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The literature on world regions is largely gender-blind. This article suggests ways in which the study of regionalism can incorporate gender analysis, based on the case of North America. It argues that this can be done in three ways: through an examination of the gendered impact of regional integration; through an examination of how gender concerns are, or can be, mainstreamed into regional policies; and through research on new forms of feminist-inspired activism that may shape regional outcomes. After applying these perspectives to the case of North America and the new Canada–United States–Mexico Agreement, it argues that despite the failure of the Canadian government to achieve the inclusion of a gender chapter, the inclusion of language around gender discrimination in the labour chapter makes the new agreement a more effective (if still limited) tool for promotion of some forms of gender equality.

This study set out to identify emerging trends in advancing engineering for sustainable development, supporting the engineering workforce to address wicked problems, and strengthening pathways between engineering education, industry, and policy. The following question guided this work: What are the emerging factors impacting the future of global sustainability efforts within engineering, and how can these be amplified to increase the impact of engineering for sustainable development? Using an adapted Delphi method with surveys, focus groups, and member-checking interviews, we hosted the American Society of Mechanical Engineers (ASME) 2022 Engineering Global Development (EGD) Stakeholder Summit. The summit convened industry leaders, innovators, and academics to explore emerging factors impacting the future of global sustainability efforts in engineering. This manuscript synthesizes emerging trends and proposes recommendations for engineering, particularly in the specific focus area of engineering for sustainable development (e.g., ‘humanitarian engineering’, ‘global engineering’). Critical recommendations include the adoption of emerging cultural mindsets, which include: (1) take an interdisciplinary and multi-stakeholder approach, (2) consider dynamic and interconnected systems, (3) increase humility and intercultural competence, (4) prioritize diversity and inclusion, (5) increase localization and center community perspectives, (6) challenge the perception that engineering is neutral, and (7) broaden the goals of engineering. Ultimately, this study highlights pathways forward for the broader engineering community to more effectively contribute to advancing the United Nations Sustainable Development Goals. Published version

Global engineers must be taught to consider the historical and present causes of persistent poverty and systematic barriers to prosperity. Such training will better inform the choices engineers make and help move the engineering sector away from a product and community-level focus towards working to address the root causes of poverty. A framing for Global Engineering has recently been proposed by the Mortenson Center in Global Engineering at the University of Colorado Boulder, building on over 15 years of curricular efforts. Global Engineering, as taught by the Mortenson Center, positions the field as a complement to Global Health and Development Economics while further embracing a historically contextualized and anti-colonial training.

Background: Pneumococcal conjugate vaccines covering 10 (PCV10) and 13 (PCV13) serotypes have been introduced in the infant immunization schedule of most European countries in 2010-11. To provide additional real-life data, we measured the effectiveness of PCV10 and PCV13 against invasive pneumococcal disease (IPD) in children of 12 European sites (SplDnet). Methods: We compared the vaccination status of PCV10 and PCV13 serotype IPD (cases) to that of nonPCV13 serotype IPD (controls) reported in 2012-2018. We calculated pooled effectiveness as (1-vaccination odds ratio)*100, and measured effectiveness over time since booster dose. Results: The PCV13 and PCV10 studies included 2522 IPD cases from ten sites and 486 cases from four sites, respectively. The effectiveness of >= 1 PCV13 dose was 84.2% (95 %CI: 79.0-88.1) against PCV13 serotypes (n = 2353) and decreased from 93.1% (87.8-96.1) < 12 months to 85.1% (72.0-92.1) ( )>= 24 mont hs after booster dose. PCV13 effectiveness of >= 1 dose was 84.7% (55.7-94.7) against fatal PCV13 IPD, 64.5% (43.7-77.6), 83.2% (73.7-89.3) and 85.1% (67.6-93.1) against top serotypes 3, 19A and 1, respectively, and 85.4% (62.3-94.4) against 6C. Serotype 3 and 19A effectiveness declined more rapidly. PCV10 effectiveness of >= 1 dose was 84.8% (69.4-92.5) against PCV10 serotypes (n = 370), 27.2% (187.6 to 81.6) and 85.3% (35.2-96.7) against top serotypes 1 and 7F, 32.5% (-28.3 to 64.5) and -14.4% (-526.5 to 79.1) against vaccine-related serotypes 19A and 6C, respectively. Conclusions: PCV10 and PCV13 provide similar protection against IPD due to the respective vaccine serotype groups but serotype-specific effectiveness varies by serotype and vaccine. PCV13 provided individual protection against serotype 3 and vaccine-related serotype 6C IPD. PCV10 effectiveness was not significant against vaccine-related serotypes 19A and 6C. PCV13 effectiveness declined with time after booster vaccination. This multinational study enabled measuring serotype-specific vaccine effectiveness with a precision rarely possible at the national level. Such large networks are crucial for the post-licensure evaluation of vaccines. (C) 2022 Elsevier Ltd. All rights reserved.

This article analyses the way in which free trade agreements may become a new form of migration governance architecture, through an examination of the case of the North American Free Trade Agreemen...

