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Background: Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Methods: Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Results: Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering "vicious" cyclical patterns to increase coordinated multisector PPAP are key. Conclusions: The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points. [ABSTRACT FROM AUTHOR]

Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations. [ABSTRACT FROM AUTHOR]

Introduction: For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors. Methods: Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures. Results: From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97 (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8 of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings. Conclusion: General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8 of their caseload and approximately 6 of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs. Introduction: Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux. Méthodes: Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralistes travaillant dans les communautés du « Rural Subsidiary Agreement » (RSA). Les codes d'honoraires du MSP ont été organisés en procédures essentielles ou non essentielles, comme indiqué par le BCPD. Les APC ont été évalués et comparés aux procédures non essentielles. Résultats: Entre 2011 et 2021, 223 103 procédures ont été réalisées dans des sites ruraux en Colombie-Britannique. En moyenne, 90,97 (écart-type = 20,78) des procédures effectuées dans toutes les communautés étaient des procédures de base du BCPD. Les soins chirurgicaux non essentiels les plus courants effectués par les chirurgiens généraux étaient la chirurgie plastique (n = 8035). Plus de 8 des procédures réalisées n'étaient pas des APC de chirurgie générale. Il est à noter qu'aucune des APC n'est considérée comme un privilège non essentiel et que toutes ont été réalisées en milieu rural. Conclusion: Les chirurgiens généraux travaillant en milieu rural pratiquent de nombreuses procédures en dehors de l'APC, représentant plus de 8 de leur charge de travail et environ 6 des procédures pratiquées sont des privilèges non essentiels. Cela donne une idée des limites potentielles du BCPD pour les diplômés qui espèrent exercer dans les communautés rurales. Étant donné que le programme d'études CPC est réputé offrir une approche plus souple de l'apprentissage, il peut être adapté aux objectifs d'apprentissage et de carrière des résidents, notamment en leur permettant d'acquérir des compétences chirurgicales variées pour répondre aux besoins des zones rurales. Keywords: Medical education, residency, rural surgery, Author(s): Rebecca M. Afford (corresponding author) [1]; Sara D. Bolin [1]; Madeleine E. Armstrong [1]; Tracy M. Scott [1]; Ahmer A. Karimuddin [1] INTRODUCTION General surgery residency in Canada is [...]

Introduction: We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR. Methods: This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021. Information regarding CCHR criteria, transfer status and patient demographics was collected. Descriptive analyses were completed to determine the percentage of patients who received appropriate transfer for imaging, did not receive transfer for imaging when indicated and received unnecessary transfer. Results: A total of 124 charts met our inclusion criteria (17 [12.1] charts excluded), with 25.8 transferred to the nearest hospital for CT imaging. After applying the CCHR criteria to our charts, 62.1 were indicated for CT. Of the 62.1, only 35.1 were transferred for imaging (51.2 of high-risk and 16.7 of medium-risk). Conclusion: By exploring CT rates for mTBIs in a rural Canadian ED, we found low transfer rates (35.1) of CCHR-indicated patients for imaging needed to guide further healthcare decisions. This work highlights a discrepancy within the Canadian healthcare system between rural and urban centres and allows for opportunities to help narrow the gap in health care. Introduction: Nous avons cherché à déterminer la différence entre les taux d'imagerie indiqués par le Canadian CT Head Rule (CCHR, règlement canadien relatif à la tomodensitométrie de la tête) et les taux d'imagerie réels pour les patients souffrant de traumatismes craniocérébraux légers (TCCL) dans un service d'urgence rural ne disposant pas d'une tomographie par ordinateur interne. En outre, nous avons comparé l'adhésion au CCHR dans un hôpital sans tomographie par ordinateur à des publications antérieures provenant de centres avec tomographie par ordinateur afin de déterminer si les populations rurales reçoivent moins d'imagerie par tomodensitométrie pour les traumatismes crâniens mineurs lorsque le CCHR l'indique. Méthodes: Cette étude rétrospective des dossiers a exploré les personnes qui SE sont présentées à une urgence rurale (sans tomodensitomètre interne) avec un diagnostic primaire de traumatisme crânien léger ou de commotion cérébrale entre le 1[sup.er] janvier 2017 et le 31 décembre 2021. Les informations concernant les critères du CCHR, l'état de transfert et les données démographiques des patients ont été recueillies. Des analyses descriptives ont été réalisées pour déterminer le pourcentage de patients ayant reçu un transfert approprié pour l'imagerie, n'ayant pas reçu de transfert pour l'imagerie quand c'était indiqué et ayant reçu un transfert inutile. Résultats: Au total, 124 dossiers répondaient à nos critères d'inclusion [17 (12,1) dossiers exclus], dont 25,8 ont été transférés à l'hôpital le plus proche pour une imagerie par tomodensitométrie. Après avoir appliqué les critères du CCHR à nos dossiers, 62,1 d'entre eux étaient indiqués pour une tomodensitométrie. Sur ces 62,1, seuls 35,1 ont été transférés pour imagerie (51,2 de haut risque, 16,7 de risque moyen). Conclusion: En explorant les taux de tomodensitométrie pour les TCCL dans un service d'urgence rural canadien, nous avons constaté de faibles taux de transfert (35,1) des patients recommandés par le CCRH pour une imagerie nécessaire dans le but de guider les décisions de soins de santé ultérieures. Ce travail met en évidence un écart dans le système de santé canadien entre les centres ruraux et urbains et offre des opportunités pour aider à réduire l'écart dans les soins de santé. Keywords: Emergency imaging, emergency medicine, head injury, rural medicine, Author(s): Matthew D. Lavery (corresponding author) [1]; Rylen A. Williamson [1]; Jason Curran [2,3]; July Wilkey [4]; Kirk McCarroll [4] INTRODUCTION Between 2002 and 2018, more than 5 million emergency [...]

To support older adults during the first wave of COVID-19, we rapidly adapted our effective health-promoting intervention (Choose to Move [CTM]) for virtual delivery in British Columbia, Canada. The intervention was delivered (April–October 2020) to 33 groups of older adults ("programs") who were a convenience sample (had previously completed CTM in person; n = 153; 86% female; 73 [6] years). We compared implementation outcomes (recruitment, dose received, retention, and completion of virtual data collection) to predetermined feasibility targets. We assessed mobility, physical activity, and social health outcomes pre- and postintervention (3 months) with validated surveys. We met most (dose received, retention, and virtual data collection), but not all (recruitment), feasibility targets. Approximately two thirds of older adults maintained or improved mobility, physical activity, and social health outcomes at 3 months. It was feasible to implement and evaluate CTM virtually. In future, virtual CTM could help us reach homebound older adults and/or serve as support during public health emergencies. [ABSTRACT FROM AUTHOR]

In this article, Dr. Ryser recounts the key events and strategies that led to the successful Indigenous movement to safeguard Indigenous rights during the Canadian Patriation. He tracks the movement's development from the 1969 'White Paper,' in which Prime Minister Pierre Trudeau and Minister of Indian Affairs Jean Chretien proposed eliminating the special status of Indigenous peoples in the new constitution, to Grand Cheif George Manuel's 1980 initiative, the 'Constitution Express,' in which he organized more than 600 Indigenous activists to travel across Canada by train to demand that the rights guaranteed in their Indigenous treaties with the British be upheld by the new Canadian Constitution. This article was initially published in 2012 as Chapter 4 of his book Indigenous Nations and Modern States: The Political Emergence of Nations Challenging State Power., My first-hand participation in the political transformation of 'band councils' into 'First Nations' during the period from 1970 through to 2006 began when I became an advisor to Chief George [...]

