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Background: Collection of HPC by apheresis (HPC-A) can sometimes result in higher collection volumes, increasing the dimethyl sulfoxide (DMSO) volume infused into patients and the space requirements in liquid nitrogen freezers. Volume reduction prior to the addition of cryoprotectant is an efficient means to reduce the DMSO load infused into patients and to optimize freezer storage space.Study Design and Methods: To implement a closed semi-automated volume reduction process, a method was developed to produce leukocyte-rich mock apheresis products using buffy coats derived from whole blood collections. The mock HPC products were then used to measure the efficiency and reliability of the semi-automated process over a range of volumes and cell concentrations. The resulting data was used to support the implementation of the process with concurrent monitoring.Results: A closed, semi-automated volume reduction process resulted in recoveries of over 93% and 91% of white blood cells and CD34+ cells with no significant loss of product viability or potency. Mean doses of CD34+ and CFU infused per kilogram recipient body weight were 4.0 ± 1.1 × 106 /kg and 4.2 ± 1.7 × 105 /kg, resulting in no delays in median time to neutrophil and platelet engraftment, significant increase in adverse reaction or nonconformances.Discussion: The effectiveness outcomes of the first Canadian experience in the implementation of a closed semi-automated volume reduction system in the processing of HPC-A products for autologous transplant have met the predetermined acceptance criteria, supporting its use in a stem cell manufacturing laboratory compliant with good manufacturing practice regulations. [ABSTRACT FROM AUTHOR]

An introduction is presented discusses the work of historian Don Morrow as a sport historian in Canada, noting issue articles on Canadian high jumper Eva Dawes, lacrosse player Frank Grace, and an Indigenous lacrosse team at the 1904 Olympic games.

Objective: The Moms' Empowerment Program (MEP) provides affordable services to address the effects of women experiencing intimate partner violence (IPV) and to enhance their mental health. In past evaluations with mothers of school-age children this ten-session program was successful in reducing women's symptoms of posttraumatic stress. Method: A new efficacy trial compares outcomes for women with preschool-age children who received the MEP to those randomly assigned to a waitlist comparison condition. Women with young children (N = 120) who had experienced IPV living in Southeast Michigan and Ontario, Canada, were assessed at baseline, 5 weeks later (at post-intervention) and at approximately 8-month follow-up. Using standardized measures, this evaluation compared rates of change in women's symptoms of posttraumatic stress. Results: Approximately 46% of the women were diagnosed with posttraumatic stress disorder (PTSD); 94% reported re-experiencing symptoms, 85% physiological arousal symptoms, and 69% avoidance/numbing symptoms. Hierarchical Linear Modeling (HLM) results showed that the MEP was somewhat successful in reducing women's symptoms of posttraumatic stress symptoms. However, the extent of improvement was related to both age and the number of sessions attended during the program. Conclusion: This finding indicates that mothers with young children, who have experienced IPV and who are significantly distressed, may be successfully treated by attending this group intervention designed specifically to address their unique experiences and needs. Clinical impact: High rates of traumatic stress and PTSD are found in women who experience intimate partner violence. A comparison study showed that a 10-session group intervention, the MEP, was success in reducing their traumatic stress. [ABSTRACT FROM AUTHOR]

Long-term studies on wildlife populations are necessary to track population abundance and shifts in demography over time, yet such studies are difficult to plan, fund, and conduct and are therefore rarely undertaken. Such studies are especially important for long-lived species that can persist for long periods of time with little to no reproductive output or recruitment. We conducted two population studies spanning a 30-year time frame on the globally endangered Spotted Turtle (Clemmys guttata) on protected land in the center of their range. Spotted Turtles are endangered in Canada, listed as globally endangered on the IUCN red list, and declining throughout their range. However, there has only been one previous long-term study tracking their long-term population trajectory. Here, we use mark–recapture data collected over a 30-year time frame and report that the estimated population size of Spotted Turtles has decreased by 49% at our study site despite the habitat residing with a protected area. This decline was concurrent with a significant increase in the proportion of larger individuals within the population, indicating a lack of recruitment into the sub-adult stage class. These results highlight the value of long-term studies in monitoring population changes of long-lived species, the importance of active management within protected areas, and the ability of long-lived species to persist for long periods of time despite having little recruitment and a declining population trajectory. [ABSTRACT FROM AUTHOR]

Roads impact wildlife in a variety of direct and indirect ways. Roads may act as barriers to dispersal, lead to decreasing population size and genetic diversity, change animal behavior, result in direct mortality, and increase habitat disturbance. Road mortality is especially detrimental to long-lived species, such as freshwater turtles, whose population persistence relies on high adult and subadult survivorship to counter high egg and hatchling mortality. The Spotted Turtle (Clemmys guttata) is a small-bodied, freshwater turtle species that is listed as endangered in Canada and proposed for federal listing in the United States. We used a population viability analysis to attempt to quantify the impact that road mortality has on two distinct populations of Spotted Turtles. The baseline model for the North Wetland Complex (NWC) population predicted a probability of quasi-extinction within 150 yr of 20%. The baseline model for the South Wetland Complex (SWC) predicted a probability of quasi-extinction within 150 yr of 24%. Including an estimate of road mortality (modeled as a reduction in adult survival through annual catastrophic events) into the models, the probability of quasiextinction within 150 yr changed to 93% for the NWC and 94% for the SWC. Our results highlight the critical importance that anthropogenic additive adult mortality has on small populations of turtles and the necessity of detailed demographic studies to detect potential declines in populations of long-lived species. [ABSTRACT FROM AUTHOR]

