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Assessments of greenhouse gas (GHG) emissions in managed areas are facing various challenges. A non-flow-through, non-steady-state (NFT-NSS) chamber coupled to a frame permanently inserted into the landfilled substrates is a standard method for quantifying GHG emissions in managed areas, such as pulp and paper mill sludge (PPMS) landfill sites. Frequent measurements are needed to minimize uncertainties on GHG emission factors at the landfill site scale. However, maintaining a frame inserted into the substrates for a long time period is often impossible due to landfilling management operations. Therefore, GHG measurements using NFT-NSS chambers placed directly on substrates' surface could be an interesting option. Our objectives were to determine the relationships between CO 2 , CH 4 , and N 2 O fluxes measured with (F + ) and without (F-) a frame inserted in the substrates' surface and to develop correction factors for fluxes measured without a frame. Measurements were made at different PPMS landfill sites in the province of Québec, Canada. Stronger GHG flux relationships were observed at the provincial (across sites) than the specific site scale: the variance in GHG fluxes from F- chambers explained up to 80 % of variance in fluxes from F + chambers. The measured CO 2 , CH 4 , and N 2 O fluxes in F- chambers were on average 53, 78, and 63 % lower, respectively, than those estimated by the models at provincial scale. The correction factors developed with this approach could greatly extend the number of sites where in situ GHG measurements can be done and would help refining GHG inventories at the provincial and national levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry., Methods: The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols., Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols., Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 American Dental Hygienists' Association and the Canadian Dental Hygienists Association.)

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols. Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery., (Copyright © 2024 The American Dental Hygienists’ Association.)

Introduction: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis., Objective: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care., Methods: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today., Conclusion: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided., (© 2023. The Author(s).)

Abstract: In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Recycling is a commonly acknowledged strategy to reduce the environmental impacts linked to primary resource exploitation. Large regional variations can be observed in recycling processes' parameters, like efficiency, energy mix and treatment of rejects. Life-cycle assessment (LCA) is widely used to evaluate the environmental impacts of recycling processes, but existing studies are neither harmonized nor sufficient to provide a comprehensive geographical and technological coverage of recycling processes. The purpose of this research is to develop an efficient and iterative approach for the parametrized generation of semi-automated regionalized life-cycle inventories that take into account technological and geographical variabilities in the recycling sector. The regionalization framework is then applied to create a parametrized paper recycling regionalization tool. This tool is used in the results section to compare the national climate change impacts of recycling three paper grades. Results show a significant global warming impact variability between countries for recycled graphic paper (0.36 to 2.25 kg CO 2 -Eq/kg wastepaper recycled), newsprint (0.27 to 1.84 kg CO 2 -Eq/kg wastepaper recycled) and corrugated cardboard (0.28 to 1.68 kg CO 2 -Eq/kg wastepaper recycled) productions. A regionalized LCA of the international recycling of the mixed wastepaper exported from Quebec's (Canada) sorting centers is also performed with the tool and compared to the non-regionalized mixed wastepaper recycling process available in the ecoinvent database. Only nine midpoint ReCiPe impact categories remain environmentally advantageous compared to virgin paper production when applying the regionalization methodology, compared to sixteen when using the ecoinvent process, illustrating how regionalization can substantially influence LCA results., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Treat-to-target (T2T) recommendations for the use of systemic therapies (including biologics) in patients with moderate-to-severe plaque psoriasis have been published by a few groups of experts worldwide. However, there remains considerable variability in the choice of target severity measure and timing of milestones. To develop consensus recommendations for implementing T2T strategies for the management of moderate-to-severe plaque psoriasis using biologics. An expert group of Canadian dermatologists (the Committee) convened to develop a T2T consensus statement. They held a virtual meeting during which a preliminary set of criteria was created. These criteria were then reviewed, modified, and recirculated until unanimous agreement was achieved. The Committee agreed that defining treatment target is multidimensional and should reflect objective severity measures, as well as clinician and patient-reported outcomes. The Committee unanimously proposes a criterion-based system for determining the achievement of treatment target. The proposed T2T approach presented here provides a clinical framework for defining treatment success, measuring progress toward treatment success, recognizing when treatment modifications are warranted, and recommending treatment optimization strategies., (© 2022 Wiley Periodicals LLC.)

Objective: This study assessed the features of the 100 most-cited papers on oral health-related quality of life (OHRQoL)., Methods: The 100 most-cited OHRQoL papers were collected from Web of Science, adopting a combined keyword search strategy. Google Scholar and Scopus databases were searched to compare citations. The following data were extracted from papers: title of the paper, number of citations, authorship, country, year of publication, title of the journal, study design, sample size, topic and OHRQoL instruments used. Graphical bibliometric networks were created using VOSviewer software., Results: The number of citations of the top 100 most-cited OHRQoL papers ranged from 73 to 949. Fifty-six papers received at least 100 citations and two received more than 400 citations. Most papers were from Canada (23%) and had been published in Community Dentistry and Oral Epidemiology (37%). David Locker was the most-cited author (25 papers; 3,521 citations). The cross-sectional study design was the most common (68%). The impact of oral health conditions on OHRQoL (43%) was the most frequent topic, and the Oral Health Impact Profile (OHIP) was the most commonly used OHRQoL instrument (48%)., Conclusions: This bibliometric analysis highlighted the characteristics of the 100 most-cited OHRQoL papers, demonstrating that this field is far from saturated. This list of the most-cited articles can provide a reference point to guide oral health research, education and services., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.