Thyroid cancer is the most common endocrine malignancy and incidences are rising rapidly, in both pediatric and adult populations. Many thyroid tumors are successfully treated which results in low mortality rates, but there is often a significant morbidity associated with thyroid cancer treatments. For patients with tumors that are not successfully treated with surgical resection or radioactive iodine treatment, prognosis is dramatically reduced. Patients diagnosed with anaplastic thyroid cancer face a very grim prognosis with a median survival of 6 months post-diagnosis. There is a critical need to identify patients who are at greatest risk of developing persistent disease and progressing to poorly differentiated or anaplastic disease. Furthermore, development of treatments associated with less morbidity would represent a significant improvement for thyroid cancer survivors. It is well established the stromal cells and components of the tumor microenvironment can drive tumor progression and resistance to therapy. Here we review the current state of what is known regarding the thyroid tumor microenvironment and how these factors may contribute to thyroid tumor pathogenesis. Study of the tumor microenvironment within thyroid cancer is a relatively new field, and more studies are needed to dissect the complex and dynamic crosstalk between thyroid tumor cells and its tumor niche.

IntroductionInterprofessional collaborative practice is a key strategy for strengthening a system of integrated, coordinated care and improving health outcomes. The healthcare system is faced with greater demands, particularly with the growth in chronic conditions, highlighting the need for multi-provider expertise and well-designed collective action that will meet diverse patients’ needs. But interprofessional collaboration is not a simple solution. Clinically integrated care, as the goal of interprofessional team-based approaches, has been described as conceptually ambiguous with little understanding of what success looks like in different practice settings or in various situations. Aims Objectives Theory or MethodsThe goal of this project is to understand the factors influencing interprofessional collaborative practice among newly practicing primary health care providers, specifically: 1) their experiences of transitioning from education to interprofessional practice, and 2) the opportunities and barriers for operationalizing interprofessional practice. We will administer a survey to individuals who have completed the Interprofessional Education (IPE) curriculum at the University of Manitoba and are within the first five years of practice. Descriptive statistics will be used to analyze survey responses. We will examine these findings in relation to IPE training outcomes, and domains such as organization, team composition and functions. Highlights or Results or Key FindingsWe present this work in progress, which seeks to identify the micro- and meso-level challenges and facilitators that influence the capacity for integrated and interprofessional collaborative practice. The survey responses will provide insights on the more concrete experiences and broad factors affectinginterprofessional performance and with potential to enhance the development of IPE to equip the health workforce with knowledge and skills that can be transferred into ‘real world’ settings. The current competency frameworks guiding interprofessional education and collaboration are relatively new. This research will identify the critical determinants of interprofessional practice, and as a product of the complex interplay of training, evidence, organization and operations.ConclusionsUnderstanding gaps in capacity and transferring learning from IPE to practice is key to building workforce capacity and nurturing a culture of interprofessionality. Identifying concrete actions and context will illustrate the reality of interprofessional practice, and inform future curricula for preparing the health workforce for interprofessional and integrated care. Implications for applicability/transferability sustainability and limitations These findings will be important for understanding the challenges presented to new practitioners who face different practice contexts and situations. The lessons learned may contribute to the ongoing development of IPE curricula and practice-oriented strategies that will advance collaborative primary health care practice and optimize integrated care.

Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010.The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus.We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to 31 December 2014) were searched for conference proceedings. Additionally, two periodontology journals were handsearched for completeness, Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003). We searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 DM (T1DM/T2DM) with a diagnosis of periodontitis. Interventions included periodontal treatments such as mechanical debridement, surgical treatment and antimicrobial therapy. Two broad comparisons were proposed:1. periodontal therapy versus no active intervention/usual care;2. periodontal therapy versus alternative periodontal therapy.For this review update, at least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials and assessed included trials for risk of bias.Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c).Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and probing pocket depth (PPD)), cost implications and diabetic complications.We included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. All studies used a parallel RCT design, and 33 studies (94%) only targeted T2DM patients. There was variation between studies with regards to included age groups (ages 18 to 80), duration of follow-up (3 to 12 months), use of antidiabetic therapy, and included participants' baseline HbA1c levels (from 5.5% to 13.1%).We assessed 29 studies (83%) as being at high risk of bias, two studies (6%) as being at low risk of bias, and four studies (11%) as unclear. Thirty-four of the studies provided data suitable for analysis under one or both of the two comparisons.Comparison 1: low quality evidence from 14 studies (1499 participants) comparing periodontal therapy with no active intervention/usual care demonstrated that mean HbA1c was 0.29% lower (95% confidence interval (CI) 0.48% to 0.10% lower) 3 to 4 months post-treatment, and 0.02% lower after 6 months (five studies, 826 participants; 95% CI 0.20% lower to 0.16% higher).Comparison 2: 21 studies (920 participants) compared different periodontal therapies with each other. There was only very low quality evidence for the multiple head-to-head comparisons, the majority of which were unsuitable to be pooled, and provided no clear evidence of a benefit for one periodontal intervention over another. We were able to pool the specific comparison between scaling and root planing (SRP) plus antimicrobial versus SRP and there was no consistent evidence that the addition of antimicrobials to SRP was of any benefit to delivering SRP alone (mean HbA1c 0.00% lower: 12 studies, 450 participants; 95% CI 0.22% lower to 0.22% higher) at 3-4 months post-treatment, or after 6 months (mean HbA1c 0.04% lower: five studies, 206 patients; 95% CI 0.41% lower to 0.32% higher).Less than half of the studies measured adverse effects. The evidence was insufficient to conclude whether any of the treatments were associated with harm. No other patient-reported outcomes (e.g. quality of life) were measured by the included studies, and neither were cost implications or diabetic complications.Studies showed varying degrees of success with regards to achieving periodontal health, with some showing high levels of residual inflammation following treatment. Statistically significant improvements were shown for all periodontal indices (BOP, CAL, GI, PI and PPD) at 3-4 and 6 months in comparison 1; however, this was less clear for individual comparisons within the broad category of comparison 2.There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus.In clinical practice, ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months. Further research is required to determine whether adjunctive drug therapies should be used with periodontal treatment. Future RCTs should evaluate this, provide longer follow-up periods, and consider the inclusion of a third 'no treatment' control arm.Larger, well conducted and clearly reported studies are needed in order to understand the potential of periodontal treatment to improve glycaemic control among people with diabetes mellitus. In addition, it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation.

