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Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada's 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University's evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada's two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance. [ABSTRACT FROM AUTHOR]

We propose a multiagent, large-scale, vehicle routing modeling framework for the simulation of transportation system. The goal of this paper is twofold. Firstly, we investigate how individual and social knowledge interact and ultimately influence the effectiveness of resulting traffic flow. Secondly, we evaluate how different discrete-event simulation designs (delays vs. queuing) affect conclusions within the model. We present a new agent-based model that combines the efficient discrete-event approach to modeling with the intelligent drivers who are capable to learn about their environment in the long-term perspective from both, individual experience, and widely available social knowledge. The approach is illustrated as practical application to modeling commuter behavior in the city of Winnipeg, Manitoba, Canada. All simulations in the paper are fully reproducible as they have been carried out by utilizing a set of opensource libraries and tools that we have developed for the Julia programming language and that are openly available on GitHub. [ABSTRACT FROM AUTHOR]

Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada's 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University's evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada's two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Steam-assisted gravity drainage (SAGD) has been used to develop the "super heavy" oil reservoirs in Canada. The viscosity can reach more than 30,000 cp at 50°C. Moreover, owing to their continental deposit origin, the reservoirs have a low porosity and permeability. Because of these challenges, the conventional steam circulation start-up process takes 6 to 12 months before the well pair can be switched to production. Solvent has been used to start-up SAGD with success. But now, low price of oil and high cost of solvent make solvent-assisted start-up process limited. This paper applies experimental schemes, such as viscosity reduction rate evaluation, core flooding, and 3D physical simulation, tests solvent performance, optimizes process parameters, and designs process solutions. Apply numerical simulation to test solvent-assisted SAGD start-up effect and calculate the cost. This paper researches a unique low-cost solvent compare with xylene. The basic properties and core flood experiment show that the two solvents are similar with viscosity reduction rate, asphalt dissolution rate, and injection pressure, and the price of solvent is 18% lower. The 3D model experiment shows that the average start-up time is reduced by 15%, and steam injection volume is reduced by 21.4%. The numerical simulation results show that without solvent, it will take 180 d for start-up process, and with solvent, the time has reduced by 50% and takes 90 days. Cost calculation results show that the cost will reduce 18% by solvent compared to xylene. Moreover, the production rate has been improved in production stage. This paper applies a 3D physical model to simulate the solvent-assisted SAGD start-up process. Research conclusions show the start-up mechanism of solvent and the process of temperature change of steam chamber. [ABSTRACT FROM AUTHOR]

According to the Public Health Agency of Canada, approximately 62,050 people were living with HIV in Canada in 2018, and of those, 13% were undiagnosed. Currently, no single strategy provides complete protection or is universally effective across all demographic groups at risk for HIV. However, HIV preexposure prophylaxis (PrEP) is the newest HIV prevention strategy that shows promise. To date, two products have received an indication for PrEP by Health Canada: emtricitabine/tenofovir disoproxil fumarate (Truvada®; FTC/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; FTC/TAF). Despite the high efficacy of these PrEP intervention methods, access to PrEP in Canada remains low. Identifying and addressing barriers to PrEP access, especially in high-risk groups, are necessary to reduce HIV transmission in Canada. While guidelines published by the Center for Disease Control and Prevention (CDC) include FTC/TAF information, the efficacy of FTC/TAF for PrEP has not yet been considered in Canada's clinical practice guidelines. Thus, the current paper reviews data regarding the use of FTC/TDF and FTC/TAF for PrEP, which may be useful for Canadian healthcare providers when counseling and implementing HIV prevention methods. The authors highlight these data in relation to various at-risk populations and review ongoing clinical trials investigating novel PrEP agents. Overall, FTC/TDF PrEP is effective for many populations, including men who have sex with men, transgender women, heterosexuals with partners living with HIV, and people who use drugs. While there is fewer data reported on the efficacy of FTC/TAF to date, recent clinical trials have demonstrated noninferiority of FTC/TAF in comparison to FTC/TDF. Notably, as studies have shown that FTC/TAF maintains renal function and bone mineral density to a greater extent than FTC/TDF, FTC/TAF may be a safer option for patients experiencing renal and/or bone dysfunction, for those at risk of renal and bone complications, and for those who develop FTC/TDF-related adverse events. [ABSTRACT FROM AUTHOR]

