Search

With Canada becoming the first G20 country to legalize the recreational use of cannabis, there has been increasing interest in the emergence of this new marketplace. Newspaper framing helps to shape public opinion on legalization and news sources play a role in determining how the public perceives the use of cannabis. This research analyzes how mainstream newspapers reported on the legalization of recreational cannabis in Canada in the years before and after legalization (between 2016 and 2019). Using a content analysis of 1,390 cannabis-related articles, 11 dominant reporting themes are identified. Over time, there was a shift from negative and sensationalist cannabis news coverage toward more balanced and progressive framing. The findings identify the influence of editorial political stance on thematic coverage. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context. [ABSTRACT FROM AUTHOR]

This paper investigates the role of admission forms in the regulation of asylum confinement in the second half of the nineteenth century. Taking the Toronto Lunatic Asylum as a case study it traces the evolution of the forms' content and structure during the first decades of this institution. Admission forms provide important material for understanding the medico-legal assessment of lunacy in a certain jurisdiction. First, they show how the description of insanity depended on a plurality of actors. Second, doctors were not necessarily required to indicate symptoms of derangement. Third, patients' relatives played a fundamental role in providing clinical information. From an historiographical perspective, this paper invites scholars to consider the function of standardized documents in shaping the written identity of patients. [ABSTRACT FROM AUTHOR]

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation. [ABSTRACT FROM AUTHOR]

The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 1 of this article will inform CAR members on principles of de-identification, pseudonymization, encryption, direct and indirect identifiers, k-anonymization, risks of reidentification, implementations, data set release models, and validation of AI algorithms, with a view to developing appropriate standards to safeguard patient information effectively. [ABSTRACT FROM AUTHOR]

The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 2 of this article will inform CAR members on the practical aspects of medical imaging de-identification, strengths and limitations of de-identification approaches, list of de-identification software and tools available, and perspectives on future directions. [ABSTRACT FROM AUTHOR]

In pediatric settings, the concept of hope is frequently positioned as a fundamental aspect of care and at odds with the possibility and proximity of death. This arguably fosters silence about death and dying in childhood despite evidence indicating the benefits of open communication at the end of life. In this paper, we describe the unspeakable nature of death and dying in childhood, including its conceptual and clinical causes and dimensions, its persistence, and the associated challenges for children and youth facing critical illnesses, their families, and society. We explore how the tension between hope and death can be reframed and apply our analysis to the context of medical assistance in dying for mature minors in Canada. Considering the lack of related literature, this paper offers initial reflections to form a framework for the unspeakable nature of death and dying in childhood and to advance the crucial need for research. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system. [ABSTRACT FROM AUTHOR]

Abstract Artificial intelligence (AI) is rapidly moving from an experimental phase to an implementation phase in many fields, including medicine. The combination of improved availability of large datasets, increasing computing power, and advances in learning algorithms has created major performance breakthroughs in the development of AI applications. In the last 5 years, AI techniques known as deep learning have delivered rapidly improving performance in image recognition, caption generation, and speech recognition. Radiology, in particular, is a prime candidate for early adoption of these techniques. It is anticipated that the implementation of AI in radiology over the next decade will significantly improve the quality, value, and depth of radiology's contribution to patient care and population health, and will revolutionize radiologists' workflows. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI working group with the mandate to discuss and deliberate on practice, policy, and patient care issues related to the introduction and implementation of AI in imaging. This white paper provides recommendations for the CAR derived from deliberations between members of the AI working group. This white paper on AI in radiology will inform CAR members and policymakers on key terminology, educational needs of members, research and development, partnerships, potential clinical applications, implementation, structure and governance, role of radiologists, and potential impact of AI on radiology in Canada. [ABSTRACT FROM AUTHOR]

Examines the 19th-century Canadian paper money's iconographies. Discussion on the intersection of culture, society and economy; Indepth look at the consolidation of paper monies in the 18th and 19th centuries; Analysis of the design and production of paper money; Exploration of the national and imperial monetary narratives.

