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Background: Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables. Methods: Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables. Results: Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education. Conclusions: The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada. [ABSTRACT FROM AUTHOR]

This study assesses the likely economic impact of the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on Saskatchewan's (a Canadian province) economy in 2030 by building a subnational computable general equilibrium (CGE) model. The approach was based on splitting Canada into two regions: Saskatchewan and the Rest of Canada (RoC). Saskatchewan was treated as a separate trading entity with interprovincial and international trade flows. Saskatchewan exports were estimated to increase by 0.81% but imports to increase by 1.75% under the CPTPP. The analysis showed evidence that trade agreements may have different impacts on regions within a country. [ABSTRACT FROM AUTHOR]

Background: Healthcare providers (HCP) continue to provide patient care during the COVID-19 pandemic despite the known risks for transmission. Studies conducted early in the pandemic showed that factors associated with higher levels of distress among HCP included being of younger age, female, in close contact with people with COVID-19, and lower levels of education. The goal of this study was to determine if level of patient contact was associated with concern for post-traumatic stress disorder (PTSD) as measured by the Impact of Event Scale-Revised (IES-R). Methods: This cross-sectional study, embedded within a prospective cohort study, recruited HCP working in hospitals in four Canadian provinces from June 2020 to June 2023. Data were collected at enrolment and annually from baseline surveys with the IES-R scale completed at withdrawal/study completion. Modified Poisson regression was used to determine the association between level of patient contact and concern for PTSD (i.e., IES-R scores ≥24). Results: The adjusted rate ratio (RR) associated with concern for PTSD among HCP with physical contact/direct patient care was 1.19 (95% confidence interval (CI) 1.03, 1.38) times higher than for HCP with no direct contact. In fully adjusted linear regression models, physical care/contact was associated with higher avoidance and hyperarousal scores, but not intrusion scores. Conclusions: Administrators and planners need to consider the impact of heightened and ongoing stress among HCP by providing early screening for adverse emotional outcomes and delivery of tailored preventive strategies to ensure immediate and long-term HCP health. [ABSTRACT FROM AUTHOR]

Introduction: Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL. Method: Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14]. Results: HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Background: Federal deregulation of opioid agonist therapies are an attractive policy option to improve access to opioid use disorder care and achieve widespread beneficial impacts on growing opioid-related harms. There have been few evaluations of such policy interventions and understanding effects can help policy planning across jurisdictions. Methods: Using health administrative data from eight of ten Canadian provinces, this study evaluated the impacts of Health Canada's decision in May 2018 to rescind the requirement for Canadian health professionals to obtain an exemption from the Canadian Drugs and Substance Act to prescribe methadone for opioid use disorder. Over the study period of June 2017 to May 2019, we used descriptive statistics to capture overall trends in the number of agonist therapy prescribers across provinces and we used interrupted time series analysis to determine the effect of this decision on the trajectories of the agonist therapy prescribing workforces. Results: There were important baseline differences in the numbers of agonist therapy prescribers. The province with the highest concentration of prescribers had 7.5 more prescribers per 100,000 residents compared to the province with the lowest. All provinces showed encouraging growth in the number of prescribers through the study period, though the fastest growing province grew 4.5 times more than the slowest. Interrupted time series analyses demonstrated a range of effects of the federal policy intervention on the provinces, from clearly positive changes to possibly negative effects. Conclusions: Federal drug regulation policy change interacted in complex ways with provincial health professional regulation and healthcare delivery, kaleidoscoping the effects of federal policy intervention. For Canada and other health systems such as the US, federal policy must account for significant subnational variation in OUD epidemiology and drug regulation to maximize intended beneficial effects and mitigate the risks of negative effects. [ABSTRACT FROM AUTHOR]

Introduction: Individuals on the autism spectrum (ASD) often experience poor mental health and coping strategies compared to their peers due to social exclusion and co-occurring conditions. Resiliency has been identified as a key factor in preventing adverse outcomes and promoting mental health. Therefore, it is important to determine what strategies can be used to build resiliency among autistic individuals. The current paper is one of the first studies that aims to collect information from autistic individuals and their caregivers on potential strategies to enhance resiliency. Methods: We interviewed 18 participants from various provinces in Canada, comprising of 13 autistic individuals and 5 parents. We used thematic analysis to identify patterns in the data. Results: Thematic analysis revealed three themes to indicate strategies that could be used to enhance resiliency, including: (a) self-reliant strategies, (b) using community-based facilities, and (c) contextual and individual characteristics. Conclusion: Although the body of literature on resiliency is evolving, this paper provides a unique perspective as it is one of the few studies that considers the experiences of individuals on the spectrum. In addition, this study focuses on identifying and describing specific strategies that can be used to enhance resiliency and mental health, which consequently can help address the existing gaps in knowledge and practice. [ABSTRACT FROM AUTHOR]

In April 2020, the British Columbia Utilities Commission released the Final Report of its Indigenous Utilities Regulation Inquiry. The Inquiry was tasked with determining the regulatory environment for Indigenous utility providers across the Canadian province. We analyse the Inquiry as a colonial encounter between Indigenous nations and the settler state, arguing that technical bodies like the Commission represent a sort of security professional working to depoliticize the reproduction of settler sovereignty, highlighting the operations of non-traditional security professionals in settler colonial contexts. Through the Inquiry, security comes through providing certainty for existing energy infrastructure and institutions as 'colonial beachheads', legitimizing the settler colonial political-economic order. However, the Inquiry also demonstrates that such processes offer opportunities for Indigenous nations to contest that order. Indeed, Indigenous nations used the Inquiry to both contest the legitimization of settler sovereignty and accumulation, and press for the capacity to build their own infrastructure and institutions, thereby enacting their decision-making authority. We explore this tension in the context of the contemporary reconciliation discourse, finding the Inquiry's final recommendations represent an attempt to reify settler sovereignty, while also deepening settler insecurity through the possibilities opened for greater Indigenous self-determination. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic posed unheralded challenges to people, business, government at all levels (federal, provincial, regional), and society at large. In addition to the direct consequences of taking care of infected people, which in some countries led to a virtual collapse of the healthcare system, the pandemic strained eldercare, employment, economic growth, and exacerbated mental health and social problems. During the first year of the pandemic, researchers' and policy makers' main focus was on 'flattening the curve,' and on predictive modeling of infections and deaths. In this paper we present a non-parametric data-driven descriptive analysis based on Data Envelopment Analysis to assess COVID-19 in ten Canadian provinces over the two year period 2020 to 2021. The objective is to derive worst- and best-case intra-provincial benchmarks to assess if and to what extent the situation could have been worse respectively better. To take account for any indirect socio-economic impact our analysis incorporates official monthly unemployment rates and a stringency index reflecting the level of social policy restrictions imposed by the provincial governments. A major contribution of the model framework is that it provides a mechanism for measuring the impact of the two main strategies in curbing the pandemic, namely vaccination and social policy restrictions. As a robustness check, the bench-mark results are compared against bias-corrected efficiency measures. [ABSTRACT FROM AUTHOR]

