deaths has risen rapidly and the categories of eligibility continue to expand. The country is poised, as of March 2024, to allow MAID for those whose sole underlying condition is mental illness, generating considerable debate. Advocates of MAID for mental illness often frame it as a question of equal access, but this extension involves considerable complexities not present in other cases. This paper examines psychiatric MAID in the Canadian context, engaging directly with the most pertinent arguments of the practice􀂶s advocates. The paper argues that independent of any prior commitments vis-à-vis the permissibility of MAID per se, there is a clear ethical and legal necessity to oppose extending MAID on the grounds of mental illness if we follow the parameters set up within the Canadian regime. The paper advances three arguments: first, that mental illnesses cannot be deemed irremediable, as required by the Canadian law; second, that we cannot establish with adequate certainty that a mentally ill patient has the decision-making capacity to choose MAID; and third, that allowing psychiatric MAID will have a devastating impact on care and support of the mentally ill. [ABSTRACT FROM AUTHOR]

Since its original formulation, various extensions of the Kuznets hypothesis have been proposed. In this paper, we make use of a unique panel dataset of Canadian regions to test whether inter‐personal income inequality increases once the initial inverted‐U pattern is completed. Our results support the notion of a sideways S‐shaped curve describing a wavelike decrease to increase shift, with a turning point in the late‐1990s/early‐2000s where inter‐personal inequality across regions "bottoms out" before alternating to an upward‐sloping trajectory. While there are many factors associated with this reversal of trends, we find evidence that a region's size plays a role in explaining the more recent rise in inequality. [ABSTRACT FROM AUTHOR]

Background: Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population. Methods: We undertook a scoping review using the framework by Arksey and O'Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers. Results: The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings. Conclusion: Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada. [ABSTRACT FROM AUTHOR]

This paper aims to introduce a novel family of probability distributions by the well-known method of the T–X family of distributions. The proposed family is called a "Novel Generalized Exponent Power X Family" of distributions. A three-parameters special sub-model of the proposed method is derived and named a "Novel Generalized Exponent Power Weibull" distribution (NGEP-Wei for short). For the proposed family, some statistical properties are derived including the hazard rate function, moments, moment generating function, order statistics, residual life, and reverse residual life. The well-known method of estimation, the maximum likelihood estimation method is used for estimating the model parameters. Besides, a comprehensive Monte Carlo simulation study is conducted to assess the efficacy of this estimation method. Finally, the model selection criterion such as Akaike information criterion (AINC), the correct information criterion (CINC), the Bayesian information criterion (BINC), the Hannan–Quinn information criterion (HQINC), the Cramer–von-Misses (CRMI), and the ANDA (Anderson–Darling) are used for comparison purpose. The comparison of the NGEP-Wei with other rival distributions is made by Two COVID-19 data sets. In terms of performance, we show that the proposed method outperforms the other competing methods included in this study. [ABSTRACT FROM AUTHOR]

Geothermal energy exploration, development, and research have been ongoing in Canada for several decades. The country's cold climate and the push to develop renewable energy sources have driven interest in geothermal energy. Despite this drive, regulatory complexities and competition with other relatively inexpensive energy sources with existing infrastructure have hindered development. As such, interest has grown and waned with changes in the energy economy over several decades, leaving many projects at a standstill. As of January 2023, there are currently no operational geothermal power projects in Canada. Many hot spring pool and spa complexes remain active, and Canada is a leading country in the installation of ground source heat pumps (GSHPs; also called geo-exchange systems). However, in the last decade, the interest in deep geothermal systems has renewed, with many new projects starting up across several provinces and territories. Moreover, projects that had shown limited progress for many years—such as Mount Meager in British Columbia—have begun to renew their development efforts. Research is also expanding within prominent research groups and universities. The areas of focus include both building upon previous studies (such as thermal gradients and the heat flow in sedimentary basins) and researching new methods and resources (such as GSHPs, closed-loop systems, integrated geothermal operations, and hybrid systems, including heat storage). The development is supported by federal, provincial, and territorial governments through grants and the development of regulatory frameworks. Although challenges still remain for Canada to develop its geothermal energy resources, several power, thermal, and co-production projects, ongoing research, funding, and regulatory acts are all moving forward to support geothermal development. This paper aims to study Canada's geothermal energy update in 2023 regarding the aspects mentioned above. [ABSTRACT FROM AUTHOR]

