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This scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.

This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.

Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population. [ABSTRACT FROM AUTHOR]

Globally, self-employed people were among the hardest hit by the repercussions of the COVID-19 pandemic and faced hardships such as financial decline, restrictions, and business closures. A plethora of financial support measures were rolled out worldwide to support them, but there is a lack of research looking at the effect of the policy measures on self-employed people. To understand how different governmental financial support measures enhanced the resilience of the self-employed and improved their ability to manage the pandemic, we conducted a mixed-method study using policy analysis and semi-structured interviews. The documents described policies addressing governmental financial support in Sweden and Canada during the pandemic, and the interviews were conducted with Swedish and Canadian self-employed people to explore how they experienced the support measures in relation to their resilience. The key results were that self-employed people in both countries who were unable to telework were less resilient during the pandemic due to financial problems, restrictions, and lockdowns. The interviews revealed that many self-employed people in hard-hit industries were dissatisfied with the support measures and found them to be unfairly distributed. In addition, the self-employed people experiencing difficulties running their businesses reported reduced well-being, negatively affecting their business survival. [ABSTRACT FROM AUTHOR]

Purpose: Although there is a growing body of work on immigrants' information behavior, little is known about the pre-arrival information experiences of immigrants who consult formal information sources such as immigration agents. Drawn from a larger study on the information behavior of immigrants, this paper mainly reports the semi-structured interview findings on the pre-arrival information experiences of Bangladeshi immigrants who used formal information sources with discussion on how that affected their post-arrival settlement into Canada. Design/methodology/approach: The study used a mixed method approach with semi-structured interviews (n = 60) and surveys (n = 205) with participants who arrived in Canada between the years of 1971 and 2017. Data were collected from May 2017 to February 2018. Findings: Although the overall scope of the original study is much larger, this paper features findings on the pre-arrival information experiences derived mainly from an analysis of interview data. This study provides insights into the pre-arrival information experiences of Bangladeshi immigrants consulting formal information sources such as immigration firms, individual immigration consultants and more formal government agencies. The author introduces a new concept of "information crafting" by exploring the negative consequences of selective information sharing by immigration consultants/agents in newcomers' settlements in Canada, primarily positive information about life in Canada, sometimes with exaggeration and falsification. The interview participants shared story after the story of the settlement challenges they faced after arriving in Canada and how the expectations they built through the information received from immigration consultants and government agencies did not match after arrival. This study emphasizes the importance of providing comprehensive information about life in Canada to potential newcomers so that they can make informed decisions even before they apply. Originality/value: The findings of this study have theoretical and practical implications for policy and research. This study provides insights into the complicated culturally situated pre-arrival information experiences of Bangladeshi immigrants. Moreover, the study findings encourage researchers in various disciplines, including psychology, migration studies and geography, to delve more deeply into newcomers' information experiences using an informational lens to examine the information newcomers receive from diverse sources and their effects on their post-arrival settlement in a new country. The study challenges the general assumptions that formal information sources are always reputable, useful, and comprehensive, and it provides some future directions for research that seeks to understand the culturally situated information behavior of diverse immigrant groups. [ABSTRACT FROM AUTHOR]

Background: The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use., Methods: Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22., Results: Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001)., Conclusions: Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

