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Understanding inequalities in SARS-CoV-2 transmission associated with the social determinants of health could help the development of effective mitigation strategies that are responsive to local transmission dynamics. This study aims to quantify social determinants of geographic concentration of SARS-CoV-2 cases across 16 census metropolitan areas (hereafter, cities) in 4 Canadian provinces, British Columbia, Manitoba, Ontario and Quebec.We used surveillance data on confirmed SARS-CoV-2 cases and census data for social determinants at the level of the dissemination area (DA). We calculated Gini coefficients to determine the overall geographic heterogeneity of confirmed cases of SARS-CoV-2 in each city, and calculated Gini covariance coefficients to determine each city's heterogeneity by each social determinant (income, education, housing density and proportions of visible minorities, recent immigrants and essential workers). We visualized heterogeneity using Lorenz (concentration) curves.We observed geographic concentration of SARS-CoV-2 cases in cities, as half of the cumulative cases were concentrated in DAs containing 21%-35% of their population, with the greatest geographic heterogeneity in Ontario cities (Gini coefficients 0.32-0.47), followed by British Columbia (0.23-0.36), Manitoba (0.32) and Quebec (0.28-0.37). Cases were disproportionately concentrated in areas with lower income and educational attainment, and in areas with a higher proportion of visible minorities, recent immigrants, high-density housing and essential workers. Although a consistent feature across cities was concentration by the proportion of visible minorities, the magnitude of concentration by social determinant varied across cities.Geographic concentration of SARS-CoV-2 cases was observed in all of the included cities, but the pattern by social determinants varied. Geographically prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to the resurgence of SARS-CoV-2.

Cardioneuroablation (CNA) has emerged as promising therapy for patients with refractory vasovagal syncope (VVS).The purpose of this study was to provide a freedom from syncope estimate for CNA, including subgroup analysis by method and target of ablation.A systematic search was performed in MEDLINE and EMBASE according to the PRISMA guidelines until February 14, 2022. Observational studies and clinical trials reporting freedom from syncope were included. Meta-analysis was performed with a random-effects model.A total of 465 patients were included across 14 studies (mean age 39.8 ± 4.0 year; 53.5% female). Different techniques were used to guide CNA: 50 patients (10.8%) by mapping fractionated electrograms, 73 (15.7%) with the spectral method, 210 (45.2%) with high-frequency stimulation, 73 (15.7%) with a purely anatomically guided method, and 59 (12.6%) with a combination. The target was biatrial in 168 patients (36.1%), left atrium only in 259 (55.7%), and right atrium only in 38 (8.2%). The freedom from syncope was 91.9% (95% confidence interval [CI] 88.1%-94.6%; IThis meta-analysis suggests a high freedom from syncope after CNA in VVS. Well-designed, double-blind, multicenter, sham-controlled randomized clinical trials are needed to provide evidence for future guidelines.

BackgroundThere is a growing recognition that strategies to reduce SARS-CoV-2 transmission should be responsive to local transmission dynamics. Studies have revealed inequalities along social determinants of health, but little investigation was conducted surrounding geographic concentration within cities. We quantified social determinants of geographic concentration of COVID-19 cases across sixteen census metropolitan areas (CMA) in four Canadian provinces.MethodsWe used surveillance data on confirmed COVID-19 cases at the level of dissemination area. Gini (co-Gini) coefficients were calculated by CMA based on the proportion of the population in ranks of diagnosed cases and each social determinant using census data (income, education, visible minority, recent immigration, suitable housing, and essential workers) and the corresponding share of cases. Heterogeneity was visualized using Lorenz (concentration) curves.ResultsGeographic concentration was observed in all CMAs (half of the cumulative cases were concentrated among 21-35% of each city’s population): with the greatest geographic heterogeneity in Ontario CMAs (Gini coefficients, 0.32-0.47), followed by British Columbia (0.23-0.36), Manitoba (0.32), and Québec (0.28-0.37). Cases were disproportionately concentrated in areas with lower income, education attainment, and suitable housing; and higher proportion of visible minorities, recent immigrants, and essential workers. Although a consistent feature across CMAs was concentration by proportion visible minorities, the magnitude of concentration by social determinants varied across CMAs.InterpretationThe feature of geographical concentration of COVID-19 cases was consistent across CMAs, but the pattern by social determinants varied. Geographically-prioritized allocation of resources and services should be tailored to the local drivers of inequalities in transmission in response to SARS-CoV-2’s resurgence.

