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• Canadian E-waste recycling data from 2012 to 2020 are systematically assessed. • Regression and Mann-Kendall analyses are used to quantify the temporal trends. • Both collection points and stewardship organizations have grown exponentially. • The role of public awareness on e-waste recycling varied between provinces. • Operational expenditure and revenue on stewardship resilience should be monitored. Electronic waste recycling companies have proliferated in many countries due to valuable materials present in end-of-life electronic and electrical equipment. This article examined the business characteristics and management performance of Electronic Products Recycling Association (EPRA), a Canadian nationwide electronic product stewardship organization. The organization's annual performance reports, from 2012 to 2020, for nine Canadian provinces in which it currently operates were aggregated and analyzed. Temporal analysis using regression and Mann-Kendall tests were employed, and five characteristics of EPRA's business were analyzed, including e-waste products collected, number of drop-off locations, efforts to build public awareness, operating expenses, and growth of e-waste stewardship. Results show a decline in the amount of e-waste collected across the provinces, except in New Brunswick, which started its program in 2017. The Mann-Kendall test revealed declining temporal trends in most provinces. Although the collection/drop off sites and stewardship organizations increased astronomically over the study period in Canada, the amounts of e-waste collected decreased. We found that public awareness generally did not increase the amount of e-waste collected, and these campaigns only appeared to be effective in jurisdictions with good accessibility of e-waste recycling. Processing cost accounted for the majority of the e-waste management budget in Canada, and different factors affected the financial success of the stewards differently. [ABSTRACT FROM AUTHOR]

Venetoclax is a first-in-class B-cell lymphoma-2 (BCL-2) inhibitor approved as continuous monotherapy and in combination with rituximab as fixed-treatment duration for relapsed and refractory chronic lymphocytic leukemia (R/R CLL). DEVOTE was a 24-week, multicenter observational study (NCT03310190) evaluating the safety, healthcare resource utilization (HCRU) and health-related quality of life (HRQoL) of patients initiating venetoclax for R/R CLL in Canada. Overall, 89 patients received 1 dose of venetoclax; 80% had prior exposure (42% resistant) to ibrutinib. Biochemical tumor lysis syndrome (TLS) occurred in five patients. We observed differences in hospitalization across Canadian provinces including in patients at low risk for TLS with no clear impact on TLS incidence. Additionally, a rapid and sustained improvement in several domains of HRQoL was observed during venetoclax initiation. Early adoption of venetoclax was mainly for R/R CLL patients with few treatment options; nonetheless, acceptable toxicity and a positive impact on HRQoL were observed. [ABSTRACT FROM AUTHOR]

Understanding the phenology of migration is fundamental to management of migratory gamebirds, in part because of the role migratory timing plays in setting harvest regulations. Migratory timing is particularly important for determining appropriate dates for hunting seasons, which may be selected to coincide with major periods of migration, according to local management objectives. We used global positioning system (GPS)‐transmitters to track American woodcock (Scolopax minor), characterize the timing of woodcock migration, and identify sources of variation in timing relative to current hunting season structures in eastern North America. We captured 304 woodcock in 3 Canadian provinces and 12 states from 2017 to 2020, primarily within the Eastern Woodcock Management Region. Using locations collected every 1.7 days on average, we assessed whether initiation, termination, or stopover timing of woodcock migration during fall and early spring varied geographically, differed among age and sex classes, or was influenced by individual body condition. During fall, woodcock migrating from summer use areas farther north and west (e.g., Ontario, Quebec, Canada) initiated and terminated migration earlier than woodcock migrating from areas farther south and east (e.g., Rhode Island, USA). Adult woodcock made multiday stopovers that were 3 days longer on average than juveniles and females made more stopovers on average (8.0 stopovers) compared to males (6.1 stopovers). During the onset of spring migration, woodcock that wintered farther west initiated migration before birds that spent the winter farther east, and males initiated migration on average 6 days earlier than females. Under the current 45‐day harvest regulatory framework in the United States, hunting seasons in northern breeding and southern wintering areas are generally consistent with migration phenology. At more intermediate latitudes, however, periods of migration are generally longer than 45 days, resulting in many circumstances where migrating woodcock are present during periods when hunting seasons are closed. Managers in mid‐latitude states could consider opening hunting seasons later, allowing hunters to harvest more migrant woodcock. [ABSTRACT FROM AUTHOR]

