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Plastic contamination is commonly reported in urban and rural soils, as well as in fresh and ocean waters. Canada's government has attempted to limit the contamination of single-use plastic by banning the manufacturing and selling of specific types of plastic. In British Columbia, current regulations governing commercial composting state that when compost has less than 1% of its dry weight representing foreign materials (including plastic), it can be sold and used in soils. However, due to the low density of plastic and its potential to break down into microparticles, this amount may be enough to become toxic when used in agricultural soils. This paper studies contamination of plastic in garden soils and summarizes how this can affect the environment with a preliminary examination of a garden soil sample. The examination showed that the garden soil sample contained mainly low-density polyethylene, polyethylene and polypropylene plastics (identified through ATR-FTIR) in oxidized and unoxidized forms that can come from commercial composting and hypothesizes that this plastic could break down into microplastic particles. In order to limit the amount of plastic contamination in agricultural soils, it is necessary to modify current compost regulations in order to treat plastic differently than other foreign materials (glass, metal, wood). [ABSTRACT FROM AUTHOR]

An unprecedented heat wave occurred over the Pacific Northwest and southwest Canada on 25–30 June 2021, resulting in all-time temperature records that greatly exceeded previous record maximum temperatures. The impacts were substantial, including several hundred deaths, thousands of hospitalizations, a major wildfire in Lytton, British Columbia, Canada, and severe damage to regional vegetation. Several factors came together to produce this extreme event: a record-breaking midtropospheric ridge over British Columbia in the optimal location, record-breaking midtropospheric temperatures, strong subsidence in the lower atmosphere, low-level easterly flow that produced downslope warming on regional terrain and the removal of cooler marine air, an approaching low-level trough that enhanced downslope flow, the occurrence at a time of maximum insolation, and drier-than-normal soil moisture. It is shown that all-time-record temperatures have not become more frequent and that annual high temperatures only increased at the rate of baseline global warming. Although anthropogenic warming may have contributed as much as 1°C to the event, there is little evidence of further amplification from increasing greenhouse gases. Weather forecasts were excellent for this event, with highly accurate predictions of the extreme temperatures. Significance Statement: This paper describes the atmospheric evolution that produced an extreme heat wave over the Pacific Northwest during June 2021 and puts this event into historical perspective. [ABSTRACT FROM AUTHOR]

How fires burn across British Columbia (BC), Canada is shaped by settler coloniality, timber capitalism, state forestry regimes, criminalization of burning, and Indigenous resistance. Despite the urgency of confronting the fire suppression paradox embedded in settler colonial fire management laws and practices, approaches to studying fire in Canada that foreground Indigenous law and de-center settler colonial governance is scarce. As political ecologists and geographers working and living in the context of unceded and ancestral lək̓ʷəŋən, W̱SÁNEĆ, xʷməθkʷəy̓əm, Sḵwx̱wú7mesh, səlilwətaɬ, and syilx territories, we engage with Indigenous feminist scholarship to expose how coloniality and gender intersect in attempts to erase Indigenous sovereignty to structure and naturalize provincial fire policy and its emplaced impacts on Indigenous legal orders. Our analysis contextualizes settler-colonial provincial fire management policy in the purview of Indigenous legal orders to foreground how racial-colonial and gendered politics are obscured when colonial fire and wildfire practices are naturalized. Revisiting key moments in the political development of fire suppression across so-called BC, we contend that the suppression paradox is embedded in and reproduces a colonial logic that widens existing social and economic gaps. These gaps are uniquely gendered, as settler coloniality operates upon patriarchal lines that have actively attempted to erase Indigenous women and Two-Spirit peoples, including the laws and legal authorities that they possess and practice. Considering the 1910 Fulton Commission, we highlight an example of how women and Indigenous people were excluded from the political decision-making structures that shaped colonial fire management practices in BC. These gendered and racialized exclusions bear directly on the exclusion of Indigenous women and gender-diverse folx, and Indigenous legal orders guided by matriarchal lines of fire knowledge. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway. Methods: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders. Results: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway. Conclusions: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway. Trial registration: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03508557. [ABSTRACT FROM AUTHOR]

Food systems are complex and multifaceted, comprising a diverse range of actors, processes, and interactions. Participatory system mapping can be employed to help understand this complexity and support the development of sustainable and resilient food systems. This article shares a participatory mapping approach that has been developed as part of the Climate–Biodiversity–Health (CBH) Nexus project in the Comox Valley, British Columbia, Canada. This research pursues two main aims: (1) to ground truth in the CBH system map of food systems, developed with the participation of stakeholders; and (2) to explain how participatory system mapping can be employed to clarify the complexity of food systems in a clear and concise manner for all stakeholders. This research contributes to the literature on participatory system mapping, including critiques of its practical utility, by employing participatory approaches to visualize multi-dimensional and multi-level system maps with an emphasis on verifying that they are clear, understandable/useful, and reliable for diverse stakeholder audiences. [ABSTRACT FROM AUTHOR]

