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Background: The COVID-19 pandemic caused disruptions across healthcare systems globally exposing the precarious state of patient engagement across all levels of healthcare. While evidence is emerging to describe how engagement was affected across various settings, insights about how some organizations at the policy and practice level of healthcare were able to sustain or adapt patient engagement activities is lacking. Objective: This paper addresses the following research question: "How were healthcare, government, and patient partner organizations able to sustain or adapt patient engagement activities during the COVID-19 pandemic?" Methods: A qualitative descriptive study was conducted to understand how patient engagement activities were maintained or adapted in a variety of healthcare, government, and patient partner organizations in Canada throughout the pandemic. This analysis was part of a larger qualitative, multiple case study where one-to-one interviews were conducted with organizational leaders, managers and patient partners. Results: The following themes were identified as key aspects of maintaining or adapting patient engagement activities: 1) having an embedded organizational culture of patient engagement; 2) adapting patient engagement activities to focus on COVID-19 response efforts; 3) having patient partners who exercised leadership and advocacy to support patient care and experiences during the pandemic; and 4) leveraging virtual technology as a communication tool to engage patient partners. Conclusion: This paper highlights important insights that may be useful to other health care organizations on how to sustain or adapt patient engagement activities during a healthcare crisis. Having patient engagement embedded within an organization's culture supported by, but not limited to, infrastructure, resources, investments in dedicated staff and patient partner leadership, and communication strategies and tools enabled continued patient engagement activities during the pandemic. [ABSTRACT FROM AUTHOR]

Background: The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. Methods/Design: Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. Conclusion: The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families. [ABSTRACT FROM AUTHOR]

This paper builds on prior work exploring the use of risk-associated alternative healthcare (RAAH) in Canada. RAAH uptake was surveyed to explore the characteristics of adult RAAH users and the value of established psychometric instruments previously used in alternative healthcare studies in predicting RAAH behaviours: the Control Beliefs Inventory (CBI), the Reward Responsiveness Behavioural Activation System (RBAS) scale, the Positive Attitudes to Science (PAS) scale, the Satisfaction with Orthodox Medicine (SOM) scale, and the brief version of the Susceptibility to Persuasion-II (StP-II-B) scale. Findings suggest RAAH is influenced by gender, age, income, education, employment, chronic illness status, and ethnicity. Engagement in some form of RAAH was common (around 40%) and the most common types of RAAH use reported were physical manipulation and herbal/nutritional supplement use. Other higher-risk AH activities (such as use of toxins and physically invasive procedures) were also reported by about 5% of respondents. The StP-II-B and PAS instruments were predictive of the likelihood of engagement in RAAH behaviours, as illustrated by higher risk tolerance, desire for novelty, positive attitude to advertising and social influence, and positive beliefs about science. The CBI, RBAS, and SOM instruments were not predictive overall. However, the CBI and SOM instruments were predictive of engagement with physical manipulative RAAH activities, while the RBAS was predictive of herbal/nutritional RAAH engagement. These findings can help inform health professionals' understanding of public health-seeking behaviours with respect to risk. [ABSTRACT FROM AUTHOR]

Study design: Single-cohort longitudinal survey design. Objectives: To identify what ongoing impact the COVID-19 pandemic has on functioning and health in individuals with SCI. Using the ICF model as a guide, outcome measures were chosen to explore potential constructs and aspects of health and functioning which may have been affected by regulations. Setting: Online, Canada. Methods: Participants provided demographic and clinical characteristics at baseline. They completed standardized online measures at three time points, each roughly one month apart (June, July, and August of 2020). The measures assessed mental health, resilience, boredom, social support, technology use, life space, and participation. Repeated measures ANOVAs were used to identify longitudinal changes for each measure. Results: We collected data from 21 participants with SCI (mean age 54 years, 12 male). We found a large effect size for participation (η2 = 0.20), which increased over time. We also found medium effect sizes in both anxiety (η2 = 0.12) and social network usage (η2 = 0.12). Anxiety decreased over time and social networking usage fluctuated slightly but with an increase from time point one to time point two. Conclusion: The results indicate that individuals with spinal cord injury appear to be staying relatively stable during the pandemic with improvements in a few key aspects, such as potentially increased participation and decreased anxiety. The results also suggest that it is important to continue fostering ways for individuals with spinal cord injury to stay connected, engaged, and informed. [ABSTRACT FROM AUTHOR]

Objective: To conduct a time-cost analysis of formatting in scientific publishing. Design: International, cross-sectional study (one-time survey). Setting: Internet-based self-report survey, live between September 2018 and January 2019. Participants: Anyone working in research, science, or academia and who submitted at least one peer-reviewed manuscript for consideration for publication in 2017. Completed surveys were available for 372 participants from 41 countries (60% of respondents were from Canada). Main outcome measure: Time (hours) and cost (wage per hour x time) associated with formatting a research paper for publication in a peer-reviewed academic journal. Results: The median annual income category was US$61,000–80,999, and the median number of publications formatted per year was four. Manuscripts required a median of two attempts before they were accepted for publication. The median formatting time was 14 hours per manuscript, or 52 hours per person, per year. This resulted in a median calculated cost of US$477 per manuscript or US$1,908 per person, per year. Conclusions: To our knowledge, this is the first study to analyze the cost of manuscript formatting in scientific publishing. Our results suggest that scientific formatting represents a loss of 52 hours, costing the equivalent of US$1,908 per researcher per year. These results identify the hidden and pernicious price associated with scientific publishing and provide evidence to advocate for the elimination of strict formatting guidelines, at least prior to acceptance. [ABSTRACT FROM AUTHOR]

