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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]

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]

The American eel (Anguilla rostrata) has long been regarded as a panmictic fish and has been confirmed as such in the northern part of its range. In this paper, we tested for the first time whether panmixia extends to the tropical range of the species. To do so, we first assembled a reference genome (975 Mbp, 19 chromosomes) combining long (PacBio and Nanopore and short (Illumina paired‐end) reads technologies to support both this study and future research. To test for population structure, we estimated genotype likelihoods from low‐coverage whole‐genome sequencing of 460 American eels, collected at 21 sampling sites (in seven geographic regions) ranging from Canada to Trinidad and Tobago. We estimated genetic distance between regions, performed ADMIXTURE‐like clustering analysis and multivariate analysis, and found no evidence of population structure, thus confirming that panmixia extends to the tropical range of the species. In addition, two genomic regions with putative inversions were observed, both geographically widespread and present at similar frequencies in all regions. We discuss the implications of lack of genetic population structure for the species. Our results are key for the future genomic research in the American eel and the implementation of conservation measures throughout its geographic range. Additionally, our results can be applied to fisheries management and aquaculture of the species. [ABSTRACT FROM AUTHOR]

In Canada, municipalities are involved in an increasing number of policy areas, but they remain largely absent from the nation's system of intergovernmental relations. Municipal representatives do not attend First Ministers' meetings that gather the Prime Minister and heads of each province and territory. They are also largely excluded from intergovernmental councils or committees focused on specific policy areas. Nor do they participate in the negotiation of most intergovernmental agreements. This paper explores how Canada's intergovernmental infrastructure could be reformed to include municipalities. It does so through an analysis of how other countries have made space for municipalities in their intergovernmental processes. After drawing five lessons from international experience, the paper concludes with four approaches to reforming intergovernmental relations in Canada: (1) ensure municipalities have the capacity, voice and structures to participate effectively in intergovernmental relations; (2) increase municipal involvement in provincial policy-making, including potentially through co-governed intergovernmental councils; (3) as far as possible, eliminate unfunded mandates (ie responsibilities devolved without adequate funding to discharge them) through, for example, provincial legislation or provincial-municipal intergovernmental agreements that require consultation on the fiscal impacts of draft legislation or regulation on municipalities; (4) strengthen trilateral (national/provincial/municipal) relations, including through location-specific or policy-specific agreements, and trilateral intergovernmental councils. [ABSTRACT FROM AUTHOR]

This paper examines how policymakers interpret and deploy cultural economy approaches within municipal economic development strategies and cultural plans. Focusing on the 33 largest municipalities in Ontario, Canada, we conduct a keyword analysis of 63 municipal planning documents, supplemented with key informant interviews with economic development and cultural planning staff. Our analysis reveals that the use of cultural economy approaches in economic development and cultural plans varies depending upon city size, municipal governance structure and municipal organizational structure. However, despite the widespread use of cultural economy ideas in planning documents, we conclude that its uptake in municipal policymaking fails to reflect its professional and scholarly popularity. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is twofold: to introduce scholars and practitioners of foresight to the emerging Canadian foresight ecosystem, and to provide lessons learned on developing policy foresight from the Government of Canada context. Design/methodology/approach: The paper provides a series of lessons based in part on informal and indirect observations and engagement with established Canadian foresight entities, including Policy Horizons Canada, and numerous newly established foresight initiatives at Global Affairs Canada, Standards Council of Canada and the Canadian Forest Service. Findings: The paper finds that Canada's newly emerging foresight units and initiatives face structural, institutional and organizational challenges to their long-term success, including in concretely measuring foresight outcome (rather than simply output) in policy making. Originality/value: The paper provides a unique and empirically driven perspective of the foresight ecosystem that has emerged within the Canadian federal public service since 2015. Lessons are culled from this emerging network of Canadian foresight practitioners for international application. [ABSTRACT FROM AUTHOR]

Aims: In 2014, in response to evidence that Canada's tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a "Tobacco Endgame" for Canada. The "Tobacco Endgame" defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen's University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by '35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted "<5 × '35" tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by '35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada's Endgame goal. [ABSTRACT FROM AUTHOR]

