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Background: Antibiotics remain the primary treatment for community acquired pneumonia (CAP), however rising rates of antimicrobial resistance may jeopardize their future efficacy. With higher rates of disease reported in the youngest populations, effective treatment courses for pediatric pneumonia are of paramount importance. This study is the first to examine the quality of pediatric antibiotic use by agent, dose and duration. Methods: A retrospective cohort study included all outpatient/primary care physician visits for pediatric CAP (aged < 19 years) between January 1 2014 to December 31 2018. Relevant practice guidelines were identified, and treatment recommendations extracted. Amoxicillin was the primary first-line agent for pediatric CAP. Categories of prescribing included: guideline adherent, effective but unnecessary (excess dose and/or duration), under treatment (insufficient dose and/or duration), and not recommended. Proportions of attributable-antibiotic use were examined by prescribing category, and then stratified by age and sex. Result(s): A total of 42,452 episodes of pediatric CAP were identified. Of those, 31,347 (76%) resulted in an antibiotic prescription. Amoxicillin accounted for 51% of all prescriptions. Overall, 27% of prescribing was fully guideline adherent, 19% effective but unnecessary, 10% under treatment, and 44% not recommended by agent. Excessive duration was the hallmark of effective but unnecessary prescribing (97%) Macrolides accounted for the majority on non-first line agent use, with only 32% of not recommended prescribing preceded by a previous course of antibiotics. Conclusion(s): This study is the first in Canada to examine prescribing quality for pediatric CAP by agent, dose and duration. Utilizing first-line agents, and shorter-course treatments are targets for stewardship. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous (IV) fluids are routinely used in hospitalized patients. As IV fluids are an everyday occurrence, their importance is often overlooked. Many patients receive large volumes of fluid during resuscitation to aid in the promotion of tissue perfusion. Nurses regularly administer IV fluids as part of maintenance infusions or as life-saving therapies and, therefore, need to understand these fluids' impact on their patients. Understanding nurses' existing perceptions of IV fluid management practices are crucial to improving practice. Methods: This study used an online survey to gather information on nursing perceptions of IV fluids. Four hundred and sixty-two Canadian nurses from diverse backgrounds were surveyed, including registered nurses, licensed practical nurses and student nurses. Results: The study found that the majority of participants agreed that IV fluids, including type, amount, and rationale for infusion, were important. They also agreed that fluids could impact patient outcomes. However, the study found that, despite recognizing the value and importance of fluid management, many nurses struggled with recognizing how to determine a patient's fluid status versus fluid responsiveness. Conclusion: This study supports improving nursing education to understand better the differences between fluid volume status and volume responsiveness. Our study also provides evidence that nurses need access to more sophisticated tools to conduct dynamic assessments and better meet patients' needs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Water Resources Journal / Revue Canadienne des Ressources Hydriques is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adherence to guideline recommendations for venous thromboembolism prophylaxis (VTE) in hospitalized medical patients is suboptimal despite national policies and institutional interventions. The aim of this quality improvement project was to improve adherence to guidelines and decrease the overuse of VTE prophylaxis in order to reduce the institutional cost for heparins. A multidisciplinary anticoagulation stewardship program (ACSP) using the audit and feedback strategy was implemented on the medicine inpatient units at a teaching hospital in Canada. The primary outcome measure was a comparison, pre and post introduction of the ACSP, of the costs per 6-month period for prophylactic dose enoxaparin and unfractionated heparin on the medicine units. The balancing measures were the 90-day VTE rate and major bleeding rate during the hospitalization. Six months after the implementation of the ACSP, the cost was decreased by >50 % without any observed negative impact on patient safety. This study demonstrates the potential for anticoagulation stewardship programs to optimize the use of VTE prophylaxis and reduce the associated costs and risks. • Adherence to guideline recommendation for venous thromboembolism (VTE) prophylaxis in hospital is suboptimal. • Overuse of VTE prophylaxis in hospitalized medical patients is common. • Anticoagulation stewardship programs can improve the adherence to VTE prophylaxis guidelines. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a global concern as it poses a serious threat to our capacity to treat common infectious diseases. Canada has been engaged in actions to address the AMR challenge since 1997, and these actions include a four-pillar national strategy: surveillance; stewardship; infection prevention and control; and research and innovation. Dentists play a significant role in contributing to the efforts around these four-pillars, especially that of stewardship. Studies show that antibiotic prescriptions for oral health reasons, are increasing over time, and 60% to 80% of antibiotics prescribed in a dental setting are not necessarily clinically indicated. The development, promotion and implementation of initiatives to promote optimal use of antimicrobials across Canada will require collaboration among many stakeholders, including the oral health community. Antimicrobial resistance and antimicrobial stewardship are already being discussed within the dental profession in Canada; however, there is still more work to be done in a variety of areas including, but not limited to, dentists' access to and use of current evidence-based guidelines and prescribing protocols enforced by their governing bodies to ensure appropriate prescribing of antibiotics when necessary, and timely and affordable access to oral health care services by Canadians. [ABSTRACT FROM AUTHOR]