This paper investigates how positive and negative work-personal life interface constructs are differentially associated with intentions to stay in or leave the profession. The findings help map work-personal life interface constructs on the typology of determinants of intention to stay and intention to leave (disengagers, retainers, criticals, and neutrals). The ordered logistic regression (ologit) modelling of cross-sectional data from a representative sample (n = 601) of midwives in Canada shows that work interference with personal life is a disengager, which has a stronger association with intention to leave than with intention to stay in the profession. Among the work-personal life interface constructs, work enhancement of personal life seems to be the most critical determinant, showing the most substantive association with both intention to stay and intention to leave. This finding suggests that interventions to increase midwives' intention to stay and decrease their intention to leave should focus on amplifying the enhancing effects of working on midwives' personal lives. Interventions that aim to reduce work interference with personal life might be more effective in decreasing intention to leave the profession than increasing intention to stay. [ABSTRACT FROM AUTHOR]

In 2020–2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) carries the potential for unprecedented disruption in radiology, with possible positive and negative consequences. The integration of AI in radiology holds the potential to revolutionize healthcare practices by advancing diagnosis, quantification, and management of multiple medical conditions. Nevertheless, the ever‑growing availability of AI tools in radiology highlights an increasing need to critically evaluate claims for its utility and to differentiate safe product offerings from potentially harmful, or fundamentally unhelpful ones. This multi‑society paper, presenting the views of Radiology Societies in the USA, Canada, Europe, Australia, and New Zealand, defines the potential practical problems and ethical issues surrounding the incorporation of AI into radiological practice. In addition to delineating the main points of concern that developers, regulators, and purchasers of AI tools should consider prior to their introduction into clinical practice, this statement also suggests methods to monitor their stability and safety in clinical use, and their suitability for possible autonomous function. This statement is intended to serve as a useful summary of the practical issues which should be considered by all parties involved in the development of radiology AI resources, and their implementation as clinical tools. [ABSTRACT FROM AUTHOR]

Although women's representation in STEM fields and occupations has increased, science and math continue to be stereotyped as male domains. This paper links psychological and sociological explanations for gendered disparities in STEM by examining the relationship between the local "micro-situational" female learning environment and the gender gap in academic self-concept in math and science. We applied hybrid models to TIMSS 2015 data comprised of a pseudo-panel of repeated measures for individual student and peer achievement, academic self-concept, utility value, and interest-enjoyment value in math/science (at age 14). We analyzed data from three countries, including a subsample of students who were taught by the same teacher in both math and science, thus eliminating unobserved teacher heterogeneity. Results indicate that female peer climate in the classroom is important for understanding how girls' self-concept in math/science is formed, even though it was unrelated to the gender gap. [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]

Epidemiology of mental disorders emerged in the post-1945 era at the intersections of different areas of knowledge. Given its ambitions, the Stirling County Study provides an instructive case study. It is also a good example of how the epidemiology applied methodological skills from social sciences. This paper aims, first, to reconstruct one of the first episodes in the development of psychiatric epidemiology. Its second purpose is to provide a detailed description of interdisciplinarity at work, and to examine its effects. After explaining some of the major features of the Stirling County Study, I emphasize the links between some of the first results, particularly regarding young people as a population at risk, and the job market after the Great Depression. [ABSTRACT FROM AUTHOR]

This paper explores how politicians respond to the public salience of policy issues when determining which topics to publicly address. Using new data and state-of-the-art methodology, our study provides a fresh perspective on this fundamental question. We focus on a multi-party parliamentary system, specifically the Canadian House of Commons, with a specific emphasis on the issue of climate change. To assess the attention given by political parties to various policy issues, we analyze transcripts from the Question Period spanning from April 2006 to June 2021. To gauge the public's level of concern for these issues, we incorporate data obtained from Google Trends. Employing an instrumental variable estimation strategy, our study causally estimates the extent to which the public salience of climate change influences elite attention. Our findings reveal that the public salience of climate change significantly influences the attention given to this issue by parties, albeit with noticeable partisan variations. Moreover, our research highlights the effectiveness of the Question Period in compelling the government to address challenging or potentially embarrassing issues. Lastly, we uncover evidence suggesting that the Liberal Party of Canada successfully increased the public salience of climate change during its tenure in government. [ABSTRACT FROM AUTHOR]

