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Niraparib was recently funded in Canada for the maintenance treatment of ovarian cancer following platinum-based chemotherapy. However, the drug's safety profile in the real world remains uncertain. We conducted a cohort study to describe the patient population using niraparib and the proportion that experienced adverse events between June 2019 and December 2022 in four Canadian provinces (Ontario, Alberta, British Columbia [BC], and Quebec). We used administrative data and electronic medical records from Ontario Health, Alberta Health Services, and BC Cancer, and registry data from Exactis Innovation. We summarized baseline characteristics using descriptive statistics and reported safety outcomes using cumulative incidence. We identified 514 patients receiving niraparib. Mean age was 67 years and most were initiated on a daily dose of 100 or 200 mg/day. Grade 3/4 anemia, neutropenia, and thrombocytopenia occurred in 11–16% of the cohort. In Ontario, the three-month cumulative incidence of grade 3/4 thrombocytopenia was 11.6% (95% CI, 8.3–15.4%), neutropenia was 7.1% (95% CI, 4.6–10.4%), and anemia was 11.3% (95% CI, 8.0–15.2%). Cumulative incidences in the remaining provinces were similar. Initial daily dose and proportions of hematological adverse events were low in the real world and may be related to cautious prescribing and close monitoring by clinicians. [ABSTRACT FROM AUTHOR]

Infertility is a common diagnosis: in its original, heteronormative definition, it is known to impact about 1 in 6 couples worldwide. Governments across Canada and beyond have been increasingly providing support for those undergoing fertility treatment, and BC is the most recent province to announce funding, beginning in 2025. As the amount of proposed funding is not sufficient to cover treatment for all who seek it, we look to examples from other provinces and countries to guide us in forming criteria that balance fair access with likelihood of successful treatment. A majority of Canadian provinces currently provide publicly funded fertility care, albeit with highly variable models. Quebec previously introduced a model with generous coverage, including up to three cycles of in vitro fertilization (IVF), along with medications, associated procedures, and embryo transfers for each live birth. Due to high costs, this funding was removed and reintroduced in 2021 with a more restrictive model, as well as age cutoffs for IVF and embryo transfers. In Ontario, the current funding model was introduced in 2015 and covers intrauterine insemination cycles and one cycle of IVF in patients younger than 43 years of age. Other provinces have offered a fertility treatment tax credit. While the BC announcement stated that one cycle of IVF with medications will be covered, the details on how this finite resource will be distributed are still unclear. We hope BC will consider the lessons learned from other provinces and countries and implement a program that is fair and accessible to those who need it. [ABSTRACT FROM AUTHOR]

This review paper investigates the landscape of wildfire-related studies with a focus on infrastructure and evacuations across Canadian provinces, revealing a predominant focus on Alberta, particularly after the 2016 Fort McMurray wildfire. The aftermath of this event has heightened attention to the unique challenges faced during evacuations, emphasizing the urgent need for heightened awareness and preparedness, especially in the vulnerable northern communities of Alberta. Studies beyond Alberta contribute to understanding Canadian wildfire dynamics. However, a noticeable research gap in British Columbia raises concerns about research prioritization and resource allocation despite heightened wildfire activity. The fact that some provinces are contributing less than 4.2%, such as Quebec, Saskatchewan, Ontario, Northwest Territories, Yukon, and the Prairies, might be attributed to regional variations influenced by historical wildfire frequency and population density. Thematic analysis categorizing studies into "community support/resilience", "evacuation efficiency", and "infrastructure protection/raising awareness" provides nuanced insights. The dominance of the "community support/resilience" category, comprising over 40% of studies, signifies a societal shift towards proactive community engagement. Balanced representation in the "evacuation efficiency" and "infrastructure protection/raising awareness" categories, each contributing over 29%, reflects a collective effort to glean lessons from past evacuations and enhance community preparedness. Temporal trends and thematic analyses spotlight a commitment to continuous improvement, adaptability to emerging challenges, and a growing recognition of the multifaceted aspects of wildfire management. The evolving emphasis on community involvement, responsiveness to changing evacuation dynamics, and heightened awareness of infrastructure protection underscores the proactive stance of the research community, providing insights for shaping future research priorities, policy frameworks, and community resilience strategies in the face of evolving wildfire threats in Canada. [ABSTRACT FROM AUTHOR]

Introduction: The use of osimertinib in the first-line (1L) setting is an effective treatment option for sensitizing EGFR-mutations (EGFRm+) and has significantly altered the standard of care practice for EGFRm+ disease in Canada. Unfortunately, acquired resistance to osimertinib is almost universal, and outcomes are disparate. Post-progression treatment patterns and the outcome of real-world Canadian EGFRm+ patients receiving 1L osimertinib were the focus of this retrospective review. Methods: The Glans-Look Lung Cancer Research database was used to identify and collect demographic, clinical, treatment, and outcome data on EGFRm+ patients who received 1L osimertinib in the Canadian province of Alberta between 2018 and 2022. Results: A total of 150 patients receiving 1L osimertinib were identified. In total, 86 developed progressive disease, with 56 (65%) continuing systemic therapy, 73% continuing osimertinib, and 27% switching to second-line (2L) systemic therapy. Patients were similar both in clinical characteristics at 1L osimertinib initiation and patterns of treatment failure at progression; those continuing 1L osimertinib post-progression had a longer time to progression (13.5 vs. 8.8 months, p = 0.05) and subsequent post-osimertinib initiation survival (34.7 vs. 22.8 months, p = 0.11). Conclusions: The continuation of osimertinib post-progression is an effective disease management strategy for select real-world EGFRm+ patients, providing continued clinical benefit, potentially due to different underlying disease pathogenesis. [ABSTRACT FROM AUTHOR]

This study investigated the diagnostic capacity for Fetal Alcohol Spectrum Disorder (FASD) in multidisciplinary clinics across several provincial and one territorial jurisdictions of Canada: Alberta, British Columbia, Manitoba, Ontario and Northwest Territories. The data were collected directly from clinics capable of providing diagnoses of FASD and examined annual capacity for the assessment and diagnosis of FASD per year from 2015 to 2019. In total, 58 FASD diagnostic clinics were identified and 33 clinics participated in this survey. The study identified inadequate FASD diagnostic capacity in all participating jurisdictions. Based on the findings and the current population sizes, it is estimated that 98% of individuals with FASD are undiagnosed or misdiagnosed in Canada. Wait times for FASD diagnosis ranged from 1 month to 4.5 years across participating jurisdictions. The annual FASD diagnostic capacity in the select provinces and territories require at least a 67-fold increase per year. [ABSTRACT FROM AUTHOR]

