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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]

Streptococcus pneumoniae serotype 19A is a highly diverse, often antimicrobial-resistant Gram-positive bacterium which can cause invasive pneumococcal disease (IPD). In 2021, public health authorities in the Canadian province of Québec observed an increase of serotype 19A IPD in children <5 years. The purpose of this study was to determine the clonal composition of serotype 19A isolates collected from this age group in Québec, from 2016 to 2021. Forty-one and 37 IPD isolates from children <5 years from Québec and the remainder of Canada, respectively, were sequenced using the Illumina NextSeq platform. Phylogenetic analysis using SNVPhyl identified three clusters, corresponding to three common clones of serotype 19A: CC199, CC320 and ST695. CC199, predominantly represented by ST416, accounted for similar proportions of serotype 19A isolates collected from children in Québec (19.5 %) and other Canadian jurisdictions (OCJs, 21.6 %), with significant presence of ermB (62.5 % and 60 % of ST416 isolates, respectively). CC320 was more commonly identified from OCJs in comparison to Québec (18.9 % vs. 7.3 %, respectively), but were highly antimicrobial-resistant regardless of region. ST695 was the most common clone of serotype 19A collected in Québec from children <5 years, representing 65.9 % of isolates collected over the study period (40.5 % of isolates collected in OCJs). Phylogenetic analysis identified geographical differences in ST695 across Canada; including a large clade specific to Québec (with both susceptible and macrolide-resistant [ ermB ] subclades), and a separate macrolide-resistant (mefA) clade associated with OCJs. The Québec-specific ermB -ST695 clone represented 48.1 % of ST695 collected from the province. Continued genomic surveillance of S. pneumoniae serotype 19A is required to: i) track the prevalence and clonal composition of serotype 19A in Québec in future years; ii) characterize the clonal distribution of serotype 19A in adult populations; and iii) monitor whether the currently geographically restricted ermB -ST695 clone observed in Québec expands to OCJs. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure. • NACI made many strategic adaptations to facilitate timely vaccine advice in Canada. • The pandemic highlighted critical roles for NITAGs in vaccine program design. • Learning from COVID-19 pandemic adaptations, we see a roadmap for future pandemics. The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure and frameworks, and added urgency and complexity to the operation of National Immunization Technical Advisory Groups (NITAGs). Canada's National Advisory Committee on Immunization (NACI) provides immunization guidance to the Public Health Agency of Canada (PHAC) who publicly shares expert and evidence-informed guidance with Canadian provinces and territories. Throughout the pandemic, NACI and PHAC implemented many adaptations to meet urgent needs for pandemic vaccine guidance. In this paper, we describe: structural adaptations in response to the accelerated pace and amount of work required to issue recommendations that were timed around product authorizations and dynamic epidemiology; technical adaptations in response to rapidly evolving evidence of variable quality which required close monitoring, and which promoted reliance on basic vaccine principles due to incomplete direct evidence; the need to provide nimble advice (e.g., off-label recommendations, preferential recommendations); communications adaptations (e.g. identify sustainable spokespeople for the committee, receive stakeholder feedback, and ensure urgent nuanced advice was communicated to a diverse audience); and research adaptations focussing on solutions to constrained supply (e.g. prioritisation, extended intervals, and heterologous schedules). The early pandemic vaccine experience has created a roadmap of lessons and adaptations that should be leveraged in future pandemic vaccine programs, and has highlighted the essential role of NITAGs to complement regulatory structures during pandemics to ensure timely, impactful, and evidence-informed public health vaccine guidance. [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]

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]

The enactment of COVID-19 policies in Canada falls under provincial jurisdiction. This study exploits time-series variation across four Canadian provinces to evaluate the effects of stricter COVID-19 policies on daily case counts. Employing data from this time-period allows an evaluation of the efficacy of policies independent of vaccine impacts. While both OLS and IV results offer evidence that more stringent Non-Pharmaceutical Interventions (NPIs) can reduce daily case counts within a short time-period, IV estimates are larger in magnitude. Hence, studies that fail to control for simultaneity bias might produce confounded estimates of the efficacy of NPIs. However, IV estimates should be treated as correlations given the possibility of other unobserved determinants of COVID-19 spread and mismeasurement of daily cases. With respect to specific policies, mandatory mask usage in indoor spaces and restrictions on business operations are significantly associated with lower daily cases. We also test the efficacy of different forecasting models. Our results suggest that Gradient Boosted Regression Trees (GBRT) and Seasonal Autoregressive-Integrated Moving Average (SARIMA) models produce more accurate short-run forecasts relative to Vector Auto Regressive (VAR), and Susceptible–Infected–Removed (SIR) epidemiology models. Forecasts from SIR models are also inferior to results from basic OLS regressions. However, predictions from models that are unable to correct for endogeneity bias should be treated with caution. [ABSTRACT FROM AUTHOR]