This article explores ordinary individuals' understandings of nationhood. In so doing, it focuses on the case of Armenian migrants from Turkey to Canada and their conceptualizations of the host country. The paper captures multiple strands of nationhood and argues that these are pertinent to different boundary-making processes. The outer boundary of nationhood is defined along inclusive and civic lines where difference is recognized and appreciated. Living with difference, on the other hand, brings to the fore the tension between recognizing it on the one hand and accommodating it on the other. The case study further reveals how the exercise of state power and individuals' encounters with the state shape their understandings of nationhood. [ABSTRACT FROM AUTHOR]

Little is known about the lived experience of the dyad following a fetal death and the impact on relationships. The purpose of this paper is to explore the dyadic relationship between partners, with health care providers, and with the baby's memory after birth. This qualitative study utilized hermeneutic phenomenology. The sample included 10 heterosexual dyads from the United States and Canada. All experienced a fetal death between 6 months and 7 years prior to their interviews. The data revealed three themes: (a) The Dyad Relationship: Moving Through the Experience Together; (b) Keeping the Memory Alive: Memorializing the Baby; and (c) Relationships With Health Care Providers: A Spectrum of Caring. The findings from this study provide the beginning knowledge needed to improve the care of dyads who have experienced a fetal death and for future studies to improve care delivery for dyads as their relationships change after fetal death. [ABSTRACT FROM AUTHOR]

There exist ongoing calls among social work scholars and practitioners to cultivate applied knowledge of critical and emancipatory practice. In this paper, I explore the utility of text-based vignettes as instruments that can be used to elicit insight from marginalized service users on critical social work practice. To do this work, I draw on data from interviews with 20 transgender and gender diverse (TGD) social service users, along with 10 social workers, whose responses to a text-based vignette were originally used to build an understanding of the constituents of equitable social work practice with TGD people. Incorporating critical pragmatism as a conceptual framework and constructivist grounded theory as a methodological orientation, I analyze data from this study as an exemplar that substantiates the promise of using text-based vignettes in qualitative social work research to generate knowledge of critical social work practice. Specifically, I demonstrate how text-based vignettes in this study (1) contextualized the meaning, significance, and impact of oppression for service users, (2) built insight on practice that reflects solidarity and allyship, and (3) identified opportunities for social workers' reflexive use of professional power to effect change. Accounting for the tensions between empiricism and critical praxis in social work, I consider the promise of incorporating text-based vignettes to develop empirical social work literature that is rooted in the voices of marginalized service users. [ABSTRACT FROM AUTHOR]

From November 2015 to October 2020, Canada had welcomed 44,620 Syrian refugees to more than 350 communities across the country. In 2019, it further surpassed the United States and Australia in the number of refugees settled. Lacking the necessary language skills for living and working in a new country is one of the most critical barriers refugees face. This paper aims to inform language-teaching professionals about pertinent linguistic and nonlinguistic issues as well as pedagogical implications associated with supporting adult Syrian refugee learners, drawing both on the literature more broadly and on the author's research in the Canadian context. [ABSTRACT FROM AUTHOR]

Summary: Drawing on historical constructions of Indigenous peoples, this paper analyses the continued impact of settler discourses of Indigenous families, parenting, and children on child welfare policy in Canada today. Findings: In this work, two provincial children's Advocate reports on the deaths of Indigenous children in care, Tina Fontaine and Alex Gervais, are critically assessed in order to explore the processes through which these colonial constructions operate to create adverse outcomes for Indigenous people. Through this analysis, a number of contemporary colonial narratives are made visible, including the belief that Indigenous parents are inherently incapable of caring for their children, and the gendered construction of Indigenous men and boys as criminal and deviant and Indigenous girls as sexually exploitable. Application: These findings suggest that greater critical reflection is needed when working with Indigenous peoples, including greater awareness of the ongoing impact of settler colonialism and the necessity of engaging in anti-colonial work. [ABSTRACT FROM AUTHOR]

