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Summary Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed‐method randomized control trial of a 6‐month participatory, team‐based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6‐month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams.

As one of the most popular vegetation indices to monitor terrestrial vegetation productivity, Normalized Difference Vegetation Index (NDVI) has been widely used to study the plant growth and vegetation productivity around the world, especially the dynamic response of vegetation to climate change in terms of precipitation and temperature. Alberta is the most important agricultural and forestry province and with the best climatic observation systems in Canada. However, few studies pertaining to climate change and vegetation productivity are found. The objectives of this paper therefore were to better understand impacts of climate change on vegetation productivity in Alberta using the NDVI and provide reference for policy makers and stakeholders. We investigated the following: (1) the variations of Alberta's smoothed NDVI (sNDVI, eliminated noise compared to NDVI) and two climatic variables (precipitation and temperature) using non-parametric Mann-Kendall monotonic test and Thiel-Sen's slope; (2) the relationships between sNDVI and climatic variables, and the potential predictability of sNDVI using climatic variables as predictors based on two predicted models; and (3) the use of a linear regression model and an artificial neural network calibrated by the genetic algorithm (ANN-GA) to estimate Alberta's sNDVI using precipitation and temperature as predictors. The results showed that (1) the monthly sNDVI has increased during the past 30 years and a lengthened growing season was detected; (2) vegetation productivity in northern Alberta was mainly temperature driven and the vegetation in southern Alberta was predominantly precipitation driven for the period of 1982-2011; and (3) better performances of the sNDVI-climate relationships were obtained by nonlinear model (ANN-GA) than using linear (regression) model. Similar results detected in both monthly and summer sNDVI prediction using climatic variables as predictors revealed the applicability of two models for different period of year ecologists might focus on.

This paper describes the development and evaluation of training intended to enhance students' performance on their first live-animal ovariohysterectomy (OVH). Cognitive task analysis informed a seven-page lab manual, 30-minute video, and 46-item OVH checklist (categorized into nine surgery components and three phases of surgery). We compared two spay simulator models (higher-fidelity silicone versus lower-fidelity cloth and foam). Third-year veterinary students were randomly assigned to a training intervention: lab manual and video only; lab manual, video, and $675 silicone-based model; lab manual, video, and $64 cloth and foam model. We then assessed transfer of training to a live-animal OVH. Chi-square analyses determined statistically significant differences between the interventions on four of nine surgery components, all three phases of surgery, and overall score. Odds ratio analyses indicated that training with a spay model improved the odds of attaining an excellent or good rating on 25 of 46 checklist items, six of nine surgery components, all three phases of surgery, and the overall score. Odds ratio analyses comparing the spay models indicated an advantage for the $675 silicon-based model on only 6 of 46 checklist items, three of nine surgery components, and one phase of surgery. Training with a spay model improved performance when compared to training with a manual and video only. Results suggested that training with a lower-fidelity/cost model might be as effective when compared to a higher-fidelity/cost model. Further research is required to investigate simulator fidelity and costs on transfer of training to the operational environment.

This paper intends to develop quantitative indicators for comparative sustainability assessment of petroleum oil pathways in the province of Alberta, Canada. Eighteen pathways of oil production were developed in this study, and the sustainability indicators were assigned for each pathway to cover greenhouse gas (GHG) emissions, water demand, and land use in addition to the cost of supply. The developed sustainability indicators were aligned per functional unit and covered the full life cycle of petroleum oil production. The developed GHG emissions, cost of supply, and land use indicators are found in the range 17.50&ndash, 226.20 kg of CO2 eq./bbl, 12.28&ndash, 53.53 USD/bbl, and 0.06&ndash, 0.178 m2/bbl, respectively. Four scenarios were comparatively conducted and assessed against the business-as-usual scenario within the period horizon 2009&ndash, 2030. The cost-effective scenario was optimized with the objective function to minimize the cost of supply based on the constraints derived from the business-as-usual scenario. Sustainable scenarios were conducted with the lowest possible impacts on natural resources, GHG emissions, and the cost of supply accompanied by specific assumptions for petroleum oil production from different pathways in Alberta. The average annual savings on water demand and land area were found to be 67 and 30%, respectively, due to the shifting of upgrader feedstock from surface mining to the in-situ steam-assisted gravity drainage (SAGD) pathway. The corresponding increases due to this shifting in upgrader feedstock were found to be 40 and 3% in GHG emissions and cost of supply, respectively.

Alberta has extensive non-renewable energy resources which contribute to the Canadian economy. A downturn in oil and gas energy prices in 2014 contributed to increased idle and orphaned wells, posing potential environmental and human health risks, as well as an economic burden on the province of Alberta. Idle and orphaned wells contribute to local adverse environmental and human health effects from soil and groundwater contamination to greenhouse gas emissions. With increasing numbers of idle and orphaned wells, current monitoring measures, including regulation and cost to identify well leakage, are insufficient. Current policy measures to manage idle and orphaned well environmental liabilities were found to be inadequate to cover cleanup costs. With oil and gas prices showing no signs of rebound, these idle and orphaned well liabilities need to be addressed. This paper discusses potential environmental risks that idle and orphaned oil and gas wells pose, compares Alberta’s current monitoring and policy initiatives to those in other provinces as well as the USA, and recommends future management strategies to mitigate the issue.

Background Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians’ awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways. Conclusion Most of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients.Other Information Published in: BMC Family Practice License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1186/s12875-020-01159-0

Mitigating climate change will require reduced use of fossil fuels to generate electricity. To do so while eschewing nuclear power, countries have turned to wind and solar energy. In this paper, load duration and screening curves are used to investigate the extent to which a jurisdiction should invest in intermittent (solar and wind) sources of energy, gas and nuclear power. The application is to the Alberta electricity grid because it is nearly 90 percent reliant on fossil fuels, particularly coal, and recent policy intends to eliminate coal generating capacity by 2030 and replace two-thirds of the lost capacity with renewables. Results suggest that solar and wind are unable to replace two-thirds of coal generation, and that larger than anticipated investments in natural gas capacity will be required. However, if Alberta is serious about reducing emissions, it will need to rely on nuclear energy; at high carbon prices, nuclear power could reduce CO2 emissions by some 95% compared to only 55% when relying totally on solar and wind.