We present a study design, pre-analysis plan, process evaluation and baseline results designed to establish the impact of trailbridges on health, education, agricultural and economic outcomes of households in rural Rwanda. This intervention and study is being implemented in communities that face barriers to socioeconomic development through periodic isolation caused by flooding. We describe a mixed methods approach to measure the impacts of these trailbridges on outcomes at the village level. The study is anchored on a stepped-wedge randomized controlled trial (RCT) implemented in 147 sites: 97 phased-in intervention sites and 50 long-term control sites. These sites are being monitored in four annual waves comprising of a baseline period and three subsequent follow-up waves. We will supplement the RCT with three sub-studies. First, we are investigating the role of weather events and streamflow variability on temporal and spatial bridge use patterns among intervention sites. We will then find the relationship between the weather events, streamflow and bridge use from motion-activated cameras installed in intervention sites. Secondly, we are following 42 markets serving study sites to investigate the impact of the trailbridges on the market prices of key goods including crops, livestock and agricultural inputs. Lastly, we are following 30 villages that are more distant from the river crossings to determine the spatial extent of the trailbridge impacts. Our study will advance knowledge by generating new data on the impact of rural infrastructure and providing the opportunity to explore a range of outcomes for future evaluation of infrastructure in low- and middle-income countries. We will enable an outcomes-based funding model that ties implementer payments to demonstrated positive impacts of these trailbridges. Furthermore, we will identify cost-effective, easily assessed measures that are highly correlated to the economic and health benefits of the intervention. These measures may then be used by a portfolio of interventions across multiple geographies without always requiring complex trials.

Static positioning and awkward postures put dental hygienists at risk for work-related musculoskeletal disorders. These disorders often appear during professional training programs. Ergonomics education has been shown to reduce the incidence of injuries, but fitness training to improve postural awareness and endurance is not typically included in dental hygiene curricula. This study assessed the effects of a 12-week functional fitness training program on ergonomic and postural knowledge, outcome expectations and self-efficacy related to exercise, and core stability in final-year dental hygiene students.Participants (n = 24) completed surveys and core stability tests and demonstrated postural movements before and after completing a mandatory weekly training program focusing on dynamic core stabilization, aerobic exercise, and postural awareness.Participants improved static plank hold time and left leg forward lunge scores, with no significant changes in right lunge or stability push-up tests. Accuracy in demonstrating postural movements in response to verbal cues improved for 2 of 6 movements. Knowledge about injury risk factors and body mechanics was relatively high at pre-test and did not change post-test. Outcome expectations and self-efficacy were not significantly different from pre- to post-test.Functional fitness training resulted in increased core endurance and improved execution of some movement patterns associated with good body mechanics. Our study provides evidence for the inclusion of this type of conditioning program in the dental hygiene curriculum. Further research, including more sensitive tests of physical function as well as the transfer of knowledge and safe postures into clinically relevant situations, is warranted.Le positionnement statique et les mauvaises postures mettent les hygiénistes dentaires à risque de troubles musculosquelettiques liés au travail. Ces troubles surviennent souvent au cours des programmes de formation professionnelle. Il a été démontré que la formation en matière d’ergonomie réduit l’incidence des blessures, alors que le conditionnement physique effectué pour améliorer la prise de conscience posturale et l’endurance ne fait généralement pas partie du programme d’étude en hygiène dentaire. La présente recherche a évalué les effets d’un programme de conditionnement physique fonctionnel de 12 semaines sur les connaissances en matière de l’ergonomie et de la posture, des attentes de résultats, de la connaissance de ses propres capacités liées à l’exercice, ainsi que de la stabilité du tronc chez les étudiants de dernière année en hygiène dentaire.Les participants (n = 24) ont rempli des sondages, effectué des tests de stabilité du tronc et démontré des mouvements posturaux avant et après avoir terminé une formation hebdomadaire obligatoire axée sur la stabilisation dynamique du tronc, les exercices aérobiques et la prise de conscience posturale.Les participants ont amélioré leurs résultats de temps de planche statique et de l’exercice de fente avant de la jambe gauche et n’ont pas montré de changements significatifs dans leurs tests d’exercice de fente avant de la jambe droite ou de répulsions, des exercices de stabilisation du tronc. La précision des mouvements posturaux en réponse aux stimulations verbales s’est améliorée dans 2 des 6 mouvements. Les connaissances sur les facteurs de risque en matière des blessures et sur la mécanique du corps étaient relativement élevées au moment du test préliminaire et n’ont pas changé après le test. Les attentes de résultats et la connaissance de ses propres capacités n’étaient pas significativement différentes entre le test préliminaire et le post-test.Le conditionnement physique fonctionnel s’est traduit en une meilleure endurance du tronc et une performance améliorée de certaines séquences de mouvements associés à la bonne fonction mécanique du corps. Notre étude apporte des preuves qui appuient l’ajout de ce type de programme de conditionnement au programme d’hygiène dentaire. Il est justifié de faire des recherches plus poussées, y compris des évaluations plus sensibles de la fonction physique, ainsi que du transfert des connaissances et des postures sécuritaires aux situations cliniques pertin.

