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The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation. [ABSTRACT FROM AUTHOR]

The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 2 of this article will inform CAR members on the practical aspects of medical imaging de-identification, strengths and limitations of de-identification approaches, list of de-identification software and tools available, and perspectives on future directions. [ABSTRACT FROM AUTHOR]

The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 1 of this article will inform CAR members on principles of de-identification, pseudonymization, encryption, direct and indirect identifiers, k-anonymization, risks of reidentification, implementations, data set release models, and validation of AI algorithms, with a view to developing appropriate standards to safeguard patient information effectively. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system. [ABSTRACT FROM AUTHOR]

Abstract Artificial intelligence (AI) is rapidly moving from an experimental phase to an implementation phase in many fields, including medicine. The combination of improved availability of large datasets, increasing computing power, and advances in learning algorithms has created major performance breakthroughs in the development of AI applications. In the last 5 years, AI techniques known as deep learning have delivered rapidly improving performance in image recognition, caption generation, and speech recognition. Radiology, in particular, is a prime candidate for early adoption of these techniques. It is anticipated that the implementation of AI in radiology over the next decade will significantly improve the quality, value, and depth of radiology's contribution to patient care and population health, and will revolutionize radiologists' workflows. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI working group with the mandate to discuss and deliberate on practice, policy, and patient care issues related to the introduction and implementation of AI in imaging. This white paper provides recommendations for the CAR derived from deliberations between members of the AI working group. This white paper on AI in radiology will inform CAR members and policymakers on key terminology, educational needs of members, research and development, partnerships, potential clinical applications, implementation, structure and governance, role of radiologists, and potential impact of AI on radiology in Canada. [ABSTRACT FROM AUTHOR]

This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008. [ABSTRACT FROM AUTHOR]

Researchers have found that many post-secondary music students suffer from physical and mental health issues. However, researchers have mainly studied these problems at the individual level, with little investigation of how music students' work is shaped by the coordinating effects of policies, texts, and discourses at and beyond their local site. This paper describes a protocol for an international project that will explore the health of music students in the context of their daily work. Using an institutional ethnography approach, we will examine the social organization of music students' work at three universities: two in Canada and one in Australia. This will be the first set of studies that use institutional ethnography specifically for the purpose of understanding how the social organization of music students' work shapes their health. Data will be collected using several methods common to institutional ethnography: interviews, focus groups, observations, and collecting texts. Data analysis will begin during the data collection process and proceed in two fluid stages. The first stage will involve a detailed investigation of the pertinent work activities at each music school. The second will involve linking that work to specific social relations within and beyond the institution. After data analysis has been completed at all three sites, findings will be compared to one another to identify commonalities and differences in how students' work is organized. Findings of the entire project may inform policy-making and lead to positive change at the institutions studied, as well as others where similar social organization may occur. The novel approach described here will provide opportunities to expand current knowledge about music students' work and health beyond what has been learned through approaches that focus on students' individual behaviours and attributes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Objective: Previous research has evaluated the sources of post-secondary student stress, but has failed to explore whether stressors fluctuate over time. The purpose of this research was to use the Post-Secondary Student Stressors Index to examine whether stressors changed significantly and meaningfully over the course of an academic year. Due to the timing of data collection, results also provide context around students' experiences of stress during the COVID-19 pandemic. Method: Cross-sectional data was collected at 3 time points via online surveys over the course of the 2020–2021 academic year from >10,000 students. Participants attended 15 post-secondary institutions across Canada, representing 9 provinces and 1 territory. Validated instruments were used to assess levels of stress, distress and the severity of student-specific stressors. Kruskal–Wallis ranked tests and multiple pairwise comparison analyses were conducted to assess whether the mean severity of stressors changed over time. Standard effect sizes were calculated using Cohen's d. Results: Mean levels of stress and psychological distress were high at the start of the study and remained high across time points. A similarly high level of stress was observed on average for student-specific stressors. While significant differences in mean severity were observed over time for some stressors, standardized effect sizes were negligible, suggesting little meaningful change and consistent levels of chronic stress over the course of the academic year. Conclusions: This is the first paper to examine trends in student-specific stress using a nationwide sample of Canadian post-secondary students during the first year of the COVID-19 pandemic. Patterns observed in student-specific stressors reflected changes likely to be indicative of the pandemic, including the most severe stress associated with academics, finances and concerns for the future. Implications for future research are discussed, in particular, the importance of examining stressors related to COVID-19 and their impact on student mental health. [ABSTRACT FROM AUTHOR]