In British Columbia, Canada, unidentified skeletal human remains are often recovered by law enforcement or civilians and there is a question if they are modern and of medicolegal significance, or historical or archaeological. We used relatively fast and inexpensive carbon and nitrogen stable isotope analysis of human bone collagen from a selection of these remains (n = 48) combined with a logistic regression model to classify remains as modern, historical, or archaeological. We then confirmed our temporal classification through directly radiocarbon dating each individual and found that we could predict the temporal group with 93% accuracy. In regions where archaeological remains have dietary isotope values distinct from living people, dietary stable isotope analysis can provide a time‐, and resource‐efficient method to screen cases of unidentified human remains early in death investigation. [ABSTRACT FROM AUTHOR]

Introduction: Competence committees (CCs) centre their work around documentation of trainees' performance; undocumented contributions (i.e. informal, unrecorded material like personal judgements, experiential anecdotes and contextual information) evoke suspicion even though they may play a role in decision making. This qualitative multiple case study incorporates insights from a social practice perspective on writing to examine the use of undocumented contributions by the CCs of two large post‐graduate training programmes, one in a more procedural (MP) speciality and the other in a less procedural (LP) one. Methods: Data were collected via observations of meetings and semi‐structured interviews with CC members. In the analysis, conversations were organised into triptychs of lead‐up, undocumented contribution(s), and follow‐up. We then created thick descriptions around the undocumented contributions, drawing on conversational context and interview data to assign possible motivations and significance. Results: We found no instances in which undocumented contributions superseded the contents of a trainee's file or stood in for missing documentation. The number of undocumented contributions varied between the MP CC (six instances over two meetings) and the LP CC (22 instances over three meetings). MP CC discussions emphasised Entrustable Professional Activity (EPA) observations, whereas LP CC members paid more attention to narrative data. The divergent orientations of the CCs—adding an 'advis[ing]/guid[ing]' role versus focusing simply on evaluation—offers the most compelling explanation. In lead‐ups, undocumented contributions were prompted by missing and flawed documentation, conflicting evidence and documentation at odds with members' perceptions. Recognising other 'red flags' in documentation often required professional experience. In follow‐ups, purposes served by undocumented contributions varied with context and were difficult to generalise; we, therefore, provide deeper analysis of two vignettes to illustrate. Conclusions: Our data suggest undocumented contributions often serve best efforts to ground decisions in documentation. We would encourage CC practices and policies be rooted in more nuanced approaches to documentation. van Enk and colleagues show that undocumented contributions in competency committees often work in service of best efforts to ground decisions in documentation. [ABSTRACT FROM AUTHOR]

In 2017, British Columbia (BC) transferred responsibility for healthcare services in provincial correctional facilities from the Ministry of Public Safety and Solicitor General to the Ministry of Health. This study explored how healthcare leadership perceived the impact of the transfer on services, work-life, and job satisfaction. We conducted one-on-one interviews (n = 8) with healthcare managers and medical and administrative leadership within Correctional Health Services. Using the Two-Factor theory of job satisfaction as a framework, we applied Interpretive Description methodology to analyse interview data. Participants identified changes to four areas of the working environment: (1) staffing, equipment, and resources (2) systems of supervision and support (3) standards, policies, and quality improvement and (4) culture and orientation. These changes predominantly affected motivational factors of job satisfaction and were described as enriching the roles of managers and staff. Participants described improved autonomy and recognition of providers, increased quality of services delivered, and a shift toward patient-centred care. The perspectives of healthcare leaders provide new insight into the potential impact of transferring healthcare services in custody to a public healthcare system. Discussion of changes and their affects also provide practical learning for jurisdictions seeking to improve healthcare under a variety of governance and service-delivery models. [ABSTRACT FROM AUTHOR]

When thinking about contemporary machinic architecture, often one imagines the sort of buildings that might be described as high‐tech: full of ductwork, hydraulic struts, pistons, and sleek, metallic, shiny carapaces. Yet there are other ways to invoke the machine in more human‐friendly manifestations. Tom Kundig and his design practice Olson Kundig have spent much of their time exploring age‐old technologies – the hinge, the wheel and the pulley, for example – to create architecture that does not alienate people, but instead engages and facilitates them in transformational, spatial activities. [ABSTRACT FROM AUTHOR]

Rationale: High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. Objectives: We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. Methods: We applied a controlled interrupted time series design to administrative claims data in British Columbia, Canada from 2017 to 2020. Cases were individuals with an annual household income <$13,750 in whom copays were eliminated in January 2019; there was no change in public coverage for the control group with annual income >$45,000. We evaluated trends in asthma medication costs, use, the ratio of inhaled corticosteroid-containing medications to all asthma medications, excessive use of short-acting β-agonists (more than one canister per month), and the proportion of days covered by controller therapies. Results: There were 12,940 cases (62% female; mean age, 30.3 yr; standard deviation [SD], 14.9) and 71,331 controls (55% female; mean age, 31.3 yr; SD, 16.3). Removal of OOP payments increased monthly mean medication costs by $3.32 (95% confidence interval [CI], $0.08 to $6.56, 2020 Canadian dollars), days' supply of controller medications by 1.50 days (95% CI, 0.61 to 2.40 d), and the ratio of inhaled corticosteroid-containing medications to total medications by 4.20% (95% CI, 0.73% to 7.66%) compared with the control group. The policy had no effect on the proportion of days covered by controller therapies (0.01; 95% CI, −0.01 to 0.04), but nonsignificantly decreased the percentage of patients with excessive short-acting β-agonist use (−6.37%; 95% CI, −12.90% to 0.16%). Conclusions: Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related nonadherence could impair optimal asthma management. [ABSTRACT FROM AUTHOR]

Background: Progressive harm reduction policies have been implemented in British Columbia, Canada. However, youth who use drugs face barriers to receiving harm reduction care, resulting in increasing opioid-related hospitalizations and drug toxicity deaths. This scoping review collates peer-reviewed evidence to understand the barriers and facilitators faced by youth who use drugs when accessing harm reduction programming in British Columbia, Canada. Methods: This scoping review entailed conducting a systematic search of relevant databases to identify relevant articles. Articles were included if they: (i) contained youth falling between the ages of 12 and 26 years old; (ii) explored accessibility, barriers, and/or facilitators to harm reduction care or related topics; (iii) were empirical research articles using primary data (i.e., reviews, grey literature, theoretical or conceptual papers, books, etc. were excluded); and (iv) were available in the English language, given the geographic focus on British Columbia. Results: A total of 398 sources were identified and ultimately, data from 13 sources were charted and extracted. When investigating barriers to harm reduction care among youth, four themes emerged: self-stigma, service navigation, service delivery, and negative provider interactions. Furthermore, in exploring factors that facilitate harm reduction care for youth, four themes surfaced: ability to meet basic needs, positive provider interactions, social networks, and risk mitigation guidance. Conclusions: The expansion of harm reduction services in 2016 did not fully address accessibility challenges faced by youth who use drugs. Barriers continue to hinder harm reduction engagement, while supportive networks, positive provider interactions, and the ability to meet basic needs facilitated sustained access. Tailored policy interventions rooted in equity are crucial to improving access to harm reduction services for youth who use drugs. [ABSTRACT FROM AUTHOR]

