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Background: Children who sustain injuries resulting in facial fractures are at risk for concomitant concussion. Prompt diagnosis and appropriate management of concussions are crucial in preventing neurocognitive impairment. The goal of this study is to examine the relationships between distinct craniofacial fracture patterns, injury mechanism, and concussion in pediatric patients. Methods: A retrospective review of 3334 patients Results: Two hundred twenty-seven patients met inclusion criteria (67.9% male), mean age at injury was 12.3 ± 4.3 years. Overall, concussions were more common in children >12 years old (54.2%), with sports as the most common cause of injury (32.5%). In patients Conclusions: Nearly 7% of pediatric patients with facial fractures in this retrospective series were diagnosed with a concomitant concussion. The results suggest that a higher index of suspicion for concussions should be maintained for patients with midface fractures and those with a previous history of concussions.

Background Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote phys-ical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. Methods The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. Results A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Conclusions Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention–EMBOLDEN.

This study aims to determine the utility of 3D photography for evaluating the severity of metopic craniosynostosis (MCS) using a validated, supervised machine learning (ML) algorithm. This single-center retrospective cohort study included patients who were evaluated at our tertiary care center for MCS from 2016 to 2020 and underwent both head CT and 3D photography within a 2-month period. The analysis method builds on our previously established ML algorithm for evaluating MCS severity using skull shape from CT scans. In this study, we regress the model to analyze 3D photographs and correlate the severity scores from both imaging modalities. 14 patients met inclusion criteria, 64.3% male (n = 9). The mean age in years at 3D photography and CT imaging was 0.97 and 0.94, respectively. Ten patient images were obtained preoperatively, and 4 patients did not require surgery. The severity prediction of the ML algorithm correlates closely when comparing the 3D photographs to CT bone data (Spearman correlation coefficient [SCC] r = 0.75; Pearson correlation coefficient [PCC] r = 0.82). The results of this study show that 3D photography is a valid alternative to CT for evaluation of head shape in MCS. Its use will provide an objective, quantifiable means of assessing outcomes in a rigorous manner while decreasing radiation exposure in this patient population.

Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Although revision pharyngoplasty may be necessary in those with persistent VPI, little is known regarding the indications for and outcomes after such procedures. The purpose of this study is to describe the authors' experience with indications for and outcomes after revision pharyngoplasty.A single-center retrospective review was performed of all patients undergoing revision pharyngoplasty between 2002 and 2019. Demographic data and Pittsburgh Weighted Speech Scores, diagnoses, comorbidities, and complications were tabulated. Two-tailed Student t test was used, and a P value of 0.05 or less was considered statistically significant.Thirty-two patients (65.6% male) met inclusion criteria for this study. The most common diagnoses included cleft palate (68.8%), submucous cleft palate (SMCP, 18.8%), and congenital VPI (6.3%, likely occult SMCP). Most patients (84.4%) underwent palatoplasty before their initial pharyngoplasty. The primary indication for initial pharyngoplasty was VPI (mean age 7.1 ± 4.6 years). The most common indication for revision pharyngoplasty (mean age 11.2 ± 5.1 years) included persistent VPI (n = 22), followed by obstructive sleep apnea (OSA) (n = 11). Persistent VPI (n = 8) and OSA (n = 6) were the most common complications after secondary pharyngoplasty. Thirteen patients (40.6%) within the revision pharyngoplasty cohort required additional surgical intervention: 4 underwent tertiary pharyngoplasty, 4 underwent takedown for OSA (n = 3) or persistent VPI (n = 1), 3 underwent takedown and conversion Furlow for persistent VPI (n = 2), OSA (n = 2) and/or flap dehiscence (n = 1), and 2 underwent palatal lengthening with buccal myomucosal flaps for persistent VPI. Of the 4 patients who required a tertiary pharyngoplasty, the mean age at repair was 6.6 ± 1.1 years and their speech scores improved from 13.5 to 2.3 after tertiary pharyngoplasty (P = 0.11). The overall speech score after completion of all procedures improved significantly from 19 to 3.3.Patients who fail primary pharyngoplasty represent a challenging population. Of patients who underwent secondary pharyngoplasty, nearly half required a tertiary procedure to achieve acceptable speech scores or resolve complications.

Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and postsurgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery.Medical records were reviewed from all FtM patients undergoing gender-affirming chest reconstructive surgery from January 2010 to February 2021 by 3 plastic surgeons at the University of Pittsburgh Medical Center. Relative risk of malignant progression was used to stratify pathologic data. Subsequent management of atypical, in situ, and invasive pathology were recorded.A total of 318 patients were included in this study; the average age at surgery was 24.6 ± 8.1 years. Eighty-six patients (27%) had a family history of breast and/or ovarian cancer. Overall, 21 patients (6.6%) had some increased risk of breast cancer: 17 (5.3%) had proliferative lesions, mean age 38.2 ± 12.4 years; 2 had atypical ductal hyperplasia, ages 33.4 and 38.3 years; and 2 had invasive ductal carcinoma, ages 35.4 and 40.6 years.In this study, we found that 6.6% of FtM transgender patients undergoing top surgery had an elevated risk of breast cancer, with 1.2% of patients having a greater than 2 times risk of breast cancer. These results highlight the importance of appropriate preoperative screening as well as pathological analysis of surgical specimens to help guide clinical care. The authors advocate for a thorough breast cancer risk assessment before surgery for all patients, as well as using pathologic findings to guide postoperative cancer screening and follow-up.

Independent mobility is an important component of healthy ageing. Public transit may be an affordable way to achieve independent mobility, and yet little is known about older adults’ transition to public transit. This paper addresses this research gap by providing an exploration of older adults’ experiences transitioning to public transit use, and by comparing these experiences to those of older people who have always travelled using transit. Twenty-four older adults (65+) living in Hamilton, Canada, who use public transit completed semi-structured interviews during which they discussed their experiences when they first began to use transit. These experiences are framed herein with the concept self-efficacy, i.e. how one's belief in their ability to complete a task shapes their ability to complete said task. Results indicate that most older adults acquire skills to transition to public transit, such as trip planning, boarding, knowing where to sit and exiting the bus. These skills are developed through practice. As one gains experience, one becomes more confident in their ability to meet their daily travel needs using transit. Therefore, the transition to public transit as an older adult can be more challenging for those with little experience using public transit. This paper highlights the danger of assuming all older adults will effortlessly take up transit and stresses the importance of older adults gaining experience using public transit.

BackgroundFunctional dyspepsia is characterised by chronic symptoms of post-prandial distress or epigastric pain not associated with defined structural pathology. Increased peripheral gut-homing T cells have been previously identified in patients. To date, it is unknown if these T cells were antigen-experienced, or if a specific phenotype was associated with FD.ObjectiveThis study aimed to characterise T cell populations in the blood and duodenal mucosa of FD patients that may be implicated in disease pathophysiology.MethodsWe identified duodenal T cell populations from 23 controls and 49 Rome III FD patients by flow cytometry using a surface marker antibody panel. We also analysed T cell populations in peripheral blood from 37 controls and 61 patients. Where available, we examined the number of duodenal eosinophils in patients and controls.ResultsThere was a shift in the duodenal T helper cell balance in FD patients compared to controls. For example, patients had increased duodenal mucosal Th2 populations in the effector (13.03 ± 16.11, 19.84 ± 15.51, p=0.038), central memory (23.75 ± 18.97, 37.52 ± 17.51, p=0.007) and effector memory (9.80±10.50 vs 20.53±14.15, p=0.001) populations. Th17 populations were also increased in the effector (31.74±24.73 vs 45.57±23.75, p=0.03) and effector memory (11.95±8.42 vs 18.44±15.63, p=0.027) subsets. Peripheral T cell populations were unchanged between FD and control.ConclusionOur findings identify an association between lymphocyte populations and FD, specifically a Th2 and Th17 signature in the duodenal mucosa. The presence of effector and memory cells suggest that the microinflammation in FD is antigen driven.