ObjectivesNo randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine.MethodsThe nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming.ResultsThe panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools.ConclusionsThe nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.

Many studies have examined the effectiveness of non-pharmaceutical interventions (NPIs) on SARS-CoV-2 transmission worldwide. However, less attention has been devoted to understanding the limits of NPIs across the course of the pandemic and along a continuum of their stringency. In this study, we explore the relationship between the growth of SARS-CoV-2 cases and an NPI stringency index across Canada before the accelerated vaccine roll-out.We conducted an ecological time-series study of daily SARS-CoV-2 case growth in Canada from February 2020 to February 2021. Our outcome was a back-projected version of the daily growth ratio in a stringency period (i.e., a 10-point range of the stringency index) relative to the last day of the previous period. We examined the trends in case growth using a linear mixed-effects model accounting for stringency period, province, and mobility in public domains.Case growth declined rapidly by 20-60% and plateaued within the first month of the first wave, irrespective of the starting values of the stringency index. When stringency periods increased, changes in case growth were not immediate and were faster in the first wave than in the second. In the first wave, the largest decreasing trends from our mixed effects model occurred in both early and late stringency periods, depending on the province, at a geometric mean index value of 30⋅1 out of 100. When compared with the first wave, the stringency periods in the second wave possessed little association with case growth.The minimal association in the first wave, and the lack thereof in the second, is compatible with the hypothesis that NPIs do not, per se, lead to a decline in case growth. Instead, the correlations we observed might be better explained by a combination of underlying behaviors of the populations in each province and the natural dynamics of SARS-CoV-2. Although there exist alternative explanations for the equivocal relationship between NPIs and case growth, the onus of providing evidence shifts to demonstrating how NPIs can consistently have flat association, despite incrementally high stringency.

The aim of this chapter will be to continue to develop the themes in Chap. 1 above. The ‘Engine Room’ was the name given to a group of middle managers at one production site who were given the task of managing redundancies and production line closures. The chapter will explore the practices used and the delays and subterfuge of everyday managerial practices to subvert and reconfigure the organisation’s strategic ‘choice’. Again ethnography in an insider account will demonstrate how practices are constructed and deployed as well as how a SasP perspective can be applied by researchers in other organisational settings. In addition, the theme of nonhuman actors will be developed drawing upon Actor-Network Theory themes (Callon, Some elements of a sociology of translation: Domestication of the scallops and the fishermen of Saint Brieuc bay. In J. Law (Ed.), Power, action and belief (pp. 196–233). London: Routledge and Kegan Paul, 1986).

The aim of this chapter will be to employ a Strategy as Practice (SasP) perspective to consider the organisation’s ‘Asset Optimisation Process’ (AOP). The AOP process was a rationalisation of products and production capacity that was conducted within the organisation. The rationalisation outcome was delayed, subverted and reconfigured by networks of middle managers, trade unions and other actors. The chapter will draw upon and inform SasP literature (e.g., Nicolini, Organization Studies, 30(12), 1391–1418, 2009, Practice theory, work, and organization: An introduction, Oxford University Press; Whittington, Long Range Planning, 29(5), 731–735, 1996, Organization Studies, 27(5), 613–634, 2006) and combine Actor-Network Theory perspectives with SasP (see Nicolini 2012). By using ethnography in an insider account the chapter will demonstrate how practices are constructed and deployed as well as how a SasP perspective can be applied by researchers in other organisational settings.

