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Purpose: Working memory and linguistic knowledge are highly intertwined in language tasks. Verbal working memory in particular has been studied as a potential constraint on language performance. This, in turn, highlights the need for a clinical assessment tool that will assist clinicians in understanding individual children's performance in relation to working memory and language. In this study, we investigated whether performance on the Token Test could capture differences in verbal working memory and linguistic knowledge given its manipulation of length and syntactic complexity. Method: In Experiment 1, 257 children ages 4-7 years completed our Modified-Shortened Token Test, in which they carried out commands of increasing length and complexity. Experiment 2 was an exploratory study that included a separate group of 24 kindergarten-age children who completed our Modified-Shortened Token Test as well as other memory and language measures. Results: The factor analysis in Experiment 1 revealed a three-factor solution with factors corresponding to verbal working memory, linguistic, and basic attention constructs. In Experiment 2, we conducted exploratory correlations between composite scores formed based on identified factors (from Experiment 1) and related measures. Recalling sentences and formulating sentences correlated with the working memory demands of the Token Test, whereas following directions and word structure correlated with Token Test linguistic factor. Conclusions: A modified Token Test has the potential to be used clinically to understand language performance. In particular, differential performance across sentences could reveal relative verbal working memory and linguistic knowledge abilities.

Thirty per cent of school districts in British Columbia do not ban smoking outright on school grounds, and in several instances, smoking is permitted in smoking pits, regardless of school district policy. While there is evidence to suggest that enforcing a tobacco-free environment for students does reduce adolescent smoking rates, the concomitant safety and discipline problems it creates for school staff and administration are demanding and complex, and may override concerns regarding student smoking. This study uses a qualitative approach to explore the meanings that students place on tobacco control policy and the impact that these meanings have on their own smoking behaviours. We found that students were surprised and concerned that smoking was permitted on school property and that it negatively impacted their own tobacco prevention/control/cessation attempts. (Contains 1 table.)

Adolescents and young adults (AYAs; 15-39 years) diagnosed with cancer have unique medical and psychosocial needs. These needs could be better addressed through research that is focused on the topics that matter most to them. However, there is currently no patient-oriented research agenda for AYA cancer in Canada. This manuscript describes the early development and project protocol for a priority-setting partnership (PSP) for establishing the top 10 research priorities for AYA cancer in Canada. This project follows the PSP methodology outlined by the James Lind Alliance (JLA) to engage patients, caregivers, and clinicians in research prioritization. The steps of a JLA PSP include establishing a steering group and project partners, gathering uncertainties, data processing and verifying uncertainties, interim priority setting, and a final priority setting workshop. The AYA cancer PSP will result in a top 10 list of research priorities identified by Canadian AYA patients, caregivers, and clinicians that will be published and shared broadly with the research community. The first steering group meeting was held in April 2023, and the project is ongoing. The establishment of a patient-oriented research agenda for AYA cancer will catalyze a long-term and impactful research focus and ultimately improve outcomes for AYA patients with cancer in Canada.

Introduction: Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed., Aims and Methods: A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status., Results: Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids., Conclusions: Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions., Implications: Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16-19 year-olds in United States, Canada and England (2018-2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping., (© The Author(s) 2024. Published by Oxford University Press.)

