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Objective and Approach Understanding vaccine hesitancy among distinct communities is crucial to ensuring equitable uptake of vaccination. The objective was to examine the influence of psychological antecedents of vaccine uptake, known as the “5Cs”, on COVID-19 vaccination among Métis Nation of Ontario (MNO) citizens. The Métis people are one of three Indigenous peoples in Canada. A population-based online survey was implemented by the MNO, including the short version of the “5C” (confidence, complacency, constraint, calculation, collective responsibility) psychological antecedents of vaccination scale. Census sampling achieved a 39% response rate and respondents were linked to the COVID-19 vaccine database (COVAX) in Ontario (n=4,012). Analyses included logistic regression models (adjusted for sociodemographics) and exploratory latent class analyses. Results In logistic regression models, MNO citizens who were less confident that COVID-19 vaccines were safe (OR=0.04; 95% CI=0.03-0.06) and did not agree vaccination was a collective action to prevent the spread of disease (OR=0.11, 95% CI: 0.07-0.17) had lower odds of being vaccinated. MNO citizens who disagreed the risk of COVID-19 was small (OR=14.87, 95% CI: 9.99-22.13) had a higher odds of being vaccinated. Vaccine hesitancy profiles with (i) lower confidence in availability/safety of COVID-19 vaccines, (ii) lower perceptions about severity of COVID-19 and (iii) higher everyday life constraints/stressors were associated with lower vaccination rates (males, OR: 4.69; CI: 3.18–6.92; females, OR: 4.77, CI: 3.03–7.51) in latent class analyses. Conclusions and Implications Métis-specific analyses enabled a community-driven response, resulting in low vaccine hesitancy and high uptake.

Fractures and dislocations of the sternoclavicular joint (SCJ) are uncommon, accounting for

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.

Abstract Objectives To describe the clinical phenotype and prognosis of people in the Australian Scleroderma (SSc) Cohort Study with pulmonary arterial hypertension (PAH) with or without interstitial lung disease (ILD). Methods Participants meeting ACR/EULAR criteria for SSc were divided into four mutually exclusive groups: those meeting criteria for PAH (PAH-only), ILD (ILD-only), concurrent PAH and ILD (PAH-ILD) or neither PAH nor ILD (SSc-only). Logistic or linear regression analyses were used for associations between clinical features, health-related quality of life (HRQoL) and physical function. Survival analysis was performed using Kaplan–Meier estimates and Cox-regression modelling. Results Of 1561 participants, 7% fulfilled criteria for PAH-only, 24% ILD-only, 7% PAH-ILD and 62% SSc-only. People with PAH-ILD were more frequently male, with diffuse skin involvement, higher inflammatory markers, older age of SSc onset and higher frequency of extensive ILD than the cohort overall (p

Objectives To adapt the content and functionalities of Brain Health PRO, a web-based multidomain program designed to increase dementia literacy, to the context and needs of users, providers and community organisations across Québec, Canada.Design Five consecutive qualitative co-creation focus group sessions 30–90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention.Setting Virtual meetings.Participants A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies.Data analysis Session recordings were summarised through both qualitative description and thematic analysis.Results The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of Brain Health PRO.Conclusions Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.

Abstract Background To describe the epidemiology, determinants and survival impact of gastric antral vascular ectasia (GAVE) in systemic sclerosis (SSc). Methods Consecutive SSc patients prospectively enrolled in the Australian Scleroderma Cohort Study (ASCS) were included. Univariable and multivariable logistic regression were used to determine the associations of GAVE with clinical manifestations and serological parameters. Kaplan-Meier (K-M) survival curves were used to estimate survival. Results The prevalence of GAVE in this SSc cohort of 2039 SSc patients was 10.6% (n = 216) over a median follow-up period of 4.3(1.7–8.4) years. SSc patients with a history of GAVE compared with those without a history of GAVE were older at SSc onset [49.5 (40.0–58.2) vs 46.7 (36.0–56.7) years, p = 0.05]; more likely to have diffuse disease subtype (dcSSc) (35.3% vs 24.1%, p < 0.001); be negative for Scl-70, U1RNP and Scl/PM antibody (4.0% vs 16.1%, p < 0.001, 3.5% vs 7.4%, p = 0.041, 0.0% vs 2.0%, p = 0.042; and respectively) and positive for RNAP III antibody (24.9% vs 8.3%, p < 0.001). Those with GAVE had a worse HRQoL (p = 0.002). Independent determinants of GAVE included the presence of RNAP III antibody (OR 3.46, p < 0.001), absence of Scl-70 antibody (OR 0.23, p = 0.001), presence of GIT dysmotility (OR 1.64, p = 0.004), and digital ulcers; pits; or digital amputation (OR 1.59, p = 0.014). Conclusions GAVE is an underestimated and underappreciated SSc manifestation of SSc, which occurs with a relatively high frequency. Identifying an at-risk GAVE phenotype, as presented herein, is of practical importance as screening may prove advantageous given GAVE can be easily diagnosed and treated.