Rural isolation can limit access to basic services and income-generating opportunities. Among some communities, rainfall induced flooding can cause increased uncertainty where first-mile transportation infrastructure is limited. In Rwanda, this challenge is apparent, where 90% of the population below the poverty line live in rural areas that are typically mountainous with frequent flooding - events that may be increasing in frequency and severity as the climate changes. To reduce these transportation barriers, the non-profit organization Bridges to Prosperity (B2P) plans to construct hundreds of trailbridges in Rwanda between 2018 and 2023. This scale of rural infrastructure services presents an opportunity for experimental investigation of the effects of these new trailbridges on economic, health, agricultural and education outcomes in rural communities. In this paper, we present a cohort study evaluating the potential community benefits of rural trailbridges - including economic, health and social outcomes for Rwandan communities experiencing environmental change. We examined households living near 12 trailbridge sites and 12 comparison sites over February 2019–March 2020. We found that labor market income increased by 25% attributable to the trailbridges. We did not observe any significant effects on agricultural income, education or health outcomes, however given the small sample and short duration of this study we anticipate observing additional outcomes within the recently started 200 site, 4 year trial.

Despite decades of global development programming, poverty persists in the low-and-middle-income countries targeted by these efforts. Training approaches to global development must change and the role of engineers in these efforts must evolve to account for structural and systemic barriers to global poverty reduction. Rapid growth in Global Engineering graduate programs in the United States and Canada creates an opportunity to unify efforts between academic institutions and ensure that programs align with the sector's needs as identified by practitioners. To build consensus on how to equip engineering students with the knowledge, skills and attitudes necessary, we convened practitioners, faculty and graduate students for a two-day workshop to establish an agreed-upon Global Engineering body of knowledge. The workshop was informed by a pre-event survey of individual participants and representatives of participating academic institutions with graduate programs in Global Engineering or a related field. Through the workshop breakout sessions and post-event work by the authors, we developed the following priority learning objectives for graduate education in global engineering: Contextual Comprehension and Analysis; Cross-cultural Humility; Global Engineering Ethics; Stakeholder Analysis and Engagement; Complex Systems Analysis; Data Collection and Analysis; Data-driven Decision Making; Applied Engineering Knowledge; Project Design; Project Management; Multidisciplinary Teamwork and Leadership; Communication; Climate Change, Sustainability, and Resilience; Global Health; and Development Economics. Although technical skills are central to preparing the next generation of Global Engineers, transversal and interdisciplinary skills are equally important in equipping students to work across sectors and account for barriers to global development and equity.

ObjectivesTo study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10–11 years old.DesignCross-sectional study.SettingData were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study.Participants713 children (male (n=330) and female (n=383) 10–11 years old) from Studying Physical Activity in Children’s Environments across Scotland.Primary and secondary outcome measuresChildren who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (ResultsDistance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with ‘most’ walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2–Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys).ConclusionWalkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children’s ATS.

In subjects like cell biology, genetics, and immunology, a solid understanding of signal transduction is key to mastering new content. Often times students’ approach to learning signal transduction pathways relies heavily on memorization. In this paper, we describe a modular method to introduce students to signal transduction. In this method, students are first presented with the discreet building blocks or molecules that comprise signaling pathways (such as the vocabulary terms signal molecule, receptor, effector and target) and asked to integrate the knowledge by building (“do it yourself” or DIY) their own signaling pathway. Students are then given the opportunity to learn about each other’s pathways to identify ways in which they overlap and diverge. Ultimately, students are given the task to search the literature to identify a real-world example that mimics or is very similar to the pathway they came up with and note similarities and differences. We find this is a way to foster students integrating signal transduction knowledge.

Internationally, a growing number of interprofessional education (IPE) offices are being established within academic institutions. However, few are applying educational improvement methodologies to evaluate and improve the interprofessional (IP) learning opportunities offered. The University of Manitoba IPE Initiative was established in 2008 to facilitate the development of IP learning opportunities for pre-licensure learners. The research question for this secondary analysis was: what, if any, changes in the number and attributes of IP learning opportunities occurred in the academic year 2008–2009 compared to 2011–2012? The Points for Interprofessional Scoring (PIPES) tool was used to quantify the attributes of each IP learning opportunity. Most notably in 2012, eight (73%) of 11 IP learning opportunities achieved the highest PIPES score (> 55), compared to only four (36%) in 2009. The concept of the PIPES score is introduced as an educational improvement strategy and a potential predictor of achieving the desired educational outcome: collaborative competence.

Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for collaborative person-centred practice (IECPCP) is complex and requires “harmonization of motivations” within and between academia, governments, healthcare delivery sectors, and consumers. The main lesson learned at the University of Manitoba was the value of using a formal implementation framework to guide its work. This framework identifies key factors that must be addressed at the micro, meso, and macro levels and emphasizes that interventions occurring only at any single level will likely not lead to sustainable change. This paper describes lessons learned when using the framework and offers recommendations to support other institutions in their efforts to enable the roll out and integration of IECPCP.