Background: Young adults aged 18–39 years commonly experience persistent side effects following cancer treatment that can impair their quality of life. Physical activity (PA) holds promise as a behavioral intervention to mitigate persistent side effects and improve quality of life. Yet, few young adults are active enough to incur these benefits and efforts to promote PA after cancer treatment ends are lacking. Therefore, we developed a novel theory-driven behavior change intervention to promote PA via videoconferencing technology in young adults who have completed cancer treatment, and are undertaking a pilot randomized controlled trial (RCT) to gather evidence to inform the design of a large, full-scale RCT. The specific aims of this parallel, two-arm pilot RCT are to: (1) assess intervention and trial protocol feasibility and acceptability; and (2) generate data on PA behavior. To promote transparency, improve reproducibility, and serve as a reference for forthcoming publication of results, we present the study protocol for this pilot RCT (version 7) within this paper. Methods: Young adults who have completed cancer treatment are being recruited from across Canada. After informed consent is obtained and baseline assessments are completed, participants are randomized to the intervention group (i.e., a 12-week behavior change intervention delivered via videoconferencing technology by trained PA counsellors) or usual care group (i.e., no intervention). Several feasibility outcomes covering enrollment, allocation, follow-up, and analysis are tracked by study staff. Acceptability is assessed through interviews exploring participants' experiences, thoughts, and perspectives of the trial protocol (i.e., intervention and usual care groups), as well as participants' views of the intervention and its mode of delivery (i.e., intervention group only) and PA counsellors' experiences delivering the intervention. PA behavior is measured using accelerometers at baseline (pre-randomization), post-intervention, and at follow-up (24 weeks post-baseline). Discussion: There are growing calls to develop interventions to support young adults' motivation to engage in PA and adopt an active lifestyle to improve their quality of life after cancer treatment ends. Real-time videoconferencing shows promise for disseminating behavior change interventions to young adults and addressing participation barriers. Considering the importance of establishing intervention and trial protocol feasibility and acceptability prior to evaluating intervention efficacy (or effectiveness), this pilot RCT is critical to understand how participants embrace, engage with, and complete the intervention and trial protocol. Indeed, these data will help to determine which refinements, if any, are required to the intervention and trial protocol (e.g., implementation approach, evaluation methods) prior to a large, full-scale RCT aiming to test the effects of the intervention on PA behavior. Additionally, the PA behavior data collected will be useful to inform the sample size calculation for a large, full-scale RCT. Trial registration: The trial was registered with the ClinicalTrials.gov database (ID: NCT04163042) on November 14, 2019, prior to the start of the trial in February, 2021. [ABSTRACT FROM AUTHOR]

Monogenic, high penetrance syndromes, conferring an increased risk of malignancies in multiple organs, are important contributors to the hereditary burden of cancer. Early detection and risk reduction strategies in patients with a cancer predisposition syndrome can save their lives. However, despite evidence supporting the benefits of early detection and risk reduction strategies, most Canadian jurisdictions have not implemented programmatic follow up of these patients. In our study site in the province of Newfoundland and Labrador (NL), Canada, there is no centralized, provincial registry of high-risk individuals. There is no continuity or coordination of care providing cancer genetics expertise and no process to ensure that patients are referred to the appropriate specialists or risk management interventions. This paper describes a study protocol to test the feasibility of obtaining and analyzing patient risk management data, specifically patients affected by hereditary breast ovarian cancer syndrome (HBOC; BRCA 1 and BRCA 2 genes) and Lynch syndrome (LS; MLH1, MSH2, MSH6, and PMS2 genes). Through a retrospective cohort study, we will describe these patients' adherence to risk management guidelines and test its relationship to health outcomes, including cancer incidence and stage. Through a qualitative interviews, we will determine the priorities and preferences of patients with any inherited cancer mutation for a follow up navigation model of risk management. Study data will inform a subsequent funding application focused on creating and evaluating a research registry and follow up nurse navigation model. It is not currently known what proportion of cancer mutation carriers are receiving care according to guidelines. Data collected in this study will provide clinical uptake and health outcome information so gaps in care can be identified. Data will also provide patient preference information to inform ongoing and planned research with cancer mutation carriers. [ABSTRACT FROM AUTHOR]

Background: Cancer is a leading cause of disease burden worldwide and the first cause of mortality in Canada with 30.2% of deaths attributable to cancer. Given aging of the population and the improvement of prevention and treatment protocols, the number of cancer survivors is steadily increasing. These individuals have unique physical and mental health needs some of which can be addressed by integrating physical activity promotion into ongoing and long-term care. Despite the benefits of being active, delivery of PA programs for cancer patients in both clinical and community settings remains challenging. This knowledge-to-action protocol–called Kiné-Onco–aims to develop a practice guideline for the delivery, implementation, and scaling-up of cancer-specific physical activity promotion programs and services in clinical and community settings located in Québec, Canada. Method: The Kiné-Onco project involves knowledge synthesis of scientific and grey literature to establish the benefits and added value of physical activity for cancer patients and survivors, describes current practices in delivering physical activity programs, analyses quantitative data from electronic health records (EHR) of patients participating in a novel hospital-based physical activity program, collects and analyses qualitative data from patients and healthcare providers interviews about lived experience, facilitators, and barriers to physical activity promotion, outlines deliberative workshops among multidisciplinary team members to develop implementation guidelines for physical activity promotion, and summarizes a variety of knowledge transfer and exchange activities to disseminate the practice guidelines. Discussion: This paper describes the protocol for a knowledge-to-action project aimed at producing and sharing actionable evidence. Our aim is that physical activity promotion programs and services be scaled up in such a way as to successfully integrate physical activity promotion throughout cancer treatment and survivorship in order to improve the physical and mental health of the growing population of individuals having received a cancer diagnosis. [ABSTRACT FROM AUTHOR]

In the last decade, several cases affected by Developmental Topographical Disorientation (DTD) have been described. DTD consists of a neurodevelopmental disorder affecting the ability to orient in the environment despite well-preserved cognitive functions, and in the absence of a brain lesion or other neurological or psychiatric conditions. Described cases showed different impairments in navigational skills ranging from topographic memory deficits to landmark agnosia. All cases lacked a mental representation of the environment that would allow them to use high-order spatial orientation strategies. In addition to the single case studies, a group study performed in Canada showed that the disorder is more widespread than imagined. The present work intends to investigate the occurrence of the disorder in 1,698 young Italian participants. The sample is deliberately composed of individuals aged between 18 and 35 years to exclude people who could manifest the loss of the ability to navigate as a result of an onset of cognitive decline. The sample was collected between 2016 and 2019 using the Qualtrics platform, by which the Familiarity and Spatial Cognitive Style Scale and anamnestic interview were administered. The data showed that the disorder is present in 3% of the sample and that the sense of direction is closely related to town knowledge, navigational strategies adopted, and gender. In general, males use more complex navigational strategies than females, although DTD is more prevalent in males than in females, in line with the already described cases. Finally, the paper discusses which protective factors can reduce DTD onset and which intervention measures should be implemented to prevent the spread of navigational disorders, which severely impact individuals' autonomy and social relationships. [ABSTRACT FROM AUTHOR]

Primary caregivers are the main mediators of care for children with an autism diagnosis in Canada, and the navigation process to gain access to autism-related services is known to be a major burden. These challenges to service access are compounded for newcomers to Canada, which include immigrants and refugees. The purpose of this scoping review is to describe the available research on Canadian newcomer caregiver experiences navigating and accessing autism-related services. After a systematic search and screening process, 28 studies were included. Data were extracted regarding the populations, study aims, and themes reported. Included studies characterized barriers and facilitators to service access and navigation specific to immigrants, while limited information was available for refugees. Based on the existing literature, the authors provide recommendations for possible research approaches, populations to include, and themes to examine in future research to promote health equity in Canadian autism service access. [ABSTRACT FROM AUTHOR]