This paper presents the findings of fifteen energy audits conducted on industrial sites in Canada's Greater Toronto Area (GTA). The audits covered a range of industries including food processing, packaged goods, and finishing processes (powder-coating). The primary focus of the audits was to analyze the natural gas consumption and the performance of major-gas-consuming equipment. The audits identified natural-gas-consuming equipment that could be optimized to yield energy and operational cost savings and greenhouse gas (GHG) reduction opportunities. Food production plants' energy intensity ranges from 5.59 m3/ft2 to 17.73 m3/ft2. Therefore, there is a significant opportunity to improve energy consumption through better technology integration. The results of the audits indicate a trend of an increase in the percentage of non-productive consumption with non-productive time. The proposed energy-saving measures include reducing non-productive natural gas consumption, gas-fired equipment tune-up, optimizing boiler loads, and reducing oven exhaust by using variable frequency drives (VFDs). The findings of this study could be used to develop a demand-side management program specifically for small- and medium-sized industrial facilities in the Greater Toronto Area and other parts of Canada. [ABSTRACT FROM AUTHOR]

Age estimation is crucial for investigating animal populations in the past and present. Visual examination of tooth wear and eruption is one of the most common ageing methods in zooarchaeology, wildlife management, palaeontology, and veterinary research. Such approaches are particularly advantageous because they are non-destructive, can be completed using photographs, and do not require specialized training. Several tooth wear and eruption methods have been developed for Rangifer tarandus, a widely distributed and long-utilized species in the North. This paper evaluates the practicality and effectiveness of three existing visual tooth wear and eruption methods for this species using a large known-age sample from several caribou populations in northern Canada (Bluenose East, Bluenose West, Dolphin-Union, Qamanirjuaq, and Beverly herds). These methods are evaluated based on: (1) the amount of error and bias between estimated and actual ages, (2) suitable and interpretable results, (3) user-friendly and unambiguous procedures, and (4) which teeth and visual features of those teeth are used to record wear and eruption status. This study finds that the three evaluated methods all have variable errors and biases, and two show extensive biases when applied to older individuals. Demographic data is simpler to generate and more flexible to report when methods allow age to be estimated as a continuous or discrete variable, rather than as age ranges. The dentition samples used by two of the previously developed methods impact their applicability to other populations of Rangifer. In one existing method, individuals were unavailable from some age ranges leaving gaps when assigning ages. For another Rangifer-ageing method, the population utilized was too distinct in morphology or diet to be used with the Canadian caribou analyzed here. Additional refinement of tooth wear and eruption ageing methods will benefit zooarchaeological research on reindeer and caribou remains. [ABSTRACT FROM AUTHOR]

On 15–16 June 2023, healthcare professionals and breast cancer patients and advocates from across Canada met in Toronto, Ontario, for the 2023 Canadian Breast Cancer Symposium (CBSC.). The CBSC. is a national, multidisciplinary event that occurs every 2 years with the goal of developing a personalized approach to the management of breast cancer in Canada. Experts provided state-of-the-art information to help optimally manage breast cancer patients, including etiology, prevention, diagnosis, experimental biology, and therapy of breast cancer and premalignant breast disease. The symposium also had the objectives of increasing communication and collaboration among breast cancer healthcare providers nationwide and providing a comprehensive and real-life review of the many facets of breast cancer. The sessions covered the patient voice, the top breast cancer papers from different disciplines in 2022, artificial intelligence in breast cancer, systemic therapy updates, the management of central nervous system metastases, multidisciplinary management of ductal carcinoma in situ, special populations, optimization-based individual prognostic factors, toxicity management of novel therapeutics, survivorship, and updates in surgical oncology. The key takeaways of these sessions have been summarized in this conference report. [ABSTRACT FROM AUTHOR]

Over the last two decades, patient engagement in cancer research has evolved significantly, especially in addressing the unique challenges faced by adolescent and young adult (AYA) cancer populations. This paper introduces a framework for meaningful engagement with AYA cancer patient research partners, drawing insights from the "FUTURE" Study, a qualitative study that utilizes focus groups to explore the impact of cancer diagnosis and treatment on the sexual and reproductive health of AYA cancer patients in Canada. The framework's development integrates insights from prior works and addresses challenges with patient engagement in research specific to AYA cancer populations. The framework is guided by overarching principles (safety, flexibility, and sensitivity) and includes considerations that apply across all phases of a research study (collaboration; iteration; communication; and equity, diversity, and inclusion) and tasks that apply to specific phases of a research study (developing, conducting, and translating the study). The proposed framework seeks to increase patient engagement in AYA cancer research beyond a supplementary aspect to an integral component for conducting research with impact on patients. [ABSTRACT FROM AUTHOR]