In 2021, the ten provinces in Canada enacted COVID-19 vaccine mandates that restricted access to non-essential businesses and services to those that could provide proof of full vaccination to decrease the risk of transmission and provide an incentive for vaccination. This analysis aims to examine the effects of vaccine mandate announcements on vaccine uptake over time by age group and province. Aggregated data from the Canadian COVID-19 Vaccination Coverage Surveillance System (CCVCSS) were used to measure vaccine uptake (defined as the weekly proportion of individuals who received at least one dose) among those 12 years and older following the announcement of vaccination requirements. We performed an interrupted time series analysis using a quasi-binomial autoregressive model adjusted for the weekly number of new COVID-19 cases, hospitalizations, and deaths to model the effect of mandate announcements on vaccine uptake. Additionally, counterfactuals were produced for each province and age group to estimate vaccine uptake without mandate implementation. The times series models demonstrated significant increases in vaccine uptake following mandate announcement in BC, AB, SK, MB, NS, and NL. No trends in the effect of mandate announcements were observed by age group. In AB and SK, counterfactual analysis showed that announcement were followed by 8 % and 7 % (310,890 and 71,711 people, respectively) increases in vaccination coverage over the following 10 weeks. In MB, NS, and NL, there was at least a 5 % (63,936, 44,054, and 29,814 people, respectively) increase in coverage. Lastly, BC announcements were followed by a 4 % (203,300 people) increase in coverage. Vaccine mandate announcements could have increased vaccine uptake. However, it is difficult to interpret this effect within the larger epidemiological context. Effectiveness of the mandates can be affected by pre-existing levels of uptake, hesitancy, timing of announcements and local COVID-19 activity. [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]

Calf rearing practices differ among farms, including feeding and weaning methods. These differences may relate to how dairy producers view these practices and evaluate their own success. The aim of this study was to investigate perspectives of dairy producers on calf rearing, focusing on calf weaning and how they characterized weaning success. We interviewed dairy producers from 16 farms in Western Canada in the following provinces: British Columbia (n = 12), Manitoba (n = 2), and Alberta (n = 2). Participants were asked to describe their heifer calf weaning and rearing practices, and what they viewed as successes and challenges in weaning and rearing calves. Interviews were recorded, transcribed, and subjected to qualitative analysis from which we identified the following 4 major themes: (1) reliance on calf-based measures (e.g., health, growth, and behavior), (2) management factors and personal experiences (e.g., ease, consistency, and habit), (3) environmental factors (e.g., facilities and equipment), and (4) external support (e.g., advice and educational opportunities). These results provided insight into how dairy producers view calf weaning and rearing, and may help inform the design of future research and knowledge transfer projects aimed at improving management practices on dairy farms. [ABSTRACT FROM AUTHOR]

• All-cancer radiotherapy utilization ratios (RTUR) varied across Canada by 9%, and up to 28% by cancer type. • RTURs were below Ontario benchmarks for many provinces and cancer subsites. • RTURs can be a reasonable surrogate for linked (patient-specific) utilization. Access to radiotherapy (RT) is a key component of a cancer control strategy. However, radiotherapy utilization (RTU) rates fall short of desired benchmarks in certain Canadian provinces. We aimed to describe provincial variations in RTU across Canada. We calculated radiotherapy utilization ratios (RTUR) for each Canadian province from 2016 (RT case counts divided by incidence counts), by cancer type (all cancers, lung, breast, rectal, prostate) and treatment intent (curative, palliative) where data were available. Data were extracted from each provincial RT data repository, cancer registry and/or RT department. We compared RTURs descriptively across provinces and to Ontario benchmarks, and calculated an estimated national RTUR. In provinces with capacity for data linkage, RTURs were compared to a linked (patient-specific) method of calculating utilization, by linking each incident case to whether RT was received within 1 year of diagnosis (RTU-1 yr). Excluding three provinces that included re-treatments, all-cancer RTURs ranged from 0.31 in Manitoba to 0.40 in Nova Scotia. The national all-cancer RTUR was 0.35, which was comparable to Ontario benchmarks (0.34). Larger variations were seen by cancer type, with an absolute difference in RTURs of 28% for lung cancers, 27% for breast cancers, 21% for rectal cancers, and 18% for prostate cancers. RTURs for nearly all provinces were below established Ontario benchmarks for each cancer type, except prostate cancer. RTURs over-estimated RTU-1 yr by at most 5%, except for prostate cancers where they over-estimated RTU-1 yr by up to 15%. RTU varies by province in Canada, and most notably by cancer subsite. More granular data at the regional level and by healthcare facility is required to further tailor strategies aimed at improving RT access. RTURs also serve as a reasonable surrogate for linked RTU, and both methods can contribute meaningfully to measure RTU depending on the context and data availability. [ABSTRACT FROM AUTHOR]