Background: Public health services and systems research is under-developed in Canada and this is particularly the case with respect to research on local public health unit operational functioning and capacity. The purpose of this paper is to report on a study that will collect retrospective information on the local public health response to COVID-19 throughout Canada between 2020 and 2021. Methods/Design: The goal of the study is to develop and implement a study framework that will collect retrospective information on the local public health system response to the COVID-19 pandemic in Canada. This study will involve administering a mixed-method survey to Medical Health Officers/Medical Officers of Health in every local and regional public health unit across the country, followed by a process of coding and grouping these responses in a consistent and comparable way. Coded responses will be assessed for patterns of divergent or convergent roles and approaches of local public health across the country with respect to interventions in their response to COVID-19. The Framework Method of thematic analysis will be applied to assess the qualitative answers to the open-ended questions that speak to public health policy features. Discussion: The strengths of the study protocol include the engagement of Medical Health Officers/Medical Officers of Health as research partners and a robust integrated knowledge translation approach to further public health services and systems research in Canada. [ABSTRACT FROM AUTHOR]

The cannabis community typically uses the terms "Sativa" and "Indica" to characterize drug strains with high tetrahydrocannabinol (THC) levels. Due to large scale, extensive, and unrecorded hybridization in the past 40 years, this vernacular naming convention has become unreliable and inadequate for identifying or selecting strains for clinical research and medicinal production. Additionally, cannabidiol (CBD) dominant strains and balanced strains (or intermediate strains, which have intermediate levels of THC and CBD), are not included in the current classification studies despite the increasing research interest in the therapeutic potential of CBD. This paper is the first in a series of studies proposing that a new classification system be established based on genome-wide variation and supplemented by data on secondary metabolites and morphological characteristics. This study performed a whole-genome sequencing of 23 cannabis strains marketed in Canada, aligned sequences to a reference genome, and, after filtering for minor allele frequency of 10%, identified 137,858 single nucleotide polymorphisms (SNPs). Discriminant analysis of principal components (DAPC) was applied to these SNPs and further identified 344 structural SNPs, which classified individual strains into five chemotype-aligned groups: one CBD dominant, one balanced, and three THC dominant clusters. These structural SNPs were all multiallelic and were predominantly tri-allelic (339/344). The largest portion of these SNPs (37%) occurred on the same chromosome containing genes for CBD acid synthases (CBDAS) and THC acid synthases (THCAS). The remainder (63%) were located on the other nine chromosomes. These results showed that the genetic differences between modern cannabis strains were at a whole-genome level and not limited to THC or CBD production. These SNPs contained enough genetic variation for classifying individual strains into corresponding chemotypes. In an effort to elucidate the confused genetic backgrounds of commercially available cannabis strains, this classification attempt investigated the utility of DAPC for classifying modern cannabis strains and for identifying structural SNPs. [ABSTRACT FROM AUTHOR]

Injuries have become devastating and often under-recognized public health concerns. In Canada, injuries are the leading cause of potential years of life lost before the age of 65. The geographical patterns of injury, however, are evident both over space and time, suggesting the possibility of spatial optimization of policies at the neighborhood scale to mitigate injury risk, foster prevention, and control within metropolitan regions. In this paper, Canada's National Ambulatory Care Reporting System is used to assess unintentional and intentional injuries for Toronto between 2004 and 2010, exploring the spatial relations of injury throughout the city, together with Wellbeing Toronto data. Corroborating with these findings, spatial autocorrelations at global and local levels are performed for the reported over 1.7 million injuries. The sub-categorization for Toronto's neighborhood further distills the most vulnerable communities throughout the city, registering a robust spatial profile throughout. Individual neighborhoods pave the need for distinct policy profiles for injury prevention. This brings one of the main novelties of this contribution. A comparison of the three regression models is carried out. The findings suggest that the performance of spatial regression models is significantly stronger, showing evidence that spatial regressions should be used for injury research. Wellbeing Toronto data performs reasonably well in assessing unintentional injuries, morbidity, and falls. Less so to understand the dynamics of intentional injuries. The results enable a framework to allow tailor-made injury prevention initiatives at the neighborhood level as a vital source for planning and participatory decision making in the medical field in developed cities such as Toronto. [ABSTRACT FROM AUTHOR]

There is a paucity of population health data on the experiences of transgender, non-binary, and other gender minority gay, bisexual, and queer men, and Two-Spirit people in Canada. To address this gap, this article presents a socio-demographic and health profile of trans and non-binary participants from the community-based bilingual 2018 Sex Now Survey. Participants were recruited in-person from Pride festivals in 15 communities to self-complete an anonymous paper-and-pen questionnaire. To be eligible, participants needed to be at least 15 years old, live in Canada, either report a non-heterosexual sexual identity or report sex with a man in the past 5 years, and not report gender identity as a woman. Through community consultations the survey was inclusive of trans men, non-binary people, and Two-Spirit people. Three gender groups (cisgender, transgender, and non-binary) were created, and trans and non-binary participants were compared with their cisgender peers across a variety of demographic, mental health, sexual health, and general health indicators. Odds ratios were calculated to determine initial significance for categorical variables, and adjusted odds ratios were calculated to control for five possible confounders (age, ethnoracial identity, country of birth, sexual identity, and financial strain). Significant differences emerged across all sets of indicators, with many of these findings remaining significant after adjusting for confounding variables, including significantly higher reported rates of mental health challenges and sexual health service barriers for trans and non-binary participants compared to the cisgender group. Trans and non-binary participants were also more likely to be in polyamorous relationships. Collectively, our findings demonstrate that trans and non-binary people experience significant disadvantages compared with cisgender sexual minority men. Improved educational supports and employment protections, access to queer and gender affirming healthcare, and trauma-informed mental health services are needed to improve the health wellbeing of trans and non-binary people in Canada. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines condom use in penile-vaginal sexual intercourse among adults in Canada. Data and method: The Sex in Canada survey is a national survey of Canadian adults, ages 18+ (N = 2,303). The online survey used quota-based population sample matching of 2016 census targets for gender, age, region, language, visible minority status, and education level. We report general patterns of self-reported condom use, as well as results from zero-inflated negative binomial regression models on the relationship between condom use and social location, relationship status, and sexual health. Results: Condom use varies by gender, age, education, visible minority status, and relationship status. Use of condoms is related to the perception of risk of being diagnosed with a sexually transmitted infection in the next six months and to the experience of receiving lessons in condom use. No significant associations were found between condom use and region, rural/urban residence, income, or religion. Among men, but not women, condom use is associated with language preference, past diagnosis with a sexually transmitted infection, and self-reported sexual health. Conclusion: Canadian adults report using a condom in approximately 30% of their sexual encounters involving penile-vaginal sex. Condom use is highest among young adults. Single people use condoms more often than people with marital or common-law partners. Condom use is higher among those with higher levels of education, among people belonging to visible minorities relative to white people, and for men relative to women. People who think they are likely to be diagnosed with a sexually transmitted infection in the next six months are more likely to use condoms than those who do not. [ABSTRACT FROM AUTHOR]