We present an algorithm to detect melt onset over Arctic sea ice using high resolution synthetic aperture radar (SAR) images from RADARSAT. The algorithm is based on the temporal evolution of the SAR backscatter coefficient (σ°), using an ice type specific threshold approach that also corrects for incidence angle variation. Using 4457 RADARSAT images, the algorithm was applied over sea ice in the northern Canadian Arctic Archipelago that low spatial resolution microwave sensors have difficulty resolving, thus generating a new time series of melt onset from 1997 to 2014. Over the 1997–2014 period, the mean annual average melt onset date in the northern CAA was on year day 164 (mid–June) with a standard deviation of 4 days. No significant trend for melt onset date was found over the 18-year period. An earlier (later) melt onset was associated with increased (decreased) solar energy absorption ( r = 0.64, significant at 95% confidence) and subsequently associated in lighter (heavier) September sea ice coverage in the northern CAA ( r = 0.62, significant at 95% confidence). RADARSAT estimates of melt onset were found to be in good agreement but more robust compared to passive microwave and scatterometer estimates over the northern CAA. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual and developmental disability (IDD) have historically had high unemployment and underemployment rates and continue to face significant barriers to attaining and sustaining employment. The purpose of this research, conducted in Ontario, Canada was to better understand the experiences of people with IDD gaining and keeping productivity roles.Method: We used qualitative semi-structured interviews with 74 participants with IDD and their families or caregivers as proxies regarding the employment of a person with IDD. We selected a sample of persons from three different geographic regions in Ontario, Canada, and analyzed data through coding methods consistent with a grounded theory approach.Results: Our results demonstrate the importance of parents and other members of social and family networks relative to connecting with work options and sustaining work over time, especially through continued advocacy and investment. Parents helped individuals with IDD negotiate the right job fit, though they often encountered challenges as a result of their efforts.Conclusion: Practitioners must understand how to support parents to be effective advocates for their adult children with IDD, assist them to develop and maintain their social networks and help them to avoid caregiver burnout.Implications for RehabilitationPeople with intellectual and developmental disability (IDD) face numerous challenges in indentifying work options and overcoming barriers to employment.Parents and other non-paid support members of social networks can be instrumental in ensuring that persons with IDD not only secure initial job placements, but also sustain employment and employment alternatives.Professionals that support persons with IDD can direct their efforts to helping persons with IDD develop strong social connections, as well as helping parents to prevent burnout. [ABSTRACT FROM PUBLISHER]

The article discusses the reintegration of Canadian aboriginal peoples into the community following their prison sentences in the Canadian Criminal Justice System (CJS), including through referencing the theory of desistance. An overview of the culture and spirituality of aboriginal ex-convicts is provided. Rehabilitation programs in Canada for aboriginal ex-convicts are discussed.

Background: Why do many patients not die at their preferred location?Aim: Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults(barriers and facilitators).Design: Cross-country comparison study from a "most similar-most different" perspective, triangulating evidence from a scopingreview of the literature, document analyses, and semi-structured key informant interviews.Setting: Case study of Canada, England, Germany, and the United States.Results: While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models ofservice provision were employed in the four countries studied. Although hospice and palliative care services were generally offeredwith standard care along the disease continuum and in various settings, and featured common elements such as physical, psychosocial,and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provisionincluded legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledgeand perception ("giving up hope") challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care,including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identifiedas facilitators.Conclusion: Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as sharedcare, requires concerted action to align these system-level characteristics; many factors were identified as being essential but notsufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (CRF) in adults. Methods The internationally endorsed ADAPTE methodology was used to develop a practice guideline for pan- Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of CRF. The search included MEDLINE, EMBASE, CINAHL, the Cochrane Library, and other guideline and data sources to December 2009. Results Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process. Conclusions Practice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care. [ABSTRACT FROM AUTHOR]

Abstract: Context: The Provincial Palliative Care Integration Project (PPCIP) was implemented in Ontario, Canada, to enhance the quality of palliative care delivery. The PPCIP promoted collaboration and integration across service sectors to improve screening and assessment, palliative care processes, as well as clinician practice and outcomes for cancer patients. Objectives: The project involved 1) implementation of the Edmonton Symptom Assessment System (ESAS) for symptom screening, 2) use of “rapid-cycle change” quality improvement processes to improve screening and symptom management, and 3) improvements in integration and access to palliative care services. Methods: Symptom scores were collected and made accessible to the care team through a web-based tool and kiosk technology, which helped patients enter their ESAS scores at each visit to the regional cancer center or at home with their nurse. Symptom response data were gathered through clinical chart audits. Results: Within one year of implementation, regional cancer centers saw improvements in symptom screening (54% of lung cancer patients), symptom control (69% of patients with pain scores and 31% of patients with dyspnea scores seven or more were reduced to six or less within 72 hours), and functional assessment (23% of all patients and 64% of palliative care clinic patients). ESAS screening rates reached 29%, and functional assessment reached 26% of targeted home care patients. Conclusion: The PPCIP demonstrated that significant strides in symptom screening and response can be achieved within a year using rapid-cycle change and collaborative approaches. It showed that both short- and long-term improvement require ongoing facilitation to embed the changes in system design and change the culture of clinical practice. [Copyright &y& Elsevier]

