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This paper explores student perceptions of the effects of pairing discipline-specific language instruction with the traditional method of course delivery in economics. Our research involved teaching content-based English as an additional language (EAL) tutorials to a small group of ten international students taking first-year introductory economics courses. These voluntary participants completed pre- and post-treatment assessments with exit interviews at the end of the project. Assessment results and interviews suggest that students perceive that discipline-specific language instruction such as our EAL tutorials assists in the development of increased content and language proficiency. They also believe that vocabulary development is one of the most critical activities to support these goals; reading skills are also important but require more time and commitment than students can afford to give. Despite the students' interest in the project, their heavy class schedules prevented many from participating; our group was limited to ten students which precludes any assurance of statistical significance. In spite of the limitations, we believe that the project can still contribute valuable qualitative lessons to the literature of content-based language instruction in which the discipline of economics has not been well represented.

This paper examines news media coverage of hydraulic fracturing in Canada over a five-year period in five newspapers. Hydraulic fracturing, or 'fracking,' has reenergized the North American oil and gas market. This technology has increased economic growth, but it also comes with unknown and uncertain environmental and public health risks. Regulation of the fracking industry varies globally. In Canada there are three provinces that engage in large volume fracking and four provinces that have placed a moratorium on fracking. This paper demonstrates that the Canadian fracking story is about five frames: water pollution, economic benefits, uncertain risks, moratoriums, and energy independence. There is a difference between coverage in the two national newspapers as well as a difference in national and provincial coverage. In Nova Scotia, where fracking is banned, the media focuses primarily on environmental issues and benefits to the local economy. In Saskatchewan, where fracking for oil is an essential part of the economy, the media focuses on economic benefits and downplays other frames. Overall, across the five papers, the media coverage is highly selective and focuses on particular stories about the economy or the environment, but not both. Quelle est la chronique de la fracturation hydraulique au Canada? Cet article fait état de la couverture médiatique liée à la fracturation hydraulique au Canada par cinq journaux sur une période de cinq ans. La fracturation hydraulique a revitalisé le marché nord-américain des hydrocarbures. Cette technologie favorise la croissance économique, mais comporte également des risques écologiques et sanitaires inconnus et incertains. La réglementation régissant l'industrie de la fracturation varie selon les pays. À l'échelle canadienne, trois provinces ont réalisé d'importantes opérations de fracturation et quatre provinces ont imposé un moratoire à la fracturation hydraulique. Cet article montre que le cadrage médiatique de la fracturation hydraulique repose sur cinq thématiques : la pollution hydrique, les retombées économiques, l'incertitude liée aux risques, les moratoires et la souveraineté énergétique. Le cadrage médiatique varie entre les deux journaux nationaux ainsi qu'entre les médias nationaux et provinciaux. En Nouvelle-Écosse, où la fracturation est interdite, les médias mettent l'accent sur les questions environnementales et les retombées pour l'économie locale. En Saskatchewan, où la fracturation pour extraire du pétrole joue un rôle économique primordial, les médias se concentrent sur les retombées économiques et minorent l'importance des autres thématiques. Dans l'ensemble, les cinq journaux appliquent un filtre sélectif dans le traitement du sujet et publient des reportages spécifiques portant sur l'économie ou sur l'environnement, mais pas les deux. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

The article puts Canadian economist Dave Donaldson's research on empirical international trade and geography in the broader context of work on market integration and international trade. It lists selected papers by Donaldson including one which analyzes the link between railroads and U.S. economic growth and another which explores the size and implications of intranational trade costs. It also examines the implications of his work for trade policy.