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Of all cancers in female Canadians, the most rapidly increasing incidence is that of cervical cancer. The objective of this pilot study was to assess how HPV self-sampling might improve cervical cancer screening participation in both urban and rural settings in Saskatchewan, one of the most sparsely populated provinces in Canada. Study groups consisted of n = 250 participants to whom self-swabbing kits were mailed with instructions and n = 250 participants to whom kits were handed out in 6 urban and rural clinics. The inclusion criteria selected subjects aged 30–69 years who were Saskatchewan residents for at least 5 years with valid health coverage, had a cervix, and had no record of cervical cancer screening in 4 years. The returned samples were analyzed for specific HPV strains using the Roche Molecular Diagnostics Cobas 4800® System. The overall response rate was ~16%, with the response to the handout distribution being roughly double that of the mailout. While HPV positivity did not differ across the distribution groups, participants at a specific inner-city clinic reported significantly higher positivity to at least one HPV strain as compared to any other clinic and all mailouts combined. For this high-risk population, in-person handout of self-sampling kits may be the most effective means of improving screening. [ABSTRACT FROM AUTHOR]

Reducing the carbon intensity of human well-being (CIWB) is a potential form of climate action. We conduct a preliminary analysis of the effects of economic growth and income inequality on the CIWB of Canada's provinces, and find that both increase CIWB in this sub-national context. We also find that their effects are symmetrical, meaning that positive and negative changes in economic growth and income inequality result in the same proportional changes in CIWB. Therefore, and while incredibly difficult to do, it is possible that efforts to reduce income inequality and economic growth are potential pathways to reducing CIWB. [ABSTRACT FROM AUTHOR]

Policing faces increased accountability measures, influencing officers to engage in "covering your ass" and over-documentation. In this qualitative study of police officers across three Canadian provinces, we unpack the "covering your ass" mentality by exploring the paperwork burden as an unintended consequence of movements toward greater policing accountability. We find that covering your ass leads officers to complete paperwork to protect themselves from personally being investigated. They use paperwork to ensure they overcome any legal vulnerabilities by justifying their actions and explaining their interpretations of other officers' actions. We present policy implications of these findings tied to police accountability, the impacts of covering your ass, and the resulting paperwork burden. [ABSTRACT FROM AUTHOR]

Configurators have recently emerged as essential tools in the construction industry to enable builders to offer a wide range of customizable designs. Due to significant challenges in information integration between construction suppliers and clients, existing configurator systems often lack crucial usability and supply chain information, presenting barriers to wider adoption among residential communities, especially in single-family residence development that requires a high degree of customization. To address this challenge in the design and construction supply chain, this study presents a lightweight cloud-based modular home configuration methodology as a robust unified platform solution to integrate parametric design options with a certified kit-of-parts library to meet local design codes. The configurator prototype developed under this framework seamlessly integrates essential design and supply chain information by leveraging (1) a generative layout design with pre-approved blueprints, (2) a knowledge-based recommender system to link the design process with certified material catalogs, and (3) a user-friendly web interface to present possible designs. The implementation of a single-family housing design adhering to the building codes in the British Columbia Province of Canada illustrates the benefits of the proposed configurator functionalities and efficient supplier data integration. Lightweight and automated, the proposed configurator has substantial potential to be scaled and adopted across different communities. [ABSTRACT FROM AUTHOR]

Purpose: This pan-Canadian study examines the information practices of STEM-trained immigrant women to Canada as they navigate workfinding and workplace integration. Our study focuses on a population of highly skilled immigrant women from across Canada and uses an information practice lens to examine their lived experiences of migration and labour market integration. As highly trained STEM professionals in pursuit of employment, our participants have specific needs and challenges, and as we explore these, we consider the intersection of their information practices with government policies, settlement services and the hiring practices of STEM employers. Design/methodology/approach: We conducted a qualitative study using in-depth interviews with 74 immigrant women across 13 Canadian provinces and territories to understand the nature of their engagement with employment-seeking in STEM sectors. This article reports the findings related to the settlement and information experiences of the immigrant women as they navigate new information landscapes. Findings: As immigrants, as women and as STEM professionals, the experiences of the 74 participants reflect both marginality and privilege. The reality of their intersectional identities is that these women may not be well-served by broader settlement resources targeting newcomers, but neither are the specific conventions of networking and job-seeking in the STEM sectors in Canada fully apparent or accessible to them. The findings also point to the broader systemic and contextual factors that participants have to navigate and that shape in a major way their workfinding journeys. Originality/value: The findings of this pan-Canadian study have theoretical and practical implications for policy and research. Through interviews with these STEM professionals, we highlight the barriers and challenges of an under-studied category of migrants (the highly skilled and "desirable" type of immigrants). We provide a critical discussion of their settlement experiences and expose the idiosyncrasies of a system that claims to value skilled talent while structurally making it very difficult to deliver on its promises to recruit and retain highly qualified personnel. Our findings point to specific aspects of these skilled professionals' experiences, as well as the broader systemic and contextual factors that shape their workfinding journey. [ABSTRACT FROM AUTHOR]

Given the increasing damage effect of climate change, the Canadian government has taken a further step to ensure that carbon pricing is implemented in all provinces to reduce its GHGs emissions as a means of addressing climate change. Thus, this paper examines the effect of carbon pricing on energy consumption which is the main source of CO2 emission to enhance our understanding beyond carbon-pricing effects on households and revenue recycling in the prior research. Our study analyzes the energy efficiency of Canada using the province-level data between 2000 and 2021, by developing an SFA production model to understand the drivers of energy consumption and then compute the total factor energy efficiency index while controlling for the role of carbon pricing. Our empirical results reveal that increased labor input, as well as output, mitigate the rising capital-induced energy consumption, while carbon pricing policy plays no significant role in influencing energy consumption. However, the effectiveness of carbon pricing is found in reducing province-level energy efficiency. This striking evidence suggests that policymakers should consider a labor-oriented energy saving scheme and conduct a comprehensive review of the current carbon pricing policy in order to align with energy efficiency interventions toward the achievement of Canada's Paris Agreement targets. [ABSTRACT FROM AUTHOR]