Aim: The aim of this position paper is to investigate the current state of the evidence for proposed associations between periodontitis and rheumatoid arthritis, Alzheimer's disease, obesity, inflammatory cancers, and renal disease using a narrative review approach. This is the last of a series of 5 position papers from the Canadian Dental Hygienists Association (CDHA) on the relationship between periodontitis and systemic conditions., Methods: Individual literature searches were conducted for each of the 5 proposed linkages and limited to human studies, with a preference for systematic reviews (SRs) and prospective studies, in the English language, published between 2015 and 2021, focused on associations between 1) periodontitis and rheumatoid arthritis; 2) periodontitis and Alzheimer's disease/cognitive impairment; 3) periodontitis and obesity; 4) periodontitis and inflammatory cancers; and 5) periodontitis and chronic kidney disease. Databases searched were PubMed, MEDLINE/OVID, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Web of Science., Results: A total of 39 papers were selected for discussion, including 6 SRs for rheumatoid arthritis; 7 SRs for Alzheimer's disease/cognitive impairment; 11 SRs, 1 meta-review of SRs, and 1 population-based cohort study for obesity; 9 SRs for inflammatory cancers; and 4 SRs for kidney disease., Conclusions: The evidence for the 5 proposed associations varied in strength, with obesity being most strongly associated with periodontal disease. More robust studies are recommended to clarify the exact nature of these associations., Competing Interests: The author has declared no conflicts of interest., (Copyright © 2022 CDHA | ACHD.)

Summary Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-described intervention for noncompressible torso hemorrhage. Several Canadian centres have included REBOA in their hemorrhagic shock protocols. However, REBOA has known complications and equipoise regarding its use persists. The Canadian Collaborative on Urgent Care Surgery (CANUCS) comprises surgeons who provide acute trauma care and leadership in Canada, with experience in REBOA implementation, use, education and research. Our goal is to provide evidence- and experience-based recommendations regarding institutional implementation of a REBOA program, including multidisciplinary educational programs, attention to device and care pathway logistics, and a robust quality assurance program. This will allow Canadian trauma centres to maximize patient benefits and minimize risks of this potentially life-saving technology., Competing Interests: Competing interests: Andrew Kirkpatrick has consulted for Zoll, Innovative Trauma Care, CSL Behring and SAM Medical Corporations, and is the principal investigator of a prospective randomized controlled trial that is partially supported by the Acelity Corporation (https://clinicaltrials.gov/ct2/show/NCT03163095). No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Introduction: Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on-site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on-site drug testing technologies., Methods: Paper spray mass spectrometry was used to provide on-site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2-day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components., Results: During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4-anilino-N-phenethyl-piperidine (4-ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co-measured with fentanyl, and in seven cases it was detected alone., Discussion and Conclusions: The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on-site drug checking methods and harm reduction services., (© 2021 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Over 64 billion paper-plastic laminate (PPL) coffee cups are consumed between the United States and Canada annually, the majority accumulating in landfills due to a hydrophobic plastic inner-lining. Recycling can mitigate environmental damage and provide economic value from repurposed products. We found that standard repulping methods were insufficient to separate fiber from plastic due to the low intensity of treatment. To increase process intensity, we mechanically refined shredded PPL coffee cups and Kraft eucalyptus sheets (control) at 2%, 3%, and 4% consistencies with three passes to determine the energy required to separate fibers from plastic and the effects on fiber quality. 2% and 3% consistency PPL cups measured under 40 kWh/tonne of input material for one refiner pass and ∼ 80 kWh/tonne for 4% consistency PPL cups. Recovered fiber fraction totaled 87.7%, 85.3%, and 80.5% of input mass of Kraft eucalyptus and 72.3%, 72.6%, and 79.6% of input mass of PPL cups at 2%, 3%, and 4% consistency, respectively. Fines content of PPL cups jumped from 8% pre-refining to ∼ 30% post-refining while Kraft eucalyptus fibers were unaffected, suggesting that breaking the plastic-fiber bonds results in fines generation. Mean fiber length of PPL cups slightly decreased with consistency and tensile strength improved. Freeness decreased with consistency only in PPL cup samples. These results demonstrate a low energy requirement to effectively separate fiber and plastics in PPL cups as well as minimal impact on fiber quality using existing refining technology, and provides an estimate of the financial costs of local recycling efforts., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: We evaluated reporting completeness and transparency in randomized controlled trials (RCTs) conducted using administrative data based on 2021 CONSORT Extension for Trials Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria., Study Design and Setting: MEDLINE and the Cochrane Methodology Register were searched (2011 and 2018). Eligible RCTs used administrative databases for identifying eligible participants or collecting outcomes. We evaluated reporting based on CONSORT-ROUTINE, which modified eight items from CONSORT 2010 and added five new items., Results: Of 33 included trials (76% used administrative databases for outcomes, 3% for identifying participants, 21% both), most were conducted in the United States (55%), Canada (18%), or the United Kingdom (12%). Of eight items modified in the extension; six were adequately reported in a majority (>50%) of trials. For the CONSORT-ROUTINE modification portion of those items, three items were reported adequately in >50% of trials, two in <50%, two only applied to some trials, and one only had wording modifications and was not evaluated. For five new items, four that address use of routine data in trials were reported inadequately in most trials., Conclusion: How administrative data are used in trials is often sub-optimally reported. CONSORT-ROUTINE uptake may improve reporting., Competing Interests: Declaration of Competing Interests All authors have completed the ICJME uniform disclosure form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, (Copyright © 2021. Published by Elsevier Inc.)