The purpose of this study was to investigate the education and preparedness of athletic trainers when caring for athletes with Attention.Deficit.Hyperactivity.Disorder (ADHD) and or Autism Spectrum Disorder (ASD).

Understand the degree to which concussions go unreported among members of the Law Enforcement community.

The purpose of this study was to investigate the use of dietary supplements or ergogenic aids amongst high school athletes.

The purpose of this study was to investigate the effects of COVID-19 related tasks on the rates of burnout in athletic trainers practicing in the collegiate setting.

Abstract Background Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. Methods Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. Results The simulation model suggests that Connecticut’s GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. Conclusions The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.

The Strategy for Patient Oriented Research (SPOR) Evidence Alliance is a research initiative in Canada whose mission is to promote the synthesis, dissemination, and integration of research results into health care and public health decision-making and clinical practice. The aim of this paper is to (i) outline the governance and committee structure of the SPOR Evidence Alliance, (ii) outline the procedures for patient and health system decision-maker engagement, and (iii) present the capacity-building strategy for governance members. The governance structure includes the following six standing committees: the International Advisory Committee, Steering Committee, Executive Committee, Knowledge Translation Committee, Partnerships Committee, and Training and Capacity Development Committee. The guiding principles embrace inclusiveness, support, mutual respect, transparency, and co-building. There are currently 64 committee members across the six committees, 13 patient and public partners, 8 health system decision-makers, 7 research trainees, and 36 researchers. A multi-disciplinary and diverse group of people in Canada are represented from all regions and at various levels of training in knowledge generation, exchange, and translation. This collaborative model makes the SPOR Evidence Alliance strong and sustainable by leveraging the knowledge, lived experiences, expertise, skills, and networks among its 342 members and 12 principal investigators.

Anoxic marine zones are expanding and intensifying with climate change. Here the authors show that microbial dark carbon fixation influences the carbonate system and the stable isotope composition in waters off Chile, contributing up to 35% of the organic carbon reaching the mesopelagic region.

Systemic sclerosis (SSc) is an autoinflammatory, fibrotic condition of unknown aetiology. The presence of detectable autoantibodies against diverse nuclear antigens, as well as strong HLA associations with disease, suggest autoimmune involvement, however the links between endogenous and exogenous risk factors and SSc pathology remain undetermined. We have conducted a genetic analysis of HLA inheritance in two independent and meta-analysed cohorts of 1,465 SSc cases and 13,273 controls, including stratified association analyses in clinical and autoantibody positive subgroups of disease. Additionally, we have used patient genotypes to impute gene dosages across the KIR locus, encoding paired activating and inhibitory lymphocyte receptors for Class I HLA ligands, to conduct the largest analysis of KIR-HLA epistatic interactions in SSc to date. We confirm previous Class II HLA associations with SSc risk and report a new Class I association with haplotype HLA-B*44:03-HLA-C*16:01 at genome-wide significance (GWS). We further report statistically significant HLA associations with clinical and serological subtypes of disease through direct case-case comparison, and report a new association of HLA-DRB1*15:01, previously shown to bind topoisomerase-1 derived peptides, with anti-topoisomerase (ATA) positive disease. Finally, we identify genetic epistasis between KIRs and HLA class I ligands, suggesting genetic modulation of lymphocyte activation may further contribute to an individual’s underlying disease risk. Taken together, these findings support future functional investigation into endogenous immunological and environmental stimuli for disrupted immune tolerance in SSc.