Slave Province in Canada is an Archean granite–supracrustal terrane at the northwestern corner of the Canadian Shield. It is bordered by the Thelon–Taltson orogen (2.0 to 1.9 Ga) to the southeast and the Wopmay orogen (1.9 to 1.8 Ga) to the west. Acasta gneisses, exposed in the westernmost Slave Province, and the Wopmay rocks, located close to the gneisses, were systematically collected for K–Ar and laser step-heating 40Ar/39Ar single-crystal analyses of the biotite and amphibole. The K–Ar biotite ages of the four Wopmay samples range from 1816 ± 18 Ma to 1854 ± 26 Ma. The 40Ar/39Ar biotite analyses of the three Wopmay samples yield plateau ages of 1826 ± 21 Ma, 1886 ± 13 Ma, and 1870 ± 18 Ma. These ages fall within the reported U–Pb zircon age range of the Wopmay orogen. The K–Ar biotite ages of the fifteen Acasta gneisses range from 1779 ± 25 Ma to 1877 ± 26 Ma, except for one younger sample (1711 ± 25 Ma). The 40Ar/39Ar analyses of the biotite crystals from three samples give the plateau ages of 1877 ± 8 Ma, 1935 ± 14 Ma, and 1951 ± 11 Ma. The K–Ar amphibole ages from twelve samples range from 1949 ± 19 Ma to 1685 ± 25 Ma. Two samples of them give ages older than the zircon U-Pb age of Hepburn plutons. The 40Ar/39Ar analyses of the amphibole crystals show varied age relations. The two samples give plateau ages of 1814 ± 22 Ma and 1964 ± 12 Ma. Some samples exhibit apparent old ages of ~2000 Ma in the middle temperature fractions. These old fractions result from the amphibole crystals, originally formed in the Archean, being affected by the thermal events during the Wopmay orogeny but not fully resetting. These observations suggest that the K–Ar system ages of the biotite and amphibole in the Archean Acasta gneiss were rejuvenated during the Paleoproterozoic ages. The Discussion explores the possibility that the heat source rejuvenating the K–Ar system ages may have arisen due to asthenospheric extrusion into the wedge mantle, a process likely triggered by subduction rollback. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) can improve the physical and psychosocial health of individuals with cancer, yet PA levels remain low. Technology may address PA maintenance barriers in oncology, though the intervention effectiveness to date remains mixed. Qualitative research can reveal the nuances of using technology-based PA maintenance tools. The present study aimed to understand the perspectives of individuals with cancer on using an app to support PA maintenance. Methods: Individuals were interviewed after using a self-monitoring app for 24 weeks, asking about their app use, ease of use, and perceived value for supporting PA. Analyses were guided by an interpretive description. Results: Eighteen individuals were interviewed. The participants were 37–75 years old; lived in seven Canadian provinces/territories; identified as White, South Asian, or Indigenous; and had eight different cancers. Four themes were developed: some did not need the app to stay physically active, some valued the app for helping them maintain their PA, the user experience ranged from intuitive to confusing, and the time burden of app use ranged from acceptable to overwhelming. Conclusions: The participants provided insights on using a self-monitoring app to improve PA maintenance in oncology. Work is needed to capture additional perspectives and apply findings to the development of technology-based PA maintenance tools. [ABSTRACT FROM AUTHOR]

Forests contain substantial carbon stores, including above and belowground biomass and living and non-living biomass. Different management regimes produce different outcomes related to stored and sequestered carbon in forests. The geographic focus of this study is the Wabanaki-Acadian Forest of the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island). This study reviews the literature to evaluate the carbon impacts of (1) intensive forest management for fiber products, (2) unharvested (or conservation) forest, and (3) climate-focused, ecological forestry. Each of these forest management strategies and concomitant silviculture regimes sequester and store carbon at varying rates and across different carbon pools in the forest. The literature suggests that unharvested (conservation) forests store and sequester the most carbon, and traditional, intensive fiber management stores and sequesters the least. Ecological forestry may provide the best balance between carbon sequestration and storage and climate adaptability, while also allowing for the provision of some timber/fiber products. This study also discusses the co-benefits offered by forests under each of the three management regimes. New research, in general and in the region, needs to examine further belowground carbon dynamics in soil as most efforts to document carbon focus on aboveground carbon pools. [ABSTRACT FROM AUTHOR]

Objective: To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. Methods: We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. Results: We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. Conclusions: Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD. [ABSTRACT FROM AUTHOR]

Introduction: Wildfires impact large populations worldwide with increasing frequency and severity. In Canada, the fire season has affected more areas this year with potential implications for individuals' well-being and quality of life (QoL). Objective: This study aimed to explore data related to the well-being and QoL of individuals living in areas impacted by wildfires in two Canadian provinces. Methodology: A cross-sectional survey was used to collect data from the residents in the two provinces who subscribed to the Text4Hope mental health support service. Descriptive and inferential statistics were applied using World Health Organization Well-Being Index (WHO-5). Results: Out of 1802 Text4Hope subscribers, 298 responded to the baseline surveys, yielding a response rate of (16.5%). The mean score of QoL was (40.8/100 ± 20.7). Most respondents were from Alberta (84.2%), 40 years old or below (28.3%), females (85.2%), Caucasian (83.5%), in a relationship (56.4%), employed (63.6%), received diagnoses of depression (56.6%), and anxiety (52.9%).The overall prevalence of low QoL was (67.3%; 95% CI: 61.2–73.1%) that was mostly reported among subscribers who were from Nova Scotia (70.5%), 40 years old or younger (71.2%), other gender (83.3%), Black/Hispanic and other ethnicity (85.7% each), having high-school or less education (70.3%), not in a relationship (74.1%), and unemployed (73.6%). In terms of clinical factors, low QoL was most prevalent among those who received the diagnoses of depression (74%) and anxiety (74.3%), and those who have been receiving antidepressants (71.8%) or benzodiazepines (93.3%). Regarding wildfire-related factors, the highest prevalence of low QoL was reported among those living in a region that has recently been impacted by the wildfires (74.7%) and those who have been less frequently watching television images about the devastation caused by the recent wildfires (72.6%). The multivariate logistic regression analysis model predicting the low QoL including the various variables was statistically significant; Χ2 (df = 19; n = 254) = 31.69, p = 0.03. It was found that living in a region impacted by wildfires (37.9%) was the only significant predictor of low QoL (adjusted OR: 1.96; 95% CI: 1.05–3.65). Conclusions: The impact of wildfire on the QoL and well-being among people living in impacted regions is significant. It is empirical for the health authorities to support those who are disadvantaged by wildfire via running of screening programs to early identify mental health symptoms and addressing the living conditions of the survivors, along with the provision of innovative means of mental health support. This necessitates enhanced planning of the governments and health authorities to overcome such adverse psychological consequences of these events. [ABSTRACT FROM AUTHOR]

