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To protect vulnerable populations during heat waves, public health agencies recommend maintaining indoor air temperature below ∼24–28 °C. While we recently demonstrated that maintaining indoor temperatures ≤26 °C mitigates the development of hyperthermia and cardiovascular strain in older adults, the cellular consequences of prolonged indoor heat stress are poorly understood. We therefore evaluated the cellular stress response in 16 adults (six females) aged 66–78 years during 8 h rest in ambient conditions simulating homes maintained at 22 °C (control) and 26 °C (indoor temperature upper limit proposed by health agencies), as well as non-air-conditioned domiciles during hot weather and heat waves (31 and 36 °C, respectively; all 45% relative humidity). Western blot analysis was used to assess changes in proteins associated with the cellular stress response (autophagy, apoptosis, acute inflammation, and heat shock proteins) in peripheral blood mononuclear cells harvested prior to and following exposure. Following 8 h exposure, no cellular stress response-related proteins differed significantly between the 26 and 22 °C conditions (all, P ≥ 0.056). By contrast, autophagy-related proteins were elevated following exposure to 31 °C (p62: 1.5-fold; P = 0.003) and 36 °C (LC3-II, LC3-II/I, p62; all ≥2.0-fold; P ≤ 0.002) compared to 22 °C. These responses were accompanied by elevations in apoptotic signaling in the 31 and 36 °C conditions (cleaved-caspase-3: 1.8-fold and 3.7-fold, respectively; P ≤ 0.002). Furthermore, HSP90 was significantly reduced in the 36 °C compared to 22 °C condition (0.7-fold; P = 0.014). Our findings show that older adults experience considerable cellular stress during prolonged exposure to elevated ambient temperatures and support recommendations to maintain indoor temperatures ≤26 °C to prevent physiological strain in heat-vulnerable persons. [ABSTRACT FROM AUTHOR]

Canadian wildfires in 2023 were record breaking with wide‐reaching impacts on people, nature, and climate. Extreme heat and low rainfall associated with climate change led to unprecedented forest fires that released enormous amounts of carbon as they burned. This study used data on fire‐driven tree cover loss and forest carbon fluxes to estimate the total extent of stand‐replacing forest fires and their associated carbon emissions. We found that the 2023 Canadian wildfires burned nearly 7.8 million hectares of forest and accounted for more than a quarter of all tree cover loss globally. Furthermore, forests impacted by wildfires emitted nearly 3 billion tons of CO2 or about 25% more carbon than all primary tropical tree cover loss that year. These results have important implications for global carbon budgets because emissions from these wildfires will largely be excluded from official greenhouse gas reporting. [ABSTRACT FROM AUTHOR]

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

Objective: Investigate the effect of cumulative head impacts on saccade latency and errors, measured across two successive football seasons. Design: Participants were acquired from a sample of convenience—one Canadian university football team. Head impacts were collected during training camp, practices, eight regular season games, and four playoff games in each season. Saccade measurements were collected at five time points—before and after training camp, at midseason, after regular season, and after playoffs. Setting: Two seasons following players from a single USports football team during practices and games. Participants: Players who completed a baseline saccade measurement and a minimum of one follow-up measurement were included in the study. A total of 127 players were monitored across two competitive seasons, including 61 players who participated in both seasons. Independent Variables: Head impact measurements were collected using helmet-mounted sensors. Main Outcome Measures: Saccade latency and number of errors were measured using high-speed video or electro-oculography. Results: On average, each head impact increased prosaccade latency by 5.16 × 10−3 ms (95% confidence interval [CI], 2.26 × 10−4-1.00 × 10−2, P = 0.03) and antisaccade latency by 5.74 × 10−3 ms (95% CI, 7.18 × 10−4-1.06 × 10−2, P = 0.02). These latency increases did not decrease between the two seasons; in fact, prosaccade latencies were 23.20 ms longer (95% CI, 19.40-27.14, P < 0.001) at the second season's baseline measurement than the first. The number of saccade errors was not affected by cumulative head impacts. Conclusions: Repetitive head impacts in Canadian university football result in cumulative declines in brain function as measured by saccade performance. [ABSTRACT FROM AUTHOR]

Insulin, insulin-like growth factors (IGF) and their receptors are highly expressed in the adult hippocampus. Thus, disturbances in the insulin-IGF signalling pathway may account for the selective vulnerability of the hippocampus to nascent Alzheimer's disease (AD) pathology. In the present study, we examined the predominant IGF-binding protein in the CSF, IGFBP2. CSF was collected from 109 asymptomatic members of the parental history-positive PREVENT-AD cohort. CSF levels of IGFBP2, core AD and synaptic biomarkers were measured using proximity extension assay, ELISA and mass spectrometry. Cortical amyloid-beta (Aβ) and tau deposition were examined using 18F-NAV4694 and flortaucipir. Cognitive assessments were performed during up to 8 years of follow-up, using the Repeatable Battery for the Assessment of Neuropsychological Status. T1-weighted structural MRI scans were acquired, and neuroimaging analyses were performed on pre-specified temporal and parietal brain regions. Next, in an independent cohort, we allocated 241 dementia-free ADNI-1 participants into four stages of AD progression based on the biomarkers CSF Aβ42 and total-tau (t-tau). In this analysis, differences in CSF and plasma IGFBP2 levels were examined across the pathological stages. Finally, IGFBP2 mRNA and protein levels were examined in the frontal cortex of 55 autopsy-confirmed AD and 31 control brains from the Quebec Founder Population (QFP) cohort, a unique population isolated from Eastern Canada. CSF IGFBP2 progressively increased over 5 years in asymptomatic PREVENT-AD participants. Baseline CSF IGFBP2 was positively correlated with CSF AD biomarkers and synaptic biomarkers, and negatively correlated with longitudinal changes in delayed memory (P = 0.024) and visuospatial abilities (P = 0.019). CSF IGFBP2 was negatively correlated at a trend-level with entorhinal cortex volume (P = 0.082) and cortical thickness in the piriform (P = 0.039), inferior temporal (P = 0.008), middle temporal (P = 0.014) and precuneus (P = 0.033) regions. In ADNI-1, CSF (P = 0.009) and plasma (P = 0.001) IGFBP2 were significantly elevated in Stage 2 [CSF Aβ(+)/t-tau(+)]. In survival analyses in ADNI-1, elevated plasma IGFBP2 was associated with a greater rate of AD conversion (hazard ratio = 1.62, P = 0.021). In the QFP cohort, IGFBP2 mRNA was reduced (P = 0.049); however, IGFBP2 protein levels did not differ in the frontal cortex of autopsy-confirmed AD brains (P = 0.462). Nascent AD pathology may induce an upregulation in IGFBP2 in asymptomatic individuals. CSF and plasma IGFBP2 may be valuable markers for identifying CSF Aβ(+)/t-tau(+) individuals and those with a greater risk of AD conversion. [ABSTRACT FROM AUTHOR]

The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada. Tracking the details of activity-based therapy (ABT) sessions and programs across the continuum of care and injury trajectory may provide important information to support the development of ABT practice guidelines and implementation strategies. Tracking objective and subjective parameters are needed to provide a comprehensive description of an ABT session and program. Clinicians and individuals with spinal cord injury or disease (SCI/D) should both be able to track ABT to accommodate all settings and types of data. Digital tracking tools, such as an app, may provide an accessible, versatile and efficient way of tracking ABT. [ABSTRACT FROM AUTHOR]