Background Generic drugs have been seen as a potentially powerful way to alleviate the financial burden on patients and health care systems. Two strategies for achieving rational prices of generic drugs are tiered pricing framework and pooled purchasing power. We compare the pan-Canadian Tiered Pricing Framework (TPF) and the Chinese National Volume-Based Procurement (NVBP) as comparators to explore the similarities and differences between the two mechanisms and summarise lessons for other jurisdictions. Methods This comparative study applies Donabedian's structure-process-outcome framework to systematically analyse the macro contexts, procedures, and long- and short-term results of each pricing mechanism, and the interactions between them. Results Structure: TPF is an upstream initiative aimed at lowering the prices of generic drugs and increasing coverage and price consistency. NVBP is a downstream national initiative prioritised for reducing drug prices to achieve value-based purchasing. Process: By associating the number of manufacturers with price cuts, TPF leaves the choice to manufacturers to decide if they want to enter a specific market. In contrast, the Chinese government determines NVBP list and has the authority to choose manufacturer(s) with the lowest price(s). TPF provides clear price information to potential suppliers with unclear order quantity. The NVBP drug price is determined by tendering, while procurement volume is clear and massive. Outcome: The effectiveness of TPF and NVBP is similar, with both achieving a 53% price cut. Both TPF and NVBP experienced efficiency improvement since their establishment, with 98 and 86 drugs priced per year. By comparing 60 drugs covered by both programmes, the NVBP price is 57% of that of the TPF counterpart on average (1.1 to 301.6%), by purchase power parity. Conclusions The tiered pricing scheme is feasible in regions with a stable and mature pharmaceutical market, typically seen in high-income countries, while tendering is more workable in low- and middle-income countries where the pharmaceutical market is weak and unstable. Experience in the two countries shows that a coordinated pricing mechanism involves many piecemeal interactive problems, which a sophisticated system with a robust long-range plan may address better. [ABSTRACT FROM AUTHOR]

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

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

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

Background: Many older adults with mobility limitations use assistive technology to help them perform daily activities. However, little attention has been paid to the impact on their family caregivers. This neglect produces an incomplete portrayal of the outcomes of assistive technology provision. This paper describes the protocol for a study that examines the impact of a tailored assistive technology intervention that is inclusive of assistance users and their family caregivers.Methods/design: This research will use a combination of quantitative and qualitative methods. The quantitative portion will be an experimental, single-blinded study in which participants are randomly assigned to either an experimental assistive technology intervention or a standard care group. We will enroll 240 participants (120 dyads) into the study from three Canadian sites. Participants will include older adults (>55) and family caregivers who provide ≥4 h per week of assistance with daily activities and social participation. The primary outcome measure for the older adults will be the Functional Autonomy Measurement System, and the primary outcome measure for the caregivers will be the Caregiver Assistive Technology Outcomes Measure. Qualitative data will be collected through detailed records of the therapists' interventions, as well as through interviews with dyads and therapists following the interventions. Data collection will occur at baseline (T0) with follow-ups at 6 weeks (T1), 22 weeks (T2), and 58 weeks (T3) after baseline evaluation.Discussion: The findings from this study will help service providers and clinicians to move forward with assistive technology recommendations that are more attuned to the needs of both older adults with mobility limitations and their family caregivers. Additionally, the study's findings will enhance our conceptual understanding of the spectrum of assistive technology outcomes and set the stage for econometric studies assessing cost-effectiveness.Trial Registration: ClinicalTrials.gov Identifier: NCT01640470 . Registered 11/21/2011. [ABSTRACT FROM AUTHOR]