Increasing global rates of wildlife species extinctions, extirpations, and declines warrant improvements to population monitoring and management approaches. To address regional environmental and wildlife issues, Indigenous communities globally are re-establishing traditional roles as stewards of the land through emerging Indigenous Guardianship Programs (IGPs). By providing the opportunity for community-level participation in monitoring and management, IGPs help foster cohesive solutions for long-term conservation of species while promoting environmental stewardship at the community level. Addressing challenges in monitoring and management of wildlife is especially critical for species that are of cultural and ecological importance at both community and distribution-wide scales. Herein, we describe IGPs in Canada with a focus on moose (Alces alces), an important species to many Indigenous Peoples across the species' distribution. We outline common Western approaches to moose monitoring applied across Canadian jurisdictions and discuss ways in which weaving Indigenous knowledge systems and information gathered through local participation from Indigenous communities enhances monitoring initiatives at regional levels. We elaborate on a case study on moose monitoring and co-management in the community of Gitanyow in British Columbia, Canada to highlight the value of Guardianship to communities and species conservation in relation to moose. Our study reveals how IGPs and the weaving of Indigenous and Western knowledge systems can contribute to the maintenance of both ecological and cultural integrity to strengthen wildlife monitoring and management under changing global environments. [ABSTRACT FROM AUTHOR]

Copyright of Revue Generale de Droit is the property of Universite d'Ottawa, Section de Droit Civil and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Fisheries management is often data-limited, and conducted at spatial scales that are too large to address the needs of Indigenous peoples, whose cultures depend upon the local availability of marine resources. Outcomes: We combined Indigenous ecological knowledge with simulation modelling to inform modern fishery management. Semi-structured interviews with Indigenous fishers in coastal British Columbia, Canada, uncovered severe declines in the abundance and catches of Dungeness crab (Cancer magister) since the 1990s. We modelled the current probability of "successful" crab harvesting trips—as defined by expectations from past catches by Indigenous fishers—using fishery-independent data from nine sites. These probabilities were very low (<20%) for all sites except one. Discussion: Our study highlights that local depletions, which Indigenous fishers attribute to commercial and recreational fisheries, have been widespread and undetected by federal managers who manage Dungeness crab at regional scales without fishery-independent data. Further, local depletions impacted the ability of Indigenous fishers to access traditional foods. Conclusion: Integrating Indigenous knowledge with scientific research is crucial to inform locally-relevant fisheries management and conservation. [ABSTRACT FROM AUTHOR]

Background: Infectious disease (ID) consultations have been shown to increase adherence to guidelines and decrease mortality for patients with Staphylococcus aureus bacteremia (SAB). Here, we assessed the impact of a mandatory ID consultation policy for SAB.Methods: We retrospectively reviewed all consecutive adult patients with SAB at two tertiary care teaching hospitals in Hamilton, ON, Canada. Mandatory ID consults for SAB were implemented on January 1(st) 2012. We compared SAB cases in 2011 (control group) with those in 2012 (intervention group). Outcomes included adherence to the Infectious Diseases Society of America guidelines and patient outcomes.Results: We reviewed 128 SAB cases in 2011 and 124 in 2012. The majority of S. aureus were methicillin-susceptible (97/128, 75.8 % in 2011 and 100/124, 80.6 % in 2012). ID involvement increased significantly from 93/128 (72.7 %) in 2011, to 103/124 (83.1 %) in 2012 (odds ratio [OR] 1.9, 95 % confidence interval [CI] 1.1-3.3, p = 0.047). There was also a significant decrease in the median time to ID involvement from 2 days to 1 (p = 0.001). In patients who survived the minimum treatment course (greater than 13 days), there was a significant improvement in adherence to IDSA guidelines in 2012 (65/102, 63.7 % vs. 77/96, 80.2 %; OR 2.3, 95 % CI 1.2-4.4, p = 0.01). Mortality and SAB relapse rates were similar in both groups.Conclusions: Creating an automated ID consultation for SAB led to an increase in involvement of ID, a significant decrease in time to ID involvement, and better adherence to IDSA guidelines. The study was not sufficiently powered to detect significant changes in mortality and SAB relapse rates. [ABSTRACT FROM AUTHOR]