Background: There is little research examining perceptions of cannabis use risk to mental health in countries with differing cannabis regulations. This study therefore examines such perceptions among youth between 2017 and 2021 in Canada (non-medical cannabis legalized in October 2018), England (highly-restricted medical cannabis legalized November 2018), and the US (non-medical cannabis legal in some states)., Methods: Seven repeat cross-sectional online surveys were conducted between July 2017 to August 2021 among youth aged 16-19 in Canada (N=29,420), England (N=28,155), and the US (N=32,974). Logistic regression models, stratified by country, were used to examine perceptions of cannabis use risk to mental health over time, adjusting for age group, sex, race/ethnicity, cannabis use and, for the US only, state-level cannabis legalization., Results: Perceptions that cannabis use posed "no risk" to mental health decreased between July 2017 and August 2021 in Canada (6.1-4.4%; AOR=0.64, 95% CI=0.52-0.78) and the US (14.0-11.3%; AOR=0.74, 0.65-0.84) but not England (3.7-4.5%; AOR=1.21, 0.97-1.52). No significant changes were observed from immediately before (August 2018) to after (August 2019) legalization of non-medical cannabis in Canada (AOR=0.99, 0.83-1.20) or highly-restricted medical cannabis in England (AOR=0.90, 0.70-1.17). In the US, perceptions of "no risk" were more likely in states where cannabis use was illegal (15.0%) compared with legal non-medical (12.2%) (AOR=0.68, 0.63-0.74)., Conclusion: There were modest decreases in perceptions that cannabis use poses no risk to mental health in Canada and the US between 2017 and 2021 but no clear association with cannabis legalization status., Competing Interests: Declaration of Competing Interest DH has served as a paid expert witness on behalf of governments and public health authorities in legal challenges against tobacco, vaping, and cannabis companies. All other authors have no potential conflicts of interest to disclose., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Hemolysis is a rare adverse event associated with the use of intravenous immune globulin (IVIG). Using the Canadian experience, this article compares two methods used for case ascertainment of hemolysis after IVIG., Study Design and Methods: This is a retrospective, descriptive analysis of case reports of hemolytic reaction after exposure to IVIG. The cases were ascertained from the Canada Vigilance database using the standardized MedDRA query for hemolytic disorders between the years 2006 and 2012 inclusively. The presence of a causal relationship was determined by using the Transfusion Transmitted Injuries Surveillance System (TTISS) algorithm. Cases were then reviewed against the standardized case definition of IVIG-associated hemolysis proposed by the IVIG Hemolysis Pharmacovigilance Group., Results: A total of 942 adverse event reports after exposure to IVIG had been received by Canada Vigilance during the study period. A search for the adverse event of hemolytic disorder retrieved 313 reports (33%). Using a modified TTISS definition of hemolysis and the TTISS causality assessment algorithm, 226 cases were found to be at least possibly related to administration of IVIG, whereas 69 cases met the definition of the IVIG Hemolysis Pharmacovigilance Group. The amount of IVIG distributed increased over the study period; this trend was not reflected in the number of adverse reaction reports for "hemolytic disorder" received., Conclusion: The number of case reports per year received for the adverse event "hemolytic disorder" after exposure to IVIG fluctuated. The number of confirmed case reports varied depending on the case definition being used., (© 2015 AABB.)

As a result of a number of factors, the treatment of insulin-dependent diabetes has moved away from using insulin of beef or pork origin to using recombinant (biosynthetic) insulin preparations. However, some people with type 1 diabetes can manage their diabetes better using animal-sourced insulin. Despite dwindling options and decreased production, animal-sourced insulin (and pork insulin in particular) is still available on the Canadian market. This communication describes the actions taken by Health Canada with respect to the availability of animal insulin.

In this study, the magnitude and direction of gene flow and estimates of effective population sizes (N(e) ) were quantified among two life-history types (lacustrine and anadromous) of broad whitefish Coregonus nasus in the lower Mackenzie River system. The data suggest that dispersal and subsequent gene flow occurs between these groups, with the former appearing to be asymmetrical. Gene flow may potentially be directionally biased as well, a result attributed to source-sink population dynamics and the ongoing process of post-glacial colonization and contemporary range expansion. Additionally, average N(e) estimates were consistently lower for lacustrine populations of C. nasus although confidence intervals for both contemporary and historical estimates broadly overlapped. The lower average estimates of N(e) for lacustrine populations was suggested to be the result of more recent founding events following post-glacial dispersal. This study provides one of the first assessments of gene flow and N(e) in an Arctic coregonine, results that may be relevant to other freshwater and anadromous Arctic species persisting in systems near the periphery of their range., (© 2012 The Authors. Journal of Fish Biology © 2012 The Fisheries Society of the British Isles.)

Monoclonal antibodies have become an important treatment option for a number of serious conditions. Concerns have arisen about the potential association of these products with progressive multifocal leukoencephalopathy (PML). A list of monoclonal antibodies authorized for sale was derived from the Health Canada Drug Product Database. Case reports of PML after exposure to a monoclonal antibody authorized for use in Canada were retrieved by searching Canada Vigilance and WHO adverse event databases and through a Pub MED/Medline literature search. 182 adverse event case reports were retrieved (adalimumab -1 case, alemtuzumab-14, bevacizumab -3, cetuximab -1, efalizumab - 8, ibritumomab tiuxetan-5, infliximab-4, natalizumab-32, and rituximab-114). The Canadian Product Monographs for natalizumab and ritiximab contain box warnings for PML. A natalizumab registry has been established.