Aim The aim of the study was to examine changes over time in satisfaction with usual transport mode, explore individual and area level characteristics as mediators in the likelihood of transport satisfaction, and whether any changes in transport satisfaction varied by these factors over time. Methods Adults from West Central Scotland, United Kingdom, who participated at both waves of the repeat cross-sectional ‘Transport, Health and Well-being Study’ conducted in 1997 (n=2735) and 2010 (n=2024) were assessed. Individuals completed a detailed postal questionnaire at both time points including self-rated satisfaction with usual transport mode (using a seven point scale subsequently dichotomised to a binary outcome of satisfied (1–2) and other (3–7)). Participants reported usual transport mode for travel to various destinations. A multilevel logistic regression model was used and individuals were nested within areas (c. 4000 population). Results At the 2010 sweep, two thirds (n=1345) of individuals were satisfied with their transport choice. Those with fair/poor health were less satisfied with their usual transport compared to those in better health (Odds Ratio (OR) 0.49, p, Highlights • This study described change over time in satisfaction with usual transport mode from 1997 to 2010. • Two third of individuals were satisfied with their usual transport for journeys. • Those with poor or fair health experienced worse transport satisfaction. • Access to a car at household increased transport satisfaction regardless of main mode. • Continued efforts should be made to promote health beneficial active transport modes.

Unsafe drinking water contributes to diarrheal disease and is a major cause of morbidity and mortality in low-income contexts, especially among children under five years of age. Household-level water treatment interventions have previously been deployed in Rwanda to address microbial contamination of drinking water. In this paper, we describe an effort to integrate best practices regarding distribution and promotion of a household water filter with an on-going health behavior messaging program. We describe the implementation of this program and highlight key roles including the evaluators who secured overall funding and conducted a water quality and health impact trial, the promoters who were experts in the technology and behavioral messaging, and the implementers who were responsible for product distribution and education. In January 2019, 1023 LifeStraw Family 2.0 household water filters were distributed in 30 villages in the Rwamagana District of Rwanda. Approximately a year after distribution, 99.5% of filters were present in the household, and water was observed in 95.1% of filters. Compared to another recent water filter program in Rwanda, a lighter-touch engagement with households and supervision of data collection was observed, while also costing approximately twice per household compared to the predecessor program.

Background Recent research on the determinants of health-related behaviours, such as smoking, heavy drinking and poor diet, has begun to focus on physical environmental factors, such as the retail environment, and associations with area level deprivation. This study utilises an innovative application of spatial cluster analysis to examine the socio-spatial patterning of various categories of outlets, selling potentially health-damaging goods/services (alcohol, fast food, tobacco and gambling) within Glasgow. This novel application advances existing methods for quantifying spatial access to retail outlets as it is not restricted by pre-defined boundaries. Methods Outlet address data was obtained from Glasgow City Council for 2012 (tobacco, fast food), and 2013 (alcohol, gambling) and mapped using GIS software. SaTScan, a well-established cluster analysis tool, was used to detect spatial clusters of outlets and ascertain their statistical significance (at the 5% level). Analysis was performed for all categories of outlets combined (to examine co-location), and individually for alcohol, fast food, tobacco, and gambling outlets. Software provided output for clusters centroids, size (radius) and statistical significance. Clusters were assigned a Scottish Index of Multiple Deprivation 2012 Income score; quintiles of income deprivation were calculated from 1 (most deprived) to 5 (least deprived) and compared for numbers of clusters. Results Across the city, there were 28 areas where all four types of outlets were co-located; and for individual outlets, there were 20 alcohol outlet clusters, 16 fast food outlet clusters, 15 tobacco outlet clusters and 5 gambling outlet clusters. Co-occurrence clusters were more common in deprived areas, with ten clusters in the more deprived quintile compared to one in the most affluent quintile. In terms of individual categories of outlet, poorer areas contained the largest number of alcohol, fast food, tobacco and gambling outlet clusters. Co-location of individual types of outlets in similar geographical areas was also evident, for example: located in the central business district, other retail, office, service hubs, and also deprived areas in the ‘east end’. Conclusion The study makes use of a robust technique to detect clusters and adds to evidence that deprived areas have increased access to potentially health damaging goods/services. Such research can inform interventions to tackle the co-occurrence of health behaviours, and findings could aid authorities to develop policy/planning regulations appropriate for areas in greatest need.