This paper describes the development and implementation of the INFO (immediate, not for personal assessment, fast facilitated feedback, and opportunity to ask questions) clinical debriefing process. INFO enabled charge nurses to facilitate a group debriefing after critical events across three adult emergency departments (EDs) in Calgary, Alberta. Prior to implementation at our institutions, ED critical event debriefing was a highly variable event. Post-implementation, INFO critical event debriefings have become part of our ED culture, take place regularly in our EDs (254 documented debriefings between March 2016 and September 2017), with recommendations arising from these debriefings being introduced into clinical practice. The INFO clinical debriefing process addresses two significant barriers to regular ED clinical debriefing: a lack of trained facilitators and the focus on physician-led debriefings. Our experience shows that a nurse-facilitated debriefing is feasible, can be successfully implemented in diverse EDs, and can be performed by relatively inexperienced debriefers. A structured approach means that debriefings are more likely to take place and become a routine part of improving team management of high stakes or unexpected clinical events.

Background The Solo Smart pericardial aortic valve has been widely used in Europe as an option for aortic valve replacement (AVR). We are reporting early and midterm clinical outcomes of AVR with the Solo Smart valve in a single North America center. Methods This is a retrospective study of 270 consecutive patients who had AVR at Mazankowski Alberta Heart Institute from February 2011 to March 2015. Follow-up and echocardiographic data were collected retrospectively from electronic and paper charts. Univariate and multivariate analysis were performed to evaluate the results. Results The mean age was 71.2±10.0 years, 67.4% were male, and 79.3% had combined procedures. Mean STS Score was 4.18±3.91. Early mortality was 3.7% for the entire group and 0% for isolated AVR group. Mean cross-clamp time for isolated AVR and AVR with concomitant procedure was 70.8±12.7 min and 117.0±45.0 min, respectively. Permanent pacemaker implantation was necessary in 2.2% of patients. Echocardiography demonstrated a reduction in mean gradients from 40.8±17.4 mmHg to 7.6±3.7 mmHg and peak gradient from 72.5±48.8 mmHg to 15.5±7.5 mmHg. The 1-, 3-, and 5-year overall survival was 93.0%, 86.5% and 75.9%, respectively. At 5 years, freedom from valve-related death was 92.4%, freedom from structural valve deterioration and freedom from aortic valve reoperation were 96.4% and 98%, respectively. Conclusions The Solo Smart valve is safe and has excellent hemodynamic performance. Aortic valve reoperation and rates of valve-related adverse events during midterm follow-up were low.

Child discipline remains a topic of public health interest across the globe. Despite this enduring interest, very little is known about the child disciplinary practices of African immigrants in Canada. This paper explores the disciplinary practices of African immigrant parents in Alberta, a Canadian province with a recent surge in the population of African immigrants. Employing a critical ethnographic methodology, informed by transnational theory, we collected data through in-depth qualitative interviews with a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), policymakers (n = 2), and health and immigrant settlement workers (n = 10). As members of the African immigrant community, we were deeply immersed in the research settings, which afforded us the opportunity to collect pertinent observational data in the form of reflexive notes. Thematic analysis of the data revealed child disciplinary approaches that incorporate Canadian and African parenting practices, as well as practices that appear somewhat unique to this demographic. We found that African immigrant parents used corporal discipline, persuasive discipline, and a hybrid of the two, as well as emerging practices involving transnational fostering and emotional isolation of children who persistently misbehaved. These practices, in their totality, appeared to be influenced by the transnational experiences of parents and precepts that are traceable to Canada’s legal and educational systems. We present theoretical, policy, and service implications of our findings, including a recommendation to incorporate sociocultural dimensions of child discipline into Canadian child welfare policies and practices.

Background: Administrative health data, such as the hospital Discharge Abstract Database (DAD), can potentially be used to identify patients with non-traumatic spinal cord dysfunction (NTSCD). Algorithms utilizing administrative health data for this purpose should be validated before clinical use. Objective: To validate an algorithm designed to identify patients with NTSCD through DAD. Method: DAD between 2006 and 2016 for Southern Alberta in Canada were obtained through Alberta Health Services. Cases of NTSCD were identified using the algorithm designed by the research team. These were then validated by chart review using electronic medical records where possible and paper records where electronic records were unavailable. Measures of diagnostic accuracy including sensitivity, specificity, and positive and negative predictive values and 95% confidence intervals (CI) were computed. Results: Two hundred and eighty cases were identified to have both the administrative codes for neurological impairments and NTSCD etiology. Twenty-eight cases were excluded from analysis as 5 had inadequate medical record information, 17 had traumatic spinal cord injury, and 6 were considered “other” non-spinal cord conditions. Measures of diagnostic accuracy that were computed were sensitivity 97% (95% CI, 94%–98%), specificity 60% (95% CI, 47%–73%), positive predictive value (PPV) 92% (95% CI, 88%–95%), and negative predictive value (NPV) 80% (95% CI, 65%–90%). The most prevalent etiologies were degenerative (36.9%), infection (19.0%), oncology malignant (15.1%), and vascular (10.3%). Conclusion: Our algorithm has high sensitivity and PPV and satisfactory specificity and NPV for the identification of persons with NTSCD using DAD, though the limitations for using this method should be recognized.

One of the largest wildfires in Canadian history raged through northern Alberta in May to July 2016, and prompted the largest emergency air evacuation in Canadian history. Central to the challenges were the evacuation of a regional hospital, and the emergency and recovery management associated with healthcare services. This paper describes multiple phases of emergency and recovery management, which employed and adapted the Incident Command System to healthcare services. There were no injuries reported throughout the medical evacuation and recovery of medical services. The leadership and management of healthcare services achieved the goals of evacuating patients and staff effectively, supporting emergency first responders and the re-entry of the population to Fort McMurray.