Introduction The concept of “overcorrection” for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of “overcorrection” and objectively evaluate intermediate results. Methods This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. Results Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. Conclusions This standardized “overcorrection” approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.

Background Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and upper airway obstruction. Early recognition and appropriate perinatal management is crucial for optimizing outcomes. This study aimed to evaluate 20-week fetal ultrasounds to determine if specific mandibular measurements could predict PRS diagnosis and disease severity. Methods A retrospective case-control study of 48 patients with PRS and gender-matched controls was performed. Medical records were reviewed for respiratory and surgical interventions. Three parameters to assess micrognathia were measured on mid-sagittal profile ultrasound images: frontal nasal-mental angle (FNMA), facial-maxillary angle (FMA), and alveolar overjet. Student's t-test and univariate logistic regression was performed. P ≤ 0.05 was considered statistically significant. Results Patients with PRS demonstrated a significantly smaller mean FNMA compared to the control group, 129.3 ± 8.6° and 137.4 ± 3.2°, respectively (p Conclusions Mandibular features on the 20-week ultrasound can be measured to predict diagnosis and severity of PRS. This is an important first step to prepare for potential respiratory intervention at delivery to minimize perinatal hypoxia. Alveolar overjet, previously not described in prenatal ultrasound literature, is measurable and has utility in prenatal screening for PRS, as do FMA and FNMA.

Objective Several severity metrics have been developed for metopic craniosynostosis, including a recent machine learning-derived algorithm. This study assessed the diagnostic concordance between machine learning and previously published severity indices. Design Preoperative computed tomography (CT) scans of patients who underwent surgical correction of metopic craniosynostosis were quantitatively analyzed for severity. Each scan was manually measured to derive manual severity scores and also received a scaled metopic severity score (MSS) assigned by the machine learning algorithm. Regression analysis was used to correlate manually captured measurements to MSS. ROC analysis was performed for each severity metric and were compared to how accurately they distinguished cases of metopic synostosis from controls. Results In total, 194 CT scans were analyzed, 167 with metopic synostosis and 27 controls. The mean scaled MSS for the patients with metopic was 6.18 ± 2.53 compared to 0.60 ± 1.25 for controls. Multivariable regression analyses yielded an R-square of 0.66, with significant manual measurements of endocranial bifrontal angle (EBA) (P = 0.023), posterior angle of the anterior cranial fossa (p Conclusions The machine learning algorithm offers an objective assessment of morphologic severity that provides a reliable composite impression of severity. The generated score is comparable to other severity indices in ability to distinguish cases of metopic synostosis from controls.

Purpose Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty remains a difficult problem to treat. This study evaluates speech outcomes following revision palatoplasty with tissue augmentation using buccal myomucosal flaps (BMF) as an alternative to pharyngoplasty for patients with VPI. Methods A retrospective single-center review of revision palatoplasty with tissue augmentation at a tertiary pediatric hospital Cleft-Craniofacial Center between January 2017 and March 2021 was conducted. Patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI, and comprehensive pre- and postoperative speech evaluations who underwent revision palatoplasty with BMF were included. Results Twenty patients met inclusion criteria (35% female, 20% syndromic). Mean age at the time of revision palatoplasty with BMF was 9.7 years. Preoperatively, all patients had stigmatizing speech and received the recommendation for speech surgery; the mean Pittsburgh Weighted Speech Score (PWSS) was 14.3 ± 4.9. The mean postoperative PWSS at the most recent assessment was 4.2 ± 2.3, representing a statistically significant improvement from preoperative scores ( P Conclusion In patients with VPI following primary palatoplasty, revision palatoplasty with tissue augmentation offers an alternative to pharyngoplasty. This approach preserves dynamic velopharyngeal function, improves speech outcomes, and should be considered an option when treating patients with post-primary palatoplasty VPI.