Background: The last two decades have witnessed a considerable growth in the literature focusing on LGBTQ2S+ employment, labour market inequality, and income. During the same period, Canada has emerged as a trailblazer in employment protections for both sexual and gender minorities. Unfortunately, the Canadian literature on LGBTQ2S+ employment outcomes and experiences is disperse and underdeveloped. Objective: This paper brings together this disperse research and provides the first systematic review of Canada’s LGBTQ2S+ employment and earnings literature. Methods: We start with a systematic review and thematic synthesis of the broadly defined literature on LGBTQ2S+ poverty in Canada. We use a thematic synthesis to isolate the LGBTQ2S+ literature on employment, labour market inequality, and earnings. Our search of electronic databases took place in April 2018 and was updated in January 2019. Results: A total of 532 abstracts and full texts were screened by reviewers, which resulted in 84 articles included in our final sample. These articles were then sorted by keywords and those pertaining to employment, labour market inequality, and income (n = 31) were included in this analysis. While estimates of sexual minority wage gaps vary depending on the data and methods used, most studies have found wage penalties for gay men and wage premiums for lesbians, relative to their heterosexual counterparts. The literature on bisexual employment is particularly scant but finds that bisexual men and women also earn less than their heterosexual counterparts. Research on the subjective workplace experiences of LGBTQ2S+ individuals find unique challenges, barriers and, at times, exclusion from the Canadian labour market. Conclusions and implications: While the literature on LGBTQ2S+ employment outcomes and experiences in Canada is growing, much is left unknown. The principal limitation for researchers continues to be the dearth of population-based surveys that include questions on sexual orientation, gender identity, and relevant employment characteristics. To date, few studies have explored employment outcomes or the subjective workplace experiences of bisexuals, transgender, two-spirit or other gender minority peoples. [ABSTRACT FROM AUTHOR]

Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results. [ABSTRACT FROM AUTHOR]

Freely-available satellite data streams and the ability to process these data on cloud-computing platforms such as Google Earth Engine have made frequent, large-scale landcover mapping at high resolution a real possibility. In this paper we apply these technologies, along with machine learning, to the mapping of peatlands–a landcover class that is critical for preserving biodiversity, helping to address climate change impacts, and providing ecosystem services, e.g., carbon storage–in the Boreal Forest Natural Region of Alberta, Canada. We outline a data-driven, scientific framework that: compiles large amounts of Earth observation data sets (radar, optical, and LiDAR); examines the extracted variables for suitability in peatland modelling; optimizes model parameterization; and finally, predicts peatland occurrence across a large boreal area (397, 958 km2) of Alberta at 10 m spatial resolution (equalling 3.9 billion pixels across Alberta). The resulting peatland occurrence model shows an accuracy of 87% and a kappa statistic of 0.57 when compared to our validation data set. Differentiating peatlands from mineral wetlands achieved an accuracy of 69% and kappa statistic of 0.37. This data-driven approach is applicable at large geopolitical scales (e.g., provincial, national) for wetland and landcover inventories that support long-term, responsible resource management. [ABSTRACT FROM AUTHOR]

Introduction: Health services research generates useful knowledge. Promotion of implementation of this knowledge in medical practice is essential. Prior to initiation of a major study on rural emergency departments (EDs), we deployed two knowledge transfer strategies designed to generate interest and engagement from potential knowledge users. The objective of this paper was to review: 1) a combined project launch and media press release strategy, and 2) a pre-study survey designed to survey potential knowledge users’ opinions on the proposed study variables. Materials and Methods: We evaluated the impact of the project launch (presentation at two conferences hosted by key stakeholders) and media press release via a survey of participants/stakeholders and by calculating the number of media interview requests and reports generated. We used a pre-study survey to collect potential key stakeholder’ opinions on the study variables. Results: Twenty-one of Quebec’s 26 rural EDs participated in the pre-study survey (81% participation rate). The press release about the study generated 51 press articles and 20 media request for interviews, and contributed to public awareness of a major rural research initiative. In the pre-study survey, thirteen participants (46%) mentioned prior knowledge of the research project. Results from the pre-study survey revealed that all of the potential study variables were considered to be relevant for inclusion in the research project. Respondents also proposed additional variables of interest, including factors promoting retention of human resources. Conclusions: The present study demonstrated the potential utility of a two-pronged knowledge transfer strategy, including a combined formal launch and press release, and a pre-study survey designed to ensure that the included variables were of interest to participants and stakeholders. [ABSTRACT FROM AUTHOR]

Background: This study reports on physicians’ experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. Methods: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. Findings: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. Interpretation: Our findings show that care providers find the treatment of patients with chronic pain–especially those patients also experiencing poverty–to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients’ social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision. [ABSTRACT FROM AUTHOR]

Background: Previous research has identified the impacts of legal frameworks that criminalize HIV non-disclosure among people living with HIV (e.g., elevated stigma and violence). However, far less is known about the perspectives or experiences of people–particularly, men–who are HIV-seronegative or who are unaware of their status. The objective of this paper is to describe the health and social risks that young men perceive to be associated with an HIV diagnosis in the context of Canada’s current legal framework pertaining to HIV non-disclosure. Methods: We analyzed data from 100 in-depth interviews (2013–2016) conducted with 85 young men ages 18–30 in Vancouver on the topic of the criminalization of HIV non-disclosure. Results: Our analysis revealed two dominant narratives in relation to HIV criminalization: (a) interrogation and (b) justification. An interrogation narrative problematized the moral permissibility of criminalizing HIV non-disclosure. In this narrative, Canada’s HIV non-disclosure legal framework was characterized as creating unjust barriers to HIV testing uptake, as well as impeding access to and reducing retention in care for those living with HIV. Conversely, a justification narrative featured a surprising number of references to HIV as a “death sentence”, despite effective treatments being universally available in Canada. However, most of those who presented the justification narrative asserted that the criminalization of HIV non-disclosure was morally justified in light of the perceived negative stigma-related impacts of HIV (e.g., discrimination; being ostracized from sex or romantic partners, friends, family). The justification narrative often reflected a belief that the legal framework provides both punishment and deterrence, which were perceived to supersede any barriers to care for both HIV-positive and -negative individuals. Conclusion: Public education regarding contemporary medical advances in HIV may help contest lay understandings of HIV as a “death sentence”, which is particularly relevant to destabilizing justification narratives. However, significant strengthening of HIV stigma-reduction efforts will be needed to move society away from narratives that attempt to justify Canada’s current HIV non-disclosure legal framework. [ABSTRACT FROM AUTHOR]

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed. [ABSTRACT FROM AUTHOR]

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries. [ABSTRACT FROM AUTHOR]