Background: The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2lineages have been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Variants of concern (VOCs) and SARS-CoV-2 lineages associated with increased transmissibility and/or severity are of particular interest. Method: Here, we consider clinical and wastewater data sources to assess the emergence and spread of VOCs in Canada retrospectively. Results: We show that, overall, wastewater-based VOC identification provides similar insights to the surveillance based on clinical samples. Based on clinical data, we observed synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. Conclusion: In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence. In contrast, VOC Omicron achieved the same contribution in less than one month. This study provides significant benchmarks to enhance planning for future VOCs, and to some extent for future pandemics caused by other pathogens, by quantifying the rate of SARS-CoV-2 VOCs invasion in Canada. [ABSTRACT FROM AUTHOR]

Canadian provinces are required to regulate their power sectors using carbon pricing systems that meet national minimum stringency standards, which are set by the federal government. A diverse set of systems has emerged as a result. However, there has been limited assessment of how different pricing mechanisms impact the evolution of Canada's electricity system. To address this gap, we use an electricity system planning model called COPPER and a scenario-based approach to assess if, and to what extent, different policy regimes impact power sector greenhouse gas emissions and costs. Our results show that carbon pricing systems currently in place lead to significant carbon reductions over the long term, provided that free emissions allocations are reduced. However, the cost-optimal pathway for the power sector differs across provinces depending on the carbon pricing mechanism. Some provinces achieve least-cost emissions reductions by switching from high-carbon technologies to renewables, while others are better served by replacing high-carbon technologies with low-carbon fossil fuel alternatives. Further, provinces that implement cap-and-trade systems may affect the transitions of interconnected jurisdictions. Power sector climate policy design should reflect the heterogeneity of available assets, resources, and neighbouring approaches. [ABSTRACT FROM AUTHOR]

The package PbIso is a free and open R toolbox for commonly used calculations and plots of Pb–Pb isotope data and for generating Pb evolution models. In this paper, we review Pb isotope systematics and the calculations that are commonly used, such as model age, model source μ (238U/204Pb), time-integrated κ (232Th/238U), and initial Pb isotope ratios. These equations are implemented into R functions in the package PbIso. In addition, functions are provided for generating Pb evolution models, paleoisochrons, and isochrons. This allows users to apply calculations to their data in a straightforward way while providing transparency and flexibility of the calculations used. We have implemented some basic features of the PbIso package into an online shiny R application (see https://shereearmistead.github.io/software/pbiso), which makes it easy for users without any R experience to use these calculations with their own data and to generate plots. We have provided a case study from the Superior Province in Canada, showing how different Pb evolution models can be generated in PbIso and compared to Pb isotope data. [ABSTRACT FROM AUTHOR]

Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada. [ABSTRACT FROM AUTHOR]

Legg Calve Perthes disease is a pediatric hip condition that leads to early hip degeneration. The efficacy of operative and nonoperative treatment is not well defined in the literature. Using the rate of total hip arthroplasty as a surrogate measure for symptomatic hip degeneration, the rate of total hip arthroplasty was compared in Legg Calve Perthes disease patients with and without previous surgical intervention in the province of Manitoba, Canada. A retrospective review was conducted using de-identified, individual-level administrative records of health services for the entire population of Manitoba. Codes for Legg Calve Perthes disease, femoral osteotomies, pelvic osteotomies, adductor tenotomies, and total hip arthroplasty were searched from 1984 to 2018. The rate of total hip arthroplasty in patients with Legg Calve Perthes disease was determined for two groups: (1) patients with earlier surgical intervention and (2) patients with no previous surgical intervention. Of the 202 patients included in the study, 180 had no prior surgery and 22 had prior surgery. The rate of total hip arthroplasty between the previous operative and nonoperative groups was found to be 32% and 40%, respectively (p = 0.458). There was no significant difference in rates of total hip arthroplasty in the operative and nonoperative groups. Further prospective studies are required to elucidate the differences in outcomes between operative and nonoperative treatment groups in patients with Legg Calve Perthes disease. [ABSTRACT FROM AUTHOR]

Simple Summary: The whitemarked tussock moth is a pest of balsam fir in the Maritime provinces of Canada, and also poses a threat to human health because the hairs on the larvae are urticating (i.e., they irritate the skin). In this manuscript, we improve a known lure, based on the pheromone of this insect, with the aim to use it as a widespread monitoring/detection method. Because the female-produced sex pheromone of this moth is unstable, lures containing this pheromone only last a day or two in the field; however, our detection method takes advantage of a synthetic propheromone, or pheromone precursor, that is converted to the pheromone by acid within the lure and releases it over time, circumventing the problem of its instability. We found that our lure formulation and pheromone delivery method is more effective as a lure for whitemarked tussock moth than the control treatments in our field study. The whitemarked tussock moth (WMTM), Orgyia leucostigma (J.E. Smith) (Lepidoptera: Erebidae), is an economic pest in Nova Scotia, Canada, where it undergoes periodic outbreaks defoliating several tree species of economic value, including balsam fir, Abies balsamea (L.) Miller (Pinaceae). Herein is described a releasing device for the WMTM sex pheromone (Z,Z)-6, 9-heneicosadien-11-one based on a rubber septum, which converts pheromone precursors, such as acetals, namely (Z,Z)-11,11-dimethoxy-6,9-heneicosadiene and (Z,Z)-6,9-heneicosadien-11-one ethylene ketal, to the pheromone itself by the action of acetic acid and releases it over time. The pheromone is unstable in nature and, consequently, lures made with this compound will only attract WMTM for a day or two. The two pheromone precursors, however, are more stable, and are converted slowly into the pheromone by acetic acid impregnated in the releasing device, or by acidic conditions in the environment. The two pheromone precursors were synthesized in 2019 using a modified, previously published approach. Field trapping studies conducted from 2019–22 showed that traps baited with rubber septa loaded with either (Z,Z)-11,11-dimethoxy-6,9-heneicosadiene by itself or (Z,Z)-6,9-heneicosadien-11-one ethylene ketal plus acetic acid consistently caught significantly more WMTM than traps baited with blank septa in most experiments. [ABSTRACT FROM AUTHOR]

Background: Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians' practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods: We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant's data were summarized by code. Results: Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal). Conclusions: This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care. [ABSTRACT FROM AUTHOR]