Background: In this paper we assess the quality of six deliberative stakeholder consultations regarding the implementation of a precision diagnostic for life-threatening pediatric brain tumors. Decision makers who base policy recommendations on the outputs of consultative exercises can presuppose that all deliberants are well informed of the policy issue, that participation in the deliberative process was fair, and that overcoming implementation barriers will necessarily result in practice change. Additional evidence is therefore needed to substantiate the informational quality of the deliberation, measure the equality of participation and study the effects on stakeholder reasoning to appropriately guide uptake of proposed recommendation(s). Methods: Using the DeVries framework for assessing the deliberative quality, we analyzed data from 44 post-consultation evaluation surveys completed by pediatric oncology and palliative care teams at two tertiary pediatric healthcare centers in Canada. We also conducted turn-taking and word-contribution analyses from the text transcriptions of each deliberation to assess equality of participation using descriptive statistics. Results: Deliberants agreed the quality of the deliberative process was fair (median ratings ranging from 9–10 out of 10) and the opportunities to receive expert information and discuss with others about the implementation of a new LDT were helpful (9.5 out of 10). While the session improved understanding of the implementation barriers and opportunities, it had marginal effects on deliberants' reasoning about whether LDTs would change their own clinical practice (3–10 out of 10). Participation was proportionate in at least four of the six deliberations, where no deliberant took more than 20% of total turns and contributed equal to, or less than 20% of total words. Conclusion: The quality assessment we performed demonstrates high informational value and perceived fairness of two deliberative stakeholder consultations involving pediatric palliative care and oncology teams in Canada. Quality assessments can reveal how the process of deliberation unfolds, whether deliberative outputs are the result of equitable participation among deliberants and what, if any, stakeholder voices may be missing. Such assessments should be routinely reported as a condition of methodological rigor and trustworthiness of deliberative stakeholder engagement research. [ABSTRACT FROM AUTHOR]

In an era which marks an exceptional phase of growth in science and technology, the acute disparities in access to healthcare still persist. So where on one hand scientific advancement in medicine aims at increasing life expectancy, on the other hand there are millions who are denied access to existing medicines. Patents on medicines also pose a significant barrier to access new drugs, especially in low and middle income countries which already suffer from poor health financing mechanisms. The patent laws were built on the assumption of incentivizing the innovators by rewarding them with the exclusive right to produce, sell or market the innovation. The basic premise for granting patents was based on the thought that it would increase investment in research and development promoting dynamic gains through newer innovations. However, evidence found to support this justification is meager. So in a situation where the drug gap still persists and we aim to achieve sustainable development goals by 2030, this paper attempts to focus on understanding how compulsory licensing has been used in selected cases to alleviate the major legal and political barriers to access medicines. The methodology comprises of cross-country comparison of patent framework and compulsory licensing cases. The sample selected for study includes both developed as well as developing countries. The aim is to evaluate the policy approaches used by selected countries to grant compulsory licenses and to identify the best practices for evidence-based policy making on international issues related to pharmaceutical patents. In each case, a driving factor has been the international extension of patent laws through trade agreements; first bilaterally (US-Canada) and subsequently internationally (1995 Uruguay round, under which low- and middle-income countries were granted a grace period until 2005 to comply). [ABSTRACT FROM AUTHOR]

The scholarship on state-building has devoted a significant amount of attention to the role of taxation in building state institutions and capacities. It has also emphasised the crucial role of taxation in driving state-society relations. Scholars have argued that the linkage between taxation and state building also applies to the area of social policy. In this paper, we draw on a fiscal-centred perspective on welfare state development that highlights the fiscal policy role of social insurance as a revenue raising institution to study the fiscal relationship between social insurance and state-building in Israel and Canada – two 'most dissimilar cases' that nonetheless feature strikingly similar patterns with regard to this relationship. As our findings show, in both cases, social insurance programmes were introduced, designed, and utilized to advance fiscal and economic policy capacity and thereby promote state building. Using these programmes and the commitments they created, political actors could legitimize the generation of revenues, build institutional infrastructure for tax collection, and create capital reserves for investing in the economy. [ABSTRACT FROM AUTHOR]

The Canadian government recently sanctioned a supervised consumption site (SCS) that is currently in Vancouver, British Columbia. The government is open to sanctioning more sites across the country; however, by law the federal health minister must consider whether such facilities are supported by local governments representing the cities where the sites are proposed to be located. Until 2016, the government of Canada's largest city, Toronto, did not support SCSs. Drawing on Lenton cannabis policy research, this study analyses government documents, policy papers, scientific reports, and newspaper articles and secondary literature to identify some of the significant barriers that minimised the likelihood that Toronto's council would support SCSs between 2003 and 2016. The report compares conditions in Toronto to those of Vancouver where SCSs have enjoyed council support since 2001. This study find that three conditions play an important role in explaining why SCSs were supported in Vancouver 14 years before they were endorsed in Toronto: (1) Strong public support; (2) Favourable electoral conditions; and (3) Law enforcement support. Changes in Toronto surrounding these conditions help explain why its council endorsed SCSs in 2016. This study concludes that Lenton's research holds utility as a socio-legal theory of municipal drug policy change. [ABSTRACT FROM AUTHOR]