This paper examines the distribution of physicians and dentists among Alberta census divisions and among Alberta incorporated cities, towns, and villages from 1956 to 1976. Gini coefficients were used to assess the degree of disparity in the rural-urban distribution of medical personnel and to indicate changes in the distributional pattern. The more specialized services including primary care physicians were found to be less equitably distributed than the more generalized services. For most categories of medical service, the distribution patterns were relatively unchanging over the twenty years studied. The most notable changes were equalizing trends in the census division distributions of primary care physicians and general surgeons although considerable disparities remained. There was no evidence that these equalizing trends proceeded down a size hierarchy benefiting the larger regions before the smaller-regions. Nevertheless, there was evidence that convergence trends were constrained by minimal population requirements necessary to support given types of services. Minimal population requirements were larger for the more specialized services and there was evidence that primary care physicians and dentists required larger populations in 1976 than they did in 1956. It was suggested that minimal population requirements coupled with the trend towards medical specialization indicate that the complete removal of rural-urban disparities in the distribution of medical personnel is an unrealistic ideal. This paper argues that restrictions on medical specialization will help to moderate rural urban disparities. It is argued that policies should aim to optimize service distribution rather than to equalize service distribution.

ObjectivesOver the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities.DesignFrom June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation.Setting and participantsWe conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey.Primary outcome measuresThe pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities.ResultsWe received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value ConclusionThe utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities.

Large-scale oil production from oil sands deposits in Alberta, Canada has raised concerns about environmental impacts, such as the magnitude of air pollution emissions. This paper reports compound emission rates (E) for 69–89 nonbiogenic volatile organic compounds (VOCs) for each of four surface mining facilities, determined with a top-down approach using aircraft measurements in the summer of 2013. The aggregate emission rate (aE) of the nonbiogenic VOCs ranged from 50 ± 14 to 70 ± 22 t/d depending on the facility. In comparison, equivalent VOC emission rates reported to the Canadian National Pollutant Release Inventory (NPRI) using accepted estimation methods were lower than the aE values by factors of 2.0 ± 0.6, 3.1 ± 1.1, 4.5 ± 1.5, and 4.1 ± 1.6 for the four facilities, indicating underestimation in the reported VOC emissions. For 11 of the combined 93 VOC species reported by all four facilities, the reported emission rate and E were similar; but for the other 82 species, the reported emission rate was lower than E. The median ratio of E to that reported for all species by a facility ranged from 4.5 to 375 depending on the facility. Moreover, between 9 and 53 VOCs, for which there are existing reporting requirements to the NPRI, were not included in the facility emission reports. The comparisons between the emission reports and measurement-based emission rates indicate that improvements to VOC emission estimation methods would enhance the accuracy and completeness of emission estimates and their applicability to environmental impact assessments of oil sands developments.

Since the publishing of the Kelly et al. papers (2009, 2010) describing elevated contaminants in snow near the Alberta oil sands, there has been a significant expansion of monitoring efforts, enhanced by $50M a year contributed by industry to a regional Joint Oil Sands Monitoring (JOSM) program. In parallel to the intensification of research and monitoring efforts, including expansion of measured indicators, techniques for chemical analysis have also become more sensitive. Both factors contribute to the increased sensitivity and power, and improve our capacity to detect any change. The increase in capability requires a counterbalance to account for trivial change. This can be done using an interpretative approach that requires contextualization of differences to meaningfully inform environmental monitoring programs and provide focus for action. Experience obtained through 25 years of involvement with Canada's Environmental Effects Monitoring (EEM) program has shown that a tiered program informed by triggers can provide the context to make decisions about monitoring priorities. Here we provide a potential interpretation framework using a case study around the Korosi et al. (2016) study which found recent increases in alkylated polycyclic aromatic compounds (aPACs) in the Cold Lake in situ oil sands area. Public contaminant profiles from the JOSM studies in the oil sands region are used to evaluate the changes using an interpretation framework based on estimated normal ranges using existing data for site-specific, local and regional (distant) levels that was modelled after the tiered Canadian EEM design.

This paper situates the current political moment in Alberta, Canada, within a broader analysis of the global crisis of fossil capitalism. Alberta’s political economy and ecology are deeply riven by the conflict between its heavy dependence for revenue and employment on the exportation of fossil fuels, on the one hand, and the multiple harms, risks, and forms of opposition to this development model, on the other hand. With the election in May 2015 of a social democratic party, a rare window for change has opened, and much is at stake in the choices and strategies that the new government will adopt. Two potential paths –which parallel what is emerging globally--are becoming clearer: rapid and deep decarbonisation underpinned by an equally deep democratization of citizenship and societal-decision making (ecological democracy), or a “climate capitalist” project to prolong the carbon extractive model.

Water extraction in many of the world’s rivers is reaching unsustainable levels and continued supplyof water of adequate quality for human and productive needs is threatened. In response, authorities inmany river basins have stopped issuing new water entitlements and there are increased calls to divertless water for consumptive use. New mechanisms for sharing existing water entitlements among com-peting users are therefore needed. Since agriculture accounts for up to 80% of current water entitlementsin many stressed basins, it will have to play a central role in achieving water sharing objectives for asustainable future. However, attempts to facilitate water sharing have met vocal opposition in manycountries and across stakeholder groups. This paper uses the results from a number of studies in Alberta,Canada, to explore some of the underlying reasons for this opposition. It finds that policy makers andwater managers’ lack of understanding of what drives irrigators’ behaviour, plus the heterogeneity of theirrigation sector, have been major factors. It recommends that water sharing solutions have to be contextspecific and take into account the aspirations and interests of people across the society in which they areto be implemented. Refereed/Peer-reviewed

Purpose – The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners’ perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. Design/methodology/approach – The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. Findings – Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. Research limitations/implications – Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. Practical implications – Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. Originality/value – This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.

