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As Canadian policy-makers recognize the urgency for concerted actions to reduce plastics (e.g., Canada’s involvement in the international plastics treaty negotiations, zero plastic waste strategy, and single-use plastics regulations), the healthcare sector must also consider a more sustainable plastics system. In this context, the potential for novel bioplastics to mitigate healthcare’s substantial plastic waste problem must be carefully interrogated. Our analysis examines the complexities of bioplastics, highlighting the technical challenges of identifying legitimate sustainable alternatives, and the practical barriers for implementing bioplastics as substitutes for consumable plastics in healthcare. We focus on the Canadian healthcare sector and regulatory landscape with the insights gained being applicable to other sectors and countries. Given the limitations identified, the focus on reducing consumption should remain the priority.

In an era of significant human and fiscal constraints, hospitals increasingly rely on industry representatives to fill gaps related to practice-based education. Given their dual sales and support functions, the extent to which education and support functions are, or ought to be, fulfilled by industry representatives is unclear. We conducted an interpretive qualitative study at a large, academic medical centre in Ontario, Canada, during 2021-2022, interviewing 36 participants across the organization with direct and varied experiences with industry-delivered education. We found that ongoing fiscal and human resource challenges prompted hospital leaders to outsource practice-based education to industry representatives, which created an expanded role for industry beyond initial product rollouts. Outsourcing, however, generated downstream costs to the organization and undermined the goals of practice-based education. To attract and retain clinicians, participants advocated for re-investment in practice-based education in-house, with a limited and supervised role for industry representatives.

Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals’ interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.

During the first year of the COVID-19 pandemic, a group of academic geographers got together across borders to share our varied experiences. In this paper we illustrate how this storying of pandemiahelped us critically and collaboratively understand, (re)imagine and reconfigure ways of living during a global pandemic. We were especially interested in exploring different forms and practices of collective thinking and academic labour, within and beyond the academy. This paper foregrounds emotions and lived experiences, power and positionality, natures, bodies, and relations, and how they have come to our attention in new, different, or more pronounced ways, through everyday geographies of pandemia. Our aim is to emphasise two important aspects: that pandemiais a state of being with/as/through pandemic, and, as a collective noun, pandemiacentres plurality, focusing on the potential to attend to the ways experiences of pandemic are redolent with multiple, overlapping exclusions and belongings, openings and closures.

In this article, on behalf of The Shadow Places Network, we outline a working manifesto of politics and practice. We mobilise the format of the manifesto to speak to an uncertain and damaged future, to begin to imagine other possible worlds. For feminist philosopher Val Plumwood, whose thinking inspires this network, shadow places are the underside of the capitalist fantasy, ‘the multiple disregarded places of economic and ecological support’. In turning towards shadow places, and the unjust and unsustainable processes that produce them, we call for an environmental humanities that reaches beyond abstraction, fosters new responsibilities, considers the uncomfortable, and generates reparative possibilities and alternative futures. We aim to continue to trace out a world of shadow places. We acknowledge that these shadow places cannot be known in full, but through a willingness to engage in careful conversation with the beings and places harmed by (or strategically shielded from) processes of the Anthropocene, we can learn how to relate to each other and these places in more just ways. Recognising that shadow places are impermanent and contingent, this working manifesto does not look to predetermine or prescribe but rather invites conversation, encounter and exchange. In so doing we choose to contribute to making different worlds possible by pursuing new collaborations, new methods and new politics.

The phrase, “the federal spending power,” identifies the federal government’s ability to spend in areas beyond its constitutional authority to legislate—a power that has supported the development of a national system of universal healthcare coverage in Canada. Even before the COVID-19 pandemic, this power was critical to the expansion of Canada’s narrow but deep basket of universally covered services. The challenges exposed by the pandemic mean that still more federal investment will be required. Yet for traditionalists, the material basis of this power is now constrained: the federal government may possess the constitutional authority to invest, but it lacks the fiscal capacity; some form of belt tightening—even austerity—will be necessary. As debates over public spending intensify, health leaders will need to address these questions. Depending on how they do so, health leaders will either support or detract from a healthy recovery.

Standardized approaches to measuring clinical utility will enable more robust evaluations of genetic tests. To characterize how clinical utility has been measured, this scoping review examined outcomes used to operationalize this concept in the context of genetic testing, spanning relevant literature (2015–2017). The search strategy and analysis were guided by the Fryback and Thornbury hierarchical model of efficacy (FT Model). Through searches in Ovid MEDLINE, EMBASE and Web of Science, 194 publications were identified for inclusion. Two coders reviewed titles, abstracts, and full texts to determine eligibility. Results were analyzed using thematic and frequency analyses. This review generated a catalog of outcomes mapped to the efficacy domains of the FT Model. The degree of representation observed in each domain varied by the clinical purpose and clinical indication of genetic testing. Diagnostic accuracy (68%), technical (28.4%), and patient outcome (28.4%) efficacy studies were represented at the highest rate. Findings suggest that the FT Model is suitable for the genetics context however domain refinements may be warranted. More diverse clinical settings, robust study designs, and novel strategies for measuring clinical utility are needed.