This paper explores the knowledge and opinions of cannabis users regarding Canadian laws regulating possession of cannabis. Our study is based on data from 165 in-depth interviews with adult cannabis users from four Canadian cities. Our participants revealed a limited awareness of cannabis policy in Canada. When researchers informed them about actual Canadian laws, the majority of participants regarded the specified laws as "harsh," "excessive," "absurd" and/or "ridiculous." In practice, the common experience of participants suggests the existence of two sets of enforcement practice in Canada--"there's what's on paper and then there's what happens, out on the sidewalk." We situate our analysis of these practices in the context of broader debates regarding the putative normalization of drugs like cannabis in Canada. We conclude that greater consideration of the character of local law enforcement practices has the capacity to add further conceptual and analytical clarity to existing theories of normalization. [ABSTRACT FROM AUTHOR]

The article discusses the conclusions and recommendations from the position paper on interventional radiology (IR) in Canada. The Millennium Research Group has been commissioned to produce a position paper on IR in the country, as part of a lobbying and public relations campaign initiated by the Canadian Interventional Radiology Association. The position paper has aimed to highlight the current state of IR in the country, to identify disease and treatment trends.

Birthday cards are a ceremonial token that may purposefully or unintentionally transmit stereotypes about the ageing process. In the current study, the authors examined 150 age-specific paper birthday cards sold in retail outlets located in a small metropolitan area. Results suggest that a greater proportion of the cards' textual messages represented ageing in a negative manner (66.7%). Further, the negativity of these written messages did not appear to vary as a function of the intended recipient's chronological age or sex. The findings are compared to those of previous studies conducted in this area. As well, limitations and directions for future research are outlined. [ABSTRACT FROM AUTHOR]

List several papers presented at the First International Conference on the Critical and Qualitative Approaches to Health Psychology in NewFoundland on July 1999. 'Acquiring Personal Knowledge for Theory and Therapy,' by Nick Milton; Theorizing Personal Change in Health,' by Carla Willig and Angela Harden; 'Health Psychology as Agent of Change,' by David Marks.

This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008. [ABSTRACT FROM AUTHOR]

Background: The gender disparity in surgical disciplines, specifically in speakers across North American medical and surgical specialty conferences, has been highlighted in recent literature. Improving gender diversity at society meetings and panels may provide many benefits. Our aim was to determine the state of gender diversity amongst presenters and speakers at the annual Canadian Society of Otolaryngology-Head and Neck Surgery (CSO) meetings. Methods: Scientific programs for the CSO annual meetings from 2008 to 2020 were obtained from the national society website. Participant name, role, gender, location, and subspecialty topic were recorded for all roles other than poster presenter. Gender (male or female) was determined using an online search. The total number of opportunity spots and proportion of women was then calculated. Gender differences were analyzed using chi-square test and logistic regression with odds ratios. Four categories were analyzed: Society Leadership, Invited Speaker Opportunities, Workshop Composition (male-only panels or "manels", female-only panels, or with at least one female speaker), and Oral Paper Presenters (first authors). Results: There were 1874 leadership opportunity spots from 2008 to 2020, of which 18.6% were filled by women. Among elected leadership positions in the society, only 92 unique women filled 738 leadership opportunity spots. 13.2% of workshop chairs, 20.8% of panelists and 22.7% of paper session chairs were female. There was an overall increase in the proportion of leadership positions held by women, from 13.9% of leadership spots in 2008 to 30.1% in 2020. Of the 368 workshops, 61.1% were led by men only, 36.4% by at least 1 female surgeon, and 2.5% by women only. "Manels" have comprised at least 37.5% of workshops each year. Conclusions: The proportion of women in speaking roles at the annual CSO meetings has generally increased over time, particularly among panelists, leading to fewer male-only speaking panels. However, there has been a slower rate of growth in the proportion of unique women in speaker roles. There remains an opportunity to increase gender/sex diversity at the major Canadian otolaryngology meeting. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient (κ ) value > 0.61. Results: After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Comments on the six papers presented at the Symposium on the Ontario Experience which represent a valuable contribution to the literature on health services research and on treatment systems. Comparison of the Ontario assessment and referral (A/R) centers for addicts to a transistor; Crucial importance of determining outcome; Flow diagrams and design document.