Using Statistics Canada’s 2011-2016 Labor Force Surveys, this paper examines the spatial dimensions of precarious forms of employment (PFE) in Canada. We first compare different PFEs across a range of geographies including national, provincial, census metropolitan areas and urban/rural areas. The results show that different PFEs exhibited distinct spatial patterns across space and scale. Second, using logistic regression models, results show that patterns in PFEs were reinforced by factors such as immigration status, gender, age, education, and income. These models further confirm that spatial variations in PFEs were robust even when controlling for socio-demographic and socio-economic effects. Taken together, these marked spatial patterns advances our understanding of the spatial divisions of precariousness in Canada.

Background: Pierre Robin sequence (PRS), characterized by the triad of retrognathia, glossoptosis, and airway obstruction, remains challenging to treat and no standard treatment protocols exist. Inadequate treatment may lead to obstructive sleep apnea and necessitate more invasive airway interventions. The purpose of this study is to present the results of a single center’s treatment protocol and the postoperative effect on airway status. Methods: A retrospective cohort study of consecutive patients with PRS treated with MDO from 2010 to 2020 was identified. Descriptive statistics and student’s t-tests were analyzed, and a P

Do older workers, including those that work beyond age 65, have different commuting patterns than their younger counterparts? With a focus on older working adults, including those that continue to work beyond age 65, this paper examines the relationship between migration, residential location, and commute distance within Toronto's commuter shed. The study utilizes data from the master file of the 2016 Canadian Census, allowing migrants to be disaggregated by duration of residence. Results indicate that living in rural areas and being a recent migrant are significantly associated with longer commutes. Furthermore, findings demonstrate that the commute distance of very recent migrants (those who migrated in the year immediately prior to the census) and individuals who moved to rural areas have the longest commute distances. As residential duration increases, commute distance decreases. Older workers have similar commuting behaviors as younger workers, although older workers who recently migrated have some of the longest commute distances as well.The online version contains supplementary material available at 10.1007/s11116-022-10341-5.

Background and Purpose: The study of nasal changes in cleft lip and palate (CLP) orthognathics is limited. This study aimed to determine differences in 3-dimensional (3D) nasal changes for unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients after Le Fort I advancement. Methods: This study was a retrospective cohort evaluation of 18 subjects (9 male, 9 female) treated at a single institution over a 5-year period who had class III skeletal and dentoalveolar malocclusion related to non-syndromic cleft lip and/or palate and underwent surgical correction via Le Fort I osteotomy. Patients underwent pre- and postoperative cephalometric measurements and 3D volumetric assessment for comparison to analyze nasal changes. Statistical analysis was performed to determine changes in nasal parameters using student’s t-test and multivariate analysis. Differences were considered significant for P-values ≤.05. Results: All nasal parameters except for nasolabial angle and nasal length changed significantly postoperatively in the entire cohort. Alar base and flare width both increased significantly (2.1 mm, P = .0002, 1.4 mm, P = .0005), while both relative and total tip projection decreased (−3.4 mm, P = .000004, −2.2 mm, P = .0008). An advancement of the entire nasal complex was seen postoperatively (1.0 mm, P = .0005). UCLP patients had a significantly larger decrease in total nasal tip projection following surgery relative to BCLP patients (−3.5 ± 1.2 mm, −0.8 ± 2.1 mm, P = .008). BCLP morphology increases the degree of 3D nasal surface area advancement relative to UCLP (1.2 mm ± 0.3, 0.8 mm ± 0.6, P = .028). Alar cinch stitch decreases nasolabial angle ( P = .024) but increases nasal length ( P = .004). Conclusion: Discrepancies exist in nasal changes after Le Fort I advancement between UCLP and BCLP patients. Increased understanding of outcomes for cleft patients undergoing Le Fort I can help improve the predictability of nasal esthetic changes in this patient population.

In the wake of the COVID-19 pandemic, those planning and conducting research involving older adults have faced many challenges, in part because of the public health measures in place. This article details the early steps and corresponding strategies implemented by our multidisciplinary team to pivot our large-scale aging and mobility study. Based on the premise that all current and emerging research in aging has been impacted by the pandemic, we propose a continuum approach whereby the research question, analysis, and interpretation are situated in accordance with the stage of the pandemic. Using examples from our own study, we outline potential ways to partner with older adults and other stakeholders as well as to encourage collaboration beyond disciplinary silos even under the current circumstances. Finally, we suggest the formation of a Canadian-led consortium that leverages cross-disciplinary expertise to address the complexities of our aging population in the COVID-19 era and beyond.