ObjectivesThe healthcare sector lags behind other industries in efforts to reduce its environmental footprint. This study aims to better understand how those who design new health technologies (devices, technical aids and information technologies) perceive and address environmental considerations in their practice.MethodsWe conducted in-depth interviews with engineers, industrial designers, entrepreneurs and clinicians (n=31) involved in the design, development and distribution of health innovations in Quebec and Ontario (Canada). A qualitative thematic data analysis identified similarities and variations across respondents’ viewpoints.ResultsInnovators’ views emphasise the following: (1) the double burden of supporting patient care and reducing the environmental impact of healthcare; (2) systemic challenges to integrating environmental considerations in health innovation design, development and use and (3) solutions to foster the development of environmental-friendly health innovations. Although innovators tend to prioritise patient care over the environment, they also call for public policies that can transform these two imperatives into a single duty to care.ConclusionsHealth innovators are uniquely positioned to tackle challenges and develop creative solutions. Policymakers and regulators should, however, actively steer the healthcare industry towards a more sustainable modus operandi by giving full attention to environmental considerations in health innovation design.

Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada. This research supports the claim that adopting and supporting reusable PPE systems throughout the health sector can, if used appropriately on an ongoing basis, provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs, domestic jobs, and improved environmental performance such as reduced waste and greenhouse gas emissions.

Purpose:Newborn screening (NBS) for cystic fibrosis (CF) can identify carriers, which is considered a benefit that enables reproductive planning. We examined the reproductive impact of carrier result disclosure of NBS for CF.Methods:We surveyed mothers of carrier infants after NBS (Time 1) and 1 year later (Time 2) to ascertain intended and reported communication of their infants’ carrier results to relatives, carrier testing for themselves/other children, and reproductive decisions. A sub-sample of mothers was also interviewed at Time 1 and Time 2.Results:The response rate was 54%. A little more than half (55%) of mothers underwent carrier testing at Time 1; another 40% of those who intended to undergo testing at Time 1 underwent testing at Time 2. Carrier result communication to relatives was high (92%), but a majority of participants did not expect the results to influence family planning (65%). All interviewed mothers valued learning their infants’ carrier results. Some underwent carrier testing and then shared results with family. Others did not use the results or used them in unintended ways.Conclusion:Although mothers valued learning carrier results from NBS, they reported moderate uptake of carrier testing and limited influence on family planning. Our study highlights the secondary nature of the benefit of disclosing carrier results of NBS.Genet Med 19 4, 403–411.

Newborn screening (NBS) for cystic fibrosis (CF) can identify carriers, which is considered a benefit that enables reproductive planning. We examined the reproductive impact of carrier result disclosure of NBS for CF.

Personal narratives are presented which explores experiences of various readers, which include getting married to a person sentenced to prison, starting of a technology company in Silicon Valley, and shifting to U.S. from India as an immigrant.

Newborn bloodspot screening is one of the most enduring and successful population screening initiatives. Yet technological innovation to permit simultaneous measurement of multiple biomarkers — and potentially, entire genomes — has spurred expansion and debate. Through a cross-jurisdictional comparison, we describe the varied roles and reach of screening-related governance structures in the United States, the United Kingdom, New Zealand and Canada, and highlight the distinct values and resources brought to bear by the genetics, public health and maternal-child health communities in adjudicating the benefits and burdens of expanded newborn screening. We call for the expansion of formal governance structures that are balanced in resources and perspective and mandated to ensure that the organization and delivery of newborn screening achieves optimal quality.

Post-disaster reconstruction relies on, and is shaped by, the good intentions of states, non-governmental organizations, and donors. These intentions, however, are inescapably framed by historical circumstances and cultural values. Consequently, post-disaster interventions can reinforce patterns of prejudice, injustice, and disadvantage that were entrenched in pre-disaster settings. Focusing on the experiences of Indigenous Rukai communities in southern Taiwan during recovery and reconstruction following Typhoon Morakot in 2009, this article explores the challenges faced in addressing Indigenous-specific concerns in post-disaster reconstruction and community development. We argue that institutional capacity (and capacity deficits) and the procedural vulnerability created in post-disaster responses are components of the risk landscape which require greater attention to diverse cultural values, protocols, and experiences in fostering resilient and inclusive disaster recovery approaches. In Taiwan, the particular complexities of Indigenous geographies, colonial and postcolonial circumstances, and contemporary political dynamics make developing approaches that are respectful of Indigenous cultural values, social aspirations, and political processes not only more difficult but also more important in shaping post-disaster community at multiple scales. Attentiveness to these values, aspirations, and processes generates opportunities for decreasing vulnerability to the extraordinary andthe everyday disasters that communities confront.