Neospora caninum is an important abortive agent of domestic ruminants, but few diagnostic tools are available to reliably assess the exposure of wild cervid species such as elk (Cervus elaphus) to this pathogen, which limits our ability to understand their role in the life cycle of this parasite. In the absence of a gold standard test or panels of samples from individuals of known infection status, classical laboratory-based validation methods are not applicable. However, there are a number of statistical methods that can help in selecting an appropriate cut-off value and estimating the resulting diagnostic test performances. In this paper, the performance of a commercial competitive enzyme-linked immunosorbent assay (cELISA) on elk serum samples was evaluated with two statistical approaches: a mixture distribution model fitted to the cELISA results, and a Bayesian latent class analysis combining results from the cELISA and an indirect immuno-fluorescence antibody test. Both methods indicated that the commercial kit could be used on elk serum with the specifications recommended by the manufacturer. In particular, the optimal combination of sensitivity and specificity were obtained for a percentage of inhibition cutoff of 30 %. The 95 % probability interval of the proportion of elk exposed to N. caninum, adjusting for the sensitivity and specificity of this test in elk, was estimated between 1.3 and 7.4 %. There was no association between the serological status of female elk and their pregnancy status. These results point out to the involvement of elk in a sylvatic cycle of N. caninum in this area.

The purpose of this paper is to examine the advantages and challenges of co-supervision of doctoral students, as found in the literature and from our experiences. We define co-supervision and then discuss the process in detail. Examples are based on experiences of co-supervision from faculty perspectives as well as from the point of view of a former doctoral student. We propose that the advantages of co-supervision far outweigh the challenges and should be regularly considered by seasoned academics to enhance student learning. In addition, we suggest that co-supervision is intellectually stimulating for academics.

Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks ("pathways") that connect patients with exercise-related resources. In the present paper, we describe a pathway model and related resources that were developed by an expert panel of practitioners and researchers in the field of exercise and rehabilitation in oncology and that support the transition from health care practitioner to exercise programs or services for people with cancer. The model acknowledges the nuanced distinctions between research and exercise programming, as well as physical activity promotion, that, depending on the available programming in the local community or region, might influence practitioner use. Furthermore, the pathway identifies and provides examples of processes for referral, screening, medical clearance, and programming for people after a cancer diagnosis. The pathway supports the implementation of exercise guidelines and should serve as a model of enhanced care delivery to increase the health and well-being of people with cancer.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) does not appear to be diminishing over time. Indeed, recent data suggests that the disorder may be more prevalent than previously thought. A variety of public education programs developed over the last 20 years have promoted alcohol abstention during pregnancy, yet FASD remains a serious public health concern. This paper reports on a secondary data analysis of public awareness in one Canadian province looking at possible creative pathways to consider for future prevention efforts. The data indicates that the focus on women of childbearing age continues to make sense. The data also suggests that targeting formal (health care providers for examples) and informal support (partner, spouse, family, and friends) might also be valuable. They are seen as sources of encouragement, so ensuring they understand the risks, as well as effective ways to encourage abstinence or harm reduction, may be beneficial for both the woman and the pregnancy. Educating people who might support a woman in pregnancy may be as important as programs targeted towards women who may become or are pregnant. The data also suggests that there is already a significant level of awareness of FASD, thus highlighting the need to explore the effectiveness and value of current prevention approaches.

IntroductionThe appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods.Methods and analysisWe will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual’s first positive influenza test during the season, and potential controls will be defined based on an individual’s first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression.Ethics and disseminationEthics approval was obtained from the University of Alberta’s Health Research Ethics Board—Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.

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.

Decision making in land management can be greatly enhanced if the perspectives of concerned stakeholders are taken into consideration. This often implies negotiation in order to reach an agreement based on the examination of multiple alternatives. This paper describes a spatial web/agent-based modeling system that was developed to support the negotiation process of stakeholders regarding land development in southern Alberta, Canada. This system integrates a fuzzy analytic hierarchy procedure within an agent-based model in an interactive visualization environment provided through a web interface to facilitate the learning and negotiation of the stakeholders. In the pre-negotiation phase, the stakeholders compare their evaluation criteria using linguistic expressions. Due to the uncertainty and fuzzy nature of such comparisons, a fuzzy Analytic Hierarchy Process is then used to prioritize the criteria. The negotiation starts by a development plan being submitted by a user (stakeholder) through the web interface. An agent called the proposer, which represents the proposer of the plan, receives this plan and starts negotiating with all other agents. The negotiation is conducted in a step-wise manner where the agents change their attitudes by assigning a new set of weights to their criteria. If an agreement is not achieved, a new location for development is proposed by the proposer agent. This process is repeated until a location is found that satisfies all agents to a certain predefined degree. To evaluate the performance of the model, the negotiation was simulated with four agents, one of which being the proposer agent, using two hypothetical development plans. The first plan was selected randomly; the other one was chosen in an area that is of high importance to one of the agents. While the agents managed to achieve an agreement about the location of the land development after three rounds of negotiation in the first scenario, seven rounds were required in the second scenario. The proposed web/agent-based model facilitates the interaction and learning among stakeholders when facing multiple alternatives.

Our purpose in this paper is to report on the frustrations and unmet needs of paid, formal caregivers and unpaid, family caregivers who together provide care to adults with disabilities and/or mental health issues. We conducted eight focus group interviews between November 2010 and June 2011 in two large, urban centres and one smaller centre in Western Canada. Four of our focus groups were with family members including adults with disabilities and/or mental health issues, their parents and their siblings, and four were with representatives from agencies providing support and services to adults with disabilities and/or mental health issues and their families. Data were collected from 23 family members and 24 agency representatives who responded to questions about successes and struggles in meeting, and collaborating to meet, care needs of adults with disabilities and/or mental health issues. Each focus group session was digitally recorded and transcribed; field notes were also taken and we thematically analysed data according to family versus agency perspectives of their successes and barriers in care provision and care collaboration. We found that family members desire greater and more effective support in enriching the lives of adults with disabilities and/or mental health issues and in preparing for age-related changes. Agency representatives are keenly aware of the needs and challenges faced by families, yet grapple with being effective collaborators with families of widely varying priorities and styles of care and collaboration.