A considerable number of institutions offer courses in restoration ecology and its application, ecological restoration. We quantified the scope and structure of introductory restoration courses at 67 post-secondary institutions by reviewing institutional course catalogs and course syllabi. Most courses were available at Research-level institutions. More than half of the courses were offered within departments that focused on natural resource management, and were required or optional in a degree program. Most courses were taught in classroom settings during the academic year and were geared toward advanced students. Course titles suggested an emphasis on the science of restoration ecology over the practice of ecological restoration, and learning objectives focused primarily on concepts and less on skills and attitudes. Assessment was largely via conventional methods, notably exams. Many courses assigned readings from the primary literature; there was little consensus in terms of text selection. We conclude that restoration is being presented to students as an advanced undertaking and in largely theoretical terms. Although we were unable to consider other important elements such as thematic content, class size, or pedagogical method, our study provides a baseline assessment of introductory restoration courses that can be used to evaluate changes in restoration education or opportunities for restoration education in other countries. These results can inform the development of new introductory restoration courses, and raise important considerations in light of the development of a Practitioners' Certification Program by the Society for Ecological Restoration. [ABSTRACT FROM AUTHOR]

Abstract: Irregular residues of a yellow deposit that was assumed to be seal fat used for waterproofing were observed in the creases of the outer surface of a pair of Inuit boots from Arctic Canada. A sample of this deposit detached from one of these areas on these boots was examined initially by FT-Raman microscopy, from which interesting and rather surprising results demanded further analysis using FT-IR and GC–MS. The non-destructive Raman spectroscopic analysis yielded spectra which indicated the presence of a tree resin from the Pinaceae sp. The Raman spectra were also characteristic of a well-preserved keratotic protein and indicative of adherent skin. Subsequent FT-IR spectroscopic analysis supported the attribution of a Pinaceae resin to the yellow deposit. GC–MS analysis of the same deposits identified the presence of pimaric, sandaracopimaric, dehydroabietic and abietic acids, all indicative of an aged Pinaceae resin. These results confirmed that the Inuit people had access to tree resins which they probably used as a waterproofing agent. [Copyright &y& Elsevier]

The article focuses on the effect of physician shortages on patient wait times in Canada. The shortages of physicians are considered to be the primary obstacle in lengthening wait times. Another factor that contributes to the shortage of physicians is the absence of a central agency in the country to track the number or shortage of specialists, and the lack of report to track the impact of the shortfalls on medical care. The government and the public rely on the physician specialty organizations to forecast manpower requirements with data from national agencies. However, there are definitional and demographic difficulties in determining the number of working specialists and their capacity to resolve wait times.

Although cruise travel to the Canadian Arctic has grown steadily since 1984, some commentators have suggested that growth in this sector of the tourism industry might accelerate, given the warming effects of climate change that are making formerly remote Canadian Arctic communities more accessible to cruise vessels. Using sea-ice charts from the Canadian Ice Service, we argue that Global Climate Model predictions of an ice-free Arctic as early as 2050-70 may lead to a false sense of optimism regarding the potential exploitation of all Canadian Arctic waters for tourism purposes. This is because climate warming is altering the character and distribution of sea ice, increasing the likelihood of hullpenetrating, high-latitude, multi-year ice that could cause major pitfalls for future navigation in some places in Arctic Canada. These changes may have negative implications for cruise tourism in the Canadian Arctic, and, in particular, for tourist transits through the Northwest Passage and High Arctic regions. [ABSTRACT FROM AUTHOR]

This article reports on the delivery of education to students with special needs in Canada. Four students in Canada who use assistive technology comment on how this helped or hindered their transition from primary to secondary school. Assistive technology is defined. The study found that providing assisted technology is not enough to ease the transition for special needs students.

Research on norms for emotional expression and self-disclosure provided the basis for two hypotheses concerning the perceived intimacy of emotional self-disclosure. The first hypothesis was that the perceived intimacy of negative emotional disclosure would be greater than that of positive emotional disclosure; the second was that disclosures of more intense emotional states would be perceived as more intimate than disclosures of less intense emotional states for both negative and positive disclosures. Both hypotheses received support when male students in Canada rated the perceived intimacy of self-disclosures that were equated for topic and that covered a comprehensive sample of emotions and a range of emotional intensities. The effects were observed across all the topics of disclosure examined. [ABSTRACT FROM AUTHOR]