Background: Performance reporting in primary health care in Canada is challenging because of the dearth of concise and synthesized information. The paucity of information occurs, in part, because the majority of primary health care in Canada is delivered through a multitude of privately owned small businesses with no mechanism or incentives to provide information about their performance. The purpose of this paper is to report the methods used to recruit family physicians and their patients across 10 provinces to provide self-reported information about primary care and how this information could be used in recruitment and data collection for future large scale pan-Canadian and other cross-country studies. Methods: Canada participated in an international large scale study-the QUALICO-PC (Quality and Costs of Primary Care) study. A set of four surveys, designed to collect in-depth information regarding primary care activities was collected from: practices, providers, and patients (experiences and values). Invitations (telephone, electronic or mailed) were sent to family physicians. Eligible participants were sent a package of surveys. Provincial teams kept records on the number of: invitation emails/letters sent, physicians who registered, practices that were sent surveys, and practices returning completed surveys. Response and cooperation rates were calculated. Results: Invitations to participate were sent to approximately 23,000 family physicians across Canada. A total of 792 physicians and 8,332 patients from 772 primary care practices completed the surveys, including 1,160 participants completing a Patient Values survey and 7,172 participants completing a Patient Experience survey. Overall, the response rate was very low ranging from 2% (British Columbia) to 21% (Nova Scotia). However, the participation rate was high, ranging from 72% (Ontario) to 100% (New Brunswick/Prince Edward Island and Newfoundland & Labrador). Conclusions: The difficulties obtaining acceptable response rates by family physicians for survey participation is a universal challenge. This response rate for the QUALICO-PC arm in Canada was similar to rates found in other countries such as Australia and New Zealand. Even though most family physicians operate as self-employed small businesses, they could be supported to routinely submit data through a collective effort and provincial mandate. The groundwork in setting up pan-Canadian collaboration in primary care has been established through this study. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to examine the relationship between foreign direct investment (FDI) flows and institutional stability. The focus country is Canada. It is one of the few countries where the economy remained relatively stable compared to other economies during the Global Financial Crisis. It is crucial for Canada to determine the optimal level of institutional development to attract more FDI and sustain the sound financial stability in future. Design/methodology/approach - This study uses the auto-regressive distributive lag (ARDL) approach to understand the relationship between FDI and institutional stability along with other controlled variables, for instance, gross national product, inflation and exports. Findings - The key finding of this work is that FDI and institutional stability are cointegrated in the long run. The error correction model of ARDL shed light on institutional stability being an exogenous variable, and FDI is an endogenous variable. Institutional stability affects FDI, as it is exogenous. The findings will help policymakers to implement policies to strengthen the institution's settings, and this, in turn, will attract more investment. Originality/value - Based on previous theoretical and empirical literature, most of the research points to FDI positively affect institutional stability. In some cases, the relationship does not always hold true. This study will fix the gap in the literature by investigating the relationship between FDI and institutional stability of Canada. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programs (ASPs) have been shown to reduce inappropriate antimicrobial use and its consequences. However, these programs lack legislative requirements in many places and it can be difficult to determine what human resources are required for these programs and how to create a business case to present to hospital administrators for program funding. The objectives of the current paper were to review legislative requirements and outline human resource requirements for ASPs, and to create a base business case for ASPs. Methods: A working group of antimicrobial stewardship experts from across Canada met to discuss the necessary components for creation of a business case for antimicrobial stewardship. A narrative review of the literature of the regulatory requirements and human resource recommendations for ASPs was conducted. Informed by the review and using a consensus decision-making process, the expert working group developed human resource recommendations based on a 1000 bed acute care health care facility in Canada. A spreadsheet based business case model for ASPs was also created. Results: Legislative and /or regulatory requirements for ASPs were found in 2 countries and one state jurisdiction. The literature review and consensus development process recommended the following minimum human resources complement: 1 physician, 3 pharmacists, 0.5 program administrative and coordination support, and 0.4 data analyst support as full time equivalents (FTEs) per 1000 acute care beds. Necessary components for the business case model, including the human resource requirements, were determined to create a spreadsheet based model. Conclusions: There is evidence to support the negative outcomes of inappropriate antimicrobial use as well as the benefits of ASPs. Legislative and /or regulatory requirements for ASPs are not common. The available evidence for human resource recommendations for ASPs using a narrative review process was examined and a base business case modelling scenario was created. As regulatory requirements for ASPs increase, it will be necessary to create accurate business cases for ASPs in order to obtain the necessary funding to render these programs successful. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, panel regression analysis is used to examine the fiscal impact of urban growth on per-capita or perhousehold expenditures of providing municipal services in the province of Ontario, Canada. Three variables are used to measure growth: households, population and assessment. Using a panel data set for 68 municipalities, we find that for the most part, urban growth has no effect on per-capita or per-household expenditures. The policy implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Using recent data from the Canadian General Social Survey, I examine how religious belief and practice relate to labour earnings in Canada. Noting that religious landscape strongly varies across Canadian provinces, I explore whether these discrepancies are reflected in the association of wages and religiosity indicators, for men and women. Moreover, I identify two groups of individuals, one without any tie with religion and spirituality, and the other shaping their lives around them. I find that males belonging to the least religious group earn significantly below otherwise identical individuals in the high affiliation province of Newfoundland, while they enjoy a ceteris paribus wage premium in the low religiosity provinces of British Columbia and Québec. Females of the most religious group, on the other hand, are found at a disadvantage in the Canadian west, where affiliation with Conservative Protestantism is more prevalent. [ABSTRACT FROM AUTHOR]

