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Introduction: The shift to remote working/learning to slow transmission of the SARS-CoV-2 virus has had widespread mental health impacts. We aimed to describe how the COVID-19 pandemic impacted the mental health of students and faculty within a health sciences faculty at a central Canadian university. Methods: Via an online survey, we queried mental health in the first four months of the COVID-19 pandemic quantitatively (scale: 1 (most negative)-100 (most positive)) and qualitatively. Results: The sample (n = 110) was predominantly women (faculty 39/59; [66.1%]; students 46/50; [92.0%]). Most faculty were married/common law (50/60; [84.8%]) and had children at home (36/60; [60.0%]); the opposite was true for most students. Faculty and students self-reported comparable mental health (40.47±24.26 and 37.62±26.13; respectively). Amongst women, those with vs. without children at home, reported significantly worse mental health impacts (31.78±23.68 vs. 44.29±27.98; respectively, p = 0.032). Qualitative themes included: “Sharing resources,” “spending money,” “few changes,” for those without children at home; “working at home can be isolating,” including the subtheme, “balancing act”: “working in isolation,” “working more,” for those with children at home. Discussion: Amongst women in academia, including both students and faculty, those with children at home have disproportionately worse mental health than those without children at home.

On 15 June 2006, Bill 33: Act to amend the Act respecting health services and social services and other legislative provisions, was tabled at the Québec Legislature. It served as the government's response to the Supreme Court of Canada's 2005 ruling in Chaoulli vs. Québec (Attorney General), which had ruled that Québec's ban on duplicative health insurance was not consistent with the Québec Charter of Human Rights and Freedoms. Bill 33 implemented centralized waiting lists, specialized private medical centres and introduced duplicative private health insurance. The stated objectives were to reduce wait times and abide by the SCC ruling. However, the scope of the reform was strictly limited to three services: hip and knee replacement, cataract extraction, and intraocular lens implantation. It also placed regulations on the ability of physicians to practice in the private sector, suggesting that the government sought to achieve these reforms while attempting to maintain the integrity of the public system and change as little as possible. Minimal evaluations of Bill 33 have been conducted by the government, with no further evaluations planned. However, analysis of the current Québec health care landscape indicates that despite the stated aspirations of Bill 33, it has not made a substantial impact on reducing wait times. At the same time, it has not contributed to the growth of a private insurance market in Québec, as many of its detractors feared. The implications of the Chaoulli decision and Québec's response provide key lessons for government and stakeholders in responding to legal challenges on health equity and parallel health system.

Much of the contemporary crisis in coming to terms with the past may have digital origins. We can see this crisis as engineered or assembled through a new series of historical actors: memes and posts on social media and, behind them, the work of trolls and paid influencers. These actors do not travel with first-person accounts of events so much as accumulate in the digital ephemera of daily lives and are then archived as the currency of digital capitalism, saved in individual online albums, on smart phones and then republished elsewhere. Their circulation and accumulation can be strategically directed by political actors who seek to overturn established historical consensus. Tracing the trajectory of memes featuring the Philippines’ President Duterte, this paper explores how digital objects have contributed to attempts to rework the history of the Martial Law era.

Background Inadequately controlled sternotomy pain after cardiac surgery can lead to delayed recovery and patient suffering. Preoperative intravenous methadone is effective for reducing both postoperative pain and opioid consumption. Despite ease of administration, the effects of preoperative oral methadone are not well described in the literature. Aims This pilot study investigated the effect of preoperative oral methadone on pain scores, analgesia requirements, and opioid-induced side effects. Methods A randomized double-blind placebo-controlled model was used with sampling of patients undergoing sternotomy for isolated coronary artery bypass graft (CABG) surgery (ClinicalTrials.gov registration no. NCT02774499). Participants were randomized to receive oral methadone (0.3 mg/kg) or oral placebo prior to entering the operating room. The primary outcome was pain scores on a 0–10 Verbal Rating Scale. Secondary outcomes included morphine requirements using patient-controlled analgesia (PCA), time to extubation, level of sedation, and side effects such as nausea, vomiting, pruritus, hypoventilation, and hypoxia over a 72-h monitoring time. Results Twenty-one patients completed the study. Oral methadone did not reduce pain scores in the methadone group (P = 0.08). However, postoperative morphine requirement during the first 24 h was reduced by a mean of 23 mg in the methadone group (mean difference, −23; 99% confidence interval [CI], 37–13 mg; P