The purpose of this article is to reveal that the settler life writing preserves the all-but-forgotten wisdom of traditional mixed-farming methods. My study focuses on the farm logs or journals kept by three members of the Sheppard family, British immigrants who settled in southern Alberta in the late nineteenth century to establish ranches. Pioneers such as the Sheppards imagined the prairies as an Eden where they could lead prosperous lives and radically transformed the prairies, changing the nature of that life form. I explore the Sheppard journals through a lens shaped by Virgil’s Georgics. There is value in the Georgics as a model of sustainability; thus, such analysis reveals a traditional, cyclical agrarian pattern in the journals from which emerges an ethic of sustainability. [ABSTRACT FROM PUBLISHER]

Farming in Canada and the USA is dominated by row cropping concentrated in central regions. Using the Corn Belt of Iowa and the Lake Erie Lowlands of Ontario—sources of pollution affecting the Gulf of Mexico and Great Lakes—as exemplary regions, this paper provides a retrospective review of the landscape effects of policies and practices related to environmental stewardship and agricultural trade. Conservation policies and typical farm practices are described and compared for the two regions with an emphasis on lasting beneficial environmental outcomes. Connections among land cover changes, environmental consequences, and changes in environmental and trade policies and programs are considered along with future changes in farm management, trade liberalisation, and farm revenue sources. The paper concludes with prospective ideas of how policies and practices can maintain or enhance environmental benefits within intensively farmed landscapes as best approaches for agriculture. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Education / Revue Canadienne de l'Éducation is the property of Canadian Society for the Study of Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Surveillance of antimicrobial use (AMU) and antimicrobial resistance (AMR) is a core component of the 2017 Pan-Canadian Framework for Action. There are existing AMU and AMR surveillance systems in Canada, but some stakeholders are interested in developing their own AMU monitoring/surveillance systems. It was recognized that the establishment of core (minimum) AMU data elements, as is necessary for policy or intervention development, would inform the development of practical and sustainable AMU surveillance capacity across food animal sectors in Canada. The Canadian Animal Health Surveillance System (CAHSS) AMU Network was established as a multisectoral working group to explore the possibility of harmonizing data inputs and outputs. There was a consensus that a minimum AMU dataset for AMU surveillance (MDS-AMU-surv) should be developed to guide interested parties in initiating AMU data collection. This multisectoral collaboration is an example of how consultative consensus building across relevant sectors can contribute to the development of harmonized approaches to AMU data collection and reporting and ultimately improve AMU stewardship. The MDS-AMU-surv could be used as a starting point for the progressive development or strengthening of AMU surveillance programs, and the collaborative work could serve as a model for addressing AMR and other shared threats at the human–animal–environment interface. [ABSTRACT FROM AUTHOR]

This article presents an adaptable community-based monitoring (CBM) framework. The investigators used a well-tested conceptual CBM framework developed by the Canadian Community Monitoring Network (CCMN) as a basis from which to work. With the use of feedback from various types of CBM groups in the Province of Nova Scotia, Canada, obtained through surveys and interviews, the CCMN framework was modified into a document that attempts to address current disparities and inefficiencies within most CBM systems. The need for such a framework was underscored by the lack of stewardship groups’ use of standardized monitoring protocols and inability to effectively provide information to decision makers. From the information collected through the survey, it was concluded that the proposed framework must be a functional, multiparty form of CBM that addresses the key concerns of a standardized monitoring and communication program and must be able to be fed into the environmental-management system. [ABSTRACT FROM AUTHOR]

Concerns about the management of agro-ecosystems in Ontario Canada have been precipitated by the increasing intensity of agriculture operations and concerns about its impact on the environment and human health. The management of agro-ecosystems for sustainability is particularly challenging due to their inherent features and the complex web of institutional arrangements in which they arc set. This paper focuses on the concepts of regulation and stewardship. The contribution of the environmental farm plan (EFP) program to environmental management in Ontario farms is specifically examined. The EFP program was initiated by farmers to minimize environmental impacts from farming practices; it is voluntary and founded upon the principles of stewardship. Results of a survey conducted with participants in the EFP program demonstrate that appreciable measures are being taken to manage environmental impacts from farming. The contributions of stewardship to managing agro-ecosystems are explored in the conclusion. [ABSTRACT FROM AUTHOR]