In the City of Edmonton, in order to reduce the prevalence of collisions, the Operation 24 Hours program (OPS24) was developed by using existing police and transportation services resources. The program uses traditional manned police speed enforcement method, which are supplemented by traffic safety messages displayed on permanent and mobile dynamic messaging signs (DMS). In this paper, collision data analysis was performed by looking at the daily number of collisions from 2008 to 2011 that covers 28 Operation 24 Hours (OPS24) events. The objective of the collision data analysis is to analyze if there is a reduction in collision frequencies after OPS24 was held and examined how long the collision reduction effect last. Weather factors such as temperature, thickness of snow, and wind gust have been considered by many as a great influence on collision occurrences, especially in a city with long and cold winter such as Edmonton. Therefore, collision modeling was performed by considering these external weather factors. To analyze the linear and periodic trend of different collision types (injury, fatal, and property damage only (PDO)) and examine the influence of weather factors on collisions, negative binomial time series model that accounts for seasonality and weather factors was used to model daily collision data. The modeling also considered collision proportion to account for missing traffic volume data; the Gaussian time series model that accounts for seasonality and weather factors was used to model collision proportion. To estimate the collision trend and test for changes in collision levels before/after OPS24, interrupted time series model with segmented regression was used. While for estimating how long the effect of the OPS24 last, change point method was applied.

PurposeWhen introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi‐criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed‐upon criteria and decision tools to enhance a pre‐existing local health technology assessment (HTA) decision support program.Design/methodology/approachThe authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools.FindingsA set of user‐validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent.Practical implicationsThis framework can be used by others to develop decision‐making criteria and tools to enhance similar technology adoption programs.Originality/valueThe development of clear, user‐validated criteria for evaluating new technologies adds a critical element to improve decision‐making on technology adoption, and the decision tools ensure consistency, transparency, and real‐world relevance.

To address the speeding problem in residential areas, the City of Edmonton initiated a pilot project to reduce the posted speed limit from 50 km/h to 40 km/h within six residential communities. This paper investigates the community perceptions of traffic safety within the six pilot communities in two phases: prior to project initiation (pre-pilot) and following the end of the project (post-pilot). This objective was accomplished by analyzing the results of two random dialing telephone surveys comprising 300 residents each. A preliminary analysis showed compatible demographic configurations for the two samples and confirmed that the residents were aware of both the posted speed limits and the adopted speed management controls. For the confirmatory factor analysis (CFA), a two-group (pre-pilot and post-pilot) three-factor model was used to assess the residents’ perceptions of the speeding behavior (Speeding), their concerns about traffic safety issues (Concerns), and their perceptions of traffic safety (Safety). Comparing the CFA results of the post-pilot survey versus those of the pre-pilot survey, it was evident that there was a significant decrease in Speeding and Concerns accompanied by a significant increase in Safety. A structural equations model (SEM) was also fitted to the data in order to assess the impact of Speeding and Concerns on Safety. The results showed that Concerns increase significantly with Speeding, and that both factors have significant negative impacts on Safety. However, while the impact of Concerns on Safety was direct, that of Speeding on Safety was largely indirect (i.e., mediated through Concerns). Overall, the multivariate analysis has demonstrated that the pilot project was successful in improving the residents’ perceptions of traffic safety in their community.

OBJECTIVES: The purpose of this paper was to investigate the contributions of sociodemographic, neurologic, and neuropsychological variables to health-related quality of life (HRQoL) in children with epilepsy and high seizure burden. Focus was placed on the relationship between memory and HRQoL, which has not been previously investigated. METHODS: Ninety children with epilepsy receiving clinical care at a tertiary-level children’s hospital were retrospectively identified. Primary assessment measures were verbal memory (California Verbal Learning Test–Children’s Version) and HRQoL. Other neuropsychological variables included intellectual function, executive function, emotional and behavioral function, and adaptive function. Sociodemographic and neurologic variables were extracted from chart review. RESULTS: No significant correlations were found between HRQoL and sociodemographic or neurologic variables. Moderate correlations were found between neuropsychological variables and HRQoL. Emotional function (Child Behavior Checklist) and verbal memory (California Verbal Learning Test–Children’s Version) emerged as significant predictor variables of HRQoL. Low verbal memory was associated with a twofold risk of low HRQoL, emotional and behavioral difficulty with a 10-fold risk, and the combination of emotional and behavioral difficulty and low verbal memory with a 17-fold risk. CONCLUSIONS: Verbal memory and emotional and behavioral difficulty are associated with increased risk of low HRQoL, even when other important variables are considered in children with high seizure burden. The results reinforce the importance of neuropsychological assessment in clinical care in pediatric epilepsy and suggest important areas of focus for psychological intervention.

OBJECTIVES: Little is known about the prevalence and incidence of dementia in Aboriginal communities in Canada. As with the Canadian population, dementia in Aboriginal people is expected to be an increasing challenge for federal, provincial and community health care systems. To respond to a dearth of information concerning the prevalence of dementia in First Nations, this paper reports population-level data on dementia in the First Nations population in Alberta, Canada. METHODS: Aggregate data obtained from Alberta Health and Wellness were analyzed. Physician-treated prevalence rates for dementia were calculated for First Nations and non-First Nations populations seeking treatment in Alberta (1998-2009). Trends in age-adjusted rates over time were compared using linear regression models. Age and sex effects were also examined. RESULTS: In 2009, the age-standardized prevalence of dementia in First Nations in Alberta was 7.5 per 1,000 (95% CI: 6.6 to 8.5 per 1,000) compared to non-First Nations, at 5.6 per 1,000 (95% CI: 5.5 to 5.6). The prevalence of dementia rose more quickly for First Nations (p=0.032). The data suggest that dementia disproportionately affects younger age groups and males (p=0.017) in First Nations populations compared to non-First Nations. CONCLUSIONS: Dementia represents an emerging health concern for First Nations. This increase may be driven by parallel trends, such as population aging, changing perceptions of dementia, and disproportionately higher rates of associated risk factors, impacts of the social determinants of health, and co-morbid illnesses. The unique epidemiological profile supports the need for responsive policies, programs and care geared specifically to First Nations.