Researchers have found that many post-secondary music students suffer from physical and mental health issues. However, researchers have mainly studied these problems at the individual level, with little investigation of how music students' work is shaped by the coordinating effects of policies, texts, and discourses at and beyond their local site. This paper describes a protocol for an international project that will explore the health of music students in the context of their daily work. Using an institutional ethnography approach, we will examine the social organization of music students' work at three universities: two in Canada and one in Australia. This will be the first set of studies that use institutional ethnography specifically for the purpose of understanding how the social organization of music students' work shapes their health. Data will be collected using several methods common to institutional ethnography: interviews, focus groups, observations, and collecting texts. Data analysis will begin during the data collection process and proceed in two fluid stages. The first stage will involve a detailed investigation of the pertinent work activities at each music school. The second will involve linking that work to specific social relations within and beyond the institution. After data analysis has been completed at all three sites, findings will be compared to one another to identify commonalities and differences in how students' work is organized. Findings of the entire project may inform policy-making and lead to positive change at the institutions studied, as well as others where similar social organization may occur. The novel approach described here will provide opportunities to expand current knowledge about music students' work and health beyond what has been learned through approaches that focus on students' individual behaviours and attributes. [ABSTRACT FROM AUTHOR]

Territorial inequalities have long been a subject of study and concern in Canada. In the face of large structural changes such as industrial shifts and the decarbonization of our economies, there is an urgency to understand such inequalities and design effective policy interventions for those places facing persistent economic decline. This paper shares a novel composite index that measures economic disparity across Canadian Census Subdivisions (CSDs) using Census data from 2001 through 2016 and the 2011 National Household Survey. Named the "Index of Economic Disparity," it is comprised of an equally weighted average of four sub‐indices that assign percentile rankings for all CSDs based on whether they experience persistent and substantial decline in key economic areas: population, labour force outcomes, working‐age share of population, and industrial diversity. The variation of outcomes across geographies—urban and rural—highlights the importance of place‐based policies. [ABSTRACT FROM AUTHOR]

Canada has one of the most complex and rigorous drug approval and public reimbursement processes and is, unfortunately, one of the countries with the longest delays in drug access. To assess the overall impact of systemic delays in access to cancer therapy, a targeted literature review (TLR) was performed to identify studies associated with the clinical, economic, and quality of life impacts of delayed access to oncology drugs. Using MEDLINE/PubMed databases and snowballing, four unique records met the eligibility criteria. Results revealed that clinical outcomes were the most impacted by systemic delays in access to oncology drugs (e.g., life years lost, overall survival, and progression-free survival). The four articles retrieved by the TLR specifically illustrated that a substantial number of life years could potentially be saved by increasing systemic efficiency regarding the development, approval, and reimbursement processes of new drugs for advanced malignancies. It is imperative that initiatives are put in place to improve the performance and speed of Canadian drug regulatory and health technology assessment (HTA) processes, especially for new cancer therapeutics. The proposed solutions in this paper include better coordination between HTA and Canadian payers to harmonize coverage decisions, international collaborations, information sharing, and national standards for timeliness in oncology drug access. [ABSTRACT FROM AUTHOR]

This is a consensus-based Canadian guideline whose primary purpose is to standardize and facilitate the management of chronic graft-versus-host disease (cGvHD) across the country. Creating uniform healthcare guidance in Canada is a challenge for a number of reasons including the differences in healthcare authority structure, funding and access to healthcare resources between provinces and territories, as well as the geographic size. These differences can lead to variable and unequal access to effective therapies for GvHD. This document will provide comprehensive and practical guidance that can be applied across Canada by healthcare professionals caring for patients with cGvHD. Hopefully, this guideline, based on input from GvHD treaters across the country, will aid in standardizing cGvHD care and facilitate access to much-needed novel therapies. This consensus paper aims to discuss the optimal approach to the initial assessment of cGvHD, review the severity scoring and global grading system, discuss systemic and topical treatments, as well as supportive therapies, and propose a therapeutic algorithm for frontline and subsequent lines of cGvHD treatment in adults and pediatric patients. Finally, we will make suggestions about the future direction of cGvHD treatment development such as (1) a mode-of-action-based cGvHD drug selection, according to the pathogenesis of cGvHD, (2) a combination strategy with the introduction of newer targeted drugs, (3) a steroid-free regimen, particularly for front line therapy for cGvHD treatment, and (4) a pre-emptive approach which can prevent the progression of cGvHD in high-risk patients destined to develop severe and highly morbid forms of cGvHD. [ABSTRACT FROM AUTHOR]