Background: The number of Lyme disease risk areas in Canada is growing. In regions with emerging tick populations, it is important to emphasize peridomestic risk and the importance of protective behaviours in local public health communication. This study aims to identify characteristics associated with high levels of Lyme disease knowledge and adoption of protective behaviours among residents in the Ottawa, Ontario region. Methods: A geographically stratified web survey was conducted in November 2020 (n = 2018) to determine knowledge, attitudes, and practices regarding Lyme disease among adult residents. Responses were used to calculate: (i) composite scores for knowledge and adoption of protective practices; and (ii) an exposure risk index based on reported activity in woodlands during the spring-to-fall tick exposure risk period. Results: 60% of respondents had a high knowledge of Lyme disease, yet only 14% indicated they often use five or more measures to protect themselves. Factors strongly associated with a high level of Lyme disease knowledge included being 55 or older (Odds Ratio (OR) = 2.04), living on a property with a yard (OR = 3.22), having a high exposure index (OR = 1.59), and knowing someone previously infected with Lyme disease (OR = 2.05). Strong associations with the adoption of a high number of protective behaviours were observed with membership in a non-Indigenous racialized group (OR = 1.70), living on a property with a yard (OR = 2.37), previous infection with Lyme disease (OR = 2.13), prior tick bite exposure (OR = 1.62), and primarily occupational activity in wooded areas (OR = 2.31). Conclusions: This study highlights the dynamics between Lyme disease knowledge, patterns of exposure risk awareness, and vigilance of personal protection in a Canadian region with emerging Lyme disease risk. Notably, this study identified gaps between perceived local risk and protective behaviours, presenting opportunities for targeted enhanced communication efforts in areas of Lyme disease emergence. [ABSTRACT FROM AUTHOR]

Background: Early substance use is associated with increased risks for mental health and substance use problems which are compounded when using several substances (i.e., polysubstance use). A notable increase in substance use occurs when adolescents transition from elementary to secondary schooling. Objective: This study seeks to characterize student and school classes of substance use. Methods: A cross-sectional multilevel latent class analysis and regression was conducted on a representative sample of 19,130 grade 6-8 students from 180 elementary schools in Ontario, Canada to: 1) identify distinct classes of student substance use; 2) identify classes of schools based on student classes; and 3) explore correlates of these classes, including mental health, school climate, belonging, safety, and extracurricular participation. Results: Two student and two school classes were identified. 4.1% of students were assigned to the high probability of early polysubstance use class while the remaining 95.9% were in the low probability class. Students experiencing depressive and externalizing symptoms had higher odds of being in the early polysubstance use class (Odds Ratio [OR]s=1.1-1.25). At the school level, 19% of schools had higher proportions of students endorsing polysubstance use. Perceptions of positive school climate, belonging, and safety increased the odds of students being in the low probability of early polysubstance use student-level class (ORs=0.85-0.93) and lower probability of early polysubstance use school-level class. Associations related to extracurricular participation were largely not statistically significant. Conclusions: Student and school substance use classes may serve as targets for tailored prevention and early interventions. Results support examining school-based interventions targeting school climate, belonging, and safety. [ABSTRACT FROM AUTHOR]

In Canada and the United States, front-of-package protein content claims require data to support the quality of the protein. In general, protein quality reflects the product of the amino acid composition of the food protein relative to human amino acid requirements and a measure of digestibility. The currently accepted method in both jurisdictions is the protein digestibility-corrected amino acid score (PDCAAS) that requires the measurement of true fecal protein (nitrogen) digestibility. The latter must be measured in vivo using a rat model. This requirement for animal testing is inconsistent with international efforts to reduce the usage of animals in testing for regulatory purposes. The current commentary positions four options to remove the need to use animal testing for determining protein quality, when considering protein content claim substantiation. These options include (i) a focus on protein quantity alone; (ii) the use of the amino acid score alone, with no correction for digestibility; (iii) the use of a fixed digestibility coefficient to estimate protein quality; and (iv) the use of in vitro methods to measure protein and/or amino acid digestibility. The relative merits and deficiencies of the options are positioned with the goal of encouraging dialogue within the regulatory agencies to move towards alternative approaches for substantiating protein content claims on foods, including those derived from plant-based sources. [ABSTRACT FROM AUTHOR]

The effect of two different extraction methods (alkaline extraction isoelectric precipitation––AEIP and salt extraction dialysis––SE) on the production of protein isolates from four different pulse types grown in Canada (yellow pea-YP, green lentil-GL, chickpea-CH and navy bean-NB) were studied for their physicochemical, functional, and nutritional properties. The extraction method and type of pulse had an effect on protein and extraction yields. The method used for extraction had an influence on the surface properties as well as the functionality of the isolated proteins. SE-produced isolates presented higher solubility, foaming capacity and emulsion activity than those prepared through AEIP. Protein quality results showed that higher in-vitro protein digestibility (IVPD) and in-vitro protein digestibility corrected amino-acid scores (IV-PDCAAS) were achieved for proteins obtained through AEIP than those prepared for SE samples. The current study contributes to a better understanding of the effects of extraction methods on the resulting protein characteristics and properties of different pulses grown in Canada, which can impact their suitability for different product applications. [ABSTRACT FROM AUTHOR]

Social-ecological models suggest that a strategy for increasing population physical activity participation is to reconstruct the "social climate" through changing social norms and beliefs about physical activity (PA). In this study, we assessed whether the PA social climate in Canada has changed over a five-year period after controlling for sociodemographic factors and PA levels. Replicating a survey administered in 2018, a sample of adults in Canada (n = 2,507) completed an online survey assessing social climate dimensions, including but not limited to descriptive and injunctive norms. Descriptive statistics were calculated, and binary logistic regressions were conducted to assess the associations of sociodemographic factors and year of the survey with social climate dimensions. Results suggest some social climate constructs are trending in a positive direction between 2018 and 2023. Physical inactivity was considered a serious public health concern by 49% of respondents, second to unhealthy diets (52%). Compared to those who participated in the 2018 survey, participants in 2023 were less likely to see others walking or wheeling in their neighbourhood (OR = 1.58, 95% CI: 1.41, 1.78), but more likely to see people exercising (OR = 0.82, 95% CI: 0.73, 0.92) and kids playing in their neighbourhood (OR = 0.75, 95% CI: 0.66, 0.85). No changes were reported between 2018 and 2023 in individuals' perceptions of whether physical inactivity is due to individual versus external factors (OR = 0.99, 95% CI: 0.87, 1.13). The findings of this work indicate a modest positive shift in some measured components of the social climate surrounding PA although attributing causes for these changes remain speculative. [ABSTRACT FROM AUTHOR]

Within the financialisation literature, scholars have turned their attention to the state, exploring the adoption of financial activities by state actors, paying less attention to the limits of state financialisation. This paper explores these limits using the case of social impact bonds (SIBs). Pioneered in the UK in 2010 and subsequently trialed in some 35 countries, SIBs use private capital to fund social programs, with governments providing a return based on the degree of success. Despite expectations of dramatic growth, the SIB model has never truly taken hold. Based on the rollout of SIBs in the UK, Israel, and Canada, the paper considers the challenges encountered by the SIB enterprise as a form of financialised statecraft and identifies three barriers: (1) resistance to political agendas of state financialisation; (2) clashes between finance and public sector cultures; (3) financial innovation seen as 'risk' and 'disruption' to entrenched socio-technical routines. These barriers reveal tensions both within the state itself and between finance and the public sector, and indicate the importance of thinking about the limits and failures of state financialisation. [ABSTRACT FROM AUTHOR]