Background: Our previous study revealed that the COVID-19 pandemic posed mental health challenges to eye care professionals and students. The intent of this study was to identify the longitudinal impact of the COVID-19 pandemic on mental health among ophthalmic personnel and students. Additionally, the potential risk factors for mental health problems were investigated. Methods: A two-phase survey among eye care professionals and students in the USA and Canada was conducted. Phase 1 was administrated from June 23 to July 8, 2020, and has been published; Phase 2 was conducted from January 21 to February 2, 2021. A total of 824 eye care professionals and students participated in Phase 2, with a response rate of 44.1%. Symptoms of depression, anxiety, and stress were measured and calculated. Results: Compared with Phase 1, stress scores in Phase 2 were significantly reduced (P<0.001) although they were still higher than the pre-COVID level (P <.001). Scores for depression (P = 0.20) and anxiety (P = 0.40) showed no change, comparing Phase 2 to Phase 1. Reduction of stress scores significantly differed among occupations (P = 0.005); students had less reduction of stress than other eye care professionals (all P<0.05). Vaccination status was significantly associated with a reduction in stress scores (P = 0.04). Conclusions: With the continuing COVID pandemic, although stress level was reduced at 7-month follow-up, the mental health of eye care professionals was still impacted. In this population, COVID-19 vaccination was associated with fewer stress symptoms. These results indicate that the COVID-19 pandemic continues impacting mental health among eye care professionals, especially students. These study results warrant future interventions for eye care personnel and students to prevent or treat mental health disorders. [ABSTRACT FROM AUTHOR]

The objective of this paper is to fill a gap in the literature on internationalization, in relation to the absence of objective and measurable performance indicators for the process of how firms sequentially enter external markets. To that end, this research develops a quantitative tool for use as a performance indicator of gradualness for firms entering external markets at a sectoral level. The performance indicator is based on firms’ export volumes, number of years operating in the export market, geographic areas targeted for export and when exports began to each area. The indicator is tested empirically in the wine sector. The main contribution of this study is the creation of a reliable international priority index, which can serve more widely as a valuable tool because of its potential use in other industry sectors and geographic areas, and which would allow the analysis of how geographically differentiated internationalization strategies develop. [ABSTRACT FROM AUTHOR]

Background: Charting is an essential component of professional nursing practice and is arguably a key element of patient safety in surgery: without proper, objective, and timely documentation, both benign and tragical errors can occur. From surgery on wrong patients to wrong limbs, to the omission of antibiotics administration, many harms can happen in the operating room. Documentation has thus served as a safeguard for patient safety, professional responsibility, and professional accountability. In this context, we were puzzled by the practices we observed with respect to charting compliance with the surgical safety checklist (SSC) during a study of surgical teams in a large, urban teaching hospital in Canada (pseudonym 'C&C'). Methods: This article leverages institutional ethnography and a subset of data from a larger study to describe and explain the social organisation of the system that monitored surgical safety compliance at C&C from the standpoint of operating room nurses. This data included fieldnotes from observations of 51 surgical cases, on-the-spot interviews with nurses, formal interviews with individuals who were involved in the design and implementation of the SSC, and open-ended questions from two rounds of survey of OR teams. Findings: We found that the compliance form and not the SSC itself formed the basis for reporting. To meet hospital accuracy in charting goals and legislated compliance documentation reporting requirements nurses 'pre-charted' compliance with the surgical checklist. The adoption of this workaround technically violated nursing charting principles and put them in ethically untenable positions. Conclusions: Documenting compliance of the SSC constituted a moral hazard, constrained nurses' autonomy and moral agency, and obscured poor checklist adherence. The findings highlight how local and extra local texts, technologies and relations create ethical issues, raise questions about the effectiveness of resulting data for decision-making and contribute to ongoing conversations about nursing workarounds. [ABSTRACT FROM AUTHOR]

Background: Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. Methods and findings: Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21–26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2–16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. Conclusions: Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income. [ABSTRACT FROM AUTHOR]

There is an abundance of research focusing on the nutritional needs of the cat, though aspects surrounding treat feeding have received far less attention. Feeding practices have the potential to cause nutrient imbalances and adverse health outcomes, including obesity. The objective of this study was to identify and describe the perceptions, motivations, and behaviours surrounding treats, and factors that influence treat feeding by cat caregivers. A 56-question online survey was disseminated to cat caregivers (n = 337) predominantly from Canada and the USA to collect data regarding caregiver and cat demographics, the pet-caregiver relationship, perceptions surrounding treats, and feeding practices and behaviours. Descriptive statistics, chi-square tests, Kruskal-Wallis one-way ANOVA, Wilcoxon signed-rank tests, and multivariable logistic regression models were used to analyze the survey data. Caregivers had varying interpretations of the term 'treat' and how treats relate to the primary diet, and these perceptions appeared to influence the quantity of treats provided. Aspects relating to the human-animal bond were highlighted as an important factor in decisions and behaviours surrounding treat feeding in our results. Though the majority (224/337, 66%) of respondents indicated they monitor their pet's treat intake, using an eyeball estimate was the most frequent (139/337, 41%) method reported to measure treats. Multivariable logistic regression results revealed feeding jerky, bones, dental treats, and table scraps in select frequencies were predictive of caregivers perceiving their cat as overweight/obese. Results provide valuable new insights to cat caregiver feeding practices and perceptions of treats and can be used to inform veterinary nutrition support to caregivers. More research is warranted to further our understanding and ensure that cats receive optimal nutrition and care. [ABSTRACT FROM AUTHOR]

Although the threat and uncertainty of the COVID-19 pandemic has become a significant source of distress, using religion to cope may be associated with more positive health. Given the severity and chronicity of the pandemic, religious individuals may also have relied on a variety of non-religious coping methods. Much of the existing COVID-19 research overlooks the role of religious group membership and beliefs in relation to coping responses and associated mental health, with an additional lack of such research within the Canadian context. Thus, this cross-sectional study investigated relations among religiosity, stressor appraisals, (both religious and non-religious) coping strategies, mental and physical health in a religiously-diverse Canadian community sample (N = 280) during the pandemic's 2nd wave from March to June 2021. Numerous differences were apparent in appraisal-coping methods and health across five (non)religious groups (i.e., Atheists, Agnostics, "Spiritual but not religious", Christians, and those considered to be religious "Minorities" in Canada). Religiosity was also associated with better mental health, appraisals of the pandemic as a challenge from which one might learn or grow, and a greater reliance on problem-focused, emotional-engagement, and religious coping. Moreover, both problem-focused and emotional-engagement coping mediated the relations between religiosity and health. Taken together, this research has implications for individual-level coping as well as informing culturally-sensitive public health messages promoting targeted self-care recommendations with integrated religious or spiritual elements during times of threat and uncertainty, such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program. Methods: This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years. Findings: Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival. Key conclusions: Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended. [ABSTRACT FROM AUTHOR]