Identifying optimal maintenance policies for transportation infrastructure such as bridges, is a challenging task that requires taking into account many aspects relating to budget availability, resource allocation and traffic rerouting. In practice, it is difficult to accurately quantify all of the aforementioned factors; accordingly, it is equally difficult to obtain network-scale optimal maintenance policies. This paper presents an approach to evaluate the costs associated with deviations from optimal bridge-level maintenance policies, specifically focusing on delays in maintenance actions. Evaluating the cost of maintenance delays is performed using a reinforcement learning (RL) approach that relies on a probabilistic deterioration model to describe the deterioration in the structural components. The RL framework provides estimates for the total expected discounted maintenance costs associated with each maintenance policy over time, allowing comparison of maintenance policies where maintenance actions are delayed against an optimal maintenance policy. The comparisons are performed by probabilistically quantifying the ratio of expected costs associated with each maintenance policy. This ratio represents the trade-offs between performing or delaying maintenance actions over time. Moreover, the proposed approach is scalable, making it applicable to bridges with numerous structural elements. Example of application using the proposed framework is demonstrated using inspection data from bridges in the Quebec province of Canada. [ABSTRACT FROM AUTHOR]

Introduction: Homophobia is well-documented as key to social regulation of masculine behavior and practices in Western settings. Yet, empirical data from a number of Western settings has shown a decline in overt homophobic attitudes in the past decade, leading some to suggest that the nature of masculinities is also changing. However, theorizing on the changing nature of masculinities among adolescents has received limited quantitative attention. Research is needed to better understand shifts in adolescent masculinities in contemporary Western settings. Methods: In this paper, we investigate the application of one newer approach to explore masculinities in context – hybrid masculinities – in a sample of cisgender, heterosexual, mid-adolescent boys in one province in Western Canada (N  = 873, mean age (SD)  =  14.39 (0.37)). Data were collected from nine cohorts of grade 9 youth over a 10-year period (2013–2022) as part of the baseline survey of an ongoing evaluation of a gender-transformative healthy relationships program. Results and discussion: We hypothesized that if the ideas of hybrid masculinities held in our sample, we would find that overt homophobic attitudes and adherence to related patriarchal norms (e.g., avoidance of femininity) would decline over this period, but that the use of homophobic name-calling would remain differentiated in terms of to whom it was directed (e.g., a friend, someone they thought was gay). We did find a significant decline in homophobic attitudes and norms related to emotional restriction and avoidance of femininity over the 10-year period, but also found that homophobic name-calling remained differentiated, with significantly higher name-calling toward a friend than toward someone the youth thought was gay. Thus, our hypotheses were supported. We discuss the implications of our findings for future theory and research on understanding adolescent masculinities in context. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic hepatitis C (CHC) can be cured with the new highly effective interferon‐free combination treatments (DAA) that were approved in 2014. However, CHC is a largely silent disease, and many individuals are unaware of their infections until the late stages of the disease. The impact of wider access to effective treatments and improved awareness of the disease on the number of infections and the number of patients who remain undiagnosed is not known in Canada. Such evidence can guide the development of strategies and interventions to reduce the burden of CHC and meet World Health Organization's (WHO) 2030 elimination targets. The purpose of this study is to use a back‐calculation framework informed by provincial population‐level health administrative data to estimate the prevalence of CHC and the proportion of cases that remain undiagnosed in the three most populated provinces in Canada: British Columbia (BC), Ontario and Quebec. Methods: We have conducted a population‐based retrospective analysis of health administrative data for the three provinces to generate the annual incidence of newly diagnosed CHC cases, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV treatment initiations. For each province, the data were stratified in three birth cohorts: individuals born prior to 1945, individuals born between 1945 and 1965 and individuals born after 1965. We used a back‐calculation modelling approach to estimate prevalence and the undiagnosed proportion of CHC. The historical prevalence of CHC was inferred through a calibration process based on a Bayesian Markov chain Monte Carlo (MCMC) algorithm. The algorithm constructs the historical prevalence of CHC for each cohort by comparing the model‐generated outcomes of the annual incidence of the CHC‐related health events against the data set of observed diagnosed cases generated in the retrospective analysis. Results: The results show a decreasing trend in both CHC prevalence and undiagnosed proportion in BC, Ontario and Quebec. In 2018, CHC prevalence was estimated to be 1.23% (95% CI:.96%–1.62%),.91% (95% CI:.82%–1.04%) and.57% (95% CI:.51%–.64%) in BC, Ontario and Quebec respectively. The CHC undiagnosed proportion was assessed to be 35.44% (95% CI: 27.07%–45.83%), 34.28% (95% CI: 26.74%–41.62%) and 46.32% (95% CI: 37.85%–52.80%) in BC, Ontario and Quebec, respectively, in 2018. Also, since the introduction of new DAA treatment in 2014, CHC prevalence decreased from 1.39% to 1.23%,.97% to.91% and.65% to.57% in BC, Ontario and Quebec respectively. Similarly, the CHC undiagnosed proportion decreased from 38.78% to 35.44%, 38.70% to 34.28% and 47.54% to 46.32% in BC, Ontario and Quebec, respectively, from 2014 to 2018. Conclusions: We estimated that the CHC prevalence and undiagnosed proportion have declined for all three provinces since the new DAA treatment has been approved in 2014. Yet, our findings show that a significant proportion of HCV cases remain undiagnosed across all provinces highlighting the need to increase investment in screening. Our findings provide essential evidence to guide decisions about current and future HCV strategies and help achieve the WHO goal of eliminating hepatitis C in Canada by 2030. [ABSTRACT FROM AUTHOR]

Ground ice maps at small scales offer generalized depictions of abundance across broad circumpolar regions. In this paper, the effect of surficial geology mapping scale on modelled ground ice abundance is examined in the Slave Geological Province of the Canadian Shield, a region where the geological and glacial legacy has produced a landscape with significant variation in surface cover. Existing model routines from the Ground ice map of Canada (GIMC) were used with a 1:125000 -scale regional surficial geology compilation and compared to the national outputs, which are based on surficial geology at a 1:5000000 scale. Overall, the regional-scale modelling predicts much more ground ice than the GIMC due to greater representation of unconsolidated sediments in the region. Improved modelling accuracy is indicated by comparison of the outputs to empirical datasets due to improved representation of the inherent regional heterogeneity in surficial geology. The results demonstrate that the GIMC significantly underestimates the abundance and distribution of ground ice over Canadian Shield terrain. In areas with limited information on ground ice, regional-scale modelling may provide useful reconnaissance-level information to help guide the field-based investigations required for planning infrastructure development. The use of current small-scale ground ice mapping in risk or cost assessments related to permafrost thaw may significantly influence the accuracy of outputs in areas like the Canadian Shield, where surficial materials range from bedrock to frost-susceptible deposits over relatively short distances. [ABSTRACT FROM AUTHOR]