First Nations, Inuit, and Métis, Indigenous peoples in Canada, have long experienced racism within health services resulting in a health service system that many Indigenous people in Canada do not want to access. Research informing Indigenous health services must consider how findings and analysis happen within the community, what information is shared, and how it improves access to health services. Information shared in Indigenous research methods was communicated at the end and throughout the project. Indigenous knowledge mobilization in Indigenous research methods requires researchers to receive knowledge from the community and research participants. Also, knowledge sharing and moving into practice happen continuously throughout the research process. These qualities of Indigenous knowledge mobilization facilitate increasing accessibility to health services through Indigenous knowledge identified in research. This article describes an Indigenous knowledge mobilization framework that may be adapted within Indigenous communities looking to make transparent how Indigenous knowledge is incorporated within health services. [ABSTRACT FROM AUTHOR]

Pertussis causes significant morbidity and mortality in infants aged <6 months. Maternal pertussis vaccination during pregnancy has been recommended in Canada since 2018 to reduce these negative outcomes. In the absence of routine immunization coverage data, our objective was to evaluate uptake in Toronto, Canada. We recruited mother-infant pairs at The Hospital for Sick Children, Toronto, between 2018 and 2020. We performed logistic regression to examine associations between demographics and self-reported pertussis vaccination. 76/243 mothers (31.3 %) reported receiving pertussis vaccination during their most recent pregnancy. Odds of receiving vaccination more than doubled with each 1-year increase in year of pregnancy (aOR: 2.2; 95 % CI: 1.3, 3.6; p < 0.01) and among those born in Canada as compared to those not (aOR: 2.0; 95 % CI: 1.1, 3.6; p = 0.02) Uptake of pertussis vaccination during pregnancy in Ontario has increased in recent years, however coverage remains lower than desirable. [ABSTRACT FROM AUTHOR]

The Canadian Earth System Model version 5.0 (CanESM5.0), the most recent major version of the global climate model developed at the Canadian Centre for Climate Modelling and Analysis (CCCma) at Environment and Climate Change Canada (ECCC), has been used extensively in climate research and for providing future climate projections in the context of climate services. Previous studies have shown that CanESM5.0 performs well compared to other models and have revealed several model biases. To address these biases, the CCCma has recently initiated the "Analysis for Development" (A4D) activity, a coordinated analysis activity in support of CanESM development. Here we describe the goals and organization of this effort and introduce two variants ("p1" and "p2") of a new CanESM version, CanESM5.1, which features important improvements as a result of the A4D activity. These improvements include the elimination of spurious stratospheric temperature spikes and an improved simulation of tropospheric dust. Other climate aspects of the p1 variant of CanESM5.1 are similar to those of CanESM5.0, while the p2 variant of CanESM5.1 features reduced equilibrium climate sensitivity and improved El Niño–Southern Oscillation (ENSO) variability as a result of intentional tuning of the atmospheric component. The A4D activity has also led to the improved understanding of other notable CanESM5.0 and CanESM5.1 biases, including the overestimation of North Atlantic sea ice, a cold bias over sea ice, biases in the stratospheric circulation and a cold bias over the Himalayas. It provides a potential framework for the broader climate community to contribute to CanESM development, which will facilitate further model improvements and ultimately lead to improved climate change information. [ABSTRACT FROM AUTHOR]

The reemergence and spread of Xanthomonas translucens, the causal agent of bacterial leaf streak in cereal crops and wilt in turfgrass and forage species, is a concern to growers in the United States and Canada. The pathogen is seedborne and listed as an A2 quarantine organism by EPPO, making it a major constraint to international trade and exchange of germplasm. The pathovar concept of the X. translucens group is confusing due to overlapping of plant host ranges and specificity. Here, comparative genomics, phylogenomics, and 81 up-to-date bacterial core gene set (ubcg2) were used to assign the pathovars of X. translucens into three genetically and taxonomically distinct clusters. The study also showed that whole genome-based digital DNA-DNA hybridization unambiguously can differentiate the pvs. translucens and undulosa. Orthologous gene and proteome matrix analyses suggest that the cluster consisting of graminis, poae, arrhenatheri, phlei, and phleipratensis is very divergent. Whole-genome data were exploited to develop the first pathovar-specific TaqMan real-time PCR tool for detection of pv. translucens on barley. Specificity of the TaqMan assay was validated using 62 Xanthomonas and non-Xanthomonas strains as well as growth chamber-inoculated and naturally infected barley leaves. Sensitivity levels of 0.1 pg (purified DNA) and 23 CFUs per reaction (direct culture) compared favorably with other previously reported real-time PCR assays. The phylogenomics data reported here suggest that the clusters could constitute novel taxonomic units or new species. Finally, the pathovar-specific diagnostic tool will have significant benefits to growers and facilitate international exchange of barley germplasm and trade. [ABSTRACT FROM AUTHOR]

Peatlands store approximately one-half of terrestrial soil carbon and one-tenth of non-glacial freshwater. Some of these important ecosystems are located near heavy metal emitting smelters. To improve the understanding of smelter impacts and potential recovery after initial pollution controls in the 1970s (roughly 50 years of potential recovery), we sampled peatlands along a distance gradient of 134 km from a smelter in Sudbury, Ontario, Canada, an area with over a century of nickel (Ni) and copper (Cu) mining activity. This work is aimed at evaluating potential shifts in bacterial and archaeal community structures in Sphagnum moss and its underlying peat within smelter-impacted poor fens. In peat, total Ni and Cu concentrations were higher (0.062–0.067 and 0.110–0.208 mg/g, respectively) at sites close to the smelter and exponentially dropped with distance from the smelter. This exponential decrease in Ni concentrations was also observed in Sphagnum. 16S rDNA amplicon sequencing showed that peat and Sphagnum moss host distinct microbiomes with peat accommodating a more diverse community structure. The microbiomes of Sphagnum were dominated by Proteobacteria (62.5%), followed by Acidobacteria (11.9%), with no observable trends with distance from the smelter. Dominance of Acidobacteria (32.4%) and Proteobacteria (29.6%) in peat was reported across all sites. No drift in taxonomy was seen across the distance gradient or from the reference sites, suggesting a potential microbiome recovery toward that of the reference peatlands microbiomes after decades of pollution controls. These results advance the understanding of peat and Sphagnum moss microbiomes, as well as depict the sensitivities and the resilience of peatland ecosystems. [ABSTRACT FROM AUTHOR]

Introduction: People living with HIV (PLWH) and/or who inject drugs may experience lower vaccine effectiveness (VE) against SARS‐CoV‐2 infection. Methods: A validated algorithm was applied to population‐based, linked administrative datasets in the British Columbia COVID‐19 Cohort (BCC19C) to ascertain HIV status and create a population of PLWH and matched HIV‐negative individuals. The study population was limited to individuals who received an RT‐PCR laboratory test for SARS‐CoV‐2 between 15 December 2020 and 21 November 2021 in BC, Canada. Any history of injection drug use (IDU) was ascertained using a validated administrative algorithm. We used a test‐negative study design (modified case−control analysis) and multivariable logistic regression to estimate adjusted VE by HIV status and history of IDU. Results: Our analysis included 2700 PLWH and a matched population of 375,043 HIV‐negative individuals, among whom there were 351 and 103,049 SARS‐CoV‐2 cases, respectively. The proportion of people with IDU history was much higher among PLWH compared to HIV‐negative individuals (40.7% vs. 4.3%). Overall VE during the first 6 months after second dose was lower among PLWH with IDU history (65.8%, 95% CI = 43.5–79.3) than PLWH with no IDU history (80.3%, 95% CI = 62.7–89.6), and VE was particularly low at 4–6 months (42.4%, 95% CI = −17.8 to 71.8 with IDU history vs. 64.0%; 95% CI = 15.7–84.7 without), although confidence intervals were wide. In contrast, overall VE was 88.6% (95% CI = 88.2–89.0) in the matched HIV‐negative population with no history of IDU and remained relatively high at 4–6 months after second dose (84.6%, 95% CI = 83.8–85.4). Despite different patterns of vaccine protection by HIV status and IDU history, peak estimates were similar (≥88%) across all populations. Conclusions: PLWH with a history of IDU may experience lower VE against COVID‐19 infection, although findings were limited by a small sample size. The lower VE at 4–6 months may have implications for booster dose prioritization for PLWH and people who inject drugs. The immunocompromising effect of HIV, substance use and/or co‐occurring comorbidities may partly explain these findings. [ABSTRACT FROM AUTHOR]