We assess the extent to which subsidies for home energy efficiency improvements in Canada have been paid to households that would have undertaken the improvements anyway--the so-called free rider rate. We focus on forced-air natural gas furnaces, replaced between April 1, 2007 and March 31, 2011, under both federal and provincial subsidy programs as well as the 2009 federal Home Renovation Tax Credit. Our results indicate that around 50 percent of expenditures under the Canadian subsidy and tax credit programs represented free riding. In the long run, our estimates suggest that over 80 percent of grant recipients would have chosen an identical furnace at the time of replacement. We estimate that the cost effectiveness of the programs in terms of greenhouse gas reduced was between $70 and $110/t CO2, depending on the assumptions made. Further, we find that a substantial majority of the grants were received by middle- and high-income households, such that the grant had a regressive effect on the distribution of income. We conclude that such grants are not an optimal way to improve residential energy efficiency. [ABSTRACT FROM AUTHOR]

We examine the impact of physical distance, language, and religion on Law of One Price (LOP) deviations across interwar Canadian and modern Nigerian cities. The data comprise monthly average retail prices for narrowly defined goods collected by national statistical agencies. We find that differences in the fraction of the city population sharing a common language and religion have a significant impact on LOP deviations. The impact of language differences is consistent with a recently developed theory in which both trade costs and differences in signal-noise ratios contribute to LOP deviations. [ABSTRACT FROM AUTHOR]

How much might poor financial market returns affect the financial well-being of Canadian seniors? We compare three scenarios: if Canadian financial markets (a) never experienced the financial crisis of 2008 (i.e., continued on their pre-2008 path); (b) experienced the crisis and return to historical trends; or (c) enter a new low normal of depressed stock market returns and continued low interest rates. Using a population microsimulation model, we model the first order impacts-that is, before behavioural responses such as delayed retirement or increased savings-on the retirement income flows of Baby Boom retirees. While annual income from private savings of the median Canadian baby-boom senior drops by over half in the event of continuing low financial market returns, median financial welfare drops by only just over a fifth. Rising social transfers and stable income sources (such as Canada/Quebec Pension Plan and implicit income from home ownership) partially shield Canadian seniors from financial market risk. Canadian research has long recognized that the Canadian social pension system protects poorer Canadian seniors from destitution. Our results indicate that it also helps shield the Canadian elderly population as a whole from financial market risk. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Plant Science is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Infections continue to be a major cause of post‐transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April‐2009 and March‐2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non‐SOT patients with pneumonia [(C$14 923 ± C$29 147) vs. (C$11 274 ± C$18 284)] and sepsis [(C$23 434 ± C$39 685) vs. (C$20 849 ± C$36 257)]. Mortality (7.6% vs. 12.5%; P < 0.001), long‐term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 ± 17.7 days vs. 13.1 ± 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8–12%) lower compared to non‐SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

Over the past four decades, governments have backed away from the promotion of collective bargaining in Canada resulting in a tendency towards anti-unionism. Examining this new reality, this article investigates two interrelated trends in Canadian anti-unionism over the last two decades in an effort to conceptualize the role of the state in regulating labour relations. First, we investigate legislative attempts to undermine or eliminate the ability of workers to collectively bargain and strike. Second, the article unpacks the political economy of anti-unionism in the private sector by focusing on the role of lobby groups that have shaped labour legislation. These two interrelated threads allow us to expose the relationship between employers and governments, which has threatened the strength of organized labour in the private and public sector and shaped a uniquely Canadian anti-unionism. Finally, we conclude by examining both the strengths and limitations of the unique fight-back strategies used by the labour movement, which has sought to elevate aspects of Canadian labour law to be protected by the Charter of Rights and Freedoms. This, we argue, offers restrictive possibilities for advancing collective bargaining rights in the existing labour relations framework. [ABSTRACT FROM AUTHOR]

With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess the alignment of HIV care settings with the CCM. We conducted a mixed methods study to explore structures, organization and care processes of Canadian HIV care settings. The quantitative results of phase one are published elsewhere. For phase two, we conducted semi-structured interviews with key informants from 12 HIV care settings across Canada. Irrespective of composition of the care setting or its location, HIV care in Canada is well aligned with several components of the CCM, most prominently in the areas of linkage to community resources and delivery system design with inter-professional team-based care. We propose the need for improvements in the availability of electronic clinical information systems and self-management support services to support better care delivery and health outcomes among people living with HIV in Canada. [ABSTRACT FROM AUTHOR]