The orange wheat blossom midge, Sitodiplosis mosellana (Géhin) (Diptera: Cecidomyiidae), is a significant wheat pest in the Prairie Provinces of Canada and northern regions of the USA. Wheat phenology plays a critical role in wheat midge oviposition. We hypothesized that S. mosellana oviposition behaviour is influenced by volatile organic compounds (VOCs) emitted by wheat at two adjacent wheat growth stages: preanthesis and postanthesis. A higher number of S. mosellana eggs laid on preanthesis than postanthesis spikes in an oviposition choice experiment using the susceptible spring wheat cultivar 'Roblin'. In preanthesis, wheat emitted higher amounts of Z-3-hexenyl acetate (Z3-06:OAc) than at the postanthesis stage. Higher amounts of methyl ketones such as 2-tridecanone, 2-pentadecanone, and 2-undecanone were emitted by wheat in the postanthesis stage and these VOCs were sensitive to S. mosellana antennae used in the Gas Chromatography-Electroantennographic Detection. Females were attracted to synthetic Z3-06:OAc but were deterred by 2-tridecanone relative to the solvent control in the vertical Y-tube olfactometer. 2-Undecanone and 2-pentadecanone did not show any attractiveness or deterrence. In a no-choice oviposition experiment, fewer eggs were laid in preanthesis wheat exposed to a synthetic VOC blend of Z3-06:OAc, 2-undecanone, 2-tridecanone, and 2-pentadecanone at the concentrations released by postanthesis spikes. This study shows that the reduction of Z3-06:OAc, in the VOC mix, and possibly the increase in 2-tridecanone, are likely responsible for the reduction in oviposition on postanthesis wheat. These results elucidate for the first time the role of specific VOCs mediating S. mosellana oviposition in preanthesis and postanthesis wheat. [ABSTRACT FROM AUTHOR]

Holocene quartz-rich sands such as in the Orinoco River of Venezuela and Columbia, develop under a unique set of conditions including tectonic stability, intense weathering and long-term storage of sediment prior to burial. This review paper proposes that a similar set of conditions existed on the Mesoarchaean Earth by 3.0 Ga. Compositionally and texturally mature quartz arenites are present in the Mesoarchaean Hospital Hill Subgroup and correlative lower Mozaan Group, in the cover rocks of the Beitbridge Complex in the Limpopo Belt and at Buhwa in southern Zimbabwe as well as the Neoarchaean Manjeri Formation of Zimbabwe. These quartz arenites are interpreted as first-cycle and developed following the formation of stable cratons under conditions of slow subsidence (<10 cm/1 000 years), intense weathering in a hostile chemical environment related to the ambient carbon dioxide-rich atmosphere, long-distance intrabasinal transport by tides and/or waves and microbial processes that influenced the local chemical environment. Similar examples of Mesoarchaean quartz arenites are documented from the Yilgarn Block in Western Australia, the Slave and Superior provinces in Canada and the Dharwar and Singhbhum cratons in India. On a global scale, cratonisation was diachronous with the Kaapvaal Craton stabilised on a regional scale by 3.0 Ga whereas microcontinents existed over the remainder of Earth. [ABSTRACT FROM AUTHOR]

In the westernmost Canadian province of British Columbia, fishers (Pekania pennanti) occur in low-elevation forested ecosystems in the central and northern portions of the province, with several substantial mountain ranges and rivers bisecting this distribution. The effect of these geographic features on gene flow and population structuring is unknown and may contribute to fishers differentiating into 2 or more populations within the province. To better understand population structuring within the range of fishers in British Columbia, we collected tissue samples from 491 fishers from throughout the province and evaluated variation of neutral genetic markers using a 385-base pair section of the mitochondrial DNA control region and 13 microsatellite loci. Fishers appeared to be genetically structured as hierarchical stepping-stone populations where an upper hierarchical level of genetic partitioning resulted in 2 populations at the provincial scale, with 3 subpopulations occurring in the central interior region. We observed gene flow of 2 to 5 migrants per generation between the 2 upper populations, which was substantially less than the 90 migrants per generation estimated as needed to maintain genetic homogeneity. This resulted in differentiated upper populations (haplotype F ST = 0.272, microsatellite F ST = 0.049) characterized by relatively low N e (Columbian population = 252, 95% CI = 185 to 332; Boreal population [British Columbia only] = 136, 95% CI = 92 to 234). The consequence of low gene flow and resultant population structuring is that the Columbian population likely receives relatively little genetic and demographic support from other populations and, combined with precipitous recent declines in its numbers, puts this population at heightened conservation risk. As a result, swift and effective actions are needed to conserve this vulnerable population of fishers. [ABSTRACT FROM AUTHOR]

During the past 30 years, research on policy analytical capacity's multidimensional nature and the evolution of policy advisory systems (PASs) has both increased knowledge of these processes and structures and opened new avenues of inquiry. While it is clear that changes in PASs in many countries have occurred ‐ featuring processes such as the increased externalisation and politicisation of policy advice ‐ studies of changes among the roles played by core policy professionals in advice provision have lagged. One aspect of this question concerns the nature and extent of changes in this 'forgotten fundamental' of advice systems related to how these professionals are arrayed within 'policy shops'—that is organisational units identified in the 1960s and 1970s as the main organisational home of policy professionals in government. Whether or not such shops have changed from the central‐integrated model identified in early studies and, if so, how, remain outstanding and foundational questions. Recent research in Canada has mapped the distribution of policy professionals at the central and provincial level and found more types of analysts and venues than in earlier eras— which range from the 'classical' integrated policy shops of the 1960s and 1970s which remain in central agencies and single‐purpose line departments to the much more 'distributed' patterns found in many departments dealing with multiple or complex controversial issues. Using Canadian data, this study outlines the development of these organisational types and their distribution in government and discusses the implications of these changes for better understanding the work, and needs, of core professionals in policy advice systems.. Points for practitioners: 'Policy professionals' or public employees specifically tasked with policy analysis in government are key players in policy advisory systems despite the addition of more external and internal actors in policy advice systems in recent years.How these advisors and analysts are organised in government, whether they work in clusters or small groups, and how they interact with other civil servants and policy‐makers are a key determinant of their activities and influence in policy‐making.In the policy sciences, work in the 1960s and 1970s established 'the policy shop', that is relatively small centrally located organisational units employing mainly policy analysts, as the main home of policy professionals in government. These units often enjoyed a monopoly in analysis and played a key role in policy‐making. However, research on these organisations has not kept up with changes in advisory relations within and outside of governments and the impact such changes have had on the influence and activities of core professionals.Recent work by the authors looking at the large Canadian province of Ontario has identified more than a single type of arrangement of analysts in the current era. This paper expands this analysis to both small and large jurisdictions in Canada, including the federal government, and develops two detailed case studies of the current organisation of policy professionals in smaller central agencies like Ministries of Justice as well as in larger omnibus Ministries of the Environment.The study finds a 'distributed' model of policy shops—in which multiple policy units exist throughout the agency—to be dominant in both cases and in all the governments examined and suggests this is now the new normal, replacing the dominance of the older more integrated central shop model. The predominance of the distributed model contributes to the fragmentation of policy advice already underway in government due to the growth in the number of external advisors such as consultants and think tanks, and internal ones such as political staffers. [ABSTRACT FROM AUTHOR]