Background: Randomized clinical trial data show that early plasma transfusion may save lives among trauma patients. Supplying plasma in remote environments is logistically challenging. Freeze‐dried plasma (FDP) offers a possible solution. Study Design and Methods: A Terumo BCT plasma freeze‐drying system was evaluated. We compared pooled frozen plasma (FP) units with derived Terumo BCT FDP (TFDP) units and pooled COVID‐19 convalescent apheresis fresh‐frozen plasma (CC‐AFFP) with derived CC‐TFDP units. Parameters measured were: coagulation factors (F) II; V; VII; VIII; IX; XI; XIII; fibrinogen; Proteins C (PC) and S (PS); antithrombin (AT); α2‐antiplasmin (α2AP); ADAMTS13; von Willebrand Factor (vWF); thrombin–antithrombin (TAT); D‐dimer; activated complement factors 3 (C3a) and 5 (C5a); pH; osmolality; prothrombin time (PT); and activated partial thromboplastin time (aPTT). Antibodies to SARS‐CoV‐2 in CC‐AFFP and CC‐TFDP units were compared by plaque reduction assays and viral protein immunoassays. Results: Most parameters were unchanged in TFDP versus FP or differed ≤15%. Mean aPTT, PT, C3a, and pH were elevated 5.9%, 6.9%, 64%, and 0.28 units, respectively, versus FP. CC‐TFDP showed no loss of SARS‐CoV‐2 neutralization titer versus CC‐AFFP and no mean signal loss in most pools by viral protein immunoassays. Conclusion: Changes in protein activities or clotting times arising from freeze‐drying were <15%. Although C3a levels in TFDP were elevated, they were less than literature values for transfusable plasma. SARS‐CoV‐2‐neutralizing antibody titers and viral protein binding levels were largely unaffected by freeze‐drying. In vitro characteristics of TFDP or CC‐TFDP were comparable to their originating plasma, making future clinical studies appropriate. See editorial on page 257–260, in this issue [ABSTRACT FROM AUTHOR]

Background: Exposure to marketing and promotion of commercial milk formula is associated with an increased likelihood of formula-feeding. In 1981, the International Code (IC) of Marketing of Breastmilk Substitutes was adopted by the 34th World Health Assembly to restrict the promotion, marketing and advertising of commercial milk formula and protect breastfeeding. Research Aim: The current study examines mothers' exposure to violations of the IC in Newfoundland and Labrador, a province of Canada with low breastfeeding rates. Methods: A cross-sectional online survey measured exposure to IC violations (e.g., marketing, advertising and promotion of commercial milk formula) by mothers of infants less than two years old (n = 119). Data were collected on type, frequency, and location of violation. Results: Most participants (87%, n = 104/119) reported exposure to at least one IC violation. Of this group (n = 104): 94% received coupons or discount codes for the purchase of commercial milk formula; 88% received free samples of commercial milk formula from manufacturers, and 79% were contacted directly by commercial milk formula companies via email, text message, mail or phone for advertising purposes. One-third (n = 28/104, 27%) observed commercial milk formula promotional materials in health care facilities. The most frequent locations were violations occurred were doctors' offices (79%), supermarkets(75%), and pharmacies (71%). Conclusion: The majority of mothers of young infants were exposed to violations of the IC involving the marketing, advertising and promotion of commercial milk formula. Companies producing commercial milk formula reached out directly to new mothers to offer unsolicited promotions and free samples of commercial milk formula. [ABSTRACT FROM AUTHOR]

This study examined associations between HPV status and weight change in oropharyngeal cancer (OPC). OPC patients receiving concurrent chemoradiotherapy in Toronto, Canada were included. Relationships were assessed between HPV status and weight loss grade (WLG, combining weight loss and current body mass index); weight change during treatment; and HPV status and WLG/weight change on overall (OS) and cancer-specific (CSS) survival. Of 717 patients, WLG pre-radiation was less severe among HPV-positive compared to HPV-negative, though weight loss during treatment was greater. The adjusted odds ratio for greater WLG among HPV-positive versus HPV-negative was 0.47 (95%CI 0.28–0.78). Grade-4 WLG (worst category) experienced poorer OS and CSS (OS adjusted hazard ratio (aHR) 4.08; 95%CI 1.48–11.2, compared to Grade-0); and was non-significant for HPV-negative (aHR 2.34; 95%CI 0.69–7.95). Relationships between weight change before/during treatment and survival had similar direction between HPV-positive and HPV-negative, but of greater magnitude in HPV-positive patients. [ABSTRACT FROM AUTHOR]

Corporal punishment is a widely used and widely endorsed form of parental discipline. Inter-partner violence places enormous stress upon women. The rate of corporal punishment is higher in homes where other types of domestic violence are also occurring. This study compares two groups: those who participated in an intervention for women exposed to intimate partner violence (The Moms' Empowerment Program [MEP]) and those in a comparison group. Using standardized measures, women in both groups were assessed at baseline and at the end of the program, 5 weeks later. The 113 mothers who participated in the MEP program had significantly improved their parenting, such that they had less use of physical punishment post-intervention. Findings suggest that a relatively brief community-based intervention program can reduce the use of parental physical punishment even in disadvantaged populations coping with stressful circumstances. [ABSTRACT FROM AUTHOR]

Improving the status of endangered species can be challenging because the efficacy of conservation actions is often uncertain. Conservation aquaculture has been the main recovery action for endangered white sturgeon (Acipenser transmontanus) in the Transboundary Reach of the upper Columbia River. Using long-term mark-recapture data (2002–2018), we predicted variation in growth rates due to genetic, environmental, and competition effects to evaluate the efficacy of the aquaculture program. Environmental conditions (by season and country) and competition had the greatest effects on growth. Growth, length-at-age, weight-at-age, and condition factor were higher for fish residing in reservoir habitats (US) compared to those in riverine habitat (Canada). Growth declined over the study period but growth in length for larger fish remained higher in the US as fish > 100 cm fork length in Canada were not growing. Small differences in growth among families indicate that differences in genetics among parents spawned in the hatchery had negligible effects on growth in the wild. Our estimate of substantive negative density-dependent growth in Canada is important for management of conservation aquaculture for sturgeons. [ABSTRACT FROM AUTHOR]