During the COVID-19 pandemic, telework best practices decreased in importance compared to the need for social distancing. It is important that ergonomics assessments for home office workstations are equally as effective as assessment for traditional offices to maintain teleworker wellbeing. The purpose of this case study is to compare a remote, picture-based, home office assessment to a traditional, in-person, office assessment for employees of one Canadian University. Intraclass Correlation Coefficients (ICCs) and Bland-Altman Analyses (BAAs) revealed that the two methods provide repeatable results, with good agreement. Feedback from the participants suggested that picture-based assessments were as effective as in-person assessments; but that picture-based assessments could be improved with video conferencing to discuss findings and ask follow-up questions. Participants found value in remote assessments and, while they preferred in-person assessments, picture-based assessments are suitable when needed as they allow for many assessments to be completed without violating social distancing restrictions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: In 2018, Canada's Cannabis Act legalized adult recreational cannabis use and limited cannabis product advertising to adults. Cannabis product advertising to youth remains illegal. The extent to which adult-targeted, or illicit youth-targeted cannabis advertisements is reaching and impacting Canadian youth is unknown. We used Ecological Momentary Assessment (EMA) to describe how often and how much exposures to cannabis advertising influence Canadian youths' real-world, real-time intentions to use cannabis., Methods: 120 Ontario, Canada youths ages 14-18, took photos of cannabis advertising that they encountered in their natural environments over a period of nine consecutive days. Following each exposure and twice daily device-issued random prompts, they also rated their intentions to use cannabis., Results: Many participating youth (n = 85; 70.83 %) reported at least one cannabis advertising exposure during the study (range 1-30, M = 4.02). Exposures occurred through a range of advertising channels (e.g., internet ads, billboards). Multilevel modeling showed that youth advertising exposure increased cannabis use intentions in vivo (β = 0.06,SE = 0.03;t = 1.98;p =.04;n = 1,348)., Conclusion: Data from this study shows that cannabis advertisements are regularly reaching Canadian youth and increasing their intentions to use cannabis. This suggests that current Canadian prohibitions on cannabis advertising to youth are ineffective and/or ineffectively enforced, and that the Canadian government needs additional or enhanced prohibitions on cannabis promotion to protect youth from harms associated with increased advertisement exposure, such as increased cannabis use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This paper investigates how positive and negative work-personal life interface constructs are differentially associated with intentions to stay in or leave the profession. The findings help map work-personal life interface constructs on the typology of determinants of intention to stay and intention to leave (disengagers, retainers, criticals, and neutrals). The ordered logistic regression (ologit) modelling of cross-sectional data from a representative sample ( n = 601) of midwives in Canada shows that work interference with personal life is a disengager, which has a stronger association with intention to leave than with intention to stay in the profession. Among the work-personal life interface constructs, work enhancement of personal life seems to be the most critical determinant, showing the most substantive association with both intention to stay and intention to leave. This finding suggests that interventions to increase midwives' intention to stay and decrease their intention to leave should focus on amplifying the enhancing effects of working on midwives' personal lives. Interventions that aim to reduce work interference with personal life might be more effective in decreasing intention to leave the profession than increasing intention to stay., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The high output cardiac state (HOCS) [cardiac index (CI) >4 L/min/m2 ], primarily driven by abnormally low systemic vascular resistance (SVR), is a relatively under-recognized condition. Although, majority of these patients meet criteria for heart failure (HF), their treatment should be aimed at the primary pathology, as the majority of guideline directed HF therapies can reduce SVR further., Objectives: To characterize patients with HOCS and provide valuable insight into the condition., Methods: Patients investigated by right heart catheterization (RHC) at the St. Boniface Hospital, Winnipeg, Canada between January 2009 and November 2021 were reviewed. Two groups of patients were included: 1) HOCS [CI >4 L/min/m 2 ], and 2) pre-HOCS [CI between 3.8-4.0 L/min/m 2 ]. Their medical records were reviewed to identify plausible etiologies, relevant investigations, and outcomes., Results: 177/2950 (6 %) patients met criteria for inclusion: 144/177 (81 %) with HOCS [mean age 51 years (range 19 - 82); 67/144 (47 %) female] and 33/177 (19 %) with pre-HOCS [mean age 55 years (range 30 - 83); 6/33 (18 %) female]. The most common plausible etiologies for the HOCS included anemia (36 %), obesity (34 %), cirrhosis (17 %), and lung disease (32 %). Trans-thoracic echocardiography and magnetic resonance imaging findings were non-specific and predominantly described preserved left ventricular ejection fraction, and pulmonary hypertension. The population experienced high rates of hospitalization, and significantly high mortality [36/144 (25 %) of HOCS at a median follow-up of 31.5 months, and 13/33 (39 %) of pre-HOCS at a median follow-up of 17 months]., Conclusions: HOCS is not an uncommon condition and is associated with high mortality. Current HF guideline should incorporate such evaluation into the diagnostic criteria., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: None. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The incoming Canadian cohort of medical students is comprised mainly of individuals from Generation Z (Gen Z; born between 1997 and 2012), with greater than 50% of applicants identifying as female. A gap remains in our understanding of Gen Z women learners in their challenges in navigating medical education, their expectations for their medical careers and the influences that have impacted their worldview. This study explored the needs, values, and experiences of Gen Z women medical students and the impact of these factors on mentorship expectations among this population that will soon be entering the workforce., Methods: Upon receiving ethics approval from the University of Toronto Research Ethics Board, semi-structured interviews were conducted (February-May 2021) with 15 Gen Z women students from 14 English-speaking Canadian medical schools who had given written consent to participate. An iterative constant comparative team approach was utilised in which the interview guide and sampling were adjusted as the data evolved. Transcripts were line by line coded into categories, then grouped into themes using descriptive analysis., Results: These socially aware learners described how society had afforded them greater opportunities for expression, which gave them a sense of feeling advantaged over older generations. However, participants paradoxically expressed feelings of powerlessness and commented on tensions they experienced when interacting with older generation physician mentors, especially during conversations on social justice issues. They also highlighted instances of biased mentorship specific to their gender. Participants emphasised a desire for inclusive mentorship that considered the mentee's identity and intersectionality., Conclusions: The growing number of women learners in Canadian medical schools necessitates a re-evaluation of mentorship delivery. Mentors must adapt by integrating Gen Z ideals to overcome mentorship challenges., (© 2023 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

The performance of constant false alarm rate (CFAR) detectors is often severely degraded in clutter edge and under multiple target interference. CFAR detection in the above environments often uses generalised likelihood ratio method or mean ratio method to find out the clutter edge demarcation line and suppress the sharp increase of false alarm rate, or remove the interference and modify the threshold factor to suppress the interference and improve the detection performance, but this sacrifices the detection gain from the number of clutter samples. In this paper, the feature information is fused to construct feature vectors, and the edge location is judged by the modulus of the cross product of the feature vector pair (MCPFVP), this edge demarcation line detection method fusing with features can be implemented without the need of clutter statistical distribution information. In addition, this paper reconstructs the sea clutter masked by multiple target interference by fusing the sea clutter amplitude correlation information, and these reconstructed sea clutter samples are used for power estimation together with the unmasked sea clutter without changing the threshold factor. This method can not only suppress the target masking effect of multiple target interference as the censoring type CFAR detector, but also maintain the detection gain from the number of clutter samples, which is not possible with the traditional censoring type CFAR detector. In addition, the relative weighted ratio summation (RWRS) is proposed to detect the multiple target interference, which takes into account the asymmetry of the shape of the statistical distribution. Both simulated and real sea clutter data are used to validate the above methods. The measured data are obtained from radar data collected at Yantai Yangma Island, China, Darmouth, Canada and Grimsby, Canada. (The latter two datasets are collected by the IPIX radar - Ice Multiparameter Imaging X-Band Radar). [ABSTRACT FROM AUTHOR]

