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This paper forms Part 2 of a two-part discussion paper. Part 1 outlined a short history of adoption in Canada, examined the impact of forced, closed, and external adoptions on Indigenous adoptees and families, and traced the move toward more open statutory adoptions and greater cultural continuity in adoptions. Having zeroed in on the entangled histories of adoption and colonization in Part 1, here we explore traditional and contemporary practices of Indigenous custom adoption and caretaking. We first recount Western understandings and impositions, then feature Indigenous perspectives that centre spiritual and ceremonial protocols, values regarding child well-being and community connectedness, and the importance of kinship and customary forms of caretaking. We consider both the promises and complexities involved in designing and implementing custom adoptions, and the urgent need for adequate, equitable funding and supports to ensure their feasibility and sustainability. Finally, we highlight the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance. [ABSTRACT FROM AUTHOR]

This paper forms Part 1 of a two-part discussion paper on Indigenous custom adoption. Zeroing in on the entangled histories of adoption and colonization, it outlines a short history of adoption in Canada, examines the impact of forced, closed, and external adoptions on Indigenous adoptees, and traces the move toward more open statutory adoptions and greater cultural connection and continuity in adoptions. This historical review sets the stage for Part 2 of our discussion paper, "Honouring Our Caretaking Traditions," where we highlight the connections between customary laws regarding caregiving and the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance. [ABSTRACT FROM AUTHOR]

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension., (© 2020 Wiley Periodicals, Inc.)

Objective: To contrast how Brazil's and Canada's different jurisdictional and judicial realities have led to different types of telemedicine and how further scale and improvement can be achieved., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada and Canadian telemedicine experts developed connections with colleagues in Porto Alegre, Brazil, and collaborated to undertake a between-country comparison of their respective telemedicine programs., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of telemedicine in Canada and Brazil., Report: Both Brazil and Canada share expansive geographies, creating substantial barriers to health for rural patients. Telemedicine is an important part of a universal health system. Both countries have achieved telemedicine programs that have scaled up across large regions and are showing important effects on health care costs and outcomes. However, each system is unique in design and implementation and faces unique challenges for further scale and improvement. Addressing regional differences, the normalization of telemedicine, and potential alignment of telemedicine and artificial intelligence technologies for health care are seen as promising approaches to scaling up and improving telemedicine in both countries., (Copyright© the College of Family Physicians of Canada.)

Objectives : This study evaluated a standardized paper triage process conducted by an advanced practice physiotherapist (APP) at a rheumatology center. The aims were to (1) determine the concordance between paper triage priority assignment and the rheumatologist's diagnosis; (2) determine the sensitivity and specificity of the paper triage process; and (3) assess reasons for incorrect priority ranking. Methods : Referrals were triaged by a formally trained APP into one of the three priorities, guided by a priority referral tool. A retrospective review of 192 charts was performed. Raw proportion of agreement between paper triage and rheumatologist's diagnosis was supplemented by a prevalence-adjusted bias-adjusted kappa (PABAK). Priority categories were collapsed to calculate sensitivity and specificity. For discordant cases, additional information was collected from the referral and chart to identify potential features leading to discrepancy. Results : Overall agreement was 76%. The PABAK was 0.80 [95% confidence interval 0.70-0.90]. Sensitivity ranged 0.64-0.92 and specificity ranged 0.81-0.94, depending on the priority category. Forty-six cases were discordant, with the APP choosing a higher priority in 37 cases. An incorrect diagnosis from the family physician with no supporting information for the paper triage led to discordance in 16 cases. Conclusion : A standardized paper triage process conducted by an APP showed substantial concordance, sensitivity, and specificity.

Objective: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil., Report: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil., (Copyright© the College of Family Physicians of Canada.)