Photovoice is an emerging qualitative research method used to engage community members in research that highlights their lived experiences and initiate change. Photovoice offers potential benefits to research conducted by and with Indigenous communities through privileging Indigenous knowledge and perspectives. There is a lack of synthesized evidence about the usage, benefits, and challenges of conducting Photovoice research by and with Indigenous communities, which this systematic methods review aims to address. We specifically focus on Indigenous young people in Canada, Australia, Aotearoa New Zealand, and the United States. Five databases were searched systematically for articles including keywords for 'Indigenous' and 'Photovoice'. Empirical studies and methods papers reporting the use of Photovoice with majority cohorts of young Indigenous participants were included. Relevant data were extracted and Photovoice methods analysed using an integrative approach. Database searches yielded 1402 articles, with 109 reviewed in full and 41 included in the review. These articles represented 37 unique studies, with most from Canada (n = 17), and the United States (n = 14). Our analysis revealed great variability in how Photovoice has been applied across studies with Indigenous young people. However, some notable commonalities include recruitment of participants via community networks, and participant involvement in data collection and analysis. The potential benefits associated with using Photovoice with Indigenous young people included: fostering participant autonomy and authority; photography being familiar and fun; the visual medium being culturally appropriate for Indigenous peoples; and the method being effective for engaging the whole community. Challenges associated with Photovoice included: engagement difficulties between researchers and participants; issues with photography; and ethical complexities. These findings suggest that Photovoice is an appropriate and largely effective method to engage young Indigenous people in research. However, there are logistical and ethical issues associated with the method that require careful consideration. [ABSTRACT FROM AUTHOR]

Photovoice is an emerging qualitative research method used to engage community members in research that highlights their lived experiences and initiate change. Photovoice offers potential benefits to research conducted by and with Indigenous communities through privileging Indigenous knowledge and perspectives. There is a lack of synthesized evidence about the usage, benefits, and challenges of conducting Photovoice research by and with Indigenous communities, which this systematic methods review aims to address. We specifically focus on Indigenous young people in Canada, Australia, Aotearoa New Zealand, and the United States. Five databases were searched systematically for articles including keywords for 'Indigenous' and 'Photovoice'. Empirical studies and methods papers reporting the use of Photovoice with majority cohorts of young Indigenous participants were included. Relevant data were extracted and Photovoice methods analysed using an integrative approach. Database searches yielded 1402 articles, with 109 reviewed in full and 41 included in the review. These articles represented 37 unique studies, with most from Canada (n = 17), and the United States (n = 14). Our analysis revealed great variability in how Photovoice has been applied across studies with Indigenous young people. However, some notable commonalities include recruitment of participants via community networks, and participant involvement in data collection and analysis. The potential benefits associated with using Photovoice with Indigenous young people included: fostering participant autonomy and authority; photography being familiar and fun; the visual medium being culturally appropriate for Indigenous peoples; and the method being effective for engaging the whole community. Challenges associated with Photovoice included: engagement difficulties between researchers and participants; issues with photography; and ethical complexities. These findings suggest that Photovoice is an appropriate and largely effective method to engage young Indigenous people in research. However, there are logistical and ethical issues associated with the method that require careful consideration. [ABSTRACT FROM AUTHOR]