Residential segregation into spatial neighborhoods and boroughs is a well-known spatial dynamic process that characterise complex urban environments. Existing models of segregation, including the pioneering Schelling ones, often do not consider all the factors that can contribute to this process. Segregation as well as aggregation emerges from local interactions among individuals, and is rooted in the complexity of social, economic and environmental interactions. The main objective of this study is to develop and implement a geospatial agent-based model to simulate the decision-making process of location of new household for incoming immigrant populations. Particularly this study aims to simulate and analyse the dynamics of the new immigrant populations arriving in the bilingual cities and boroughs of the island of Montreal. The model was implemented in NetLogo software, using real geospatial datasets. The obtained simulation results indicate realistic spatial patterns of spatial composition of the ethnographic fabric on the island of Montreal. The proposed model has the potential to be used as part of the city planning purposes. [ABSTRACT FROM AUTHOR]

Recent developments in the social epidemiological literature indicate that health inequalities between the employed and the unemployed are widening in many advanced capitalist countries. At present, we know relatively little about why these inequalities are worsening. Drawing on nationally-representative data from the largest health survey in Canada, we explored this question by analyzing changes in self-rated health inequalities between employed and unemployed Canadians from 2000 to 2014. Using a regression-based method that decomposes a given inequality into its component sources, we investigated the extent to which risk factors that account for unemployment-related health inequalities at a single point in time can also explain the extent and direction of change in these unemployment-related health inequalities over time. Our results indicate that relative and absolute health inequalities between employed and unemployed Canadians widened over the study period. Between 2000 and 2014, the prevalence of poor self-rated health among unemployed Canadians increased from 10.8% to 14.6%, while rates among employed Canadians were stable at around 6%. Our findings suggest that the demographic, socioeconomic, and proximal risk factors that are routinely used to explain unemployment-related health inequalities may not be as powerful for explaining how and why these inequalities change over time. In the case of unemployment-related health inequalities in Canada, these risk factors explain neither the increasing prevalence of poor self-rated health among the unemployed nor the growing gap between the unemployed and their employed counterparts. We provide several possible explanations for these puzzling findings. We conclude by suggesting that widening health inequalities may be driven by macrosocial trends (e.g. widening income inequality and declining social safety nets) which have changed the meaning and context of unemployment, as well as its associated risk factors, in ways that are not easy to capture using routinely available survey data. [ABSTRACT FROM AUTHOR]

Experts have long conjectured that pension accounting rules, by which pension expense depends on a managerial estimate that is directly tied to the riskiness of plan assets (i.e., the expected rate of return, or ERR, on plan assets), encourage risk-taking with pension investments. The recent passage of IAS 19, Employee Benefits (Revised) (hereafter, IAS 19R) eliminates the ERR and replaces it with a managerial estimate unrelated to plan asset riskiness (the discount rate). We demonstrate that a sample of Canadian firms affected by IAS 19R reduces risk-taking in pension investments post-IAS 19R, compared to a control sample of U.S. firms unaffected by IAS 19R. Therefore, removing firms' ability to recognize immediately in net income the expected higher returns from risk-taking (via a higher ERR) reduces their propensity for that risk-taking—providing some of the first empirical evidence on the economic consequences of eliminating the ERR-based pension accounting model. [ABSTRACT FROM AUTHOR]

Salt marshes are highly effective carbon (C) sinks and have higher rates of soil C burial (per square meter) than terrestrial ecosystems. Marsh reclamation and anthropogenic impacts, however, have resulted in extensive losses of salt marshes. Restoration of marshes drained and “reclaimed” for agriculture (referred to in Canada as dykelands) and degraded marshes can generate C credits, but only if C burial is reliably quantified. To date, studies reporting on C burial rates have been limited primarily to restored marshes which are more than 10 years old. Here we report on a study which assessed C burial six years after the return of tidal flooding to a section of dykeland in Aulac, New Brunswick on Canada’s Bay of Fundy. The C burial rate in the restored marsh averaged 1 329 g C m-2 yr-1, more than five times the rate reported for a nearby mature marsh. Carbon density in the recovering marsh was relatively consistent with depth and although salt marsh cordgrass (Spartina alterniflora) became established in 2012, the bulk of the C in the new marsh deposit is assumed to be allochthonous. Financial constraints are a barrier to marsh restoration projects and C markets could provide a considerable source of funding for restoration work in the future. For marsh restoration projects to be recognized in C crediting systems, however, it must also be demonstrated that the allochthonous C would not otherwise have been sequestered; the potential for this is discussed. [ABSTRACT FROM AUTHOR]