Background Postoperative pain management (POPM) appeared to be weak in Rwanda. Aims The aim of this study was to compare POPM measures in a teaching hospital between 2013 and 2017. Methods A two-phase observational study in 2013 and 2017. was conducted. Participants were recruited prior to major surgery and followed for two postoperative days. A numerical rating scale (0–10) was administered to all participants in both years, and the International Pain Outcomes questionnaire was administered in 2017. Recruitment, consent, and data collection were performed in participants’ preferred language. Results One hundred adult participants undergoing major general, gynecologic, orthopedic, or urologic surgery were recruited in 2013 and 83 were recruited in 2017. Fourteen percent of participants in 2013 and 46% in 2017 scored their worst pain as severe (>6; P

Federal and provincial governments in Canada have mobilized resources to address the challenges of care associated with the growing population of older adults with major neurocognitive disorders (MND), which include Alzheimer's and other related diseases. Researchers and practitioners in Québec, Ontario, and Saskatchewan identified a need for better integrated care for older adults with MND, improved capacity for assessment, diagnosis, and management of cases, as well as greater accessibility for those living in rural and remote regions. To this end, three distinct programs---the Réseau de services intégrés pour personnes âgées en perte d'autonomie cognitive (RSI-PAPAC) in Québec, the Primary Care Collaborative Memory Clinic (PCCMC) in Ontario, and the Rural and Remote Memory Clinic (RRMC) in Saskatchewan---were developed with the help of funding from provincial governments and federal research grants. The objective of this article is to compare and analyze the implementation and performance of these programs. Each program saw a large scope of services offered with the integration of community services and a great degree of coordination between these actors. The RSI-PAPAC was a roster program implemented in a collection of community health centres in Québec, while the latter two were clinical models that originated out of one central clinic. In Québec, while the specific program we analyzed is no longer active today, the ministry of health and social services has since adopted a comprehensive action plan rolling out services at a provincial scale (unrelated to the program we analyzed). In Ontario, with the help of interested organizations, the PCCMC has since been scaled up across the province, with over 100 clinics now active. It was easily adopted due to the quick training program offered to physicians and its reliance on patients' existing circle of care. Finally, in Saskatchewan, the RRMC has not scaled up to other clinics, likely due to the lack of existing collaborative primary clinics such as those in Ontario; however, provincial governments and other health organizations have mobilized to fund its continuation, and it currently operates out of one clinic in Saskatoon, serving as a node of care and research within the University of Saskatchewan.

We show that compact complex manifolds of algebraic dimension zero bearing a holomorphic Cartan geometry of algebraic type have infinite fundamental group. This generalizes the main Theorem in [DM] where the same result was proved for the special cases of holomorphic affine connections and holomorphic conformal structures.

Background: Personality is one of the key elements in professional identity formation and is self-identified as one of the top two influences for Canadian medical graduates when making a specialty choice yet little is known about the personalities of Canadian medical students. This study is the first to report personality data regarding Canadian medical students. Methods: Personality is one of the key elements in professional identity formation and is self-identified as one of the top two influences for Canadian medical graduates when making a specialty choice yet little is known about the personalities of Canadian medical students. This study is the first to report personality data regarding Canadian medical students. Results: The data were analyzed using Chi square. The distribution of personalities [Guardian, Idealist, Artisan, Rational] for medical students differs from the distribution reported for the general Canadian population. The distribution of personalities is similar for each Canadian medical school. Conclusion: Results from this first national accounting of the personalities of Canadian medical students suggest either that the personalities of medical school applicants differ from the general population or that personality affects medical school admissions success. Knowing the personalities of medical students could be important for medical schools in such areas as admissions, career counselling and professional identity formation.

In the past two decades there has been a more concerted effort to make rational, evidence-based approaches to what has been, for the previous two centuries, a somewhat chaotic mixture of missionary-based, NGO-based, university and United Nations-based efforts at international research and clinical practice in financially poor countries. Essential Clinical Global Health is a welcome new addition to problems of providing good quality health care in resource-limited settings. The emphasis is on poor countries, although some information is useful for remote settings in developed countries.

Over the last 50 years, Australian governments have introduced a range of measures that seek to deter asylum seekers. Current practice sees asylum seekers once again detained in offshore detention in neighbouring countries.