This Special Section explores the interplay between Indigenous peoples, industry, and the state in five proposed and active mining projects in Canada and Sweden. The overall aim is to identify factors shaping the quality of Indigenous community-industry-state interactions in mining and mine development. An ambition underlying the research is to develop knowledge to help manage mining related land-use conflicts in Sweden by drawing on Canadian comparisons and experience. This paper synthesizes the comparative research that has been conducted across jurisdictions in three Canadian provinces and Sweden. It focuses on the interplay between the properties of the governance system, the quality of interaction and governance outcomes. We combine institutional and interactive governance theory and use the concept of governability to assess how and why specific outcomes, such as mutually beneficial interaction, collaboration, or opposition, occurred. The analysis suggests there are measures that can be taken by the Swedish Government to improve the governability of mining related issues, by developing alternative, and more effective, avenues to recognize, and protect, Sámi rights and culture, to broaden the scope and increase the legitimacy and transparency of the EIAs, to raise the quality of interaction and consultation, and to develop tools to actively stimulate and support collaboration and partnerships on equal terms. Generally, we argue that Indigenous community responses to mining must be understood within a larger framework of Indigenous self-determination, in particular the communities' own assessments of their opportunities to achieve their long-term objectives using alternative governing modes and types of interactions. [ABSTRACT FROM AUTHOR]

Background: The drug toxicity crisis continues to accelerate across Canada, with rapid increases in opioid-related harms following the onset of the COVID-19 pandemic. We sought to describe trends in the burden of opioid-related deaths across Canada throughout the pandemic, comparing these trends by province or territory, age, and sex. Methods: We conducted a repeated cross-sectional analysis of accidental opioid-related deaths between Jan. 1, 2019, and Dec. 31, 2021, across 9 Canadian provinces and territories using aggregated national data. Our primary measure was the burden of premature opioid-related death, measured by potential years of life lost. Our secondary measure was the proportion of all deaths attributable to opioids; we used the Cochrane–Armitage test for trend to compare proportions. Results: Between 2019 and 2021, the annual number of opioid-related deaths increased from 3007 to 6222 and years of life lost increased from 126 115 to 256 336 (from 3.5 to 7.0 yr of life lost per 1000 population). In 2021, the highest number of years of life lost was among males (181 525 yr) and people aged 30–39 years (87 045 yr). In 2019, we found that 1.7% of all deaths among those younger than 85 years were related to opioids, rising to 3.2% in 2021. Significant increases in the proportion of deaths related to opioids were observed across all age groups (p < 0.001), representing 29.3% and 29.0% of deaths among people aged 20–29 and 30–39 years in 2021, respectively. Interpretation: Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults. The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts. [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]

Despite the ubiquity of the concept of the complete community or neighborhood in Canadian planning practice and the recent spread of the idea in the United States, few scholars have examined the idea's development and implications. Based on a content and thematic analysis of 102 plans and policies representing all Canadian provinces and territories, along with 205 planner interviews, I argue that the complete community represents an integrative, scalable, and flexible planning theory originating from practice. Borrowing principles from other theories (such as smart growth and sustainable development), practitioners built the complete community idea bottom-up, as a persuasive rhetorical vehicle for describing planning intentions and justifying higher densities in positive ways. Contemporary planning values increasing urban densities, mix, and walkability. Here I illustrate how planners adapted to community resistance to ideas generated by external experts—and to efforts to increase growth and densities—by articulating a socially and politically positive option for urban transformation. The complete community concept places a halo over density, promising vibrancy and livability. [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]

The development and implementation of extended producer responsibility (EPR) policies to manage e‐waste provide multilevel governance frameworks for achieving greater material circularity. However, the roles and responsibilities that are allocated to various stakeholders under these policies, which are crucial for program effectiveness, often vary across jurisdictions, and consensus is lacking about the best types of relationships and collaboration that should govern municipalities' contributions to EPR programs. Against this backdrop, and since this issue is poorly researched, we conducted an empirical investigation to identify the main drivers and barriers influencing municipalities' collaboration with an e‐waste EPR program in a Canadian province where municipalities are free to decide whether or not to engage with the program. Based on our study, we explore policy implications for similar programs in other jurisdictions, and propose questions for further research. Our findings identify key motivations for collaboration, including perceived program legitimacy, program funding, and logistical efficiencies. Conversely, a lack of program transparency, failure to support local employment, a focus on recycling instead of reuse, and limited program scope are identified as disincentives to program participation. Policymaking for e‐waste management and circularity need to consider municipalities' interests and contributions to ensure successful implementation. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and "as the crow flies" distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands. [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]

