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Problem-based learning (PBL) was originally introduced in medical education programs as a form of small-group learning, but its use has now spread to large undergraduate classrooms in various other disciplines. Introduction of new teaching techniques, including PBL-based methods, needs to be justified by demonstrating the benefits of such techniques over classical teaching styles. Previously, we demonstrated that introduction of tutor-less PBL in a large third-year biochemistry undergraduate class increased student satisfaction and attendance. The current study assessed the generic problem-solving abilities of students from the same class at the beginning and end of the term, and compared student scores with similar data obtained in three classes not using PBL. Two generic problem-solving tests of equal difficulty were administered such that students took different tests at the beginning and the end of the term. Blinded marking showed a statistically significant 13% increase in the test scores of the biochemistry students exposed to PBL, while no trend toward significant change in scores was observed in any of the control groups not using PBL. Our study is among the first to demonstrate that use of tutor-less PBL in a large classroom leads to statistically significant improvement in generic problem-solving skills of students. (Contains 4 tables and 1 figure.)

Background: Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming the backbone for PBRLNs. The purpose of this work is to: (1) report on descriptive findings from recent frailty work, (2) describe strategies for working across PBRLNs in primary care, and (3) provide lessons learned for engaging PBRLNs. Methods: We carried out a participatory based descriptive study that engaged five different PBRLNs. We collected Clinical Frailty Scale scores from a sample of participating physicians within each PBRLN. Descriptive statistics were used to analyze frailty scores and patients' associated risk factors and demographics. We used the Consolidated Framework for Implementation Research to inform thematic analysis of qualitative data (meeting minutes, notes, and conversations with co-investigators of each network) in recognizing challenges of working across networks. Results: One hundred nine physicians participated in collecting CFS scores across the five provinces (n = 5466). Percentages of frail (11-17%) and not frail (82-91%) patients were similar in all networks, except Ontario who had a higher percentage of frail patients (25%). The majority of frail patients were female (65%) and had a significantly higher prevalence of hypertension, dementia, and depression. Frail patients had more prescribed medications and numbers of healthcare encounters. There were several noteworthy challenges experienced throughout the research process related to differences across provinces in the areas of: numbers of stakeholders/staff involved and thus levels of burden, recruitment strategies, data collection strategies, enhancing engagement, and timelines. Discussion: Lessons learned throughout this multi-jurisdictional work included: the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for structural support and recognizing differences in data sharing across provinces. Conclusion: The differences noted across CPCSSN networks in our frailty study highlight the challenges of multi-jurisdictional work across provinces and the need for consistent and collaborative healthcare planning efforts. [ABSTRACT FROM AUTHOR]

Purpose: Historically, anesthesiology departments have played a small role in teaching the pre-clerkship component of undergraduate medical education (UGME). The purpose of this study was to measure the current participation of Canadian anesthesiologists in UGME with a focus on pre-clerkship.Methods: Three surveys were developed in collaboration with the Association of Canadian Departments of Anesthesia. After an initial series of validation procedures, the surveys were distributed to anesthesia department heads, UGME directors, and associate deans at the 17 Canadian medical schools.Results: The median [interquartile range (IQR)] percentage of anesthesiologists with teaching roles in pre-clerkship was 10.0 [3.4-21]%. The median [IQR] hours taught per anesthesiologist during pre-clerkship was 2.2 [0.4-6.1] hr·yr-1, representing an 817% increase over the last 15 years. Eleven of 17 departments contributed at a level less than expected based on their proportional faculty size, and 6 of 17 departments contributed less than 1% of pre-clerkship hours. Anesthesiology departments thought more strongly than associate deans that their contributions were limited by a lack of teaching opportunities (P = 0.01) and that their contributions were indispensable (P = 0.033). Only 12 of 17 schools had mandatory anesthesia clerkships, with a median [IQR] duration of 10 [10-11] days.Conclusion: The contribution of anesthesiology departments to pre-clerkship has increased over the past fifteen years but remains much less than expected based on proportional faculty size. While the increase is encouraging, the relatively poor engagement is concerning, representing not only a missed opportunity but also a possible threat to the academic standing of the profession. [ABSTRACT FROM AUTHOR]