Discusses the efficacy of the psychotherapies in Canada. Skills needed by psychiatrists to be effective and competent; Role of psychotherapies in psychiatry; Economic impact of psychotherapy; Limitations of psychotherapy.

Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease. [ABSTRACT FROM AUTHOR]

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology – Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease. [ABSTRACT FROM AUTHOR]

Introduction: In light of North America's persisting drug toxicity crisis, alternative drug policy approaches such as decriminalization, legalization, regulation, and safer supply have increasingly come to the forefront of drug policy discourse. The views of people who use drugs toward drug policy and drug law reform in the Canadian context are essential, yet largely missing from the conversation. The aim of this study was to capture the opinions, ideas, and attitudes of people who use drugs toward Canadian drug laws and potential future alternatives. Methods: This paper was developed as part of the Canadian Drug Laws Project, a cross-jurisdictional qualitative study conducted in British Columbia, Canada between July and September 2020. The qualitative data are from 24 semi-structured interviews with a diverse sample of people who use illegal drugs. Interviews were recorded, transcribed, coded, and analyzed thematically by the research team. Results: Two main themes and corresponding sub-themes are presented: (1) The experience of stigma as a consequence of criminalization; (2) The perceived benefits of drug law reform. Participants spoke in-depth about their experiences living within a criminalized drug policy context and offered suggestions for new pathways forward. Their perspectives illuminate how Canada's drug laws may shape public attitudes toward people who use drugs and the consequent manifestations of structural, social, and self-stigma experienced by people who use drugs. Conclusion: Participants openly and profoundly believed that current drug laws produced and propagated the public attitudes and structural inequities experienced by people who use drugs in Canada. This matters, not only because our findings highlight the fact that people who use drugs experience stigma in tangible and clearly impactful ways, but it also suggests that the criminlilization of drugs shapes the experience of structural, social, and self stigma. Finally, participants believed that efforts to destigmatize people who use drugs would be ineffectual without the enactment of more robust forms of drug law reform such as the decriminalization of illegal drugs. [ABSTRACT FROM AUTHOR]

Objective: Previous research has evaluated the sources of post-secondary student stress, but has failed to explore whether stressors fluctuate over time. The purpose of this research was to use the Post-Secondary Student Stressors Index to examine whether stressors changed significantly and meaningfully over the course of an academic year. Due to the timing of data collection, results also provide context around students' experiences of stress during the COVID-19 pandemic. Method: Cross-sectional data was collected at 3 time points via online surveys over the course of the 2020–2021 academic year from >10,000 students. Participants attended 15 post-secondary institutions across Canada, representing 9 provinces and 1 territory. Validated instruments were used to assess levels of stress, distress and the severity of student-specific stressors. Kruskal–Wallis ranked tests and multiple pairwise comparison analyses were conducted to assess whether the mean severity of stressors changed over time. Standard effect sizes were calculated using Cohen's d. Results: Mean levels of stress and psychological distress were high at the start of the study and remained high across time points. A similarly high level of stress was observed on average for student-specific stressors. While significant differences in mean severity were observed over time for some stressors, standardized effect sizes were negligible, suggesting little meaningful change and consistent levels of chronic stress over the course of the academic year. Conclusions: This is the first paper to examine trends in student-specific stress using a nationwide sample of Canadian post-secondary students during the first year of the COVID-19 pandemic. Patterns observed in student-specific stressors reflected changes likely to be indicative of the pandemic, including the most severe stress associated with academics, finances and concerns for the future. Implications for future research are discussed, in particular, the importance of examining stressors related to COVID-19 and their impact on student mental health. [ABSTRACT FROM AUTHOR]