Background: People with intellectual/developmental disabilities (IDD) are known to have high rates of prescription drug use, particularly for psychotropic medications. This is of concern due to the many side effects associated with these medications and because of the risks of polypharmacy. In this paper we compare the most commonly dispensed drugs and all psychotropic medications for youth with IDD compared with youth without IDD. Methods: Using population‐level administrative health data over a 10‐year period, this study examined medications dispensed to youth with an IDD aged 15–24 years compared with youth without an IDD. The most common medications dispensed and the number of youth they were dispensed to were determined. As well a wide variety of psychotropic medications were examined. Results: There were a total of 20 591 youth with IDD and 1 293 791 youth without IDD identified. Youth with IDD had higher odds of being dispensed pain medications, amoxicillin, salbutamol, levothyroxine and all the psychotropic medications (antidepressants, antipsychotics, anxiolytics, anti‐adrenergic agents, mood stabilisers and stimulants). For youth with IDD, 6558 (31.85%) were dispensed two or more different psychotropic medications within a year, compared with 75 963 (5.87%) of youth without IDD. Discussion: Compared to youth without IDD, youth with IDD had significantly higher odds of being dispensed most of the prescription medications studied, including all of the psychotropic medications. They were also twice as likely to be dispensed two or more medications from different classes of psychotropic drugs within the same year. These findings have important implications for the health of people with IDD and for their health care providers. [ABSTRACT FROM AUTHOR]

This study aimed to synthesise and interpret stable isotopic data (δ2H and δ18O) from various sources to understand the isotope hydrology around coal mine operations in Elk Valley, B.C., Canada. The data, including precipitation, groundwaters, seeps, and mine rock drains, were used to construct a local meteoric water line (LMWL) for the Elk Valley, evaluate the spatiotemporal isotopic composition of its groundwater, and assess mine seepage and mine rock drain discharge. The study revealed a robust LMWL relation (δ2H = 7.4 ± 0.2 · δ18O – 4.3 ± 4.1). The groundwater and seep data indicated a winter season bias and a north–south latitudinal gradient, suggesting rapid near-surface groundwater flow without significant post-precipitation evaporation. Porewater isotope samples from unsaturated mine rock piles (MRPs) showed site-specific evaporation patterns, potentially due to convective air flows or exothermic sulphide oxidation. This research revealed the influence of groundwater and meltwater on rock drain discharge. Based on evaporative mass balance calculations, MRPs seasonally contributed ca. 5 %(December base flow) and 22 % (snowmelt) to drain discharge. The findings underscore the value of stable isotope data collections in the Elk Valley to help better define and quantify the hydrology–hydrogeology, including a better understanding of evaporative conditions in MRPs. [ABSTRACT FROM AUTHOR]

The article discusses the Surrey Union of Drug Users (SUDU) in British Columbia, emphasizing harm reduction, safe supply, and destigmatization for drug users. As a peer-led group, SUDU actively resists carceral state policies. The analysis explores challenges faced by peer-led groups, including formation, sustainability, and mobilization efforts. It highlights the need for supportive frameworks to enhance peer-led harm reduction initiatives and argues that such advocacy enables alternative knowledge and institutional innovations that are conducive to building a real world abolitionist future. [ABSTRACT FROM AUTHOR]

Contemporary discourses of net-zero decarbonization (also referred to as carbon neutrality) routinely overlook the landscape transformations required to offset carbon emissions. Conventional analyses also often fail to engage with decarbonization as an inherently spatial process, embedded in landscapes in which the biophysical, socionatural, and political economic dimensions of energy intersect. This creates a conceptual pitfall: the potential to misread and depoliticize strategies of putative decarbonization that might not, in fact, be carbon neutral, particularly when the cumulative effects of broader landscape transformations are considered. To illustrate this pitfall, our analysis queries net-zero decarbonization strategies that arise alongside—and often as a result of—simultaneous investments in fossil fuel production, a process we term recarbonization. We posit recarbonization as a variegated sociospatial phenomenon that materializes through the site-specific interplay between capitalist social relations and biophysical processes. In making this claim, we seek to bridge political economy with concepts of materiality and relationality that, we suggest, enable deeper theoretical engagement with multifaceted landscape transformations entailed by processes of energy transition. Drawing on a case study of the Peace River region in the western Canadian provinces of Alberta and British Columbia, this article exposes the cumulative environmental effects and ongoing forms of colonial violence of some net-zero decarbonization agendas. [ABSTRACT FROM AUTHOR]

In the past, immigrants and refugees tended to overlook small and mid-sized cities in Canada, but this has changed since the beginning of the 21th century, and the mid-sized city of Kelowna has gradually emerged as a popular destination for newcomers from all over the world. Housing is critical to the resettlement and integration of all immigrants. Recent immigrants, especially renters, face challenges in their settlement and housing experiences, including limited financial resources, language barriers, and rental-housing discrimination based on ethnicity or race, and yet relatively little is known about these experiences and the barriers they encounter in mid-sized cities. This paper explores the settlement and housing experiences of recent immigrants in the city of Kelowna, a mid-sized city in the interior of British Columbia (Canada) with a focus on the rental housing market. The study draws on data from questionnaire surveys administered in 2015 and 2018 with a total of 67 recent immigrant respondents. The findings reveal that immigrant newcomers experienced financial stress and significant challenges in locating affordable rental housing due to high housing costs, low vacancy rates, lack of reliable information, language barriers, and discrimination by landlords based on immigrants’ ethnic and racial background. Immigrants are increasingly redefining the social and cultural geography of mid-sized Canadian cities, and there is a need to ensure that they are able to access affordable, adequate, and suitable housing, and ultimately settle into society. This is particularly crucial given the rising cost of living in Canada, the projected increase in immigrant levels for 2023-25, and the importance of immigrant settlement in a post-pandemic context. [ABSTRACT FROM AUTHOR]

Background: British Columbia, Canada, is experiencing an overdose crisis that has pushed drug liberalization policies to the forefront of the response. This study examines police officers' perceptions of enforcement and drug liberalization policies, including support for decriminalization and regulation or 'safer supply', in this context. Methods: Qualitative interview data were collected in September-November 2020 from active police officers involved in drug law enforcement in British Columbia, prior to decriminalization reforms being introduced in the province. We conducted a thematic analysis of this data with a focus on police officer views towards drug enforcement and drug liberalization policies. Results: Policing and reforms amid the overdose crisis has shaped officer perceptions and actions towards illegal drugs and drug policies. Although officers saw overdose as a health issue, these views coincided with a strong emphasis on supply-side policing, such as drug trafficking investigations. Policing continues to be entrenched in the overdose crisis, which has impacted the way police officers view drugs and drug use, particularly, their belief that current interventions to disrupt the illegal drug market are not working. Conclusion: This study advances knowledge on the motivations for promoting drug enforcement, and enacting drug policies, in the context of an overdose crisis. [ABSTRACT FROM AUTHOR]