Background: Cannabis poisonings among children are of public health concern. Existing evidence from the US and from four provinces in Canada (Quebec, Ontario, Alberta, British Columbia) indicate an increase in pediatric cannabis-related poisonings since the legalization of cannabis. This study evaluates trends in cannabis-related poisoning pediatric emergency department (ED) visits and hospitalizations in Canada and addresses a gap in literature by describing trends and context around cannabis edible-related poisoning cases using data from a Canadian sentinel surveillance system. Methods: Mixed-methods using data from two administrative data sources and one injury/poisoning sentinel surveillance system to estimate age-specific rates of cannabis-related poisonings ED visits (Ontario and Alberta), edible-related events (sentinel surveillance Canada), and hospitalizations (Canada with the exception of Quebec) among children between the ages of 0 to 11 from 2015/2016 to 2021. Annual absolute changes were calculated to quantify the magnitude of change between each age-specific rate. Joinpoint regression was used for trend analysis. A thematic analysis was completed to gain a better understanding of cannabis edible-related poisoning cases in the ED. Results: The pediatric age-specific rates for cannabis-related poisoning ED visits (average annual percent change (AAPC) Ontario: 98.2%, 95% CI: 79.1, 119.2; AAPC Alberta: 57.4%, 95% CI: 36.7, 81.2), hospitalizations (AAPC: 63.4%, 95% CI: 42.0, 87.9) and cannabis edible-related events (AAPC: 122.8%, 95% CI: 64.0, 202.6) increased significantly from 2015 to 2021. Almost half of all pediatric edible-related events involved gummy edible products (48.8%, n = 143). Based on the thematic analysis, 88% cannabis edible-related events were attributed to inadvertent ingestion due to access to such products or lack of safe storage practices. Conclusion: Age-specific rates of cannabis-related poisoning ED visits (Ontario and Alberta) and hospitalizations (Canada with the exception of Quebec) have increased since cannabis legalization, with the largest increase in rates occurring from 2019 to 2020. A similar increase in the rate of cannabis edible-related cases from sentinel surveillance data underscores the importance of monitoring this outcome. Public health messaging and national public health promotion strategies targeted towards raising awareness on the risks associated with consuming illegal cannabis and safe storage of cannabis could help mitigate cannabis poisonings among children. [ABSTRACT FROM AUTHOR]

Background: The number of patients with sickle cell disease in Ontario, Canada, is unknown. In the absence of a formal registry, we performed a study to determine an approximate census via analysis of health administrative databases. Methods: We identified Ontario patients with a diagnosis of sickle cell disease through queries of the Discharge Abstract Database, National Ambulatory Care Reporting System and Newborn Screening Ontario database. The period of inquiry was Apr. 1, 2007, through Mar. 31, 2017. We identified repeat interactions by the same patient by cross-referencing provincial health insurance plan numbers. Results: We documented health care system interactions for 3418 unique patients (1912 [55.9%] female, median age at the time of identification 24 yr). Over the 10-year study period, patients visited the emergency department a median of 2 (interquartile range [IQR] 1--7) times and an average of 6.69 (standard deviation [SD] 26.71) times, and were admitted to hospital a median of 1 (IQR 1--5) time and an average of 4.38 (SD 8.53) times for treatment related to sickle cell disease. A total of 229 patients (6.7%) died during the study period, with an average age at death of 55 years. Even without accounting for the effects of immigration, the rate of natural increase slowed slightly over the study period owing to a decrease in the annual number of affected births. Interpretation: The estimated prevalence of patients with sickle cell disease in Ontario in 2007/08--2016/17 was 1 in 4200, and affected patients' need for hospital-based care was substantial, although highly variable. Similar queries of health administrative databases may be feasible in other Canadian provinces. [ABSTRACT FROM AUTHOR]

Infections with antimicrobial resistant pathogens are a major threat to human and animal health worldwide. Further, reduction of livestock-associated antimicrobial use (AMU) is often identified as an area of focus. Selective dry cow therapy (DCT) warrants consideration as an important way to decrease AMU on Canadian dairy farms. In addition, teat sealants (TS) are a nonantimicrobial alternative for prevention of intramammary infection during the dry period. Therefore, objectives of this study were to determine how antimicrobials and TS are used at dry-off on Canadian dairy farms to determine selective DCT uptake and enacted selection protocols. It was expected that these data will provide a baseline understanding of DCT practices and highlight areas for future intervention to further reduce AMU. An observational study was conducted utilizing 2 in-person questionnaires conducted between July 2019 and September 2021 on 144 participating dairy farms in 5 Canadian provinces (British Columbia = 30, Alberta = 30, Ontario = 31, Québec = 29, and Nova Scotia = 24). Overall, 45 farms (31%) reported adopting selective DCT, 95 (66%) enacted blanket DCT, and 4 (3%) did not provide antimicrobial DCT. Farms enacting selective DCT had approximately 50% less intramammary antimicrobials used at dry-off compared with blanket DCT farms. Cow somatic cell count history was the most common criterion for selective DCT decision-making, followed by previous clinical mastitis history, bacteriological culture, and milk production. A slight majority of farms (56%) applied TS to all cows at dry-off, whereas 17 farms (12%) used TS selectively, and 46 farms (32%) did not use TS. Larger herds more often used TS, and farms with an automatic milking system more often used TS selectively than applied to all cows. Results highlighted the variability in antimicrobial treatment and TS use protocols at dry-off on Canadian dairy farms, and the potential for further antimicrobial reduction with increased adoption of selective DCT. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). Methods: This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16–22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. Results: The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. Conclusions: Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems. [ABSTRACT FROM AUTHOR]

Saltmarsh (Ammospiza caudacuta) and Nelson's (A. nelsoni) sparrows are sister taxa that breed in tidal marshes along the coast of the Northeastern United States and Canada. The Saltmarsh Sparrow breeds from mid‐coast Maine south to Virginia, while the Acadian Nelson's Sparrow breeds from the Canadian maritime provinces south to northern Massachusetts. Here, we present three extralimital observations of breeding Saltmarsh (n = 2) and Nelson's (n = 1) sparrows. In 2021 and 2022, we observed Saltmarsh Sparrow females attending nests at Mendall Marsh, ME, and Milbridge, ME, respectively, approximately 60 and 110 km beyond the documented northern extent of the Saltmarsh Sparrow breeding range. In 2022, we observed a breeding‐condition male Nelson's sparrow singing in the upriver portion of a marsh on Cape Cod, Massachusetts, approximately 115 km beyond the previously documented southern extent of the Nelson's Sparrow breeding range. We confirmed morphological species identification using a panel of microsatellite DNA loci. Due to both the well‐documented population declines of these species in the region and the intensity of sampling effort undertaken in recent years, we suggest that these observations likely are not indicative of range expansion. However, they do indicate that these 2 taxa have the capacity to use and successfully reproduce in marshes well beyond their established breeding limits. Our findings provide novel insight into the potential for these taxa to occur and successfully breed outside their documented breeding ranges. Given increased interest in their conservation, these results support the idea that management actions aimed at creating or maintaining nesting habitat across both species ranges could benefit both taxa. [ABSTRACT FROM AUTHOR]