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are associated with decreased health‐related quality of life and debilitating symptoms. These experiences can be defined as patient‐reported outcome (PRO) concepts and measured using PRO instruments. We identified all PRO concepts and instruments used in the PBC and PSC literature. This systematic review identified PBC and/or PSC studies from January 1, 1990, to May 6, 2019, that measured at least one PRO concept. Study population, design, PRO concept, PRO instrument, and validation data for PRO instruments were investigated. We provided descriptive statistics of PRO concepts and instruments used, stratified by population type. Use of PRO concepts and instruments were assessed over time. The search yielded 318 articles (69% in PBC, 18% in PSC, 13% in both, and 24% in drug trials). Forty‐nine unique PRO concepts were identified. The five most common PRO concepts included pruritus (25%), fatigue (19%), broad health‐related quality of life (16%), gastrointestinal adverse events (6%), and physical adverse events (6%). Only 60% of PRO concepts were measured with a PRO instrument, most of which were nonvalidated visual analogue or numeric rating scales. Only three of 83 PRO instruments were developed with feedback from the target populations (one for PBC, one for PSC, and one for both), and only six documented any psychometric testing in the target populations. Use of PRO instruments increased over time from 30% in the 1990s to 67% by 2019. Conclusion: The overwhelming majority of PRO instruments used in PBC/PSC were nonspecific and lacked patient validation or empirical justification. Significant opportunities exist to use qualitative methods to better understand patient experiences, and translate this knowledge into meaningful, patient‐driven study outcomes.

OBJECTIVE: The purpose of this study was to investigate the comfort levels of male student athletes at a Division III college in reporting symptoms of eating disorders to Athletic Trainers. MAIN OUTCOME MEASUREMENT: Likert scale questions with one open ended question.

OBJECTIVE: The purpose of this study was to investigate anxiety levels due to balancing academic and team responsibilities in one Division III womens’ and mens’ soccer teams. MAIN.OUTCOME.MEASURE: 5-point,6-point Likert scale.

OBJECTIVE: The purpose of this study was to investigate the medical care perceptions of rodeo athletes at one Southwest Ohio rodeo as compared to others. MAIN.OUTCOME.MEASURE: The survey was made of 23 Likert-scale questions.

OBJECTIVE: Rock Steady Boxing’s (non-profit organization) program goal is improving Parkinson’s patients’ quality of life through a non-contact, boxing-based fitness class. The purpose of this study was to investigate the effects of Parkinson’s patients perceived improvement on proprioception from one hospital-based Rock Steady Boxing Program. The program was led by athletic trainers and physical therapists. MAIN.OUTCOME.MEASURE: Likert scale survey was used with one fill in the blank question.

The Canadian Arctic is warming at three times the rate of the rest of the planet and the effects of climate change on the Arctic marine carbon cycle remains unconstrained. Baffin Bay is a semi-enclosed, Arctic basin that connects the Arctic Ocean to the north to the Labrador Sea to the south. While the physical oceanography of surface Baffin Bay is well characterized, less is known about deep water formation mechanisms within the Basin. Only a few residence-time estimates for Baffin Bay Deep Water (BBDW) exist and range from 20 to 1450 years. Better residence time estimates are needed to understand the oceanographic significance of Baffin Bay. Here we report stable carbon (δ13C) and radiocarbon (Δ14C) values of dissolved inorganic carbon (DIC) collected aboard the CCGS Amundsen in 2019. DIC δ13C and Δ14C values between ranged between -0.7‰ to +1.9‰ and -90.0‰ to +29.8‰, respectively. Surface DIC δ13C values were between +0.7‰ to +1.9‰, while deep (>100m) values were 0.0 to -0.7‰. Surface DIC Δ14C values ranged between -5.4‰ to +22.9‰, while deep DIC (>1400m) DIC Δ14C averaged -82.2 ± 8.5‰ (n = 9). To constrain natural DIC Δ14C values, we quantified the amount of atmospheric “bomb” 14C in DIC (Δ14Cbomb; using the potential alkalinity method; Palk) and anthropogenic DIC (DICanth; using the ΔC* method). Both proxies indicate an absence of Δ14Cbomb and DICanth below 1000m. Using two previously proposed deep water formation mechanisms and our corrected DIC Δ14Cnatural values, we estimated a 14C-based residence time of 360-690 years for BBDW. Based on these residence times, we infer carbon is likely stored for centuries in deep Baffin Bay.