This is a review of Great Lakes coastal wetland protection measures for both the United States and Canada, including regulatory mechanisms, tax incentives, securement stewardship initiatives and special programs/partnerships. International, federal, provincial, state, and local government and nongovernment programs are reviewed with commentary on effectiveness of such programs. Programs vary in scope and comprehensiveness at all levels. Major recent initiatives focus on water quality improvement from federal/state government and waterfowl habitat restoration from government/nongovernment partnerships. [ABSTRACT FROM AUTHOR]

While national parks (NPs) have for a long time made substantial contributions to visitor well-being, many spaces remain out of reach of people with disabilities (PwDs). This is partly due to a lack of policies that take accessibility for broader intersectional audiences into consideration. This paper evaluates governance and legal frameworks in NPs in both Canada and Spain. A decision-making framework based on intersectionality realities is proposed to assess current conditions of environmental good governance using a set of descriptors created to scrutinize laws and technical documents that can promote equitable access to NPs. To validate results derived from the regulatory evaluation, semistructured interviews with park managers were carried out. Results revealed the importance of incorporating equity discourses into policies that regulate NP networks to guarantee that all the intersectional realities for park uses are considered in their management. Furthermore, when a country develops a well-structured federal framework under which the rights of PwDs are ensured, it transcends other fields of law. Differences between the Canadian and the Spanish situation are highlighted, as well as the need for links between higher-level policies and laws and on-the-ground implementation, with NP management plans playing an important role.

Nanotechnology has increasing applications in numerous markets, particularly in additive processing (3D printing) and manufacturing, which is important for consumer products, medical devices, construction, and general research and development across many other industries. Nanomaterials are desirable in many products due to their unique properties, but those same properties have made evaluating the risk and regulation of these materials challenging. For risk-based regulations, new applications and nanomaterials should be assessed for both human and environmental hazards and exposure to ensure protection. In general, many risk assessments to date have focused on the non-nano versions of chemicals. The lack of guidance on assessing the hazard and exposure of nanomaterials in 3D printing is apparent, and these areas of assessment are actively being evaluated. Industry in most cases will now need to provide specific additional information for assessing the risk of nanomaterials in 3D printing. This review paper focuses on the use of nanomaterials in 3D printing for industrial and manufacturing applications, summarizes the current literature on human health and safety related to 3D printing and inhalation exposure, and the regulations relating to 3D printing in the U.S., Canada, and Europe for this industry. ga1 • Standardization of nano-characterization has led to comprehensive risk assessments. • Therefore, regulations for nanomaterials are becoming more prevalent. • This paper focuses on regulations impacting the nano-additives industry. • Nanomaterial release from 3D printing needs more research. • More information is needed on assessing hazard, exposure and risk. [ABSTRACT FROM AUTHOR]

Objectives: The authors conducted a survey of measures implemented in France and abroad for a better use of antibiotics in general practice., Methods: A literature review was conducted from January 2000 to July 2014. Emails were sent to every infectious diseases department, to all regional health authorities (ARS), to the health insurance offices (CPAM) with the highest and lowest antibiotic use, and to the ministry of health to make an inventory of all antibiotic stewardship programs. The ministry of health, the board of general practitioners, infectious diseases specialists, pharmacists, and the medical and pharmacy schools of the nation's capital were contacted in 17 countries of Europe and North America., Results: The main measures implemented in France were training of healthcare professionals, publishing guidelines, feedback to the practitioners on their prescriptions, and availability of rapid diagnostic tests. Telephone networks were created in some regions, such as Antibiolor or Medqual, to help physicians with antibiotic prescription. Many foreign countries issued pedagogical material to physicians, for patients to explain what to do in case of viral infection or delayed prescription. In Alberta (Canada), the government introduced an optional authorization for quinolones. In Denmark, the government temporarily suspended the reimbursement of some agents to preserve them according to bacterial ecology. In the United-Kingdom, the antibiotic susceptibility test report must include less than 5 agents., Conclusions: The measures implemented in France and abroad were usually more persuasive than restrictive. But the bacterial resistance crisis should lead to implementing more restrictive measures., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)