This paper analyzes the nature of the debate generated prior to the implementation of the Act Respecting End-of-Life Care in 2015 in Québec (Canada). Including medical assistance in dying (MAID) along existing palliative care services, the act is an important policy change on a very sensitive issue. As such, MAID could be categorized as a morality policy issue, the latter being defined as a particular category of policy because of its specific features (issues of first principle, technical simplicity, high salience, public interest, and public participation). In line with Mucciaroni’s proposition, we rather analyze this issue by understanding morality policy as one of two framing strategies (moral and/or rational-instrumental frame). Our research reconstructs four public opinion framings as advanced and transmitted through the media between 2005 and 2015. It shows that although opponents to the bill unsurprisingly framed the debate in deontological terms, mostly referring to sanctity of life as one of the most important values in society, they also framed it on rational-instrumental grounds in a similar proportion, alleging the danger of a slippery slope and potential abuse. As well, if some of the proponents favored a moral framing centered on the argument that dignity and individual autonomy take precedence over all other values, others put forward a rational-instrumental one, where the slippery slope/abuse argument is used as a cautionary statement against the artificial prolongation of life. Our analysis reinforces Mucciaroni’s and Ferraiolo’s assertions that sensitive issues classified as morality policy cannot be apprehended solely through the unidimensional frame of morality. [ABSTRACT FROM AUTHOR]

In light of recent interest in the theoretical foundations of policy paradigms, this paper aims to specify the qualities that differentiate paradigmatic from non-paradigmatic policy ideas. While the incommensurability thesis that underlies the concept of paradigms has been the target of much criticism, there is something intuitively appealing about the incommensurability of policy alternatives that is not yet fully understood. Hesitant to abandon completely the notion of incommensurability, this paper emphasizes the relative nature of ideational commensurability and provides an account of how the exclusivity of a paradigm may wither in relation to competing perspectives. The empirical section demonstrates this pattern of paradigmatic policy-making by examining solutions advanced to alleviate problems in Canadian trade-industrial policy between 1975 and 1995. Contrary to the popular perception that paradigmatic ideas yield policy stability, the findings suggest that even in areas where clearly articulated paradigms initially exist, strictly paradigmatic thinking is often fleeting. [ABSTRACT FROM AUTHOR]

• The Finnish Baby Box provides parents of newborns with a wide range of infant clothing and other basics. • The cardboard box in which the infant can sleep was emphasized by the media and commercial companies outside Finland. • The box preventing SIDS was advanced by private companies and the media. • This was less the case in Wales and Scotland, a result of their being governed by authorities with a "left" orientation. For over 80 years the Finnish state has provided expectant mothers with a cardboard box containing an extensive collection of clothing, bathing products for the baby, nappies, bedding and a small mattress. Numerous jurisdictions have implemented it in some form. We investigated through a critical case study methodology whether its translation into the liberal welfare states of Canada, UK, and USA experienced message distortion (the box as a means of preventing SIDS), commercialization, watering down of content; and separation from the complex of Finnish welfare state policies that support families with children. We find that only Scotland and Wales recognized the decommodification and equity roles played by the baby box. This study identified numerous barriers to building progressive public policy in Canada, UK, and USA: the structures and processes of the liberal welfare state, commercial interests that skew public policymaking and media logic that limits news reporting to the concrete and simple, eschewing complex analysis. [ABSTRACT FROM AUTHOR]

The main goal of this paper is to propose a dynamic mapping for knowledge and ignorance mobilization in science research and innovation. An underlying argument is that ‘knowledge mobilization’ science policy agendas in countries such as Canada and the United Kingdom fail to capture a critical element of science and innovation: ignorance mobilization. The latter draws attention to dynamicsupstreamof knowledge in science research and innovation. Although perhaps less visible, there is ample evidence that researchers value, actively produce, and thereby mobilize ignorance. For example, scientists and policymakers routinely mobilize knowledge gaps (cf. ignorance) in the process of establishing and securing research funding to argue the relevance of a scientific paper or a presentation, and to launch new research projects. Ignorance here is non-pejorative and by and large points to the borders and the limits of scientific knowing – what is known to be unknown. In addition, processes leading to the intentional or unintentional consideration or bracketing out of what is known to be unknown are intertwined with, yet remain distinct from, knowledge mobilization dynamics. The concepts of knowledge mobilization and of ignorance mobilization, respectively, are understood to be the use of knowledge or ignorance towards the achievement of goals. The value of this paper lies in its conceptualization of the mobilization of knowledge as related to the mobilization of ignorance within a complex, dynamic and symbiotic relationship in science research and innovation: it takes two to tango. [ABSTRACT FROM AUTHOR]