Introduction Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer’s disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants’ intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health.Methods and analysis The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up.Ethics and dissemination Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.Trial registration number NCT04997681, Pre-results.

Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term “ultrasound” combined with several search terms, i.e., “probe”, “anatomy”, “difficult airway”, “endotracheal intubation”, “laryngeal edema”, and “cricothyrotomy” was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting.

Vas deferens calcification is a chronic arterio-sclerotic process that develops over many years and is strongly associated with infertility. Incidental findings on imaging are the most common means of diagnosing this condition. We report a case of a 56-year man who likely has male factor infertility and was found to have bilateral vas deferens calcification on CT imaging. This was performed during pre-procedural workup for transcatheter aortic valve replacement (TAVR) for management of severe aortic stenosis (AS). The patient was also had severe calcific multi-vessel coronary artery disease requiring percutaneous coronary intervention with atherectomy. This case highlights a novel clinical association linking infertility with coronary and valvular heart disease. It is possible that this association exists in larger numbers than previously recognized. Closer monitoring of pelvic imaging for TAVR access planning in patients with severe AS may bring more cases to light.

Aims: To determine real-life biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) retention rates in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), explore reasons for switching and to compare results to previously published data.Methods: Time-to-event analysis for mean treatment duration (estimated as the Restricted Mean Survival Time), b/tsDMARD failure, and b/tsDMARDs switching was performed for 230 patients (n = 147 RA, 46 PsA, 37 AS) who commenced their first b/tsDMARD between 2008 and 2018. Patients were managed in a dedicated “biologics” clinic in a tertiary hospital; the choice of b/tsDMARD was clinician driven based on medical factors and patient preferences. The effect of covariates on switching risk was analysed by a conditional risk-set Cox proportional-hazards model. Treatment retention data was compared to a historical analysis (2002–2008).Results: The proportions remaining on treatment (retention) were similar, throughout follow-up, for the first, second and third b/tsDMARDs across all patients (p = 0.46). When compared to RA patients, the risk of b/tsDMARD failure was halved in PsA patients [Hazard Ratio (HR) = 0.50], but no different in AS patients (HR = 1.0). The respective restricted mean (95%CI) treatment durations, estimated at 5 years of follow-up, were 3.1 (2.9, 3.4), 4.1 (3.7, 4.6), and 3.3 (2.8, 3.9) years, for RA, PsA, and AS, respectively. Age, gender, disease duration, smoking status and the use of concomitant csDMARDS were not associated with the risk of bDMARD failure. The most common reasons for switching in the first and subsequent years were secondary (n = 62) and primary (n = 35) failure. Comparison with historical data indicated no substantive differences in switching of the first biologic for RA and PsA.Conclusion: Similar retention rates of the second and third compared to the first b/tsDMARD in RA, PsA, and AS support a strategy of differential b/tsDMARDs use informed by patient presentation. Despite greater availability of b/tsDMARDs with differing mechanisms of action, retention rates of the first b/tsDMARD remain similar to previous years.