Maxillo-mandibular fixation (MMF) is common technique used in mandibular fractures to stabilize the fragments and maintain the patient in normal dental occlusion during the healing process. Arch bars with elastics are one of the most frequently used methods of MMF and are temporary, and designed to be removed after the healing process is completed. There is controversy as to what impact the hardware has on dental hygiene and oral health. No reports of long-term retention of the hardware exist. This report details the case of arch bars retained for 14 years. The patient underwent MMF and internal fixation at age 16 for a complex mandibular fracture and failed to follow-up for timely removal of the arch bars due to loss of insurance. He presented at age 30 with dental pain and returned to the treating center for removal. He was in normal occlusion, but general indices of dental and periodontal health were extremely poor with multiple non-restorable teeth despite reporting good oral hygiene in the intervening period. A decline in overall dental health was evident at 1 year following removal of arch bars. Due to the presence of smooth surface dental caries, it was concluded that the presence of the arch-bars had exacerbated already poor oral hygiene and contributed to the extensive dental pathology seen. This case highlights the need for timely follow-up and hardware removal. Understanding each patient’s individual social and financial circumstances is essential to this process and a formalized office recall process may have prevented this complication.

Objectives: Pediatric mandibular distraction osteogenesis (MDO) is an increasingly common surgical procedure used to lengthen the mandible. Little is known about the long-term effects of MDO on dental development. This retrospective study sought to identify dental abnormalities at mixed dentition and early permanent dentition stages in patients who had undergone MDO. Methods: All pediatric patients who underwent MDO with imaging and clinical exams at mixed dentition and early permanent dentition stages were evaluated identify pathology. Data included demographic information, medical and surgical history, complications, and dental exam information. Descriptive statistics were reported. Results: Twenty-two hemimandibles at mixed dentition stage and 24 at early permanent stage were included. Mean age at initial MDO was 7.95 years with a mean follow-up time of 15.1 years. Nine patients required more than 1 distraction. At the mixed dentition stage, all patients showed abnormalities. The most common abnormalities were absent, dysplastic, or ectopic molars. At early permanent dentition stage, 87.5% of patients had dental abnormalities. The most common abnormality was missing molars (third, second, and first), but dysplastic, impacted, and ectopic teeth were also noted. At both mixed and early permanent dentition stages, some patients were noted to have abnormal V-shaped sigmoid notching of the mandibular ramus of undetermined clinical significance. Buccal mucosal scarring that interfered with orthodontic treatment was observed in a subset of patients. Conclusions: This study provides long-term dental analyses of patients undergoing MDO for mandibular hypoplasia. Dental abnormalities were seen at both mixed and early permanent dentition stages. Molars were the most commonly affected with absence the most commonly seen abnormality. Dysplastic, ectopic, and impacted teeth were also seen in posterior and anterior dentition, and abnormalities in buccal soft tissue and the mandibular ramus were also seen. MDO remains a crucial tool for functional and aesthetic improvement in children with hypoplastic mandibles. Dental abnormalities as a consequence of MDO should be considered as part of surgical planning process.