Background:Child and youth mental health problems represent a substantial burden of illness in Canada, with appropriate services only inconsistently available. Charitable organizations, such as Kids Help Phone (KHP), are, therefore, crucial to filling system gaps by offering 24/7 phone, chat, texting, and peer-to-peer services. Methods:We describe the services provided by KHP, the volume of use for each service, and compare usage across Canada's provinces and territories for a 5-year period from January 2018 to December 2022. Trends seen during the COVID-19 pandemic are highlighted. Results:More than 1.5 million total number of conversations were held across texting, chat, and phone services over 5 years. Considerable growth is demonstrated between 2018 and 2022, and many of the highest peaks in volume occurred in March or April of 2020, the onset of the COVID-19 pandemic. The highest proportional volumes were consistently from the northern territories. Discussion:KHP cannot provide specialized or repeat services, nor can it alone meet the scale of unmet youth mental health needs across the country. Nonetheless, KHP plays a pivotal role in the Canadian mental health system. Efforts to understand the role that KHP and other e-mental health services like it play within the national mental health landscape should be intensified to aid in understanding unmet needs, identify system gaps, and make needed enhancements. [ABSTRACT FROM AUTHOR]

Background: The incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations. Methods: A national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center‐level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web‐based database that tracks postoperative outcomes was presented. The top two performing centers with regards to these metrics were chosen and surgeons from these hospitals discussed elements of their treatment pathways that contributed to these outcomes. Consensus recommendations were then identified with participants independently rating their level of agreement. Results: Twenty‐eight surgeons form 8 centers took part in the seminar across 5 Canadian provinces. Of the 680 included patients included, Clavien‐Dindo grade I and II/III/IV/V complications occurred in 121/39/12/2 patients (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied significantly between institutions (1 day, range 1‐3 vs. 7 days, 3‐8, p < 0.001). A strong level of agreement was achieved for 10/12 of the consensus statements generated. Conclusion: PD seminars provide a supportive forum for centers to review best evidence and experience and generate recommendations based on expert opinion. Further research is ongoing to determine if this approach effectively accomplishes this objective. [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]

This article presents the findings of a population-based study conducted in Ontario and British Columbia, Canada, on pediatric-onset multiple sclerosis (PoMS). The study found that the incidence rate of PoMS remained stable between 2003 and 2019, while the prevalence increased over time. The study highlights the need for appropriate resource allocation to support the growing PoMS population. The document provides information on the selection of cases, demographic characteristics, and compares the incidence and prevalence rates in Canada to other regions. It also discusses long-term outcomes and prognostic indicators of pediatric MS. [Extracted from the article]

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In the era of (re)legalisation of medicinal and recreational cannabis, accidental and intentional exposure to edibles, cannabis-infused food products, has increased substantially. However, there is particular concern regarding younger age groups. Most concerning is the increase in hospitalisations. According to a study by Myran et al. (1), provinces in Canada, where the sale of edibles is permitted, saw an increase in paediatric poisonings due to unintentional consumption of edibles. Similar trends have been observed in "legalised states" in the US, such as Colorado (2). The impact of using cannabis at an early age, but particularly the impact of accidental exposure to high THC quantities, may have negative mental or physical health outcomes. Whilst regulatory restrictions vary significantly from one legalised region to another, it is difficult to identify a best practice. The aim of this study is to identify and discuss new and existing risk mitigation strategies to give guidance to policymakers. Furthermore, practical aspects, such as compliance (e.g. audits by authorities), are discussed. It is noted that edibles have been around much longer than recent political attempts to regulate them. [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]

Purpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes. Patients and Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD < 16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes. Results: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥ 1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥ 1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis. Conclusion: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care. Plain Language Summary: Inflammatory bowel disease (IBD) is a chronic health condition of the gastrointestinal system, which is becoming more common in children. They require lifelong treatment and receiving high quality care is important for preventing complications. We determined if outcomes of children with IBD was different across Canada. We also tested if differences in care at diagnosis was related to outcomes. More than three-quarters of children with IBD were treated at pediatric hospitals. Children treated at some hospitals were more likely to be hospitalized and visit the emergency room when compared to children treated at other hospitals. Children with Crohn's disease (one type of IBD) were more likely to have surgery at some hospitals when compared to children treated at other hospitals. We should improve care to make sure children living with IBD have timely access to high quality specialist care. [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]

Background: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies. This protocol outlines a comprehensive research study aimed at evaluating an implementation approach for the uptake of the Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders across Canada. Eating disorders (EDs) have a significant impact on mental and physical health, necessitating evidence-based and timely interventions. To address gaps in service, we propose to use focus groups to identify barriers, facilitators, and implementation strategies for guideline uptake. We will engage stakeholders, including clinicians, administrators, and individuals with lived experience, to co-create tailored educational materials which will then be disseminated. The impact of the implementation approach will be evaluated through pre- and post-implementation surveys. This study aims to enhance the availability and utilization of evidence-based treatments for children and adolescents with EDs, ensuring equitable and improved care nationwide. [ABSTRACT FROM AUTHOR]

With limited phosphorus (P) supplies, increasing P demand, and issues with P runoff and pollution, developing an ability to reuse the large amounts of residual P stored in agricultural soils is increasingly important. In this study, we investigated the potential for residual soil P to maintain crop yields while reducing P applications and losses in Canada. Using a P cycling model coupled with a soil P dynamics model, we analyzed soil P dynamics over 110 years across Canada's provinces. We found that using soil residual P may reduce mineral P demand as large as 132 Gg P year−1 (29%) in Canada, with the highest potential for reducing P applications in the Atlantic provinces, Quebec, Ontario, and British Columbia. Using residual soil P would result in a 21% increase in Canada's cropland P use efficiency. We expected that the Atlantic provinces and Quebec would have the greatest runoff P loss reduction with use of residual soil P, with the average P loss rate decreasing from 4.24 and 1.69 kg ha−1 to 3.45 and 1.38 kg ha−1, respectively. Ontario, Manitoba, and British Columbia would experience relatively lower reductions in P loss through use of residual soil P, with the average runoff P loss rate decreasing from 0.44, 0.36, and 4.33 kg ha−1 to 0.19, 0.26, and 4.14 kg ha−1, respectively. Our study highlights the importance of considering residual soil P as a valuable resource and its potential for reducing P pollution. [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]

The Canadian boreal forest biome has been subjected to a long history of management for wood production. Here, we examined the cumulative impacts of logging on older forests in terms of area, distribution and patch configuration in the managed forest zones of the Eastern Canadian provinces of Ontario and Quebec. We also examined the consequences of these cumulative impacts on a once widely distributed and now threatened species, the woodland caribou (Rangifer tarandus caribou). The cumulative area of recently logged forest (since ~1976) was 14,024,619 ha, with 8,210,617 ha in Quebec and 5,814,002 ha in Ontario. The total area of older forests was 21,249,341 ha, with 11,840,474 ha in Quebec and 9,408,867 ha in Ontario. Patch statistics revealed that there were 1,085,822 older forests with core patches < 0.25 ha and an additional 603,052 < 1.0 ha. There were 52 > 10,00–50,000 ha and 8 < 50,000 ha. Older forest patches (critical caribou habitat) in the 21 local population ranges totalled 6,103,534 ha, distributed among ~387,102 patches with 362,933 < 10 ha and 14 > 50,000 ha. The median percentage of local population ranges that was disturbed was 53.5%, with Charlevoix having the maximum (90.3%) and Basse Côte-Nord the least (34.9%). Woodland caribou local population ranges with disturbed suitable habitats >35% are considered unable to support self-sustaining populations. We found that for the 21 caribou local population ranges examined, 3 were at very high risk (>75% area disturbed), 16 at high risk (>45 ≤ 75% area disturbed), and 2 at low risk (≤35% area disturbed). Major changes are needed in boreal forest management in Ontario and Quebec for it to be ecologically sustainable, including a greater emphasis on protection and restoration for older forests, and to lower the risks for caribou populations. [ABSTRACT FROM AUTHOR]