Abstract Background Crowdsourcing is used increasingly in health and medical research. Crowdsourcing is the process of aggregating crowd wisdom to solve a problem. The purpose of this systematic review is to summarize quantitative evidence on crowdsourcing to improve health. Methods We followed Cochrane systematic review guidance and systematically searched seven databases up to September 4th 2019. Studies were included if they reported on crowdsourcing and related to health or medicine. Studies were excluded if recruitment was the only use of crowdsourcing. We determined the level of evidence associated with review findings using the GRADE approach. Results We screened 3508 citations, accessed 362 articles, and included 188 studies. Ninety-six studies examined effectiveness, 127 examined feasibility, and 37 examined cost. The most common purposes were to evaluate surgical skills (17 studies), to create sexual health messages (seven studies), and to provide layperson cardio-pulmonary resuscitation (CPR) out-of-hospital (six studies). Seventeen observational studies used crowdsourcing to evaluate surgical skills, finding that crowdsourcing evaluation was as effective as expert evaluation (low quality). Four studies used a challenge contest to solicit human immunodeficiency virus (HIV) testing promotion materials and increase HIV testing rates (moderate quality), and two of the four studies found this approach saved money. Three studies suggested that an interactive technology system increased rates of layperson initiated CPR out-of-hospital (moderate quality). However, studies analyzing crowdsourcing to evaluate surgical skills and layperson-initiated CPR were only from high-income countries. Five studies examined crowdsourcing to inform artificial intelligence projects, most often related to annotation of medical data. Crowdsourcing was evaluated using different outcomes, limiting the extent to which studies could be pooled. Conclusions Crowdsourcing has been used to improve health in many settings. Although crowdsourcing is effective at improving behavioral outcomes, more research is needed to understand effects on clinical outcomes and costs. More research is needed on crowdsourcing as a tool to develop artificial intelligence systems in medicine. Trial registration PROSPERO: CRD42017052835. December 27, 2016.

Abstract Background To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. Methods Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1–5 DUs, moderate 6–10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008–2015. Healthcare cost determinants were estimated using logistic regression. Results Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p

Abstract Background To quantify the financial cost of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). Methods Healthcare use was captured through data linkage, wherein clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with hospital, emergency department (ED) and ambulatory care databases (MBS) for the period 2008–2015. PAH was diagnosed on right heart catheter according to international criteria. Determinants of healthcare cost were estimated using logistic regression. Results Total median (25th–75th) healthcare cost per patient (including hospital, ED and MBS cost but excluding medication cost) for our cohort during 2008–2015 was AUD$37,685 (18,144-78,811) with an annual per patient healthcare cost of AUD$7506 (5273-10,654). Total healthcare cost was higher for SSc-PAH patients compared with those without PAH with a total cost per patient of AUD$70,034 (37,222-110,814) vs AUD$34,325 (16,093 – 69,957), p

Introduction While First Nations communities are well aware of the unique health challenges and requirements of their populations, research evidence is often needed to support this knowledge. First Nations communities face continual challenges accessing data pertaining to the health of their people that is held by the government or other organizations. Objectives and Approach Through the Applied Health Research Question (AHRQ) program at ICES, First Nations communities in Ontario, Canada, have an avenue to access vital population health information about their people. While keeping questions of privacy, data sovereignty, data governance, and the OCAP® principles at the forefront, First Nations partners are active members and collaborators on community driven projects that are of importance to their communities. An Indigenous health data training program has also been developed to run concurrently with these projects, to enhance research knowledge and capacity within partner First Nations communities. Results First Nations community partners are the main drivers in deciding and refining the research questions for their projects. They are engaged throughout the project process to ensure the production of results that suit the specific needs of the partners. Project results are only shared with the partners, who utilize and disseminate them as appropriate within their communities. Conclusion / Implications With access to previously difficult to access population health data sources, First Nations communities are able to use health system data as an additional tool to better plan and implement community health programs, to lobby for additional funding, and ultimately to contribute to positive policy change.

This article details a correction to the article: Chen, H., Shaw, T.A., Wang, J., Engelhart, S., Nikitina, D., Pilarczyk, J.E., Walker, J., García-Artola, A. and Horton, B.P., 2020. Salt-Marsh Foraminiferal Distributions from Mainland Northern Georgia, USA: An Assessment of Their Viability for Sea-Level Studies. 'Open Quaternary', 6(1), p. 6. DOI: http://doi.org/10.5334/oq.80