Background: As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. Methods: We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. Results: Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. Conclusions: Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects. [ABSTRACT FROM AUTHOR]

The Trans-Pacific Partnership is the most comprehensive trade agreement in the world. The TPP will help deepen Canada's trade ties in the dynamic and fast growing Asia-Pacific region while strengthening existing economic partnerships with NAFTA partners and across Americas. The TPP will eliminate tariffs on almost all of Canada's key exports and offer access to new opportunities in the Asia-Pacific region. Tariffs and other barriers on a wide range of Canadian products from various sectors will be reduced, including in agriculture and agri-food, fish and seafood, forestry and wood products, metals and mining and industrial goods. These benefits can only be derived if USA ratifies it. However, the US president has already signed a presidential memorandum confirming the US withdrawal from the TPP agreement. With this background, the current study evaluates the economic impacts of the Trans-Pacific Partnership agreements on the Canadian economy by the year 2030 using a global CGE framework. The study undertakes a number of simulations based on the level of tariff reduction across selected commodities between Canada and other TPP Nations. The GTAP 9 Data Base with the reference year of 2011 is used for the study. Results show that Canada stands to benefit significantly from improved access to the TPP region. Canada expects a considerable increase in agricultural export. Canola, processed food and beverages, seafood, beef and pork sectors are expected to benefit from the deal. Industrial goods like farming and construction equipment, metal and mineral, transport equipment, machinery would gain from TPP agreements. The agreement would help increase Canada's manufacturing and exporting output. The banking sector is also expected to benefit from the deal. Additionally, a significant number of skilled and unskilled employment is likely to generate in Canada. [ABSTRACT FROM AUTHOR]

Background: Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low. The objective of this analysis was to provide a comprehensive revised estimate of this burden. Methods: We used a case--control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012. We used patient-level administrative health care data from Ontario to correctly attribute health care costs to cancer. We employed the net cost method (cost difference between patients with cancer and control subjects without cancer) to account for costs directly and indirectly related to cancer and its sequelae. Using average patient-level cost estimates from Ontario, we applied proportions from national health expenditures data to obtain the economic burden of cancer care for Canada. All costs were adjusted to 2015 Canadian dollars. Results: Costs of cancer care rose steadily over our analysis period, from $2.9 billion in 2005 to $7.5 billion in 2012, mostly owing to the increase in costs of hospital-based care. Most expenditures for health care services increased over time, with chemotherapy and radiation therapy expenditures accounting for the largest increases over the study period. Our cost estimates were larger than those in the Economic Burden of Illness in Canada 2005-2008 report for every year except 2005 and 2006. Interpretation: The economic burden of cancer care in Canada is substantial. Further research is needed to understand how the economic burden of cancer compares to that of other diseases. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)?Methods: Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and; other nuances at play. It is hypothesized that the benefits of the caregiver-friendly workplace policy intervention(s) will include improvements in caregiver-employees' mental, psychosocial and physical health, as well as evidence of cost-benefit and cost-effectiveness for the employer.Discussion: The expected project results will provide the research evidence for extensive knowledge translation work, to be carried out in collaboration with our knowledge transition partners, to the employer/human resources and occupational health/safety target populations.Trial Registration: ISRCTN16187974 Registered August 25, 2016. [ABSTRACT FROM AUTHOR]