Using a trellis to plant vegetables and fruits can double or triple the yield per acre as well as reduce diseases/pests, ease harvesting and make cleaner produce. Cultivars such as cucumbers, grapes, kiwi, melons, peas, passion fruit, pole beans, pumpkins, strawberries, squash, and tomatoes are all grown with trellises. Many of these cultivars showed increased yield with partial shading with semi-transparent solar photovoltaic (PV) systems. To further increase the efficiency of trellis-based growing systems, this study investigates novel low-cost, open-source, sustainable, wood-based PV racking designs for agrivoltaic applications. Design calculations are made to ensure these racks exceed Canadian building code standards, which with snow loads surpass those of most of the world. A complete bill of materials, fabrication instructions, and proof-of-concept prototypes are provided for three system topographies (sloped, T-shaped and inverse Y) along with economic analysis. In addition, to being cost competitive, the designs can act as trellis supports and be used for irrigation/fertigation purposes. The results indicate that these racking structures have enormous promise both agriculturally and energetically. If employed on only grape farms inside Canada, 10 GW of PV potential is made available, which is more than twice the total current installed PV in Canada. [ABSTRACT FROM AUTHOR]

While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change’s causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels. [ABSTRACT FROM AUTHOR]

Single motherhood is associated with higher demands in home and family responsibilities that may exist in similar sized households with grandparents. These demands can compete with opportunities and resources for maintenance of healthy behaviours. This may have been exacerbated during the COVID-19 pandemic since supports outside the home may have been restricted by public health measures. A qualitative narrative study was conducted to explore these issues with 12 single mothers in Canada. Semi-structured interviews provided an in-depth understanding of the challenges and facilitators to maintaining healthy eating habits, physical activity levels, and mental health. Theory-driven content and structural analysis were applied through a descriptive thematic approach. Challenges to maintaining healthy eating behaviours included stay-at-home orders, limited budget, unhealthy food/cravings, and lack of motivation. In contrast, living with grandparents who provide help or having an understanding of healthy food were factors that facilitated engagement in healthy eating. Challenges to maintaining physical activity levels included lack of willpower, lack of time, and low energy. Whereas time on one's own, weighing scales or outdoor gear, and weather conditions promoted physical activity. Spirituality and gratitude were the main coping mechanisms used to deal with loneliness, unemployment, and depressive symptoms. Further research into the utility of gratitude as a coping mechanism could inform public health interventions that aim to increase levels of well-being among single mothers. [ABSTRACT FROM AUTHOR]

A recent study of the health of Indigenous children in four First Nations Communities in remote northwestern Ontario found that 21% of children had been admitted to hospital for respiratory infections before age 2 years. Here we report a detailed analysis of the housing conditions in these communities. We employed a variety of statistical methods, including linear regression, mixed models, and logistic regression, to assess the correlations between housing conditions and loadings of biocontaminants (dust mite allergens, fungal glucan, and endotoxin) and indoor concentrations of PM2.5, CO2, benzene, and formaldehyde. The houses (n = 101) were crowded with an average of approximately 7 people. Approximately 27% of the homes had sustained CO2 concentrations above 1500 ppm. Most homes had more than one smoker. Commercial tobacco smoking and the use of non-electric heating (e.g., wood, oil) were associated with increased fine particle concentrations. Over 90% of the homes lacked working Heat Recovery Ventilators (HRVs), which was associated with increased fine particle concentrations and higher CO2. Of the 101 homes, 12 had mold damage sufficient to increase the relative risk of respiratory disease. This resulted from roof leaks, through walls or around the windows due to construction defects or lack of maintenance. A similar percentage had mold resulting from condensation on windows. Endotoxin loadings were much higher than any previous study in Canada. This work provides evidence for the need for more effort to repair existing houses and to ensure the HRVs are properly installed and maintained. [ABSTRACT FROM AUTHOR]

Background: Understanding what promotes or hinders a community's capacity to serve the priorities of its residents is essential for the alignment of citizen needs and governance. Participatory approaches that engage community residents on the topic of community wellbeing are useful methods for defining outcomes that reflect a community's goals and priorities. Using qualitative focus group methods, the aim of this study was to outline bottom-up definitions of community wellbeing from a diverse pool of community residents in Ontario, Canada. Methods: Semi-structured, two-hour group interviews were conducted with adult (≥18 years) participants (N = 15) residing in four communities across Canada's largest province of Ontario. Participants were purposively selected from a pool of screening questionnaires to ensure diverse group compositions based on race, gender, age, and educational attainment. Interviews were thematically analysed using descriptive and interpretive methods to characterize resident conceptions of community wellbeing. Results: Focus group participants were between 18 and 75 years of age and most had lived in their local community for 5 or more years. Four major themes emerged: (1) a sense of community belonging is cultivated through shared spaces, routines, support, and identities; (2) a community constitutes the amenities and social contexts that enable residents to thrive; (3) effective regional decision-making must be community-informed; and (4) the wellbeing of a community relies on equal opportunities for engagement and participation. Conclusions: Residents described their communities and their associated wellbeing as a combination of accessible amenities and opportunities to engage without marginalization. This study underscores the value of participatory approaches in community wellbeing research, where the viewpoint and life experience of residents is used to inform local decision-making and service delivery. Future research will capture more diverse perspectives towards community belonging, particularly from community newcomers, for the development of regionally appropriate indicators of community wellbeing. [ABSTRACT FROM AUTHOR]

Lichen mapping is vital for caribou management plans and sustainable land conservation. Previous studies have used random forest, dense neural network, and convolutional neural network models for mapping lichen coverage. However, to date, it is not clear how these models rank in this task. In this study, these machine learning models were evaluated on their ability to predict lichen percent coverage in Sentinel-2 imagery in Québec and Labrador, Canada. The models were trained on 10-m resolution lichen coverage (%) maps created from 20 drone surveys collected in July 2019 and 2022. The dense neural network achieved a higher accuracy than the other two, with a reported mean absolute error of 5.2% and an R2 of 0.76. By comparison, the random forest model returned a mean absolute error of 5.5% (R2: 0.74) and the convolutional neural network had a mean absolute error of 5.3% (R2: 0.74). A regional lichen map was created using the trained dense neural network and a Sentinel-2 imagery mosaic. There was greater uncertainty on land covers that the model was not exposed to in training, such as mines and deep lakes. While the dense neural network requires more computational effort to train than a random forest model, the 5.9% performance gain in the test pixel comparison renders it the most suitable for lichen mapping. This study represents progress toward determining the appropriate methodology for generating accurate lichen maps from satellite imagery for caribou conservation and sustainable land management. [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested that the COVID-19 pandemic has increased existing health challenges experienced by transgender (trans) and non-binary people. Additionally, COVID-19 has also negatively impacted youth mental health. However, the impact of the COVID-19 pandemic with respect to the intersection of youth and trans and non-binary populations is currently not well established. The present longitudinal qualitative study aimed to examine the evolving challenges experienced by trans and non-binary youth during the COVID-19 pandemic. Methods: Gender-diverse youth, defined as participants who did not identify as cisgender in April 2020, were invited to participate from among the participant pool of a COVID-19 cohort study in Canada. Qualitative interviews were conducted in August 2020, January 2021, and August 2021, during the first year and a half of the COVID-19 pandemic. Qualitative themes were identified based on reflexive thematic analysis and plot-line narrative inquiry. Results: Ten participants aged 18 to 28 were included in the present analysis, yielding 29 transcripts. We identified themes of (1) losses of connection to gender-diverse communities, (2) changes in gender identity, affirmation, and self-reflection, (3) a dual burden of trans and non-binary specific health and service access challenges as well as COVID-19 pandemic related health challenges, and (4) virtually rebuilding gender-diverse communities during the COVID-19 pandemic. Conclusions: Gender-diverse youth may experience unique challenges during the COVID-19 pandemic. The losses with gender-diverse communities may further isolate queer people from access to healthcare, housing, and employment. Public health policy targeted at gender-diverse youth may consider addressing "upstream" disparities in healthcare and housing in order to support the rebuilding of queer and gender-diverse communities by gender-diverse people. [ABSTRACT FROM AUTHOR]