Background Systematic screening for depressive symptoms may identify patients who may benefit from clinical assessment and psychosocial support. Here we assess a two-step screening using ultrabrief pre-screeners [Edmonton Symptom Assessment Survey–revised Depression item (ESASr-D) or Patient Health Questionnaire-2 (PHQ-2)] followed by the Patient-Reported Outcomes Measurement Information System Depression questionnaire (PROMIS-D) to identify depressive symptoms in patients on kidney replacement therapies. Methods We conducted a cross-sectional study of adults (kidney transplant recipients or treated with dialysis) in Toronto, ON, Canada. We simulated various two-step screening scenarios where only patients above a pre-screening cut-off score on the ESASr-D or PHQ-2 would move to step 2 (PROMIS-D). Screening performance was evaluated by sensitivity, specificity and positive and negative predictive values using the Patient Health Questionnaire-9 (PHQ-9) as the referent. The average number of items completed by patients in different scenarios was reported. Results Of 480 participants, 60% were male with a mean age of 55 years. Based on PHQ-9, 19% of patients had moderate or severe depressive symptoms. Pre-screening with a PHQ-2 score ≥1 combined with a PROMIS-D score of ≥53 provided the best two-step results (sensitivity 0.81, specificity 0.84, NPV 0.95). Two-step screening also reduces question burden. Conclusions A two-step screening using a PHQ-2 score ≥1 followed by a PROMIS-D score ≥53 has good sensitivity and specificity for identifying potentially significant depressive symptoms among patients on kidney replacement therapies. This approach has lower question burden. Screened-in patients will need further clinical assessment to establish a diagnosis. [ABSTRACT FROM AUTHOR]

The Canadian Sea Ice and Snow Evolution (Can- SISE) Network is a climate research network focused on developing and applying state of the art observational data to advance dynamical prediction, projections, and understanding of seasonal snow cover and sea ice in Canada and the circumpolar Arctic. Here, we present an assessment from the CanSISE Network on trends in the historical record of snow cover (fraction, water equivalent) and sea ice (area, concentration, type, and thickness) across Canada. We also assess projected changes in snow cover and sea ice likely to occur by mid-century, as simulated by the Coupled Model Intercomparison Project Phase 5 (CMIP5) suite of Earth system models. The historical datasets show that the fraction of Canadian land and marine areas covered by snow and ice is decreasing over time, with seasonal and regional variability in the trends consistent with regional differences in surface temperature trends. In particular, summer sea ice cover has decreased significantly across nearly all Canadian marine regions, and the rate of multi-year ice loss in the Beaufort Sea and Canadian Arctic Archipelago has nearly doubled over the last 8 years. The multi-model consensus over the 2020-2050 period shows reductions in fall and spring snow cover fraction and sea ice concentration of 5-10% per decade (or 15-30% in total), with similar reductions in winter sea ice concentration in both Hudson Bay and eastern Canadian waters. Peak pre-melt terrestrial snow water equivalent reductions of up to 10% per decade (30% in total) are projected across southern Canada. [ABSTRACT FROM AUTHOR]

The limited availability of consistent, longitudinal data sources for marine traffic in Arctic Canada has presented significant challenges for researchers, policy makers, and planners. Temporally and spatially accurate shipping data that reveal historical and current traffic trends are vital to plan safe shipping corridors, develop infrastructure, plan and manage protected areas, and understand the potential environmental and cultural impacts of change, as well as for sovereignty and safety considerations. This study uses a recently developed geospatial database of ship traffic to provide the first synthesized overview of the spatial and temporal variability of different vessel types in Arctic Canada during the 26-year period from 1990 to 2015. This examination shows that, overall, the distance traveled by ships in Arctic Canada nearly tripled (from 364 179 km in 1990 to 918 266 km in 2015), that the largest proportion of ship traffic in the region is from general cargo vessels and government icebreakers (including research ships), and that the fastest growing vessel type by far is pleasure craft (private yachts). Spatial shifts in vessel activity over the last quarter century have favoured areas with active mine sites, as well as the southern route of the Northwest Passage. As a result, some communities, including Baker Lake, Chesterfield Inlet, Pond Inlet, and Cambridge Bay, are experiencing greater increases in ship traffic. [ABSTRACT FROM AUTHOR]

Background Employment provides an important avenue to social inclusion for most adults. A range of productivity options exist for persons with intellectual and developmental disabilities ( IDD) who wish to work, each offering unique challenges relative to inclusion. Methods This qualitative study examined the productivity experiences of people with intellectual and developmental disabilities in Ontario, Canada. A purposive sample of 74 individuals with productivity experiences spanning the spectrum of no employment to community-based jobs was selected from a pool of volunteers recruited through a mailed survey. Semi-structured interviews were conducted with individuals and family members. Interview transcripts were subjected to a team-based analysis using grounded theory methods. Results Varying needs and interests exist in regard to work. Participants revealed a multitude of factors contributing to inclusion and exclusion through productivity. Conclusions Productivity, whether paid or unpaid, can be an avenue to social inclusion. The experience of inclusion, particularly of belonging, depends on a successfully negotiated congruence between worker attributes and the social features and demands of the work environment. [ABSTRACT FROM AUTHOR]