Euler deconvolution is a widely used automatic or semi-automatic method for potential field data. However, it yields many spurious solutions that complicate interpretation and must be reduced, eliminated, recognized, or ignored during interpretation. This study proposes a post-processing algorithm that converts Euler solutions produced by tensor Euler deconvolution of gravity data with an unprescribed structural index into probability values (p values) using the B-spline series density estimation (BSS) method. The p values of the Euler solution set form a probability density distribution on the estimation grid. The BSS method relies on the fact that while spurious solutions are sparse and ubiquitous, Euler deconvolution yields many similar or duplicate solutions, which may tightly cluster near real sources. The p values of the Euler solution clusters form multi-layered isosurfaces that can be used to discriminate neighboring target sources because the p values of spurious solutions are vanishingly small, making it simple to remove their interference from the probability density distribution. In all synthetic cases, the geometric outlines of anomaly sources are estimated from probability density isosurfaces approximating synthetic model parameters. The BSS method was then applied to airborne gravity data from Mount Milligan, British Columbia, Canada. Subsequently, results from synthetic models and field data show that the proposed method can successfully localize meaningful geological targets. [ABSTRACT FROM AUTHOR]

In this paper, we highlight the centrality of process in Indigenist community-based participatory research in music education to offer new methodological insights, using a recent investigation that employed conference as research method as a case study. From our perspective as university researchers who are non-Indigenous or Indigenous but not to the land now known as Canada, we describe in detail the process of co-creating a conference grounded in local First Nations Protocols as a research method for our most recent study with Indigenous partners, also showing how the process is related to ceremony. This knowledge creation and sharing conference involved more than 200 Knowledge Keepers, School District Indigenous leaders, and music educators in British Columbia endeavouring to effectively embed Indigenous knowledge in K-12 music classes. We highlight ways we found to be relationally accountable, including providing adequate time to arrive at consensus in all decisions; developing and maintaining trust throughout pandemic lockdowns and restrictions; and locating additional sources of funding to facilitate all Protocols, which led Indigenous participants to report feeling that the conference was a culturally safe place and non-Indigenous participants to report that they found it to be a culturally immersive experience. We became more aware that the very process of discussion and decision making that took place at the many committee and subcommittee meetings leading up to the conference was part and parcel of the ceremonial aspect of this research. Indigenous participants deemed the outcomes and effects of the research/conference credible and trustworthy because they emerged from a planning process that was culturally informed and that had been deemed ethical, legitimate, and appropriate by all planning parties through consensus. [ABSTRACT FROM AUTHOR]

Background: As the demand for mental health and substance use (MHSU) services increases, there will be an even greater need for health human resources to deliver this care. This study investigates how family physicians' (FP) contact volume, and more specifically, MHSU contact volume, is shaped by demographic trends among FPs in British Columbia, Canada. Methods: We used annual physician-level administrative billing data and demographic information on FPs in British Columbia between 1996 and 2017. This study analyzes trends in primary care service provision among graduating cohorts of FPs, FPs of different ages (as measured by years since graduation), and FPs practicing during different time periods. Additionally, analyses are stratified by FP sex to account for potential differences in labour supply patterns between male and female FPs. Results: Our results show that while FPs' overall contacts with patients decreased between 1996 and 2017, their annual number of MHSU contacts increased, which was largely driven by an increase in substance use visits. Demographically, the proportion of female FPs in the labour force rose over time. Observed trends were similar, though not identical in male and female FPs, as males tended to have higher overall contact volume (both total contacts and MHSU), but also steeper declines in contact volume in later careers. The number of contacts (both total and MHSU) changed across career stage - rising steadily from start to mid-career, peaking at 20–30 years in practice, and decreasing steadily thereafter. This was evident for all cohorts and consistent over the 21-year study period but flattened in amplitude over time. Our findings also point to potential cohort effects on labour supply. The inverse U-shaped career trend extended to MHSU contacts, but its peak seems to have shifted to a later career stage (peaking at 30–40 years of practice) over time. Conclusions: Our study shows changing dynamics in MHSU service delivery among FPs over time, across the life span and between FP sexes that are likely to influence access to care beyond simply the number of FPs. Given the healthcare needs of the population, these findings point to potential future changes in provision of MHSU services. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival. Methods: We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20–2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age. Results: In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40–0.45). These disparities grew wider over the course of the pandemic. Conclusion: Though among younger adults changes in access to primary care between 2019–2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed. [ABSTRACT FROM AUTHOR]

Hyperdontia refers to an excess number of teeth past the expected number of teeth for an individual located in the mandible or maxilla. These extra teeth are often referred to as "supernumerary." This condition is a relatively uncommon, infrequent phenomenon scarcely documented in Ursidae globally, with only a handful of examples documented in literature. In 2008, an indigenous hunter harvested a grizzly bear (Ursus arctos) in Smithers, British Columbia, Canada. The bear exhibited 7 maxillary incisors, with a supernumerary tooth present. This observation serves as the first-ever record of the supernumerary dentition of the incisors in brown bears. [ABSTRACT FROM AUTHOR]

Many species of fishes around the world are soniferous. The types of sounds fishes produce vary among species and regions but consist typically of low-frequency (< 1.5 kHz) pulses and grunts. These sounds can potentially be used to monitor fishes non-intrusively and could complement traditional monitoring techniques. However, the significant time required for human analysts to manually label fish sounds in acoustic recordings does not yet allow passive acoustics to be used as a viable tool for monitoring fishes. In this paper, we compare two different approaches to automatically detect fish sounds. One is a more traditional machine learning technique based on the detection of acoustic transients in the spectrogram and the classification using Random Forest (RF). The other is using a deep learning approach and is based on the classification of overlapping segments (0.2 s) of spectrogram using a ResNet18 Convolutional Neural Network (CNN). Both algorithms were trained using 21,950 manually annotated fish and non-fish sounds collected from 2014 to 2019 at five different locations in the Strait of Georgia, British Columbia, Canada. The performance of the detectors was tested on part of the data from the Strait of Georgia that was withheld from the training phase, data from Barkley Sound, British Columbia, and data collected in the Port of Miami, Florida, United States. The CNN performed up to 1.9 times better than the RF (F1 score: 0.82 vs. 0.43). In some cases, the CNN was able to find more faint fish sounds than the analyst and performed well in environments different from the one it was trained in (Miami F1 score: 0.88). Noise analysis in the 20--1,000 Hz frequency band shows that the CNN is still reliable in noise levels greater than 130 dB re 1 μPa in the Port of Miami but becomes less reliable in Barkley Sound past 100 dB re 1 μPa due to mooring noise. The proposed approach can efficiently monitor (unidentified) fish sounds in a variety of environments and can also facilitate the development of species-specific detectors. We provide the software FishSound Finder, an easy-to-use open-source implementation of the CNN detector with detailed documentation. [ABSTRACT FROM AUTHOR]