Lyme disease, caused by vector-borne Borrelia bacteria, can present with diverse multi-system symptoms that resemble other conditions. The objective of this study was to evaluate disease presentations and Borrelia seroreactivity in individuals experiencing a spectrum of chronic and complex illnesses. We recruited 157 participants from Eastern Canada who reported one or more diagnoses of Lyme disease, neurological, rheumatic, autoimmune, inflammatory, gastrointestinal, or cardiovascular illnesses, or were asymptomatic and presumed healthy. Intake categories were used to classify participants based on their perceived proximity to Lyme disease, distinguishing between those with a disclosed history of Borrelia infection, those with lookalike conditions (e.g. fibromyalgia syndrome), and those with unrelated ailments (e.g. intestinal polyps). Participants completed three questionnaires, the SF-36 v1, SIQR, and HMQ, to capture symptoms and functional burden, and provided blood serum for analysis at an accredited diagnostic lab. Two-tiered IgG and IgM serological assessments (whole cell ELISA and Western blot) were performed in a blinded fashion on all samples. The pattern of symptoms and functional burden were similarly profound in the presumptive Lyme and Lyme-like disease categories. Borrelia seroprevalence across the study cohort was 10% for each of IgG and IgM, and occurred within and beyond the Lyme disease intake category. Western blot positivity in the absence of reactive ELISA was also substantial. Fibromyalgia was the most common individual diagnostic tag disclosed by two-tier IgG-positive participants who did not report a history of Lyme disease. Within the IgG seropositive cohort, the presence of antibodies against the 31 kDa Outer Surface Protein A (OspA) was associated with significantly better health outcomes. Previously, this marker has been linked to treatment-refractory Lyme arthritis. Overall, our findings support prior observations of phenotypic overlap between Lyme and other diseases. Seropositivity associated with non-specific symptoms and functional impairment warrants further mechanistic investigation and therapeutic optimization. [ABSTRACT FROM AUTHOR]

Despite the proliferation of nudge research in the last few decades, very little published work aims to nudge the behavior of policymakers. Here we explore the impact of a well-established nudge on policymakers in the Northwest Territories of Canada. In a pre-registered randomized controlled trial, we emailed an invitation to policymakers (N = 263) to attend an online briefing on gendered impacts of policy. In the treatment condition (N = 133), the invitation contained personal stories of two women whose lives were disproportionally impacted by public policies more than men. In the control condition (N = 130), the invitation did not contain such stories. After the briefing, we sent all participants in both conditions a link to a public pledge that they could sign. The pledge was to lead and advocate for equity-oriented policymaking. Contrary to our prediction, there was a small backfiring effect where policymakers in the treatment condition (3.0%) were less likely to attend the briefing than the control condition (7.7%). However, two policymakers (1.5%) in the treatment condition signed the public pledge compared to one (0.8%) in the control condition. The current findings reveal the limits of using personal stories as a nudge to influence policymakers. We discuss insights gained from this experiment and follow-up debriefings with policymakers on how to improve future behavioral interventions designed to nudge policymakers. [ABSTRACT FROM AUTHOR]

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation. Methods: Nine focus groups involving young adults (aged 18–35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework. Results: Most participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood. Conclusion: Current diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population. [ABSTRACT FROM AUTHOR]

Climate change has severe and sweeping impacts on mental health. Although research is burgeoning on mental health impacts following climate and weather extremes, less is known about how common these impacts are outside of extreme events. Existing research exploring the prevalence of psychosocial responses to climate change primarily examines university students and uses non-random sampling methods. Herein, our protocol outlines an approach to data collection, processing, and analysis to estimate the population prevalence, magnitude, and distribution of mental health responses to climate change in Canada. A cross-sectional survey of youth and adults aged 13 years and older in Canada will be administered over the course of one year. The questionnaire will take approximately 10 minutes to complete orally and will be administered in English, French, and Inuktitut. The survey will consist of six sections: (1) self-reported past experiences of climate change; (2) self-reported climate-related emotions; (3) self-reported past and current impacts, anticipatory impacts, and vicarious experiences; (4) self-reported subclinical outcomes; (5) self-reported behavioural responses; and (6) demographics. A multi-stage, multi-stratified random probability sampling method will be used to obtain a sample representative of the Canadian population. We will use two different modes of recruitment: an addressed letter sent by postal mail or a telephone call (landlines and cellular). Population-weighted descriptive statistics, principal component analysis, and weighted multivariable regression will be used to analyse the data. The results of this survey will provide the first national prevalence estimates of subclinical mental health responses to climate change outcomes of people living in Canada. [ABSTRACT FROM AUTHOR]

Rationale: Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action. Objectives: To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups. Methods: We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range. Results: We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation. Conclusions: CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups. [ABSTRACT FROM AUTHOR]

Background: Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals. Methods: We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools. Discussion: The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations. [ABSTRACT FROM AUTHOR]

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions. [ABSTRACT FROM AUTHOR]