Purpose:In this paper we examine how the intersection of various social and political influences shapes discharge planning and rehabilitation practices in ways that may not meet the espoused aims of rehabilitation programs or the preferences of older adults and their families. Methods:Taking a critical bioethics perspective, we used microethnographic case study methods to examine discharge-planning processes in a well-established older adult inpatient rehabilitation setting in Canada. The data included observations of discharge-planning family conferences and semi-structured interviews conducted with older adults facing discharge, their family members and rehabilitation professionals involved in discharge planning. Results:From the time of admission, a contextual push to focus on discharge superseded program aims of providing interventions to increase older adults’ functional capabilities. Professionals’ primary commitment to safety limited consideration of discharge options and resulted in costly and potentially unnecessary recommendations for 24-hour care. The resulting “rehabilitation” stay was more akin to an extended process of “destination triage” biased towards the promotion of physical safety than optimizing functioning. Conclusions:The resulting reduction of rehabilitation into “destination triage” has significant social, financial and occupational implications for older adults and their families, and broader implications for healthcare services and overarching healthcare systems. Implications for RehabilitationCurrent trends promoting consideration of discharge planning from the point of admission and prioritizing physical safety are shifting the focus of rehabilitation away from interventions to maximize recovery of function, which are the stated aims of rehabilitation.Such practices furthermore promote assessments to determine prognosis early in the rehabilitation stay when accurate prognosis is difficult, which can lead to overly conservative recommendations for discharge from rehabilitation services, thus further negating the impact of rehabilitation.Further work is required to examine the social, occupational and functional implications of superseding rehabilitation interventions to maximize capabilities with practices that prioritize safety over quality of life for older adults and their family members. [ABSTRACT FROM PUBLISHER]

Political advisors in Canada are comparatively numerous and highly differentiated in role. Based on a recent survey, this article examines how senior ministerial policy advisors, a subset of the political staff community, perceive their support for ministers and their relationships with public servants. It finds that they increase ministers' policy capacity, encourage greater responsiveness from public servants, and generally feel that they enjoy good relations with officials and respect their role. Since much depends on advisors' personal maturity, however, the paper endorses the Trudeau government's release of a code of conduct for ministerial-exempt staff as a means of embedding accountability more deeply within political staff culture. [ABSTRACT FROM AUTHOR]

Through its audits and recommendations, Canada's Office of the Auditor General (OAG) has promoted financial probity and good governance for over a century. While OAG recommendations may have inherent value, their full value is realized only when implemented by government. By investigating implementation rates and the OAG's interaction with Parliament, this paper evaluates whether OAG performance and interactions with Parliament have changed over time. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to examine the progress of the Mental Health Commission of Canada (MHCC) over the first five years of its existence toward stated goals while existing outside the constitutional framework of health care funding. Design/methodology/approach – The paper is a review of the outputs of the MHCC with emphasis on its first-ever mental health strategy for Canada, knowledge exchange network, anti-stigma initiatives, randomized controlled trial of housing-first initiatives for the homeless mentally ill, as well as other completed projects. Findings – Consultation and collaboration are essential aspects of working successfully with people with lived experience of mental illness, their families, health professionals, and governments. At the same time, when expectations are high, needs are great, and opinions are varied, disappointment and frustration are inevitable. Research limitations/implications – Although the MHCC initiatives include the largest single funded research project in mental health in Canadian history, and evaluation is built into other initiatives, the political dimension of its work does not lend itself to research evaluation. Practical implications – The creation of an organization outside the constitutional framework of health care funding may allow for a catalytic role in precipitating change. Social implications – The emphasis on anti-stigma campaigns targeted at defined populations (youth, health professionals, workforce, journalists) may combat the discrimination people with mental illnesses and their families experience. Originality/value – The paper shows that the Canadian experience is, to date, largely undescribed in the peer-reviewed literature and may influence other jurisdictions. One of its interventions is already being replicated internationally. [ABSTRACT FROM AUTHOR]

Background Healthcare transition (HCT) for youth with disabilities is a complex phenomenon influenced by multiple interacting factors, including health, personal and environmental factors. Current research on the transition to adulthood for disabled youth has primarily focused on identifying these multilevel factors to guide the development of interventions to improve the HCT process. However, little is known about how this complex array of factors interacts and contributes to successful HCT. Systems thinking provides a theoretically informed perspective that accounts for complexity and can contribute to enhanced understanding of the interactions among HCT factors. The objective of this paper is to introduce general concepts of systems thinking as applied to HCT practice and research. Methods Several systems thinking concepts and principles are introduced and a discussion of HCT as a complex system is provided. Systems dynamics methodology is described as one systems method for conceptualizing HCT. A preliminary systems dynamics model is presented to facilitate discourse on the application of systems thinking principles to HCT practice, policy and research. Conclusions An understanding of the complex interactions and patterns of relationships in HCT can assist health policy makers and practitioners in determining key areas of intervention, the impact of these interventions on the system and the potential intended and unintended consequences of change. This paper provides initial examination of applying systems thinking to inform future research and practice on HCT. [ABSTRACT FROM AUTHOR]