Photovoice is an emerging qualitative research method used to engage community members in research that highlights their lived experiences and initiate change. Photovoice offers potential benefits to research conducted by and with Indigenous communities through privileging Indigenous knowledge and perspectives. There is a lack of synthesized evidence about the usage, benefits, and challenges of conducting Photovoice research by and with Indigenous communities, which this systematic methods review aims to address. We specifically focus on Indigenous young people in Canada, Australia, Aotearoa New Zealand, and the United States. Five databases were searched systematically for articles including keywords for 'Indigenous' and 'Photovoice'. Empirical studies and methods papers reporting the use of Photovoice with majority cohorts of young Indigenous participants were included. Relevant data were extracted and Photovoice methods analysed using an integrative approach. Database searches yielded 1402 articles, with 109 reviewed in full and 41 included in the review. These articles represented 37 unique studies, with most from Canada (n = 17), and the United States (n = 14). Our analysis revealed great variability in how Photovoice has been applied across studies with Indigenous young people. However, some notable commonalities include recruitment of participants via community networks, and participant involvement in data collection and analysis. The potential benefits associated with using Photovoice with Indigenous young people included: fostering participant autonomy and authority; photography being familiar and fun; the visual medium being culturally appropriate for Indigenous peoples; and the method being effective for engaging the whole community. Challenges associated with Photovoice included: engagement difficulties between researchers and participants; issues with photography; and ethical complexities. These findings suggest that Photovoice is an appropriate and largely effective method to engage young Indigenous people in research. However, there are logistical and ethical issues associated with the method that require careful consideration. [ABSTRACT FROM AUTHOR]

The naturalization of athletes for the purpose of participating in the Olympics is a noticeable feature of today's superdiverse sporting contexts. Focusing on the 2018 PyeongChang Winter Olympic Games, in this paper, I explore how North American-born male ice hockey players who have become naturalized into South Korea are reproduced in media coverage of Canada and South Korea. Applying insights from critical discourse studies, transnationalism, and critical multiculturalism, I specifically examine how each country re/forms its own imagined community through these transnational sporting migrants and the ways that concepts of immigration, citizenship, whiteness, masculinity, and multiculturalism are linked, fused, and/or conflicted within it. Analysis suggests that in both countries, the hockey migrants have been illuminated as new national symbols enhancing the multicultural national brand of each country, whether as immigrants or emigrants, solidifying in the process the hegemonic position of whiteness as a global phenomenon beyond the West. [ABSTRACT FROM AUTHOR]

Canada's Trans Mountain Expansion Pipeline project is one of the country's most controversial in recent history. At the heart of the controversy lie questions about how to conduct impact assessments (IAs) of oil spills in marine and coastal ecosystems. This paper offers an analysis of two such IAs: one carried out by Canada through its National Energy Board and the other by Tsleil-Waututh Nation, whose unceded ancestral territory encompasses the last twenty-eight kilometers of the project's terminus in the Burrard Inlet, British Columbia. The comparison is informed by a science and technology studies approach to coproduction, displaying the close relationship between IA law and applied scientific practice on both sides of the dispute. By attending to differing perspectives on concepts central to IA such as significance and mitigation, this case study illustrates how coproduction supports legal pluralism's attention to diverse forms of world making inherent in IA. We close by reflecting on how such attention is relevant to Canada's ongoing commitments, including those under the UN Declaration on the Rights of Indigenous Peoples. [ABSTRACT FROM AUTHOR]

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]

The Protocol of Amendment to the Agreement between the United States of America, Canada and the United Mexican States erased many of the TRIPS-plus provisions inserted earlier into the Canada- United States of America-Mexico Agreement (hereafter, CUSMA) signed on 30 November 2018. While the erasure of the provisions shows the contributions made to promote access to medicines, the Agreement still retains TRIPS-plus provisions, including the provisions on patent term extensions. Thus seen, irrespective of the changes introduced by the Protocol of Amendment, patent term extensions may have a negative implication on access to cost-cutting medicines (biosimilars and generics). Against this backdrop, this paper focuses on patent term extensions, as contained in the CUSMA's Intellectual Property Rights (IPRs) chapter. The paper investigates if & how the patent term extension has the potential to impede access to affordable medicines (biologics and chemically synthesized medicines). In so doing, the paper provides possible responses to the question, do the provisions on patent term extensions hinder the timely access to affordable medicines? As such, the first part of the paper succinctly looks at CUSMA. Section "Patent protection under the TRIPS agreement" examines the TRIPS patent regime. While "The CUSMA's rules on patent term extension" section discusses the nature of obligations included in the CUSMA's IPRs chapter, the Section "The CUSMA's rules on patent term extension vis-à-vis access to medicines" analyzes the potential implications of patent term extensions on access to affordable medicines. The final section concludes the paper. [ABSTRACT FROM AUTHOR]