Background Edentulism is relatively common and is often treated with the provision of complete or partial removable dentures. Clinicians make final impressions of complete dentures (CD) and removable partial dentures (RPD) using different techniques and materials. Applying the correct impression technique and material, based on an individual's oral condition, improves the quality of the prosthesis, which may improve quality of life. Objectives To assess the effects of different final-impression techniques and materials used to make complete dentures, for retention, stability, comfort, and quality of life in completely edentulous people.To assess the effects of different final-impression techniques and materials used to make removable partial dentures, for stability, comfort, overextension, and quality of life in partially edentulous people. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 22 November 2017), MEDLINE Ovid (1946 to 22 November 2017), and Embase Ovid (21 December 2015 to 22 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases, however the search of Embase was restricted by date due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. Selection criteria We included randomised controlled trials (RCTs) comparing different final-impression techniques and materials for treating people with complete dentures (CD) and removable partial dentures (RPD). For CD, we included trials that compared different materials or different techniques or both. In RPD for tooth-supported conditions, we included trials comparing the same material and different techniques, or different materials and the same technique. In tooth- and tissue-supported RPD, we included trials comparing the same material and different dual-impression techniques, and different materials with different dual-impression techniques. Data collection and analysis Two review authors independently, and in duplicate, screened studies for eligibility, extracted data, and assessed the risk of bias for each included trial. We expressed results as risk ratios (RR) for dichotomous outcomes, and as mean differences (MD) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI), using the random-effects model. We constructed 'Summary of findings' tables for the main comparisons and outcomes (participant-reported oral health-related quality of life, quality of the denture, and denture border adjustments). Main results We included nine studies in this review. Eight studies involved 485 participants with CD. We assessed six of the studies to be at high risk of bias, and two to be at low risk of bias. We judged one study on RPD with 72 randomised participants to be at high risk of bias.Overall, the quality of the evidence for each comparison and outcome was either low or very low, therefore, results should be interpreted with caution, as future research is likely to change the findings.Complete denturesTwo studies compared the same material and different techniques (one study contributed data to a secondary outcome only); two studies compared the same technique and different materials; and four studies compared different materials and techniques.One study (10 participants) evaluated two stage-two step, Biofunctional Prosthetic system (BPS) using additional silicone elastomer compared to conventional methods, and found no evidence of a clear difference for oral health-related quality of life, or quality of the dentures (denture satisfaction). The study reported that BPS required fewer adjustments. We assessed the quality of the evidence as very low.One study (27 participants) compared selective pressure final-impression technique using wax versus polysulfide elastomeric (rubber) material. The study did not measure quality of life or dentures, and found no evidence of a clear difference between interventions in the need for adjustments (RR 0.81, 95% CI 0.38 to 1.70). We assessed the quality of the evidence as very low.One study compared two stage-two step final impression with alginate versus silicone elastomer. Oral health-related quality of life measured by the OHIP-EDENT seemed to be better with silicone (MD 7.20, 95% CI 2.71 to 11.69; 144 participants). The study found no clear differences in participant-reported quality of the denture (comfort) after a two-week 'confirmation' period, but reported that silicone was better for stability and chewing efficiency. We assessed the quality of the evidence as low.Three studies compared single-stage impressions with alginate versus two stage-two step with elastomer (silicone, polysulfide, or polyether) impressions. There was no evidence of a clear difference in the OHIP-EDENT at one month (MD 0.05, 95% CI -2.37 to 2.47; two studies, 98 participants). There was no evidence of a clear difference in participant-rated general satisfaction with dentures at six months (MD 0.00, 95% CI -8.23 to 8.23; one study, 105 participants). We assessed the quality of the evidence as very low.One study compared single-stage alginate versus two stage-two step using zinc-oxide eugenol, and found no evidence of a clear difference in OHIP-EDENT (MD 0.50, 95% CI -2.67 to 3.67; 39 participants), or general satisfaction (RR 3.15, 95% CI 0.14 to 72.88; 39 participants) at six months. We assessed the quality of the evidence as very low.Removable partial denturesOne study randomised 72 participants and compared altered-cast technique versus one-piece cast technique. The study did not measure quality of life, but reported that most participants were satisfied with the dentures and there was no evidence of any clear difference between groups for general satisfaction at one-year follow-up (low-quality evidence). There was no evidence of a clear difference in number of intaglio adjustments at one year (RR 1.43, 95% CI 0.61 to 3.34) (very low-quality evidence). Authors' conclusions We conclude that there is no clear evidence that one technique or material has a substantial advantage over another for making complete dentures and removable partial dentures. Available evidence for the relative benefits of different denture fabrication techniques and final-impression materials is limited and is of low or very low quality. More high-quality RCTs are required.

The introduction to this special issue on Canada and emerging markets introduces some of the key concepts and theoretical perspectives developed in the issue. The rise of emerging markets, especially the BRICS (Brazil, Russia, India, China and South Africa) poses serious challenges to the conduct of Canadian foreign and economic policy. In this special issue, we review Canada's record of relations with these countries (including the 2013 Global Markets Action Plan), and identify some of the main obstacles to improved relations. All of the authors argue that the response to this challenge to date has been inadequate, and that Canada is falling behind in the reshuffling global order. This introductory article describes changes in Canada's global economic position and identifies literature on institutions and cognitive commitments, global bricolage and the relationship between “old” and “new” middle powers which provide some guidance for evaluating the challenges and limitations of Canada's relations...

In the biological sciences, students frequently equate understanding to compiling and memorizing information as a series of isolated facts. For this reason, they struggle to connect major concepts across course curriculums. In other disciplines, improvisation techniques have been introduced as a way to engage with millenials, who learn best through inductive and experiential learning. Here we present an improvisational classroom activity called “Yes, and…” as a review technique that can be used throughout the semester and in multiple contexts to help students assimilate and integrate information. Students in small groups first review a major topic provided by the instructor (for example, DNA structure or DNA properties). Then, one student in the group contributes one sentence that starts a narrative about the topic being reviewed as learned in class. Additional members of the group then take turns, one at a time, to add additional layers of details to the narrative. The group dynamic continues until all of the students in the group have contributed at least one sentence to the narrative. Students are encouraged to listen carefully to their classmates’ contributions so that inaccurate ideas can be identified and tweaked through conversation at the end of one round of the exercise. The instructor moves between groups to continue to foster the learning experience. We find that the “Yes, and…” approach promotes deep student engagement with course material, collaboration among students of different backgrounds, and fosters development of oral communication skills.

Summary Background Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. Aim To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.