Electronic waste recycling companies have proliferated in many countries due to valuable materials present in end-of-life electronic and electrical equipment. This article examined the business characteristics and management performance of Electronic Products Recycling Association (EPRA), a Canadian nationwide electronic product stewardship organization. The organization's annual performance reports, from 2012 to 2020, for nine Canadian provinces in which it currently operates were aggregated and analyzed. Temporal analysis using regression and Mann-Kendall tests were employed, and five characteristics of EPRA's business were analyzed, including e-waste products collected, number of drop-off locations, efforts to build public awareness, operating expenses, and growth of e-waste stewardship. Results show a decline in the amount of e-waste collected across the provinces, except in New Brunswick, which started its program in 2017. The Mann-Kendall test revealed declining temporal trends in most provinces. Although the collection/drop off sites and stewardship organizations increased astronomically over the study period in Canada, the amounts of e-waste collected decreased. We found that public awareness generally did not increase the amount of e-waste collected, and these campaigns only appeared to be effective in jurisdictions with good accessibility of e-waste recycling. Processing cost accounted for the majority of the e-waste management budget in Canada, and different factors affected the financial success of the stewards differently., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The Canadian wildfires in June 2023 significantly impacted the northeastern United States, particularly in terms of worsened air pollution and environmental justice concerns. While advancements have been made in low-cost sensor deployments and satellite observations of atmospheric composition, integrating dynamic human mobility with wildfire PM 2.5 exposure to fully understand the environmental justice implications remains underinvestigated. This study aims to enhance the accuracy of estimating ground-level fine particulate matter (PM 2.5 ) concentrations by fusing chemical transport model outputs with empirical observations, estimating exposures using human mobility data, and evaluating the impact of environmental justice. Employing a novel data fusion technique, the study combines the Weather Research and Forecasting model with Chemistry (WRF-Chem) outputs and surface PM 2.5 measurements, providing a more accurate estimation of PM 2.5 distribution. The study addresses the gap in traditional exposure assessments by incorporating human mobility data and further investigates the spatial correlation of PM 2.5 levels with various environmental and demographic factors from the US Environmental Protection Agency (EPA) Environmental Justice Screening and Mapping Tool (EJScreen). Results reveal that despite reduced mobility during high PM 2.5 levels from wildfire smoke, exposure for both residents and individuals on the move remains high. Regions already burdened with high environmental pollution levels face amplified PM 2.5 effects from wildfire smoke. Furthermore, we observed mixed correlations between PM 2.5 concentrations and various demographic and socioeconomic factors, indicating complex exposure patterns across communities. Urban areas, in particular, experience persistent high exposure, while significant correlations in rural areas with EJScreen factors highlight the unique vulnerabilities of these populations to smoke exposure. These results advocate for a comprehensive approach to environmental health that leverages advanced models, integrates human mobility data, and addresses socio-demographic disparities, contributing to the development of equitable strategies against the growing threat of wildfires., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Reinforced concrete is a commonly used material for constructing basements in low-rise buildings or residential houses in Canada, and as the use of cross-laminated timber (CLT) advances, the door to think of an alternative basement material to offset greenhouse gas emissions associated with reinforced concrete is open. However, the evaluation of CLT durability in below-grade environments, specifically concerning moisture and mould development, remains an unexplored field in research. Hence, this paper aims to analyze CLT's moisture response and mould growth risk in below-grade environments using field and laboratory experiments. A laboratory experiment was carried out to test a waterproofing membrane solution selected to compose the wall assembly in the field experiment. A large-scale experimental CLT basement was built at a cohesive soil site in Edmonton, Canada. The field experiment involved monitoring the relative humidity, temperature, and soil volumetric water content of the CLT panels, which measure 3 m by 6 m in plan and 2 m deep. Data was collected for an extended period from June 2022 to July 2023. The VVT model, developed by Hukka and Viitanen (1999) and updated by Viitanen et al., 2011 to estimate the mould growth level, was used to predict the risk of mould growth. The laboratory experiment showed that the waterproofing membrane is suitable for protection against moisture in a still-water setup. Field experiment results suggested that the primary moisture source was below the basement floor when the floor was finished inadequately. The moisture content of CLT walls was significantly increased by floor flooding and decreased by heating the basement interior. The acceptable mould index of three was surpassed during periods of abundant water below the basement floor due to flood events, showing that the CLT panels were at risk of mould growth development. • CLT use inbasements is in research stage. This paper contains insights for developing future research on this subject. • CLT in basement construction requires robust envelope with waterproofing membranes that perform well below grade. • Elevated moisture levels could pose structural and biological risks to the CLT basement and its occupants. • CLT basement walls take time to dry, and during this period, the walls may be exposed to risky levels of mould growth. [ABSTRACT FROM AUTHOR]

This paper investigates the relationships among the important process parameters that impact Post-combustion Carbon Capture (PCC) carbon dioxide (C O 2) separation. A better understanding of the complex relationships among those parameters can support optimization and performance enhancement of the separation process. Being able to precisely predict the process parameters will enable the operator to determine the current state of the process, forecast any potential changes or events, and adjust process parameters to enhance the plant's performance. With the objective of studying the process parameters' correlations in the amine-based PCC process, we modeled the multi-year historical production data of the Clean Energy Technologies Research Institute (CETRi) (formerly known as the International Test Center for PCC or ITC) in Regina, Saskatchewan, Canada, using a Decision Forest approach. The model validation process revealed that the Decision Forest model produced higher predictive accuracy than previous efforts. The Decision Forest models we developed also represent knowledge about the importance of parameters involved in the capture process, and such knowledge is useful for further optimization of the capture process in the future. • Modeling the parameters of the Carbon Capture process with machine learning (ML). • The ML models used Decision Forest with Gradient Boosting and Oblique Split. • The ML models achieved superior predictive accuracy compared to past efforts. • The ML models support interpretability by visualizing weights and prediction paths. [ABSTRACT FROM AUTHOR]

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

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

The monitoring of forest ecosystems is significantly affected by the lack of consistent historical data of low-severity (forest partially disturbed) or gradual disturbance (e.g. eastern spruce budworm epidemic). The goal of this paper is to explore the use of a subset of Landsat time series and deep learning models to identify both the type and the year of disturbances, including low-severity and gradual disturbances, in the boreal forest of eastern Canada at the pixel level. Remote sensing data such as the spectral information from Landsat time series are the best available option for large scale observations of disturbances that go back decades. Traditional modeling approaches, like LandTrendr, require substantial handcrafted pre-processing to remove noise and to extract temporal features from the image sequences before using them as input to a classical machine-learning model. Deep-learning models can autonomously discern which features are relevant within the coarse temporal and spectral information from the Landsat annual dense time series. We evaluated the performance of TempCNN and Transformer model in detecting and classifying the type and the year of the forest disturbance using Landsat time series subsequences. Our findings resulted in the generation of four disturbance maps outlining the forest history from 1986 to 2021 within the eastern Canadian boreal forest. Our experimental outcomes demonstrate several significant benefits of employing deep learning models. Firstly, using noisy Landsat time series they achieve comparable accuracy for classifying fire and total harvesting than existing publicly available disturbance maps. Secondly, the use of shorter time series subsequence with deep learning models enables to map adequately different overlapping disturbances occurring in the complete time series. Finally, they increase the number of distinguishable disturbance classes by adding partial harvesting, gradual disturbances, and forest recovery from older events, making them useful approaches for obtaining the first remote sensing-based map for areas affected by the eastern spruce budworm. • TempCNN, Transformer tested on Landsat time series for disturbance classification. • The type and the year of disturbance events were classified with good accuracy. • Deep learning effective for identifying partial and progressive disturbances. • Landsat subsequences extract overlapping disturbances. [ABSTRACT FROM AUTHOR]