Niraparib was recently funded in Canada for the maintenance treatment of ovarian cancer following platinum-based chemotherapy. However, the drug's safety profile in the real world remains uncertain. We conducted a cohort study to describe the patient population using niraparib and the proportion that experienced adverse events between June 2019 and December 2022 in four Canadian provinces (Ontario, Alberta, British Columbia [BC], and Quebec). We used administrative data and electronic medical records from Ontario Health, Alberta Health Services, and BC Cancer, and registry data from Exactis Innovation. We summarized baseline characteristics using descriptive statistics and reported safety outcomes using cumulative incidence. We identified 514 patients receiving niraparib. Mean age was 67 years and most were initiated on a daily dose of 100 or 200 mg/day. Grade 3/4 anemia, neutropenia, and thrombocytopenia occurred in 11–16% of the cohort. In Ontario, the three-month cumulative incidence of grade 3/4 thrombocytopenia was 11.6% (95% CI, 8.3–15.4%), neutropenia was 7.1% (95% CI, 4.6–10.4%), and anemia was 11.3% (95% CI, 8.0–15.2%). Cumulative incidences in the remaining provinces were similar. Initial daily dose and proportions of hematological adverse events were low in the real world and may be related to cautious prescribing and close monitoring by clinicians. [ABSTRACT FROM AUTHOR]

Infertility is a common diagnosis: in its original, heteronormative definition, it is known to impact about 1 in 6 couples worldwide. Governments across Canada and beyond have been increasingly providing support for those undergoing fertility treatment, and BC is the most recent province to announce funding, beginning in 2025. As the amount of proposed funding is not sufficient to cover treatment for all who seek it, we look to examples from other provinces and countries to guide us in forming criteria that balance fair access with likelihood of successful treatment. A majority of Canadian provinces currently provide publicly funded fertility care, albeit with highly variable models. Quebec previously introduced a model with generous coverage, including up to three cycles of in vitro fertilization (IVF), along with medications, associated procedures, and embryo transfers for each live birth. Due to high costs, this funding was removed and reintroduced in 2021 with a more restrictive model, as well as age cutoffs for IVF and embryo transfers. In Ontario, the current funding model was introduced in 2015 and covers intrauterine insemination cycles and one cycle of IVF in patients younger than 43 years of age. Other provinces have offered a fertility treatment tax credit. While the BC announcement stated that one cycle of IVF with medications will be covered, the details on how this finite resource will be distributed are still unclear. We hope BC will consider the lessons learned from other provinces and countries and implement a program that is fair and accessible to those who need it. [ABSTRACT FROM AUTHOR]

Venetoclax is a first-in-class B-cell lymphoma-2 (BCL-2) inhibitor approved as continuous monotherapy and in combination with rituximab as fixed-treatment duration for relapsed and refractory chronic lymphocytic leukemia (R/R CLL). DEVOTE was a 24-week, multicenter observational study (NCT03310190) evaluating the safety, healthcare resource utilization (HCRU) and health-related quality of life (HRQoL) of patients initiating venetoclax for R/R CLL in Canada. Overall, 89 patients received 1 dose of venetoclax; 80% had prior exposure (42% resistant) to ibrutinib. Biochemical tumor lysis syndrome (TLS) occurred in five patients. We observed differences in hospitalization across Canadian provinces including in patients at low risk for TLS with no clear impact on TLS incidence. Additionally, a rapid and sustained improvement in several domains of HRQoL was observed during venetoclax initiation. Early adoption of venetoclax was mainly for R/R CLL patients with few treatment options; nonetheless, acceptable toxicity and a positive impact on HRQoL were observed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This review paper investigates the landscape of wildfire-related studies with a focus on infrastructure and evacuations across Canadian provinces, revealing a predominant focus on Alberta, particularly after the 2016 Fort McMurray wildfire. The aftermath of this event has heightened attention to the unique challenges faced during evacuations, emphasizing the urgent need for heightened awareness and preparedness, especially in the vulnerable northern communities of Alberta. Studies beyond Alberta contribute to understanding Canadian wildfire dynamics. However, a noticeable research gap in British Columbia raises concerns about research prioritization and resource allocation despite heightened wildfire activity. The fact that some provinces are contributing less than 4.2%, such as Quebec, Saskatchewan, Ontario, Northwest Territories, Yukon, and the Prairies, might be attributed to regional variations influenced by historical wildfire frequency and population density. Thematic analysis categorizing studies into "community support/resilience", "evacuation efficiency", and "infrastructure protection/raising awareness" provides nuanced insights. The dominance of the "community support/resilience" category, comprising over 40% of studies, signifies a societal shift towards proactive community engagement. Balanced representation in the "evacuation efficiency" and "infrastructure protection/raising awareness" categories, each contributing over 29%, reflects a collective effort to glean lessons from past evacuations and enhance community preparedness. Temporal trends and thematic analyses spotlight a commitment to continuous improvement, adaptability to emerging challenges, and a growing recognition of the multifaceted aspects of wildfire management. The evolving emphasis on community involvement, responsiveness to changing evacuation dynamics, and heightened awareness of infrastructure protection underscores the proactive stance of the research community, providing insights for shaping future research priorities, policy frameworks, and community resilience strategies in the face of evolving wildfire threats in Canada. [ABSTRACT FROM AUTHOR]

Understanding the phenology of migration is fundamental to management of migratory gamebirds, in part because of the role migratory timing plays in setting harvest regulations. Migratory timing is particularly important for determining appropriate dates for hunting seasons, which may be selected to coincide with major periods of migration, according to local management objectives. We used global positioning system (GPS)‐transmitters to track American woodcock (Scolopax minor), characterize the timing of woodcock migration, and identify sources of variation in timing relative to current hunting season structures in eastern North America. We captured 304 woodcock in 3 Canadian provinces and 12 states from 2017 to 2020, primarily within the Eastern Woodcock Management Region. Using locations collected every 1.7 days on average, we assessed whether initiation, termination, or stopover timing of woodcock migration during fall and early spring varied geographically, differed among age and sex classes, or was influenced by individual body condition. During fall, woodcock migrating from summer use areas farther north and west (e.g., Ontario, Quebec, Canada) initiated and terminated migration earlier than woodcock migrating from areas farther south and east (e.g., Rhode Island, USA). Adult woodcock made multiday stopovers that were 3 days longer on average than juveniles and females made more stopovers on average (8.0 stopovers) compared to males (6.1 stopovers). During the onset of spring migration, woodcock that wintered farther west initiated migration before birds that spent the winter farther east, and males initiated migration on average 6 days earlier than females. Under the current 45‐day harvest regulatory framework in the United States, hunting seasons in northern breeding and southern wintering areas are generally consistent with migration phenology. At more intermediate latitudes, however, periods of migration are generally longer than 45 days, resulting in many circumstances where migrating woodcock are present during periods when hunting seasons are closed. Managers in mid‐latitude states could consider opening hunting seasons later, allowing hunters to harvest more migrant woodcock. [ABSTRACT FROM AUTHOR]