Sedentary behaviour is an emerging risk factor for poor health. This study aimed to identify ecological determinants of sedentary behaviour, for which evidence is currently scarce. The study participants were community dwelling adults from, respectively, the Lothian Birth Cohort 1936 (n = 271, mean age 79) and the 1930s (n = 119, mean age 83) and 1950s (n = 310, mean age 64) cohorts of the West of Scotland Twenty-07 study. The outcome measure, percentage of waking time spent sedentary (sedentary time), was measured using an activPAL activity monitor worn continuously for seven days. Potential determinants included objective and subjective neighbourhood measures such as natural space, crime, social cohesion and fear of crime. Other determinants included measures of social participation such as social support, social group membership and providing care. Results from multivariable regression analyses indicated that providing care was associated with reduced sedentary time in retired participants in all cohorts. Fear of crime and perceived absence of services were associated with increased sedentary time for retired 1950s cohort members. Higher crime rates were associated with increased sedentary time in all cohorts but this was not significant after adjustment for socio-demographic characteristics. Most other neighbourhood and social participation measures showed no association with sedentary time.

Every year thousands of Mexicans travel to Canada to work in Canadian fields and greenhouses under the Mexico-Canada Seasonal Agricultural Worker Program. While the programme is often praised, it has also been the subject of persistent criticism about its failure to meet certain human rights standards. In this article, we examine the legal strategies civil society advocates of migrant workers have adopted to promote migrant workers' rights in Canada. Specifically, we examine legal struggles undertaken by the United Food and Commercial Workers union to challenge Ontario government legislation that does not permit collective bargaining by farmworkers in the province. We argue that this case demonstrates that despite the fact that many of the workers involved are transnationalized, appeals to international bodies or to international human rights standards have been of limited utility in promoting their rights. Despite frequent arguments about the increased relevance of international human rights and citizens...

AIMS: To examine how glassware functions as a marketing tool. METHODS: Content analysis of trade journals. RESULTS: Glassware is used as an integral part of marketing activity to recruit customers, revive brands, build profits and increase consumption. CONCLUSION: Glassware should be subject to the same control as other forms of marketing. Glasses could be re-engineered to promote safer drinking. Language: en

Associations between different alcohol outcomes and outlet density measures vary between studies and may not be generalisable to adolescents. In a cross-sectional study of 979 15-year old Glaswegians, we investigated the association between alcohol outlet availability (outlet density and proximity), outlet type (on-premise vs. off-premise) and frequent (weekly) alcohol consumption. We adjusted for social background (gender, social class, family structure). Proximity and density of on-premise outlets were not associated with weekly drinking. However, adolescents living close (within 200 m) to an off-sales outlet were more likely to drink frequently (OR 1.97, p=0.004), as were adolescents living in areas with many nearby off-premises outlets (OR 1.60, p=0.016). Our findings suggest that certain alcohol behaviours (e.g. binge drinking) may be linked to the characteristics of alcohol outlets in the vicinity., Highlights ► We examined the link between adolescent alcohol use and alcohol outlet availability. ► Proximity and density of on-premises outlets is unrelated to adolescent alcohol use. ► Adolescents in close proximity to off-licence outlets have elevated alcohol use.

Background: It is usually assumed that housing tenure and car access are associated with health simply because they are acting as markers for social class or income and wealth. However, previous studies conducted in the late 1990s found that these household assets were associated with health independently of social class and income. Here, we set out to examine if this is still the case.\ud \ud Methods: We use data from our 2010 postal survey of a random sample of adults (n=2092) in 8 local authority areas in the West of Scotland. Self-reported health measures included limiting longstanding illness (LLSI), general health over the last year and the Hospital Anxiety and Depression Scale.\ud \ud Results: We found a statistically significant relationship between housing tenure and all 4 health measures, regardless of the inclusion of social class or income as controls. Compared with owner occupiers, social renters were more likely to report ill-health (controlling for social class—LLSI OR: 3.24, general health OR: 2.82, anxiety η2: 0.031, depression η2: 0.048, controlling for income—LLSI OR: 3.28, general health OR: 2.82, anxiety η2: 0.033, depression η2: 0.057) (p

Background Oral leukoplakia is a relatively common oral lesion that, in a small proportion of people, precedes the development of oral cancer. Most leukoplakias are asymptomatic; therefore, the primary objective of treatment should be to prevent onset of cancer. This review updates our previous review, published in 2006. Objectives To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer. Search methods We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 4), MEDLINE Ovid (1946 to 16 May 2016), Embase Ovid (1980 to 16 May 2016) and CancerLit via PubMed (1950 to 16 May 2016). We searched the metaRegister of Controlled Trials (to 10 February 2015), ClinicalTrials.gov (to 16 May 2016) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 16 May 2016). We placed no restrictions on the language or date of publication when searching electronic databases. Selection criteria We included randomised controlled trials (RCTs) that enrolled people with a diagnosis of oral leukoplakia and compared any treatment versus placebo or no treatment. Data collection and analysis We collected data using a data extraction form. Oral cancer development, demonstrated by histopathological examination, was our primary outcome. Secondary outcomes were clinical resolution of the lesion, improvement of histological features and adverse events. We contacted trial authors for further details when information was unclear. When valid and relevant data were available, we conducted a meta-analysis of the data using a fixed-effect model when we identified fewer than four studies with no heterogeneity. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We assessed risk of bias in studies by using the Cochrane tool. We assessed the overall quality of the evidence by using standardised criteria (Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE)). Main results We included 14 studies (909 participants) in this review. Surgical interventions, including laser therapy and cryotherapy, have never been studied by means of an RCT that included a no treatment or placebo arm. The included trials tested a range of medical and complementary treatments, in particular, vitamin A and retinoids (four studies); beta carotene or carotenoids (three studies); non-steroidal anti-inflammatory drugs (NSAIDs), specifically ketorolac and celecoxib (two studies); herbal extracts (four studies), including tea components, a Chinese herbal mixture and freeze-dried black raspberry gel; bleomycin (one study); and Bowman-Birk inhibitor (one study). We judged one study to be at low risk of bias, seven at unclear risk and six at high risk. In general, we judged the overall quality of the evidence to be low or very low, so findings are uncertain and further research is needed. Five studies recorded cancer incidence, only three of which provided useable data. None of the studies provided evidence that active treatment reduced the risk of oral cancer more than placebo: systemic vitamin A (RR 0.11, 95% CI 0.01 to 2.05; 85 participants, one study); systemic beta carotene (RR 0.71, 95% CI 0.24 to 2.09; 132 participants, two studies); and topical bleomycin (RR 3.00, 95% CI 0.32 to 27.83; 20 participants, one study). Follow-up ranged between two and seven years. Some individual studies suggested effectiveness of some proposed treatments, namely, systemic vitamin A, beta carotene and lycopene, for achieving clinical resolution of lesions more often than placebo. Similarly, single studies found that systemic retinoic acid and lycopene may provide some benefit in terms of improvement in histological features. Some studies also reported a high rate of relapse. Side effects of varying severity were often described; however, it seems likely that interventions were well accepted by participants because drop-out rates were similar between treatment and control groups. Authors' conclusions Surgical treatment for oral leukoplakia has not been assessed in an RCT that included a no treatment or placebo comparison. Nor has cessation of risk factors such as smoking been assessed. The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer. Treatments such as vitamin A and beta carotene may be effective in healing oral lesions, but relapses and adverse effects are common. Larger trials of longer duration are required to properly evaluate the effects of leukoplakia treatments on the risk of developing oral cancer. High-quality research is particularly needed to assess surgical treatment and to assess the effects of risk factor cessation in people with leukoplakia.