Negative social and ecological trends are putting essential life-support systems at risk. Necessary responses include sustainability transformations in diverse sectors to enhance the planetary capacity to deliver more positive effects to all. Sustainability-based assessment frameworks are tools to guide the evaluation of initiatives in different human sectors and promote decisions that enhance overall social and ecological well-being. However, advancing sustainability remains difficult, in part because it must be pursued in a world of complex interactions and must respect the specifics of each case and context. This paper reports the process of building a sustainability-based assessment framework for electrical energy systems carried out by Aguilar. This work further specified the framework for electrical energy systems for application in the case and context of the electrical energy system in the Canadian province of Ontario. The illustrative application revealed that Ontario's electrical energy system has made some progress towards contributions to sustainability but requires improved efforts to be on a path to adequate transformation. The research found that the sustainability-based assessment framework for electrical energy systems is promising and well-suited for further application to particular electricity-related initiatives. However, more applications are needed to further test the utility of the framework and refine the proposed criteria. [ABSTRACT FROM AUTHOR]

Background: The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces. Methods: An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results. Results: After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. Discussion: We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups. [ABSTRACT FROM AUTHOR]

Unlike other high-income countries, Canada has no national policy for drugs treating rare diseases (orphan drugs). Nevertheless, in 2022, the Canadian government committed to creating a national strategy to make access to these drugs more consistent. Our aim was to study whether recommendations made by the Canadian Agency for Drugs and Technology in Health (CADTH) translated into coverage decisions for orphan drugs in Ontario, the largest Canadian province. This study is the first to look at this question for orphan drugs, which are at the center of policy attention. We included 155 orphan drug-indication pairs approved and marketed in Canada between October 2002 and April 2022. Cohen's kappa was used to test the agreement across health technology assessment (HTA) recommendations and coverage decisions in Ontario. Logistic regression was used to test which factors, relevant to decision-makers, might be associated with funding in Ontario. We found only fair agreement between CADTH's recommendations and coverage decisions in Ontario. Although a positive and statistically significant association between favorable HTA recommendations and coverage was found, more than half of the drugs with a negative HTA recommendation were available in Ontario, predominately through specialized funds. Successful pan-Canadian pricing negotiations were a strong predictor of coverage in Ontario. Despite efforts to harmonize access to drugs across Canada, considerable room for improvement remains. Introducing a national strategy for orphan drugs could help increase transparency, consistency, promote collaborations, and make access to orphan drugs a national priority. • Recommendations by the Canadian Agency for Drugs and Technology in Health do not always translate to provincial coverage decisions for new drugs. • We explored whether Canadian Agency for Drugs and Technology in Health's recommendations are aligned with coverage decisions for orphan drugs in Ontario. • Negative health technology assessment recommendations did not necessarily translate to no pan-Canadian pricing negotiations. • More than half the drugs with negative health technology assessment recommendations were available in Ontario through specialized funds. • A national strategy for orphan drugs could prioritize access to these treatments at a national level and harmonize access, at least to some extent, across Canada. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). Methods: A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). Results: Clinical operations of ECT programs were disrupted across all four regions – however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. Conclusions: The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments. [ABSTRACT FROM AUTHOR]

Background: Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. Methods: A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. Results: Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. Conclusion: Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices. [ABSTRACT FROM AUTHOR]

Background: Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries with a variable incidence worldwide. Previous studies reported an unexpectedly high incidence of KD in the Canadian Atlantic Provinces. The goals of our study were to validate this finding in the province of Nova Scotia and to carefully review patients' characteristics and disease outcomes. Methods: This was a retrospective review of all children < 16 years old from Nova Scotia diagnosed with KD between 2007–2018. Cases were identified using a combination of administrative and clinical databases. Clinical information was collected retrospectively by health record review using a standardized form. Results: Between 2007–2018, 220 patients were diagnosed with KD; 61.4% and 23.2% met the criteria for complete and incomplete disease, respectively. The annual incidence was 29.6 per 100,000 children < 5 years. The male to female ratio was 1.3:1 and the median age was 3.6 years. All patients diagnosed with KD in the acute phase received intravenous immunoglobulin (IVIG); 23 (12%) were refractory to the first dose. Coronary artery aneurysms were found in 13 (6%) patients and one patient died with multiple giant aneurysms. Conclusion: We have confirmed an incidence of KD in our population which is higher than that reported in Europe and other regions of North America despite our small Asian population. The comprehensive method to capture patients may have contributed to the detection of the higher incidence. The role of local environmental and genetic factors also deserves further study. Increased attention to regional differences in the epidemiology of KD may improve our understanding of this important childhood vasculitis. [ABSTRACT FROM AUTHOR]

Background The Brain Tumor Registry of Canada was established in 2016 to enhance infrastructure for surveillance and clinical research on Central Nervous System (CNS) tumors. We present information on primary CNS tumors diagnosed among residents of Canada from 2010 to 2015. Methods Data from 4 provincial cancer registries were analyzed representing approximately 67% of the Canadian population. Age-standardized incidence rates (ASIR) and 95% confidence intervals (CI) were calculated using the 2011 Canadian population age distribution. Net survival was estimated using the Pohar-Perme method. Results A total of 31 644 primary tumors were identified for an ASIR of 22.8 per 100 000 person-years. Nonmalignant tumors made up 47.1% of all classified tumors, with mixed behaviors present in over half of histology groupings. Unclassified were 19.5% of all tumors. The most common histological subtypes are meningiomas (ASIR = 5.5 per 100 000 person-years); followed by glioblastomas (ASIR 4.0 per 100 000 person-years). The overall 5-year net survival rate for CNS tumors was 65.5%; females 70.2% and males 60.4%. GBMs continue to be the most lethal CNS tumors for all sex and age groups. Conclusions The low annual frequency of most CNS tumor subtypes emphasizes the value of population-based data on all primary CNS tumors diagnosed among Canadians. The large number of histological categories including mixed behaviors and the proportion of unclassified tumors emphasizes the need for complete reporting. Variation in incidence and survival across histological groups by sex and age highlights the need for comprehensive and histology-specific reporting. These data can be used to better inform research and health system planning. [ABSTRACT FROM AUTHOR]