As more jurisdictions consider legalizing medical assistance in dying or assisted death (AD), there is an ongoing debate about whether AD is driven by socioeconomic deprivation or inadequate supportive services. Attention has shifted away from population studies that refute this narrative, and focused on individual cases reported in the media that would appear to support these concerns. In this editorial, the authors address these concerns using recent experience in Canada, and argue that even if we accept these stories at face value, the logical policy response would be to address the root causes of structural vulnerability rather than attempt to restrict access to AD. In terms of concerns about safety, the authors go on to point out the parallels between media reports about the misuse of AD and reports of wrongful deaths due to the misuse of palliative care (PC) in jurisdictions where AD was not legal. Ultimately, we cannot justify having a different response to these reports when they apply to AD instead of PC, and nobody has argued that PC should be criminalized in response to such reports. If we are skeptical of the oversight mechanisms used for AD in Canada, we must be equally skeptical of the oversight mechanisms used for end-of-life care in every jurisdiction where AD is not legal, and ask whether prohibiting AD protects the lives of the vulnerable any better than legalization of AD with safeguards. [ABSTRACT FROM AUTHOR]

A growing body of comparative public policy research examines the effects of delegated delivery of public services and the related emergence of what is labelled a submerged state that obscures the role of government in the provision of public services. Data limitations have constrained investigations of these dynamics in Canada, including for K–12 education. In this research note, we draw on charitable tax records and provincial and federal spending data to present the evolution of provincial and federal financial support for independent schools over time, drawing on the case of British Columbia (BC). By factoring in indirect support through various tax mechanisms, we establish that BC independent schools have seen increasing financial support from both the federal and provincial governments in recent decades, primarily via tax expenditures tied to their charitable status—a "not hidden but not visible" shift in public expenditure that has substantial political, distributive and accountability implications. [ABSTRACT FROM AUTHOR]

Background: The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. Methods: The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. Results: At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. Conclusion: We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA. [ABSTRACT FROM AUTHOR]

During a time of rapid urban growth and development, it is becoming ever more important to monitor the carbon fluxes of our cities. Unlike Canada's commercially managed forests that have a long history of inventory and modelling tools, there is both a lack of coordinated data and considerable uncertainty on assessment procedures for urban forest carbon. Nonetheless, independent studies have been carried out across Canada. To improve upon Canada's federal government reporting on carbon storage and sequestration by urban forests, this study builds on existing data to develop an updated assessment of carbon storage and sequestration for Canada's urban forests. Using canopy cover estimates derived from ortho-imagery and satellite imagery ranging from 2008 to 2012 and field-based urban forest inventory and assessment data from 16 Canadian cities and one US city, this study found that Canadian urban forests store approximately 27,297.8 kt C (− 37%, + 45%) in above and belowground biomass and sequester approximately 1497.7 kt C year−1 (− 26%, + 28%). In comparison with the previous national assessment of urban forest carbon, this study suggested that in urban areas carbon storage has been overestimated and carbon sequestration has been underestimated. Maximizing urban forest carbon sinks will contribute to Canada's mitigation efforts and, while being a smaller carbon sink compared to commercial forests, will also provide important ecosystem services and co-benefits to approximately 83% of Canadian people. [ABSTRACT FROM AUTHOR]

Canadian environmental governance formally began in the 1970s with an ambitious vision critical of the status quo. Until the Justin Trudeau government from 2015, this vision had been largely eroded when compared to the transformative environmental ideas, ambition, and efforts initially put forth. Drawing on elite interviews in Canadian environmental politics and an articulation of the dominant system, we develop and demonstrate a novel explanation for Canada's systematic failure to act more ambitiously on the environment. We argue that this failure is the result of progressive selection of Canadian environmental governance in relation to the dominant system at key selection moments. It is at those moments when the environment is least prioritized and the economy most urgently needs attention that environmental governance suffers the most. The paper concludes by emphasizing how features of the dominant political-economic system not typically thought of as environmental can have systematic environmental impacts. [ABSTRACT FROM AUTHOR]

Background: Allergic disease is on the rise. Waitlists for specialists are long, and many referred patients have already received prior allergic assessment, either by a certified Allergist, Primary Care Provider, or other Specialist. It is important to understand the prevalence and motivating factors for multiple-opinion referrals, to deliver timely assessment for patients with allergic disease. Methods: A retrospective chart review of demographic information, number of previous consultations, and motivation for new consults and multiple-opinion referrals, of pediatric patients aged 8 months–17 years to BC Children's Hospital Allergy Clinic from September 1, 2016–August 31, 2017, was performed. Referral data including reason for referral or multiple-opinion, primary allergic concerns, and others, from referral forms and consult notes were accessed through local Electronic Medical Records and subsequently analyzed for trends in categorical variables to assess the rationale for and impact of multiple-opinion referrals to our clinic. Results: Of 1029 new referrals received, 210 (20.4%) were multiple-opinion referrals. Food allergy was the predominant allergic concern prompting further opinion (75.7%). The main rationale for seeking further opinions was wanting an assessment by a certified allergist in cases where prior consultation was performed by non-allergist specialist, primary care provider, or alternative health care provider. Of second-opinion referrals generated, 70 (33.3%) initial consultations were performed by an Allergist, whereas 140 (66.7%) were performed by a non-allergist. Conclusions: Many new consults at the BCCH Allergy Clinic are multiple-opinion assessments, contributing to long waitlists. Advocacy at the systems level through standardized referral guidelines, centralized triaging systems, and stronger support for Primary Care Providers is needed to provide better access in Canada for children needing a specialized Allergist. Trial registration UBC/BCCH Research Ethics Board [ABSTRACT FROM AUTHOR]

Background: There is a paucity of literature on the normative levels of plasma renin concentration (PRC) and serum aldosterone (SA) in premature neonates. This study aims to provide normative data on PRC and SA levels in preterm neonates in the first 2 weeks after birth and explore associations with maternal, perinatal, or postnatal factors. Methods: Neonates born at 26- to 34-week gestation were recruited from two neonatal intensive care units in Canada and Australia. The direct renin assay PRC and SA were analyzed on day 1 and days 14–21 after birth to compare across categorical variables and to produce normative values. Results: A total of 262 subjects were enrolled from the Canadian (29%) and Australian (71%) sites. The mean gestational age was 30 weeks, with a mean birth weight of 1457 g. The normative values of PRC and SA for neonates born between 26 + 0 and 29 + 6 weeks and 30 + 0 and 34 + 0 weeks of gestation were produced for day 1 and day 14–21 after birth. Both PRC and SA increased from day 1 to day 14–21. The more premature neonates reached a higher PRC on days 14–21 after birth but exhibited lower SA levels on day 1 after birth. When comparing gender, birth weight, and maternal risk factor categories, no statistical differences in PRC or SA were found. A small but significant decrease in PRC, but not SA, was noted for neonates with placental pathology. Conclusions: This study produced normative values of PRA and SA in clinically stable preterm neonates that can be referenced for use in clinical practice. [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]