Because of concerns about human health, the environment, and animal welfare, meat is a highly contentious food. Accordingly, a broad range of alternative, small-scale practices for raising livestock and producing non-industrial meat are in the spotlight. While scholars have examined consumer perspectives on "ethical" meat, less is known about producers' perceptions of how small-scale meat production fits into the broader food system, and how their perceptions relate to broader sustainability debates surrounding meat. We explore producer perspectives on small-scale "ethical" meat production and its role in a sustainable food system. We do so through interviews and site visits with 74 people working within alternative meat production in four Canadian provinces, a sample that includes farmers, ranchers, butchers, and meat-focussed chefs. We find that, in the face of practical challenges linked to small-scale production, producers are passionately committed to the project of small-scale animal rearing that they regard as humane and sustainable. Despite these similarities, producers have radically different ideas about the purpose and potential of ethical meat. We observed major differences among producers' cultural imagination of meat, exemplifying varied ideas for fitting meat into a sustainable food system. Our findings underscore the importance of charting not only producers' practices, but also their cultural orientations. • We interview producers and distributors of "ethical" meat to understand their perspectives about the role of their products in the broader food system. • Producing ethical meat was seen as meaningful work, but interviewees were also acutely aware of the limits of small-scale operations. • We investigate producers' cultural imagination: how do they imagine meat can fit into a sustainable food system? • We identify three producer positions on the role of ethical meat in the food system: 1) support for the status quo, 2) a vision for "less meat, better meat", and 3) a challenge to the cultural centrality of meat. [ABSTRACT FROM AUTHOR]

• Non-zero I/(Ca + Mg) values were detected in Archean and Paleoproterozoic shallow marine carbonates. • The samples are from several locations and range in age from 2.93 to 2.31 Ga. • These non-zero values indicate the original localized presence of dissolved marine oxygen. Marine oxygenation during the Archean and Paleoproterozoic is poorly constrained. Iodine in carbonate is a possible oxygen indicator. We obtained molar ratios of iodine to calcium-magnesium [I/(Ca + Mg)] for 2.93–2.31 Ga from shallow marine Ca-carbonate (limestone, dolostone) platform sediments at several locations in the southern Superior Province in Canada and the USA. Maximum I/(Ca + Mg) ratios obtained are 0.13, 0.26, 0.05 and 0.22 μmol/mol, for 2.93, 2.86, 2.80 and 2.31 Ga samples, respectively. These non-zero carbonate I/(Ca + Mg) ratios indicate localized oxygen in Archean and Paleoproterozoic shallow marine environments. These data support an early origin for biological oxygen-production and, specifically, the idea that mid-late Archean oxygenation was sufficient to facilitate Ca-carbonate precipitation in shallow marine 'oxygen oases' adjacent to anoxic iron-rich seas [ABSTRACT FROM AUTHOR]

Deploying negative emission technologies has become crucial for limiting the global temperature rise to approximately 1.5 °C above preindustrial levels. DAC technologies are being explored as one of the prospective options. These technologies have been thoroughly investigated as a potential project to capture CO 2 emissions and provide purified air, natural gas, or fuel oil. An applied approach, on the other hand, was not taken into consideration while evaluating the influence that this technology has on emissions. For this reason, British Columbia provides a substantial chance to examine emissions that were produced after the DAC actions were put into place in 2015. In this study, the difference-in-differences methodology is employed for the very first time to compare the emissions that are produced by the transport sectors in British Columbia with those emitted by other provinces in Canada. The role that GDP and population play in the release of emissions is also taken into consideration in this paper. Based on the research results, it can be observed that the implementation of DAC initiatives has yielded notable effects. Evidence shows that the DAC effort has led to an average reduction of 0.08 in logarithmic CO 2 emissions in the transport sector. By accounting for GDP and population, the empirical results indicate that DAC technology reduced CO 2 emissions in British Columbia compared to provinces without DAC facilities. DAC initiatives are expected to become increasingly prevalent between the mid-2030s and 2040s. Overall policy implications suggest that there is a need for DAC technologies to collaborate with alternative mitigation technologies, or alternative technologies should collaborate with DAC technologies that are more efficient to achieve the targeted goals in a short time. • The study offers empirical evidence of DAC technology's impact, providing insights beyond theoretical conjectures. • Based on the research results, it can be seen that the implementation of DAC facilities has yielded notable effects. • DAC technology in British Columbia has led to a significant and negative impact on CO 2 emissions compared to other provinces without DAC facilities. • The study highlights the differential effectiveness of DAC across transport sectors, pointing toward a need for tailored implementation strategies. [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]