Objectives: Knowledge gaps exist regarding the effects of experiencing child protective services (CPS) out‐of‐home care (e.g. foster homes) among women with HIV. We examined whether CPS out‐of‐home care was associated with HIV clinical outcome trajectories among women with HIV in a longitudinal cohort study in Ontario, British Columbia, and Quebec, Canada. Methods: At three timepoints across 5 years (2013–2018), we examined self‐reported current antiretroviral therapy (ART) use and viral load (VL) detectability (>50 copies/mL). We used latent class growth analysis (LCGA) to identify trajectories of ART use and VL outcomes across study waves. LCGA identifies subgroups (classes) with similar trajectories within the sample. We assessed whether HIV outcome trajectories could be predicted by CPS history. We then conducted a mediation analysis to test whether a mental health latent construct mediated the association between CPS history and detectable VL. Results: Nearly one‐fifth (n = 272; 19%) of participants (n = 1422; mean age 42.8 years) reported CPS out‐of‐home care. Most participants (89%) were in classes that consistently used ART and had an undetectable VL. Individuals with CPS out‐of‐home care histories were twice as likely to have a consistently detectable VL (β = 0.72, p = 0.02); there were no differences in ART use trajectories. In mediation analyses, we found an indirect path from CPS history to a consistently detectable VL via baseline mental health status (β = 0.02, 95% confidence interval 0.005–0.04, p = 0.02), with a significant odds ratio (1.12, z = 2.43, p = 0.02). Conclusion: Among women with HIV in Canada, experiencing childhood CPS out‐of‐home care was associated with a reduced likelihood of achieving viral suppression, via poorer mental health. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has changed healthcare service delivery. We examined the overall impact of COVID‐19 on people living with HIV in British Columbia (BC), Canada, with a special focus on the potential impact of COVID‐19 on antiretroviral treatment interruptions (TIs). Methods: Purposive sampling was used to enrol people living with HIV aged ≥19 years across BC into the STOP HIV/AIDS Program Evaluation study between January 2016 and September 2018. Participants completed surveys at baseline enrolment and 18 and 36 months later. Additional COVID‐19 questions were added to the survey in October 2020. TIs were defined as >60 days late for antiretroviral therapy (ART) refill using data from the BC HIV Drug Treatment Program. Generalized linear mixed models were used to examine trends in TIs over time and associations with reported health service access. Results: Of 581 participants, 6.1%–7.7% experienced a TI during each 6‐month period between March 2019 and August 2021. The frequency of TIs did not statistically increase during the COVID‐19 epidemic. Among the 188 participants who completed the COVID‐19 questionnaire, 32.8% reported difficulty accessing healthcare during COVID‐19, 9.7% reported avoiding continuing a healthcare service due to COVID‐19‐related concerns, and 74.6% reported using virtual healthcare services since March 2020. In multivariable analysis, the odds of a TI in any 6‐month period were not significantly different from March to August 2019. None of the reported challenges to healthcare services were associated with TIs. Conclusions: Although some participants reported challenges to accessing services or avoidance of services due to COVID‐19, TIs were not more likely during COVID‐19 than before. [ABSTRACT FROM AUTHOR]

Objectives To explore the implementation of a provincial virtual paediatric consulting service, Child Health Advice in Real-Time Electronically (CHARLiE), integrated into the paediatric on-call schedule in Northwestern British Columbia. Methods Healthcare providers in Northwestern British Columbia responded to a survey (n = 72) and participated in focus groups (n = 35) and key informant interviews (n = 4) to share their experiences engaging in a healthcare model that incorporated virtual paediatric consultants in lieu of in-person local paediatrician coverage over a 28-month period. Survey data was analyzed using descriptive statistics. Themes were generated from a qualitative descriptive approach to focus groups and key informant interview transcripts. Results 96.1% of survey respondents who had used CHARLiE rated it as 'good' or 'very good' in the provision of overall support, while 77.6% reported that CHARLiE improved access to paediatric care. Focus group and key informant interview participants valued CHARLiE's timely, dedicated virtual bedside assessments of patients; collegiality and professionalism; amelioration of local paediatrician burnout; prevention of unnecessary transfers; and offloading of indirect patient care tasks. Video support improved provider confidence and appeared to improve caregiver trust. Suggested improvements included addressing technological barriers, enhancing providers' knowledge of local resources, and enabling continuity of care. Participants identified that virtual care does not replace on-the-ground specialist care. Conclusions Participants valued CHARLiE's 24/7, timely, and collegial video support. While maintaining a full complement of on-the-ground paediatricians remains the goal for some rural communities, dedicated virtual support provides access to paediatric care in smaller communities, thereby improving health equity for children in British Columbia. [ABSTRACT FROM AUTHOR]

Background: Nivolumab, an immune checkpoint inhibitor used to treat several malignancies, is associated with immune-related adverse events (IrAEs). Original dosing for melanoma was 3 mg/kg (maximum 240 mg) every 2 weeks (Q2W). Based on simulation studies depicting similar efficacy and toxicity to original dosing, extended interval dosing of 6 mg/kg (maximum 480 mg) every 4 weeks (Q4W) was introduced. Objective: This study will compare safety between Q2W and Q4W dosing at BC Cancer in melanoma patients. Methods: Retrospective chart review for reported incidence, onset, and severity of IrAEs in melanoma patients treated with nivolumab Q2W and Q4W dosing was completed. Fisher's test was conducted for first incidence IrAEs using Microsoft Excel. Results: Seventy-one patients were identified (Q2W n = 35, Q4W n = 36). Baseline characteristics were similar in both groups. No statistically significant difference was found in incidence of IrAEs between Q2W and Q4W dosing (Q2W 40% vs Q4W 50%, p = 0.477). Rash was most common (Q2W 79% vs Q4W 50%) followed by hypothyroidism (Q2W 33% vs Q4W 20%). Median onset of IrAEs seemed later with Q4W dosing (Q2W cycle 1 vs Q4W cycle 4). Regardless of dosing, most IrAEs were grade 1–2 in severity (Q2W 100% vs Q4W 89%). Conclusion: Q4W dosing is associated with comparable incidence and potentially later onset of IrAEs compared to Q2W dosing. Most IrAEs in both dosing groups were similar and mild. Therefore, Q4W dosing offers a safe alternative to Q2W dosing while providing benefits including decreased workload for staff, decreased clinic visits, and viral exposure by patients. [ABSTRACT FROM AUTHOR]