Background: Play is an important part of the childhood. The learning potential of playing and creating non-digital games, like tabletop games, however, has not been fully explored. Aim: The study discussed in this paper identified a range of activities through which learners redesigned a mathematics-oriented tabletop game to develop their ideas and competencies in an integrated STEM (science, technology, engineering, and mathematics) class. Method: Third and fourth graders worked as teams to make changes on Triominos over a period of six weeks. Considering what could be changed from the original game, each group provided a different design for Triominos to accommodate the changes introduced. We gathered data through weekly observations of two classes (about 45 learners, ranging from age eight to ten) in a west-Canada school. In this paper, we present the works of three groups of three teammates. Results: We found that any change made by learners not only influenced mechanics, dynamics, and aesthetics of the game but also helped engage learners, encourage unconventional ideas, promote learning, and solve problems. Based on our findings, we suggest redesigning games facilitated learners deepen their understanding of mathematical concepts as part of a designed game system in STEM classes. [ABSTRACT FROM AUTHOR]

Purpose: To identify trends in female authorship in the Canadian Association of Radiologists Journal (CARJ) from 2010 to 2019. Methods: We retrieved papers published in the CARJ over a 10-year period, and retrospectively reviewed 602 articles. All articles except editorials and advertisements were included. We categorized the names of the first and last position authors as female or male and excluded articles that had at least one author of which gender was not known. We compared the trends in the first and last position authors of the articles from 2010 to 2019. For statistical analysis, logistic regression was performed with reported odds ratios (ORs), and a P value of <.05 was defined as statistically significant. Results: Five hundred thirteen articles met inclusion criteria. Among them, 23 articles with a single author were classified as having only a first author. 39.8% (204/513) of first authors were female and 26.9% (132/490) of last authors were female. There has been an overall temporal increase in the odds of both the first and last author being female in CARJ publications (OR: 1.11, P =.034). Similarly, the odds a CARJ publication's first author being female increased over time (OR: 1.07, P =.033). Female last author did not predict female first author (OR: 1.48, P =.056). There was no association identified between female last author and year of publication (OR: 1.04, P =.225). Conclusion: There has been an overall increase in engagement of female authorship in CARJ. [ABSTRACT FROM AUTHOR]

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

The Canadian youth services system is fragmented with less than one third of youth accessing the mental health services they need. Experts have called for systems transformation that will increase the integration of youth services and take advantage of complementary services, such as peer supports. Further, researchers have suggested that there is a need to identify the unique contribution and underlying mechanisms that support client recovery within youth peer support interventions. This paper describes the steps taken to implement a hybrid realist and participatory evaluation examining peer support services for youth (14–26 years old) with mental health, physical health and/or substance use challenges. We describe the procedures followed to engage peers in the design of the study and how this was integrated with a realist approach. We also provide a detailed description of the related adaptations to the methods applied within the second stage of the study. Lessons learned through the integration of the two methods are provided as well as potential implications for the findings and related research. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus disease (COVID-19) pandemic has swept the globe, with a domino effect on medical education and training. In this study, we surveyed Canadian radiology residents to understand the impact of the pandemic on their residency training, strategies utilized by the residency programs in mitigating those impacts, and factors important to residents in the selection of educational resources on COVID-19. Methods: A 10-item questionnaire was distributed to 460 resident members of the Canadian Association of Radiologists. The survey was open for 2 weeks, with a reminder sent at half-way mark. Results: We received 96 responses (response rate: 20.9%). The 4 highest affected domains of training were daytime case volumes (92.4%), daytime schedules (87.4%), internal and external assessments (86.5%), and vacation/travel (83.3%). Virtual teaching rounds (91.7%), change in schedules to allow staying home (78.1%), and virtual/phone readouts (72.9%) were the most utilized strategies by the Canadian radiology residency programs. Overall stress of exposure to the disease was moderate to low (86.5%). A minority of the residents were redeployed (6.2%), although most (68.8%) were on standby for redeployment. Residents preferred published society guidelines (92.3%), review papers (79.3%), video lectures (79.3%), and web tools (76.9%) for learning about COVID-19 imaging manifestations. Conclusion: The COVID-19 pandemic has had a significant impact on various domains of the Canadian radiology residency programs, which has been mitigated by several strategies employed by the training programs. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic (COVID-19) has altered the undergraduate learning experience for many students across Canada. Medical education is no exception; clinical programs, in-person lectures, and mandatory hands-on activities have been suspended to adhere to social distancing guidelines. As remote teaching becomes the forefront of education, medical curricula have been forced to adapt accordingly in order to fulfill the core competencies of medical training and to provide quality education to medical students. With that in mind, the COVID-19 crisis offers a unique opportunity to evaluate the current "continuity plans" in medical education as they stand. This paper provides the perspective of medical students on how medical education is changing for both pre-clerkship and clerkship students, using their experience at McGill University as an example for the Canadian medical education system. Additionally, we discuss the accommodations put forth by the undergraduate medical education (UGME) office, and reflect on the limitations and sustainable solutions in supporting quality medical education. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic (COVID-19) has altered the undergraduate learning experience for many students across Canada. Medical education is no exception; clinical programs, in-person lectures, and mandatory hands-on activities have been suspended to adhere to social distancing guidelines. As remote teaching becomes the forefront of education, medical curricula have been forced to adapt accordingly in order to fulfill the core competencies of medical training and to provide quality education to medical students. With that in mind, the COVID-19 crisis offers a unique opportunity to evaluate the current "continuity plans" in medical education as they stand. This paper provides the perspective of medical students on how medical education is changing for both pre-clerkship and clerkship students, using their experience at McGill University as an example for the Canadian medical education system. Additionally, we discuss the accommodations put forth by the undergraduate medical education (UGME) office, and reflect on the limitations and sustainable solutions in supporting quality medical education. [ABSTRACT FROM AUTHOR]