Species conservation requires an understanding of the factors and interactions affecting species distribution and behavior, habitat availability and use, and corresponding vital rates at multiple temporal and spatial scales. Opportunities to investigate these relationships across broad geographic regions are rare. We combined long‐term waterfowl population surveys, and studies of habitat use and breeding success, to develop models that identify and incorporate these interactions for upland‐nesting waterfowl in the Prairie Pothole Region (PPR) of Canada. Specifically, we used data from the annual Waterfowl Breeding Population and Habitat Survey (1961–2009) at the survey segment level and associated habitat covariates to model and map the long‐term average duck density across the Canadian PPR. We analyzed nest location and fate data from approximately 25,000 duck nests found during 3 multi‐year nesting studies (1994–2011) to model factors associated with nest survival and habitat selection through the nesting season for the 5 most common upland nesting duck species: mallard (Anas platyrhynchos), gadwall (Mareca strepera), blue‐winged teal (Spatula discors), northern shoveler (Spatula clypeata), and northern pintail (Anas acuta). Duck density was highly variable across the Canadian PPR, reflecting positive responses to local wetland area and count, and amounts of cropland and grassland, a regional positive response to latitude, and a negative response to local amounts of tree cover. Nest survival was affected by temporal and spatial variables at multiple scales. Specifically, nest survival demonstrated interactive effects among species, nest initiation date, and nesting cover type and was influenced by relative annual wetness, population density, and surrounding landscape composition at landscape scales, and broad geographic gradients (east‐west and north‐south). Likewise, species‐specific probability of nest habitat selection was influenced by timing of nest initiation, population density, relative annual wetness, herbaceous cover, and tree cover in the surrounding landscape, and location within the Canadian PPR. We combined these models, with estimates of breeding effort (nesting, renesting, and nest attempts) from existing literature, in a stochastic conservation planning model that estimates nest distribution and success given spatiotemporal variation in duck density, habitat availability, and influential covariates. We demonstrate the use of this model by examining various conservation planning scenarios. These models allow estimation of local, landscape, and regional influence of conservation investments and other landscape changes on the productivity of breeding duck populations across the PPR of Canada. These models lay the groundwork for the incorporation of conservation delivery costs for full return‐on‐investment analyses and scenario analyses of climate, habitat, and land use change in regional and continental population models. [ABSTRACT FROM AUTHOR]

Climate and land use change are two of the primary threats to global biodiversity; however, each species within a community may respond differently to these facets of global change. Although it is typically assumed that species use the habitat that is advantageous for survival and reproduction, anthropogenic changes to the environment can create ecological traps, making it critical to assess both habitat selection (e.g. where species congregate on the landscape) and the influence of selected habitats on the demographic processes that govern population dynamics.We used a long‐term (1958–2011), large‐scale, multi‐species dataset for waterfowl that spans the United States and Canada to estimate species‐specific responses to climate and land use variables in a landscape that has undergone significant environmental change across space and time. We first estimated the effects of change in climate and land use variables on habitat selection and population dynamics for nine species. We then hypothesized that species‐specific responses to environmental change would scale with life‐history traits, specifically: longevity, nesting phenology and female breeding site fidelity.We observed species‐level heterogeneity in the demographic and habitat selection responses to climate and land use change, which would complicate community‐level habitat management. Our work highlights the importance of multi‐species monitoring and community‐level analysis, even among closely related species.We detected several relationships between life‐history traits, particularly nesting phenology, and species' responses to environmental change. One species, the early‐nesting northern pintail (Anas acuta), was consistently at the extreme end of responses to land use and climate predictors and has been a species of conservation concern since their population began to decline in the 1980s. They, and the blue‐winged teal, also demonstrated a positive habitat selection response to the proportion of cropland on the landscape that simultaneously reduced abundance the following year, indicative of susceptibility to ecological traps.By distilling the diversity of species' responses to environmental change within a community, our methodological approach and findings will help improve predictions of community responses to global change and can inform multi‐species management and conservation plans in dynamic landscapes that are based on simple tenets of life‐history theory. [ABSTRACT FROM AUTHOR]

Objectives To investigate the levels of MDR in the predominant serotypes of invasive Streptococcus pneumoniae isolated in Canada over a 10 year period. Methods All isolates were serotyped and had antimicrobial susceptibility testing performed, in accordance with CLSI guidelines (M07-11 Ed. 2018). Complete susceptibility profiles were available for 13 712 isolates. MDR was defined as resistance to three or more classes of antimicrobial agents (penicillin MIC ≥2 mg/L defined as resistant). Serotypes were determined by Quellung reaction. Results In total, 14 138 invasive isolates of S. pneumoniae were tested in the SAVE study (S. pneumoniae Serotyping and Antimicrobial Susceptibility: Assessment for Vaccine Efficacy in Canada), a collaboration between the Canadian Antimicrobial Resistance Alliance and Public Health Agency of Canada—National Microbiology Laboratory. The rate of MDR S. pneumoniae in SAVE was 6.6% (902/13 712). Annual rates of MDR S. pneumoniae decreased between 2011 and 2015 (8.5% to 5.7%) and increased between 2016 and 2020 (3.9% to 9.4%). Serotypes 19A and 15A were the most common serotypes demonstrating MDR (25.4% and 23.5% of the MDR isolates, respectively); however, the serotype diversity index increased from 0.7 in 2011 to 0.9 in 2020 with a statistically significant linear increasing trend (P  < 0.001). In 2020, MDR isolates were frequently serotypes 4 and 12F in addition to serotypes 15A and 19A. In 2020, 27.3%, 45.5%, 50.5%, 65.7% and 68.7% of invasive MDR S. pneumoniae were serotypes included in the PCV10, PCV13, PCV15, PCV20 and PPSV23 vaccines, respectively. Conclusions Although current vaccine coverage of MDR S. pneumoniae in Canada is high, the increasing diversity of serotypes observed among the MDR isolates highlights the ability of S. pneumoniae to rapidly evolve. [ABSTRACT FROM AUTHOR]