Background: Falls among older adults can cause serious morbidity and pose economic burdens on society. Older age is a known risk factor for falls and age has been shown to influence the effectiveness of fall prevention programs. To our knowledge, no studies have explicitly investigated whether cost-effectiveness of a multifactorial fall prevention intervention (the intervention) is influenced by age. This economic evaluation explores: 1) the cost-effectiveness of a multifactorial fall prevention intervention compared to usual care for community-dwelling adults ≥ 75 years at risk of falling in Canada; and 2) the influence of age on the cost-effectiveness of the intervention.Methods: Net benefit regression was used to examine the cost-effectiveness of the intervention with willingness-to-pay values ranging from $0-$50,000. Effects were measured as change in the number of falls, from baseline to 6-month follow-up. Costs were measured using a societal perspective. The cost-effectiveness analysis was conducted for both the total sample and by age subgroups (75-84 and 85+ years).Results: For the total sample, the intervention was not economically attractive. However, the intervention was cost-effective at higher willingness-to-pay (WTP) (≥ $25,000) for adults 75-84 years and at lower WTP (< $5,000) for adults 85+ years.Conclusions: The cost-effectiveness of the intervention depends on age and decision makers' WTP to prevent falls. Understanding the influence of age on the cost-effectiveness of an intervention may help to target resources to those who benefit most.Trial Registration: Retrospectively registered. Clinicaltrials.gov identifier: NCT00463658 (18 April 2007). [ABSTRACT FROM AUTHOR]

Background: Reliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams.Methods: We use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied.Results: Our conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved.Conclusions: The development and application of a conceptual framework is an important step to the systematic study of the best performing financial models in the context of interdisciplinary primary care. The identification of optimal financial arrangements must be contextualized in terms of feasibility and the implementation environment. In general, financial hierarchy, both overt and covert, is considered a barrier to collaboration. [ABSTRACT FROM AUTHOR]

Economic transition is necessary to prolong the lifespan of formerly resource-dependent places. This article seeks to discover if migrant-induced, neoendogenous development is contributing to this process in Dawson City, Yukon Territory, Canada. This once mine-dependent municipality emerged during the Klondike Gold Rush, but has since transitioned into a multi-functional space that capitalizes on its cultural assets. Using survey and interview data, we discover that migrants, particularly southern counterurbanites, have contributed to Dawson's evolution. Their injection of externally accumulated capital has enhanced the community's identity, mobilized local labour, and built local factor capacities. Our findings confirm that migrant-induced, neo-endogenous development is contributing to economic transition in this formerly resource-dependent region. Our results have implications for other isolated spaces, hoping to establish new economic identities. [ABSTRACT FROM AUTHOR]

Background: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.Methods: All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.Results: Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.Conclusions: ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged. [ABSTRACT FROM AUTHOR]

The article provides information on the economic growth of Canadian Oil & Gas Compaines in the year 2013 as compare to the world. It also states on the Exploration and Production Companies of Canada. Topics discussed includes natural gas liquid, international trade and energy industries production.