This paper investigates the role of admission forms in the regulation of asylum confinement in the second half of the nineteenth century. Taking the Toronto Lunatic Asylum as a case study it traces the evolution of the forms' content and structure during the first decades of this institution. Admission forms provide important material for understanding the medico-legal assessment of lunacy in a certain jurisdiction. First, they show how the description of insanity depended on a plurality of actors. Second, doctors were not necessarily required to indicate symptoms of derangement. Third, patients' relatives played a fundamental role in providing clinical information. From an historiographical perspective, this paper invites scholars to consider the function of standardized documents in shaping the written identity of patients.

Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Patient reported outcome measures (PROMs) provide valuable insight on patients' well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to (a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; (b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and (c) gather feedback on user experience., Methods: Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95 % Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes., Results: 196 patients participated in this project. Scores on the forms had high ICC agreement > 0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83 % of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10 % of respondents suggested improvements to improve the user interface., Conclusions: E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.

Introduction: Canada promulgated mandatory front-of-pack labelling (FOPL) regulations in 2022, requiring pre-packaged foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, sugars) to display a "high-in" nutrition symbol. However, there is limited evidence on how Canadian FOPL (CAN-FOPL) regulations compare to other FOPL systems and dietary guidelines. Therefore, the objectives of the study were to examine the diet quality of Canadians using the CAN-FOPL dietary index system and its alignment with other FOPL systems and dietary guidelines., Methods: Nationally representative dietary data from the 2015 Canadian Community Health Survey-Nutrition survey ( n  = 13,495) was assigned dietary index scores that underpin CAN-FOPL, Diabetes Canada Clinical Practice (DCCP) Guidelines, Nutri-score, Dietary Approaches to Stop Hypertension (DASH) and Canada's Food Guide (Healthy Eating Food Index-2019 [HEFI-2019]). Diet quality was examined by assessing linear trends of nutrient intakes across quintile groups of CAN-FOPL dietary index scores. The alignment of CAN-FOPL dietary index system compared with other dietary index systems, with HEFI as the reference standard, was examined using Pearson's correlations and к statistics., Results: The mean [95% CI] dietary index scores (range: 0-100) for CAN-FOPL, DCCP, Nutri-score, DASH, and HEFI-2019 were 73.0 [72.8, 73.2], 64.2 [64.0, 64.3], 54.9 [54.7, 55.1], 51.7 [51.4, 51.9], and 54.3 [54.1, 54.6], respectively. Moving from the "least healthy" to the "most healthy" quintile in the CAN-FOPL dietary index system, intakes of protein, fiber, vitamin A, vitamin C, and potassium increased, while intakes of energy, saturated fat, total and free sugars, and sodium decreased. CAN-FOPL showed moderate association with DCCP ( r  = 0.545, p  < 0.001), Nutri-score ( r  = 0.444, p  < 0.001),  and HEFI-2019 ( r  = 0.401, p  < 0.001), but poor association with DASH ( r  = 0.242, p  < 0.001). Slight to fair agreement was seen between quintile combinations of CAN-FOPL and all dietary index scores ( к  = 0.05-0.38)., Discussion: Our findings show that CAN-FOPL rates the dietary quality of Canadian adults to be healthier than other systems. The disagreement between CAN-FOPL with other systems suggest a need to provide additional guidance to help Canadians select and consume 'healthier' options among foods that would not display a front-of-pack nutrition symbol., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lee, Ahmed, Julia, Ng, Paper, Lou and L’Abbé.)

Purpose: To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers., Methods: 1836 adults (18-74 years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24 h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores., Results: Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46 mmol/dl, p trend  = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8 kg/m 2 vs. Q5 = 25.8 kg/m 2 , p trend  = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers., Conclusions: This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

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

Background: Twitter is rich in data for text and data analytics research, with the ability to capture trends., Objectives: This study examines Canadian tweets on marijuana legalization and terminology used. Presented as a case study, Twitter analytics will demonstrate the varied applications of how this kind of research method may be used to inform library practice., Methods: Twitter API was used to extract a subset of tweets using seven relevant hashtags. Using open-source programming tools, the sampled tweets were analysed between September to November 2018, identifying themes, frequently used terms, sentiment, and co-occurring hashtags., Results: More than 1,176,000 tweets were collected. The most popular hashtag co-occurrence, two hashtags appearing together, was #cannabis and #CdnPoli. There was a high variance in the sentiment analysis of all collected tweets but most scores had neutral sentiment., Discussion: The case study presents text-mining applications relevant to help make informed decisions in library practice through service analysis, quality analysis, and collection analysis., Conclusions: Findings from sentiment analysis may determine usage patterns from users. There are several ways in which libraries may use text mining to make evidence-informed decisions such as examining all possible terminologies used by the public to help inform comprehensive evidence synthesis projects and build taxonomies for digital libraries and repositories., (© 2023 Health Libraries Group.)

Housing prices in Canada have increased dramatically, giving rise to a housing affordability crisis. Young adults have been disproportionately affected by this crisis. To cope, many young adults have had to alter their living arrangements, contributing to the diversification of their living arrangements. Young adults' diverse living arrangements are the product of growing inequalities in young adults' economic prospects and access to family support. Extant work has yet to document how young adults' risk of having unaffordable housing varies according to their living arrangements. Our comparison of young adults' risk of having unaffordable housing according to their living arrangements reveals that co-residence with parents, relatives, or roommates reduces young adults' risk of having unaffordable housing. This protective effect is smaller for the foreign-born than the Canadian-born. The National Housing Strategy should allocate more resources to increase the supply of affordable housing earmarked for young adults, particularly the foreign-born who live alone or with children., (© 2024 The Authors. Canadian Review of Sociology/Revue canadienne de sociologie published by Wiley Periodicals LLC on behalf of Canadian Sociological Association/La Société canadienne de sociologie.)