Background Health literacy enables the patients in understanding the basic healthcare information and taking informed health decisions; thus, it is a desirable goal of any healthcare system. It increases patients’ adherence to treatment, improves the quality of care and eases the overall burden on the healthcare system. In recent years, technological solutions are being increasingly used in educating patients and achieving better health literacy. Augmented reality (AR) provides powerful, contextual and situated learning experiences and supplements the real world with virtual objects. AR could potentially be an effective learning methodology for the patients, thus, warranting a comprehensive overview of the current state of AR in patient education and health literacy.Methods The proposed scoping review will be based on the framework developed by Arksey and O’Malley, including the refinements suggested by Levac et al. A systematic search for references in the published literature will be conducted in nine research databases—Institute of Electrical and Electronics Engineers (IEEE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycInfo, Embase, Web of Science, Scopus, Association for Computing Machinery (ACM) and Association for Information Systems eLibrary (AISeL). The unpublished studies from ProQuest Dissertations and Theses, Conference Proceedings Citation Index and grey literature references obtained from a web search will also be included. Databases will be searched from inception to 14 January 2020. Two independent reviewers will screen the studies from the search results in two successive stages of title/abstract screening followed by full-text screening. Data variables will be extracted from the selected studies to characterise study design, type of AR technology employed and the relational factors affecting patient education. Lastly, key stakeholders will be consulted to gather their insights about the study findings.Ethics and dissemination The results will be disseminated through stakeholder meetings and conference presentations. The data used are from publicly available secondary sources, so this study does not require ethical review.

Mi’kmaq Elder Albert Marshall coined “Two-Eyed Seeing” in 2004, an Indigenous concept that emphasizes integrating the strengths of multiple perspectives to address complex challenges in ways that benefit all. In 2011, Two-Eyed Seeing became a policy of the Canadian Institutes of Health Research (CIHR)–Institute of Aboriginal Peoples’ Health, as a part of its 5-year plan, and in 2012, CIHR funding was directed toward supporting efforts that apply the concept of Two-Eyed Seeing to research. However, little is known about how Two-Eyed Seeing has been operationalized in research. To address this ambiguity, a scoping review was conducted to map the key concepts involved when researchers intend to follow Two-Eyed Seeing guiding principles to study Indigenous health topics. Three research questions guided this scoping review: (1) What are the general characteristics (e.g., location of study, health topic studied) of primary research that has attempted to apply Two-Eyed Seeing when studying Indigenous health topics? (2) How did researchers operationalize the concept of Two-Eyed Seeing when they applied it to primary studies regarding Indigenous health topics? and (3) What process-related elements were present in Two-Eyed Seeing studies that accomplished their objectives? The results of this scoping review indicate there is an increasing trend in Two-Eyed Seeing–related peer-reviewed publications since its formal introduction by Mi’kmaq Elder Albert Marshall. The selected Two-Eyed Seeing–related projects were predominately conducted in Canada and published between 2011 and 2019. Projects predominately incorporated a community-based (participatory) research approach and qualitative/Indigenous methods, and six core process–related themes/elements were identified: (i) power was shared, (ii) culturally safe spaces were fostered, (iii) institutional and community ethics were followed, (iv) research projects were transformative, (v) rigor was maintained, and (vi) the structure of Western academia and traditional policy decision-making processes provided challenges for research teams and community partners, respectively.