By 2020 mental illness will be one of the 5 most common illnesses causing morbidity, mortality and disability among youth. At least 20% of Canadian youth have a psychiatric disorder the impact of which can dramatically alter their life trajectory. Focus on the factors contributing to this problem is crucial. Lack of coordination between child and adolescent mental health systems (CAMHS) and adult mental health systems (AMHS) and consequent disruption of care during this vulnerable time of transition is one such factor. Reasons for and the impact of this divide are multilayered, many of which are embedded in outdated, poorly informed approaches to care for this population in transition. This paper considers the etiology behind these reasons as potential foci for change. The paper also briefly outlines recent initiatives ongoing in Canada and internationally that reflect appreciation of these factors in the attempt to minimize the gap in service provision for youth in transition. The need to continue with research and program development endeavours for youth with mental illness whereby access to services and readiness for transition is no longer determined by age is strongly supported. [ABSTRACT FROM AUTHOR]

Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample.Method: Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health.Results: Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys.Conclusions: Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders. [ABSTRACT FROM AUTHOR]

The article presents a paper, a part of a planned series of Elements of Care papers, focusing on identifying common elements which are important for providing appropriate psychiatric care in different models of care in Canada. It focuses on direct patient care or service for payment in traditional care model and also discusses indirect services involved in such models, like diagnostic assessment or patient management. It also focuses on involvement of family or caregivers in indirect services.

This position paper has been substantially revised by the Canadian Psychiatric Association's Professional Standards and Practice Committee and approved for republication by the CPA's Board of Directors on August 31, 2016. The original position paper1 was developed by the Professional Standards and Practice Council and approved by the Board of Directors on April 9, 1994. [ABSTRACT FROM AUTHOR]

Retail gasoline pricing in Canada has typically followed certain distinct patterns, ranging from long durations of price rigidity relative to wholesale prices to daily price cycles. This paper examines recent changes to pricing patterns in Canadian cities resulting in new equilibrium behavior, and discusses possible reasons for these changes. Using high frequency retail price data obtained from GasBuddy.com, it is demonstrated that volatility changes exhibited in Toronto appear to correspond to an increased frequency of the price cycle, and replacement of the cycle with fixed retail margins. While multiple factors may have contributed to the first pricing change, the second change corresponds closely to a refinery fire in southem Ontario; this temporary event (in conjunction with a rail strike and refinery maintenance) could have triggered a permanent change in equilibrium behavior. This paper also illustrates problems for academic researchers and policymakers when using low frequency price data to analyze pricing in a market characterized by a price cycle. [ABSTRACT FROM AUTHOR]