Background: Palliative radiotherapy (PRT) can significantly improve quality of life for patients dying of cancer with bone metastases. However, an aggressive cancer treatment near end of life is an indicator of poor-quality care. But the optimal rate of overall palliative RT use near the end of life is still unknown. We sought to determine the patterns of palliative radiation therapy (RT) utilization in patients with bone metastases towards their end of life in a population-based, publicly funded health care system. Methods: All consecutive patients with bone metastases treated with RT between 2007 and 2011 were identified in a provincial Canadian cancer registry database. Patients were categorized as receiving RT in the last 2 weeks, 2-4 weeks, or >4 weeks before their death. Associations between RT fractionation utilization by these categories, and patient and provider characteristics were assessed through logistic regression. Results: Of the 16,898 courses 1734 (10.3) and 709 (4.2 %) were prescribed to patients in the last 2-4 weeks and <2 weeks of their life, respectively. Primary lung (8 %) and gastrointestinal (6.9 %) cancers received palliative RT more commonly in the last 2 weeks of life (OR 3.72 [2.86-4.84] & 3.33 [2.42-4.58] respectively, p <0.001). Among the 709 patients who received RT in the last 2 weeks of life, 350 (49), 167 (24), and 127 (18 %) were for spine, pelvis, and extremity metastases, respectively. RT was prescribed most frequently to spine (5 %) and extremity (4 %) metastases p <0.001 in the last two weeks of life, though only varied between 1 % (sternum) and 5 % (spine) by site of metastases. Single fraction RT was prescribed more commonly in the last 2 weeks of life (64.2 %), compared to individuals who received RT 2-4 weeks (54.5), and >4 weeks (47.9 %) before death (p <0.001). Conclusions: This population-based analysis found that only 4 % of patients with bone metastases received radiation therapy during the last 2 weeks of their life in our population-based, publicly funded program, though it was significantly higher in patients with lung cancer and those with metastases to the spine or extremity. Appropriately, use of multiple fractions palliative RT was less common in patients closer to death. [ABSTRACT FROM AUTHOR]

Engaging stakeholders is crucial for health promotion and programme evaluations; understanding how to best engage stakeholders is less clear, especially within Indigenous communities. The objectives of this thesis research were to use participatory methods to: (1) co-develop and evaluate a whiteboard video for use as a public health promotion tool in Rigolet, Nunatsiavut, and (2) develop and validate a framework for participatory evaluation of Inuit public health initiatives in Nunatsiavut, Labrador. Data collection tools included interactive workshops, community events, interviews, focus-group discussions and surveys. Results indicated the whiteboard video was an engaging and suitable medium for sharing public health messaging due to its contextually relevant elements. Participants identified 4 foundational evaluation framework components necessary to conduct appropriate evaluations, including: (1) community engagement, (2) collaborative evaluation development, (3) tailored evaluation data collection and (4) evaluation scope. This research illustrates stakeholder participation is critical to develop and evaluate contextually relevant public health initiatives in Nunatsiavut, Labrador and should be considered in other Indigenous communities. [ABSTRACT FROM AUTHOR]

Due to their relatively high trophic position and importance as a food source for many communities in the circumpolar north, seabird eggs are an important matrix for monitoring contaminant levels. In fact, many countries, including Canada, have established long-term seabird egg contaminant monitoring programs, with oil related compounds a contaminant of emerging concern for seabirds in several regions. Current approaches to measuring many contaminant burdens in seabird eggs are time-consuming and often require large volumes of solvent. Here we propose an alternative approach, based on the principle of microbead beating tissue extraction using custom designed stainless-steel extraction tubes and lids, to measure a suite of 75 polycyclic aromatic compounds (polycyclic aromatic hydrocarbons (PAHs), alkyl-PAHs, halogenated-PAHs and some heterocyclic compounds) comprising a wide-range of chemical properties. Our method was conducted in strict accordance with ISO/IEC 17025 guidelines for method validation. Accuracies for our analytes generally ranged from 70 - 120%, and intra and inter-day repeatability for most analytes were < 30%. Limits of detection/quantitation for the 75 target analytes were < 0.2/0.6 ng g−1. The level of contamination in our method blanks was significantly smaller in our stainless-steel tubes/lids relative to commercially available high-density plastic alternatives. Overall, our method meets our data quality objectives and results in a notable reduction in sample processing times relative to current approaches. [Display omitted] • A new approach for analysis of 75 polycyclic aromatic compounds in seabird eggs is validated. • Methods based on a micro-bead tissue homogenization and extraction. • Accuracy generally ranged from 70 - 120%, and repeatability for most analytes was < 30%. • LODs and LOQs were in the sub-ppm range. • The method results in significant reduction in sample processing times. [ABSTRACT FROM AUTHOR]