Employing critical discourse analysis (CDA), this paper examines the attempt to bridge a Canadian adult second language policy with an employment skills policy. The result is a third policy intended to improve language education and employment skills training for immigrants. The analysis reveals that the knowledge economy and human capital theory are the predominant discourses embedded in the policy documents. The paper argues that predominant discourses perpetuate power imbalances and essentialize worker and migrant subjectivities. Engaging in postcolonial theories of second language learning, the paper proposes another way of conceiving adult second language learning and its potential for policy development. [ABSTRACT FROM AUTHOR]

Aims: This study provides an examination of normalization trends associated with the use of cannabis and tobacco, and whether and to what extent health concerns and legal contexts appear to modify the tolerance displayed to users.Methods: Data for this paper are drawn from a mixed methods interview study involving 202 respondents who reported being regular users of cannabis (alonen = 100 or in conjunction with tobaccon = 67) or tobacco only users (n = 35), in four Canadian cities (Halifax, Montreal, Toronto and Vancouver).Findings: While participants commonly attributed serious health risks to the use of tobacco, cannabis was viewed as relatively low risk. All groups described cannabis laws as too punitive, while most agreed with the regulatory controls for tobacco. Drawing on norms around appropriate context for use, cannabis users illustrate the expansion of normalization, with varying degrees of acceptability in different spaces. In contrast, tobacco users’ heightened awareness of the dangers of smoking leads them to engage in a reflexive process-limiting appropriate venues and contexts for use.Conclusions: These findings suggest that perceptions of health risk shape users’ experience of normalization (and denormalization) and help to contextualize the larger societal processes where both drugs are in a stage of societal re-evaluation. Much can be learned about the cannabis future from the tobacco past. [ABSTRACT FROM PUBLISHER]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision. [ABSTRACT FROM AUTHOR]

The POpulation HEalth Model (POHEM) is a health microsimulation model that was developed at Statistics Canada in the early 1990s. POHEM draws together rich multivariate data from a wide range of sources to simulate the lifecycle of the Canadian population, specifically focusing on aspects of health. The model dynamically simulates individuals' disease states, risk factors, and health determinants, in order to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, quality of life, and healthcare costs. Additionally, POHEM was conceptualized and built with the ability to assess the impact of policy and program interventions, not limited to those taking place in the healthcare system, on the health status of Canadians. Internationally, POHEM and other microsimulation models have been used to inform clinical guidelines and health policies in relation to complex health and health system problems. This paper provides a high-level overview of the rationale, methodology, and applications of POHEM. Applications of POHEM to cardiovascular disease, physical activity, cancer, osteoarthritis, and neurological diseases are highlighted. [ABSTRACT FROM AUTHOR]

This paper describes the relationship between research and policy in the development of server training policy in Ontario. With the emergence of civil liability for the conduct of intoxicated patrons, there has been a growing movement toward the training of managers and servers in licensed establishment in the responsible service of alcohol. As part of a major government reform of alcohol regulations which has led to a new Liquor Licence Act, all persons who serve alcohol in licensed establishments in Ontario will be required to attend a server training course. The process leading to new alcohol regulations in Ontario is summarized with particular attention to the implementation of mandatory server training. The paper concludes with a discussion of the role of research in policy development. It is argued that the role of research in policy making is limited by an inherent conflict between the nature of scientific enquiry and the exigencies of policy development. [ABSTRACT FROM AUTHOR]

Child care, conceptualized as one area of social policy, is a good example of a population health intervention (PHI) that operates outside of the health sector. Exploration of child care as a PHI could help to clarify the scope of the PHI field, and contribute to a credible base from which to advocate for PHIs, yet such exploration is not yet prominent in the population health research literature. The purpose of this paper is to consider child care through the lens of PHI, and in particular, to consider whether a strong case can be made for a universal approach to child care in Canada and perhaps other liberal welfare regimes where targeted approaches are more commonly accepted. We first examine the peer-reviewed evidence on the impact of universal and targeted child care for later outcomes. We then interrogate other issues that are pertinent to making a strong case for universal child care in Canada as one example of a liberal regime; namely, (1) limitations and challenges of research on the impact of universal child care; (2) the intuitive appeal of targeting; (3) the fundamental differences between targeted and universal approaches; and (4) the values inherent in judgments about the equity of universal interventions. Notably, some of these issues do not lend themselves to empirical resolution, which raises interesting questions about the acceptable balance of ideology and empiricism in population health. [ABSTRACT FROM AUTHOR]