Objective: To investigate gastrointestinal (GI)‐related physician visits and drug dispensations in the 5 years preceding a first recorded demyelinating event or multiple sclerosis (MS) onset. Methods: Using linked administrative and clinical data from British Columbia (1996–2013), Canada, we identified an administrative cohort via a validated algorithm (n = 6863), a clinical cohort diagnosed at a MS clinic (n = 966), and matched controls (administrative cohort: n = 31,865; clinical cohort: n = 4534). In each cohort, the 5 years before a first demyelinating event or MS symptom onset (i.e., index date) were examined. We compared rates of GI‐related physician visits and risk of ≥1 GI‐related dispensation between MS cases and controls using negative binomial and robust Poisson models. Sex differences were tested using interaction terms. Results: The administrative cohort MS cases had higher rates of physician visits related to gastritis and duodenitis (adjusted rate/risk ratio (aRR):1.42, 95% CI: 1.10–1.83) and diseases of the esophagus (aRR: 1.46, 95% CI: 1.06–2.02) prior to the index date. MS cases also had greater risk of at least one dispensation for several drug classes, including constipation‐related (aRR: 1.82, 95% CI: 1.50–2.22), antiemetics/antinauseants (aRR: 1.64, 95% CI: 1.43–1.89), and propulsives (promotility drugs; aRR: 1.62, 95% CI: 1.47–1.79). Men had a disproportionally higher relative risk for propulsives than women (aRR: men = 2.32, 95% CI: 1.79–3.00; women = 1.54, 95% CI: 1.36–1.72). Several findings were similar in the smaller clinical cohort though none reached statistical significance. Interpretation: GI‐related physician visits and drug dispensations were more common in the 5 years before the first demyelinating event versus matched controls. GI symptoms are a measurable feature of the prodromal or early phase of MS, with a sex difference evident. [ABSTRACT FROM AUTHOR]

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A 'drug strategy' is a policy document that structures the priorities and directions for interventions for drug related issues within a particular jurisdiction and/or context. A 'pillars' drug strategy concentrates efforts through clustering separated columns of activity, such as law enforcement, harm reduction, treatment, and prevention. In this study, we examined drug policy stakeholders' perspectives on the structure, function, and fit of a four pillar drug strategy framework in Vancouver, Canada. Utilizing qualitative interview data from fifteen drug policy stakeholders, we examine perspectives on Vancouver's four pillar drug strategy that was implemented over 20 years ago. Our findings are organized under three main themes: (1) the notion of 'balance' of efforts, resources, and attention across the pillars; (2) how the pillars function as a cohesive whole; (3) whether the pillars' architecture is still fit-for-purpose. The architecture of four discrete pillars did not enable a sense of cohesion and collaboration of efforts, and instead elicited a sense of competition, conflict, fragmentation, simplicity, and rigidity of the strategy as a whole. These findings suggest that, in practice, a four pillars framework may be structurally dysfunctional in working towards a common goal. Our study questions the effectiveness of a commonly used 'pillars' framework and whether it needs to be reenvisaged., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Despite well-established evidence showing that young sexual and gender minority (SGM) men experience disproportionate mental health and substance use inequities, few sexual health services provide mental health and substance use care. This qualitative study examined the experiences and perspectives about integrated care models within sexual health services among young SGM men experiencing mental health and substance use challenges., Methods: Semi-structured interviews were conducted with 50 SGM men aged 18-30 years who reported using substances with sex in Vancouver, Canada. Interviews were analyzed using thematic analysis., Results: Three themes were identified: 1) participants asserted that their sexual health, mental health and substance use-related health needs were interrelated and that not addressing all three concurrently could result in even more negative health outcomes. These concurrent health needs were described as stemming from the oppressive social conditions in which SGM men live. 2) Although sexual health clinics were considered a safe place to discuss sexual health needs, participants reported not being invited by health providers to engage in discussions about their mental health and substance use health-related needs. Participants also perceived how stigmas associated with mental health and substance use limited their ability to express and receive support. 3) Participants identified key characteristics they preferred and wanted within integrated care, including training for health providers on mental health and SGM men's health and connections (e.g., referral processes) between services. Participants also recommended integrating social support programs to help them address SGM-related social challenges., Conclusion: Our findings highlight that SGM men's sexual health, mental health and substance use-related health needs and preferences are interrelated and should be addressed together. Tailored training and resources as well as structural adaptations to improve communication channels and collaborative connections between health providers are required to facilitate the development of integrated care for young SGM men., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: As part of the response to Canada's worsening overdose crisis driven by a toxic, adulterated drug supply, there has been increased attention to and expansion of drug treatment, options, including injectable opioid agonist treatment (iOAT). iOAT typically involves the, witnessed daily injection of opioids under healthcare provider supervision. There is a robust, evidence base on iOAT; however, there has been less focus on how people engage with this; treatment outside of clinical trials. This paper examines how people engage with iOAT programs, in expanded treatment settings in Canada, focusing on how the broader socio-structural context, shapes patient subjectivities in treatment., Methods: This study draws on critical ethnographic and community-based research approaches, conducted with people accessing four iOAT programs in Vancouver's Downtown Eastside; neighbourhood from May 2018 to November 2019. Data included in-depth baseline and followup, interviews and approximately 50 h of observation fieldwork conducted in one iOAT, program and with a subsample of participants in the surrounding neighbourhood. Analysis, leveraged the concepts of biological citizenship and structural vulnerability., Results: This analysis characterized three narrative frames-regular long-term engagers, pain, patients, and sporadic and short-term engagers-through in-depth case presentations of participants with distinct types of engagement with iOAT programs. Participants within these, narrative frames described a dominant form of iOAT citizenship, an autonomous patient who, regularly engages in treatment and avoids pleasure. However, structural vulnerabilities, including, homelessness and housing instability, entrenched poverty, criminal-legal system engagement, and unmanaged pain, shaped the ability of participants to make claims to this normative model of citizenship., Conclusion: This study examined how structural vulnerabilities impact people's construction and ability to make iOAT citizenship claims. Findings point to the need for changes within and outside of iOAT programs, such as lower threshold treatment models, improved social services (e.g., secure housing), and pain management support., (Copyright © 2024 Elsevier Ltd. All rights reserved.)