Persistent organic pollutants (POPs) are organic chemical substances that threaten human health and the planet's ecosystems due to their toxicity and their ability to remain intact for a long time, wide distribution throughout the environment, and accumulation and magnification in living organisms through the food chain. Discarded products from landfills and dumpsites are potential sources of POPs due to their persistence for several decades and constant release to surrounding environment. POPs in aquatic systems signal input predominantly from landfills, wastewater treatment plants, sewage, and urban runoff, suggesting a research gap to guide policies to address these unabated releases. This scoping review aims to rapidly identify the key concepts underpinning the containment, translation, and migration of POPs in Canadian and US landfill leachate. The review targeted multidisciplinary perspectives on the topic and spanned forensic biology, environmental sciences, chemistry, and geology. Contaminated municipal solid waste (MSW) landfill characteristics, as reported by government agencies in Canada and the US, were synthesized and harmonized to illustrate the geographical scope of MSW landfills releasing POPs into the surrounding environment. The knowledge and data gaps summarized in this study highlight the need to address the inadvertent release of POPs from Canadian and US landfills, particularly in consideration of dated and degrading landfill infrastructure, the proximity of marginalized people, and the implications of climate change on the countries' more vulnerable landscapes. This review is applicable to the development of future studies that aim to guide environmental protective policies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Dioxins, furans, and dioxin-like polychlorinated biphenyls (PCBs) are a group of persistent and toxic chemicals that are known to have human health effects at low levels. These chemicals have been produced for commercial use (PCBs) or unintentionally as by-products of industry or natural processes (PCBs, dioxins, and furans). Additionally, dioxin-like PCBs were formerly used in electrical applications before being banned internationally (2004). These chemicals are widely dispersed in the environment as they can contaminate air and travel hundreds to thousands of kilometers before depositing on land or water, thereafter, potentially entering food chains. Community concerns surrounding the safety of traditional foods prompted a human biomonitoring project in Old Crow, Yukon Territory (YT), Canada (2019). Through collaborative community engagement, dioxins and like compounds were identified as a priority for exposure assessment from biobanked samples. In 2022, biobanked plasma samples (n = 54) collected in Old Crow were used to measure exposures to seven dioxins, ten furans, and four dioxin-like PCBs. 1,2,3,6,7,8-HxCDD, 1,2,3,7,8,9-HxCDD, 1,2,3,4,6,7,8-HpCDD, OCDD, 2,3,4,7,8-PeCDF, 1,2,3,6,7,8-HxCDF, PCB 126, and PCB 169 were detected in at least 50 % of samples. Among these analytes, the only congener at elevated levels was PCB 169, which was approximately ∼2-fold higher than the general population of Canada. No significant sex-based or body mass index (BMI) differences in biomarker concentrations were observed. Generally, the concentrations of the detected congeners increased with age, except for 1,2,3,4,6,7,8-HpCDD. For the first time, this research measures dioxin and like-compound exposures in Old Crow, advancing the information available on chemical exposures in the Arctic. Further research could be directed towards the investigation of PCB 169 exposure sources and temporal monitoring of exposures and determinants., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

To evaluate effects of tertiary treated wastewater treatment plant effluent (MWWE) on transcriptomic responses in longnose dace (Rhinichthys cataractae; LND) we conducted a semi-controlled study in experimental raceways (Advancing Canadian Water Assets facility) imbedded in the Pine Creek treatment plant (Calgary, AB). LND collected from a reference site in the Bow River (REF) were caged in raceways containing either 5 % Pine Creek effluent (PC) or Bow River water (BR; control) over 28 d. Liver transcriptomes were analyzed in males and females sampled on days 7, 14 and 28 from BR and PC, and compared to REF fish on day 0. Concurrent with the caging, selected environmental substances of concern were analyzed in the BR and PC. Significantly different unigenes (SDUs) in females (vs males) within both BR and PC raceways increased over time and compared to REF fish. Moreover, SDUs in females and males within the same treatment (i.e., BR, PC) showed a temporal increase as well as compared to REF fish. Time was the dominant factor affecting SDUs, whereas sex and treatment had less of an impact on the transcriptome profiling. Gene Set Enrichment Analysis of BR vs PC over time revealed effects on genes involved in growth, metabolism of carbohydrates and lipids, and immune system on day 7; however, by day 28, 80-100 % of the transcripts localized to enriched biomarkers were associated with tissue immune responses in both sexes. Exposure to 5 % effluent had significant effects on female liver somatic index but no effects were observed on other phenotypic health indices in either sex. BR was used as the source of reference water, but analyses showed trace amounts of ESOCs. Analyses did not point towards definitive response patterns that could be used in field-based ecotoxicogenomic studies on the impacts of well-treated MWWE but suggested compromised adaptive immune responses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Reactive skin decontamination lotion (RSDL) is a Health Canada approved product used by the Canadian Armed Forces for removal and inactivation of toxic chemicals on skin. Although it is considered very safe when used as directed, questions have been raised regarding whether topical RSDL in the medical setting will react exothermically with antiseptic compounds on the casualty's epidermis that could result in thermal burns. Benchtop experiments were conducted to investigate reactivity of RSDL with various antiseptic compounds or hemostatic agents. Temperature changes were closely monitored in three different volume ratios, 1:10, 1:1, and 10:1 over a time course of 16 minutes. Chlorine based bleaches versus RSDL were included as a positive control and were the only combination that exhibited a significant exothermic reaction capable of causing minor thermal burns. RSDL was also evaluated with antiseptic solution applied to swine epidermal tissue without observation of visual irritation; then in lacerated skeletal muscle tissue which resulted in no measured temperature change. The conclusion of this study is that antiseptics and hemostatic agents can be used as required on a patient decontaminated with RSDL as no exothermic reaction will occur., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