The Canadian physician Sir William Osler is a key figure in the history of modern medicine. He encouraged lifelong learning for doctors, starting with bedside teaching. Contemporary with Old World figures such as Pasteur in Paris and Virchow in Berlin, he played a major role in raising awareness among clinicians of the importance of the scientific basis for the practice of medicine. He championed a rational approach to treatment and did much to encourage avoidance of 'unnecessary drugging' by prescribers. He is credited with playing a key role in improving education of medical students and postgraduate education of doctors, with important benefits for the care of hospital patients. He also had a major influence on his medical colleagues through founding and leading medical societies. A century on from his death in December 1919, his specific contributions and how he achieved them are not well known. The aim of this article is to consider the evidence that Osler was an influential medical leader and to reflect on the extent to which the achievements which resulted from his leadership are relevant to modern clinical medicine. Questions of interest include his leadership style, what made for his success as a leader, his medical achievements both in North America and in England, his own insight into leadership and how he was viewed by his peers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Full-scale anaerobic digestion processes for organic solid waste are common in Europe but are generally unaffordable in Canada and the United States because of inadequate regulations to restrict cheaper forms of disposal, particularly landfill. We investigated the viability of solid-state anaerobic digestion (SS-AD) as an alternative that reduces the costs of waste pretreatment and subsequent wastewater treatment. A laboratory SS-AD digester, comprising six 10 L leach beds and an upflow anaerobic sludge blanket reactor treating the leachate, was operated continuously for 88 weeks, with a mass balance based on chemical oxygen demand (COD) of 100 ± 2% (COD out /COD in ). The feed was a mixture of fibers (cardboard, boxboard, newsprint, and fine paper) with varying amounts of food waste added. The process remained stable throughout. The addition of food waste caused a synergistic effect, raising methane production from the fiber mixture from a low of 52.7 L kg -1 COD fibers added at no food waste, to 152 L kg -1 COD fibers added at 29% food waste, an increase of 190%. Substrate COD destruction efficiency reached 65%, and the methane yield reached 225 L kg -1 COD added at 29% food waste on a COD basis, with a solids retention time of 42 days. This performance was similar to that of a completely stirred tank reactor digesting similar wastes, but with much lower energy input. Multiple factors likely contributed to the enhanced fiber destruction, including the action of hydrolytic enzymes derived from fresh food waste and continuous leachate recirculation between leach beds of different ages.

Palliative care is an evolving field with extensive studies demonstrating its benefits to patients, families, and the health care system. Many health systems have developed or are developing palliative care programs. The Canadian Society of Palliative Care Physicians (CSPCP) is often asked to recommend how many palliative care specialists are needed to implement and support an integrated palliative care program. This information would allow health service decision makers and educational institutions to plan resources accordingly to manage the needs of their communities. The CSPCP is well positioned to answer this question, as many of its members are Directors of palliative care programs and have been responsible for creating and overseeing the pioneering work of building these programs over the past few decades. In 2017, the CSPCP commissioned a working group to develop a staffing model for specialist palliative care teams based on the interdependence of three key professional roles, an extensive literature search, key stakeholder interviews, and expert opinions. This article is the Canadian Society of Palliative Care's recommended starting point that will be further evaluated as it is utilized across Canada. For more information and to see sample calculations go to the Canadian Society of Palliative Care Physicians Staffing Model for Palliative Care Programs (https://www.cspcp.ca).

Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients' nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.

Objective: To develop an ethical framework for collaboration in international academic partnerships in family medicine., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships., Methods: Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017., Report: Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: accountability, cost and efficiencies, excellence, equity, humility, justice, leadership, reciprocity, respect for self-determination, and transparency. Based on these principles, a decision-making framework was created to translate these values into actions and to promote a cohesive and transparent structure for discussions. Fostering fairness, transparency, and consistency in decision making reduces the potential for inequity in a partnership, leading to lasting relationships that endure beyond the scope of a partnership agreement., (Copyright© the College of Family Physicians of Canada.)

Wilder Penfield is justly famous for his contributions to our understanding of epilepsy and of the structure-function relationship of the brain. His theory on the relationship of the brain and mind is less well known. Based on the effects of the electrical stimulation of the cortex in conscious patients, Penfield believed that consciousness and mind are functions of what he referred to as the centrencephalic integrating system. This functional system comprised bidirectional pathways between the upper brainstem, the thalami, and the cerebral cortex of both hemispheres, and was the physical substrate from which memory, perception, initiative, will, and judgment arose. It was the source of the stream of consciousness and the physical basis of mind. This paper reviews how Penfield arrived at this conception of the mind-brain relationship. Although Penfield ultimately felt that he had failed in his attempt to unify brain and mind, his work shed new light on the relationship of memory to the mesial temporal structures and to the temporal cortex; and his association of consciousness and the brainstem preceded the conceptualization of the reticular activating system by a generation. In these, as in so many aspects of neurobiology, Penfield was prescient.