SAGD technology has been successfully and widely applied in the development of superheavy oil and oil sand projects. Before normal SAGD process, some preheating ways are often needed to realize interwell hydraulic connection, and this means that determining reasonable SAGD conversion timing from the preheating stage is an essential precondition for good performance. Previous numerical simulations or qualitative analysis of temperature fall-off data are often adopted in the industry, but they have deficiencies in terms of dependent on static geological model or insufficient data utilization. Therefore, on the basis of the temperature and pressure monitoring process comparison in China's superheavy oil and Canada's oil sand projects, this paper proposed a temperature fall-off interpretation model to obtain thermal diffusivity and preheating radius at different measurement points along the horizontal section by combining an unsteady thermal conduction model under constant heating power of wellbores in the radial coordinate system and approximately unsteady thermal conduction model with constant wellbore temperature and Fourier's law of thermal conduction. Besides, the duration time, interpretation method, and application flow chart of temperature fall-off test were presented. Then, it was validated to successfully determine the timing of SAGD conversion from the preheating stage by an example combining with tracking numerical simulation, temperature inflection point analysis, and index analysis during the partial-SAGD and initial SAGD stages. The findings of this study can help determine the SAGD conversion timing from the preheating stage simpler and faster especially for the case of long horizontal well section deployed with more temperature measurement points. [ABSTRACT FROM AUTHOR]

Background. Oxycodone is a widely used opioid analgesic, which is involved in cancer pain and non-cancer pain. This study is intended to understand the publication characteristics of oxycodone research field and assess the quality of pertinent articles from 1998 to 2017. Methods. Oxycodone-related publications from 1998 to 2017 were retrieved from the Web of Science (WOS) and PubMed database. These papers were coded across several categories, such as total number, journals, countries, institutions, authors and citations reports. And the analysis of co-occurrence keywords was handled by VOSviewer software. Results. According to search strategies, a total of 2659 articles on oxycodone were published in world from 1998 to 2017 in WOS. Among the top 10 most productive organizations, six of them were American institutes, two of them were pharmaceutical enterprises and the other three were Finnish, Australian and Canadian institutes, which is similar with the distribution by country/region. Drewes AM from Denmark published most articles and PAIN MEDICINE is the most productive journal in oxycodone area. Meanwhile, clinical studies occupy a dominant position during the past 20 years. The 10 most cited papers were listed. Among these articles, 8 of them are reviews and 2 of those are meta-analysis. And the last decade (2008–2017) displayed that the newest keywords focus on "double-blind", "randomized controlled trial" and "neuropathic pain". Conclusions. The findings provided a comprehensive overview of oxycodone research. In view of the adverse effects of oxycodone, high-quality oxycodone studies both in basic studies and clinical trials need to be completed. [ABSTRACT FROM AUTHOR]

Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, “Obesity in Canada: A Whole-Of-Society Approach,” exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight-centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies. [ABSTRACT FROM AUTHOR]

This paper investigates the duration of over qualification in Canada, the time-varying probability of leaving overqualification, and the wage consequences associated with the transition. The paper also applies a survival analysis approach to examine the impact of key driving factors on the probability of transitioning from overqualification to a job match using a proportional hazard (Cox) model. The analysis shows that within a 5-year period, an overqualified worker has a 22 percent probability of transitioning to an occupation that matches the education level. The probability of transition also decreases quickly over time, thus lowering the chances of finding a job match after 12 months. Regression analyses also provide evidence that overqualified workers with short tenure are more likely to transition than workers with medium to long tenure. Finally, job-related training nearly doubles the chance of transitioning out of overqualification. [ABSTRACT FROM AUTHOR]

Most diversity management programs in Canada maintain that enhancing workforce diversity is of tremendous significance for business organizations in today's competitive global urban markets. Since well-meaning diversity management initiatives have been largely ineffective thus far in dealing with workplace discrimination and racism in the Canadian workplace, this paper underscores the need to decenter the focus of diversity management from a business imperative to an antidiscrimination and social justice imperative. Within this latter perspective, the paper examines the strengths and limitations of the antiracism approach that has been implemented in various developed countries in recent years. The antiracism approach is an action-oriented strategy for institutional and systemic change that has at its core the interrogation of privilege, power disparities, and other forms of inequity within the organization. Drawing from the lessons of various initiatives that have utilized this approach, the present paper emphasizes the need for a nuanced antiracism approach in the multicultural Canadian society if diversity management is to attain its goal of greater inclusion of all individuals in informal networks and formal organizational programs. [ABSTRACT FROM AUTHOR]

Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients’ experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs. [ABSTRACT FROM AUTHOR]