This study aims to examine how gendered precariousness is spatially patterned across Canada's landscape using Statistics Canada's Labour Force Survey. We compare gender differences in distinct precarious forms of employment (PFEs) across a range of geographies, including national, provincial, census metropolitan areas, and urban/rural areas. We find that distinct spatial patterns and degree of gendered precariousness were evident within and across geographic spaces. Logit models further confirmed the robustness of gender differences in PFEs across space, revealing that PFEs were associated with gender, immigration status, age, type of economic family, education, income, and occupation. This study has implications for further understanding the causal factors at play in producing these uneven economic geographies. In terms of policy recommendations, this study calls for greater gender equity in social safety net policies, especially in the wake of the labor market shocks brought by the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR] Copyright of Tijdschrift voor Economische en Sociale Geografie (Journal of Economic & Social Geography) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The role of computed tomography (CT) for diagnosis and surgical planning for craniosynostosis (CS) is well-established. The aim of this study was to quantify the cumulative medical radiation exposure from CT in patients with CS at a tertiary care children’s hospital. Medical records of patients who presented at 6 months, 5.3 ± 1.9 versus 4.3 ± 1.4 mSv, respectively (p = 0.001). Patients with nonsyndromic CS undergo 2 CT scans on average related to their diagnosis, with a mean total ERD of 9.1 mSv; this is equivalent to 1.5 years of the average annual background radiation dose a person living in the USA will encounter from environmental radiation, medical exposures, and consumer products. A CT obtained at

With higher temperatures linked to increased human morbidity and mortality, the projected increase in the number of extreme heat events (EHEs) due to climate change poses increased risks. Although the old, individuals with pre-existing illnesses, the socially isolated, and individuals with low income or low educational status are more vulnerable to the health effects of EHEs and are targeted in public health messaging, newcomers and immigrants may be less aware of the dangers of EHEs. The impacts of EHEs on the immigrant and newcomer population are not well documented in the Canadian context and the combination of a greater number of heat events and a growing and diverse immigrant population necessitates further exploration. Framed by intersectionality and using Hamilton, Ontario, as a case example, this work explores the barriers that may affect immigrant’s awareness of EHEs.

This paper explores the impact of smartphone apps on discretionary travel by utilizing a survey of smartphone users in the Canadian city of Halifax, Nova Scotia. Both subjective and objective measu...

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

OBJECTIVE The current study was designed to evaluate the translation of clinical trial outcomes and clinical guidelines for the treatment of fibromyalgia (FM) into an intensive multicomponent clinical program embedded in routine care delivery. The study aimed to assess the adaptation of these recommended strategies into routine clinical care while evaluating their effectiveness and durability in improving functional status and level of distress in a large clinical sample of FM patients. METHODS Four hundred eighty-nine patients with FM completed a 2-day program that incorporated best practice recommendations for the treatment of FM. Patients completed the Fibromyalgia Impact Questionnaire-Revised, the Center for Epidemiologic Studies Depression Scale, and the Pain Catastrophizing Scale at admission to the program and at follow-up on average 5 months posttreatment. RESULTS Significant improvements were seen in functional status (p < 0.0001), depressive symptoms (p < 0.0001), and pain catastrophizing (p < 0.0001) after participation in the intensive multicomponent treatment program. CONCLUSIONS The present study shows that an intensive multicomponent treatment program embedded in routine care delivery is effective in significantly improving functional status and psychological distress in a large sample of FM patients. The significant improvements were durable and maintained at follow-up.

An experimental study has been conducted to investigate unsteady flow phenomena observed within various two-dimensional configurations of shock/boundary layer interactions. Six configurations have been tested in Mach 2 flow: ϕ1 = 14◦ and 20◦ compression ramps, and incident shock reflections from ϕ1 = 7◦ , 8 ◦ , 9 ◦ , and 10◦ shock generators; Reynolds numbers in each case are Reθ ≈ 8350. The flow is assessed using an array of fast-response pressure transducers in conjunction with a high-repetition rate PIV system. Development of the mean flow structures early in each interaction is observed to be consistent with the Free Interaction concept. Unsteady wall-pressure energy content at frequencies above those associated with the characteristic low-frequency shock motion also show significant similarities in the vicinity of the shock foot. Results confirm that this low-frequency peak is not associated with a narrow-band forcing mechanism from either upstream or downstream, but rather a characteristic frequency that varies with interaction strength, which describes the flow’s dynamic response. These findings support various models published in literature that have sought to explain the source of low-frequency unsteady shock motion.