The process of icing and the resulting layered ice masses, called aufeis, are caused by the freezing of overflow originating from groundwater or surface water. Aufeis can directly impact infrastructure and property, most commonly through winter ice formation and spring flooding within, against, and on the surface of hydraulic structures and transportation infrastructure. They also represent a safety concern for drivers. This geohazard often needs to be managed proactively and efficiently to mitigate associated risks. This paper provides an overview of the consequences of aufeis in northwestern Canada. A total of 50 existing and novel icing and aufeis mitigation approaches are described and classified. The context of applicability for each approach is identified, considering the source of water, the type of infrastructure, and its role in the formation of aufeis. Finally, future research avenues to support the development or improvement of aufeis risk reduction techniques are presented. [ABSTRACT FROM AUTHOR]

Patient scheduling is a difficult task involving stochastic factors, such as the unknown arrival times of patients. Similarly, the scheduling of radiotherapy for cancer treatments needs to handle patients with different urgency levels when allocating resources. High-priority patients may arrive at any time, and there must be resources available to accommodate them. A common solution is to reserve a flat percentage of treatment capacity for emergency patients. However, this solution can result in overdue treatments for urgent patients, a failure to fully exploit treatment capacity, and delayed treatments for low-priority patients. This problem is especially severe in large and crowded hospitals. In this paper, we propose a prediction-based approach for online dynamic radiotherapy scheduling that dynamically adapts the present scheduling decision based on each incoming patient and the current allocation of resources. Our approach is based on a regression model trained to recognize the links between patients' arrival patterns and their ideal waiting time in optimal off-line solutions when all future arrivals are known in advance. When our prediction-based approach is compared with flat-reservation policies, it does a better job of preventing overdue treatments for emergency patients and also maintains comparable waiting times for the other patients. We also demonstrate how our proposed approach supports explainability and interpretability in scheduling decisions using Shapley additive explanation values. History: Accepted by Erwin Pesch, Area Editor for Heuristic Search & Approximation Algorithms. Funding: Mitacs Accélération IT26995 and Canada Research Chair in Analytics and Logistics in Healthcare (HANALOG). Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information (https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2023.1289) as well as from the IJOC GitHub software repository (https://github.com/INFORMSJoC/2021.0342) at (http://dx.doi.org/10.5281/zenodo.7579533). [ABSTRACT FROM AUTHOR]

Recently, convolutional neural networks (CNNs) have been widely used in image denoising, and their performance has been enhanced through residual learning. However, previous research mostly focused on optimizing the network architecture of CNNs, ignoring the limitations of the commonly used residual learning. This paper identifies two of its limitations, which are the neglect of image information and the lack of effective consideration of image self-similarity. To solve these limitations, this paper proposes a compositional denoising network (CDN), which contains two sub-paths, the image information path (IIP) and the noise estimation path (NEP), respectively. IIP is trained via an image-to-image method to extract image information. For NEP, it utilizes image self-similarity from the perspective of training. This similarity-based training method constrains NEP to output similar estimated noise distributions for different image patches with a specific kind of noise. Finally, image information and noise distribution information are comprehensively considered for image denoising. Experimental results indicate that CDN outperforms other CNN-based methods in both synthetic and real-world image denoising, achieving state-of-the-art performance. [ABSTRACT FROM AUTHOR]

Risk prediction models hold great promise to reduce the impact of cancer in society through advanced warning of risk and improved preventative modalities. These models are evolving and becoming more complex, increasingly integrating genetic screening data and polygenic risk scores as well as calculating risk for multiple types of a disease. However, unclear regulatory compliance requirements applicable to these models raise significant legal uncertainty and new questions about the regulation of medical devices. This paper aims to address these novel regulatory questions by presenting an initial assessment of the legal status likely applicable to risk prediction models in Canada, using the CanRisk tool for breast and ovarian cancer as an exemplar. Legal analysis is supplemented with qualitative perspectives from expert stakeholders regarding the accessibility and compliance challenges of the Canadian regulatory framework. While the paper focuses on the Canadian context, it also refers to European and U.S. regulations in this domain to contrast them. Legal analysis and stakeholder perspectives highlight the need to clarify and update the Canadian regulatory framework for Software as a Medical Device as it applies to risk prediction models. Findings demonstrate how normative guidance perceived as convoluted, contradictory or overly burdensome can discourage innovation, compliance, and ultimately, implementation. This contribution aims to initiate discussion about a more optimal legal framework for risk prediction models as they continue to evolve and are increasingly integrated into landscape for public health. [ABSTRACT FROM AUTHOR]