Purpose: To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process., Method: The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation., Results: Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%-93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%-97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%-95%., Conclusions: The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties., (Copyright © 2023 the Association of American Medical Colleges.)

The COVID-19 pandemic led to the widespread adoption of virtual care-the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID-19 pandemic on health-care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportionately experiences sexual and mental health disparities in Canada. Adopting a sociomaterial theoretical perspective, we analysed 93 semi-structured interviews with GBQM (n = 93) in Montreal, Toronto and Vancouver, Canada, conducted between November 2020 and February 2021 (n = 42) and June-October 2021 (n = 51). We focused on explicating how the dynamic relations of humans and non-humans in everyday virtual care practices have opened or foreclosed different care capacities for GBQM. Our analysis revealed that the rapid expansion and implementation of virtual care during the COVID-19 pandemic enacted disruptions and challenges while providing benefits to health-care access among some GBQM. Further, virtual care required participants to change their sociomaterial practices to receive health care effectively, including learning new ways of communicating with providers. Our sociomaterial analysis provides a framework that helps identify what works and what needs to be improved when delivering virtual care to meet the health needs of GBQM and other diverse populations., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Background: Dietitians (RDs) are well-positioned to promote sustainable food systems and diets. This research aims to review the literature for how RDs in Canada define sustainability and determine the types of relevant activities that exist in practice as described in published literature., Methods: Using standardised scoping review methods, researchers searched CINAHL, ACASP, PubMed and ENVCOM databases to identify peer-reviewed articles and conducted a grey literature search to locate other publications related to sustainability in Canadian dietetic practice. Qualitative, thematic coding methods were used to examine definitions and existing practice. The PRISMA extension for scoping reviews guided reporting., Results: The search resulted in 1059 documents and, after screening, 11 peer-reviewed and 16 grey literature documents remained. Ten unique definitions were used, the most common being Sustainable Diets. Definitions were multidimensional, including environmental, social, economic and health dimensions, and 31 unique subtopics. However, existing practice activities appear to reduce actions to one to two dimensions. Existing practice areas well-reflected include Food and Nutrition Expertise, Management and Leadership, Food Provision and Population Health Promotion. Notable gaps include action in Professionalism and Ethics and Nutrition Care., Conclusions: No single definition supports all professional contexts, and agency in choice of language to define the work is helpful for contextual clarity. Strengthening practitioners' ability to analyse issues using systems thinking and applying this in practice will help to address challenges and reduce risks of trade-offs. Updates to competency standards that reflect the breadth of existing activities, as well as curricular supports or practice standards, are needed., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Using US National Education Longitudinal Study (NELS) data, we explore how parental education and primary students' perceptions of their teachers interact to impact students' self-efficacy in mathematics. Our results demonstrate that students tend to have higher self-efficacy if they perceive that their teacher promotes the importance of mathematics. This relationship holds regardless of parental education, though it is strongest for children of parents without a university education. Children of less educated parents also tend to have lower self-efficacy if they attend private schools, which typically have high average parental socio-economic status (SES). School type has no discernable impact on children of university-educated parents. These findings are highly relevant to the Canadian context, which is characterized by schools being stratified by SES and the high importance of STEM education for occupational outcomes., (© 2023 Canadian Sociological Association/La Société canadienne de sociologie.)

Objectives: Although the cyclic nature of bipolarity is almost by definition a network system, no research to date has attempted to scrutinize the relationship of the two bipolar poles using network psychometrics. We used state-of-the-art network and machine learning methodologies to identify symptoms, as well as relations thereof, that bridge depression and mania., Methods: Observational study that used mental health data (12 symptoms for depression and 12 for mania) from a large, representative Canadian sample (the Canadian Community Health Survey of 2002). Complete data (N = 36,557; 54.6% female) were analysed using network psychometrics, in conjunction with a random forest algorithm, to examine the bidirectional interplay of depressive and manic symptoms., Results: Centrality analyses pointed to symptoms relating to emotionality and hyperactivity as being the most central aspects of depression and mania, respectively. The two syndromes were spatially segregated in the bipolar model and four symptoms appeared crucial in bridging them: sleep disturbances (insomnia and hypersomnia), anhedonia, suicidal ideation, and impulsivity. Our machine learning algorithm validated the clinical utility of central and bridge symptoms (in the prediction of lifetime episodes of mania and depression), and suggested that centrality, but not bridge, metrics map almost perfectly onto a data-driven measure of diagnostic utility., Conclusions: Our results replicate key findings from past network studies on bipolar disorder, but also extend them by highlighting symptoms that bridge the two bipolar poles, while also demonstrating their clinical utility. If replicated, these endophenotypes could prove fruitful targets for prevention/intervention strategies for bipolar disorders., (© 2023 The Authors. Bipolar Disorders published by John Wiley & Sons Ltd.)

This paper investigates the long-run relationship between health care expenditures (HCE) and income using Canadian provincial data spanning a period of 40 years from 1981 to 2020. We study the non-stationary and cointegration properties of HCE and income and estimate the long-run income elasticities of HCE. Using heterogeneous panel models that incorporate cross-section dependence via unobserved common correlated factors to capture global shocks, we estimate long-run income elasticities that lie in the 0.11-0.16 range. Our results indicate that health care is a necessity good for Canada. These elasticity estimates are much smaller than those estimated in other studies for Canada. We find that HCE and income in Canada are cointegrated and that short-run changes in federal transfers significantly and positively affect HCE., (© 2023 John Wiley & Sons Ltd.)