This chapter outlines the ontological and epistemological positioning of this book and then explores the at-home ethnographic methods employed in this book and the underpinning literature (e.g., Alvesson, Methodology for close up studies—struggling with closeness and closure. Higher Education, 46 (2), 167–193, 2003; At-home ethnography: Struggling with closeness and closure. In S. Ybema, D. Yanow, H. Wels, & F. Kamsteeg (Eds.), Organizational ethnography: Studying the complexity of everyday life (pp. 156–174). London: Sage, 2009; Punch, The politics and ethics of fieldwork. Beverly Hills: Sage, 1986; Van Maanen, Ethnography as work: Some rules of engagement. Journal of Management Studies, 48(1), 218–234, 2011; Vickers, At-home ethnography: a method for practitioners. Qualitative Research in Organizations and Management: An International Journal, 14 (1), 10–26, 2019). The book then gives an overview of Actor-Network Theory (ANT) (e.g., Latour, Reassembling the social. Oxford: Oxford University Press, 2005) and Strategy-as-Practice (SasP) (e.g., Whittington, Strategy as practice. Long Range Planning, 29 (5), 731–735, 1996) and explores the wider theoretical contributions of the book.

The aim of this chapter will be to consider how human resource procedures, policies, systems and documentation are deployed to control others and achieve conformity to organisational goals. As an insider ethnographic account it is also possible to demonstrate how the interpretation of these policies, practices, systems and documents are contested. This will involve the exploration of counter networks and the idea of hegemonic and ante-narrative (see Vickers, Beyond the hegemonic narrative – A study of managers. Journal of Organizational Change Management, 21, 560–573, 2008) This chapter will draw upon and inform Actor-Network Theory (Latour, The pasteurization of France. Cambridge, MA: Harvard, 1988; Latour, Reassembling the social – An introduction to actor-network-theory. Oxford: Oxford University Press, 2005; Callon, Some elements of a sociology of translation: Domestication of the scallops and the fishermen of Saint Brieuc Bay. In Law, J. (Ed.) Power, action and belief (pp. 196–233). London: Routledge and Kegan Paul, 1986; Law, On the methods of long‐distance control: Vessels, navigation and the Portuguese route to India. In Law, J. (Ed.) Power, action and belief (pp. 234–263). London: Routledge and Kegan Paul, 1984) in relation to HR and critical HR literature (Watson, HRM and critical social science analysis. Journal of Management Studies, 41 (3), 447–467, 2004; Delbridge and Keenoy, Beyond managerialism? International Journal of Human Resource Management, 21 (6), 799–817, 2010; Vickers and Fox, Towards practice-based studies of HRM: An actor network and communities of practice informed approach. International Journal of Human Resource Management, 21 (6), 899–914, 2010).

The aim of this chapter will be to consider how safety practices are learned and carried out in situ. The employees at the production site having been newly acquired are required to learn new ways of practising safety. The chapter explores the espoused safety narrative and culture of the organisation and the reality of the everyday practice of safety and how managers, in particular, re-learn to practise safety and reconcile the difference between espoused safety and practice. The chapter will draw upon Communities of Practice theory, especially the ideas of noncanonical communities (Brown and Duguid, Organizational learning and communities of practice: Toward a unified view of working, learning and innovation. In E. L. Lesser, M. A. Fontaine, & J. A. Slusher (Eds.), Knowledge and communities (pp. 99–121). Oxford: Butterworth Heinemann, 1991) and newcomers as legitimate peripheral participants (Lave and Wenger, Situated learning: Legitimate peripheral participation. Cambridge: Cambridge University Press, 1991) and how this might inform SasP.

Background: The SARS-CoV-2 disease 2019 (COVID-19) pandemic has spread across the world with varying impact on health systems and outcomes. We assessed how the type and timing of public- health interventions impacted the course of the outbreak in Alberta and other Canadian provinces. Methods: We used publicly-available data to summarize rates of laboratory data and mortality in relation to measures implemented to contain the outbreak and testing strategy. We estimated the transmission potential of SARS-CoV-2 before the state of emergency declaration for each province (R0) and at the study end date (Rt). Results: The first cases were confirmed in Ontario (January 25) and British Columbia (January 28). All provinces implemented the same health-policy measures between March 12 and March 30. Alberta had a higher percentage of the population tested (3.8%) and a lower mortality rate (3/100,000) than Ontario (2.6%; 11/100,000) or Quebec (3.1%; 31/100,000). British Columbia tested fewer people (1.7%) and had similar mortality as Alberta. Data on provincial testing strategies were insufficient to inform further analyses. Mortality rates increased with increasing rates of lab- confirmed cases in Ontario and Quebec, but not in Alberta. R0 was similar across all provinces, but varied widely from 2.6 (95% confidence intervals 1.9-3.4) to 6.4 (4.3-8.5), depending on the assumed time interval between onset of symptoms in a primary and a secondary case (serial interval). The outbreak is currently under control in Alberta, British Columbia and Nova Scotia (Rt