Background The economic impact on society associated with the healthcare of older adults depends on their health status. The aim was to estimate the excess costs associated with co-morbid mental and physical disorders. Methods Data were from a health survey of 2004 older adults. Two-year healthcare costs were identified from administrative databases. Generalized linear models were used to study healthcare costs as a function of co-morbid mental disorders (MDs) and heart disease (HD), arthritis, diabetes, cancer, respiratory disease (RD) and cerebral vascular accident (CVA). Results Participants with HD and CVA with MD incurred higher costs reaching $1696(95% confidence interval (CI): $30, $3422) and $14 772 (95% CI: $1909, $31 454) than those without MD. RD and MD incurred higher costs reaching $5343 (95% CI: $343, $10 343) than those without RD. The excess annual adjusted healthcare costs associated with co-morbid MD and physical disorders reach close to $600 M per 1 000 000 population of older adults. Conclusion The presence of MDs with HD, CVA and RDs has a synergistic effect on healthcare costs. These findings underline the need for improved primary care for the prevention and treatment of co-mental and physical disorders that can potentially save hundreds of millions to society. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To estimate the economic burden and cost attributable to Fetal Alcohol Spectrum Disorder (FASD) in Canada in 2013.~Aim~Objective~This cost-of-illness study examined the impact of FASD on the material welfare of the Canadian society in 2013 by analyzing the direct costs of resources expended on health care, law enforcement, children and youth in care, special education, supportive housing, long-term care, prevention and research, as well as the indirect costs of productivity losses of individuals with FASD due to their increased morbidity and premature mortality.~Methods~Methods~The costs totaled approximately $1.8 billion (from about $1.3 billion as the lower estimate up to $2.3 billion as the upper estimate). The highest contributor to the overall FASD-attributable cost was the cost of productivity losses due to morbidity and premature mortality, which accounted for 41% ($532 million-$1.2 billion) of the overall cost. The second highest contributor to the total cost was the cost of corrections, accounting for 29% ($378.3 million). The third highest contributor was the cost of health care at 10% ($128.5-$226.3 million).~Results~Results~FASD is a significant public health and social problem that consumes resources, both economic and societal, in Canada. Many of the costs could be reduced with the implementation of effective social policies and intervention programs.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Background: Admission to the neonatal intensive care unit (NICU) may disrupt parent-infant interaction with adverse consequences for infants and their families. Several family-centered care programs promote parent-infant interaction in the NICU; however, all of these retain the premise that health-care professionals should provide most of the infant's care. Parents play a mainly supportive role in the NICU and continue to feel anxious and unprepared to care for their infant after discharge. In the Family Integrated Care (FICare) model, parents provide all except the most advanced medical care for their infants with support from the medical team. Our hypothesis is that infants whose families complete the FICare program will have greater weight gain and better clinical and parental outcomes compared with infants provided with standard NICU care.Methods/design: FICare is being evaluated in a cluster randomized controlled trial among infants born at ≤ 33 weeks' gestation admitted to 19 Canadian, 6 Australian, and 1 New Zealand tertiary-level NICU. Trial enrollment began in April, 2013, with a target sample size of 675 infants in each arm, to be completed by August, 2015. Participating sites were stratified by country, and by NICU size within Canada, for randomization to either the FICare intervention or control arm. In intervention sites, parents are taught how to provide most of their infant's care and supported by nursing staff, veteran parents, a program coordinator, and education sessions. In control sites standard NICU care is provided. The primary outcome is infants' weight gain at 21 days after enrollment, which will be compared between the FICare and control groups using Student's t-test adjusted for site-level clustering, and multi-level hierarchical models accounting for both clustering and potential confounders. Similar analyses will examine secondary outcomes including breastfeeding, clinical outcomes, safety, parental stress and anxiety, and resource use. The trial was designed, is being conducted, and will be reported according to the CONSORT 2010 guidelines for cluster randomized controlled trials.Discussion: By evaluating the impact of integrating parents into the care of their infant in the NICU, this trial may transform the delivery of neonatal care.Trial Registration: NCT01852695 , registered December 19, 2012. [ABSTRACT FROM AUTHOR]

Background: We developed an evidence service that draws inputs from Health Systems Evidence (HSE), which is a comprehensive database of research evidence about governance, financial and delivery arrangements within health systems and about implementation strategies relevant to health systems. Our goal was to evaluate whether, how and why a 'full-serve' evidence service increases the use of synthesized research evidence by policy analysts and advisors in the Ontario Ministry of Health and Long-Term Care as compared to a 'self-serve' evidence service.Methods: We attempted to conduct a two-arm, 10-month randomized controlled trial (RCT), along with a follow-up qualitative process evaluation, but we terminated the RCT when we failed to reach our recruitment target. For the qualitative process evaluation we modified the original interview guide to allow us to explore the (1) factors influencing participation in the trial; (2) usage of HSE, factors explaining usage patterns, and strategies to increase usage; (3) participation in training workshops and use of other supports; and (4) views about and experiences with key HSE features.Results: We terminated the RCT given our 15% recruitment rate. Six factors were identified by those who had agreed to participate in the trial as encouraging their participation: relevance of the study to participants' own work; familiarity with the researchers; personal view of the importance of using research evidence in policymaking; academic background; support from supervisors; and participation of colleagues. Most reported that they never, infrequently or inconsistently used HSE and suggested strategies to increase its use, including regular email reminders and employee training. However, only two participants indicated that employee training, in the form of a workshop about finding and using research evidence, had influenced their use of HSE. Most participants found HSE features to be intuitive and helpful, although registration/sign-in and some page formats (particularly the advanced search page and detailed search results page) discouraged their use or did not optimize the user experience.Conclusions: The qualitative findings informed a re-design of HSE, which allows users to more efficiently find and use research evidence about how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them. Our experience with RCT recruitment suggests the need to consider changing the unit of allocation to divisions instead of individuals within divisions, among other lessons.Trial Registration: This protocol for this study is published in Implementation Science and registered with ClinicalTrials.gov ( HHS/FHS REB 10-267 ). [ABSTRACT FROM AUTHOR]