An important, but generally overlooked source in intraspecific variability of characters used in tardigrades taxonomy is sexual dimorphism. Dioecious tardigrades species with unisexual or bisexual populations are common, but external sexual dimorphism is rarely observed. The discovery and integrative analysis of a Diploechiniscus species population with high sexual dimorphism from Calvert Island (Canada) has allowed its description as a new species. Diploechiniscus dimorphus n. sp. is characterized by a different chaetotaxy in males and females, and by enlarged cephalic sensory appendages in the males. The discovery of this new species shows that it is important to consider sexual dimorphism as a source of intraspecific variability in tardigrade taxonomy due to its implications on the use of traits commonly used to delineate species such as chaetotaxy. Lastly, the finding of individuals of Diploechiniscus horningi (Schuster and Grigarick, 1971), a species previously synonymized with Diploechiniscus oihonnae (Richters, 1903), allows us to prove that it is genetically a separate species and to reinstate it. [ABSTRACT FROM AUTHOR]

Humans have a proclivity for storytelling and narration. Although a lot of attention in the field of episodic memory focuses on the mnemonic content of narratives, memory narratives are not just for conveying the past. Instead, narratives provide a vehicle for meaning-making, social connection, and other complex facets of human cognition and thinking. This short reflection piece discusses the importance of narratives in these diverse realms. In addition, it briefly touches on the role of memory narration in the modern digital era. [ABSTRACT FROM AUTHOR]

Humpback whales (Megaptera novaeangliae) use southern British Columbia waters to feed, but the type and quantity of prey in many areas used for feeding is unknown. We conducted active acoustic prey mapping in 55 small grid-surveys in two regions off Vancouver Island. We quantitatively compared fish and zooplankton-dominated biomass in known feeding areas with and without foraging humpback whales, and qualitatively described the prey characteristics of the foraged areas. Surveys of the water column suggest that, on average, humpback whale foraging was associated more with increased zooplankton than fish biomass. Prey characteristics varied between the two regions (∼500 km apart), but there was no significant difference in mean backscatter strength in the actively foraged areas between the two regions. Frequency differencing discriminated between the dominant taxa in the water column, but potential epipelagic prey (<10 m) would have been omitted from analysis. However, average depth at the maximum acoustic prey detections was significantly deeper when whales were present (84 m) versus absent (60 m), suggesting predominantly subsurface foraging opportunities suitable to prey mapping. [ABSTRACT FROM AUTHOR]

While well-being of school principals is becoming an increasing concern in public education, the understanding of well-being and its manifestation is still lacking in research. This research tackles the nuances and complexities surrounding the notion of well-being and sheds light on its conceptualisation, manifestation, and contributing factors. Data for this research come from an online survey among public school principals in the province of British Columbia, Canada. This survey research utilised reliability, factor, correlation analysis, and structural equation modelling (SEM) and examined how well-being of school principals is manifested along different well-being dimensions and what underlying relationships exist between each dimension in relation to principals' overall well-being and their demographics. The results reaffirm that well-being is a multidimensional construct, encompassing dimensions that speak to different but interrelated aspects of a principal's well-being state, among which emotional and psychological well-being has been revealed as a vital component in principals' overall well-being. The findings have significant implications on health and well-being related support for school principals in order to prepare them for the increasingly demanding job. [ABSTRACT FROM AUTHOR]

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Background/Objectives: We examined the feasibility, acceptability, and potential mental health impact of a digital peer support intervention involving videoconferencing and text-based support for parents of school-aged children living with T1D and analyzed posts exchanged by parents on a texting platform. Methods: Eighteen parents were recruited for Huddle4Parents, a 4-month digital intervention that involved four synchronous group-based Zoom sessions coupled with an asynchronous 24/7 peer support texting room. Primary outcomes were feasibility (i.e., ability to recruit n = 20 parents and retain at least 75%) and acceptability (i.e., satisfaction ratings of "good" to "very good"). Baseline and 4-month assessments also measured diabetes distress, quality of life, and perceived support. A content analysis of text exchanges was also performed. Results: All 15 parents who completed the intervention attended at least one Huddle and posted at least one message on the 24/7 peer support room. The retention rate was 83%, with 100% indicating that they would "definitely" or "probably yes" recommend both platforms to other parents. They also rated the topics, facilitator, and overall Huddles as "good" to "excellent." No changes were observed for psychosocial endpoints. Of the 1084 texts posted, core support themes included the following: (1) dealing with technology and devices; (2) seeking and providing emotional support; (3) managing T1D in the school setting; and (4) exchanging tips and strategies. Conclusions: Huddle4Parents, a digital T1D caregiver intervention offering synchronous and asynchronous support, is feasible based on recruitment, participation, and attrition rates and acceptable as demonstrated by engagement and satisfaction ratings for the Huddles and 24/7 peer support room. [ABSTRACT FROM AUTHOR]

OBJECTIVES: British Columbia (BC), Canada, experienced an unprecedented summer with record-breaking high temperatures in 2021. Yet the health impact has not been examined in occupational settings. This study aimed to characterize occupational heat-related illness (HRI) among BC workers estimated by incidence rates and associations between heatwaves and HRI, compare risks from 2021 and prior summers of 2001–2020, and assess differential impacts on worker groups by demographics and occupations. METHODS: We identified HRI from workers’ compensation claims that occurred between June and August from 2001–2021 in BC. Incidence rates were calculated using working population estimates from Statistics Canada’s Labour Force Survey. A time-stratified case-crossover design with conditional Poisson regression was used to examine the impact of heatwaves on occupational HRI. All analyses were stratified by year (2021 versus 2001–2020), age, sex, and occupation. RESULTS: Of the 521 claims identified, 107 (21%) occurred in 2021. Incidence rates for 2021 and prior summers were 3.97 [95% confidence interval (CI) 3.26–4.80] and 0.93 (95% CI 0.85–1.03) claims per 100 000 workers, respectively. This difference represents a 327% increase. Rates were higher in health occupations in 2021 versus 2001–2020. During 2001–2021, the risk of HRI during heatwave days was 4.33 (95% CI 2.98–6.27) times that during non-heatwave days, and the risk was higher among middle-aged workers and workers in trades, transport, and equipment operations. The 2021 heatwaves had greater impact on younger and female workers than those from prior summers. CONCLUSIONS: Heat is a crucial workplace hazard. Prevention strategies should prioritize at-risk workers and not be limited to heatwaves.

Abstract Background As the demand for mental health and substance use (MHSU) services increases, there will be an even greater need for health human resources to deliver this care. This study investigates how family physicians’ (FP) contact volume, and more specifically, MHSU contact volume, is shaped by demographic trends among FPs in British Columbia, Canada. Methods We used annual physician-level administrative billing data and demographic information on FPs in British Columbia between 1996 and 2017. This study analyzes trends in primary care service provision among graduating cohorts of FPs, FPs of different ages (as measured by years since graduation), and FPs practicing during different time periods. Additionally, analyses are stratified by FP sex to account for potential differences in labour supply patterns between male and female FPs. Results Our results show that while FPs’ overall contacts with patients decreased between 1996 and 2017, their annual number of MHSU contacts increased, which was largely driven by an increase in substance use visits. Demographically, the proportion of female FPs in the labour force rose over time. Observed trends were similar, though not identical in male and female FPs, as males tended to have higher overall contact volume (both total contacts and MHSU), but also steeper declines in contact volume in later careers. The number of contacts (both total and MHSU) changed across career stage - rising steadily from start to mid-career, peaking at 20–30 years in practice, and decreasing steadily thereafter. This was evident for all cohorts and consistent over the 21-year study period but flattened in amplitude over time. Our findings also point to potential cohort effects on labour supply. The inverse U-shaped career trend extended to MHSU contacts, but its peak seems to have shifted to a later career stage (peaking at 30–40 years of practice) over time. Conclusions Our study shows changing dynamics in MHSU service delivery among FPs over time, across the life span and between FP sexes that are likely to influence access to care beyond simply the number of FPs. Given the healthcare needs of the population, these findings point to potential future changes in provision of MHSU services.