In the present research we tested the differential effects of anger versus shame as emotional predictors of ingroup disidentification in one rather collectivistic (Japan) and two rather individualistic societies (Germany, Canada). We tested the idea that individuals cope with socially undesired emotions by disidentifying from their group. Specifically, we predicted that after a group conflict, anger, an undesired emotion in Japan, would elicit disidentification in Japan, whereas shame, an undesired emotion in Canada and Germany, would elicit disidentification in Germany and Canada. Study 1 (N = 378) found that anger, but not shame, was related to disidentification in Japan, whereas shame, but not anger, was related to disidentification in Canada and Germany. Study 2 (N = 171) shows that, after group conflict, Japanese disidentified more when imagining to feel angry, whereas Germans disidentified more when imagining to feel ashamed. Implications for these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about the health risks of cannabis remain prevalent, indicating the need to improve public health messaging and determine the effectiveness of educational programming. Our objective was to develop a standardized questionnaire to measure knowledge about cannabis in the context of cannabis legalization. Methods: A Cannabis Knowledge Assessment Tool (CKAT) was created using the Delphi method. A purposive sample of healthcare professionals, policymakers, academics, patients, and students served as the content and development experts. Principal component analysis from the codes identified from open-ended feedback guided the item development. Upon completion, the CKAT was administered as a pre- and post-test in four schools (7th and 9th Grade) in Canada. The data were analysed to determine whether knowledge scores changed after participating in a cannabis education program. Results: Twenty-four experts initially participated in the Delphi process and 18 (75% retention) continued throughout. Principal component analysis identified 3 domains: 1) effects of cannabis on the individual, 2) general information about cannabis, and 3) cannabis harm reduction. The final questionnaire consisted of 16 multiple-true-false questions (64 items) and received a Flesch-Kincaid Grade Level of 6.3, and a SMOG index score of 7.6. The CKAT was completed by 132 students; seventy-three 7th grade and fifty-nine 9th grade students. The baseline mean CKAT score was 46.2 (SD:5.5), which increased to 50.7 (SD:4.6) after the cannabis educational program (p<0.05). Conclusions: A novel tool to measure knowledge of cannabis was developed and piloted in 7th grade and 9th grade students. Future studies are required to test usability and validity of the CKAT in other contexts. [ABSTRACT FROM AUTHOR]

Fire regimes are strongly related to weather conditions that directly and indirectly influence fire ignition and propagation. Identifying the most important meteorological fire drivers is thus fundamental for daily fire risk forecasting. In this context, several fire weather indices have been developed focussing mainly on fire-related local weather conditions and fuel characteristics. The specificity of the conditions for which fire danger indices are developed makes its direct transfer and applicability problematic in different areas or with other fuel types. In this paper we used the low-to-intermediate fire-prone region of Canton Ticino as a case study to develop a new daily fire danger index by implementing a niche modelling approach (Maxent). In order to identify the most suitable weather conditions for fires, different combinations of input variables were tested (meteorological variables, existing fire danger indices or a combination of both). Our findings demonstrate that such combinations of input variables increase the predictive power of the resulting index and surprisingly even using meteorological variables only allows similar or better performances than using the complex Canadian Fire Weather Index (FWI). Furthermore, the niche modelling approach based on Maxent resulted in slightly improved model performance and in a reduced number of selected variables with respect to the classical logistic approach. Factors influencing final model robustness were the number of fire events considered and the specificity of the meteorological conditions leading to fire ignition. [ABSTRACT FROM AUTHOR]

Salmon are an essential component of the ecosystem in Tsleil-Waututh Nation's traditional, ancestral, and contemporary unceded territory, centred on present-day Burrard Inlet, BC, Canada, where Tsleil-Waututh people have been harvesting salmon, along with a wide variety of other fishes, for millennia. Tsleil-Waututh Nation is a Coast Salish community that has called the Inlet home since time immemorial. This research assesses the continuity and sustainability of the salmon fishery at təmtəmíxʷtən, an ancestral Tsleil-Waututh settlement in the Inlet, over thousands of years before European contact (1792 CE). We apply Zooarchaeology by Mass Spectrometry (ZooMS) analysis to 245 archaeological salmon vertebrae to identify the species that were harvested by the ancestral Tsleil-Waututh community that lived at təmtəmíxʷtən. The results demonstrate that Tsleil-Waututh communities consistently and preferentially fished for chum salmon (Oncorhynchus keta) over the period of almost 3,000 years. The consistent abundance indicates a sustainable chum salmon fishery over that time, and a strong salmon-to-people relationship through perhaps 100 generations. This research supports Tsleil-Waututh Nation's stewardship obligations under their ancestral legal principles to maintain conditions that uphold the Nation's way of life. [ABSTRACT FROM AUTHOR]

Monkeypox is a double-stranded DNA virus with an envelope and is a member of the Poxviridae family's Orthopoxvirus genus. This virus can transmit from human to human through direct contact with respiratory secretions, infected animals and humans, or contaminated objects and causing mutations in the human body. In May 2022, several monkeypox affected cases were found in many countries. Because of its transmitting characteristics, on July 23, 2022, a nationwide public health emergency was proclaimed by WHO due to the monkeypox virus. This study analyzed the gene mutation rate that is collected from the most recent NCBI monkeypox dataset. The collected data is prepared to independently identify the nucleotide and codon mutation. Additionally, depending on the size and availability of the gene dataset, the computed mutation rate is split into three categories: Canada, Germany, and the rest of the world. In this study, the genome mutation rate of the monkeypox virus is predicted using a deep learning-based Long Short-Term Memory (LSTM) model and compared with Gated Recurrent Unit (GRU) model. The LSTM model shows "Root Mean Square Error" (RMSE) values of 0.09 and 0.08 for testing and training, respectively. Using this time series analysis method, the prospective mutation rate of the 50th patient has been predicted. Note that this is a new report on the monkeypox gene mutation. It is found that the nucleotide mutation rates are decreasing, and the balance between bi-directional rates are maintained. [ABSTRACT FROM AUTHOR]

Environmental sustainability in agriculture is a key component of discussions to address the current climate crisis; unfortunately, many people (including researchers) presume that only certain types of agriculture (e.g., organic, local) are environmentally sustainable. Non-farmers also fail to acknowledge that many farm practices, including grazing animals, mitigate climate change. Farmers' perceptions about environmental sustainability are important because their livelihoods, and those of future generations, depend on their commitment to sustainable environmental practices. The purpose of this qualitative research was to understand Canadian farmers' perceptions of environmental sustainability, how they are implementing strategies that contribute to sustainable food production, and the challenges they face. Fifty-two farmers, representing 48 farms and over 1000 years of farming experience, participated in comprehensive in-depth interviews. Four farms were in British Columbia; 13 in the Prairies; 26 in Central Canada; and five in Eastern Canada. A wide variety of farm types (e.g., fruit/vegetables, livestock, grains) and sizes (2 to 6500 acres) were included in the study. Farmers' perceptions of environmental sustainability coalesced into four main themes: (1) definitions of sustainability and environmental sustainability, (2) current practices, (3) farming as an identity, and (4) challenges. Many participants explained that they already use sustainable practices and technology, contrary to prevailing opinion that entire food systems need to be transformed to be sustainable. As new agricultural policies and educational curricula are developed, information provided to students, policy makers, and the public must be accurate, balanced, evidence-based, and respectfully consider all perspectives, especially those of farmers. [ABSTRACT FROM AUTHOR]