Prevention and control of water pollution for maintaining and restoring the wholesomeness of rivers are unavoidable. The current water quality approach of designated best use has some limitations such as it is non-integrative and inflexible with regard to the consideration of variables and does not provide a separate rating scale for a given designated use. We thus used water quality index approach proposed by the Canadian Council of Ministers of the Environment (CCME WQI) to evaluate and develop a separate rating system for drinking and irrigation purposes of rivers Beas, Satluj and their confluence water of the Indian Punjab using information collected over 4 years (2016 to 2019). River Beas exhibited better water quality compared to river Satluj for irrigation as well as for drinking. The overall drinking water quality index (DWQI) for Beas was marginal (45.5), whereas it was poor for Satluj (37.7) and confluence waters (40.1). The spatial variation in DWQI was greater for Satluj compared to Beas and confluence waters reflecting the effect of dumping of untreated industrial and domestic waste waters. Variables such as Total coliform (T. coli), dissolved oxygen (DO), turbidity and biological oxygen demand (BOD) contributed to the deterioration of DWQI. The irrigation water quality index (IWQI) was good for Beas (86), marginal for Satluj (60.1) and fair for confluence waters (71.2). Faecal coliform (F. coli), Kelly ratio (KR) and %Na contributed to the deterioration of IWQI. Calcium-magnesium-bicarbonate (Ca-Mg-HCO 3 ) was the dominant water type in Beas and confluence waters, whereas for Satluj, in addition to Ca-Mg-HCO 3 , sodium-potassium-chloride-sulphate and mixed water types were also prevalent. The river waters witnessed salinity hazard but did not pose sodicity hazard except at a few locations of Satluj. The study indicates the need to take location specific measures for improving river water quality for drinking as well as irrigation purposes. The current status of water quality calls for an urgent need to formulate stringent policy regulations to maintain the surface water quality., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: In the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful. The objective of this project was to evaluate a similar multicomponent intervention aimed at ED physician ordering, with the primary goal of reducing the number of monthly BUN tests ordered per ED visit., Methods: A pre post intervention design was conducted over 12-months. The first intervention component was an educational presentation conducted by physician leaders. Second, a regularly used order panel within the ED electronic order system was modified, removing the BUN test. The third component involved audit and feedback; the total monthly BUN test ordered for the ED department post intervention start was shared with all ED physicians twice (at 5 and 12 months).An interrupted time series analysis was completed to evaluate the multicomponent intervention effect., Results: The total monthly ordered BUN test declined from an average of 1905 pre-intervention to 448 post-intervention, and the total monthly BUN test to total ED visit ratio declined from 0.46 to 0.1. These results were a statistically significant reduction in physician BUN test ordering., Conclusions: Targeted education, order panel design and data feedback interventions can impact physician ordering behaviour in the emergent healthcare context, where diagnostic tests are often over used., (© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

22 alkylated polycyclic aromatic hydrocarbons (alk-PAHs) were characterized in ambient air individually for the first time in urban and semi-urban locations in Toronto, Canada. Five unsubstituted PAHs were included for comparison. Results from the measurements were used to estimate benzo[ a ]pyrene equivalent toxicity (BaPeq) of individual compounds in order to investigate the significance of a single compound in contributing to the overall toxic equivalency (TEQ) of air mixtures. To determine which compounds merit further investigation, BaPeq values of individual compounds were compared to the measured BaP toxicity. Our results showed that both unsubstituted and alkylated PAHs were more abundant in the urban area (38 and 30%, respectively). Benzo[ a ]pyrene levels at the urban location exceeded Ontario's 24 h guideline (40% of the events), and on average, it was 5 times higher than that at the semi-urban area. Gas-phase two- and three-ring compounds contributed up to 39% (urban) and 76% (semi-urban) of the TEQ of all compounds analyzed. Some alk-PAHs such as 7,12-dimethylbenzo[ a ]anthracene had a huge impact on the toxicity of urban air, and its BaPeq was on average 8 times higher than that of BaP. We emphasize that the toxic impact of alkylated and gaseous PAHs, which is not routinely included in many air monitoring programs, is significant and should not be neglected.

Introduction: Frailty is a medical syndrome, commonly affecting people aged 65 years and over and is characterized by a greater risk of adverse outcomes following illness or injury. Electronic medical records contain a large amount of longitudinal data that can be used for primary care research. Machine learning can fully utilize this wide breadth of data for the detection of diseases and syndromes. The creation of a frailty case definition using machine learning may facilitate early intervention, inform advanced screening tests, and allow for surveillance., Objectives: The objective of this study was to develop a validated case definition of frailty for the primary care context, using machine learning., Methods: Physicians participating in the Canadian Primary Care Sentinel Surveillance Network across Canada were asked to retrospectively identify the level of frailty present in a sample of their own patients (total n = 5,466), collected from 2015-2019. Frailty levels were dichotomized using a cut-off of 5. Extracted features included previously prescribed medications, billing codes, and other routinely collected primary care data. We used eight supervised machine learning algorithms, with performance assessed using a hold-out test set. A balanced training dataset was also created by oversampling. Sensitivity analyses considered two alternative dichotomization cut-offs. Model performance was evaluated using area under the receiver-operating characteristic curve, F1, accuracy, sensitivity, specificity, negative predictive value and positive predictive value., Results: The prevalence of frailty within our sample was 18.4%. Of the eight models developed to identify frail patients, an XGBoost model achieved the highest sensitivity (78.14%) and specificity (74.41%). The balanced training dataset did not improve classification performance. Sensitivity analyses did not show improved performance for cut-offs other than 5., Conclusion: Supervised machine learning was able to create well performing classification models for frailty. Future research is needed to assess frailty inter-rater reliability, and link multiple data sources for frailty identification., Competing Interests: Conflict of interest: The authors declare no conflicts of interest.