Introduction: Candidemia carries significant morbidity and mortality for hospitalized patients. Local epidemiology is needed to develop strategies to reduce infections. This article describes the epidemiology of candidemia at a tertiary-care hospital in Edmonton, Canada. Methods: Between 2004 and 2013, 250 episodes of candidemia were identified using an infection control database. Binary logistic regression analysis was used to identify risk factors for non-albicans isolates and for mortality. Results: The candidemia rate increased significantly, from 0.387/10,000 patient days (PD) in 2004 to 1.45/10,000 PD in 2013 (p=0.0061). The 30-day and overall in-hospital mortality rates were 38% and 47%, respectively. Candida albicans and C. glabrata represented 80% of isolates. Overall, 48% of episodes were attributable to central venous catheter (CVC) infections. The ratio of C. albicans to non-albicans isolates and the rate of CVC infections did not change significantly over the study period (p=0.98 and 0.14, respectively). Preceding azole therapy within 30 days of candidemia conferred an increased risk of a non-albicans isolate (odds ratio [OR] 2.59, 95% CI 1.24 to 5.43). Mortality was increased with immunosuppression (OR 3.30, 95% CI 1.74 to 6.24) and age, with an OR of 2.78 (95% CI 1.21 to 6.38) for the 61- to 68-year-old age group and an OR of 4.30 (95% CI 1.84 to 10.04) for the >69-year-old age group. Mortality was similar among C. albicans and non-albicans infections (OR 0.85, 95% CI 0.49 to 1.45). Conclusion: Candidemia at the authors' institution increased during the study period without a significant change in the ratio of C. albicans to other Candida spp. The risk of non-albicans candidemia was affected by previous azole therapy, and the risk of mortality was higher with increased age and immunosuppression. The etiology of the increased candidemia rate is likely complex, and strategies to address this, as well as the high mortality rate seen with candidemia, are needed.

SUMMARYPatients with methicillin-resistant Staphylococcus aureus (MRSA) clones, which were traditionally seen in the community setting (USA400/CMRSA7 and USA300/CMRSA10), are often identified as hospital-acquired (HA) infections using Infection Prevention and Control (IPC) surveillance definitions. This study examined the demographics and healthcare risk factors of patients with HA-MRSA to help understand if community MRSA clones are from a source internal or external to the hospital setting. Despite USA300/CMRSA10 being the predominant clone in Alberta, hospital clones (USA100/CMRSA2) still dominated in the acute care setting. In the Alberta hospitalized population, patients with USA400/CMRSA7 and USA300/CMRSA10 clones were significantly younger, had fewer comorbidities, and a greater proportion had none or ambulatory care-only healthcare exposure. These findings suggest that there are two distinct populations of HA-MRSA patients, and the patients with USA400/CMRSA7 and USA300/CMRSA10 clones identified in hospital more greatly resemble patients affected by those clones in the community. It is possible that epidemiological assessment overidentifies HA acquisition of MRSA in patients unscreened for MRSA on admission to acute care.

Purpose This study aims to weave together narrative analysis (hereinafter NA) and Actor-Network Theory (hereinafter ANT), in order to address recent calls for performative studies to combine approaches and specifically to use ANT. Particularly, they address how a conflicting narrative is mobilised through a network of internal–external and human–nonhuman actors. Design/methodology/approach A fragment of data, generated from a longitudinal case study, is explored using NA and ANT in combination. Findings By engaging with ANT’s rejection of dualisms (i.e. human–nonhuman and micro–macro) and its approach to relationality, the authors inform NA and performative studies. They also add to the limited literature addressing how conflicting antenarratives are mobilised and shape the organisation’s trajectory. Research limitations/implications Generalizing from a single case study is problematic, although transferability is possible. Generalisability could be achievable through multiple performative studies. Practical/implications By demonstrating how counter networks form and antenarrative is constructed to supplant hegemonic narrative, the authors are able to problematise the taken for granted and highlight the possibilities offered by divergent voices. Originality/value The performation provides a deeper understanding of organisational performance through our NA-ANT combination, and the authors provide insight into the mobilisation of conflicting narratives in organisation studies.