Environmental movements depend on mass media to reach the public and shape political decision-making. Without media access, social movements experience political marginality. In this paper, we examine whether the internet is a more open space than traditional media for activists to speak on behalf of non-human nature. Our analysis is based upon newspaper coverage and environmental organization websites that focus on the conflict over the proposed Jumbo Glacier Resort ski resort development in British Columbia. Environmental websites and mass media texts both define Jumbo Pass as wilderness and grizzly bear habitat, while focusing on ecological issues and questions of local democracy. However, environmental group websites discuss a greater range of environmental risks and provide more detailed discussion of these issues. Environmentalist websites also integrate scientific experts and celebrity supporters to a greater degree than mass media texts, which are dominated by environmentalist, ski industry, and provincial government news sources.

Thyroid cancer is the most common endocrine malignancy, and incidence has been steadily increasing, suggesting occurrence will exceed that of colon cancer by 2030. Papillary and follicular thyroid cancer subtypes are most common, which are activated by BRAF and HRAS mutations, respectively. Interestingly, papillary and follicular thyroid cancers are associated with different pathologies and metastases. Currently, both papillary and follicular thyroid cancers are treated by surgical removal of the thyroid, followed by radioactive iodine treatment to eliminate any remaining tumor cells. Unfortunately, for individuals with progressive thyroid cancer, these treatment options are not effective, highlighting a need for increased investigation into mechanisms of drug sensitivity. In this study, we sought to evaluate mechanisms of differential drug sensitivity through RNA-seq analysis of cell lines derived from mouse models of papillary and follicular thyroid cancer. Additionally, we evaluated the effects of MAPK, AKT, and mTOR inhibitors on murine papillary and follicular thyroid cancer cell proliferation. To accurately assess drug efficacy, we calculated GR50 concentrations for each inhibitor in six papillary and follicular thyroid cancer cell lines. We discovered that papillary and follicular thyroid cancer cell lines responded differently to MAPK and AKT inhibitors, suggesting that treatment approaches should be tailored to subtype despite having mutations in the same signaling pathway. Citation Format: Brianna LeBoeuf, Braxton Anderson, Margaret Young, Aime Franco, Laura MacDonald. Evaluating the effectiveness of MAPK, AKT, and mTOR inhibitors in reducing proliferation in cellular models of papillary and follicular thyroid cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2887.

Thyroid cancer is the most common endocrine cancer, and incidence is increasing worldwide. Thyroid cancer can be classified as either well differentiated or poorly differentiated. Of well-differentiated thyroid cancers, papillary thyroid cancer is most common, and is associated with activating BRAF mutations. While our understanding of the genetic basis for thyroid cancer is fairly extensive, less is known about how the tumor microenvironment alters characteristics of tumor cells. Recently, Jolly and others reported that papillary thyroid tumors derived from cells harboring BRAFV600E mutations and PTEN deletions are enriched with fibrillar collagen. Notably, overexpression of collagen was also associated with decreased survival and worse overall prognosis in patient samples. In this study, we investigated whether growth on collagen enhanced tumorigenic characteristics of papillary thyroid cancer cell lines with BRAFV600E mutations. Three distinct cell lines derived from mouse papillary thyroid cancer tumors were grown in the presence and absence of collagen and assessed for changes in morphology, proliferation, and drug resistance. Interestingly, our results suggest that growth on collagen contributes to a more mesenchymal morphology, increased proliferation, and decreased sensitivity to chemotherapy drugs. These and other results implicate an important role for collagen in the progression of thyroid cancer. Citation Format: Anna Sharabura, Jonathan Jenkins, Laura MacDonald. Collagen increases tumorigenic characteristics of papillary thyroid cancer cells harboring BRAFV600Emutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 172.