This paper presents a comprehensive analysis of e-waste collection and management trends across six Canadian provinces, focusing on e-waste collection rates, provincial stewardship model attributes, program strategies and budget allocations from 2013 to 2020. Temporal and regression analyses were conducted using data from Electronic Product Recycling Association reports. A group characterization based on geographical proximity is proposed, aiming to explore the potential outcomes of fostering collaboration among neighboring provinces. The analysis emphasizes the significant impact of stewardship model attributes on e-waste collection rates, with Quebec emerging as a standout case, showcasing a remarkable 61.5% surge in collection rates. Findings from group analysis reveal a positive correlation between per capita e-waste collection rate and the growth of businesses and collection sites in Western Canada (Group A - British Columbia, Saskatchewan, and Manitoba). This highlights the potential benefits of a coordinated waste management approach, emphasizing the importance of shared resources and collaborative policies. Saskatchewan and Manitoba allocated only 6.6% and 7.0% of their respective budgets to e-waste transfer and storage. British Columbia's observed steady decrease of e-waste collection rate. In Group A, stewards handled 2.18-13.95 tonnes of e-waste during the study period. The cost per tonne of e-waste tended to be lower when more e-waste is managed per steward, suggesting the potential benefits of an integrated e-waste collection and management system., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A sensitive modified QuEChERS extraction method was developed to assess the levels of free and conjugated bisphenols (BPs) in human milk collected between 2018 and 2019 from two regions of South Africa (the Limpopo Province Vhembe district, n = 194; Pretoria, n = 193) and Canada (Montreal, n = 207). Total BPA (free and conjugated) and BPS were the predominant bisphenols detected in samples from Vhembe and Pretoria, whereas total BPS was the predominant bisphenol detected in Montreal samples. The levels of total BPA in samples from Vhembe and Pretoria ranged between < MDL-18.61 and

Background: As part of the response to Canada's worsening overdose crisis driven by a toxic, adulterated drug supply, there has been increased attention to and expansion of drug treatment, options, including injectable opioid agonist treatment (iOAT). iOAT typically involves the, witnessed daily injection of opioids under healthcare provider supervision. There is a robust, evidence base on iOAT; however, there has been less focus on how people engage with this; treatment outside of clinical trials. This paper examines how people engage with iOAT programs, in expanded treatment settings in Canada, focusing on how the broader socio-structural context, shapes patient subjectivities in treatment., Methods: This study draws on critical ethnographic and community-based research approaches, conducted with people accessing four iOAT programs in Vancouver's Downtown Eastside; neighbourhood from May 2018 to November 2019. Data included in-depth baseline and followup, interviews and approximately 50 h of observation fieldwork conducted in one iOAT, program and with a subsample of participants in the surrounding neighbourhood. Analysis, leveraged the concepts of biological citizenship and structural vulnerability., Results: This analysis characterized three narrative frames-regular long-term engagers, pain, patients, and sporadic and short-term engagers-through in-depth case presentations of participants with distinct types of engagement with iOAT programs. Participants within these, narrative frames described a dominant form of iOAT citizenship, an autonomous patient who, regularly engages in treatment and avoids pleasure. However, structural vulnerabilities, including, homelessness and housing instability, entrenched poverty, criminal-legal system engagement, and unmanaged pain, shaped the ability of participants to make claims to this normative model of citizenship., Conclusion: This study examined how structural vulnerabilities impact people's construction and ability to make iOAT citizenship claims. Findings point to the need for changes within and outside of iOAT programs, such as lower threshold treatment models, improved social services (e.g., secure housing), and pain management support., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study examined consumer preferences for, willingness to pay for, and the most preferred mode of delivery for immune enhanced dairy products across Canada. Two sets of choice experiments were designed to evaluate preferences for functional foods and nutraceuticals as the modes of delivery for immune enhanced dairy products. Data (N = 1001) was collected through an online stated preference survey and analyzed using conditional logit model. Results revealed that there is a general consumer interest in immune enhanced dairy products, and consumers place a premium on them. Also, the presence of children below the age of fifteen in a household was a major factor that increased consumer receptivity towards the products. Further results revealed that individuals who usually consume functional foods are less likely to be interested in nutraceuticals, and vice versa, implying that the preferred mode of delivery depended on consumer preferences for either functional foods or nutraceuticals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023. Published by Elsevier Ltd.)

Risk sharing agreements (RSAs) and managed access agreements have emerged as tools to overcome evidentiary uncertainty and contain costs of pharmaceuticals; however, Canada has relatively little experience with these health policy instruments. This article describes one of the few examples of national RSAs. Enzyme replacement therapies (ERT) were introduced in Canada to treat Fabry disease in the early 2000s through an RSA. Based on qualitative interviews with key participating actors, this article explains how this RSA ensured continuity of treatment for patients already on ERT, and collected robust real-world evidence to secure treatment for future Fabry patients. We show the importance of partnerships, collaborations, and active patient communities in establishing RSAs, as well as the critical role of robust registries for the collection, storage, and use of that real-world data. In doing so, this paper points to reasons that explain the relative dearth of RSAs in Canada, which can be resource (both human and finance) intensive and are difficult to broker in a federalist health system. Through these findings, policy lessons are developed concerning the need for technological and governance platforms on how RSA in Canada can be more effectively supported going forward in a broader move towards "social pharmaceutical innovation"., Competing Interests: Declaration of competing interest Conor M.W. Douglas has received honoraria from the Health Technology Assessment International Policy Forum to speak at their annual event., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally., Design: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022., Setting: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya., Participants: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218)., Measurements: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics., Findings: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy., Key Conclusions and Implications for Practice: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Abstract: The Human Monitoring Laboratory, Health Canada (HML), has used a 3D printer to re-engineer its Lawrence Livermore National Laboratory (LLNL) foam lung sets (manufactured by Radiology Support Devices, Inc., Long Beach, CA). The foam sets are currently the HML standard for calibrating and performance testing lung-counting systems in Canada. This paper describes the process of creating and validating new 3D-printed lung sets modeled from one of the HML's existing RSD foam sets. The existing sets were custom made, making them costly and difficult to obtain or replace. Also, after many years of use, the HML has found that they are prone to wear and tear. When used with planar inserts containing various isotopes, the blank sets can become contaminated and are difficult to clean. Using 3D printing, the HML has created new blank lung sets that are nearly identical copies of the originals and are inexpensive and easily manufactured. Measurements using natural uranium (Nat U), 241Am, and 152Eu planar lung inserts were performed to compare obtained efficiencies at a wide range of energies using the original RSD foam sets and the 3D-printed ones. Both the foam and the 3D-printed lung sets were counted using the LLNL chest phantom positioned in the same counting geometry in the lung counting system. Biases, all below 15%, were obtained between the foam and the 3D-printed sets for energies above 40 KeV. Based on these results, as well as cost benefits and ease of use, the HML has decided to replace its original RSD foam lung set with the 3D-printed version for its lung performance testing program., (Copyright © 2024 Health Physics Society.)

