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Background: Enhanced Recovery After Surgery (ERAS) is a global surgical quality-improvement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS bro-brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations. Contexte : L'initiative de recuperation amelioree apres la chirurgie (RAAC) est un projet international d'amelioration de la qualite en chirurgie. On en sait peu sur les retombees economiques, tant a court qu'a long terme, de la mise en [alpha]euvre de multiples lignes directrices de RAAC. Methodes : Nous avons realise une analyse du rendement sur l'investissement (RSI) visant la mise en oeuvre de multiples lignes directrices de RAAC (pour les operations colorectales, pancreatiques, hepatiques ou d'oncologie gynecologique et la cystectomie) dans 9 hopitaux albertains sur un horizon temporel de 30, 180 et 365 jours. L'incidence de la RAAC sur l'utilisation des services de sante (duree du sejour a l'hospitalisation initiale, nombre de readmissions, duree du sejour a la rehospitalisation et nombre de visites a l'urgence, en consultation externe, chez un specialiste et chez un omnipraticien) a ete evaluee a l'aide d'un modele multiniveau de regressions binomiales negatives a effets mixtes multivaries. Les benefices nets et le RSI ont ete estimes a l'aide d'un processus de modelisation analytique decisionnelle. Tous les couts ont ete rapportes en dollars canadiens de 2019. Resultats : Les economies nettes du systeme de sante allaient de 26,35 $ a 3606,44 $ par patient, et le RSI variait de 1,05 a 7,31; chaque dollar investi dans l'initiative de RAAC a donc genere un retour sur l'investissement de 1,05 $ a 7,31 $. Les probabilites d'economie grace au RAAC allaient de 86,5 % a 99,9 %. Les retombees generees augmentaient avec un horizon temporel a plus long terme, ce qui suggere que l'utilisation unique d'un horizon temporel de 30 jours aurait mene a une sous-estimation des benefices. Conclusion : Les resultats montrent que la mise en oeuvre de multiples lignes directrices de RAAC a permis des economies en Alberta. En vue d'obtenir un RSI optimal, il est important de tenir compte d'une grande variete d'utilisations des services de sante, des retombees a long terme, des economies d'echelle, de l'efficacite productive et de l'efficience des allocations pour la perennite, la mise a l'echelle et la diffusion des projets de mise en oeuvre de RAAC., Enhanced Recovery After Surgery (ERAS) is a multi-modal, multidisciplinary approach to providing best practice perioperative care before, during and after surgery. (1) Drawing from best practices and evidence from around [...]

This paper aims to present what is currently known about Indigenous Australians and their engagement in physical activity and to then challenge some of the "taken-for-granted" ways of thinking about promoting or researching physical activity with Indigenous Australians. Major health, education and sport databases, as well as government websites were searched using the key terms of physical activity, sport, leisure, recreation, Indigenous and Aboriginal/Aborigine. A social-ecological model of health was adapted and used as an organizing framework to synthesize the literature. It is concluded that socioecological models can be valuable tools for understanding and promoting issues related to physical activity engagement for a range of populations but they may require complementary critical insights, including those from Indigenous perspectives. Productive theoretical spaces where Western and Indigenous knowledges come together can assist health educators to consider the complexity and diversity of Indigenous people's lived experiences when planning and implementing programs. (Contains 2 figures.)

The soybean industry in Canada aimed to extensively expand soybean production to benefit from new early-maturing varieties and the warming climate. However, setbacks in the soybean industry since 2017 demonstrated the impacts of climate risk and global market uncertainty. Therefore, a better understanding of future climate conditions that will impact soybean growth in Canada is needed for decision-making in the sector, such as prioritizing regions for expansion and developing climate change adaptation strategies through either agronomic management practices or breeding new cultivars. Based on climate projections from a set of global climate models, we analyzed climate conditions for growing soybeans, including growing season start, crop heat units, precipitation, precipitation deficits and climate extremes, in the near-term (2030s), the mid-term (2050s) and the distant future (2070s). We found that a future warmer climate with an increase of 1.6, 2.8 and 4.1 °C in the growing season (May–September) mean temperature averaged over Canada's land area in the near-term, mid-term and distant future under SSP3-7.0 would favour the expansion of soybean production further north and west. However, an increase of approximately 200 mm in precipitation deficits on the semiarid Canadian Prairies in the mid-term would constrain soybean production unless irrigation could be introduced. Heat- and drought-tolerant cultivars should be developed to adapt soybean production to a changing climate, in addition to the adoption of late-maturing cultivars that would benefit from the lengthened growing season and increased crop heat units. [ABSTRACT FROM AUTHOR]

A letter to the editor about the 2007 APOT meeting for occupational therapists is presented.