We explore the spatial patterning of precarious forms of employment (PFE) by immigration status using Statistics Canada's 2011–2016 Labour Force Surveys. We provide new evidence showing that different PFEs exhibited distinct spatial patterns, with the census metropolitan areas showing the greatest spatial variation for immigrants. More so, immigrants were represented in high shares in PFEs in geographies where they tend to concentrate. Our findings raise a series of important questions on the efficacy of the regionally differentiated entitlement to Employment Insurance (EI) especially as immigrants are represented in high PFE shares in regions where EI coverage rates are low. Este articulo utiliza las encuestas sobre la fuerza laboral de Canada de 2011–2016 para estudiar el patron espacial de las formas de empleo precario (FEP) en relacion a las categorias de inmigracion. Se proporcionan nuevas pruebas que muestran que las diferentes FEP exhibieron distintos patrones espaciales, y que las areas metropolitanas del censo mostraron la mayor variacion espacial para los inmigrantes. Ademas, los inmigrantes estuvieron representados en altas proporciones en las FEP de las areas geograficas donde tienden a concentrarse. Las conclusiones plantean una serie de cuestiones importantes sobre la eficacia del derecho diferenciado por regiones al seguro de empleo, especialmente porque los inmigrantes estan representados en altos porcentajes de FEP en las regiones donde las tasas de cobertura del seguro de empleo son bajas. 本稿では、Statistics Canada(カナダ統計局)による2011~2016年のLabour Force Survey(労働力調査)のデータを用いて、滞在資格別の不安定な雇用形態(precarious forms of employment:PFE)の空間的パターンを検討する。PFEの種類によって異なる空間的パターンを示し、国勢調査都市地域が移民に対して最大の空間的変動を示す新しいエビデンスを提示する。さらに、移民が集中する傾向にある地域のPFEで働く移民の割合が高かった。本稿の知見から、特に雇用保険(EI)の適用率が低い地域においてPFEで働く移民の割合が高いため、EIの受給資格を地域別に分けることの効果に関する重要な疑問が提示される。

Background Physical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes. Methods Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation. Results In total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions Group-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

IntroductionThe squamosal suture (SQS) joins the temporal to the parietal bones bilaterally and is a poorly described site of craniosynostosis. SQS fusion is thought to occur as late as the fourth decade of life and beyond; however, we have incidentally noted its presence among our pediatric patients and hypothesize that it may occur earlier in life and more frequently than previously believed.MethodsA retrospective review of imaging performed on pediatric patients was completed to identify patients with SQS synostosis. This included a review of clinical notes as well as computed tomography (CT) images obtained by our craniofacial clinic. Relevant patient data and imaging were reviewed.ResultsForty-seven patients were identified with SQS synostosis, 21 were female (45%). Age at the time of radiographic diagnosis was 10.1 ± 8.4 years (range 17 days to 27 years). A majority of patients had bilateral SQS synostosis (57%), with a relatively even distribution of unilateral right (23%) versus left (19%). SQS was an isolated finding (no other suture involvement) in 15 patients (32%), all of whom were normocephalic and did not require surgical intervention. Thirty-two patients (68%) had concomitant craniosynostosis of other sutures, most commonly sagittal and coronal. Nine patients (19%) underwent surgery to correct cranial malformations—all these patients had multi-suture synostosis ( P = 0.012). Twenty-seven patients (57%) had SQS synostosis diagnosed incidentally compared to 20 (43%) who were imaged with suspicion for synostosis. In those who were symptomatic, common findings included developmental delay, elevated intracranial pressure, hydrocephalus, seizures, and visual/hearing impairments. Ten patients (21%) were syndromic, the most frequent of which was Crouzon syndrome. No single pattern of calvarial malformation could be definitively described for SQS synostosis.ConclusionGiven that most isolated SQS synostosis cases were normocephalic, asymptomatic, and discovered incidentally, it is likely that there are many cases of unidentified SQS synostosis. The significance of SQS synostosis is currently unclear, and warrants further investigation into this phenomenon, its natural course, and its potential presence in the spectrum of normal development.