This paper investigates the effects of a mandatory, universal prescription drug insurance policy on health behaviors and outcomes within a public health care system providing physician and hospital services free of charge. Using Canadian longitudinal data, we show that the reform improved individuals' general health while reducing body mass index and smoking. However, the program also increased drinking and had no significant impact on mental health, physical activity, or preventive care. We also examine the mechanisms through which these effects can play a role, as well as the heterogeneous effects. Estimates suggest that the policy decreased SES-based disparities in health., (© 2023 John Wiley & Sons Ltd.)

Purpose: Using data from a randomized controlled trial for treatment of prescription-type opioid use disorder in Canada, this study examines sensitivity to change in three preference-based instruments [EQ-5D-3L, EQ-5D-5L, and the Health Utilities Index Mark 3 (HUI3)] and explores an oft-overlooked consideration when working with contemporaneous responses for similar questions-data quality., Methods: Analyses focused on the relative abilities of three instruments to capture change in health status. Distributional methods were used to categorize individuals as 'improved' or 'not improved' for eight anchors (seven clinical, one generic). Sensitivity to change was assessed using area under the ROC (receiver operating characteristics) curve (AUC) analysis and comparisons of mean change scores for three time periods. A 'strict' data quality criteria, defined a priori, was applied. Analyses were replicated using 'soft' and 'no' criteria., Results: Data from 160 individuals were used in the analysis; 30% had at least one data quality violation at baseline. Despite mean index scores being significantly lower for the HUI3 compared with EQ-5D instruments at each time point, the magnitudes of change scores were similar. No instrument demonstrated superior sensitivity to change. While six of the 10 highest AUC estimates were for the HUI3, 'moderate' classifications of discriminative ability were identified in 12 (of 22) analyses for each EQ-5D instrument, compared with eight for the HUI3., Conclusion: Negligible differences were observed between the EQ-5D-3L, EQ-5D-5L, and HUI3 regarding the ability to measure change. The prevalence of data quality violations-which differed by ethnicity-requires further investigation., (© 2023. The Author(s).)

This paper focuses on the engineering profession in Canada, a regulated field with a large proportion of internationally trained professionals. Using Canadian census data, this study addresses two main questions. First, I ask whether immigrant engineers who were trained abroad are at increased disadvantage in gaining access (1) to employment in general, (2) to the engineering field, and (3) to professional and managerial employment within the field. Second, I ask how immigration status and the origin of training intersect with gender and visible minority status to shape immigrant engineers' occupational outcomes. The results reveal that immigrant engineers who were trained abroad are at increased risk of occupational mismatch and this risk is two-fold and intersectional. First, they are at a disadvantage to enter the engineering field. Second, those employed in the engineering field are more likely to occupy technical positions. These forms of disadvantage intensify and diversify for women and racial/ethnic minority immigrants. The paper concludes with a discussion of immigrants' skills transferability in regulated fields from an intersectional perspective., (© 2023 The Authors. Canadian Review of Sociology/Revue canadienne de sociologie published by Wiley Periodicals LLC on behalf of Canadian Sociological Association/La Société canadienne de sociologie.)

This article analyzes the educational pathways of Black Canadian immigrant students in Québec with Sub-Saharan African and Caribbean backgrounds. Both racialized groups have been targets of educational and social discrimination and segregation, which compromise their educational pathways. The results obtained from the longitudinal data however, show that some of these students are able to overcome such obstacles. Although they are more susceptible to experiencing major academic difficulties and lag due to grade repetition, and less likely to attend private institutions or to be admitted to enriched programs in public schools, these students have access to college in a proportion comparable to that of their peers whose parents are non-immigrants. This supports the hypothesis of resilience put forward by some authors such as Krahn and Taylor (2005) regarding Canadian students from Sub-Saharan African and Caribbean immigrant families. However, the situation is somewhat reversed with regard to obtaining a college diploma and access to university. They are less likely to have entered university and obtained a postsecondary diploma 10 years after entering secondary school. From this perspective, the resilience hypothesis should be nuanced. In short, their educational pathways are characterized by a dynamic of interaction between the cumulative disadvantage of belonging to a racialized minority and the compensatory benefit of resilience., (© 2023 The Authors. Canadian Review of Sociology/Revue canadienne de sociologie published by Wiley Periodicals LLC on behalf of Canadian Sociological Association/La Société canadienne de sociologie.)

In this paper, we examine the intersections of parental support and family socioeconomic background within an undergraduate sample (N = 596) in a mid-sized Canadian Prairie city. Coresidence, financial support, and parental and professional financial advice are examined as types of 'family capital' that may be distributed unequally across socioeconomic groups. In keeping with previous literature, findings showed that students whose parents had university education and higher incomes received more robust coverage of their housing and school expenses. Students whose parents were university-educated were also more likely to be living with a parent, though no relationship was found between parental income and coresidence. Contrasting with previous literature, few relationships were found between socioeconomic background and receipt or influence of financial advice. These results contribute to the literature by generalising claims about family capital to a Canadian student sample, where relatively few studies have empirically examined intergenerational transfers as mechanisms for transmitting privilege during the transition to adulthood. With increasing demands for higher education and simultaneous declines in government subsidisation of its costs, disparate access to family capital is likely to intensify the reproduction of social inequality across generations., (© 2023 Canadian Sociological Association/La Société canadienne de sociologie.)