Comprehensive sex education (CSE) is evidence-based, addresses a wide variety of topics, and is inclusive of sexual and gender minority (SGM) experiences. However, teachers are often not trained to deliver CSE and are uncomfortable teaching it. This can lead to the omission of important topics and leave youth dissatisfied with their sex education. Thus, more research is needed to understand educator needs/approaches when delivering sex education and how educators incorporate SGM-affirming content. We conducted fifteen interviews with sex educators in Metro Vancouver, British Columbia (BC), Canada, in autumn 2021, to understand current approaches to and gaps in the provision of CSE. We used an interpretive descriptive methodology. Personal and structural factors constrain the delivery of CSE in BC. Personal factors include motivation, teacher comfort/knowledge, personal trauma, and fear of pushback. Structural factors include inequitable access to parent advisory council funding, Learning Standards design, and the peripheral nature of sex education. Participant recommendations for the future of sex education include increased mandatory pre-service and in-service training, the implementation of 'sex education mentors' in each district, an online hub of resources, and government funding for community-based educators. We recommend (1) that government funding be allocated for at least one trained sex educator in every school district who can coach and mentor teachers; (2) the creation and promotion of an online information hub which includes lesson plans, videos, and resources for teachers; (3) and that teachers' colleges create mandatory courses on teaching CSE. KEYWORDS: Sexual and gender minorities, sexual health education, teacher training, Comprehensive sex education (CSE) is a sex-positive (e.g., recognizes that sex is normal, can be pleasurable and joyful, is inclusive of all identities) and evidenced-based approach (Smart Sex Resource, 2023). [...]

Background: Rural general surgeons perform many procedures outside the conventional scope of the specialty. Unique to British Columbia, the Rural Practice Subsidiary Agreement (RSA) formally defines rurality in the province. Our goal is to understand the scope of practice for BC's rural general surgeons and whether it has been affected over time by changing privileging guidelines. Methods: Medical Services Plan (MSP) data were collected from 2011 to 2021 for procedures billed by general surgeons in communities defined by the RSA as rural. We categorized codes from the MSP based on surgical specialty. For each community, we calculated the totals for these categories considering what other surgical specialties were present as well as changes over time. Results: From 2011 to 2021, 222 905 procedures were performed in 23 rural communities in BC. Colonoscopies were the most frequently performed procedure (n = 80114, 35.9%), followed by colorectal (n = 23891, 10.7%) and hernia procedures (n = 20 911, 9.4%). The most common unconventional procedures were plastic surgeries (n = 8077, 3.6%). Classification within the RSA did not significantly influence the percentage of unconventional general surgery procedures performed (p = 0.4). When another surgical specialty was present, there was often a decrease in the number of that specialty's procedures performed by general surgeons. Over the past decade, rural general surgeons performed fewer unconventional general surgery procedures (p < 0.001). Conclusion: General surgeons working in rural communities perform a variety of procedures based on resources, community need, and access to other specialists. Over the last decade, this appears to have been influenced by new privileging guidelines. Understanding the scope of rural general surgery can inform training opportunities and, as there is a migration away from rural surgeons performing as many unconventional procedures, can elucidate the implications on patients and communities. Contexte : En r gion rurale, les chirurgiens g n ralistes effectuent beaucoup d'interventions sortant du cadre conventionnel de pratique de leur sp cialit . La Colombie-Britannique est actuellement la seule province avoir mis en place l'entente Rural Practice Subsidiary Agreement (RSA), qui d finit officiellement la ruralit dans la province. Notre objectif est de mieux d limiter le champ de pratique des chirurgiens g n ralistes exer ant en milieu rural en Colombie-Britannique et de d terminer s'il a t affect dans le temps par l' volution des directives concernant l'octroi de privil ges. M thodes : Des donn es du r gime d'assurance maladie de la province (Medical Services Plan, ou MSP) pour la p riode de 2011 2021 ont t recueillies pour les interventions factur es par des chirurgiens g n ralistes dans les communaut s d sign es rurales selon la RSA. Nous avons class les codes du MSP selon la sp cialit chirurgicale. Pour chaque collectivit , nous avons calcul les totaux pour ces cat gories, tout en tenant compte des autres sp cialit s chirurgicales pr sentes et des changements dans le temps. R sultats : De 2011 2021, 222 905 interventions ont t effectu es dans 23 collectivit s rurales en Colombie-Britannique. La colonoscopic tait l'intervention la plus courante (n = 80 114, 35,9%), suivie des chirurgies colorectales (n = 23 891, 10,7%) et des r parations de hernies (n = 20 911, 9,4%). Parmi les interventions non classiques, la chirurgie plastique occupait le premier rang (n = 8077, 3,6%). La classification selon la RSA n'a pas eu d'influence significative sur le pourcentage de chirurgies g n rales non classiques effectu es (p = 0,4). Lorsqu'un prestataire d'une autre sp cialit chirurgicale tait pr sent, on observait souvent une baisse du nombre d'interventions de cette sp cialit effectu es par les g n ralistes. Au cours de la derni re d cennie, les chirurgiens g n ralistes en milieu rural ont effectu moins d'interventions de chirurgie g n rale non classiques (p < 0,001). Conclusion : Dans les collectivit s rurales, les chirurgiens g n ralistes effectuent un ventail d'interventions qui varie selon les ressources, les besoins communautaires, et l'acc s d'autres sp cialistes. Durant la derni re d cennie, cette diversit semble avoir t influenc e par les nouvelles directives concernant l'octroi de privil ges. En connaissant le champ de pratique des chirurgiens g n ralistes en milieu rural, on peut guider les occasions de formation et, alors que les g n ralistes effectuent de moins en moins d'interventions non classiques, mieux comprendre ce que cela signifie pour la patient le et les collectivit s., For Canadians in rural, remote, and northern settings, access to specialty surgical care is more challenging than in urban communities. Although the Canada Health Act states that its primary objective [...]