[Display omitted] • Novel method to estimate total technical potential for improving energy efficiency. • Bottom-up sector energy model used to characterize energy demands and opportunities. • Technology-explicit analysis framework used to estimate integrated energy savings. • Application to Canada's pulp & paper sector indicates major savings are possible. • Technical potential to reduce natural gas use by 95% and net electricity by 54% Industrial energy efficiency has long been recognized as a critical tool for energy management and emissions reduction and is increasingly considered to be an energy resource in its own right. However, the complexity of most industrial sectors creates barriers for modellers, companies, and policymakers in understanding and achieving the overall potential for efficiency-driven energy savings. To address this gap, we have developed a novel method that combines disaggregated bottom-up sector energy modelling with analysis of a comprehensive set of technology-explicit energy efficiency measures. This approach overcomes the deficiencies of top-down analyses and better represents the complexities of multi-measure efficiency investments compared to piecewise studies of individual measures. In this study, we demonstrated application of our method to the case of the Canadian pulp and paper sector. Our analysis shows that the sector can reduce its natural gas and electricity use by 95% and 41%, respectively, by adopting economical efficiency measures. This equates to 71 PJ of natural gas and 44 PJ of electricity saved annually and would result in cost savings of $81 per tonne of output sector-wide. Notably, we find that efficiency and fuel switching have the technical potential to reduce natural gas consumption by 98% across the sector. Taken together, the results provide quantitative evidence that energy efficiency is an underestimated resource for cost-effective energy savings in the Canadian pulp and paper sector. Our analysis framework can be applied to any industrial sector in any region to provide insights regarding energy conservation strategies and policy design. [ABSTRACT FROM AUTHOR]

Universities can play a key role in contributing to a sustainable future for our planet and its inhabitants. In times of constant changes, there is a growing urgency to reflect on the vision of universities as well as their respective practices and projects that can promote the creation of sustainable societies. As is evident in scholarly literature, there is a need to empower universities and enhance their ability to prepare individuals who can confront global sustainability challenges and pursue sustainable development. The United Nations' adoption of the 2030 Agenda for Sustainable Development in 2015 recognised that societal problems were territorially blind, meaning that no country has sufficient knowledge or research capacity to solve all challenges on its own. To that end, this qualitative, comparative research study represents the unified effort of two very different countries to explore the topic of education for sustainable development (SD) at universities. The study employed a document analysis of selected publicly funded universities in Canada and South Africa. Gathered documents are from the past seven years and include the universities' mission and vision statements, annual reports, and strategic plans. The three main questions addressed in this work are: (a) What is the status and role of higher education for SD in Canada and South Africa? (b) What areas of SD are on the agenda of universities under investigation in Canada and South Africa? (c) What are the main similarities and differences between the two contexts under investigation? Findings indicate that universities focus on several aspects of SD, namely sustainable education, sustainable relationships, and sustainable initiatives. The paper discusses these areas for each country in connection to their contextual setting. Although the study's findings cannot be generalised, they can be informative for other universities and contexts and thus contribute to the body of knowledge about education for SD in higher education.

The article offers information on the need, benefits and significance of the electronification of the cheque transaction process in Canada. It discusses the rffectiveness of the Canadian Payments Association (CPA) Rules in assisting Canadian deposit-taking financial institutions for clearing cheques and electronic payments with reference to the Bills of Exchange Act (BEA).

Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system. [ABSTRACT FROM AUTHOR]

Background: Scientific research is an essential aspect in the ongoing development of medical education and improved patient care. Dissemination of findings is a pivotal goal of any health research study. The number of citations that a published article receives is reflective of the importance that paper has on clinical practice. To date, it is unknown which journals are most frequently cited as influencing the management of pelvic trauma., Methods: The aim of this study was to identify the top 50 publications relating to the management of pelvic trauma. The database of the Science Citation Index of the Institute for Scientific Information (1945 to 2016) was reviewed to identify the 50 papers most commonly cited., Results: A total of 1535 papers were included. Of these, 31 papers were cited over 100 times with the top 50 cited 69 times or more. The top 50 were subjected to further analysis to identify the authors and institutions involved. The majority of these publications originated in the USA, followed by Canada. The most cited paper is "pelvic ring fractures-should they be fixed", published by Tile in 1988., Conclusion: We have identified and analysed the publications that have contributed most to the assessment and management of pelvic trauma over the past 50 years. We have also identified the researchers and institutions which have most influenced the evidence-based approach currently employed in the management of pelvic trauma.