This study offers insights into lifetime earnings growth differences between individuals with and without childhood-onset disabilities (COD) defined as disabilities whose onset occurred before an individual's 16th birthday. We use a newly available database linking data from the 2017 Canadian Survey of Disability with individual income tax records covering a period of over 3 decades. We estimate the average earnings growth profiles of individuals with COD from the age when individuals generally enter the labor market to the age when most retire. The main finding of our study is that individuals with COD experience very little earnings growth when they are in their mid-30 and 40s while the earnings of those without COD grow steadily until they reach their late 40s and early 50s. The largest earnings growth differences between individuals with and without COD are observed for male university graduates., (© 2023 His Majesty the King in Right of Canada. Health Economics © 2023 John Wiley & Sons Ltd.)

Purpose: The objective of this study was to describe some components of the perioperative practice in liver transplantation as reported by clinicians., Methods: We conducted a cross-sectional clinical practice survey using an online instrument containing questions on selected themes related to the perioperative care of liver transplant recipients. We sent email invitations to Canadian anesthesiologists, Canadian surgeons, and French anesthesiologists specialized in liver transplantation. We used five-point Likert-type scales (from "never" to "always") and numerical or categorical answers. Results are presented as medians or proportions., Results: We obtained answers from 130 participants (estimated response rate of 71% in Canada and 26% in France). Respondents reported rarely using transesophageal echocardiography routinely but often using it for hemodynamic instability, often using an intraoperative goal-directed hemodynamic management strategy, and never using a phlebotomy (medians from ordinal scales). Fifty-nine percent of respondents reported using a restrictive fluid management strategy to manage hemodynamic instability during the dissection phase. Forty-two percent and 15% of respondents reported using viscoelastic tests to guide intraoperative and postoperative transfusions, respectively. Fifty-four percent of respondents reported not pre-emptively treating preoperative coagulations disturbances, and 91% reported treating them intraoperatively only when bleeding was significant. Most respondents (48-64%) did not have an opinion on the maximal graft ischemic times. Forty-seven percent of respondents reported that a piggyback technique was the preferred vena cava anastomosis approach., Conclusion: Different interventions were reported to be used regarding most components of perioperative care in liver transplantation. Our results suggest that significant equipoise exists on the optimal perioperative management of this population., (© 2023. Canadian Anesthesiologists' Society.)

Background: Network meta-analyses (NMAs) are statistical techniques used to synthesize data from multiple studies and compare the effectiveness of different interventions for a particular disease or condition. They have gained popularity in recent years as a tool for evidence-based decision making in healthcare. Whether publications in NMAs have an increasing trend is still unclear. This study aimed to investigate the trends in the number of NMA articles over the past 10 years when compared to non-NMA articles., Methods: The study utilized data from the Web of Science database, specifically searching for articles containing the term "meta-analysis" published between 2013 and 2022. The analysis examined the annual number of articles, as well as the countries, institutions, departments, and authors associated with the articles and the journals in which they were published. Ten different visualization techniques, including line charts, choropleth maps, chord diagrams, circle packing charts, forest plots, temporal heatmaps, impact beam plots, pyramid plots, 4-quadrant radar plots, and scatter plots, were employed to support the hypothesis that the number of NMA-related articles has increased (or declined) over the past decade when compared to non-NMA articles., Results: Our findings indicate that there was no difference in mean citations or publication trends between NMA and non-NMA; the United States, McMaster University (Canada), medical schools, Dan Jackson from the United Kingdom, and the Journal of Medicine (Baltimore) were among the leading entities; NMA ranked highest on the coword analysis, followed by heterogeneity, quality, and protocol, with weighted centrality degrees of 32.51, 30.84, 29.43, and 24.26, respectively; and the number of NMA-related articles had increased prior to 2020 but experienced a decline in the past 3 years, potentially due to being overshadowed by the intense academic focus on COVID-19., Conclusion: It is evident that the number of NMA articles increased rapidly between 2013 and 2019 before leveling off in the years following. For researchers, policymakers, and healthcare professionals who are interested in evidence-based decision making, the visualizations used in this study may be useful., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

The weight of evidence suggests that articles written by men and women receive citations at comparable rates. This suggests that research quality or gender-based bias in research evaluation and citing behaviors may not be the reason why academic women accumulate fewer citations than men at the career level. In this article, I outline a career perspective that highlights women's disadvantages in career progression as the root causes for the gender citation gap. I also consider how the gender citation gap may perpetuate the unequal pay between genders in science. My analysis of two different datasets, one including paper and citation information for over 130,000 highly cited scholars during the 1996-2020 period and another including citation and salary information for nearly 2,000 Canadian scholars over the 2014-2019 period, shows several important findings. First, papers written by women on average receive more citations than those written by men. Second, the gender citation gap grows larger with time as men and women progress in their careers, but the opposite pattern holds when research productivity and collaborative networks are considered. Third, higher citations lead to higher pay, and gender differences in citations explain a significant share of the gender wage gap. Findings demonstrate the critical need for more attention toward gender differences in career progression when investigating the causes and solutions for gender disparities in science., (© 2023 Canadian Sociological Association/La Société canadienne de sociologie.)