Earth's continental crust has evolved through a series of supercontinent cycles, resulting in a patchwork of Archean cores surrounded by terranes, fragments, and slivers of younger crustal additions. However, the dispersal (and/or stranding) of continental fragments during breakup is not well understood. Inherited structures from previous tectonic activity may explain the generation of continental terranes by controlling first-order deformation during rifting. Here, we explored the influence of lithospheric deformation related to ancient orogenesis, focusing on the impact of the Torngat orogen in the genesis of the Nain Province continental fragment in Eastern Canada. We present three-dimensional continental extension models in the presence of an inherited lithospheric structure and show that a narrow continental terrane could be separated and stranded by deep lithospheric scarring. The results show that continental terranes formed by this method would be limited to a width of 100-150 km, imposed by tectonic conditions during continental suturing. The findings have broad implications, demonstrating an original theory on the fundamental geologic problem of terrane generation and continent breakup. [ABSTRACT FROM AUTHOR]

Background: As people live longer, they are at increased risk for chronic diseases and disability. Self-management is a strategy to improve health outcomes and quality of life of those who engage in it. This study sought to gain a better understanding of the factors, including digital technology, that affect public health policy on self-management through an analysis of government policy in the most populous and multicultural province in Canada: Ontario. The overarching question guiding the study was: What factors have influenced the development of healthcare self-management policies over time? Methods: Archival research methods, combining document review and evaluation, were used to collect data from policy documents published in Ontario. The documents were analyzed using the READ approach, evaluated using a data extraction table, and synthesized into themes using the model for health policy analysis. Results: Between January 1, 1985, and May 5, 2022, 72 policy documents on self-management of health were retrieved from databases, archives, and grey literature. Their contents largely focussed on self-management of general chronic conditions, while 47% (n = 18/72) mention diabetes, and 3% (n = 2/72) focussed solely on older adults. Digital technologies were mentioned and were viewed as tools to support self-management in the context of healthcare delivery and enhancing healthcare infrastructure (i.e., telehealth or software in healthcare settings). The actors involved in the policy document creation included mostly Ontario government agencies and departments, and sometimes expert organizations, community groups and engaged stakeholders. The results suggest that several factors including pressures on the healthcare system, hybrid top-down and bottom-up policymaking, and political context have influenced the nature and implementation timing of self-management policy in Ontario. Conclusions: The policy documents on self-management of health reveal a positive evolution of the content discussed over time. The changes were shaped by an evolving context, both from a health and political perspective, within a dynamic system of interactions between actors. This research helps understand the factors that have shaped changes and suggests that a critical evidence-based approach on public health policy is needed in understanding processes involved in the development of healthcare self-management policies from the perspective of a democratic governing system. [ABSTRACT FROM AUTHOR]

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians. [ABSTRACT FROM AUTHOR]

Background: Autosomal dominant (AD) spinocerebellar ataxias (SCAs) encompass a large group of rare disorders, which occurs in individuals of different ethnic backgrounds. To date, demographics, and clinical descriptions of AD SCA in Canada are lacking. Methods: A retrospective chart review of patients with a genetically confirmed diagnosis of AD SCAs was performed at five tertiary centers across Canada in the provinces of Quebec, Alberta, and Ontario. Demographic, genetic, and clinical information were collected and analyzed. Results: A total of 203 patients with AD SCA were identified. Weighted estimated prevalence of AD SCA in three large Canadian provinces was calculated (2.25 cases per 100.000) which is in keeping with the figures documented worldwide. We found that the distribution of the most common SCA differed when comparing provinces. The most prevalent SCA diagnosis in Ontario was SCA3 (49%), while the most prevalent SCA diagnosis in Alberta and Quebec was SCA2 in 26% and 47%, respectively. SCA6 was the third most prevalent SCA subtype in Quebec (14%), which was not seen as commonly in other provinces. SCA1 was uncommonly seen in both Alberta and Quebec, despite being common in Ontario. Conclusions: In this largest Canadian study, we describe the prevalence, distribution, and clinical characteristics of AD SCA. We found that the distribution of the most common SCA differed in the three provinces studied. This finding reflects the heterogenous nature of the Canadian population. [ABSTRACT FROM AUTHOR]

Background: Recently, we identified barriers and facilitators to the screening and treatment of depressive and anxiety symptoms in adult‐onset isolated dystonia (AOID). These symptoms are common, functionally impairing, and often underdetected and undertreated. Objectives: To develop a care pathway for mood symptoms in AOID. Methods: We used a multistep modified Delphi approach to seek consensus among healthcare professionals with experience of AOID on the screening, diagnosis, and treatment of mood symptoms. A combination of face‐to‐face meetings and online surveys was performed from 2019 to 2020. We created the survey and then reviewed with stakeholders before 2 rounds of Delphi surveys, all of which was finally reviewed in a consensus meeting. A purposive sample of 41 expert stakeholders from 4 Canadian provinces, including neurologists, nurses, psychiatrists, psychologists, and family physicians, was identified by the research team. Results: The Delphi process led to consensus on 12 statements that operationalized a pathway of care to screen for and manage depression and anxiety in people with AOID. Key actions of the pathway included yearly screening with self‐rated instruments, multidisciplinary involvement in management involving local networks of providers coordinated by movement disorders neurologists, and access to educational resources. The Delphi panel indicated the 2 core steps as the documentation of the most recent screening outcome and the documentation of a management plan for patients who were positive at the last screening. Conclusions: This new care pathway represents a potentially useful intervention that can be used to build an integrated model of care for AOID. [ABSTRACT FROM AUTHOR]

Background: With large volumes of longitudinal data in electronic medical records from diverse patients, primary care is primed for disruption by artificial intelligence (AI) technology. With AI applications in primary care still at an early stage in Canada and most countries, there is a unique opportunity to engage key stakeholders in exploring how AI would be used and what implementation would look like. Objective: To identify the barriers that patients, providers, and health leaders perceive in relation to implementing AI in primary care and strategies to overcome them. Design: 12 virtual deliberative dialogues. Dialogue data were thematically analyzed using a combination of rapid ethnographic assessment and interpretive description techniques. Setting: Virtual sessions. Participants: Participants from eight provinces in Canada, including 22 primary care service users, 21 interprofessional providers, and 5 health system leaders Results: The barriers that emerged from the deliberative dialogue sessions were grouped into four themes: (1) system and data readiness, (2) the potential for bias and inequity, (3) the regulation of AI and big data, and (4) the importance of people as technology enablers. Strategies to overcome the barriers in each of these themes were highlighted, where participatory co-design and iterative implementation were voiced most strongly by participants. Limitations: Only five health system leaders were included in the study and no self-identifying Indigenous people. This is a limitation as both groups may have provided unique perspectives to the study objective. Conclusions: These findings provide insight into the barriers and facilitators associated with implementing AI in primary care settings from different perspectives. This will be vital as decisions regarding the future of AI in this space is shaped. [ABSTRACT FROM AUTHOR]