In this paper, I describe dividing practices in making up a specific medical-legal category-the revolving door patient-to identify, label, and direct the actions of particular people living with mental illness. The revolving door patient was a category that had been spoken of for some time, but became a formal legal subject with the introduction of the Alberta Mental Health Act 2010 and Community Treatment Orders (CTOs). I demonstrate how a rationale of control over unpredictable and dangerous individuals was primary in creating this new category, and that the characterization of the revolving door patient required a disciplinary technology to reduce danger. I argue that the CTO is a medical-legal technology that solves the problem of governing a subject in order to produce a patient that manages mental illness. I conclude by reflecting on how the narrative of the revolving door patient, and of mental illness more broadly, has implications for personal identity and tensions between care and control. Dans cet article, je décris comment des 'pratiques divisées' ont créé une catégorie spécifique médico-légale - le « revolving door patient » - afin d'identifier, d'étiqueter et de contrôler les comportements de certains individus vivants avec une maladie mentale. Le «revolving door patient», une catégorie dont on avait parlé depuis un certain temps, est devenu un sujet juridique formel par l'introduction de la loi de la santé mentale de l'Alberta 2010 et de l'Ordre de Traitement Communautaire (OCT). Je démontre comment une logique de contrôle sur les individus imprévisibles et dangereux eu un rôle prépondérant lors de la création de cette catégorie et que la caractérisation du «revolving door patient», entant que telle, a nécessité une technologie disciplinaire pour réduire le danger social. Je soutiens que le OTC est une technologie médico-légale qui résout le problème de contrôle d'un sujet en produisant un patient qui gère une maladie mentale. Je conclus en démontrant de quelle façon le «revolving door patient», et la maladie mentale en général, a des répercussions sur l'identité personnelle et produisent des tensions entre les soins et le contrôle.

ObjectivesGingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians’ current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies.MethodsA national survey was conducted at all 15 national academic pediatric centres.Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions.ResultsResponse rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children.ConclusionsAs with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a second-line agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice.

Background Mental illness has been widely cited as a driver of costs in the criminal justice system. Objective The objective of this paper is to estimate the additional mental health service costs incurred within the criminal justice system that are incurred because of people with mental illnesses who go through the system. Our focus is on costs in Alberta. Methods We set up a model of the flow of all persons through the criminal justice system, including police, court, and corrections components, and for mental health diversion, review, and forensic services. We estimate the transitional probabilities and costs that accrue as persons who have been charged move through the system. Costs are estimated for the Alberta criminal justice system as a whole, and for the mental illness component. Results Public expenditures for each person diverted or charged in Alberta in the criminal justice system, including mental health costs, were $16,138. The 95% range of this estimate was from $14,530 to $19,580. Of these costs, 87% were for criminal justice services and 13% were for mental illness-related services. Hospitalization for people with mental illness who were reviewed represented the greatest additional cost associated with mental illnesses. Conclusion Treatment costs stemming from mental illnesses directly add about 13% onto those in the criminal justice system.

Rationale, aims, and objectives Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. Method We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. Results Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). Conclusion These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures.

Objective To identify the common non-otolaryngological diagnoses (N-OD) encountered by a pediatric otolaryngologist in surgical patients. This information may help in educating otolaryngologists on relevant pediatric conditions among their patients. Design/setting Cross-sectional, retrospective database review of entries from 2006 to 2008 at a tertiary pediatric centre involving the patient case load of a busy pediatric otolaryngologist. Main outcome measures The main outcome of this study was to identify the common (N-OD) encountered by a pediatric otolaryngologist. Conditions excluded from the analysis were surgical complications and diagnoses managed primarily by otolaryngologists (sleep disordered breathing and allergic rhinitis). Results 1357 pediatric surgical entries were identified. Of these, 524 (38.6%) entries contained N-OD and underwent surgery. A total of 580 N-OD were identified for these 524 patients. The N-OD were identified and categorized into the following subheadings: syndromes/associations, respiratory and cardiac, gastrointestinal, developmental, metabolic, and miscellaneous conditions. The most common N-OD are gastro-esophageal reflux disease, obesity, history of prematurity, congenital heart disease, asthma developmental delay and Down syndrome. The commonest categories encountered were developmental (138), cardio-respiratory (114) and gastro-intestinal (114). Conclusions This paper identifies the common N-OD encountered by a pediatric otolaryngologist in children managed at a tertiary level. The highlighted N-OD may help as a guide on curriculum content for training residents and fellows and continued medical education.

The role of nutrient loading on biomass growth in wastewater-impacted rivers is important in order to effectively optimize wastewater treatment to avoid excessive biomass growth in the receiving water body. This paper directly relates wastewater treatment plant (WWTP) effluent nutrients (including ammonia (NH3-N), nitrate (NO3-N) and total phosphorus (TP)) to the temporal and spatial distribution of epilithic algae and macrophyte biomass in an oligotrophic river. Annual macrophyte biomass, epilithic algae data and WWTP effluent nutrient data from 1980 to 2012 were statistically analysed. Because discharge can affect aquatic biomass growth, locally weighted scatterplot smoothing (LOWESS) was used to remove the influence of river discharge from the aquatic biomass (macrophytes and algae) data before further analysis was conducted. The results from LOWESS indicated that aquatic biomass did not increase beyond site-specific threshold discharge values in the river. The LOWESS-estimated biomass residuals showed a variable response to different nutrients. Macrophyte biomass residuals showed a decreasing trend concurrent with enhanced nutrient removal at the WWTP and decreased effluent P loading, whereas epilithic algae biomass residuals showed greater response to enhanced N removal. Correlation analysis between effluent nutrient concentrations and the biomass residuals (both epilithic algae and macrophytes) suggested that aquatic biomass is nitrogen limited, especially by NH3-N, at most sampling sites. The response of aquatic biomass residuals to effluent nutrient concentrations did not change with increasing distance to the WWTP but was different for P and N, allowing for additional conclusions about nutrient limitation in specific river reaches. The data further showed that the mixing process between the effluent and the river has an influence on the spatial distribution of biomass growth.