Background: Cooking is a substantial contributor to air pollutant exposures in many residences. Effective use of kitchen ventilation can mitigate exposure; however, information on its availability, usage, and potential to increase its use across the population has been limited., Objective: This study aimed to obtain nationally representative information on cooking methods, kitchen ventilation availability and usage, and the potential for education to increase effective usage., Methods: An online survey was sent to a representative sample of Canadian homes to collect data on cooking methods, the presence and use of mechanical kitchen ventilation devices, perceived device performance, and willingness to implement mitigation strategies. Responses were weighted to match key demographic factors and analyzed using non-parametric statistics., Results: Among the 4500 respondents, 90% had mechanical ventilation devices over the cooktop (66% of which were vented to the outside), and 30% reported regularly using their devices. Devices were used most often for deep-frying, followed by stir-frying, sautéing or pan-frying, indoor grilling, boiling or steaming. Almost half reported rarely or never using their ventilation devices during baking or oven self-cleaning. Only 10% were fully satisfied with their devices. More frequent use was associated with the device being vented to the outdoors, having more than two speed settings, quiet operation if only one speed, covering over half of the cooktop, and higher perceived effectiveness. After being informed of the benefits of kitchen ventilation, 64% indicated they would consider using their devices more often, preferentially using back burners with ventilation, and/or using higher ventilation device settings when needed., Impact: This study provides population-representative data on the most used cooking methods, kitchen ventilation availability and usage, and influencing factors in Canadian homes. Such data are needed for exposure assessments and evaluating the potential to mitigate cooking-related pollutant exposures via more effective use of kitchen ventilation. The data can be reasonably extrapolated to the United States, given the similarities in residential construction practices and cultural norms between the two countries., (© 2023. Crown.)

Rheumatic diseases are becoming increasingly prevalent in Canada, and its associated strain on the healthcare system is expected to increase over the next decades. Furthermore, there is an increasing body of evidence to suggest that access to rheumatology care is currently not meeting established quality of care benchmarks. To frame issues affecting access to care for rheumatology services in Canada, a proposed chronological framework from a rheumatology patient's perspective is proposed. Illustrating principles from a health policy lens including drawing from the stages heuristic framework and multiple streams theory, issues surrounding access to rheumatology assessment, to rheumatological investigations and lastly to appropriate treatment are explored. In particular, the current supply and demand mismatch within the rheumatology workforce presents challenges for patients in accessing rheumatic diseases providers. Potential policy solutions including increasing the pool of rheumatic diseases care providers, enhancing the clinical capacity with extended role providers and increasing uptake of virtual care are discussed. To ameliorate access to rheumatology investigations, the concept of provider education surrounding the appropriateness of investigations and merit-based funding are explored. Lastly, access to rheumatological treatment is framed using biologic therapies as an example, highlighting the policy challenges in biosimilar uptake and associated ethical and political considerations. By using a health policy lens to explore deficiencies within Canada's current system, the overarching goal of this analysis is to set the stage for reasoned and timely solutions in the future., (© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

This study examines the Canadian Code of Ethics for Registered Nurses as a discursive mechanism for shaping nurses' professional identity using a Foucauldian lens. Nurses are considered essential in healthcare, yet the nursing profession has struggled to be recognized for its discipline-specific knowledge and expertise and, as such, has remained the subject of and subject to the dominant discourses within healthcare and society generally. Developing a professional identity in nursing begins after the necessary education and training are achieved and embodies the profession's history, values, code of ethics, and expectations of the profession that distinguish it from other professions. Since nurses' professional identity is shaped through discourse, it raises the question of whether there are spaces to reconceptualize nurses' subject position within health care. Since professional identity is considered the embodiment of knowledge and practice, the code of ethics bears examination both for its effect on nurses' professional identity and as a potential site from which to challenge hegemonic assumptions. This article discusses the concept of professional identity in nursing and its development through the discursive formations in the code of ethics. The sources of power/knowledge are examined as both mechanisms of control and as spaces for change., (© 2022 John Wiley & Sons Ltd.)

A series of landmark experiments conducted throughout the 20 th century progressively localized the regions involved in consciousness to the reticular activating system (RAS) and its ascending projections. The first description of the RAS emerged in 1949 through seminal experiments performed by Moruzzi and Magoun in feline brainstems; additional experiments in the 1950s revealed connections between the RAS and the thalamus and neocortical structures. This knowledge has allowed for the explanation of disorders of consciousness with exquisite anatomic precision. The clinical relevance of the RAS is further apparent in modern definitions of brain death/death by neurologic criteria (BD/DNC), which require demonstration of the complete and permanent loss of capacity for consciousness as one of their core criteria. BD/DNC is currently understood across jurisdictions in terms of "whole brain" and "brainstem" formulations. Although their clinical examination between formulations is indistinguishable, policies for BD/DNC declaration may differ in the rare scenario of patients with isolated infratentorial brain injuries, in which ancillary testing is advised in the whole brain formulation but not the brainstem formulation. Canadian guidelines acknowledge that the distinction between whole brain and brainstem formulations is unclear with respect to clinical implications for patients with isolated infratentorial injuries. This has led to variability in Canadian clinicians' use of ancillary testing when the mechanism of BD/DNC is suspected to be an isolated infratentorial injury. The present narrative review highlights these concepts and explores implications for determination of BD/DNC in Canada, with specific emphasis on the RAS and its relevance to both formulations., (© 2023. The Author(s).)

Poverty continues to burden millions of Canadians each year, and social assistance (SA) is one program that provides last-resort financial assistance, conditional upon looking for and accepting work. Using tax panel data of SA recipients from across seven Canadian regions between 2000 and 2018, we model the probabilities of employment success (ES) across industry of employment, SA benefit amounts, unionization, and individual-level characteristics. We adopt an economic stance to explain reliance upon SA, examining the broader macroeconomic indicators of ES, and to demonstrate the factors associated with exiting SA. We find that many SA recipients do not present evidence of recent employment, indicating a disconnect between stated SA program aims and their outcomes. We provide evidence for increased SA benefits and unionization as significant predictors of ES of SA recipients., (© 2023 Canadian Sociological Association/La Société canadienne de sociologie.)