According to Health Canada (2016), only about 11% of older men meet recommended guidelines for physical activity, and participation decreases as men age. This places men at considerable risk of poor health, including an array of chronic diseases. A demographic shift toward a greater population of less healthy older men would substantially challenge an already beleaguered health-care system. One strategy to alter this trajectory might be gender-sensitized community-based physical activity. Therefore, a qualitative study was conducted to enhance understanding of community-dwelling older men's day-to-day experiences with physical activity. Four men over age 65 participated in a semistructured interview, three walk-along interviews, and a photovoice project. An interpretive descriptive approach to data analysis was used to identify three key themes related to men's experiences with physical activity: (a) "The things I've always done," (b) "Out and About," and (c) "You do need the group atmosphere at times." This research extends the knowledge base around intersections among older men, physical activity, and masculinities. The findings provide a glimpse of the diversity of older men and the need for physical activity programs that are unique to individual preferences and capacities. The findings are not generalized to all men but the learnings from this research may be of value to those who design programs for older men in similar contexts. Future studies might address implementation with a larger sample of older men who reside in a broad range of geographic locations and of different ethnicities.

Objective: Health expenditures on cardiovascular disease (CVD) account for a large proportion of health care expenditures of all the diseases in Canada, and hence there is a need to examine the responsiveness of CVD outcomes to health expenditures. The objective of this study was to examine the relationship between health care expenditures and CVD mortality, as a health care outcome at the provincial level in Canada., Methods: A 10-year (2000-2009) panel dataset was constructed from multiple data sources for the purposes of this study. The dataset composed of age standardized CVD mortalities, health care expenditures, and covariates for the 10 Canadian provinces. We employed a fixed effects model based on the results of the Hausman test, with CVD mortalities as the dependent variable and health care expenditure and other covariates, as explanatory variables., Results: Health care expenditures were significantly (0.05) and negatively associated with CVD mortality, with a 1% increase in health care expenditures associated with a decrease of 6.31 per 1 000 000 people in CVD mortality., Conclusion: In the Canadian context, increases in spending on health care were associated with improvements in CVD outcomes for the time period under investigation., (© 2018 John Wiley & Sons, Ltd.)

Purpose: There is ample evidence that single-fraction radiation therapy (SFRT) is as efficacious as more costly and morbid multifraction regimens. We previously demonstrated that an audit-based intervention increased the use of SFRT in all regional cancer centers the following year. However, other investigators have demonstrated that interventions were only associated with a transient 1-year change in prescribing practices. We sought to determine whether our intervention resulted in a more lasting impact., Methods and Materials: In 2012, we performed an audit of the prescribing practices of individual physicians, which was then presented to leaders and oncologists as an intervention to increase SFRT. We compared the use of SFRT between 2007 to 2011 (preintervention) and 2013 to 2016 (postintervention) in all 31,192 patients treated in our provincial program., Results: The use of SFRT increased from 49.2% to 58.9% postintervention (P < .001). Rates from 2007 to 2011 were 51%, 51%, 48%, 49%, and 48%, respectively, whereas the postintervention rates from 2013 to 2016 were 60%, 62%, 59%, and 56%, respectively. Postintervention, half of the centers prescribed SFRT in a relatively narrow range (55%-58%). However, across all centers, there was still a broad range, with the lowest and highest users at 35% and 81%, respectively, although the lowest-using center still showed a significant increase (26% to 35%; P < .001)., Conclusions: Our audit and education-based intervention resulted in a lasting and meaningful 10% change in practice. Our provincial rate is similar to that of a previously recommended benchmark rate of 60%, but we continue to see significant variation by center, suggesting further room for improvement in provincial standardization. With emerging evidence in support of ablative radiation therapy for select populations of patients with bone metastases, future benchmark rates of SFRT should be readdressed. However, our data suggest that programmatic comparison and dissemination of SFRT prescribing practices can achieve a population-based SFRT utilization rate near 60%., (Copyright © 2018 Elsevier Inc. All rights reserved.)