Background Despite opportunities for didactic education on obesity management, we still observe low rates of weight management visits in our primary care setting. This paper describes the co-creation by front-line interdisciplinary health care providers and researchers of the 5As Team intervention to improve obesity prevention and management in primary care. Methods We describe the theoretical foundations, design, and core elements of the 5AsT intervention, and the process of eliciting practitioners’ self-identified knowledge gaps to inform the curricula for the 5AsT intervention. Themes and topics were identified through facilitated group discussion and a curriculum relevant to this group of practitioners was developed and delivered in a series of 12 workshops. Result The research question and approach were co-created with the clinical leadership of the PCN; the PCN committed internal resources and a practice facilitator to the effort. Practice facilitation and learning collaboratives were used in the intervention For the content, front-line providers identified 43 topics, related to 13 themes around obesity assessment and management for which they felt the need for further education and training. These needs included: cultural identity and body image, emotional and mental health, motivation, setting goals, managing expectations, weight-bias, caregiver fatigue, clinic dynamics and team-based care, greater understanding of physiology and the use of a systematic framework for obesity assessment (the “4Ms” of obesity). The content of the 12 intervention sessions were designed based on these themes. There was a strong innovation values fit with the 5AsT intervention, and providers were more comfortable with obesity management following the intervention. The 5AsT intervention, including videos, resources and tools, has been compiled for use by clinical teams and is available online at http://www.obesitynetwork.ca/5As_Team. Conclusions Primary care interdisciplinary practitioners perceive important knowledge gaps across a wide range of topics relevant to obesity assessment and management. This description of the intervention provides important information for trial replication. The 5AsT intervention may be a useful aid for primary care teams interested to improve their knowledge of obesity prevention and management. Clinical Trials.gov (NCT01967797)

This paper reports relationships between symptoms assessed using a newly developed instrument for assessing patient-reported symptoms, the Modified Ambulatory Care Flow Sheet (MACFS), and other symptom assessment measures.Using a cross-sectional design, patients on active treatment for colorectal cancer were recruited in an ambulatory setting of a tertiary care cancer center in western Canada. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Cancer 30, the Rotterdam Symptom Checklist Modified, Linear analog scales for pain and coping, and the MACFS, all at a single time point.We found moderate to strong correlations between the MACFS scores and scores on the other symptom measures used. The correlations were not as strong when using the MACFS symptom change scores, as when using the MACFS scores for the presence or absence of a particular symptom.The MACFS reflects the symptom experience of colorectal cancer patients. Further evaluation in more diverse populations and of the relationship between MACFS symptom scores and quality of life will improve our understanding of the MACFS and of the cancer patient treatment experience.

The purpose of this paper is to present a case study of "evidence-based" program uptake and implementation. The process of integrating Triple P (levels 2 and 3) into existing family support centers in Alberta, Canada, was examined. We conducted ten individual interviews with directors, and ten group interviews, involving a total of 62 practitioners across ten Triple P pilot sites. Key findings show that there was variability in the approach and extent to which Triple P was integrated into family support centers. Five key factors impacting the integration process emerged from the interviews. These were: (1) the level of development of pre-existing support services; (2) the degree of "fit" between the Triple P program approach and existing agency practice, including the perceived suitability/unsuitability for some client groups; (3) practitioner perceptions of the adaptability of the program; (4) rules about who can and who cannot use Triple P resources; and (5) training and sustainability issues. In addition to identifying specific factors, this study was able to provide some insight as to why and how these factors were significant, thereby adding to the literature on knowledge/program dissemination processes.

In exploring innovative approaches to enhanced patient care, an acute care interprofessional clinical learning unit (IPCLU) was established in a medical unit of a large metropolitan hospital in Edmonton, Alberta, Canada. Part of a larger, community based, participatory mixed method research project, this acute-care model involved several post-secondary institution health science faculties, students, academics, and other post-secondary institutions partnering with the hospital to coordinate and enhance student clinical learning and improve patient care. Pre-implementation data collected from the existing acute-care unit patient-care team, students, and faculty identified areas of strength and enhancement opportunities in interprofessional education (IPE). Interested members of several professions from the patient-care units and students constituted the working group that developed the model. This paper discusses clinical IPE and its relevance in nursing education, explains the processes and mechanisms in creating the IPCLU, details the initiatives that were developed to facilitate enhanced interprofessional care, and offers considerations in advancing IPE in an acute-care setting. The work plan included initiatives that enhance interprofessional teaching and learning culture, increase awareness surrounding interprofessional teamwork and professional roles, promote interprofessional communication and decision-making strategies, and further develop clinical reflection. Insights regarding sustainability are offered.

This paper highlights the environmental impacts of implementing beneficial management practices to address cattle bedding and direct access to the creek in a study watershed in southern Alberta, Canada. Approximately 35 cow–calf pairs grazed 194 ha of grass forage and had direct access to the creek in the spring and summer. During winter, the cattle were fed adjacent to the creek at an old bedding site. The practice changes included off-stream watering, bedding site relocation and fencing for rotational grazing. The cost was $15,225 and 60 h of labour. Four years of data were used in a before-and-after experimental design to evaluate the practice changes. After two years of post-implementation monitoring, riparian assessments showed an increase in plant diversity, but no change in the percent cover of the riparian species Salix exigua and Juncus balitus and a decrease in Carex sp. (P < 0.05). Water quality monitoring showed a decrease in the difference between upstream and downstream concentrations of total phosphorus, total dissolved phosphorus, total nitrogen, organic nitrogen and Escherichia coli (P < 0.10). These results showed that improved environmental changes in riparian and water quality can be measured following the implementation of beneficial management practices for cattle bedding and grazing.