Background: Medical education has traditionally been compartmentalized into basic and clinical sciences, with the latter being viewed as the skillful application of the former. Over time, the relevance of basic sciences has become defined by their role in supporting clinical problem solving rather than being, of themselves, a defining knowledge base of physicians. Methods: As part of the national Future of Medical Education in Canada (FMEC MD) project, a comprehensive empirical environmental scan identified the timing and integration of basic sciences as a key pressing issue for medical education. Using the literature review, key informant interviews, stakeholder meetings, and subsequent consultation forums from the FMEC project, this paper details the empirical basis for focusing on the role of basic science, the evidentiary foundations for current practices, and the implications for medical education. Findings: Despite a dearth of definitive relevant studies, opinions about how best to integrate the sciences remain strong. Resource allocation, political power, educational philosophy, and the shift from a knowledge-based to a problem-solving profession all influence the debate. There was little disagreement that both sciences are important, that many traditional models emphasized deep understanding of limited basic science disciplines at the expense of other relevant content such as social sciences, or that teaching the sciences contemporaneously rather than sequentially has theoretical and practical merit. Innovations in integrated curriculum design have occurred internationally. Less clear are the appropriate balance of the sciences, the best integration model, and solutions to the political and practical challenges of integrated curricula. Discussion: New curricula tend to emphasize integration, development of more diverse physician competencies, and preparation of physicians to adapt to evolving technology and patients' expectations. Refocusing the basic/clinical dichotomy to a foundational/applied model may yield benefits in training widely competent future physicians. [ABSTRACT FROM AUTHOR]

Richter M.S., Mill J., Muller C.E., Kahwa E., Etowa J., Dawkins P. & Hepburn C. (2013) Nurses' engagement in AIDS policy development. International Nursing Review 60, 52-58 Background: A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care . One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level. [ABSTRACT FROM AUTHOR]

The complexities of professional ethics are best understood and interpreted within their sociohistorical context. This paper focuses on the experience of 20 rural psychologists from across Canada, a context rife with demographic and practice characteristics that may instigate ethical issues. Employing hermeneutic phenomenology, these qualitative research results are indicative of professional struggles that impacted the participants' experience of professional ethics and raised key questions about policy and practise. Concerns regarding competition highlight potential professional vulnerability, beget the idea of fostering general psychological practice, and question the role of professional bodies in addressing rural shortages. Dependency on government funding models and decisions highlights the benefits and medical cost-offset effect of psychological services' role in funded medical care. The controversial prescriptive authority debate for psychologists raises myriad concerns that are particularly salient to rural practitioners. These include changes to training and practice, with risks of psychopharmacology gaining prominence over behavioural health interventions. National inconsistencies in level of registration add to the growing shortage of practitioners. Finally, the results illuminate the need for advocacy to move beyond the literature and into public policy to increase public awareness, decrease the stigma of mental illness, and develop rural Canadian psychology. Although limited to this study, these results allowed for a fuller and more robust understanding of rural practice in consideration of professional ethics, which may inform policy, science, or ethical clinical practice. [ABSTRACT FROM AUTHOR]

Despite a rich literature on the political and constitutional development of the Canadian territorial North, few scholars have examined the post-devolution environment in Yukon. This lacuna is surprising since devolution is frequently cited as being crucial to the well-being of Northerners, leading both the Government of Nunavut and the Government of the Northwest Territories to lobby the federal government to devolve lands and resources to them. This paper provides an updated historical account of devolution in Yukon and assesses its impact on the territory since 2003. Relying mainly on written sources and 16 interviews with Aboriginal, government, and industry officials in the territory, it highlights some broad effects of devolution and specifically analyzes the processes of obtaining permits for land use and mining. Our findings suggest that devolution has generally had a positive effect on the territory, and in particular has led to more efficient and responsive land use and mining permit processes. [ABSTRACT FROM AUTHOR]

Scholars and practitioners from multiple perspectives, including developmental science, sociology, business, medicine, and public health, have considered the implications of employment for young people. We summarize a series of meetings designed to synthesize information from these perspectives and derive recommendations to guide research, practice, and policy with a focus on young worker safety and health. During the first three meetings, participants from the United States and Canada considered invited white papers addressing developmental issues, public health data and findings, as well as programmatic advances and evaluation needs. At the final meeting, the participants recommended both research and policy directions to advance understanding and improve young worker safety. [ABSTRACT FROM AUTHOR]