Introduction: The use of osimertinib in the first-line (1L) setting is an effective treatment option for sensitizing EGFR-mutations (EGFRm+) and has significantly altered the standard of care practice for EGFRm+ disease in Canada. Unfortunately, acquired resistance to osimertinib is almost universal, and outcomes are disparate. Post-progression treatment patterns and the outcome of real-world Canadian EGFRm+ patients receiving 1L osimertinib were the focus of this retrospective review. Methods: The Glans-Look Lung Cancer Research database was used to identify and collect demographic, clinical, treatment, and outcome data on EGFRm+ patients who received 1L osimertinib in the Canadian province of Alberta between 2018 and 2022. Results: A total of 150 patients receiving 1L osimertinib were identified. In total, 86 developed progressive disease, with 56 (65%) continuing systemic therapy, 73% continuing osimertinib, and 27% switching to second-line (2L) systemic therapy. Patients were similar both in clinical characteristics at 1L osimertinib initiation and patterns of treatment failure at progression; those continuing 1L osimertinib post-progression had a longer time to progression (13.5 vs. 8.8 months, p = 0.05) and subsequent post-osimertinib initiation survival (34.7 vs. 22.8 months, p = 0.11). Conclusions: The continuation of osimertinib post-progression is an effective disease management strategy for select real-world EGFRm+ patients, providing continued clinical benefit, potentially due to different underlying disease pathogenesis. [ABSTRACT FROM AUTHOR]

Background: The drug toxicity crisis continues to accelerate across Canada, with rapid increases in opioid-related harms following the onset of the COVID-19 pandemic. We sought to describe trends in the burden of opioid-related deaths across Canada throughout the pandemic, comparing these trends by province or territory, age, and sex. Methods: We conducted a repeated cross-sectional analysis of accidental opioid-related deaths between Jan. 1, 2019, and Dec. 31, 2021, across 9 Canadian provinces and territories using aggregated national data. Our primary measure was the burden of premature opioid-related death, measured by potential years of life lost. Our secondary measure was the proportion of all deaths attributable to opioids; we used the Cochrane–Armitage test for trend to compare proportions. Results: Between 2019 and 2021, the annual number of opioid-related deaths increased from 3007 to 6222 and years of life lost increased from 126 115 to 256 336 (from 3.5 to 7.0 yr of life lost per 1000 population). In 2021, the highest number of years of life lost was among males (181 525 yr) and people aged 30–39 years (87 045 yr). In 2019, we found that 1.7% of all deaths among those younger than 85 years were related to opioids, rising to 3.2% in 2021. Significant increases in the proportion of deaths related to opioids were observed across all age groups (p < 0.001), representing 29.3% and 29.0% of deaths among people aged 20–29 and 30–39 years in 2021, respectively. Interpretation: Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults. The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts. [ABSTRACT FROM AUTHOR]

This study investigated the diagnostic capacity for Fetal Alcohol Spectrum Disorder (FASD) in multidisciplinary clinics across several provincial and one territorial jurisdictions of Canada: Alberta, British Columbia, Manitoba, Ontario and Northwest Territories. The data were collected directly from clinics capable of providing diagnoses of FASD and examined annual capacity for the assessment and diagnosis of FASD per year from 2015 to 2019. In total, 58 FASD diagnostic clinics were identified and 33 clinics participated in this survey. The study identified inadequate FASD diagnostic capacity in all participating jurisdictions. Based on the findings and the current population sizes, it is estimated that 98% of individuals with FASD are undiagnosed or misdiagnosed in Canada. Wait times for FASD diagnosis ranged from 1 month to 4.5 years across participating jurisdictions. The annual FASD diagnostic capacity in the select provinces and territories require at least a 67-fold increase per year. [ABSTRACT FROM AUTHOR]

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The development and implementation of extended producer responsibility (EPR) policies to manage e‐waste provide multilevel governance frameworks for achieving greater material circularity. However, the roles and responsibilities that are allocated to various stakeholders under these policies, which are crucial for program effectiveness, often vary across jurisdictions, and consensus is lacking about the best types of relationships and collaboration that should govern municipalities' contributions to EPR programs. Against this backdrop, and since this issue is poorly researched, we conducted an empirical investigation to identify the main drivers and barriers influencing municipalities' collaboration with an e‐waste EPR program in a Canadian province where municipalities are free to decide whether or not to engage with the program. Based on our study, we explore policy implications for similar programs in other jurisdictions, and propose questions for further research. Our findings identify key motivations for collaboration, including perceived program legitimacy, program funding, and logistical efficiencies. Conversely, a lack of program transparency, failure to support local employment, a focus on recycling instead of reuse, and limited program scope are identified as disincentives to program participation. Policymaking for e‐waste management and circularity need to consider municipalities' interests and contributions to ensure successful implementation. [ABSTRACT FROM AUTHOR]