Objective: In 2018, the sale of non-medical cannabis was authorized in the province of Quebec in Canada, within a public monopoly under the Société Québécoise du Cannabis (SQDC). The objective of this study was to offer a description of the cannabis-using population regarding the sources of cannabis supply and to explore whether at-risk individuals are purchasing cannabis at SQDC. Method: We used data from a cross-sectional, representative population survey (age >18 years, n = 1799), the Enquête Québécoise sur le Cannabis, which was completed between February and June 2019. Analyses involved adjusted binary logistic regressions, incorporating population weights, to assess 7 potential indicators of harm. Results: The vulnerability profiles of SQDC consumers (47.8%) and those acquiring their cannabis elsewhere (52.2%) were similar in terms of frequency of cannabis use (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.12-1.67), motivation to use (aOR = 0.62; 95% CI = 0.16-2.46), concomitant consumption of other substances (aOR = 0.80; 95% CI = 0.14-4.75), cannabis-impaired driving behaviours (aOR = 0.93; 95% CI = 0.26-3.36), psychological distress (aOR = 0.99; 95% CI = 0.26-3.79), and problematic cannabis use (aOR = 0.46; 95% CI = 0.13-1.64). However, SQDC consumers were more likely to be aware of the cannabinoid content of the product purchased compared to those who acquired their cannabis from other sources (aOR = 4.12; 95% CI = 1.10-15.40). Conclusions: No association was detected between the source of cannabis supply and potential vulnerability indicators of cannabis-related harms, but SQDC consumers were more aware of the cannabinoid content of the products purchased. These results suggest that the regulated government supply in Quebec is reaching a substantial portion of those with potential high vulnerability to harm. Whether this knowledge translates into a reduction in the negative consequences related to consumption is still to be determined. [ABSTRACT FROM AUTHOR]

Solid precipitation falling near 0 °C, mainly snow, can adhere to surface features and produce major impacts. This study is concerned with characterizing this precipitation over the Canadian Prairie provinces of Manitoba and Saskatchewan in the current (2000–2013) and pseudo-global warming future climate, with an average 5.9 °C temperature increase, through the use of high resolution (4 km) model simulations. On average, simulations in the current climate suggest that this precipitation occurs within 11 events per year, lasting 33.6 h in total and producing 27.5 mm melted equivalent, but there are wide spatial variations that are partly due to enhancements arising from its relatively low terrain. Within the warmer climate, average values generally increase, and spatial patterns shift somewhat. This precipitation consists of four categories covering its occurrence just below and just above a wet-bulb temperature of 0 °C, and with or without liquid precipitation. It generally peaks in March or April, as well as in October, and these peaks move towards mid-winter by approximately one month within the warmer climate. Storms producing this precipitation generally produce winds with a northerly component during or shortly after the precipitation; these winds contribute to further damage. Overall, this study has determined the features of and expected changes to adhering precipitation across this region. [ABSTRACT FROM AUTHOR]

Background: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. Methods: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. Results: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. Conclusions: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language. [ABSTRACT FROM AUTHOR]

The Canadian Prairie Provinces (Alberta, Saskatchewan and Manitoba) are home to species from 29 of the 45 spider families currently found in Canada. Here we provide a beginner-friendly dichotomous key to the spider families of the Canadian Prairies. The key includes numerous photos, line drawings, and simplified definitions of anatomical characters necessary for family-level identification. For each family we include an illustrated summary of important character states, a whole-body photo of an exemplar of the family, and number of species of the family currently reported from the Prairie Provinces. [ABSTRACT FROM AUTHOR]

Background: The Canadian province of Nova Scotia recently became the first jurisdiction in North America to pass deemed consent organ donation legislation. The announcement of this legislation generated substantial online discussion, which we analyzed to provide insights on public perception. Methods: We performed directed content analysis on 2663 user-generated comments appearing on two widely-shared Canadian Broadcasting Company (CBC) articles published online in April 2019. We determined levels of support and opposition in comments and described the specific rhetoric used for doing so. We also performed one-way ANOVA and Pearson chi-square tests to determine how the comments were being received and engaged by other users. Results: A range of commentary was present in both support and opposition to the changes in legislation. There were more negative than positive comments, and negative commentary generated more replies. Positive comments were received more positively by other users while negative comments were received more negatively. The total sum of negative comments was greatly influenced by a small number of very active participants. Negative commentary focused more on broad concepts and principles related to government, power, and individual rights rather than specific issues in the Nova Scotian context. Substantial issues of trust in the government and healthcare system were evident. Conclusions: There were strong positive and negative sentiments expressed in the comments, but the total sum of negativity in the comments was significantly influenced by a small number of commentators. Analysis on the presumed consent concerns can be helpful to inform public outreach efforts. [ABSTRACT FROM AUTHOR]

Thirty species of Curculionoidea (28 Curculionidae and one each of Brentidae and Nemonychidae) are reported as new records from the Canadian province of Newfoundland and Labrador, most of them from the island of Newfoundland. As well, 13 species of Curculionidae and one of Brentidae previously recorded from Newfoundland are newly reported from Labrador, and one Curculionidae previously recorded from Labrador is newly reported from Newfoundland. The Palearctic species, Orthochaetes setiger ([Beck]), is herein reported as a new Canadian and North American record, with specimens documented from Newfoundland and British Columbia. Additions to the primary key for North American weevils are provided to help identify this genus among the North American fauna. Of the species of Curculionoidea previously recorded from the province in published literature, there is uncertain evidence for the occurrence of 14 species in the province as a whole or in the Labrador portion. Seven species are hereby removed from the faunal list for the province. One of those, Trachodes hispidus (Linnaeus), is also removed from the Canadian faunal list. The 134 species of Curculionoidea recorded from NL are listed and a brief synopsis of the fauna provided. [ABSTRACT FROM AUTHOR]