Background: Although pediatric lower extremity sarcoma once was routinely treated with amputation, multiagent chemotherapy as well as the evolution of tumor resection and reconstruction techniques have enabled the wide adoption of limb salvage surgery (LSS). Even though infection and tumor recurrence are established risk factors for early amputation (< 5 years) after LSS, the frequency of and factors associated with late amputation (≥ 5 years from diagnosis) in children with sarcomas are not known. Additionally, the resulting psychosocial and physical outcomes of these patients compared with those treated with primary amputation or LSS that was not complicated by subsequent amputation are not well studied. Studying these outcomes is critical to enhancing the quality of life of patients with sarcomas. Questions/purposes: (1) How have treatments changed over time in patients with lower extremity sarcoma who are included in the Childhood Cancer Survivor Study (CCSS), and did primary treatment with amputation or LSS affect overall survival at 25 years among patients who had survived at least 5 years from diagnosis? (2) What is the cumulative incidence of amputation after LSS for patients diagnosed with pediatric lower extremity sarcomas 25 years after diagnosis? (3) What are the factors associated with time to late amputation (≥ 5 years after diagnosis) in patients initially treated with LSS for lower extremity sarcomas in the CCSS? (4) What are the comparative social, physical, and emotional health-related quality of life (HRQOL) outcomes among patients with sarcoma treated with primary amputation, LSS without amputation, or LSS complicated by late amputation, as assessed by CCSS follow-up questionnaires, the SF-36, and the Brief Symptom Inventory-18 at 20 years after cancer diagnosis? Methods: The CCSS is a long-term follow-up study that began in 1994 and is coordinated through St. Jude Children's Research Hospital. It is a retrospective study with longitudinal follow-up of more than 38,000 participants treated for childhood cancer when younger than 21 years at one of 31 collaborating institutions between 1970 and 1999 in the United States and Canada. Participants were eligible for enrollment in the CCSS after they had survived 5 years from diagnosis. Within the CCSS cohort, we included participants who had a diagnosis of lower extremity sarcoma treated with primary amputation (547 patients with a mean age at diagnosis of 13 ± 4 years) or primary LSS (510 patients with a mean age 14 ± 4 years). The LSS cohort was subdivided into LSS without amputation, defined as primary LSS without amputation at the time of latest follow-up; LSS with early amputation, defined as LSS complicated by amputation occurring less than 5 years from diagnosis; or LSS with late amputation, defined as primary LSS in study patients who subsequently underwent amputation 5 years or more from cancer diagnosis. The cumulative incidence of late amputation after primary LSS was estimated. Cox proportional hazards regression with time-varying covariates identified factors associated with late amputation. Modified Poisson regression models were used to compare psychosocial, physical, and HRQOL outcomes among patients treated with primary amputation, LSS without amputation, or LSS complicated by late amputation using validated surveys. Results: More study participants were treated with LSS than with primary amputation in more recent decades. The overall survival at 25 years in this population who survived 5 years from diagnosis was not different between those treated with primary amputation (87% [95% confidence interval [CI] 82% to 91%]) compared with LSS (88% [95% CI 85% to 91%]; p = 0.31). The cumulative incidence of amputation at 25 years after cancer diagnosis and primary LSS was 18% (95% CI 14% to 21%). With the numbers available, the cumulative incidence of late amputation was not different among study patients treated in the 1970s (27% [95% CI 15% to 38%]) versus the 1980s and 1990s (19% [95% CI 13% to 25%] and 15% [95% CI 10% to 19%], respectively; p = 0.15). After controlling for gender, medical and surgical treatment variables, cancer recurrence, and chronic health conditions, gender (hazard ratio [HR] 2.02 [95% CI 1.07 to 3.82]; p = 0.03) and history of prosthetic joint reconstruction (HR 2.58 [95% CI 1.37 to 4.84]; p = 0.003) were associated with an increased likelihood of late amputation. Study patients treated with a primary amputation (relative risk [RR] 2.04 [95% CI 1.15 to 3.64]) and LSS complicated by late amputation (relative risk [RR] 3.85 [95% CI 1.66 to 8.92]) were more likely to be unemployed or unable to attend school than patients treated with LSS without amputation to date. The CCSS cohort treated with primary amputation and those with LSS complicated by late amputation reported worse physical health scores than those without amputation to date, although mental and emotional health outcomes did not differ between the groups. Conclusion: There is a substantial risk of late amputation after LSS, and both primary and late amputation status are associated with decreased physical HRQOL outcomes. Children treated for sarcoma who survive into adulthood after primary amputation and those who undergo late amputation after LSS may benefit from interventions focused on improving physical function and reaching educational and employment milestones. Efforts to improve the physical function of people who have undergone amputation either through prosthetic design or integration into the residuum should be supported. Understanding factors associated with late amputation in the setting of more modern surgical approaches and implants will help surgeons more effectively manage patient expectations and adjust practice to mitigate these risks over the life of the patient. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Ridges in sea ice and the convergent forces that form them are a serious hazard to ships traveling in the Arctic, but few studies have examined ridge distribution at a basin level in the Canadian Arctic. The Hudson Strait, which connects Hudson Bay and the North Atlantic, is a site of ongoing winter shipping where vessels frequently encounter pressured ice conditions and ridging. Here, RADARSAT-1 and RADARSAT-2 ScanSAR Wide images were used to identify ridges manually in a winter shipping corridor in the Hudson Strait for the period 1997 to 2012. Ridge count peaked in the month of March. No significant linear trend in the number of ridges was identified on either a monthly or annual scale, which is the result of great variability from year to year. However, spatial patterns of ridging distribution were evident: ridging occurred primarily in the eastern and western sectors of the study area, both in the region between Charles Island and the Quebec coastline and at the eastern entrance to the Hudson Strait. Seasonal sea level pressure (SLP) patterns from years of high and low ridge density were compared, but consistent correlations between SLP and ridge density were not found. The impacts of one-time storm events on ridge densities were also investigated. More analysis is needed to understand the factors influencing ridge density in the Hudson Strait. [ABSTRACT FROM AUTHOR]