Aims and Objectives: This discursive paper provides a call to action from an international collective of Indigenous nurse academics from Australia, Canada, Aotearoa New Zealand and the USA, for nurses to be allies in supporting policies and resources necessary to equitably promote Indigenous health outcomes., Background: Indigenous Peoples with experiences of colonisation have poorer health compared to other groups, as health systems have failed to address their needs and preferences. Achieving health equity will require leadership from Indigenous nurses to develop and implement new systems of care delivery. However, little is known about how Indigenous nurses influence health systems as levers for change., Design: A Kaupapa Māori case study design., Methods: Using a Kaupapa Māori case study methodology, coupled with expert Indigenous nursing knowledge, we developed a consensus on key themes. Themes were derived from three questions posed across the four countries. Themes were collated to illustrate how Indigenous nurses have provided nursing leadership to redress colonial injustices, contribute to models of care and enhance the Indigenous workforce., Results: These case studies highlight Indigenous nurses provide strong leadership to influence outcomes for Indigenous Peoples. Five strategies were noted across the four countries: (1) Indigenous nationhood and reconciliation as levers for change, (2) Indigenous nursing leadership, (3) Indigenous workforce strategies, (4) Development of culturally safe practice and Indigenous models of care and (5) Indigenous nurse activism., Conclusions: In light of 2020 declared International Year of the Nurse and Midwife, we assert Indigenous nurses' work must be visible to support development of strategic approaches for improving health outcomes, including resources for workforce expansion and for implementing new care models., Relevance to Clinical Practice: Curating strategies to promote Indigenous nurse leaders around the world is essential for improving models of healthcare delivery and health outcomes for Indigenous Peoples., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

As a key component of overall health and quality of life, oral health is recognized by public health organizations globally as a basic human right. Dentists are oral health experts involved in the primary prevention of oral injury and the detection and management of oral diseases. As regulated healthcare professionals, dentists identify and treat dental caries, gum disease, oral cancers, and edentulism, among other conditions. Oral diseases that go undetected and/or untreated burden patients with increased severity of disease and worse health outcomes. The Canadian Dental Association (CDA) recommends routinely scheduled reexamination and preventive care as an essential component of maintaining optimal oral health. Investments by the federal government into dental services for high-risk groups have failed to resolve pervasive oral health disparities among Canadians related to dental care affordability, accessibility, and availability. Vulnerable groups across Canada, including children, seniors in long-term care, Indigenous peoples, new immigrants with refugee status, people with special needs, and the low-income population, have been identified as having challenges accessing regular dental care. Herein, an equity-focused commentary on the current climate of oral healthcare in Canada is presented. We outline how addressing disparities in Canadian dental care will require the engagement of physicians on multiple levels of care, negotiation with both dentists and policymakers, as well as sustained oral health data collection to inform provincial and national decision-making/strategies., (© 2022. The Author(s) under exclusive license to The Canadian Public Health Association.)

Although the number of students attending university has been steadily increasing over the past 20 years, discrepancies remain across racialized student groups. Students who immigrate to Canada also face a number of barriers to university participation. However, few studies investigate variations in university participation across racialized immigrant student groups. We draw on an intersectional approach to analyze student data from the Toronto District School Board. We employ multilevel logistic regression to examine if there are interactive effects of being both racialized and having an immigrant status on confirming a university enrollment. Looking at self-identified race and immigrant status of students in combination reveals that there are important differences in the likelihood of confirming and offer of university admission between several self-identified racial categories, depending on if they were foreign-born., (© 2023 Canadian Sociological Association/La Société canadienne de sociologie.)

Applying a mixed frequency vector autoregressive (MF-VAR) approach, we examine relationships between CO 2 emissions and economic growth from 1970Q1 to 2019Q4 among G7 countries. We incorporate primary energy consumption as a control variable, to avoid any bias from an omitted variable. Our empirical results, using forecast error variance decomposition and a Granger causality check, suggest that MF-VAR exhibits better explanatory ability over the more commonly used VAR model employing single frequency data. Results from LF-VAR exhibit a feedback loop connecting economic expansion and emissions of CO 2 with one-way Granger causality from primary energy consumption to growth of the economies studied. MF-VAR model results also indicate that, in G7 countries, economic expansion exhibits a one-way causal link to CO 2 emissions in Canada, UK, and US cases. Interestingly, MF-VAR shows feedback between economic expansion and primary energy use in Germany, while LF-VAR quantifies the link from economic growth to CO 2 emissions in Canada and from CO 2 to economic growth in the UK. Results raise implications for the G7 samples' policymakers., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study. The purpose of this study was to explore how physicians perceive cultural factors (individual, organizational, and systemic) that influence the use of clinical data to inform lifelong learning and self-initiated CPD activities., Methods: This qualitative study is part of an explanatory sequential mixed-methods study examining data-informed learning. Participants were psychiatrists and general surgeons from Canada and the United States. Recruitment occurred between April 2019 and November 2019, and the authors conducted semistructured telephone interviews between May 2019 and November 2019. The authors performed thematic analysis using an iterative, inductive method of constant comparative analysis., Results: The authors interviewed 28 physicians: 17 psychiatrists (61%) and 11 general surgeons (39%). Three major themes emerged from the continuous, iterative analysis of interview transcripts: (1) a strong relationship between data and trust, (2) a team-based approach to data-informed learning for practice improvement, and (3) a need for organizational support and advocacy to put data into practice., Conclusion: Building trust, taking a team-based approach, and engaging multiple stakeholders, such as data specialists and organizational leadership, may significantly improve the use of data-informed learning. The results are situated in the existing literature, and opportunities for future research are summarized., (Copyright © 2022 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

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