The role of schools in the spread of SARS-CoV-2 is controversial, with some claiming they are an important driver of the pandemic and others arguing that transmission in schools is negligible. School cluster reports that have been collected in various jurisdictions are a source of data about transmission in schools. These reports consist of the name of a school, a date, and the number of students known to be infected. We provide a simple model for the frequency and size of clusters in this data, based on random arrivals of index cases at schools who then infect their classmates with a highly variable rate, fitting the overdispersion evident in the data. We fit our model to reports from four Canadian provinces, providing estimates of mean and dispersion for cluster size, as well as the distribution of the instantaneous transmission parameter ß, whilst factoring in imperfect ascertainment. According to our model with parameters estimated from the data, in all four provinces (i) more than 65% of non-index cases occur in the 20% largest clusters, and (ii) reducing instantaneous transmission rate and the number of contacts a student has at any given time are effective in reducing the total number of cases, whereas strict bubbling (keeping contacts consistent over time) does not contribute much to reduce cluster sizes. We predict strict bubbling to be more valuable in scenarios with substantially higher transmission rates. [ABSTRACT FROM AUTHOR]

Background: Many family medicine residency graduates indicate a desire to provide obstetric care, but a low proportion of family physicians (FPs) provide obstetric care within their practice. This suggests personal preference alone may not account for the low proportion of FPs who ultimately provide full obstetric care. If decisionmakers plan to augment the number of FPs providing obstetric care, barriers to the provision of such care must first be identified. Within this paper, we explore the perspectives of both family practice residents and early-career FPs on the factors that shaped their decision to provide obstetric care.Methods: In this qualitative study, we analyzed a subset of interview data from three Canadian provinces: British Columbia, Ontario, and Nova Scotia (n = 18 family practice residents; n = 39 early-career FPs). We used thematic analysis to analyze data relevant to obstetric care practice, applying the socio-ecological model and comparing themes across participant types, gender, and province.Results: Participants described influences affecting their decision about providing obstetric care. Key influencing factors aligned with the levels of the socio-ecological model of public policy (i.e., liability), community (i.e., community needs), organizational (e.g., obstetric care trade-offs, working in teams, sufficient exposure in training), interpersonal practice preferences (i.e., impact on family life, negative interactions with other healthcare professionals), and individual factors (i.e., defining comprehensive care as "everything but obstetrics"). Many participants were interested in providing obstetric care within their practice but did not provide such care. Participants' decision-making around providing or not providing obstetric care included considerations of personal preferences and outside influences.Conclusions: Individual-level factors alone do not account for the decrease in the type and amount of obstetric care offered by FPs. Instead, FPs' choice to provide or not provide obstetric care is influenced by factors at higher levels of the socio-ecological model. Policymakers who want to encourage obstetric practice by FPs should implement interventions at the public policy, community, organizational, interpersonal, and individual levels. [ABSTRACT FROM AUTHOR]

The article discusses the book "Imagining the Heartland: White Supremacy and the American Midwest" by Britt E. Halvorson and Joshua O. Reno. The authors argue that the Midwest has been a site of racial violence and white supremacy throughout history, despite its association with kindness and Americanness. They highlight the role of negative tropes about Indigenous populations and the myth of the virtuous white farmer in shaping the idea of the Midwest. The article also includes a review of the book "Great Plains Forts" by Jay H. Buckley and Jeffery D. Nokes, which provides an overview of forts in the Great Plains region. The review notes that the book is recommended for general readers interested in historical sites. [Extracted from the article]

Objective: To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women. Design: Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. Setting: General community setting in four Canadian provinces. Participants: In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012. Results: Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months. Conclusions: Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally. [ABSTRACT FROM AUTHOR]

Crossfield is located in the province of Alberta in Canada and is one of the most well-known reservoirs of hydrocarbons. Since the 1950s, there has been continuous exploitation of more than 10 formations such as Cardium, Viking, Ellerslie, Elkton, Shunda, and Wabamun. Because of its location near the Foothills, the southwestern part of the Western Canada Sedimentary Basin, the Crossfield area has a complex geology and relatively deeper reservoirs, therefore requiring an in-depth examination of each formation. In this study, geological, technical, and economic analyses were performed on each formation within the 10 sections of the study lands in the Crossfield area. As the result of the study, there was potential for drilling 48 horizontal wells in the Cardium A zone and the Viking formation. In addition, it turned out to be economically feasible even at the WTI price of 60 dollars per barrel considering Alberta's Royalty Framework, which is determined by the production rate and the price of oil, and the Horizontal Oil New Well Royalty Rate feature. A further study is required to investigate the exploitation potential of the Cardium B zone, the Ellerslie, and the Elkton formations in this area. [ABSTRACT FROM AUTHOR]

The authors report findings from a 15-month project that focused on the experiences of sex workers who live and work in an Eastern Canadian province. As part of a larger multi-phased study, 15 adults who identified as women, transgender, or non-binary, and received money or goods for sexual services, participated in photo-elicitation interviews. Drawing on a critical framing analysis, findings indicated supports—as identified and experienced by sex workers—encompassed three categories of care: self, community, and collective. These categories are described, with a particular focus on the latter two. Continuing with the care-based framework, recommendations to structure interventions draw on the role of accountability care in identifying how best to operationalize policies that promote health, well-being, and dignity of Canadian sex workers. The paper begins with a brief overview of the Canadian context and the role of supports. It follows with a discussion on the materials and methods and the results. It concludes with recommendations, limitations, and future considerations. [ABSTRACT FROM AUTHOR]

The Thompson River valley hosts 14 landslides along a 10 km section, which threaten the two major railroads connecting the Port of Vancouver and the interior provinces in Canada. The Ripley landslide is one of the active landslides in this section of the valley. Previous research at this site included an analysis of landslide deformations using satellite radar interferometry focusing on deformations measured in the line of sight between the satellite and the slopes, and average downslope displacement (deformations projected in the average downslope direction). Since then, further stratigraphic interpretation has provided an enhanced understanding of the Ripley landslide. In this update, the new stratigraphic interpretation is supplemented with satellite InSAR data from May 2015 to May 2017 to enhance the current understanding of the landslide kinematics. The results indicate that the Ripley landslide has been moving at a rate between 2 and 82 mm per year, corresponding to a very slow to slow landslide. It is also observed that the movements tend to be near-horizontal on areas closer to the toe of the landslide, while the vertical component of deformation increases near the scarp of the landslide. This, together with the interpreted stratigraphy, indicates the kinematics corresponds to a compound landslide. This is consistent with interpreted landslide kinematics of older, more mature landslides in the area that have shown episodes of retrogression and suggests the possibility of a similar future behaviour of the Ripley landslide. [ABSTRACT FROM AUTHOR]