Background and Aims: Even though a ban of alcohol marketing has been declared a 'best buy' of alcohol control policy, comprehensive systematic reviews on its effectiveness to reduce consumption are lacking. The aim of this paper was to systematically review the evidence for effects of total and partial bans of alcohol marketing on alcohol consumption., Methods: This descriptive systematic review sought to include all empirical studies that explored how changes in the regulation of alcohol marketing impact on alcohol consumption. The search was conducted between October and December 2022 considering various scientific databases (Web of Science, PsycINFO, MEDLINE, Embase) as well as Google and Google Scholar. The titles and abstracts of a total of 2572 records were screened. Of the 26 studies included in the full text screening, 11 studies were finally included in this review. Changes in consumption in relation to marketing bans were determined based on significance testing in primary studies. Four risk of bias domains (confounding, selection bias, information bias and reporting bias) were assessed., Results: Seven studies examined changes in marketing restrictions in one location (New Zealand, Thailand, Canadian provinces, Spain, Norway). In the remaining studies, between 17 and 45 locations were studied (mostly high-income countries from Europe and North America). Of the 11 studies identified, six studies reported null findings. Studies reporting lower alcohol consumption following marketing restrictions were of moderate, serious and critical risk of bias. Two studies with low and moderate risk of bias found increasing alcohol consumption post marketing bans. Overall, there was insufficient evidence to conclude that alcohol marketing bans reduce alcohol consumption., Conclusions: The available empirical evidence does not support the claim of alcohol marketing bans constituting a best buy for reducing alcohol consumption., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

In pediatric settings, the concept of hope is frequently positioned as a fundamental aspect of care and at odds with the possibility and proximity of death. This arguably fosters silence about death and dying in childhood despite evidence indicating the benefits of open communication at the end of life. In this paper, we describe the unspeakable nature of death and dying in childhood, including its conceptual and clinical causes and dimensions, its persistence, and the associated challenges for children and youth facing critical illnesses, their families, and society. We explore how the tension between hope and death can be reframed and apply our analysis to the context of medical assistance in dying for mature minors in Canada. Considering the lack of related literature, this paper offers initial reflections to form a framework for the unspeakable nature of death and dying in childhood and to advance the crucial need for research., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Artificial Intelligence (AI) carries the potential for unprecedented disruption in radiology, with possible positive and negative consequences. The integration of AI in radiology holds the potential to revolutionize healthcare practices by advancing diagnosis, quantification, and management of multiple medical conditions. Nevertheless, the ever‑growing availability of AI tools in radiology highlights an increasing need to critically evaluate claims for its utility and to differentiate safe product offerings from potentially harmful, or fundamentally unhelpful ones. This multi‑society paper, presenting the views of Radiology Societies in the USA, Canada, Europe, Australia, and New Zealand, defines the potential practical problems and ethical issues surrounding the incorporation of AI into radiological practice. In addition to delineating the main points of concern that developers, regulators, and purchasers of AI tools should consider prior to their introduction into clinical practice, this statement also suggests methods to monitor their stability and safety in clinical use, and their suitability for possible autonomous function. This statement is intended to serve as a useful summary of the practical issues which should be considered by all parties involved in the development of radiology AI resources, and their implementation as clinical tools., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: APB: member of the Insights into Imaging Scientific Editorial Board. He has not taken part in the review or selection process of this article. BA: No competing interests. JC: No competing interests. EK: Shareholder Gleamer, Paris and Contextflow, Vienna. NK: Consultant for ES3 (aerospace company), consultant for Synapsica Healthcare, partner (equity owner) at Radiology Partners (RP), sole or partial owner of several radiology practices managed by RP. RP has a minority interest in AIDOC. RP has an indirect minority interest in Rad AI. Associate Fellow Stanford AIMI Center. Hold several volunteer positions at RSNA, ACR, SIIM and RADequal. JM: Consultant, Microsoft (Nuance), Research funding, royalties, GE, Research funding, Siemens, Spouse employment, shareholder Annexon Biosciences, Spouse employment Bristol Meyers Squibb. LOR: No competing interests. DPDS: member of the Insights into Imaging Scientific Editorial Board. He has not taken part in the review or selection process of this article. AT: No competing interests. CW: Chair, Commission on Informatics and Member, Board of Chancellors, American College of Radiology. Advisor: Notable Systems, and RadPair. JS: No competing interests.

This Special Section explores the interplay between Indigenous peoples, industry, and the state in five proposed and active mining projects in Canada and Sweden. The overall aim is to identify factors shaping the quality of Indigenous community-industry-state interactions in mining and mine development. An ambition underlying the research is to develop knowledge to help manage mining related land-use conflicts in Sweden by drawing on Canadian comparisons and experience. This paper synthesizes the comparative research that has been conducted across jurisdictions in three Canadian provinces and Sweden. It focuses on the interplay between the properties of the governance system, the quality of interaction and governance outcomes. We combine institutional and interactive governance theory and use the concept of governability to assess how and why specific outcomes, such as mutually beneficial interaction, collaboration, or opposition, occurred. The analysis suggests there are measures that can be taken by the Swedish Government to improve the governability of mining related issues, by developing alternative, and more effective, avenues to recognize, and protect, Sámi rights and culture, to broaden the scope and increase the legitimacy and transparency of the EIAs, to raise the quality of interaction and consultation, and to develop tools to actively stimulate and support collaboration and partnerships on equal terms. Generally, we argue that Indigenous community responses to mining must be understood within a larger framework of Indigenous self-determination, in particular the communities' own assessments of their opportunities to achieve their long-term objectives using alternative governing modes and types of interactions., (© 2024. The Author(s).)