This study reports the implementation of a program for early onset disruptive behaviour (Webster- Stratton & Hammond, 1997) through a hospital– community agency partnership in a demographically highrisk community traditionally underserved for mental health services. Sixty-four families at the clinic site and 19 at the community site completed the program at similar rates. The community sample had significantly higher demographic risk (income, immigrant status, parental education). Both groups showed significant improvement on parent-rated disruptive child behaviour and parenting stress. Staff interviews indicated strong support for program continuation and identified areas needing further attention. The findings are discussed in terms of possible approaches to mental health promotion in high-risk communities.

ABSTRACTThis article engages experimentally with the idea of self-reflexivity in research. It stems from the reflections of three geographers who a decade ago undertook an Australian government consultancy, surveying public attitudes to forests. The consultancy project was part of the New South Wales Government's Regional Forest Agreement process which, amid much controversy, aimed to incorporate a deeper participation of stakeholders in decision-making processes. The article critically reflects on the context and production of academic research through a narrated script — a play, with actors and scenes — reconstructed from key moments or ‘flashpoints’ in the research process, when issues exposing the partiality of academic knowledge production were paramount. In adopting a ‘dramatic’ mode of communication, we intend to achieve two things: first, to capture in the article an acknowledgement that the production of academic knowledge incorporates hidden power relationships and alternative non-academic identities; and second, to allegorically represent the ways in which the process of conducting the research was itself a play within which the authors struggled to maintain integrity and enact agency. Although we hint at important ethical issues in research, it is left to readers to draw their own conclusions about how institutional positionalities and personal identities affected the academic knowledge production process.

This study reviews the development of a medical genetics research tradition in Toronto, Canada. This research tradition, what I call the “Ford Walker school,” was forged in the 1930s in an iconoclastic mold. It was female-dominated in an era when leading-edge science was definitely not “women's work.” It emerged in a leading research university, but in a country that lagged in the sciences. These social relations of gender and nation symbolized and sustained a marginality that was reinforced by the substantive concerns of members of this research school. They adopted a service orientation toward medicine, were sympathetic to heterodox approaches to genetic and medical science, and were principally reliant on a marginal research tool—dermatoglyphics. Despite this marginality, Norma Ford Walker was among the founding members of the institutions of human and medical genetics in North America in the postwar period. She forged a research tradition that served as the basis for further developments in medical genetics in Toronto and educated a generation of students, many of them women, who went on to populate and then institutionalize the growing science and practice of medical genetics in Canada. The heterodox approach of the early Ford Walker school was displaced as the field grew in the postwar period. Yet many members of the research school retained dermatoglyphic technique and used it to contribute to progress in medical cytogenetics. In this article, I explore why the history of this marginal research school is important. © 2002 Wiley-Liss, Inc.

Purpose To report a rare case of myeloid sarcoma infiltration of an aortic stent-graft causing chronic hemorrhage and mimicking stent-graft infection.Case Report A 90-year-old man presented 8 years after endovascular aneurysm repair with general malaise, nausea, abdominal pain, and hyperbilirubinemia. His inflammatory blood markers were elevated, and an abdominal computed tomography (CT) scan showed unusual fluid and soft tissue collection around the stent-graft. A presumptive diagnosis of stent-graft infection was made, and he was started on intravenous antibiotics because he was not fit for surgery. His condition gradually deteriorated in hospital. Four months later he died of sudden hemodynamic collapse and shock. Postmortem examination revealed large malignant periaortic lymphadenopathy with suggestion of stent-graft infiltration and chronic hemorrhage. Histology of the lymph nodes confirmed myeloid sarcoma.Conclusion Soft tissue and fluid collections around an aortic stent-graft on CT are not always indicative of a graft infection; malignant tumors, although rare, should be considered.

Abstract: We report a patient with a cyst of the posterior inter-articular joint that was decompressed using a bone biopsy Temno needle.

Presents the poem "After Love," by Fiona Miller.

Presents the poem "Security System," by Fiona Miller.

Presents the poem "A Different Way to Die," by Fiona Miller. First Line: If you are still for long enough, Last Line: in an arc on the ground.

presents the poem "This Boy," by Fiona Miller. First Line: is built like a ship, Last Line: is dive.

Presents the poem "Our Tempest," by Fiona Miller. First Line: In the darkest, fleeing moments of the morning; Last Line: while the tunnel of winter devours me whole.

Presents the poem "Spring Cleaning," by Fiona Miller.