Slave Province in Canada is an Archean granite–supracrustal terrane at the northwestern corner of the Canadian Shield. It is bordered by the Thelon–Taltson orogen (2.0 to 1.9 Ga) to the southeast and the Wopmay orogen (1.9 to 1.8 Ga) to the west. Acasta gneisses, exposed in the westernmost Slave Province, and the Wopmay rocks, located close to the gneisses, were systematically collected for K–Ar and laser step-heating 40Ar/39Ar single-crystal analyses of the biotite and amphibole. The K–Ar biotite ages of the four Wopmay samples range from 1816 ± 18 Ma to 1854 ± 26 Ma. The 40Ar/39Ar biotite analyses of the three Wopmay samples yield plateau ages of 1826 ± 21 Ma, 1886 ± 13 Ma, and 1870 ± 18 Ma. These ages fall within the reported U–Pb zircon age range of the Wopmay orogen. The K–Ar biotite ages of the fifteen Acasta gneisses range from 1779 ± 25 Ma to 1877 ± 26 Ma, except for one younger sample (1711 ± 25 Ma). The 40Ar/39Ar analyses of the biotite crystals from three samples give the plateau ages of 1877 ± 8 Ma, 1935 ± 14 Ma, and 1951 ± 11 Ma. The K–Ar amphibole ages from twelve samples range from 1949 ± 19 Ma to 1685 ± 25 Ma. Two samples of them give ages older than the zircon U-Pb age of Hepburn plutons. The 40Ar/39Ar analyses of the amphibole crystals show varied age relations. The two samples give plateau ages of 1814 ± 22 Ma and 1964 ± 12 Ma. Some samples exhibit apparent old ages of ~2000 Ma in the middle temperature fractions. These old fractions result from the amphibole crystals, originally formed in the Archean, being affected by the thermal events during the Wopmay orogeny but not fully resetting. These observations suggest that the K–Ar system ages of the biotite and amphibole in the Archean Acasta gneiss were rejuvenated during the Paleoproterozoic ages. The Discussion explores the possibility that the heat source rejuvenating the K–Ar system ages may have arisen due to asthenospheric extrusion into the wedge mantle, a process likely triggered by subduction rollback. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of the concept of the complete community or neighborhood in Canadian planning practice and the recent spread of the idea in the United States, few scholars have examined the idea's development and implications. Based on a content and thematic analysis of 102 plans and policies representing all Canadian provinces and territories, along with 205 planner interviews, I argue that the complete community represents an integrative, scalable, and flexible planning theory originating from practice. Borrowing principles from other theories (such as smart growth and sustainable development), practitioners built the complete community idea bottom-up, as a persuasive rhetorical vehicle for describing planning intentions and justifying higher densities in positive ways. Contemporary planning values increasing urban densities, mix, and walkability. Here I illustrate how planners adapted to community resistance to ideas generated by external experts—and to efforts to increase growth and densities—by articulating a socially and politically positive option for urban transformation. The complete community concept places a halo over density, promising vibrancy and livability. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and "as the crow flies" distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands. [ABSTRACT FROM AUTHOR]

Forests contain substantial carbon stores, including above and belowground biomass and living and non-living biomass. Different management regimes produce different outcomes related to stored and sequestered carbon in forests. The geographic focus of this study is the Wabanaki-Acadian Forest of the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island). This study reviews the literature to evaluate the carbon impacts of (1) intensive forest management for fiber products, (2) unharvested (or conservation) forest, and (3) climate-focused, ecological forestry. Each of these forest management strategies and concomitant silviculture regimes sequester and store carbon at varying rates and across different carbon pools in the forest. The literature suggests that unharvested (conservation) forests store and sequester the most carbon, and traditional, intensive fiber management stores and sequesters the least. Ecological forestry may provide the best balance between carbon sequestration and storage and climate adaptability, while also allowing for the provision of some timber/fiber products. This study also discusses the co-benefits offered by forests under each of the three management regimes. New research, in general and in the region, needs to examine further belowground carbon dynamics in soil as most efforts to document carbon focus on aboveground carbon pools. [ABSTRACT FROM AUTHOR]

This article presents the findings of a population-based study conducted in Ontario and British Columbia, Canada, on pediatric-onset multiple sclerosis (PoMS). The study found that the incidence rate of PoMS remained stable between 2003 and 2019, while the prevalence increased over time. The study highlights the need for appropriate resource allocation to support the growing PoMS population. The document provides information on the selection of cases, demographic characteristics, and compares the incidence and prevalence rates in Canada to other regions. It also discusses long-term outcomes and prognostic indicators of pediatric MS. [Extracted from the article]

Background:Child and youth mental health problems represent a substantial burden of illness in Canada, with appropriate services only inconsistently available. Charitable organizations, such as Kids Help Phone (KHP), are, therefore, crucial to filling system gaps by offering 24/7 phone, chat, texting, and peer-to-peer services. Methods:We describe the services provided by KHP, the volume of use for each service, and compare usage across Canada's provinces and territories for a 5-year period from January 2018 to December 2022. Trends seen during the COVID-19 pandemic are highlighted. Results:More than 1.5 million total number of conversations were held across texting, chat, and phone services over 5 years. Considerable growth is demonstrated between 2018 and 2022, and many of the highest peaks in volume occurred in March or April of 2020, the onset of the COVID-19 pandemic. The highest proportional volumes were consistently from the northern territories. Discussion:KHP cannot provide specialized or repeat services, nor can it alone meet the scale of unmet youth mental health needs across the country. Nonetheless, KHP plays a pivotal role in the Canadian mental health system. Efforts to understand the role that KHP and other e-mental health services like it play within the national mental health landscape should be intensified to aid in understanding unmet needs, identify system gaps, and make needed enhancements. [ABSTRACT FROM AUTHOR]

Background: The incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations. Methods: A national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center‐level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web‐based database that tracks postoperative outcomes was presented. The top two performing centers with regards to these metrics were chosen and surgeons from these hospitals discussed elements of their treatment pathways that contributed to these outcomes. Consensus recommendations were then identified with participants independently rating their level of agreement. Results: Twenty‐eight surgeons form 8 centers took part in the seminar across 5 Canadian provinces. Of the 680 included patients included, Clavien‐Dindo grade I and II/III/IV/V complications occurred in 121/39/12/2 patients (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied significantly between institutions (1 day, range 1‐3 vs. 7 days, 3‐8, p < 0.001). A strong level of agreement was achieved for 10/12 of the consensus statements generated. Conclusion: PD seminars provide a supportive forum for centers to review best evidence and experience and generate recommendations based on expert opinion. Further research is ongoing to determine if this approach effectively accomplishes this objective. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) can improve the physical and psychosocial health of individuals with cancer, yet PA levels remain low. Technology may address PA maintenance barriers in oncology, though the intervention effectiveness to date remains mixed. Qualitative research can reveal the nuances of using technology-based PA maintenance tools. The present study aimed to understand the perspectives of individuals with cancer on using an app to support PA maintenance. Methods: Individuals were interviewed after using a self-monitoring app for 24 weeks, asking about their app use, ease of use, and perceived value for supporting PA. Analyses were guided by an interpretive description. Results: Eighteen individuals were interviewed. The participants were 37–75 years old; lived in seven Canadian provinces/territories; identified as White, South Asian, or Indigenous; and had eight different cancers. Four themes were developed: some did not need the app to stay physically active, some valued the app for helping them maintain their PA, the user experience ranged from intuitive to confusing, and the time burden of app use ranged from acceptable to overwhelming. Conclusions: The participants provided insights on using a self-monitoring app to improve PA maintenance in oncology. Work is needed to capture additional perspectives and apply findings to the development of technology-based PA maintenance tools. [ABSTRACT FROM AUTHOR]