Objective: To compare primary care in Canada and Brazil and how both countries have embraced the Starfield principles in the design of their health care systems., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil., Report: The Brazilian and Canadian primary care systems have both adopted and advanced the Starfield principles in various ways, with both countries showing an increasing trend toward adopting interprofessional team-based care. Access to primary care remains a challenge in rural areas in both countries, and longitudinal relationships between providers and patients appear to be more common in Canada. With the advent of technology, increasing patient engagement and expectations, the decline of paternalistic medicine, and the sheer mass of readily available information (and misinformation), to be successful, primary care systems must also be constructed to engender trust at both the local and the system levels. Both countries face challenges to maintaining trust in the context of the increasing prevalence of team-based care, and a lack of trust at the system level can be seen in patients' perceptions about the difficulty of finding a family doctor and in high rates of emergency department and urgent care centre use in both countries. Primary care reform must be implemented with the public's trust in mind., Conclusion: Trust is a crucial ingredient to the success of primary care and must be protected at both local and system levels. If designed with trust in mind, primary care in Canada and Brazil has the potential to meet the challenges set out by the Starfield principles., (Copyright© the College of Family Physicians of Canada.)

Objectives: In this paper, we provide an overview of best practices in FASD prevention, diagnostic, and interventions and supports. In Canada, people diagnosed with Fetal Alcohol Spectrum Disorder (FASD) represent a fraction people living with FASD. While social stigma may deter people from seeking an FASD diagnosis, other deterrents include the lack of screening and diagnostic referrals, cost of travelling to a clinic, and lack of clarity of how a diagnosis may improve supports and services. Preventing FASD and improving lifelong outcomes for people living with FASD requires a coordinated approach between prevention, diagnostic, intervention, and support efforts., Methods: Using the example of Newfoundland and Labrador, a province where 60% of the population lives in rural communities and benefits from being involved in national initiatives and partnerships, we discuss efforts underway in other Canadian provinces to address FASD., Results: We make three recommendations that begin to address FASD-specific needs in both rural and urban regions: a) a provincial FASD consultant position, b) an explicit partnership between provincial government and fasdNL, and c) increased access to FASD diagnostic teams., Conclusion: While the recommendations are both modest and essential first steps, we also suggest that collaborations and resource-sharing in FASD prevention and supports are more about doing things differently, rather than doing more., (© 2018 Wiley Periodicals, Inc.)

I never intended to become a scientist. My career developed on the basis of chance happenings, repeated failure, the willingness to take risks and the acceptance and provision of mentoring. My career has included periods of difficulty and shifted back and forth between academic health centers and universities in Canada. Although I have been amply recognized for my successes, my greatest learning has come from my failures. My greatest satisfaction has been in the development, evaluation and dissemination of interventions. The combination of intellectual stimulation and emotional gratification has meant a rewarding career.

Abstract Artificial intelligence (AI) is rapidly moving from an experimental phase to an implementation phase in many fields, including medicine. The combination of improved availability of large datasets, increasing computing power, and advances in learning algorithms has created major performance breakthroughs in the development of AI applications. In the last 5 years, AI techniques known as deep learning have delivered rapidly improving performance in image recognition, caption generation, and speech recognition. Radiology, in particular, is a prime candidate for early adoption of these techniques. It is anticipated that the implementation of AI in radiology over the next decade will significantly improve the quality, value, and depth of radiology's contribution to patient care and population health, and will revolutionize radiologists' workflows. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI working group with the mandate to discuss and deliberate on practice, policy, and patient care issues related to the introduction and implementation of AI in imaging. This white paper provides recommendations for the CAR derived from deliberations between members of the AI working group. This white paper on AI in radiology will inform CAR members and policymakers on key terminology, educational needs of members, research and development, partnerships, potential clinical applications, implementation, structure and governance, role of radiologists, and potential impact of AI on radiology in Canada. [ABSTRACT FROM AUTHOR]