Introduction: Heated tobacco products (HTPs) are novel tobacco products that may appeal to youth. This study explored whether HTP retailer proximity and density to secondary schools were associated with youth use of HTPs in four Canadian provinces. Methods: An online search between November 2020 and March 2021 identified retailers selling IQOS devices and HEETS (tobacco sticks used in IQOS) within 500 m, 1000 m and 1500 m radius circular buffer zones around high schools (N = 120) participating in the COMPASS study in 2020-2021. Retailer proximity/density data were linked to crosssectional student-level data (N = 40 636 students), and multilevel regression models examined the association between HTP retailer proximity and density and current HTP use, controlling for relevant covariates. Results: While only 10.0% of schools had at least one retailer selling IQOS devices within 1000 m of the school, 65.0% of schools had at least one retailer selling HEETS. The school a student attended accounted for 23.7% of the variability in the likelihood of currently using an HTP. However, HTP retailer proximity to and density around schools were not significantly associated with the likelihood of students currently using HTPs. Conclusion: While the school a student attended accounted for a significant amount of variability in HTP use, these findings suggest that students may be obtaining HTPs through other, non-retail sources. Continued monitoring is warranted as HTP use among youth may change. [ABSTRACT FROM AUTHOR]

The study of Shakespeare in secondary school literature classes remains a global phenomenon across L2 contexts. Understanding said spaces is important, as the study of Shakespeare is known to expand learner knowledge of normative conventions of academic literacy – this, in service of building the cultural and linguistic capital necessary for learners to succeed on their own terms. However, little is known about how best to research this context so as to assist language learners with their academic literacy needs. To address this gap, this study employs thought modeling – an analytic tool informed by complex dynamic systems theory – to investigate the teaching and learning environment of seven secondary school ESL programs in the Canadian province of Ontario. Mining the educational experiences of 106 participants, this research explores five primary components of the educational landscape: conditions, timescales, interactions, artifacts, and agents. Thematic analyses and descriptive statistical analyses were performed on a dataset comprised of surveys and interviews. This study initiates a framework for continuing research into L2 secondary school Shakespeare studies by identifying and describing substantive avenues of research (i.e., control parameters) informing conditions for best practice and highlights thought modeling as an effective analytic framework for understanding educational dynamics. [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]

This paper presents a comprehensive analysis of e-waste collection and management trends across six Canadian provinces, focusing on e-waste collection rates, provincial stewardship model attributes, program strategies and budget allocations from 2013 to 2020. Temporal and regression analyses were conducted using data from Electronic Product Recycling Association reports. A group characterization based on geographical proximity is proposed, aiming to explore the potential outcomes of fostering collaboration among neighboring provinces. The analysis emphasizes the significant impact of stewardship model attributes on e-waste collection rates, with Quebec emerging as a standout case, showcasing a remarkable 61.5% surge in collection rates. Findings from group analysis reveal a positive correlation between per capita e-waste collection rate and the growth of businesses and collection sites in Western Canada (Group A - British Columbia, Saskatchewan, and Manitoba). This highlights the potential benefits of a coordinated waste management approach, emphasizing the importance of shared resources and collaborative policies. Saskatchewan and Manitoba allocated only 6.6% and 7.0% of their respective budgets to e-waste transfer and storage. British Columbia's observed steady decrease of e-waste collection rate. In Group A, stewards handled 2.18–13.95 tonnes of e-waste during the study period. The cost per tonne of e-waste tended to be lower when more e-waste is managed per steward, suggesting the potential benefits of an integrated e-waste collection and management system. [Display omitted] • Six Canadian e-waste stewardship models from 2013 to 2020 were examined. • E-waste collection rates were gradually declining in Canada jurisdictions. • Collection site density, expenditure, efficiency may have affected collection rates. • Eastern and western stewardships had different operational characteristics. • Region-specific collaborative approach may improve stewardship effectiveness. [ABSTRACT FROM AUTHOR]