This paper is an initial attempt to collate the literature on psychiatric inpatient recovery- based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery- oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada. [ABSTRACT FROM AUTHOR]

The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system. [ABSTRACT FROM AUTHOR]

In the context of sub-global participation in greenhouse gas mitigation efforts, this paper investigates the effectiveness of a Canada-U.S. emissions bubble under their existing regional trade agreement. It also explores the potential economic impact of carbon tariff harmonization through the implementation of a common Canada-U.S. external border tariff adjustment as a mean to address competitiveness issues. Using a multi-region, multi-sector computable general equilibrium model the paper finds that the creation of an emission bubble between the two countries could improve efficiency. The findings also suggest that a carbon tariff harmonization policy could give rise to distributional issues among Annex I regions and could fail to mitigate the negative competitiveness impacts of carbon abatement policies. [ABSTRACT FROM AUTHOR]

Research and development of early intervention (EI) services for first-episode psychosis have brought much-needed transformation of service delivery for this serious mental disorder to many jurisdictions. The effectiveness of the EI model of service delivery is contingent on timely access to all evidence-informed treatment interventions, including a rational approach to pharmacotherapy. In this perspective paper, we present a brief review of the well-established effectiveness of clozapine in patients who clearly show lack of response to regular antipsychotic therapy. We concentrate, in particular, on the need to identify eligibility for clozapine therapy very early on following failure of treatment on 2 antipsychotic medications. We suggest that attention to the low use of clozapine in the very early phase of treatment of psychosis may be of particular value, as the response to clozapine at this stage is likely to produce larger benefits in other domains of outcomes because of the greater retention of patients' personal and social agency. [ABSTRACT FROM AUTHOR]

Canada is one of the top energy users and CO2 emitters among the OECD countries. However, energy intensity has been declining, on average, by about 1.4 percent since 1980. In this paper, we use the Fisher Ideal Index to determine the contribution of changes in the composition of economic activities and efficiency to a decline in energy intensity in Canada at national, provincial, and industry levels. We also apply panel data estimation methods to further investigate the factors driving energy intensity, efficiency and activity indexes for the period 1981-2008. We test for endogeneity as well as cross-section dependency in the provincial data and control for factors such as climate, policy, and energy endowment. The national and provincial decomposition results suggest that most of the reduction in energy intensity has occurred mainly due to improvements in energy efficiency rather than shifts in economic activities. Within the industry, while energy intensity has declined significantly in manufacturing, it has remained stable in transportation, utilities, and construction, and increased significantly in oil extraction and mining industries. The provincial panel regression results indicate that energy intensity is higher in provinces with higher average incomes, faster population growth, colder climate, and a higher capital-labour ratio, and lower in provinces with higher energy prices and higher investment. The industry panel regression results show that investment has contributed to energy efficiency in utilities and mining and to a shift away from energy-intensive activities in manufacturing and transportation industries. Technological advances have been most effective in increasing energy efficiency in construction and utilities and in decreasing energy-intensive activities in manufacturing industries. The results indicate that although efficiency contributes to a reduction in energy intensity in Canada, increasing activity in energy-intensive industries, such as oil and mining, partially offsets the efficiency gains in other industries. [ABSTRACT FROM AUTHOR]

This paper explores the structures and practices of temporary migrant worker programs (TMWP) as they operate in Canadian agriculture. Acting within highly competitive, globalized markets, agri-food employers rely on the availability of migrant workers to achieve greater flexibility in their labor arrangements, drawing on employment practices beyond those possible with a domestic workforce. Most recently, changes to Canada’s two TMWP schemes have provided employers with greater scope to shape the social composition of their workforce. The paper analyzes these changes while exploring their implications for workplace regimes in agriculture. [ABSTRACT FROM AUTHOR]