Plant phenology networks of citizen scientists have a long history and have recently contributed to our understanding of climate change effects on ecosystems. This paper describes the development of the Alberta and Canada PlantWatch programs, which coordinate networks of citizen scientists who track spring development timing for common plants. Tracking spring phenology is highly suited to volunteers and, with effective volunteer management, observers will stay loyal to a phenology program for many years. Over two decades beginning in 1987, Alberta PlantWatch volunteers reported 47,000 records, the majority contributed by observers who participated for more than 9 years. We present a quantitative analysis of factors that determine the quality of this phenological data and explore sources of variation. Our goal is to help those who wish to initiate new observer networks with an analysis of the effectiveness of program protocols including selected plant species and bloom stages.

Objective: The aim of this paper is to highlight the potential impact of costs associated with overweight and obesity for provincial policy and prevention initiatives. Method: Prevalence-based cost-of-illness methodology was used to estimate the direct costs (hospital care, drugs, physician care, institutional care, additional costs) and indirect costs (short- and long-term disability, premature mortality) associated with excess weight for 22 health conditions. Total costs for each health condition were estimated using the Public Health Agency of Canada’s Economic Burden of Illness database. Population attributable fractions (PAF) were also estimated using 2004 and 2005 CCHS data and current literature reviews. Results: In 2005, the cost of excess weight in Alberta totaled $1.27 billion. The direct cost of excess weight was $630.1M (49.5%), the indirect cost $643.8M (50.5%). Excluding costs associated with premature mortality and caregiving, obesity accounted for 69.5% ($500.8M) of costs and overweight the remaining 30.5% ($220.2M). Among the 22 health conditions, coronary heart disease had the highest costs attributable to excess weight ($307.1M), followed by osteoarthritis ($167.7M) and type 2 diabetes ($161.5M). The total cost of excess weight equated to 5.6% of the province’s annual health care expenditures for 2005. Conclusion: While obesity costing research often focuses on the direct health care costs, this study reveals that the indirect costs of excess weight are also significant and can account for over half of the total costs. Interventions to reduce excess weight among Canadians have the potential to improve the health of the population while reducing provincial and national health care costs.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

The province of Alberta is endowed with the second largest oil reserves in the world behind Saudi Arabia in the form of bitumen in oil sands, with established bitumen reserves of 27.0 109 m3 extracted from initial bitumen in place of 286.6 109 m3. This huge resource base presents enormous challenges to produce and upgrade bitumen in an environmentally responsible manner, related to potential greenhouse gas emissions. Extracting this bitumen from oil sands and thereafter upgrading it to synthetic crude oil requires extensive processing using either carbon rejection (coking) or hydrogen addition (hydrocracking). The production of hydrogen for hydrocracking necessitates emissions of CO2 into the atmosphere which contributes in a significant manner to Alberta’s greenhouse gas emissions. Enhance Energy Inc. and NorthWest Upgrading Inc., two privately funded Alberta based companies, are proposing a solution by constructing CO2 capture and a backbone CO2 gathering and distribution system from Alberta’s industrial heartland area, which is the site of current and proposed bitumen upgraders, to enhanced oil recovery fields in central and southern Alberta for ultimate sequestration of such CO2. This paper presents an overview of the project which is scheduled for operation in late 2013.

The Heartland Area Redwater CO2 Storage Project (HARP) is a staged CO2 storage project located near Edmonton in the industrial heartland of Alberta, Canada. The project, being developed by ARC Resources Ltd. of Calgary, aims to store CO2 captured from diverse sources into the very large Redwater Leduc Fm. carbonate reef situated at depths between 922 and 1234 m and with a thickness of up to 275 m. In the first stage, a pilot operation will be implemented by the spring of 2011 that will inject between 200 and 300 t CO2/day. In the second stage, depending on the regulatory and economic environment, the pilot may be scaled up to a commercial-sized operation by 2015 that will inject at least 1 Mt CO2/year. Each stage of the project has several phases, with Stage I/Phase I having been completed in the summer of 2009. Work focused on the characterization of the storage unit: Namely, the Redwater reef, its caprock, and the immediately underlying and overlying aquifers. In Stage I/Phase II, injection and monitoring wells will be drilled and site-specific characterization and pilot design will be completed, while at the same time seeking regulatory approval and community acceptance for the pilot operation. In Stage I/Phase III, the pilot operation will be constructed. A multi-disciplinary, multi-organizational research program comprising major research organizations and universities in western Canada is being built around this CO2 storage project. This paper presents the results of Phase I of the project: Characterization of the storage unit and adjacent strata.

The self-monitoring of blood glucose plays a critical role in management of diabetes mellitus. Although laboratory comparisons of glucose meter accuracy are often acceptable, clinical comparisons show frequent inaccuracies. In this paper, we evaluate the accuracy of self-monitoring blood glucose meters using glucose meter and serum comparisons from a large Canadian laboratory.This study was performed using secondary data obtained from the Laboratory Information System of Calgary Services, the sole provider of laboratory testing to Calgary and surrounding areas. We examined anonymous quality assurance data for glucose meter comparisons performed on home glucose meters between January 1, 2010, and April 30, 2013.A total of 39 542 comparisons were recorded on 18 540 different subjects. Overall, 6.7% of differences were greater than the current International Standards Organization standard of 15%, and 3.7% exceeded the Canadian guideline of 20%.Glucose meter checks were infrequently performed (on average, once per 1.6 years). A significant subset of meter results was inaccurate.

A contemporary challenge for nursing educators is to connect theory with practice for nursing students in a curriculum which is largely theory based. The use of reflective writing has been widely used to increase students' critical thinking, and writing skills, as well as to help students integrate concepts within the context of clinical nursing. In the clinical context, the concept of seeing the other can be challenging for students whose life experiences may not have included many of the crises faced by patients and their families. This paper embeds an undergraduate nursing student's reflective writing response to an exercise, from a family nursing course, utilized to help students relate more confidently to the patient as the other.