Laboratory investigations provide physicians with objective data to aid in disease diagnosis, clinical decision making, and patient follow up. Clinical interpretation of laboratory test results relies heavily on the availability of appropriate population-based reference intervals (i.e. normative values) or decision limits developed through clinical outcome studies. Although reference intervals are fundamental to accurate laboratory test interpretation, and thus critically important to healthcare, the need for sound evidence-based reference intervals has been largely overlooked, particularly in the pediatric population. In the field of pediatric laboratory medicine, accurate age- and sex-specific reference intervals established using samples from healthy children and adolescents have not been readily available, forcing many clinical laboratories to report adult reference intervals with pediatric test results. When pediatric reference intervals are available, they have often been established with a small sample size, inpatient or outpatient samples, outdated methodologies, and/or inappropriate statistical procedures. To address these unacceptable limitations, several national and global initiatives have begun to close the critical evidence gaps in pediatric reference intervals. Notably, the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has made significant strides towards improving pediatric healthcare in Canada and globally. The present report is a white paper summarizing CALIPER, and provides a comprehensive compendium of the data generated through this project over the past decade as a single resource for clinical laboratory specialists, clinicians, and other healthcare workers. CALIPER launched an outreach campaign in 2008 to recruit healthy community children and adolescents, and developed a robust statistical algorithm, in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines, to develop accurate age- and sex-specific pediatric reference intervals. The first CALIPER direct reference interval study was published in 2012, with age- and sex-specific reference intervals reported for 40 common biochemical markers. To date, CALIPER has collected health information and blood samples from over 9700 community children and adolescents, and has established a comprehensive database of age- and sex-specific reference intervals for over 100 biomarkers of pediatric disease. CALIPER has also performed a series of transference and verification studies to expand the applicability of the CALIPER database to five major analytical platforms, including Abbott, Beckman, Ortho, Roche, and Siemens. Through novel knowledge translation initiatives, the CALIPER Reference Interval Database has been made freely available online (www.caliperproject.ca) as well as on a mobile application (CALIPER Reference App), and it is used by clinical laboratories across Canada, the United States, and globally. In addition to establishing this comprehensive pediatric reference interval database, CALIPER has also performed a series of sub-studies, including examining how reference intervals are affected by pre-analytical factors (i.e. sample stability at specific storage conditions, fasting status and time of sample collection), biological variation (i.e. intraindividual and interindividual biological variation, reference change values), and ethnicity and pubertal development stage. In this white paper, extensive tables of pediatric reference intervals are provided for easy reference for clinical laboratories worldwide. All data reported have been published in over 20 peer reviewed publications and are also available through the CALIPER Reference Interval Database as well as the CALIPER Reference App for mobile devices. [ABSTRACT FROM AUTHOR]

This article examines the processes of youth engagement in an "invited space" for Canadian secondary school students. The organizers created a participatory citizenship education space in which Canadian students discussed their views and visions and developed their policy position on global citizenship and global citizenship education. The content and process of "The National Youth White Paper on Global Citizenship" (2015) demonstrated that youth have important policy knowledge and understand they live in a globalized world that includes unacceptable inequalities and oppressions. They also understand that, through acts of citizenship, these conditions can be changed. The article discusses how students were engaged in developing public opinion and working in the public sphere while developing the policy paper on the topic of global citizenship.

This introduction to the special feature describes the development and application of a "full-spectrum sustainability" evaluation framework that emerged from a transdisciplinary research process. The framework and corresponding case studies described in this paper originated in the work of a Canadian Fisheries Research Network project that sought to enhance fisheries management by including diverse social-ecological considerations in fisheries management evaluation. The first section discusses the tendency of sustainability evaluation frameworks in fisheries to focus on ecological and economic considerations and introduces the Canadian Fisheries Research Network's four pillar approach, which includes ecological, economic, social and cultural, and institutional/ governance categories. To illustrate the comprehensive nature of this framework, the second section provides a comparison of the framework with elements in the United Nation's Sustainable Development Goals. The third section provides an overview of the eight papers in this special feature that explore the development and application of full-spectrum sustainability. The conclusion synthesizes some key findings, highlighting four overall critical and ongoing challenges associated with advancing full-spectrum sustainability evaluation in Canada and elsewhere: the politics of transdisciplinary research; integrating social considerations into management agencies reluctant to move beyond ecological and economic considerations; dynamic and diverse issues involved in supporting robust and inclusive governance processes; and translating technical frameworks into usable practical instruments for different societal actors. [ABSTRACT FROM AUTHOR]

Despite now long-standing recognition of the value and importance of the scholarship of teaching and learning, questions continue to be raised about how to satisfy the hybrid responsibilities of teaching and research. The key message of this paper is that instructor-researchers, educational developers, and research ethics personnel should consider two key guidance documents in tandem: the Society for Teaching and Learning in Higher Education's statement on Ethical Principles in University Teaching (Murray, Gillese, Lennon, Mercer, & Robinson, 1996) and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada, 2014). Together these documents provide much needed guidance for teaching and researching ethically.