Asians are not immune to racial discrimination and discrimination against Asians has heightened during the COVID-19 pandemic because they were blamed as the origin of the virus. A pre-registered 14-day diary explored if self-compassion was associated with subjective well-being and protective behaviors for Asians (U.S. & Canada) who faced COVID-19 discriminations (N = 82 & ndiaries =711). Participants reported discriminations experience for 28% (U.S.) and 25% (Canada) of their days. Daily self-compassion predicted daily subjective well-being despite COVID-19 discrimination experience. Daily self-compassion predicted increased COVID-19 protective behaviors on days Asian Americans experienced COVID-19 discrimination. Daily acceptance, but not daily reappraisal, explained the link between daily self-compassion and daily subjective well-being. These findings could not be accounted for by daily self-esteem. [ABSTRACT FROM AUTHOR]

The author offers observations on nurses who care for people in palliative settings. She discusses a survey of Canadian nurses in diverse care settings and their work with the dying, their efforts to counsel patients with life-threatening illnesses, and how they may become the support system for patients with serious illnesses.

The article reports on the issues concerning the national wait times databases in medical care systems in Canada. According to the author, there appears to be very little methodologic rigour in data collection, which making it all impossible to accurately compare wait times between provinces. Senior scientist Jack Tu at the Institute for Clinical Evaluative Sciences states that a national collection system is fundamental in terms of managing good wait lists. In connection, the Canada Health Infoway is established to collect electronic health records that would be an ideal place to house such as system. INSET: Ask and ye shall be included.

The article reports on the debate regarding the responsibility of physicians to consider cost and efficacy while making prescriptions, indeed part of the national effort to contain health care costs in Canada. An independent health consulting firm states that the physicians in the country often fail to take cost into account when prescribing. Brian Day, president of the Canadian Medical Association, argues that effectiveness and not expense is the primary consideration of physicians. Jeff Poston, executive director of the Canadian Pharmacists' association, explains that the physicians want to prescribe the proper drug for patients' needs and more expensive drugs are a better formula than generic.

PURPOSE: To explore how cognitive difficulties affect the everyday lives of survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT). PARTICIPANTS & SETTING: 20 survivors of alloHSCT attending follow-up care at a tertiary cancer center in Toronto, Canada. METHODOLOGIC APPROACH: This qualitative, descriptive study used semistructured interviews. FINDINGS: Cognitive symptoms affected the everyday lives of allo-HSCT survivors by changing the experience of everyday tasks, provoking emotional responses, and prompting adoption of mitigation strategies. Subthemes within each of these themes highlight the ways in which cognitive impairment shapes how allo-HSCT survivors feel about themselves, interact with others, and navigate coping challenges. IMPLICATIONS FOR NURSING: These findings demonstrate the multidimensional experience of cognitive difficulties following allo-HSCT and may inform the development of patient-centered approaches to assessing and managing cognitive difficulties. [ABSTRACT FROM AUTHOR]

In 2015, the Resident Education Committee of the North American Society for Pediatric and Adolescent Gynecology published the Long Curriculum in Resident Education to provide educators with a comprehensive document to be used in postgraduate medical education. The original curriculum was designed to meet the resident learning objectives for the Council on Resident Education in Obstetrics and Gynecology, the American Board of Pediatrics, and the Royal College of Physicians and Surgeons of Canada and to provide a more intensive, broader learning experience. The curriculum was updated in 2018. This Committee Document is the third updated version (3.0) of the Long Curriculum in Resident Education. [ABSTRACT FROM AUTHOR]

Background: Increasing demands on Canada's healthcare system require patients to take on more active roles in their health. Effective self-management has been linked to improved health outcomes; and there is evidence that effective behaviors, and subsequent healthcare utilization, are linked to self-efficacy and health literacy; however, this link has had minimal testing in the cancer context. Our aim is to examine the association between self-efficacy, health literacy, chemotherapy self-management behaviors, and health service utilization. Design and methods: A cross-sectional survey that included validated measures of self-efficacy, health literacy, chemotherapy self-management, and health service utilization was completed by participants (N = 213). Multivariable modeling using hierarchical linear regression was used to examine the association between variables. Results: Self-efficacy contributed significantly to explaining variation in chemotherapy self-management score. Health literacy was not significantly associated with any of the dependent variables. Conclusion: Participants with higher self-efficacy had higher chemotherapy self-management scores compared to participants with low self-efficacy. Contrary to evidence in the chronic disease self-management literature, this study demonstrated that health literacy was not associated with chemotherapy self-management behavior nor was it associated with self-efficacy. Building patient self-efficacy in the context of chemotherapy self-management could be particularly helpful both in the cancer center and in the domain of oral chemotherapy management at home where patients are required to take on significant responsibility for self-management. [ABSTRACT FROM AUTHOR]