Objectives To assess the antimicrobial susceptibility of 14 138 invasive Streptococcus pneumoniae isolates collected in Canada from 2011 to 2020. Methods Antimicrobial susceptibility testing was performed using the CLSI M07 broth microdilution reference method. MICs were interpreted using 2022 CLSI M100 breakpoints. Results In 2020, 90.1% and 98.6% of invasive pneumococci were penicillin-susceptible when MICs were interpreted using CLSI meningitis or oral and non-meningitis breakpoints, respectively; 96.9% (meningitis breakpoint) and 99.5% (non-meningitis breakpoint) of isolates were ceftriaxone-susceptible, and 99.9% were levofloxacin-susceptible. Numerically small, non-temporal, but statistically significant differences (P < 0.05) in the annual percentage of isolates susceptible to four of the 13 agents tested was observed across the 10-year study: chloramphenicol (4.4% difference), trimethoprim-sulfamethoxazole (3.9%), penicillin (non-meningitis breakpoint, 2.7%) and ceftriaxone (meningitis breakpoint, 2.7%; non-meningitis breakpoint, 1.2%). During the same period, annual differences in percent susceptible values for penicillin (meningitis and oral breakpoints) and all other agents did not achieve statistical significance. The percentage of isolates with an MDR phenotype (resistance to ≥3 antimicrobial classes) in 2011 and 2020 (8.5% and 9.4%) was not significantly different (P  = 0.109), although there was a significant interim decrease observed between 2011 and 2015 (P < 0.001) followed by a significant increase between 2016 and 2020 (P < 0.001). Statistically significant associations were observed between resistance rates to most antimicrobial agents included in the MDR analysis (penicillin, clarithromycin, clindamycin, doxycycline, trimethoprim/sulfamethoxazole and chloramphenicol) and patient age, specimen source, geographic location in Canada or concurrent resistance to penicillin or clarithromycin, but not biological sex of patients. Given the large isolate collection studied, statistical significance did not necessarily imply clinical or public health significance in some analyses. Conclusions Invasive pneumococcal isolates collected in Canada from 2011 to 2020 generally exhibited consistent in vitro susceptibility to commonly tested antimicrobial agents. [ABSTRACT FROM AUTHOR]

The Canadian Earth System Model version 5.0 (CanESM5.0), the most recent major version of the global climate model developed at the Canadian Centre for Climate Modelling and Analysis (CCCma) at Environment and Climate Change Canada (ECCC), has been used extensively in climate research and for providing future climate projections in the context of climate services. Previous studies have shown that CanESM5.0 performs well compared to other models and have revealed several model biases. To address these biases, CCCma has recently initiated the 'Analysis for Development' (A4D) activity, a coordinated analysis activity in support of CanESM development. Here we describe the goals and organization of this effort and introduce two variants ("p1" and "p2") of a new CanESM version, CanESM5.1, which features substantial improvements as a result of the A4D activity. These improvements include the elimination of spurious stratospheric temperature spikes and an improved simulation of tropospheric dust. Other climate aspects of the p1 variant of CanESM5.1 are similar to those of CanESM5.0, while the p2 variant of CanESM5.1 features reduced equilibrium climate sensitivity and improved ENSO variability as a result of intentional tuning of the atmospheric component. The A4D activity has also led to the improved understanding of other notable CanESM5.0/5.1 biases, including the overestimation of North Atlantic sea ice, a cold bias over sea ice, biases in the stratospheric circulation and a cold bias over the Himalayas. It provides a potential framework for the broader climate community to contribute to CanESM development, which will facilitate further model improvements and ultimately lead to improved climate change information. [ABSTRACT FROM AUTHOR]

Inversion is a fundamental step in magnetotelluric (MT) data routine analysis to retrieve a subsurface geoelectrical model that can be used to inform geological interpretations. To reduce the effect of non-uniqueness and local minimum trapping problems and improve calculation speeds, a data-driven mathematical method with a deep neural network was developed to estimate the subsurface resistivity. In this study, a deep learning (DL) inversion technique using a revised multi-head convolutional neural network (CNN) architecture was investigated for MT data analysis. We created synthetic datasets consisting of 100,000 random samples of resistivity layers to train the network's parameters. The trained model was validated with independent noised datasets, and the predicted results displayed reasonable accuracy and reliability, which demonstrates the potential application of DL inversion for real-world MT data. The trained model was used to analyze MT data collected in the southwestern Athabasca Basin, Canada. The calculated results from the DL method displayed a detailed subsurface resistivity distribution compared to traditional iterative inversion. Since this approach can predict a resistivity model without multiple forward modeling operations after the CNN model is created, this framework is suitable to speed up the computation of multidimensional MT inversion for subsurface resistivity. [ABSTRACT FROM AUTHOR]

Background: The Low-profile Visible Intraluminal Support device (LVIS Jr) has become a commonly used intracranial stent for the treatment of intracranial aneurysms. However long-term stability and effectiveness remains to be seen. The purpose of the study was to assess the long-term efficacy, safety and durability of LVIS Jr. in a retrospective multicenter registry. Methods: Patients with saccular aneurysms treated at centers across Canada using LVIS Jr for intracranial aneurysms were included in this retrospective registry between the dates of January 2013 and April 2019. Self reported outcomes were collected and used to assess both perioperative and long term safety and effectiveness. Both univariate and multivariate analysis were performed. Results: Total of 196 patients (132 Women; mean age of 57.6 years) underwent endovascular aneurysm treatment with at least 1 LVIS Jr. stent. Mean aneurysm dome size was 7.4 mm, and mean neck size of 4.3 mm. Mean clinical and imaging follow up were 950 and 899 days respectively. Class I/II was achieved in 85% on long term follow up. Periprocedural morbidity and mortality was 4.6% and 2% and additional delayed morbidity and mortality was 3% and 2.5%. Aneurysm size >10 mm was independent predictor of periprocedural complication (OR 2.59, p = 0.048) while an increased dome to neck ratio >1.5 was independent predictor of increased delayed complications (OR 3.99, p = 0.02). Conclusion: The LVIS Jr. intracranial stent is an effective device in the treatment of intracranial aneurysms. Satisfactory long term occlusion rates can be achieved safely with stent-assisted coil embolization. [ABSTRACT FROM AUTHOR]

Introduction: Health care system transformations that align with the principles of integrated care require the collaborative efforts of various macro-, meso- and microlevel stakeholders. Understanding the roles of various system actors can improve collaboration in ways that support purposeful health system change. Professional associations (PAs) have considerable influence, but little is known about the strategies they use to influence health system transformation. Methods: Using a qualitative descriptive approach, eight interviews with 11 senior level leaders from local PAs were conducted to learn about the strategies used to influence the province-wide reorganization of health care into Ontario Health Teams. Results: During times of health system transformation, PAs balance: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. The enactment of these various functions demonstrates the strategic nature of PAs, and showcases their ability to evolve in ways that align with the dynamic nature of healthcare. Discussion: PAs are highly connected groups, deeply engaged with their members and regularly engaged with other key stakeholders and decision-makers. PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. PAs strategically seek opportunities for collaboration with stakeholders that can amplify their message. Conclusion: Insights from this work could support health system leaders, policymakers, and researchers in leveraging the role of PAs in health system transformations via strategic collaboration. [ABSTRACT FROM AUTHOR]

Horseshoe crabs as a group are renowned for their morphological conservatism punctuated by marked shifts in morphology associated with the occupation of non-marine environments and have been suggested to exhibit a consistent developmental trajectory throughout their evolutionary history. Here, we report a new species of horseshoe crab from the Ordovician (Late Sandbian) of Kingston, Ontario, Canada, from juvenile and adult material. This new species provides critical insight into the ontogeny and morphology of the earliest horseshoe crabs, indicating that at least some Palaeozoic forms had freely articulating tergites anterior to the fused thoracetron and an opisthosoma comprising 13 segments. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to conduct a survey of intravesical botulinum toxin administration practices in Canada, to compare practices based on level of training, and to identify barriers to delivery. Methods: A voluntary online survey was sent to all members of the Canadian Urological Association. Respondents who provide intravesical botulinum toxin were questioned on training, surgical volume, workup, technique, and followup practices. Those with formal training in functional urology were compared to those without. Barriers to treatment delivery were identified. Results: The overall response rate was 26% (148/570). Most providers (59%) perform 1-10 treatments/month. Preoperatively, 51% perform cystoscopy and 43% perform urodynamics. A majority (66%) give routine antimicrobial prophylaxis; however, regimen and duration varied. Most (79%) perform some treatments under local anesthetic, and 66% instill lidocaine solution for analgesia. There was a wide variation in technique with regards to the number of injections administered (range <10 to >20), volume administered per injection (range 0.5-2 mL), location of injections (bladder body vs. trigone vs. both), and depth of injection. Postoperative followup ranged from three days to three months. Respondents with fellowship training in functional/reconstructive urology performed more treatments per month and administered fewer injections per treatment. Common barriers to delivery included lack of experience/training among non-providers (45%), lack of resources (34%), and lack of medication funding (32%). Conclusions: Despite intravesical botulinum toxin being a widely accepted treatment, significant variability in practices and several barriers to delivery exist in Canada. Further study is required to optimize treatment access and quality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN: We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS: Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (−4.8% per decade, 95% CI −13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (−4.1 per decade, 95% CI −7.4 to −0.8 and −1.4 per decade, 95% CI −3.0 to −0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS: Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout. [ABSTRACT FROM AUTHOR]