In this paper two gaps in North American immigrant homeownership research are addressed. The first concerns the lack of studies (especially in Canada) that identify changes in homeownership rates by skin color over time, and the second relates to the shortage of comparative research between Canada and the United States on this topic. In this paper the homeownership levels and attainment rates of Black, Chinese, Filipino, White, and South Asian immigrants are compared in Canada and the United States for 1970/1971–2000/2001. For the most part, greater similarities than differences are found between the two countries. Both Canadian and U.S. Chinese and White immigrants have the highest adjusted homeownership rates of all groups, at times even exceeding comparably positioned native-born households. Black immigrants, on the other hand, tend to have the lowest ownership rates of all groups, particularly in the United States, with Filipinos and South Asians situated between these extremes. Most of these differences stem from disparities that exist at arrival, however, and not from differential advancement into homeownership. [ABSTRACT FROM AUTHOR]

This paper focuses on the aggregate demand for electricity, natural gas, and light fuel oil in Canada as a whole and six of its provinces-Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia-in the residential, commercial, and industrial sectors. We employ the locally flexible normalized quadratic (NQ) expenditure function (in the case of the residential sector) and the NQ cost function (in the case of the commercial and industrial sectors), treat the curvature property as a maintained hypothesis, and provide evidence consistent with neoclassical microeconomic theory. We find that the Morishima interfuel elasticities of substitution are in general positive and statistically significant. Our results indicate limited substitutability between electricity and natural gas, but strong substitutability between light fuel oil and each of electricity and natural gas in most cases. [ABSTRACT FROM AUTHOR]

There is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care. Choosing Wisely is an initiative adopted by numerous specialties with the goal of starting a dialogue about efficient use of health care resources. People need to be able to access care to have an opportunity to choose wisely. There is a considerable amount of evidence that access to care is poor for specialty mental health care, particularly access to psychiatrists. Consequently, we suggest that psychiatrists and the broader mental health system need to consider working wisely, and in our paper outline key issues (for example, implementation of wait times and objective measures of need in a centralized referral management system; incorporation of performance indicators with longitudinal monitoring for continuous quality improvement) that need to be addressed to develop a mental health system that would allow people to access care to choose wisely. [ABSTRACT FROM AUTHOR]

Objectives: Community treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. It is unclear if they can reduce health service use, or improve clinical and social outcomes. This review summarizes the evidence from studies conducted in Canada.Method: A systematic literature search of PubMed and MEDLINE to March 2015 was conducted. Inclusion criteria were quantitative and qualitative studies undertaken in Canada that presented data on the effect of CTOs on outcomes.Results: Nine papers from 8 studies were included in the review. Four studies compared health service use before and after compulsory treatment as well as engagement with psychosocial supports. Three were qualitative evaluations of patients, family, or staff and the last was a postal survey of psychiatrists. Hospital readmission rates and days spent in hospital were all reduced following CTO placement, while outpatient attendance and participation in psychiatric services and housing all improved. Family members and clinicians were generally positive about the effect of CTOs but patients were ambivalent. However, the strength of the evidence was limited as many of the studies were small, only one included control subjects, and there was no adjustment for potential confounders using either matching or multivariate analyses. Only 2 qualitative studies included the views of patients and their families.Conclusions: The evidence base for the use of CTOs in Canada is limited and this lack of Canadian research is in marked contrast to other countries where there have been large studies that have used randomized or matched control subjects. Their use should be kept under review. [ABSTRACT FROM AUTHOR]

On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. [ABSTRACT FROM AUTHOR]

This paper briefly surveys the history of natural gas use and describes the main features of current gas consumption. The share of gas in total energy consumption, and the sectoral distribution of its use in major consuming regions are discussed. The main changes in the pattern of gas consumption since 1980 are reviewed and explained. I analyze the likely implications of (a) the emergence of the combined cycle gas power generation; (b) the rising environmental premium of gas; and (c) the transformation of the West European gas market structure. The paper concludes that natural gas will substantially increase its share of global energy consumption in the next 15-20 years. [ABSTRACT FROM AUTHOR]