Background: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program., Methods: We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data., Results: The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation., Conclusions: We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Children's educational experiences worldwide have been significantly impacted as a result of global school closures during the COVID-19 pandemic of Spring 2020. A growing number of studies aim to analyse impacts of these changes on social well-being, with limited studies placing an emphasis on the experiences of students with special educational needs (SENs). This article focusses on parent perspectives regarding impacts of school closures on social well-being in Canadian children with SEN., Methods: This study uses a mixed-methods approach, drawing from both qualitative and quantitative survey data from Spring/Summer 2020. Participants (n = 263) were eligible for participation if they were a parent/guardian of a child or adolescent with an SEN. We first conducted a descriptive analysis of the key variables, namely, social well-being, grade level of the child, internet and device availability, and the presence of other school-aged children in the home (single child vs. multiple children). Next, we explored the relationship between these using a bivariate correlation. Finally, open-ended responses were analysed using an inductive approach to qualitative thematic analysis., Results: The majority of parents expressed concern for their child's social well-being during the Spring 2020 school closures, with increased concerns for younger children. According to parents, children experienced communication barriers to peer interaction and many experienced emotional difficulties as a result. Technology was described as critical for some in maintaining social connections. Parents raised concerns about the impact of limited peer interaction on broader social skill development, in the short and long term. A small number of participants noted feelings of relief and reduced anxiety among their children with SEN., Conclusions: Findings highlight parent views of the negative impact of the pandemic on social well-being and the critical role in-person schooling plays in supporting peer relationships for children with SEN., (© 2024 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Purpose: This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met., Method: Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper., Results: Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students., Conclusion: Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce.

Purpose: In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14-year period., Methods: Canadian optometrists were invited to participate in an anonymous 35-item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item., Results: Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3-4 years in 2007 (53%) to 6-12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3-4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4-6 years-56% 2007; 66% 2021)., Conclusion: Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated., (© 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Background: Cerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts., Methods: A national multi-centered retrospective review of all children undergoing PF resection in four midsized Canadian academic pediatric institutions was undertaken. Patient, tumor and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identification of PF surgery patients including those developing and those that did not (internal control)., Results: The study identified 258 patients across the 4 centers between 2010 and 2020 (mean age 6.73 years; 42.2% female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%) and ependymoma (17.1%). Intraoperative impression of adherence to the floor of the 4th ventricle was positive in 36.8%. Intraoperative abrupt changes in blood pressure and/or heart rate were identified in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, significant resolution, slight improvement, no improvement and deterioration in 56.0%, 8.0%, 20.0%, 14.0% and 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the floor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%) and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a multiple regression analysis identified only abrupt changes in HR (OR 5.97, CI (1.53, 23.1), p = 0.01) to be significantly associated with the development of post-operative CM., Conclusion: As a devastating surgical complication after posterior fossa tumor surgery with variable clinical course, identifying and understanding the operative cues and revising intraoperative plans that optimizes the child's neurooncological and clinical outcome are essential., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to 'normal'. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada's early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first wave of the COVID-19 pandemic. Within an expanded three-part conceptual framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce's long-term needs., (© 2024 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Tonian (ca. 1000-720 Ma) marine environments are hypothesised to have experienced major redox changes coinciding with the evolution and diversification of multicellular eukaryotes. In particular, the earliest Tonian stratigraphic record features the colonisation of benthic habitats by multicellular macroscopic algae, which would have been powerful ecosystem engineers that contributed to the oxygenation of the oceans and the reorganisation of biogeochemical cycles. However, the paleoredox context of this expansion of macroalgal habitats in Tonian nearshore marine environments remains uncertain due to limited well-preserved fossils and stratigraphy. As such, the interdependent relationship between early complex life and ocean redox state is unclear. An assemblage of macrofossils including the chlorophyte macroalga Archaeochaeta guncho was recently discovered in the lower Mackenzie Mountains Supergroup in Yukon (Canada), which archives marine sedimentation from ca. 950-775 Ma, permitting investigation into environmental evolution coincident with eukaryotic ecosystem evolution and expansion. Here we present multi-proxy geochemical data from the lower Mackenzie Mountains Supergroup to constrain the paleoredox environment within which these large benthic macroalgae thrived. Two transects show evidence for basin-wide anoxic (ferruginous) oceanic conditions (i.e., high Fe HR /Fe T , low Fe py /Fe HR ), with muted redox-sensitive trace metal enrichments and possible seasonal variability. However, the weathering of sulfide minerals in the studied samples may obscure geochemical signatures of euxinic conditions. These results suggest that macroalgae colonized shallow environments in an ocean that remained dominantly anoxic with limited evidence for oxygenation until ca. 850 Ma. Collectively, these geochemical results provide novel insights into the environmental conditions surrounding the evolution and expansion of benthic macroalgae and the eventual dominance of oxygenated oceanic conditions required for the later emergence of animals., (© 2024 The Authors. Geobiology published by John Wiley & Sons Ltd.)

This study integrates advanced machine learning techniques, namely Artificial Neural Networks, Long Short-Term Memory, and Gated Recurrent Unit models, to forecast monkeypox outbreaks in Canada, Spain, the USA, and Portugal. The research focuses on the effectiveness of these models in predicting the spread and severity of cases using data from June 3 to December 31, 2022, and evaluates them against test data from January 1 to February 7, 2023. The study highlights the potential of neural networks in epidemiology, especially concerning recent monkeypox outbreaks. It provides a comparative analysis of the models, emphasizing their capabilities in public health strategies. The research identifies optimal model configurations and underscores the efficiency of the Levenberg-Marquardt algorithm in training. The findings suggest that ANN models, particularly those with optimized Root Mean Squared Error, Mean Absolute Percentage Error, and the Coefficient of Determination values, are effective in infectious disease forecasting and can significantly enhance public health responses., Competing Interests: The author declares that there are no conflicts of interest regarding the publication of this paper., (Copyright: © 2024 Lulah Alnaji. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This qualitative study was informed by critical race feminism and sought to examine Canadian Black women's motivations for participating in the research study that explored their experiences with the police in the context of intimate partner violence (IPV), and the key factors that complicated their decisions. Semistructured interviews were conducted with 25 self-identified women over the age of 18. Findings indicated that Black women's experiences of anti-Black racism and various forms of systemic barriers influenced their decisions to disclose their experiences of IPV. Key themes included the invisibility of Black women's narratives, fostering political change, and the impact of racialized and gendered insider positionality. Given these findings, positioning Black women's narratives at the centre of IPV research creates opportunities for Black women to share their experiences of IPV, recognizes them as experts of their own experiences, identifies their differential experiences accessing services and supports and the barriers that impact their participation in research studies. The study provides strategies on how to increase Black women's participation and engagement in IPV research. [ABSTRACT FROM AUTHOR]