The interventions used in cancer-survivorship care do not always address outcomes important to survivors. This study sought to understand stakeholders' views on the key concerns of cancer survivors after treatment and the interventions needed to meet survivors' and families' psychosocial needs after completing cancer treatment. We conducted a descriptive qualitative study using semistructured interviews with stakeholders (survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers) from across Canada. For the data analysis, we used techniques commonly employed in descriptive qualitative research, such as coding, grouping, detailing, and comparing the data. There were 44 study participants: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decision-/policy-makers. Stakeholderrelevant interventions to address survivors' psychosocial needs were categorized into five groups, as follows: information provision, peer support, navigation, knowledge translation interventions, and caregiver-specific supports. These findings, particularly interventions that deliver timely and relevant information about the post-treatment period and knowledge translation interventions that strive to integrate effective tools and programs into survivorship care, have implications for future research and practice. [ABSTRACT FROM AUTHOR]

Time series of brightness temperatures (TB) from the Advanced Microwave Scanning Radiometer–Earth Observing System (AMSR-E) are examined to determine ice phenology variables on the two largest lakes of northern Canada: Great Bear Lake (GBL) and Great Slave Lake (GSL). TB measurements from the 18.7, 23.8, 36.5, and 89.0 GHz channels (H- and V- polarization) are compared to assess their potential for detecting freeze-onset/melt-onset and ice-on/ice-off dates on both lakes. The 18.7 GHz (H-pol) channel is found to be the most suitable for estimating these ice dates as well as the duration of the ice cover and ice-free seasons. A new algorithm is proposed using this channel and applied to map all ice phenology variables on GBL and GSL over seven ice seasons (2002–2009). Analysis of the spatio-temporal patterns of each variable at the pixel level reveals that: (1) both freeze-onset and ice-on dates occur on average about one week earlier on GBL than on GSL (Day of Year (DY) 318 and 333 for GBL; DY 328 and 343 for GSL); (2) the freeze-up process or freeze duration (freeze-onset to ice-on) takes a slightly longer amount of time on GBL than on GSL (about 1 week on average); (3) melt-onset and ice-off dates occur on average one week and approximately four weeks later, respectively, on GBL (DY 143 and 183 for GBL; DY 135 and 157 for GSL); (4) the break-up process or melt duration (melt-onset to ice-off) lasts on average about three weeks longer on GBL; and (5) ice cover duration estimated from each individual pixel is on average about three weeks longer on GBL compared to its more southern counterpart, GSL. A comparison of dates for several ice phenology variables derived from other satellite remote sensing products (e.g. NOAA Interactive Multisensor Snow and Ice Mapping System (IMS), QuikSCAT, and Canadian Ice Service Database) show that, despite its relatively coarse spatial resolution, AMSR-E 18.7 GHz provides a viable means for monitoring of ice phenology on large northern lakes. [ABSTRACT FROM AUTHOR]

Tourism in the Hudson Bay region of central northern Canada generally is associated with non-consumptive forms of nature-based activities (such as polar bear viewing). However, the region has experienced variable growth in the cruise sector in recent years. This paper examines patterns of cruise activity in all subregions of the Hudson Bay region during three cruise seasons (2006, 2008, and 2009) and mainly reveals a pattern of decline. Since the prevalence of sea ice is an important part of visitor experiences of polar cruises, we examine sea ice change and occurrence of icebergs in the Hudson Bay region. Our sea ice analysis suggests that the length of the navigable shipping season is increasing in this region, which may facilitate both earlier and later shipping. But in terms of cruise traffic, we suggest that the demise of ice coverage signals a possible decline in cruise activity in most of the Hudson Bay region because ice-supported wildlife may shift north with the diminishing ice regime. Given the possible environmental and socio-cultural implications of changing cruise activity patterns in the Arctic and the absence of broad-scale monitoring and surveillance of the industry, use of these available data sources is vital to building a clearer picture. [ABSTRACT FROM AUTHOR]

This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time. [ABSTRACT FROM AUTHOR]

The outcomes assessed in cancer survivorship research do not always match the outcomes that survivors and health system stakeholders identify as most important in the post-treatment follow-up period. This study sought to identify stakeholder-relevant outcomes pertinent to posttreatment follow-up care interventions. We conducted a descriptive qualitative study using semistructured telephone interviews with stakeholders (survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers) across Canada. Data analysis involved coding, grouping, detailing, and comparing the data by using the techniques commonly employed in descriptive qualitative research. Forty-four participants took part in this study: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decisionmakers. Thirteen stakeholder-relevant outcomes were identified across participants and categorized into five outcome domains: psychosocial, physical, economic, informational, and patterns and quality of care. In the psychosocial domain, one's reintegration after cancer treatment was described by all stakeholder groups as one of the most important challenges faced by survivors and identified as a priority outcome to address in future research. The outcomes identified in this study provide a succinct suite of stakeholder-relevant outcomes, common across cancer types and populations, that should be used in future research on cancer survivorship care. [ABSTRACT FROM AUTHOR]