SUMMARY Land border crossings in North America, such as those between Canada and U.S.A., are expected to experience severe imbalance of travel demand and capacity of processors. During peak travel periods, this is already the case at high traffic locations. The land border crossing authorities have to address problems of congestion, national security and environmental impacts in the operation of the existing systems and to continue to address these problems as a part of infrastructure expansion plans. There is a need to adapt the crossing system management in order to accommodate efficiency and productivity-oriented priority crossing measures. From a methodological perspective, it is a challenge to evaluate the role of priority crossing measures within the complex border crossing system. This paper reports research on modelling priority crossing initiatives. A microsimulation approach was used to model and analyse integrated processors of the Peace Bridge crossing system between Fort Erie (Ontario) and Buffalo (New York) under different scenarios of travel demand, customs processing times, priority crossing and queue jump lanes for automobile and truck traffic. Findings show the extent to which a border crossing system with priority crossing and queue jump lanes is more efficient and productive than one without these innovations. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between health and the business cycle for the Canadian economy. The majority of existing literature shows a procyclical relationship between death rates and indicators of the business cycle, suggesting that recessions are good for one's health. We use a time series error correction model to determine the short-run and long-run impacts of the unemployment rates on death rates. Our results indicate that temporary slowdowns in economic activity are associated with lower death rates. Moreover, once we stratify the data by sex, we find a long-run negative relationship between the unemployment rate and death rates for both sexes. [ABSTRACT FROM AUTHOR]

Type 2 diabetesmellitus (T2DM) is classically viewed as a disease of adults caused by poor nutrition, physical inactivity, and obesity. However, with increasing awareness of the heterogeneity of T2DM, new risk factors are being identified that add complexity. Some of these new risk factors have been identified in Canadian people with Aboriginal Oji-Cree heritage, a group that demonstrates one of the highest rates of T2DM in the world. This high prevalence may be due to the rapid change, over the past 50 years, away from their traditional way of life on the land. Another environmental change is the increased rate of pregnancies complicated by obesity, gestational diabetes, or T2DM, resulting in more children being exposed to an abnormal intrauterine environment. Furthermore, the Oji-Cree of central Canada possesses the unique HNF-1α G319S polymorphism associated with reduced insulin secretion.We propose that intrauterine exposure to maternal obesity and T2DM, associated with the HNF-1α G319S polymorphism, results in fetal programming that accelerates the progression of early-onset T2DM. This paper describes the evolution of T2DM in children with a focus on the Oji-Cree people over the past 25 years and the unique prenatal and postnatal gene-environment interaction causing early-onset T2DM. [ABSTRACT FROM AUTHOR]

This paper reports on grounded theory findings that are relevant to promoting the mental health and well-being of immigrant women in Canada. The findings illustrate how relationships among settlement factors and dynamics of empowerment had implications for "becoming resilient" as immigrant women and how various health promotion approaches enhanced their wellbeing. Dimensions of empowerment were embedded in the content and process of the feminist health promotion approach used in this study. Four focus groups were completed in Toronto, Ontario, Canada with 35 racialized immigrant women who represented diverse countries of origin: 25 were from Africa; others were equally represented from South Asia (5), Asia (5), and Central or South America and the Caribbean (5). Participants represented diverse languages, family dynamics, and educational backgrounds. One focus group was conducted in Somali; three were conducted in English. Constructivist grounded theory, theoretical sampling, and a critical feminist approach were chosen to be congruent with health promotion research that fostered women's empowerment. Findings foreground women's agency in the study process, the ways that immigrant women name and frame issues relevant to their lives, and the interplay among individual, family, community, and structural dynamics shaping their well-being. Implications for mental health promotion are discussed. [ABSTRACT FROM AUTHOR]

Research has shown that while preceptorship offers a reality-oriented learning environment and facilitates competence of students, there are inherent rewards and stressors associated with the experience. Students and preceptors can be from different generations, and as such, they may often come to the learning space with differing values and expectations. The nature of the preceptorship experience in this intergenerational context was explored in a recent phenomenological study with seven preceptors and seven nursing students in an undergraduate nursing programin Eastern Canada. Overall the experience was found to be inclusive of three main themes: being affirmed, being challenged, and being on a pedagogical journey. In this paper we explore the first of these themes, being affirmed. Highlighting the positive aspects of the preceptorship experience in the intergenerational context is necessary to promote a culture of openness and respect for generational differences within clinical nursing practice settings and to improving the overall quality of the educational experience. [ABSTRACT FROM AUTHOR]

Aboriginal peoples are among the most food insecure groups in Canada, yet their perspectives and knowledge are often sidelined in mainstream food security debates. In order to create food security for all, Aboriginal perspectives must be included in food security research and discourse. This project demonstrates a process in which Aboriginal and non-Aboriginal partners engaged in a culturally appropriate and respectful collaboration, assessing the challenges and barriers to traditional foods access in the urban environment of Vancouver, BC, Canada. The findings highlight local, national, and international actions required to increase access to traditional foods as a means of achieving food security for all people. The paper underscores the interconnectedness of local and global food security issues and highlights challenges as well as solutions with potential to improve food security of both Aboriginal and non-Aboriginal peoples alike. [ABSTRACT FROM AUTHOR]