This article addresses the impact of war on Newfoundland, including Labrador, while Newfoundland was independent from Canada, and the role of war in the eventual addition of Newfoundland as a province of Canada in 1949. Newfoundland's small and scattered population meant that it was never a particularly prosperous place, although the railway embodied the hope of the existence of a real future. Locally, some fishing premises and farms performed well, but there was a pervasive opinion, expressed in the degree of outmigration, that one could not do well in the territory. Its leadership went through a number of changes, from responsible government with an elected assembly in 1855 to Commission of Government in the 1930s and 1940s. But the overriding issue was the Canadian Confederation of 1867, and here the Confederates had an overall advantage, given the Canadian welfare state of the late 1940s. After a referendum following the Second World War, Newfoundland joined the union as the tenth province on 30 March 1949. [ABSTRACT FROM AUTHOR]

DP915635 maize was genetically modified (GM) to express the IPD079Ea protein for corn rootworm (Diabrotica spp.) control. DP915635 maize also expresses the phosphinothricin acetyltransferase (PAT) protein for tolerance to glufosinate herbicide and the phosphomannose isomerase (PMI) protein that was used as a selectable marker. A field study was conducted at ten sites in the United States and Canada during the 2019 growing season. Of the 11 agronomic endpoints that were evaluated, two of them (early stand count and days to flowering) were statistically significant compared with the control maize based on unadjusted p-values; however, these differences were not significant after FDR-adjustment of p-values. Composition analytes from DP915635 maize grain and forage (proximates, fiber, minerals, amino acids, fatty acids, vitamins, anti-nutrients, and secondary metabolites) were compared to non-GM near-isoline control maize (control maize) and non-GM commercial maize (reference maize). Statistically significant differences were observed for 7 of the 79 compositional analytes (16:1 palmitoleic acid, 18:0 stearic acid, 18:1 oleic acid, 18:2 linoleic acid, 24:0 lignoceric acid, methionine, and α-tocopherol); however, these differences were not significant after FDR-adjustment. Additionally, all of the values for composition analytes fell within the range of natural variation established from the in-study reference range, literature range, and/or tolerance interval. These results demonstrate that DP915635 is agronomically and compositionally comparable to non-GM maize represented by non-GM near-isoline control maize and non-GM commercial maize. [ABSTRACT FROM AUTHOR]

Age group typically identifies millennials – those born between 1982 and 2004. Yet our research challenges the designation based on age group by considering this population in the context of an individual's citizenship or culture. Based on tenets of social identity theory, we explore a citizen's personal value orientation and cognitive moral reasoning to discover commonalities or differences across individuals from eight countries. We report wide variations among citizens' personal value orientations and principled moral reasoning despite being borne within an identified age group. We conclude that an individual's geographic context is a stronger classification descriptor based on values and moral reasoning than their age-based generational categories. Implications for business practice and scholarly research are discussed. [ABSTRACT FROM AUTHOR]

In recent decades, advances in the flexibility and complexity of hydrologic models have enhanced their utility in scientific studies and practice alike. However, the increasing complexity of these tools leads to a number of challenges, including steep learning curves for new users and issues regarding the reproducibility of modelling studies. Here, we present the RavenR package, an R package that leverages the power of scripting to both enhance the usability of the Raven hydrologic modelling framework and provide complementary analyses that are useful for modellers. The RavenR package contains functions that may be useful in each step of the model-building process, particularly for preparing input files and analyzing model outputs. The utility of the RavenR package is demonstrated with the presentation of six use cases for a model of the Liard River basin in Canada. These use cases provide examples of visually reviewing the model configuration, preparing input files for observation and forcing data, simplifying the model discretization, performing realism checks on the model output, and evaluating the performance of the model. All of the use cases are fully reproducible, with additional reproducible examples of RavenR functions included with the package distribution itself. It is anticipated that the RavenR package will continue to evolve with the Raven project and will provide a useful tool to new and experienced users of Raven alike. [ABSTRACT FROM AUTHOR]

Fusarium head blight (FHB), primarily incited by Fusarium graminearum Schwabe, is the most devastating disease of barley (Hordeum vulgare L.) in Canada. Contaminated grains are unsuitable for use as livestock feed or by the malting industry, primarily due to contamination by mycotoxins such as deoxynivalenol (DON). Reducing DON content has been a long-term goal of barley breeders; however, the complex genetics of resistance and laborious testing required have made it difficult to develop resistant cultivars. An Illumina 50 K SNP beadchip was used to genotype a diverse collection (n = 400) of two-row barley genotypes, selected primarily from North American-breeding programs. This genomic panel was phenotyped in three environments in Manitoba, Canada, over two growing seasons. Genotypes were evaluated for heading date, height, FHB score, and DON content. A genome-wide association study (GWAS) was carried out using a mixed linear model (MLM: Q + K) accounting for population structure (Q) and kinship (K) as covariates. This study characterized the population structure of two-row barley germplasm important to North American-breeding programs. Significant marker-trait associations were identified on all chromosomes for FHB, and on all chromosomesexcept 1 H and 6 H for DON content. Individual marker effects were small, explaining only up to 5% of the phenotypic variation. Genes within genomic regions that were associated with FHB-related traits displayed multiple functions linked with disease resistance. While numerous minor, marker-trait associations were identified, phenotypic evaluations are still the best predictors of these traits, despite their time-consuming nature and dependenceon environmental conditions. [ABSTRACT FROM AUTHOR]

Entrustable Professional Activities (EPA) assessments are intended to facilitate meaningful, low-stakes coaching and feedback, partly through the provision of written comments. We sought to explore EPA assessment comments provided to internal medicine (IM) residents for evidence of feedback and coaching language as well as politeness. We collected all written comments from EPA assessments of communication from a first-year IM resident cohort at the University of Toronto. Sensitized by politeness theory, we analyzed data using principles of constructivist grounded theory. Nearly all EPA assessments (94%) contained written feedback based on focused clinical encounters. The majority of comments demonstrated coaching language, including phrases like 'don't forget to,' and 'next steps are,' followed by specific suggestions for improvement. A variety of words, including 'autonomy' and 'independence' denoted entrustment decisions. Linguistic politeness strategies such as hedging were pervasive, seemingly to minimize harm to the supervisor-trainee relationship. Evidence of written coaching feedback suggests that EPA assessment comments are being used as intended as a means of formative feedback to promote learning. Yet, the frequent use of polite language suggests that EPAs may be higher-stakes than expected, highlighting a need for changes to the assessment culture and improved feedback literacy. [ABSTRACT FROM AUTHOR]