This paper examines the issue of prices, relative to value, for cancer drugs. The analysis focuses on the effects on manufacturer pricing incentives of insurance coverage, specifically, the effectiveness of patient cost sharing, incentives created by reimbursement rules for physician-dispensed drugs, and payer ability and incentives to negotiate discounts. For pharmacy-dispensed cancer drugs, both Medicare Part D prescription drug plans (PDPs) and private payers' pharmacy benefit managers are increasingly placing these drugs on specialty tiers that offer no leverage for negotiating discounts and imply often unaffordable cost sharing for patients who lack catastrophic coverage. Simulation analysis of financial risks faced by PDPs confirms their incentives to place costly drugs on specialty tiers if more preferred formulary placement would increase use, possibly because of adverse selection risk. Faced with largely price-insensitive consumers and payers, manufacturers would rationally charge high prices. This situation is exacerbated for physician-dispensed cancer drugs, where Medicare's average selling price plus 6% reimbursement rule favors high-priced drugs. Because U.S. payers do not require evidence on prices relative to value, U.S. data are unavailable to test whether prices are higher, relative to value, for cancer drugs than for other drugs. Evidence from the Canadian Common Drug Review on cost-utility values suggests that cancer drugs are relatively high priced, although conclusions are tentative because of very small samples and non-U.S. data. Making such outcomes-adjusted prices available in the U.S. would be helpful to physicians, payers, and patients and indirectly constrain pricing to align with value.

There is limited research on how health professionals are currently socialized to work interprofessionally. As part of a large-scale initiative funded by Health Canada, this report adds to our understanding of socialization and how it can prepare the health care student for an interprofessional health care environment. Data were collected through semistructured individual and group interviews with 83 respondents (i.e., faculty, students, health care and academic administrators, and health care providers) at seven clinical sites and five academic institutions throughout Alberta. Respondents indicated that socialization prepares health care students for interprofessional environments by "building a professional identity" and through what we are labeling "interprofessional familiarization" (i.e., where the goal is to introduce students to the roles and function of other professionals outside their own discipline). While there is interprofessional familiarization, it is neither consistently espoused as important nor systematically embedded in curriculum and clinical placements. Interprofessional competency building is lacking during this preparatory phase, leaving students ill prepared to work in interprofessional health care environments. We argue there is a need for greater interprofessional socialization in education. By creating a deliberate, planned, and integrated interprofessional socialization process that is consistent across the health professions, barriers to interprofessional practice could be mitigated.

Background: Advances in information and communication technology are influencing instructional formats and delivery modes for post secondary teaching and learning., Aims: The purpose of this study was to determine whether interprofessional team process skills traditionally taught in a small group face-to-face classroom setting could be taught in a blended learning environment; without compromising the pedagogical approach and collaborative Group Investigation Model (Sharan & Sharan 1992) used in the course., Method: A required interprofessional team development course designed to teach health science students (Medicine, Nursing, Pharmacy, Occupational Therapy, Physical Therapy, Dentistry, Dental Hygiene, Medical Laboratory Science, and Nutrition) team process skills was redesigned from a 100% face-to-face delivery format to a blended learning format where 70% of the instruction was delivered using a new synchronous virtual classroom technology (Elluminate www.elluminate.com) in conjunction with asynchronous technology (WebCT). It was hypothesized there would be no significant difference between the blended learning format and the traditional face-to-face format in the development of interprofessional team knowledge, skills and attitudes. The two formats were evaluated on demographic information, computer experience, and interprofessional team attitudes, knowledge and skills., Results: The three main findings are: (a) no significant differences between student groups on achieving team process skills, (b) an observation of differences between the groups on team dynamics, and (c) a more positive achievement of course learning objectives perceived by students in the blended learning class., Conclusions: The results provide evidence to support our blended learning format without compromising pedagogy. They also suggest that this format enhances students' perceptions of their learning.