Patterns of linguistic and interactional behavior by people at the very end of their lives are not well described, partly because data is difficult to obtain. This paper analyzes descriptions of 486 deaths gathered from 1900 to 1904 in the first-ever clinical study of dying by noted Canadian physician, Sir William Osler. Only 16 patients were noted speaking, and only four canonical last words were reported. The most frequent observation by medical staff was that the deaths were quiet (n = 30), though range of other behaviors were noted (e.g., moaning, delirium, seeming intention to speak). Osler's problematic study left behind data whose analysis is a small step toward empirically characterizing the linguistic and interactional details of a previously under-described phenomena as well as the importance of the social context in which they occur. [ABSTRACT FROM AUTHOR]

This paper compares the practice of holding prime ministers to account in four case studies: Australia, Canada, Ireland, and the United Kingdom. Using text analysis, as well as research on prime ministerial responsibilities, it investigates oral questions asked in parliamentary procedures where prime ministers are questioned together with ministers (Question Period in Canada and Question Time in Australia) versus procedures where they are questioned individually (PMQs in the United Kingdom and Oral Questions to the Taoiseach in Ireland), and explores the degree to which they are questioned for matters that are within their remit. It argues that the practice of prime ministerial accountability is decisively shaped by procedural features such as whether written notice is required for questions, as well as by the broader role of the questioning mechanism in the political system, and less by the collective or individualised nature of questioning. [ABSTRACT FROM AUTHOR]

This paper explores the structure of elite disagreement about the ideological or nonideological character of municipal politics. I propose two possible relationships between a representative's own ideology and their beliefs about the character of municipal politics: an "ends-against-the-middle" pattern, in which ideologues on the left and right embrace an ideological vision of municipal politics, whereas moderates insist that municipal politics is not ideological; and an "asymmetric visions" pattern, in which individuals on the left endorse an ideological view of municipal politics and those on the right oppose it. I use new survey data from more than 800 mayors and councillors in Canada to assess these possible relationships. While both are supported by the data, the asymmetric visions pattern is the stronger of the two: the nonideological view of municipal politics is most firmly embraced by municipal politicians of the moderate right, while the ideological vision is most common among representatives on the left. This pattern, I argue, is in keeping with a century of municipal political history and should be incorporated into our theories of municipal elections, representation, and policy disagreement. [ABSTRACT FROM AUTHOR]

A substantial minority of adolescents experience and use dating violence in their sexual and/or romantic relationships. Limited attention has been paid to exploring theory-driven questions about use and experience of adolescent dating violence (ADV), restricting knowledge about promising prevention targets for diverse groups of youth. To address this gap, this paper investigates whether factors tied to power imbalances (bullying, risk of social marginalization) are associated with patterns of ADV victimization and perpetration in a large sample of Canadian mid-adolescents. We used data from the 2017/2018 Health-Behavior in School-Aged Children (HBSC) study, a nationally representative sample of Canadian youth. Our study was comprised of adolescents who were in grades 9 or 10, and who had dated in the past 12 months (N = 3779). We assessed multiple forms of ADV and bullying victimization and perpetration. We also included six variables assessing adolescents' risk of social marginalization: gender, race/ethnicity, immigration status, family structure, food insecurity, and family affluence. We used latent class analysis to explore the ways adolescents experience and use different forms of ADV, and then examined whether factors tied to power imbalances (bullying, social marginalization) were associated with classes of ADV. Three ADV classes emerged in our sample: uninvolved (65.7%), psychological and cyber victimization only (28.9%), and mutual violence (5.4%). Bullying was most strongly associated with the mutual violence class, suggesting a transformation of power from peer to romantic contexts. Social marginalization variables were associated with ADV patterns in different ways, highlighting the need to use a critical and anti-oppressive lens in ADV research and prevention initiatives. [ABSTRACT FROM AUTHOR]