Introduction: There are limited oral antimicrobial options for the treatment of urinary infections caused by ESBL-producing and MDR Enterobacterales. Sulopenem is an investigational thiopenem antimicrobial that is being developed as both an oral and IV formulation. The purpose of this study was to evaluate the in vitro activity of sulopenem versus bacterial pathogens recovered from the urine of patients admitted to or assessed at hospitals across Canada (CANWARD).Materials and Methods: The in vitro activity of sulopenem and clinically relevant comparators was determined for 1880 Gram-negative and Gram-positive urinary isolates obtained as part of the CANWARD study (2014 to 2021) using the CLSI broth microdilution method.Results: Sulopenem demonstrated excellent in vitro activity versus members of the Enterobacterales, with MIC90 values ranging from 0.06 to 0.5 mg/L for all species tested. Over 90% of ESBL-producing, AmpC-producing and MDR (not susceptible to ≥1 antimicrobial from ≥3 classes) Escherichia coli were inhibited by ≤0.25 mg/L of sulopenem. Sulopenem had an identical MIC90 to meropenem for ESBL-producing and MDR E. coli. The MIC90 of sulopenem and meropenem versus MSSA was 0.25 mg/L. Sulopenem was not active in vitro versus Pseudomonas aeruginosa (similar to ertapenem), and it demonstrated poor activity versus Enterococcus faecalis (similar to meropenem).Conclusions: Sulopenem demonstrated excellent in vitro activity versus bacterial pathogens recovered from the urine of Canadian patients. These data suggest that sulopenem may have a role in the treatment of urinary infections caused by antimicrobial-resistant Enterobacterales, but additional clinical studies are required. [ABSTRACT FROM AUTHOR]

Aims: To measure the prevalence and changes in smokers' discussions with health professionals (HPs) about nicotine vaping products (NVPs) and HPs' recommendations about NVPs between 2016 and 2020, and their associations with tobacco product use transitions. Design: Cohort study using multinomial logistic regression analyses on data from waves 1 (2016), 2 (2018) and 3 (2020) from the International Tobacco Control Four Country Smoking and Vaping Surveys. Setting: Four countries with varying NVP regulatory environments: 'most restrictive' (Australia), 'somewhat restrictive' (Canada) and 'less restrictive' (England and the United States). Participants: Adult exclusive daily smokers who did not report NVP use at the time of their baseline survey and had visited a HP in the last 12–24 months. Prevalence data came from 4125, 4503 and 4277 respondents, respectively, for each year. Longitudinal data were from 4859 respondents who participated in at least two consecutive surveys. Measurements Prevalence of self‐reported discussions with HPs and recommendations from HPs about NVPs. Longitudinal transitions from smoking to vaping (either exclusively or concurrently with smoking) and quitting (regardless of NVP uptake). Findings The prevalence of NVP discussions was low among countries with varying regulatory environments and study waves (range = 1.4–6.2%). In 2020, a low percentage of smokers who discussed NVPs with a HP reported that their HPs recommended they use NVPs in the United States (14.7%), Australia (20.2%), Canada (25.7%), with a higher percentage in England (55.7%) where clinical guidelines for smoking cessation include NVPs. Compared with 12.0% of smokers who reported no discussion, 37.0% of those whose HPs recommended NVPs transitioned to vaping at follow‐up. Transition to quitting was 9.6% with HPs' recommendation of NVPs versus 13.5% without discussion, a non‐significant difference. Conclusions: In Australia, Canada, England and the United States between 2016 and 2020, health professionals' discussions with smokers about nicotine vaping products (NVPs) were infrequent. NVP discussions were associated with NVP uptake, but not with quitting smoking. [ABSTRACT FROM AUTHOR]

This paper discusses the joint-knowledge production that emerged through a community-based research project conducted in partnership with a social service organization. Specifically, we present an unanticipated metaphor ('Canada is clean') that became evident through utilizing an art-based methodology. The methodology had five participants assemble photo-diaries over the span of two weeks. Participants took (unedited) photographs of themselves and their environments using their smartphone. The photo diaries were then presented to two focus groups: (1) a group of consumer-recipients of the social service organization and (2) a group of program workers. The focus groups were analyzed through Interpretive Phenomenological Analysis tailored for assessing groups. We address the meaning of the central metaphor, though place an emphasis on the milieu that promoted its co-construction and thereby upon the conditions that enabled arts-based research to succeed. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused millions of deaths worldwide, leading to symptoms of grief among the bereaved. Neither the burden of severe grief nor its predictors are fully known within the context of the pandemic. Aim: To determine the prevalence and predictors of severe grief in family members who were bereaved early in the COVID-19 pandemic. Design: Prospective, matched cohort study. Setting/Participants: Family members of people who died in an acute hospital in Ottawa, Canada between November 1, 2019 and August 31, 2020. We matched relatives of patients who died of COVID (COVID +ve) with those who died of non-COVID illness either during wave 1 of the pandemic (COVID −ve) or immediately prior to its onset (pre-COVID). We abstracted decedents' medical records, contacted family members >6 months post loss, and assessed grief symptoms using the Inventory of Complicated Grief-revised. Results: We abstracted data for 425 decedents (85 COVID +ve, 170 COVID −ve, and 170 pre-COVID), and 110 of 165 contacted family members (67%) consented to participate. Pre-COVID family members were physically present more in the last 48 h of life; the COVID +ve cohort were more present virtually. Overall, 35 family members (28.9%) had severe grief symptoms, and the prevalence was similar among the cohorts (p = 0.91). Grief severity was not correlated with demographic factors, physical presence in the final 48 h of life, intubation, or relationship with the deceased. Conclusion: Severe grief is common among family members bereaved during the COVID-19 pandemic, regardless of the cause or circumstances of death, and even if their loss took place before the onset of the pandemic. This suggests that aspects of the pandemic itself contribute to severe grief, and factors that normally mitigate grief may not be as effective. [ABSTRACT FROM AUTHOR]

We review the Canadian federal government's recently enacted Food Policy for Canada (FPC). Three arguments are developed. First, the development and vision statement of the FPC implies that improving Canadian food security is a specific objective of the policy. Second, if assessed by the measure of food insecurity promulgated by Statistics Canada, the effectiveness of the FPC in reducing Canadian food insecurity will primarily depend on the extent to which it improves household incomes and/or lowers food prices. We evaluate the current programmatic content by these criteria. Third, and related to the second point, we argue that the variation in the severity of food insecurity is an important consideration in assessing the effectiveness of FPC programs in reducing food insecurity as measured by Statistics Canada. Finally, we combine these three arguments into a simple figure/heuristic that can serve as a guide to the assessment and development of FPC programs seeking to enhance food insecurity in Canada. [ABSTRACT FROM AUTHOR]

This article explores the legalization and marketing of recreational cannabis in Canada, specifically the province of Nova Scotia, that has extended state monopoly over sales. Beginning with Howard Becker's classic analysis of "becoming a marijuana user," this ethnographic investigation of the first day of state cannabis sales utilizes and extends Bourdieusian analyses, particularly by showing how "symbolic violence" and "taste distinctions" work beyond overt class reproduction to establish state classifications and rituals. The practices we observe show state formation in action at the point of sale, including education, warning, prohibition, and promotion. As we demonstrate, the state marketing of cannabis works to invite emotional identification toward becoming the state consumer as an embodied habitus. The citizen is not just redeemed morally by the legal recategorization of cannabis but brought into a new subject position as good consumer citizen at the moment of ritual consumption, that is, brought into a "tasteful state." [ABSTRACT FROM AUTHOR]