Background: DNA barcoding aims to provide an efficient method for species-level identifications using an array of species specific molecular tags derived from the 5' region of the mitochondrial cytochrome c oxidase I (COI) gene. The efficiency of the method hinges on the degree of sequence divergence among species and species-level identifications are relatively straightforward when the average genetic distance among individuals within a species does not exceed the average genetic distance between sister species. Fishes constitute a highly diverse group of vertebrates that exhibit deep phenotypic changes during development. In this context, the identification of fish species is challenging and DNA barcoding provide new perspectives in ecology and systematics of fishes. Here we examined the degree to which DNA barcoding discriminate freshwater fish species from the well-known Canadian fauna, which currently encompasses nearly 200 species, some which are of high economic value like salmons and sturgeons., Methodology/principal Findings: We bi-directionally sequenced the standard 652 bp "barcode" region of COI for 1360 individuals belonging to 190 of the 203 Canadian freshwater fish species (95%). Most species were represented by multiple individuals (7.6 on average), the majority of which were retained as voucher specimens. The average genetic distance was 27 fold higher between species than within species, as K2P distance estimates averaged 8.3% among congeners and only 0.3% among concpecifics. However, shared polymorphism between sister-species was detected in 15 species (8% of the cases). The distribution of K2P distance between individuals and species overlapped and identifications were only possible to species group using DNA barcodes in these cases. Conversely, deep hidden genetic divergence was revealed within two species, suggesting the presence of cryptic species., Conclusions/significance: The present study evidenced that freshwater fish species can be efficiently identified through the use of DNA barcoding, especially the species complex of small-sized species, and that the present COI library can be used for subsequent applications in ecology and systematics.

The number and location of Arctic glacial refugia utilized by taxa during the Pleistocene are continuing uncertainties in Holarctic phylogeography. Arctic grayling (Thymallus arcticus) are widely distributed in freshwaters from the eastern side of Hudson Bay (Canada) west to central Asia. We studied mitochondrial DNA (mtDNA) and microsatellite DNA variation in North American T. arcticus to test for genetic signatures of survival in, and postglacial dispersal from, multiple glacial refugia, and to assess their evolutionary affinities with Eurasian Thymallus. In samples from 32 localities, we resolved 12 mtDNA haplotypes belonging to three assemblages that differed from each other in sequence by between 0.75 and 2.13%: a 'South Beringia' lineage found from western Alaska to northern British Columbia, Canada; a 'North Beringia' lineage found on the north slope of Alaska, the lower Mackenzie River, and to eastern Saskatchewan; and a 'Nahanni' lineage confined to the Nahanni River area of the upper Mackenzie River drainage. Sequence analysis of a portion of the control region indicated monophyly of all North American T. arcticus and their probable origin from eastern Siberian T. arcticus at least 3 Mya. Arctic grayling sampled from 25 localities displayed low allelic diversity and expected heterozygosity (H(E)) across five microsatellite loci (means of 2.1 alleles and 0.27 H(E), respectively) and there were declines in these measures of genetic diversity with distance eastward from the lower Yukon River Valley. Assemblages defined by mtDNA divergences were less apparent at microsatellite loci, but again the Nahanni lineage was the most distinctive. Analysis of molecular variance indicated that between 24% (microsatellite DNA) and 81% (mtDNA) of the variance was attributable to differences among South Beringia, North Beringia and Nahanni lineages. Our data suggest that extant North American Arctic grayling are more diverse phylogeographically than previously suspected and that they consist of at least three major lineages that originated in distinct Pleistocene glacial refugia. T. arcticus probably originated and dispersed from Eurasia to North America in the late to mid-Pliocene, but our data also suggest more recent (mid-late Pleistocene) interactions between lineages across Beringia.

The use of different standards for coding diagnoses and procedures has been identified as a major obstacle to the collection and analysis of data across the various jurisdictions in Canada. In this article the authors briefly describe the current and future situation of medical classification systems in Canada and discuss some of the potential benefits and implications of adopting the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and a revised procedure classification, the Canadian Classification of Health Interventions, as national standards for classification systems in Canada. They further describe some of the key features of the proposed new classification systems and highlight some of the actions being taken by the Canadian Institute for Health Information to support implementation of these standards in Canada over the next few years.

Various medical procedure classifications have been used in combination with disease classifications in Canada for decades. In anticipation of the introduction of the next revision of the International Classification of Diseases (ICD-10), a project has begun to revise the Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures (CCP) that will accompany it. Changes in health care delivery dictate that this revised classification have broader application than its predecessor. This report begins with some results of the consultation processes undertaken to prepare for the revision. The planned structure and scope of the revised classification system are explained. Progress of the revision project to date and its future directions are described. The report's authors solicit information and assistance from classification users and from potential users of data based on the classification.