The diagnosis of late-presentation sagittal suture craniosynostosis (SCS) can be challenging, especially in the setting of subtle physical exam findings. The clinical significance of clinocephaly—a retro-coronal concavity along the midvault—in this context remains unknown. The aim of this study is to evaluate the predictive value of clinocephaly in identifying late-presentation SCS. A retrospective chart review of all patients >1 year old presenting to the craniofacial clinic with a concern for SCS was performed. The presence or absence of SCS in the setting of clinocephaly was recorded following diagnostic imaging. Student's t test, Chi Square test, and multivariate logistic regression analysis were performed to determine predictors for SCS. 75 patients met inclusion criteria. 32 patients (42.7%, 6% female) were diagnosed with SCS. No difference in age between patients with and without SCS was detected. Stratification of patients by age (1–2, 2–4, and >4 years) revealed a higher rate of SCS in younger patients (P = 0.04). The cephalic index (C.I.) of those with sagittal synostosis was significantly smaller but within the normal range, indicating a more scaphocephalic shape (P = 0.003). Logistic regression analysis revealed that C.I. was a strong predictor for SCS (P = 0.003). Of those with SCS, a mix of complete and partial fusion of the sagittal suture was appreciated. This study found that 42.7% of patients with clinocephaly had SCS. C.I. was the only predictor for SCS and unique suture fusion patterns were identified in those with SCS. This study suggests that clinocephaly should be considered a core component of the exam and work-up for SCS. Future studies aimed at evaluating the positive predictive value of this exam finding and identifying risk factors associated with late-presentation SCS are underway.

Head and neck injury as a consequence of in utero pressure and birth trauma is a rare event. We report a case of a patient who was born full-term via vaginal delivery and presented soon after birth with skin changes over the nasal tip consistent with a pressure-related injury that progressed to a stable eschar. Conservative management with close clinical monitoring resulted in a well-healed wound over the nasal tip. A detailed discussion regarding the diagnosis and management of head and neck lesions after birth is provided.

Based on in-depth interviews of 17 key informants in Dhaka, Bangladesh, this paper explores the reasons behind the observed modal shift toward motorized two-wheelers that occurred with the COVID-19 pandemic, along with its implications. Analysis of the key informants’ perspectives revealed that individuals’ inclination towards motorized two-wheelers occurs because of maintaining physical distance, lack of walking and bicycling infrastructure, the high social status associated with motorized two-wheelers, and brand promotion. The implications of this modal shift include increased traffic congestion, GHG emission, and traffic incidents. As interviewees suggest, mass communication, understanding users’ perspectives, and promoting equity concepts are needed for a modal shift towards more sustainable options.

Additional file 8. Muscle Strength Outcomes.

Additional file 7. Falls and Safety Outcomes.

Additional file 10. PRISMA Systematic Reviews and Meta-Analyses Checklist.

Additional file 6. Balance Outcomes.

Additional file 4. Aerobic Outcomes.

Personal technology plays an integral role in shaping people’s quality of life which includes leisure and tourism experiences. A number of personal informatics tools can support people in performing their activities by collecting biometric and environmental data; however, little is known regarding the use of psychological data to enrich leisure and tourism experiences. To address this research gap, this study aims to propose a conceptual framework that fosters memorable and meaningful leisure experiences (MMEs) based on theories from serious leisure and positive psychology. In particular, this study probes into the MMEs of serious leisure practitioners who put their efforts and resources into pursuing intrinsically rewarding leisure activities. Excelling at these activities, which may draw upon participants’ character strengths, yields sustained fulfillment which fosters personal transformation. The idiosyncratic nature of MMEs demands a phenomenological inquiry that involves in-depth interviews concerning the character strengths used and their development trajectories. Using theory triangulation from both positive psychology and serious leisure allows researchers to gain a holistic view of participants’ well-being. Character strengths were found to be the integral factors that contribute to MMEs at different stages of leisure activities. The result identified three aspects of strengths used: strengths well spent, reflection and introspection, and anticipation of the future self, which informs the development of a strengths-based personal informatics framework for leisure and tourism.