Most studies of the relationship between deputy ministers (DMs) and ministers have focused on majority governments. This paper analyses the impact of minority government on that relationship in four areas (personnel in key positions, the role of central agencies, agendas and daily relationships) on the basis of an analysis of the history of DM appointments and departures under minority governments in Canada and interviews with current DMs. It is found that, under minority governments, relationships of trust are more difficult to develop, there is a stronger tendency to develop public policy on an urgent basis and with a view to short-term issues, greater importance is attached to public opinion, and control is more centralised. [ABSTRACT FROM PUBLISHER]

Questions of timing, phasing and sequence have been central to recent critiques of science policy-making, which have highlighted sustained disjunctures between the relevance and importance given to different stakeholders at different moments in the policy-making process. In this paper we expand upon this recent 'upstream/downstream' literature through a case study analysis of xenotransplantation (XTP), one of the defining controversies of 1990s UK biotechnology regulation. Drawing on insights from the sociology of expectations we trace the emergence of a UK policy narrative concerning the future of XTP and explore how the policy role became narrowly defined as a process of 'reflex regulation', based upon technologically determinist assumptions and producing extremely short-term decision-making. We draw attention to the concrete costs of this delineation of the policy role and reveal that it is neither inevitable or necessary, by considering contrasts between the policy temporalities of the UK, Canada and the Netherlands. [ABSTRACT FROM AUTHOR]

Spatial disparities in environmental quality and practices are contributing to rising health inequalities worldwide. To date, the field of health promotion has not contributed as significantly as it might to a systematic analysis of the physical environment as a determinant of health nor to a critique of inequitable environmental governance practices responsible for social injustice—particularly in the Canadian context. In this paper, we explore ways in which health promotion and environmental justice perspectives can be combined into an integrated movement for environmental health justice in health promotion. Drawing on Canadian experiences, we describe the historical contributions and limitations of each perspective in research, policy and particularly professional practice. We then demonstrate how recent environmental justice research in Canada is moving toward a deeper and multi-level analysis of environmental health inequalities, a development that we believe can inform a comprehensive research, policy and advocacy agenda in health promotion toward environmental health justice as a fundamental determinant of health. Lastly, we propose four key considerations for health promotion professionals to consider in advancing this movement. [ABSTRACT FROM AUTHOR]

Distracted driving caused by cellphone use is a significant source of needless injuries. These injuries place unnecessary financial burden, emotional stress and health care resource misuse on society. This paper states the Canadian Association of Emergency Physician's (CAEP's) position on cellphone use while driving. In recent years, numerous studies were conducted on the danger of cellphone use while driving. Research has shown that cellphone use while driving negatively impacts cognitive functions, visual fields, reaction time and overall driving performances. Some studies found that cellphone use is as dangerous as driving under the influence of alcohol. Moreover, vehicle crash rates were shown to be significantly higher when drivers used cellphones. Countermeasures have been implemented in recent years. Over 50 countries worldwide have laws limiting the use of cellphones while driving. Six Canadian provinces, Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, British Columbia and Saskatchewan, currently have legislation prohibiting cellphone use. Other provinces are considering implementing similar bans. As emergency physicians, we must advocate for injury prevention. Cell phone related road traumas are avoidable. CAEP supports all measures to ban cellphone use while driving. [ABSTRACT FROM AUTHOR]

This paper reports on an integrated research program involving three related studies that examined successful foresight programs. It analyzes the key factors that appear to determine whether or not foresight, once launched by a government, can be successful. The study was performed by a team of researchers in Canada in the period 2005-2007. It found eight key factors, beyond the usual ones associated with the application of leading edge methods. The overall conclusion is that the methodology, appropriate budget and techniques alone are insufficient factors to explain the success of foresight programs. The interview results indicate that success is ultimately defined as the impact of the foresight exercise on government policy, and as the growth of the foresight function. Taken together, the results should help organizations establish the parameters for a successful foresight program. [ABSTRACT FROM AUTHOR]

Social capital has been a key framework in conceptualizing the place of social ties in quality of life. Families have not been among groups of interest in social capital research. Yet within the context of research and public policy on aging, the contemporary discourse on families and care is congruent with social capital assumptions. In this paper, we draw on social capital literature to frame our understanding of the social capital inherent in families of frail older adults, and hypothesize their abilities to benefit family members. Data are drawn from Statistics Canada 2002 General Social Survey on Aging and Social Support. [ABSTRACT FROM AUTHOR]