This paper reports on and synthesizes new research that examines how a collaborative community response can promote successful aging in place for older adults with hoarding behaviour. Through interviews with older adults with hoarding behaviour, who used a particular community support and a focus group interview with members of the community collaborative that directed supports for this population, our findings suggest that there were valuable outcomes for both groups. These older adults with hoarding behaviour were able to remain in their own homes, their safety was enhanced, their sense of isolation was minimized, empowerment was fostered, and they gained valuable insight into their behaviour. The members of the community collaborative were able to access the expertise of other professionals, maximize their own expertise, and they generated an enhanced understanding of the experience of older adults living with hoarding behaviour in Edmonton. This study is a significant addition to the much too sparse literature about the community planning needs of older adults with hoarding behaviour. It offers knowledge that is integral to theories and principles of better aging in place but attempts to translate this into practice. [ABSTRACT FROM AUTHOR]

Solar energy is an abundant source of renewable/sustainable energy, which has an enormous potential in reducing the foot print of the greenhouse gases. In this paper, we presented a modelling framework of estimating solar energy over a portion of a residential community of Sandstone in the northwest of Calgary, Canada. We calculated the actual daily incident solar radiation as a function of latitude, day of year, and possible day light hours; and also employed high-resolution remote sensing images to calculate the effective roof area for installing photovoltaic cells. Strong relationships (r²: 0.91-0.98) were observed between the ground-based measurements and the modelled actual incident solar radiation at three test locations in Alberta. Over the portion of Sandstone, ~1706.49m² roof surface area was suitable for potential installation of the photovoltaic cells. With 15% efficient photovoltaic cells, our analysis revealed that we might be able to produce significant amount (i.e., in the range of ~67-100%) of electrical energy needs of the residents of Sandstone community during the period between April and September. [ABSTRACT FROM AUTHOR]

This paper compares syndromic surveillance and predictive weather-based models for estimating emergency department (ED) visits for Heat-Related Illness (HRI). A retrospective time-series analysis of weather station observations and ICD-coded HRI ED visits to ten hospitals in south eastern Ontario, Canada, was performed from April 2003 to December 2008 using hospital data from the National Ambulatory Care Reporting System (NACRS) database, ED patient chief complaint data collected by a syndromic surveillance system, and weather data from Environment Canada. Poisson regression and Fast Orthogonal Search (FOS), a nonlinear time series modeling technique, were used to construct models for the expected number of HRI ED visits using weather predictor variables (temperature, humidity, and wind speed). Estimates of HRI visits from regression models using both weather variables and visit counts captured by syndromic surveillance as predictors were slightly more highly correlated with NACRS HRI ED visits than either regression models using only weather predictors or syndromic surveillance counts. [ABSTRACT FROM AUTHOR]

Tenosynovial giant cell tumor is a neoplastic disease of joints that can cause severe morbidity. Recurrences are common following local therapy, and no effective medical therapy currently exists. Recent work has demonstrated that all cases overexpress macrophage colony-stimulating factor (CSF1), usually as a consequence of an activating gene translocation, resulting in an influx of macrophages that form the bulk of the tumor. New anti-CSF1 drugs have been developed; however there are no preclinical models suitable for evaluation of drug benefits in this disease. In this paper, we describe a novel renal subcapsular xenograft model of tenosynovial giant cell tumor. Using this model, we demonstrate that an anti-CSF1 monoclonal antibody significantly inhibits host macrophage infiltration into this tumor. The results from this model support clinical trials of equivalent humanized agents and anti-CSF1R small molecule drugs in cases of tenosynovial giant cell tumor refractory to conventional local therapy. [ABSTRACT FROM AUTHOR]

This paper presents two regression models for work trips made by taxi for the year 1996 and the year 2001, respectively for 25 Canadian cities. These regression models indicates the primary factors that influence work commuting by taxi. Two major factors are identified: the total number of work trips made by public transit and the total number of low-income households. The 2001 regression model indicates an increase of the value of the transit commuter's coefficient from its 1996 figure. These results highlight the important role that taxis play in: (i) decreasing the demand for parking especially in urban cores and (ii) serving the transportation disadvantaged population especially in outlying areas poorly served by public transport. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various research papers within the issue on topics including prevention and treatment of hypertension, biobehavioral factors affected by increases in blood pressure, and impact of sleep and anxiety on blood pressure.