Training staff and volunteers is an important aspect of successful program implementation. This paper follows Part A of an evaluation of the Special Olympics Canada (SOC) Coaching Young Athletes Training course. Consistent with Kirkpatrick's four-level model of training evaluation, Part A evaluated program leaders' reactions to (level 1) and immediate learning from (level 2) the training. This Part B paper covers "on the job" behavior (level 3). In-depth semi-structured interviews were conducted with youth program leaders (n = 11) from eight provinces. Overall, participants felt that more training related to working with children with autism and promoting positive athlete behavior was needed. The findings also lead us to suggest that program leaders need to develop a more fulsome understanding of how to foster skill mastery, including how to practice the same skill in many and varied ways. [ABSTRACT FROM AUTHOR]

Canada has just enacted legislation to give the broadcast regulator, the Canadian Radiotelevision and Telecommunications Commission (CRTC), authority to regulate online streaming platforms, both domestic and international. This legislation, known as Bill C-11 as it passed through an extensive parliamentary review process, was highly controversial. The bill empowers the CRTC to review and possibly amend the definition of “Canadian content.” It will also require that streaming services contribute financially to the production of Canadian content and will impose “discoverability” requirements on digital streaming platforms (like YouTube, Spotify, Netflix and others) to ensure that Canadian content is promoted. The CRTC will have broad leeway to issue and enforce regulations to achieve these ends. The U.S. high-tech and streaming industry does not like this legislation and has used various tactics to oppose it. Among these are arguments that C-11 violates commitments that Canada made to the United States in the Canada-U.S.-Mexico Agreement (CUSMA), the replacement for NAFTA, and that implementation of C-11 will result in U.S. trade retaliation. This paper analyzes the arguments to this effect put forth by the U.S. tech industry’s trade association, the Computer & Communications Industry Association (CCIA), and refutes them, particularly the argument that Canada will need to invoke CUSMA Article 32.6 (the cultural exception clause) to justify its actions. At the same time, the paper cautions that the CRTC needs to be careful with respect to imposing a requirement on foreign streamers to contribute to Canadian production if at the same time it denies them the ability to acquire and exploit the production they have helped finance when no such limitation is imposed on equivalent Canadian streaming services. [ABSTRACT FROM AUTHOR]

In today's globalized world wood-based products are often imported from countries other than those where the wood was grown. Bilateral trade statistics are thus only of limited help for getting a better understanding of how production-related environmental impacts are caused by consumption elsewhere. This study presents a novel physical accounting model that allows flows of wood-based products to be traced along international supply chains, therefore making it possible to consistently relate the consumption of wood-based products to the origin of roundwood. In comparison to previous studies, the proposed method covers entire supply chains, including finished wood and paper products, such as furniture and printed matter, and also accounts for flows of processing residues and recovered paper. The main results of the accounting model are detailed country-by-country matrices indicating the locations of origin of the products consumed in a given nation. For instance, it is revealed that out of the finished wood products consumed in the USA in 2018, 75.6% originated domestically, 10.7% from neighbouring Canada and the remaining 13.7% from other countries. Potential applications and extensions of the presented approach are also discussed. • The accounting approach traces flows of wood-based products along supply chains. • The method has a high regional resolution and covers 16 different products. • Processing residues, recovered paper and finished products are also accounted for. • Matrices indicate the origin of the raw material contained in consumed products. • The model is useful for investigating the theory of unequal ecological exchange. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has significantly impacted families across Canada; however, rural low-income mothers and their families have experienced significant challenges due to historical and current social, economic, cultural, and health inequities. These inequities complicated mothers' ability to navigate the pandemic. This paper is based on a study that used a grounded theory framework to explore the implications of the COVID-19 pandemic on rural, low-income mothers in Nova Scotia, Canada, while supporting their families' wellbeing during the pandemic. Through 29 interviews with rural low-income mothers, and three focus groups with community organizations serving these mothers, this study found that mothers and their families were deeply impacted by the first and second waves of the COVID-19 pandemic. Factors such as inadequate internet and internet access, limited and unaffordable transportation options, food insecurity, social isolation, and mental health challenges emerged from these interviews. Three focus groups with service providers to low-income rural mothers also informed the final results. The inequities faced by rural mothers created additional barriers to accessing services and resources to support their families' wellbeing during the pandemic. The results of the study connect to the importance of addressing inequities through a holistic social determinants of heath model. As a result, the findings of this study have implications on the actions of service providers, policymakers, and researchers, as little has been written about this demographic in relation to social determinants of health and in the context of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]