Palliative care is aimed at alleviating the suffering of patients with terminal illnesses. As more patients make the decision to die at home, community palliative care has become an alternative to hospitalization. The literature was examined in relation to the needs of terminally ill patients in the community and their families to determine their priority needs. Patients were found to have physical, psychosocial, and spiritual needs, while families had needs in relation to the physical care of their loved ones, as well as information and psychosocial needs. The use of Watson’s theory of human caring, and in particular her carative factors, was found to be an appropriate nursing model to direct palliative care nurses in meeting the needs of both patients and their families.

Les soins palliatifs visent à soulager la souffrance des patients atteints de maladies terminales. Étant donné qu’un nombre toujours croissant de patients décident de mourir à domicile, les soins palliatifs communautaires offrent une solution de rechange à l’hospitalisation. On a recensé les écrits portant sur les besoins des patients en phase terminale en contexte communautaire et ceux de leur famille afin de déterminer leurs besoins prioritaires. On a constaté que ces patients avaient des besoins physiques, psychosociaux et spirituels, tandis que leurs proches avaient des besoins liés aux soins physiques des patients ainsi que des besoins d’information et des besoins psychosociaux. On a découvert que l’utilisation de la théorie de Watson sur le caring humaniste, et notamment de ses facteurs carative, constituait un modèle de soins infirmiers approprié pour guider les infirmières en soins palliatifs dans la satisfaction des besoins des patients et de leur famille.

Background: Sleep deprivation and fatigue are associated with long and irregular work hours. These work patterns are common to medical residents. Motor vehicle crashes (MVCs) are a leading cause of injury related deaths in Canada, with MVC fatality rates in rural areas up to three times higher than in urban areas. Objectives: To: 1) examine the number of adverse motor vehicle events (AMVEs) in family medicine residents in Canada; 2) assess whether residents with rural placements are at greater risk of experiencing AMVEs than urban residents; and 3) determine if family medicine residency programs across Canada have travel policies in place. Methodology: A prospective, cross-sectional study, using a national survey of second-year family medicine residents. Results: A higher percentage of rural residents reported AMVEs than urban residents. The trend was for rural residents to be involved in more MVCs during residency, while urban residents were more likely to be involved in close calls. The majority of Canadian medical schools do not have resident travel policies in place. Conclusion: AMVEs are common in family medicine residents, with a trend for the number of MVCs to be greater for rural residents. These data support the need for development and incorporation of travel policies by medical schools.

Young mothers seeking reintegration after periods of time spent livingwith fighting forces and armed groups face exclusion and stigmarather than the support they and their children badly need.

Abstract Background Genomic selection is a recently developed technology that is beginning to revolutionize animal breeding. The objective of this study was to estimate marker effects to derive prediction equations for direct genomic values for 16 routinely recorded traits of American Angus beef cattle and quantify corresponding accuracies of prediction. Methods Deregressed estimated breeding values were used as observations in a weighted analysis to derive direct genomic values for 3570 sires genotyped using the Illumina BovineSNP50 BeadChip. These bulls were clustered into five groups using K-means clustering on pedigree estimates of additive genetic relationships between animals, with the aim of increasing within-group and decreasing between-group relationships. All five combinations of four groups were used for model training, with cross-validation performed in the group not used in training. Bivariate animal models were used for each trait to estimate the genetic correlation between deregressed estimated breeding values and direct genomic values. Results Accuracies of direct genomic values ranged from 0.22 to 0.69 for the studied traits, with an average of 0.44. Predictions were more accurate when animals within the validation group were more closely related to animals in the training set. When training and validation sets were formed by random allocation, the accuracies of direct genomic values ranged from 0.38 to 0.85, with an average of 0.65, reflecting the greater relationship between animals in training and validation. The accuracies of direct genomic values obtained from training on older animals and validating in younger animals were intermediate to the accuracies obtained from K-means clustering and random clustering for most traits. The genetic correlation between deregressed estimated breeding values and direct genomic values ranged from 0.15 to 0.80 for the traits studied. Conclusions These results suggest that genomic estimates of genetic merit can be produced in beef cattle at a young age but the recurrent inclusion of genotyped sires in retraining analyses will be necessary to routinely produce for the industry the direct genomic values with the highest accuracy.