In the current climate of ever-increasing pressure on parents to become more responsible for the achievement of their children, which forms an element of neo-liberal governance with its shift from public to private, it is necessary to understand the discourses generated by parental involvement policies. This analysis showed that existing policies in Ontario (Canada) are permeated with discourses of barriers and parental deficiency. They employ a narrow definition of parental involvement, privilege parenting strategies of White middle classes, and represent diverse and immigrant parents as lacking. Although the difference among parents is acknowledged, parents receive no recognition for funds of knowledge they have. Policy documents remain silent on issues of inequality and present parental involvement as a neutral tool rather than a socially constructed and historically specific practice with its set of winners and losers. Implications for policymakers include adding parental involvement content in preservice and in-service teacher education to make parent--school partnerships truly democratic and effective for all.

Abstract Scope Antibiotic stewardship programmes (ASPs) are necessary in hospitals to improve the judicious use of antibiotics. While ASPs require complex change of key behaviours on individual, team organization and policy levels, evidence from the behavioural sciences is underutilized in antibiotic stewardship studies across the world, including high-income countries (HICs). A consensus procedure was performed to propose research priority areas for optimizing effective implementation of ASPs in hospital settings using a behavioural perspective. Methods A workgroup for behavioural approaches to ASPs was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). Eighteen clinical and academic specialists in antibiotic stewardship, implementation science and behaviour change from four HICs with publicly funded healthcare systems (e.g. Canada, Germany, Norway and the UK) met face-to-face to agree on broad research priority areas using a structured consensus method. Question addressed and recommendations : The consensus process assessing the ten identified research priority areas resulted in recommendations that need urgent scientific interest and funding to optimize effective implementation of ASPs for hospital inpatients in HICs with publicly funded healthcare systems. We suggest and detail behavioural science evidence–guided research efforts in the following areas: (a) comprehensively identifying barriers and facilitators to implementing ASPs and clinical recommendations intended to optimize antibiotic prescribing; (b) identifying actors ('who') and actions ('what needs to be done') of ASPs and clinical teams; (c) synthesizing available evidence to support future research and planning for ASPs; (d) specifying the activities in current ASPs with the purpose of defining a control group for comparison with new initiatives; (e) defining a balanced set of outcomes and measures to evaluate the effects of interventions focused on reducing unnecessary exposure to antibiotics; (f) conducting robust evaluations of ASPs with built-in process evaluations and fidelity assessments; (g) defining and designing ASPs; (h) establishing the evidence base for impact of ASPs on resistance; (i) investigating the role and impact of government and policy contexts on ASPs; and (j) understanding what matters to patients in ASPs in hospitals. Conclusions Assessment, revisions and updates of our priority-setting exercise should be considered at intervals of 2 years. To propose research priority areas in low- and middle-income countries, the methodology reported here could be applied. [ABSTRACT FROM AUTHOR]

This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper 1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008.

Next generation genomic sequencing (NGS) technologies-whole genome and whole exome sequencing-are now cheap enough to be within the grasp of many health care organizations. To many, NGS is symbolic of cutting edge health care, offering the promise of "precision" and "personalized" medicine. Historically, research and clinical application has been a two-way street in clinical genetics: research often driven directly by the desire to understand and try to solve immediate clinical problems affecting real, identifiable patients and families, accompanied by a low threshold of willingness to apply research-driven interventions without resort to formal empirical evaluations. However, NGS technologies are not simple substitutes for older technologies and need careful evaluation for use as screening, diagnostic, or prognostic tools. We have concerns across three areas. First, at the moment, analytic validity is unknown because technical platforms are not yet stable, laboratory quality assurance programs are in their infancy, and data interpretation capabilities are badly underdeveloped. Second, clinical validity of genomic findings for patient populations without pre-existing high genetic risk is doubtful, as most clinical experience with NGS technologies relates to patients with a high prior likelihood of a genetic etiology. Finally, we are concerned that proponents argue not only for clinically driven approaches to assessing a patient's genome, but also for seeking out variants associated with unrelated conditions or susceptibilities-so-called "secondary targets"-this is screening on a genomic scale. We argue that clinical uses of genomic sequencing should remain limited to specialist and research settings, that screening for secondary findings in clinical testing should be limited to the maximum extent possible, and that the benefits, harms, and economic implications of their routine use be systematically evaluated. All stakeholders have a responsibility to ensure that patients receive effective, safe health care, in an economically sustainable health care system. There should be no exception for genome-based interventions., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Indigenous peoples in Canada, regardless of their nation, have long asserted their place on their ancestral territories now known as Canada. Indigenous peoples thrived on their ancestral territories during the pre-contact period. However, with the arrival of outsiders from Europe, Indigenous peoples experienced major shifts and overwhelmingly detrimental changes to their distinct ways of life, social structures, economies, governance systems and everyday processes. This article provides an overview of both the historicity and contemporary understanding of Canada's imposition of policies and laws on Indigenous peoples, often by violent means. These actions derived as part of the continuum of building and expanding of the Canadian settler nation-state. Both past and current policies have worked to undermine Indigenous self-determination and governance. These policies were paradoxically codified using terms such as inclusionary, equality and dignity. This article specifically examines the federal government's 1969 Statement of the Government on Indian Policy (the 'White Paper, which proposed eliminating any recognition of the rights of Indigenous people in Canada'), and it references the more recent Indigenous Rights Framework which the federal government introduced in 2018. It argues that both of these documents were designed to suppress, erase and assimilate Indigenous peoples. This article also provides an overview of the ways in which Indigenous peoples have mobilized in response to these attacks on their right to selfdetermination and their historical treaty rights with Canada. [ABSTRACT FROM AUTHOR]