Background Knee and hip replacements are an effective intervention for improving quality of life. Rates of these surgeries in North America are growing, coinciding with increasing obesity and an aging population. Methods Alberta Health Services' infection prevention and control program collects data prospectively on surgical site infections (SSIs) after primary total hip and knee arthroplasty completed in Alberta, Canada. We reviewed all SSIs within 180 days of surgical procedures between March 1, 2012, and June 30, 2014. Results There were 312 SSI cases reviewed. Rates of SSI (per 100 procedures) were 1.77 and 1.26 for hip and knee arthroplasties, respectively. Seventy-nine percent of infections occurred within 30 days postoperatively. Stratified by time to infection, larger proportions of knee SSIs occurred after 30 days versus hip SSI. Colonization with methicillin-resistant Staphylococcus aureus (MRSA) was associated with subsequent infection (odds ratio, 40; 95% confidence interval, 10.2-154.2). We have identified important characteristics that may be helpful for determining optimal prevention strategies. Conclusions Intensive postoperative follow-up within 30 days of knee arthroplasty may help to identify SSI early, allowing for prompt treatment and avoiding the need for invasive therapy, such as surgery for hardware revision. Decolonization techniques may decrease subsequent MRSA SSI in colonized patients.

Background Infection Prevention and Control (IPC) surveillance for incident methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients is performed in a complete provincial surveillance network of all acute care facilities in Alberta, Canada. IPC surveillance is centralized using a web-based data entry platform so that each patient is counted only once. All diagnostic laboratories submit the first clinical MRSA isolate associated with a patient without previous MRSA positive clinical cultures in the preceding year to the Provincial Laboratory for Public Health (ProvLab) for molecular typing. This study will investigate the relationship between the IPC epidemiological classification based on time of detection following admission to hospital (Hospital Acquired and Community Associated) and the matched laboratory MRSA surveillance data using a retrospective cohort study design. Methods Incident IPC MRSA cases were classified according to IPC epidemiologic definitions. DNA sequencing of the Staphylococcus protein A (spa) gene and pulsed-field gel electrophoresis (PFGE) typing was performed. IPC MRSA surveillance data were matched to the ProvLab molecular surveillance data. Univariate comparisons of proportions were performed for categorical variables and the Student’s t test for continuous variables. Results MRSA molecular typing data were available for matching for 46.7 % (2248/4818) of incident IPC cases. There was agreement in definitions for traditional nosocomial clones (USA100/CMRSA2) with Hospital Acquired (HA)-MRSA (65.1 % of all IPC HA-MRSA) and traditional community clones (USA400/CMRSA7 and USA300/CMRSA10) with Community Acquired (CA)-MRSA (62.4 % of CA-MRSA). However, we observed discordance for both traditional nosocomial/CA-MRSA (30.4 % of CA-MRSA) and for traditional community/HA-MRSA (26.9 % of HA-MRSA). Conclusions We note agreement between traditional nosocomial clones and HA-MRSA, and traditional community clones and CA-MRSA. However, approximately one-quarter of HA-MRSA are those of traditional community clones while approximately one-third of CA-MRSA are those of traditional nosocomial clones. Collaborative provincial MRSA surveillance is important as the distinction between IPC case attribution in acute care settings and the historical definitions of MRSA clones as community- or healthcare-associated have blurred.

Giddings[1][1] suggests that Canada might benefit from a harmonized national vaccination initiative focused on increasing vaccine coverage. I’d like to suggest alternatives. Although the effect of vaccine hesitancy on particular subpopulations is unequivocal, I do not think that a national policy

What you need to know Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself.1 Finally, it includes those aspects related to the care of the dying. This guideline was commissioned with the aim to standardise end of life care for infants, children, and young people living with a life limiting condition, and thus promote equity and consistency. Important themes are to involve children and young people and their parents or carers in decisions about their care, facilitate their care in their preferred location (most likely home), and plan for day and night care. This article summarises the most recent guidance from the recent National Institute for Health and Care Excellence (NICE) on the planning and management of end of life care in infants, children, and young people.2 For a visual summary, please …