In Canada, greenhouse gas (GHG) emissions continue to remain high despite the federal government's commitment to reduce GHG emissions. Environmental policy across Canadian provinces has largely lacked consistency with some provinces implementing targeted policy such as carbon taxes while others have strongly resisted the federal government's attempts to encourage such policy. This study examines the impact of environmental policy on GHG gas emissions across Canadian provinces with policy uniquely measured by public and business sector spending on environmental protection as well as notable province-specific policies. An extended STIRPAT model is specified with the inclusion of proxies for environmental policy using panel data from Canada's ten provinces from 1995 to 2019. The cointegration and the error correction modelling approaches are employed to estimate the non-stationary panel data. A pooled mean group estimation is applied to provide short run and long run coefficients. The findings indicate that although per capita GDP is the main driver of GHG emissions in Canada, environmental policy has a significant mitigating effect, as shown by the negative association between emissions and private and public sector spending on environmental protection in the long run. Furthermore, provinces with targeted policies, such as Ontario's coal phase-out and British Columbia's carbon tax, experienced significant emissions reductions. The theoretical implication is the successful addition of policy variables to the STIRPAT model, providing the model a new application for future research. [Display omitted] • Assess the impact of environmental protection policies on per capita greenhouse gas emissions in Canada. • Utilize public and private expenditures on environmental protection, along with provincial policies. • Extend the STIRPAT model to incorporate environmental protection policies in an empirical model. • Demonstrate a significant negative relationship between environmental protection policies and GHG emissions. • Offer insights with implications for global environmental sustainability efforts. [ABSTRACT FROM AUTHOR]

• We report on a family with Carney complex harboring left atrial myxomas. • Carney complex includes skin lesions, cardiac myxoma, and endocrine disorders. • Approximately 1% of patients with cardiac myxoma have Carney complex with autosomal dominant inheritance. • In Carney complex, cardiac myxomas do not necessarily occur at fossa ovalis. • Early recognition is essential for patients with cardiac involvement. Carney syndrome is an autosomal dominant complex involving endocrinopathy, mucocutaneous hyperpigmentation, and different tumors, including cardiac myxomas. We report on a single family with several members affected with Carney syndrome. Family and individual medical histories were investigated in several Canadian provinces. The histology slides were also reviewed. Four family members (two young women, both sisters, their mother, and maternal grandmother) were found to harbor Carney syndrome. Everyone was presented with multiple and recurrent atrial myxomas of the heart, requiring multiple open cardiac surgeries. Breast myxomas and cutaneous hyperpigmentation were also revealed in one of the sisters and their mother. Interestingly, genetic testing was positive for the female family members and negative for the father and brother. We cannot rule out that the brother may have had a new mutation or harboring a mosaic. The young woman's brother did not have cardiac myxoma but developed a unilateral Sertoli cell tumor of testis. Carney syndrome is a rare complex multisystemic genetic disorder, including multiple and recurrent cardiac myxomas. We strongly suggest that reporting familial Carney syndrome is still critical in the 21st century to augment the awareness of this situation among clinicians and pathologists. [ABSTRACT FROM AUTHOR]

The present study empirically investigates whether targeted government spending and environmental policies promote green growth, as measured by greenhouse gas productivity. Government spending for pollution abatement (GEPA) represents non-market environmental policies encompassing both enforcement regulations and stakeholder incentives, while policy dummy represents province specific targeted environmental policies. Using panel data from 1995 to 2020 across ten provinces of Canada, an empirical model based on STIRPAT has been developed and estimated, addressing various econometric issues to ensure the robustness and consistency of the results. The findings confirm that both GEPA and targeted environmental policies are crucial determinants in achieving green growth. Additionally, variables such as business sector expenditures for R&D, the share of renewable energy, per capita GDP, and population also contribute to green growth. These results highlight the importance of the stick-and-carrot approach as a key strategy and policy tool for sustainable development. The implications of these findings extend beyond Canada and hold valuable lessons for emerging and developing countries that predominantly rely on command-and-control regulations without adequate support. To effectively address the challenge of achieving green growth, a coordinated approach that combines targeted government spending and environmental policies, supported by innovation and renewable energy exploration, is essential. Overall, this study's findings have significant implications for environmental sustainability on a global scale. [Display omitted] • Examines the effect of targeted government spending and environmental policies on green growth in Canada. • Uses greenhouse gas productivity as an index of green growth. • Estimates the empirical model developed addressing advanced econometric issues related to panel data for 1995–2020. • Controls renewable energy, innovation, per capita income, population. • Have significant implications for environmental sustainability on a global scale. [ABSTRACT FROM AUTHOR]