We investigated foraminiferal distributions from two salt-marsh sites at Thunderbolt and Georgetown, in mainland northern Georgia, U.S. Atlantic coast. We analyzed modern epifaunal foraminiferal assemblages across multiple transects consisting of 54 surface samples. Multivariate statistical analysis (Partitioning Around Medoids and Detrended Correspondence Analysis) revealed that dead foraminiferal assemblages are divided into three faunal zones, which are elevation-dependent and site-specific. At Thunderbolt, an intermediate salinity marsh (17‰), high marsh assemblages are dominated by 'Haplophragmoides' spp. with an elevational range of 1.19 to 1.68 m mean tide level (MTL) between Mean Higher High Water (MHHW) to Highest Astronomical Tide (HAT). Low marsh assemblages are dominated by 'Miliammina fusca' and 'Ammobaculites' spp. with an elevational range of – 0.05 to 1.14 m MTL (between MTL and MHHW). At Georgetown, a low salinity marsh (6‰), the assemblages are dominated by 'Ammoastuta inepta' with an elevational range of 0.43 to 1.16 m MTL (between MTL and MHHW). We also enumerated living infaunal foraminiferal populations from six 50-cm sediment cores from the two salt marshes to assess implications for interpretations of sea-level change. Peak concentrations of living foraminiferal populations occur in the upper 1-cm surface sediment in five of the six cores. An exception was observed in high marsh settings of Thunderbolt, where 'Haplophragmoides' spp. and 'Arenoparrella mexicana' were observed living down to 40 cm depth and both the live and dead abundance peaked (32 and 520 specimens per 10 cc respectively) between depths of 15–35 cm in the core. The dominant infaunal species were similar to those observed in modern surface samples, and the total number of infaunal foraminifera was typically less than 15% compared to the total number of dead specimens in the surface samples. Finally, we com­pared the down-core patterns of living and dead foraminiferal abundance that suggest that 90% of the tests were removed within the upper 10 cm of sediment in most cores. This may be due to taphonomic alteration from bioturbation and/or microbial processes. Selective preservation between resistant species such as 'A. mexicana' and fragile species like 'M. fusca' and 'Ammobaculites' spp. can change the subsurface foraminiferal assemblage. This has the potential to cause errors in sea-level reconstructions using foraminiferal assemblage from low marsh sediments. This study highlights the modern vertical distribution of salt-marsh foraminifera in mainland northern Georgia and their potential as modern analogues for fos­sil counterparts in reconstructing sea-level changes. Taphonomic processes may cause the absence of foraminiferal tests or differences between modern and fossil assemblages, which could be problematic when performing RSL reconstructions in low marsh environment.

Abstract Background Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role. Methods We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge. Results One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role. Conclusions Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice.

Abstract Background As the population is aging, the number of persons living with multiple chronic conditions (MCC) is expected to increase. This review seeks to answer two research questions from the perspectives of older adults with MCC, their caregivers and their health care providers (HCPs): 1) What are the health and social care needs of community-dwelling older adults with MCC and their caregivers? and 2) How do social and structural determinants of health impact these health and social care needs? Methods We conducted a scoping review guided by a refinement of the Arksey & O’Malley framework. Articles were included if participants were 55 years or older and have at least two chronic conditions. We searched 7 electronic databases. The data were summarized using thematic analysis. Results Thirty-six studies were included in this review: 28 studies included participants with MCC; 12 studies included HCPs; 5 studies included caregivers. The quality of the studies ranged from moderate to good. Five main areas of needs were identified: need for information; coordination of services and supports; preventive, maintenance and restorative strategies; training for older adults, caregivers and HCPs to help manage the older adults’ complex conditions; and the need for person-centred approaches. Structural and social determinants of health such as socioeconomic status, education and access influenced the needs of older adults with MCC. Conclusion The review highlights that most of the needs of older adults with MCC focus on lack of access to information and coordination of care. The main structural and social determinants that influenced older adults’ needs were their level of education/health literacy and their socioeconomic status.

Nearly a third of dairy cows are removed from herds annually in the United States. Our objective is to describe what is known about the process of sending a dairy cow to slaughter in the United States including our perspectives about her fitness for transport, her condition upon arrival at the slaughter plant and the decisions to transport her in the first place. This process begins when the decision is made by the farmer to remove a cow from the herd. Once a cow leaves the farm, she makes her way either directly to slaughter or goes through one or more livestock auctions or markets along the way. Cull cows can travel considerable distance to slaughter and may face a number of welfare challenges during this process. These stressors are exacerbated if the cows are compromised and not fit for transport. While all major industry stakeholders have recommendations or guidelines about fitness for transport, none are enforced rules or regulations. There is little financial disincentive for farmers to stop shipping compromised dairy cows, and, in some cases, slaughter plants are willing to take the risk on purchasing cows in this condition as those that survive the journey often generate a good margin of return. As a result, the decision to ship compromised cull cows is too common, as indicated by data about cow condition both at the farm and the slaughter plant. Compromised culled dairy cattle continue to arrive at slaughter plants and leadership within the industry is needed to tackle this welfare challenge.