Purpose: Across Canada, speech-language pathologists (SLPs) and educational psychologists (EPs) work in schools to identify and diagnose childhood learning difficulties, including language disorders; however, both professional groups use different terms to identify and diagnose them. Using the term developmental language disorder (DLD), developed by the CATALISE consortium, would provide consistency across fields. To effectively implement the use of DLD, it is crucial to understand how EPs and SLPs currently identify childhood language disorders and to investigate the potential impact of a practice change in this area. Method: The study conducted 13 moderated focus groups and one one-on-one semi-structured interview across six Canadian provinces in English and French. Results: We found some social and structural barriers that impact SLPs’ and EPs’ current practice of identifying and diagnosing language disorders generally (e.g., the belief that children should not be labeled “too early,” institutions that prioritize certain professional diagnoses over others, board policies that do not allocate funds for language disorders, professionals’ reticence to convey difficult information such as a diagnosis to collaborators) and DLD specifically (e.g., different professional taxonomies, lack of familiarity with or uncertainty about the label, not recognized as a condition in schools that may or may not even identify language disorder as a category of exceptionality). Nevertheless, the focus groups also revealed the extent to which DLD could be useful in their current practice. Conclusion: Both EPs and SLPs acknowledged the importance of working together; therefore, DLD could inspire more collaborative practice between SLPs and EPs around language disorders. [ABSTRACT FROM AUTHOR]

Geothermal systems installed at intermediate depths (∼1–2 km) in sedimentary basins represent an attractive option to provide low-carbon heat in cold countries, even where the geothermal gradient is low, using either closed- or open loop systems combined with heat pumps. However, the installation of such systems is costly and risky due to the uncertainty associated with the geological, hydrogeological and thermal properties of the targeted unit(s). Additionally, the performance of different types of systems is seldom compared in the literature for a given geological context. This paper presents a numerical approach to readily assess the maximum energy that could be produced by different geothermal systems (a deep borehole heat exchanger (DBHE) and three types of doublets) and compare their performance for preselection purposes. Since deep formations are often poorly characterized, the sensitivity of these systems to the most impactful site properties is evaluated. For each scenario of site properties, the systems were simulated for different operation flow rates. The maximum usable flow rate is determined from simulation results. The flow rate maximizing net energy production is used for the DBHE, while the maximum flow rate ensuring safe injection pressure has been selected for the doublets. The heating power produced per length drilled and system COP are calculated for each simulation and interpolated for the maximum usable flow rate to fairly compare the systems' performance. An illustrative case using the Bécancour area (eastern Canada) highlights that, even if the site stratigraphy and properties have been relatively well characterized previously, uncertainty regarding key properties significantly affects simulation results and, consequently, the choice of the geothermal system to install. Our numerical approach is intended as a decision-making aid in order to properly plan the installation of these expensive systems. [Display omitted] • New method for pre-selecting 1–2 km geothermal systems and assess heating potential. • Compares the DBHE and geothermal doublet performances for various designs. • Includes a sensitivity analysis to permeability, thermal conductivity and heat flux. • Determines the maximum usable flow rate for each system and scenario. • An application demonstrates the need to consider the uncertainty of rock properties. [ABSTRACT FROM AUTHOR]

The pulp and paper industry use biomass residues, such as paper sludge and bark as fuel to provide energy for their plants. However, issues such as high-water content or low heating value limit the amount of energy that can be utilized. Processes to improve heat generation include biomass densification, which facilitates transportation and handling and can increase energy yield. However, the technical feasibility of briquetting is a function of the feedstock and preprocessing. This study introduces a novel approach to briquette production from biomass residues by utilizing wet biomass with water as a natural binder, contrasting with conventional methods that require forced drying and/or the addition of binders. The objective of this research was to investigate the impact of briquetting both unprocessed biomass and post-hydrothermal carbonization. The study focused on manufacturing briquettes derived from different sources, including bark (Balsam fir), paper sludge, and hydrochar of paper sludge. The feedstock was characterized for ash content and higher heating value. Biomass particle size (range), moisture content (range), process temperature (range), process pressure (range), and process residence time (range) were varied in briquetting experiments to determine conditions to produce high-quality briquettes with minimal energy input. Moisture content as high a 50 wt% in feedstock produced technically feasible briquettes, with appropriate physical-mechanical properties (durability, volumetric expansion and apparent density), and energetic potential (calorific value). The addition of heat (pressing temperature of 150 °C) during the pressing process resulted in briquettes with enhanced physical-mechanical, and energetic properties, surpassing those produced at room temperature. Further tests with additional steps in the production process are required to meet commercialization standards in Canada, but the treatments conducted in this study effectively improved the energy potential of biomass for internal industrial energy gains. • Wet briquettes (20 wt% and 50 wt%) production was technically feasible. • Briquettes with added heat (150 °C) exhibited superior properties. • All biomass briquettes exhibited improved energy potential. • Hydrochar briquettes showed superior energy content and durability. [ABSTRACT FROM AUTHOR]

Individual tree diameter at breast height (DBH) distribution is an important information for forest management planning. Forest managers obtain the DBH data either by field measurements or estimations using predictive models. However, probability distribution models are still lacking or need improvement. Therefore, we aimed to construct and fit diameter distribution models that reflect forest structure and composition change. We evaluated gamma, log-normal, and Weibull probability distribution functions (PDFs) for two commercially important tree species, black spruce (Picea mariana (Mill) B.S.P.) and jack pine (Pinus banksiana Lamb), grown in natural stands across Ontario, Canada. We modelled the parameters of the distributions as a function of stand-level variables for these species. We used DBH data from 735 permanent sample plots. Our results showed that all three evaluated PDFs reflected observed DBH distribution. We demonstrated that the moment-based recovered parameters could represent the maximum likelihood-estimated parameters precisely, and parameters of the PDFs can be modelled as a function of stand-level dynamic covariates. The models unbiasedly predicted the PDF parameters DBH means and DBH classes. The R2 of the model fit ranged between 0.35 and 0.98 for the predicted parameters and 0.90 and 0.97 for the predicted DBH. [ABSTRACT FROM AUTHOR]