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River ice is a common occurrence in cold climate hydrological systems. The annual cycle of river ice formation, growth, decay and clearance can include low flows and ice jams, as well as mid-winter and spring break-up events. Reports and associated data on river ice occurrence are often limited to site and season-specific studies. Within Canada, the National Hydrometric Program (NHP) operates a network of gauging stations with water level as the primary measured variable to derive discharge. In the late 1990s, the Water Science and Technology Directorate of Environment and Climate Change Canada initiated a long-term effort to compile, archive and extract river ice related information from NHP hydrometric records. This data article describes the original research data set produced by this near 20-year effort: the Canadian River Ice Database (CRID). The CRID holds almost 73,000 variables from a network of 196 NHP stations throughout Canada that were in operation within the period 1894 to 2015. Over 100,000 paper and digital files were reviewed representing 10,378 station-years of active operation. The task of compiling this database involved manual extraction and input of more than 460,000 data entries on water level, discharge, date, time and data quality rating. Guidelines on the data extraction, rating procedure and challenges are provided. At each location, a time series of up to 15 variables specific to the occurrence of freeze-up and winter-low events, mid-winter break-up, ice thickness, spring break-up and maximum open-water level were compiled. This database follows up on several earlier efforts to compile information on river ice, which are summarized herein, and expands the scope and detail for use in Canadian river ice research and applications. Following the Government of Canada Open Data initiative, this original river ice data set is available at: https://doi.org/10.18164/c21e1852-ba8e-44af-bc13-48eeedfcf2f4 (de Rham et al., 2020). [ABSTRACT FROM AUTHOR]

The article presents a case study on disputes for the resources of Boreal Forest in Canada. Topics discussed include conflict between the paper and pulp industry Resolute Forest Products and non- government environmental organization Greenpeace International, rights of first nation over the resources of forest and the Canadian Boreal Forest Agreement (CBFA) to continue negotiations on the forest issue such as sustainable forest management programs.

Advances in technology-enabled dietary assessment include the advent of web-based food frequency questionnaires, which may reduce costs and researcher burden but may introduce new challenges related to internet connectivity and computer literacy. The purpose of this study was to evaluate the intra- and inter-version reliability, feasibility and acceptability of the paper and web Canadian Diet History Questionnaire II (CDHQ-II) in a sub-sample of 648 adults (aged 39-81 years) recruited from Alberta's Tomorrow Project. Participants were randomly assigned to one of two groups: (1) paper, web, paper; or (2) web, paper, web over a six-week period. With few exceptions, no statistically significant differences in mean nutrient intake were found in the intra- and inter-version reliability analyses. The majority of participants indicated future willingness to complete the CDHQ-II online, and 59% indicated a preference for the web over the paper version. Findings indicate that, in this population of adults drawn from an existing cohort, the CDHQ-II may be administered in paper or web modalities (increasing flexibility for questionnaire delivery), and the nutrient estimates obtained with either version are comparable. We recommend that other studies explore the feasibility and reliability of different modes of administration of dietary assessment instruments prior to widespread implementation.

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