In the era of (re)legalisation of medicinal and recreational cannabis, accidental and intentional exposure to edibles, cannabis-infused food products, has increased substantially. However, there is particular concern regarding younger age groups. Most concerning is the increase in hospitalisations. According to a study by Myran et al. (1), provinces in Canada, where the sale of edibles is permitted, saw an increase in paediatric poisonings due to unintentional consumption of edibles. Similar trends have been observed in "legalised states" in the US, such as Colorado (2). The impact of using cannabis at an early age, but particularly the impact of accidental exposure to high THC quantities, may have negative mental or physical health outcomes. Whilst regulatory restrictions vary significantly from one legalised region to another, it is difficult to identify a best practice. The aim of this study is to identify and discuss new and existing risk mitigation strategies to give guidance to policymakers. Furthermore, practical aspects, such as compliance (e.g. audits by authorities), are discussed. It is noted that edibles have been around much longer than recent political attempts to regulate them. [ABSTRACT FROM AUTHOR]

Objective: To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. Methods: We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. Results: We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. Conclusions: Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD. [ABSTRACT FROM AUTHOR]

Introduction: Wildfires impact large populations worldwide with increasing frequency and severity. In Canada, the fire season has affected more areas this year with potential implications for individuals' well-being and quality of life (QoL). Objective: This study aimed to explore data related to the well-being and QoL of individuals living in areas impacted by wildfires in two Canadian provinces. Methodology: A cross-sectional survey was used to collect data from the residents in the two provinces who subscribed to the Text4Hope mental health support service. Descriptive and inferential statistics were applied using World Health Organization Well-Being Index (WHO-5). Results: Out of 1802 Text4Hope subscribers, 298 responded to the baseline surveys, yielding a response rate of (16.5%). The mean score of QoL was (40.8/100 ± 20.7). Most respondents were from Alberta (84.2%), 40 years old or below (28.3%), females (85.2%), Caucasian (83.5%), in a relationship (56.4%), employed (63.6%), received diagnoses of depression (56.6%), and anxiety (52.9%).The overall prevalence of low QoL was (67.3%; 95% CI: 61.2–73.1%) that was mostly reported among subscribers who were from Nova Scotia (70.5%), 40 years old or younger (71.2%), other gender (83.3%), Black/Hispanic and other ethnicity (85.7% each), having high-school or less education (70.3%), not in a relationship (74.1%), and unemployed (73.6%). In terms of clinical factors, low QoL was most prevalent among those who received the diagnoses of depression (74%) and anxiety (74.3%), and those who have been receiving antidepressants (71.8%) or benzodiazepines (93.3%). Regarding wildfire-related factors, the highest prevalence of low QoL was reported among those living in a region that has recently been impacted by the wildfires (74.7%) and those who have been less frequently watching television images about the devastation caused by the recent wildfires (72.6%). The multivariate logistic regression analysis model predicting the low QoL including the various variables was statistically significant; Χ2 (df = 19; n = 254) = 31.69, p = 0.03. It was found that living in a region impacted by wildfires (37.9%) was the only significant predictor of low QoL (adjusted OR: 1.96; 95% CI: 1.05–3.65). Conclusions: The impact of wildfire on the QoL and well-being among people living in impacted regions is significant. It is empirical for the health authorities to support those who are disadvantaged by wildfire via running of screening programs to early identify mental health symptoms and addressing the living conditions of the survivors, along with the provision of innovative means of mental health support. This necessitates enhanced planning of the governments and health authorities to overcome such adverse psychological consequences of these events. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes. Patients and Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD < 16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes. Results: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥ 1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥ 1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis. Conclusion: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care. Plain Language Summary: Inflammatory bowel disease (IBD) is a chronic health condition of the gastrointestinal system, which is becoming more common in children. They require lifelong treatment and receiving high quality care is important for preventing complications. We determined if outcomes of children with IBD was different across Canada. We also tested if differences in care at diagnosis was related to outcomes. More than three-quarters of children with IBD were treated at pediatric hospitals. Children treated at some hospitals were more likely to be hospitalized and visit the emergency room when compared to children treated at other hospitals. Children with Crohn's disease (one type of IBD) were more likely to have surgery at some hospitals when compared to children treated at other hospitals. We should improve care to make sure children living with IBD have timely access to high quality specialist care. [ABSTRACT FROM AUTHOR]

Background: The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2lineages have been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Variants of concern (VOCs) and SARS-CoV-2 lineages associated with increased transmissibility and/or severity are of particular interest. Method: Here, we consider clinical and wastewater data sources to assess the emergence and spread of VOCs in Canada retrospectively. Results: We show that, overall, wastewater-based VOC identification provides similar insights to the surveillance based on clinical samples. Based on clinical data, we observed synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. Conclusion: In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence. In contrast, VOC Omicron achieved the same contribution in less than one month. This study provides significant benchmarks to enhance planning for future VOCs, and to some extent for future pandemics caused by other pathogens, by quantifying the rate of SARS-CoV-2 VOCs invasion in Canada. [ABSTRACT FROM AUTHOR]

Canadian provinces are required to regulate their power sectors using carbon pricing systems that meet national minimum stringency standards, which are set by the federal government. A diverse set of systems has emerged as a result. However, there has been limited assessment of how different pricing mechanisms impact the evolution of Canada's electricity system. To address this gap, we use an electricity system planning model called COPPER and a scenario-based approach to assess if, and to what extent, different policy regimes impact power sector greenhouse gas emissions and costs. Our results show that carbon pricing systems currently in place lead to significant carbon reductions over the long term, provided that free emissions allocations are reduced. However, the cost-optimal pathway for the power sector differs across provinces depending on the carbon pricing mechanism. Some provinces achieve least-cost emissions reductions by switching from high-carbon technologies to renewables, while others are better served by replacing high-carbon technologies with low-carbon fossil fuel alternatives. Further, provinces that implement cap-and-trade systems may affect the transitions of interconnected jurisdictions. Power sector climate policy design should reflect the heterogeneity of available assets, resources, and neighbouring approaches. [ABSTRACT FROM AUTHOR]

Background: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies. This protocol outlines a comprehensive research study aimed at evaluating an implementation approach for the uptake of the Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders across Canada. Eating disorders (EDs) have a significant impact on mental and physical health, necessitating evidence-based and timely interventions. To address gaps in service, we propose to use focus groups to identify barriers, facilitators, and implementation strategies for guideline uptake. We will engage stakeholders, including clinicians, administrators, and individuals with lived experience, to co-create tailored educational materials which will then be disseminated. The impact of the implementation approach will be evaluated through pre- and post-implementation surveys. This study aims to enhance the availability and utilization of evidence-based treatments for children and adolescents with EDs, ensuring equitable and improved care nationwide. [ABSTRACT FROM AUTHOR]