Photovoice is an emerging qualitative research method used to engage community members in research that highlights their lived experiences and initiate change. Photovoice offers potential benefits to research conducted by and with Indigenous communities through privileging Indigenous knowledge and perspectives. There is a lack of synthesized evidence about the usage, benefits, and challenges of conducting Photovoice research by and with Indigenous communities, which this systematic methods review aims to address. We specifically focus on Indigenous young people in Canada, Australia, Aotearoa New Zealand, and the United States. Five databases were searched systematically for articles including keywords for 'Indigenous' and 'Photovoice'. Empirical studies and methods papers reporting the use of Photovoice with majority cohorts of young Indigenous participants were included. Relevant data were extracted and Photovoice methods analysed using an integrative approach. Database searches yielded 1402 articles, with 109 reviewed in full and 41 included in the review. These articles represented 37 unique studies, with most from Canada (n = 17), and the United States (n = 14). Our analysis revealed great variability in how Photovoice has been applied across studies with Indigenous young people. However, some notable commonalities include recruitment of participants via community networks, and participant involvement in data collection and analysis. The potential benefits associated with using Photovoice with Indigenous young people included: fostering participant autonomy and authority; photography being familiar and fun; the visual medium being culturally appropriate for Indigenous peoples; and the method being effective for engaging the whole community. Challenges associated with Photovoice included: engagement difficulties between researchers and participants; issues with photography; and ethical complexities. These findings suggest that Photovoice is an appropriate and largely effective method to engage young Indigenous people in research. However, there are logistical and ethical issues associated with the method that require careful consideration. [ABSTRACT FROM AUTHOR]

Background: Play is an important part of the childhood. The learning potential of playing and creating non-digital games, like tabletop games, however, has not been fully explored. Aim: The study discussed in this paper identified a range of activities through which learners redesigned a mathematics-oriented tabletop game to develop their ideas and competencies in an integrated STEM (science, technology, engineering, and mathematics) class. Method: Third and fourth graders worked as teams to make changes on Triominos over a period of six weeks. Considering what could be changed from the original game, each group provided a different design for Triominos to accommodate the changes introduced. We gathered data through weekly observations of two classes (about 45 learners, ranging from age eight to ten) in a west-Canada school. In this paper, we present the works of three groups of three teammates. Results: We found that any change made by learners not only influenced mechanics, dynamics, and aesthetics of the game but also helped engage learners, encourage unconventional ideas, promote learning, and solve problems. Based on our findings, we suggest redesigning games facilitated learners deepen their understanding of mathematical concepts as part of a designed game system in STEM classes. [ABSTRACT FROM AUTHOR]

Migrants, that is people who experience forced displacement or move based on being lesbian, gay, bisexual, trans, two-spirit, queer, and intersex (LGBTQI+), experience increased trauma and stigma when compared to heterosexual and cisgender people. The aim of this paper is to highlight LGBTQI+ migrants' experiences of health and social care encounters in Canada. Gadamerian hermeneutics and an intersectionality lens was used to understand LGBTQI+ migrants' experiences. A total of 16 semi-structured individual interviews were conducted with LGBTQI+ migrants. Themes of stigma and discrimination were identified as (1) "I never went back": Stigma as an exclusionary experience, (2) "Is [your country of birth] really that bad": Fear, safety, and cultural stigma, and (3) "The circle ... is not going to fix my life": LGBTQI+ migrants' call for affirming care. Results suggest that health and social care practices are stigmatizing and discriminatory which negatively impacts LGBTQI+ migrant mental health. Salient practices for promoting mental health included affirming LGBTQI+ identities and orientations through health and social care practices that are culturally safe as well as trauma and violence informed. [ABSTRACT FROM AUTHOR]