The focus of this paper is on a microeconomic analysis of the annual transition rate from temporary to permanent work of individual workers in Canada for the period 1999–2004. Given that a large proportion of temporary employment is involuntary, an understanding of the factors associated with the transition to permanent work may inform public policy. Factors associated with the transition, namely, human capital, household structures and labour market segmentation are analyzed using data from the Statistics Canada’s Survey of Labour and Income Dynamics (SLID) for the period 1999–2004, limited to paid workers aged 20–64 years, excluding students. Among the key factors associated with the transitions are younger age and low unemployment rates. The analysis adds to the Canadian and international literature on transitions from temporary to permanent work. [ABSTRACT FROM AUTHOR]

Objective: : Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status.Method: : A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior.Result: : Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity.Conclusion: : To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a 'cross-sectoral approach', involving both gender and development issues. [ABSTRACT FROM AUTHOR]

Despite attention to the impact of mental health issues on employment, little attention has been directed to Canadian policy regarding psychiatric disabilities, and how these policies influence workplace practices. This paper reviews federal Canadian disability policy related to work, using the lens of mental illness, to answer the following questions: • With regard to psychiatric disability, what are expected outcomes in the employment domain? • How is psychiatric disability defined and described? • How is the relationship between work and psychiatric disability developed? Notions about work and psychiatric disability found in federal policy documents, implications of these notions, and recommendations for future policy development are presented. [ABSTRACT FROM AUTHOR]

This paper explores the essential policy elements of extended producer responsibility for packaging, and provides direction on two key policy elements that are currently the subject of considerable debate in Canada particularly, and North America more generally: mandatory or voluntary take-back requirements, and hidden or visible levies. The approach taken to this study was qualitative and interactive, and included interviews with packaging manufactures, food producers, trade associations, academics, and senior government officials in Canada, Germany, Austria, Sweden, and Australia, as well as a workshop with Canadian packaging stake-holders. The results indicate that Canadian packagers and fillers have not shown a great deal of interest in assuming either physical and/or fiscal responsibility for the packaging wastes created by the products they sell. This fact, in combination with the policy direction of successful EPR programs,. underscores the need for policies supporting mandatory take-back obligations and integrated levy systems that ensure design for the environment. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

This paper investigates urban policy-making and development from a regulation theory perspective. It describes major Toronto urban trends of the past 50 years in order to gauge their conformity to changing regulation conditions. Results indicate that in the 1950s and 1960s, policies in Toronto were in accord with the Fordist mass consumption and welfare orientation. They also suggest a coincidence between the post-1995 period of public-sector retrenchment and the market-driven nature of post-Fordism. The intermediary period, however, was dominated by unsuccessful efforts at maintaining Fordist-type policies in a regulation context shifting towards post-Fordism. These findings confirm the non-functionalist interpretation of links between policy-making and regulation professed by regulation theory researchers. They also cast light on the role the city plays in the changing nature of regulation. Assertive metropolitan planning and socially balanced sub-divisions characteristic of the Fordist period of regulation gradually made way for market-driven development. With a reduced government presence, urban development has become less co-ordinated and more socially polarised, thus reflecting at the urban level society-wide features of post-Fordism. [ABSTRACT FROM AUTHOR]

Although a large body of literature has examined the effect of social capital on health and theoretical models suggest a reciprocal relationship between the two variables, there are relatively few studies that have investigated the effect of mental health on social capital. This paper evaluates the impact of mental health on the stock of social capital using data from the cross-sectional 2012 (N = 21,844) and 2002 (N = 31,089) Canadian Community Health Survey – Mental Health editions. Mental health was measured retrospectively as self-rated mental health, past year mental health conditions, and past 30-day psychological distress. Given the reciprocal relationship, we used an instrumental variable approach with family history of mental health problems as the instrument and examined forms of social capital – sense of belonging and workplace social support – that are largely measures of social capital provided by non-family members in the community and workplace. The analysis suggests there are large and significant associations between measures of mental health and both outcomes, which persist in the instrumental variable analyses. These findings highlight the urgent need for policy makers to implement greater prevention and treatment of poor mental health, and provide greater support for individuals with poor mental health so they can build and maintain their social capital. • The causal impact of mental health on social capital has been relatively unexplored. • All measures of mental health were associated with a lower sense of belonging. • Workplace social supports were similarly affected by all measures of mental health. • Instrumental variable analyses suggest the observed effects are causal. [ABSTRACT FROM AUTHOR]

In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician‐assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses' moral well‐being. [ABSTRACT FROM AUTHOR]

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses' wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses' wound work as it arises within the established uptake of scientific evidence. [ABSTRACT FROM AUTHOR]