Topic: Perspectives on Linkage Involving Indigenous data Indigenous populations across the globe are reaffirming their sovereignty rights in the collection and use of Indigenous data. The Indigenous data sovereignty movement has been widely influential and can be unsettling for those who routinely use population-level linked data that include Indigenous identifiers. Ethical policies that stipulate community engagement for access, interpretation and dissemination of Indigenous data create an enabling environment through the critical process of negotiating and navigating data access in partnership with communities. This session will be designed to create space for leading Indigenous voices to set the tone for the discussion around Indigenous population data linkage. Objectives: • To provide participants with an opportunity to build on the themes of Indigenous Data Sovereignty presented in the keynote session as they apply to diverse Indigenous populations. • To explore approaches to the linkage of Indigenous-identified population data across four countries, including First Nations in three Canadian regions. • To share practical applications of Indigenous data sovereignty on data linkage and analysis and discussion. • To center Indigenous-driven data linkage and research. Facilitator: Jennifer Walker. Canada Research Chair in Indigenous Health, Laurentian University and Indigenous Lead, Institute for Clinical Evaluative Sciences. Collaborators: • Alberta: Bonnie Healy, Tina Apsassin, Chyloe Healy and William Wadsworth (Alberta First Nations Information Governance Centre) • Ontario: Carmen R. Jones (Chiefs of Ontario) and Jennifer Walker (Institute for Clinical Evaluative Sciences) • British Columbia: Jeff Reading (Providence Health Centre) and Laurel Lemchuk-Favel (First Nations Health Authority) • Australia: Raymond Lovett (Australian National University) • Aotearoa / New Zealand: Donna Cormack (University of Otago) • United States: Stephanie Rainie and Desi Rodriguez-Lonebear (University of Arizona) Session format: 90 minutes Collaborators will participate in a round-table introduction to the work they are doing. Collaborators will discuss the principles underlying their approaches to Indigenous data linkage as well as practical and concrete solutions to challenges. Questions to guide the discussion will be pre-determined by consensus among the collaborators and the themes will include: data governance, community engagement, Indigenous-led linkage and analysis of data, and decision-making regarding access to linked data. Other participants attending the session will be encouraged to listen and will have an opportunity to engage in the discussion and ask questions. Intended output or outcome: The key outcome of the session will be twofold. First, those actively working with Indigenous linked data will have an opportunity for an in-depth and meaningful dialogue about their work, which will promote international collaboration and sharing of ideas. Second, those with less experience and knowledge of the principles of Indigenous data sovereignty and their practical application will have an opportunity to listen to Indigenous people who are advancing the integration of Indigenous ways of knowing into data linkage and analysis. The output of the session will be a summary paper highlighting both the diversity and commonalities of approaches to Indigenous data linkage internationally. Areas where consensus exists, opportunities for collaboration, and challenges will be highlighted.

Introduction In Ontario, First Nations are increasingly seeking population-level data about the health of their citizens. However, First Nations people are not readily identified in standard health administrative data and indirect strategies, such as the use of on-reserve addresses, are limited in scope and validity. Objectives and Approach The Chiefs of Ontario entered into a Data Governance Agreement with the Institute for Clinical Evaluative Sciences (ICES) that enabled the linkage of the federal Indian Register (IR) to data at ICES. This study examined the impact of the IR linkage on First Nations population estimates and location of residence, measured by postal code or residence code. Overall, and for each First Nation community in Ontario, we compared First Nations population estimates from the ICES data with and without the IR linkage to estimates available from Indigenous and Northern Affairs Canada (INAC). Results Without the IR, using only Ontario residence codes or postal codes that were unique to a given community, 62,242 individuals were identified as living in First Nations communities. This is approximately 30% lower than the current INAC on-reserve population estimate of 92,234 for First Nations communities in Ontario. Adding the IR allowed the use of non-unique postal codes as well, resulting in the identification of an additional 15,183 First Nations individuals. It also allowed the identification of over 113,000 First Nations individuals who live outside of First Nations communities, especially in urban areas. Finally, the combination of residence information and the IR permits communities to identify their registered member living within and outside their communities. Conclusion/Implications Using the IR in combination with geographic residence information, made possible through the Data Governance Agreement signed between Chiefs of Ontario and ICES, will provide First Nations communities with more accurate and complete population estimates, which is key to the production of useful and relevant First Nations-specific health research.