Colonialism can be seen as a historical process, or an ideology. As this article demonstrates, for Canadian Doukhobors, it is also a lived experience. Canadian Doukhobors, or Spirit Wrestlers, are a group of pacifist religious dissenters of mixed ethnic origins who immigrated to Canada from the Russian Empire in 1899. The worldview of the Doukhobors was radically different from the principles on which the colonial government was founded. The goal of this article is to describe the colonial policies directed towards the Doukhobors, their anticolonial struggles, and to consider the implications of the Doukhobor history for contemporary anti-colonial thought in Canada and worldwide. The government subjected Doukhobors to a range of discriminatory actions including cancellation of earlier granted land registries in Saskatchewan, incarcerations for refusal of military service (despite an existing legal exemption), taking away children of some Doukhobors and placing them in a juvenile detention center to force the assimilation. While considering the significance of the Doukhobor struggles against colonialism, the article proposes a new term, 'colonial privilege.' This article is reflexive and sheds a new light on the earlier recorded facts. Keywords: Anti-colonialism, anti-racism, colonial privilege, Doukhobors (Spirit Wrestlers), linguicism, pacifism. Le colonialisme peut etre considere comme un processus historique ou une ideologie. Comme le demontre cet article, pour les Doukhobors canadiens, il s'agit egalement d'une experience vecue. Les Doukhobors canadiens, ou lutteurs spirituels, sont un groupe de dissidents religieux pacifistes d'origines ethniques diverses qui ont immigre au Canada en provenance de l'Empire russe en 1899. La vision du monde des Doukhobors etait radicalement differente des principes sur lesquels le gouvernement colonial etait fonde. L'objectif de cet article est de decrire les politiques coloniales menees a l'encontre des Doukhobors, leurs luttes anticoloniales et d'examiner les implications de l'histoire des Doukhobors pour la pensee anticoloniale contemporaine au Canada et dans le monde. Le gouvernement a soumis les Doukhobors a toute une serie d'actions discriminatoires, notamment l'annulation de l'enregistrement des terres octroyees anterieurement en Saskatchewan, l'incarceration pour refus du service militaire (malgre une exemption legale existante), l'enlevement des enfants de certains Doukhobors et leur placement dans un centre de detention pour mineurs afin de les forcer a s'assimiler. Tout en considerant l'importance des luttes des Doukhobors contre le colonialisme, l'article propose un nouveau terme, celui de 'privilege colonial'. Cet article est reflexif et jette une nouvelle lumiere sur les faits precedemment repertories. Mots-cles : Anticolonialisme, antiracisme, privilege colonial, Doukhobors (Lutteurs Spirituels), linguisme, pacifisme., 'We were brought here on a ship that had been transporting cattle, and we were treated like cattle' (from a poem in Russian by a Doukhobor). INTRODUCTION 'The pluralistic diversity' [...]

In this arts-informed inquiry, I examine Canadian sex educators' embodied sense-making of comprehensive sexual health education (CSHE). I seek to understand how educators use their bodies to negotiate contested pedagogical terrain in order to gain insights into conflicting patterns observed in the literature, as well as to challenge how educators' personal pedagogies may be implicated in uneven enactments of CSHE. Using sensory ethnographic principles, I focus inquiry on educators' embodied experiences of contentious pedagogical practices, including the over-reliance on institutionalized forms of knowledge. I conceptualize their experiences as 'interchange'--the sense of simultaneous bodily gaining and giving in response to the social-political demands of teaching CSHE. I analyze two focal experiences of interchange--namely, Feeling Right(s) and Be/ ing Schooled--to highlight paradoxical frictions of educators' personal and pedagogical anti-oppressive aims. Last, I utilize Maclaren's concept of 'unfreedom' to discuss addressing problematic CSHE practices as an intersubjective project. Keywords: embodiment, sexual health education, sex educators, arts-informed Dans cette recherche utilisant une approche renseignee par l'art, j'examine la facon dont les educateurs canadiens en education sexuelle donnent un sens concret a l'education complete a la sexualite (ECS). Je cherche a comprendre comment les educateurs mobilisent leur personne pour negocier un terrain pedagogique controverse, afin de mieux comprendre les modeles contradictoires observes dans la litterature et de verifier la facon dont les pedagogies personnelles des educateurs peuvent etre impliquees dans la mise en oeuvre inegale de l'ECS. Par l'utilisation des principes de l'ethnographie sensorielle, je concentre ma recherche sur les experiences de pratiques pedagogiques litigieuses vecues par les educateurs, y compris sur la confiance excessive en des formes institutionnalisees de connaissances. Je conceptualise leurs experiences comme un << echange >>, c'est-a-dire les sentiments simultanes d'un gain et d'un don de soi en reponse aux exigences sociopolitiques de l'enseignement de l'ECS. J'analyse deux experiences focales d'echange--a savoir le sentiment de legitimite et celui d'etre/de s'instruire--pour mettre en exergue les frictions paradoxales des objectifs anti-oppressifs personnels et pedagogiques des educateurs. J'utilise enfin le concept de << non-liberte >> de Maclaren pour discuter du traitement des pratiques problematiques de l'education a la sante sexuelle en tant que projet intersubjectif. Mots-cles: incarnation, education a la sante sexuelle, educateur en sexualite, approche renseignee par l'art, Introduction In this research, I explore educators' embodied sense-making of a sexual health education training program--that is, a program that teaches individuals how to be comprehensive sexual health educators in [...]

Introduction I. Homma through the courts II. Union Colliery v Bryden III. Homma before the Privy Council IV. Explaining the Privy Council's departure from Union Colliery 1. Features and limitations [...], This paper highlights the structural barriers to voting rights that Japanese-Canadians in BC faced in the early 20th century. It documents Tomekichi Homma&apos;s challenge of provincial legislation which prevented the Japanese from voting in local elections. His fight went to the Judicial Committee of the Privy Council, then the highest court of appeal in Canada. While Homma challenged the law because it denied voting rights based on racial grounds, the courts made little to no reference to race or ethnicity in hearing the issue; their focus was on questions of constitutionality and the division of powers. The Privy Council employed questionable legal reasoning in dismissing Homma&apos;s appeal, and departed from a recent precedent of theirs, Union Colliery, which promoted the employment rights of Chinese-Canadians in BC. This paper attempts to understand and explain why Homma was not successful before the Privy Council in the face of the Union Colliery decision. Cet article met en lumi re les obstacles structurels au droit de vote auxquels les Canadiens d&apos;origine japonaise ont t confront s en Colombie-Britannique au d but du XXe si cle. Il documente la contestation par Tomekichi Homma de la l gislation provinciale qui emp chait les Japonais de voter aux lections locales. Son combat a t port devant le comit judiciaire du Conseil priv , qui tait alors la plus haute cour d&apos;appel du Canada. Bien que Homma ait contest la loi parce qu&apos;elle refusait le droit de vote pour des motifs raciaux, les tribunaux n&apos;ont gu re fait r f rence la race ou l&apos;appartenance ethnique lors de l&apos;examen de la question; ils se sont concentr s sur les questions de constitutionnalit et de r partition des pouvoirs. Le Conseil priv a utilis un raisonnement juridique discutable pour rejeter l&apos;appel de Homma et s&apos;est cart d&apos;un de ses pr c dents r cents, Union Colliery, qui a promu les droits l&apos;emploi des Sino-Canadiens en Colombie-Britannique. Cet article tente de comprendre et d&apos;expliquer pourquoi Homma n&apos;a pas eu gain de cause devant le Conseil priv , compte tenu de la d cision de Union Colliery.

Photography is the culmination of planning, technique, vision, composition, and perception, brought together in one instant with a little (or more) editing. --LEAH GRAY Living on the west coast of [...]