Purpose: To determine the percentage of abstracts presented at the Canadian Association of Radiologists (CAR) annual scientific meetings that go on to publication. Methods: Records of previous CAR meetings from the years 2005-2011 were obtained. An Internet search was performed to determine which abstracts went on to publication. Abstracts were assessed according to exhibit category (Resident Award Papers), educational institution, publishing journal, and time to publication. Results: Of the 402 abstracts presented, 112 (28%) were published. Overall, an average of 37% of Radiologists-In-Training Presentations, 34% of Scientific Exhibits, and 20% of Educational Exhibits went on to publication. The University of British Columbia and University of Ottawa published the largest number of abstracts (66 and 62, respectively) from the years 2005-2011. The University of Montreal had the largest percentage of abstracts published (42%). The range of publishing journals was wide, but the top publisher was the Canadian Association of Radiologists Journal (27%). Eighty-three percent of abstracts were published within 3 years of being presented. Conclusion: In total, 28% of all the abstracts presented at the CAR conferences between 2005 and 2011 were published. Further exploration into the reasons and barriers for abstracts not being published may be a next step in future research. [ABSTRACT FROM AUTHOR]

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD-accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD. [ABSTRACT FROM AUTHOR]

This paper empirically studies how consumers respond to retail gasoline price cycles. Our analysis uses new station-level price data from local markets in Ontario, Canada, and a unique market-level measure of consumer responsiveness based on web traffic from gasoline price reporting websites. We first document how stations use coordinated pricing strategies that give rise to large daily changes in price levels and dispersion in cycling gasoline markets. We then show consumer responsiveness exhibits cycles that move with these price fluctuations. Through a series of tests we find that forward-looking stockpiling behavior by consumers plays a central role in generating these patterns. [ABSTRACT FROM AUTHOR]

Objective: Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables. Method: Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured. Results: Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression, Over one-third of people who had received treatment in the year prior to the survey reported discrimination In 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health. Conclusions: The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time. [ABSTRACT FROM AUTHOR]

Objective: As part of its ongoing effort to combat stigma against mental illness among healthcare providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes. Methods: Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program (n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients. Results: The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that Included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs. Conclusions: The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers. [ABSTRACT FROM AUTHOR]

Background. The purpose of this paper is to provide an overview of the study protocol for the Learning Environments' Activity Potential for Preschoolers (LEAPP) study, the goal of which is to describe the activity levels of preschoolers attending various early learning venues and explore which attributes of these facilities (e.g. curriculum, policies, equipment, etc.) support activity participation. Design and Methods. This cross-sectional study aimed to recruit approximately 30 early learning environments requesting participation from preschoolers aged 2.5-5 years. Data collection included: Actical accelerometers (MiniMitter, Oregon, USA) to measure the activity levels of children for five consecutive days (15-second epoch length) while in care; the Environment and Policy Assessment and Observation tool to explore the early learning environment's impact on activity; anthropometric data; the Child Temperament Questionnaire to assess the influence of preschoolers' temperament on physical activity; and demographic information from parents/guardians and early learning staff. ANOVA and linear regression analyses will be conducted to assess variances in activity levels among preschoolers attending different early learning types and to explore the impact of early learning environments on their activity levels. Independent sample t-tests will be used to examine differences in activity levels based on sex and weight status. Expected impact of the study for public health. This research will provide the first Canadian data to address environmental influences on preschoolers' activity levels in differing early learning environments. Additionally, this work will highlight the extent to which activity levels vary among preschoolers enrolled in full-day kindergarten, centre-, and home-based childcare. [ABSTRACT FROM AUTHOR]

Scholars and practitioners from multiple perspectives, including developmental science, sociology, business, medicine, and public health, have considered the implications of employment for young people. We summarize a series of meetings designed to synthesize information from these perspectives and derive recommendations to guide research, practice, and policy with a focus on young worker safety and health. During the first three meetings, participants from the United States and Canada considered invited white papers addressing developmental issues, public health data and findings, as well as programmatic advances and evaluation needs. At the final meeting, the participants recommended both research and policy directions to advance understanding and improve young worker safety. [ABSTRACT FROM AUTHOR]

Government, utility, and private subsidies for energy efficiency play a prominent role in current efforts to reduce greenhouse gas emissions, yet the effectiveness of this policy approach is in dispute. One opportunity for empirical analysis is provided by the past energy efficiency subsidies, called demand-side management programs, offered by electric utilities in North America over several decades. Between 1990 and 2005, most electric utilities in Canada administered such programs, with total spending of $2.9 billion (CDN$2005). This paper uses the significant inter-annual variation in demand side management spending during this period to econometrically estimate the effectiveness of these subsidies. The resulting estimates indicate that these programs have not had a substantial impact on overall electricity consumption in Canada. [ABSTRACT FROM AUTHOR]

This paper examines the development of inter-ethnic friendships between immigrants and Canadians. It uses longitudinal data from three waves of the Canadian LSIC survey, in which newly arrived immigrants were followed during the first 4 years of settlement. It is found that pre-migration characteristics play an important role in the development of inter-ethnic friendships: immigrants who arrive at a younger age and for economic reasons, as well as those who are highly educated and have a cross-ethnic partner at the moment of arrival, establish more inter-ethnic friendships over time. In addition, post-migration characteristics affect the formation of inter-ethnic friendships. Such friendships are more common among immigrants who embrace Canadian traditions and acquire the host-country language, as well as among those who work in international settings and inhabit ethnically mixed neighborhoods. The effects of pre-migration characteristics are partially mediated by post-migration characteristics. Our findings point out that economic, cultural, and spatial integration are all conducive to inter-ethnic friendships. [ABSTRACT FROM AUTHOR]

In this paper we examine how individual-level characteristics and national context affect attitudes toward immigration. Although many previous studies have compared attitudes toward immigration across countries, little attention has been paid to how attitudes may be affected by changes within a country over time. We take advantage of seventeen national Canadian Gallup surveys to consider how differences in national economic conditions and changing immigration flows affect attitudes and changes in attitudes between 1975 and 2000. While the state of the national economy affects attitudes this is not the case for the rate of immigration. Rather than affecting some groups more than others the state of the economy has a relatively uniform effect across groups. Our results also show that far from being a continuum, being anti-immigration and being pro-immigration are qualitatively different. Interest, ideology, and the national economy affect anti-immigration sentiments, but only ideology affects pro-immigration sentiments. [ABSTRACT FROM AUTHOR]

This paper examines two issues: (1) poverty dynamics among successive cohorts of entering immigrants to Canada, and (2) whether rising educational attainment and increasing share in the “skilled” class since the early 1990s has resulted in improvements in poverty entry, exit, and chronic poverty. The entry to poverty is very high during the first year in Canada, but low in subsequent years. The dramatic move toward more labor-market friendly characteristics of entering immigrants had only a very small effect on poverty outcomes, in part because the relative advantage of holding a degree diminished, and “skilled economic” class immigrants were more likely to enter poverty than their “family” class counterparts. [ABSTRACT FROM AUTHOR]

The provision of "closer-to-patient" services has increased in most industrialized countries. However, the migration of services in non-traditional health care settings implies redefining the role of technical and human entities and transforming the nature and use of technologies and places. Drawing on various scholarly efforts to conceptualize space, place, and technology, this paper compares and contrasts satellite and mobile dialysis units implemented in two regions in the province of Quebec, Canada. The satellite units were hosted in two small, local hospitals where nursing staff had been recently trained. The mobile unit was a bus adapted to host five dialysis stations; nurses traveled back and forth between a university teaching hospital and two sites located within a radius of 7.6 miles. In both projects, nephrologists supervised from a distance via a videoconferencing system. Our aim is to illustrate the ways in which the displacement of technical and human entities gives shape to new forms of emplacement in non-traditional health care settings. The satellite and mobile units contributed to the culture of dialysis care and transformed the identity of nurses, doctors, patients, and technologies. By contrasting two projects involving different spatial and clinical logics, we analyze in what ways certain forms of recombination of human and technical entities can prove incomplete but nevertheless acceptable to providers and project managers. [ABSTRACT FROM AUTHOR]