Through survey and focus groups in two provinces in Canada misunderstanding and confusion surrounding Low-Dose Ionizing Radiation (LDIR) is explored specifically surrounding medical procedures, risk, and benefits. Generally people associated the word radiation with harm, but when asked participants were not concerned about LDIR. Approximately equal numbers (40%) thought LDIR was 'difficult' as those that thought it was 'easy' but research results reveal confusion about the definition of and sources of LDIR. Most people believed the benefits of LDIR outweighed the risks. Further, many had inaccurate views of 'high' dose radiation. Scientists and the Canadian regulator were determined to be the most trusted sources of information while elected officials and industry representatives the least trusted. Participants wanted more information on whether LDIR was a problem in Canada, what the risks were associated with it, as well as the applicable protections, rules and regulations. Focus group participants expressed a preference for face-to-face exchange of information, but mass media remains an important source of information as the first-place people check for answers. Future research surrounding behavioural science and LDIR communications, and deep LDIR science communication will be important in addressing this issue. • People do not have high levels of knowledge of low dose ionizing radiation (LDIR). • Most people respond well to the term LDIR and believe benefits outweigh negatives. • Scientists are most trusted communicators followed by the regulator. • Some participants wanted more information surrounding radiation. [ABSTRACT FROM AUTHOR]

Extreme events, including tsunamis, storm surges and hurricanes, affect the western North Atlantic coast, threatening communities and impacting ecosystems. Although these extreme coastal events (ECEs) are currently thoroughly monitored in the area, older ECEs are known only from short historical evidence. Therefore, establishing a reliable ECE history that extends more than several decades into the past requires data from geological records. This study aims to refine the existing record of ECEs on the southern Burin Peninsula (Newfoundland, Canada) that extends back to the mid-18th century by providing the first lake-sediment-based reconstruction of the event history of the Canadian province of Newfoundland and Labrador. We investigated short sediment cores collected from four shallow coastal lakes. The identification of ECEs relied mainly on lithostratigraphic evidence and peak detection of sand grain counts. Diatoms, dry bulk density, and loss-on-ignition were also analyzed. The age-depth models of the cores were based on 210Pb and 137Cs dating. The correlation of our records with major historical events confirmed that statistically significant sand count peaks, sand layers, and redeposited peat clasts are indicative of major ECEs. We found that the type and characteristics of ECE records depended mainly on the availability of sediment, distance from the seashore, and magnitude of the event. Although some of our ECE markers are associated with marine inundations, only slight diatom community changes were observed, contrary to what is commonly expected from the disturbance of brackish and freshwater ecosystems by major saltwater intrusions. Combined, our records indicate that at least eight ECEs occurred since the late 17th century, three of which might correlate with historically documented events, namely the 1755 CE Lisbon tsunami, the 1775 CE Great Independence Hurricane, and the 1929 CE Newfoundland tsunami. Although further investigations are required to better constrain the type and magnitude of particular ECEs, our study confirms the suitability of geological archives for improving hazard assessment in coastal regions. • We show the northernmost reconstruction of extreme coastal events for Eastern Canada. • The lake sediment records, spanning up to 350 yrs, evidenced 8 extreme coastal events. • Our sediment markers correlate well with three known historical events. • The 1929 CE Grand Banks tsunami was likely the most catastrophic event in the area. • First sedimentary evidence of the 1755 CE tsunami impacts in NW Atlantic. [ABSTRACT FROM AUTHOR]

The Proterozoic evolution of Laurentia involved intermittent orogens and arc-related crustal growth along a modern-style convergent margin, termed the Great Proterozoic Accretionary Orogen (GPAO). The major lithotectonic provinces of the GPAO in the United States are exposed as telescoped equivalents within the thrust stack of the Grenville Province in Canada. We report zircon U Pb and Lu Hf isotope analyses for two orthogneisses and one quartzite from Archean and Paleoproterozoic domains in the gneiss belt of the SW Grenville Province, Canada. The data constrains Paleoproterozoic crustal growth and sedimentation for this part of the Laurentian margin. The orthogneisses have similar zircon U Pb and Lu Hf isotope systematics that reflect igneous reworking (ca. 1700–1660 Ma) of a Penokean aged (ca. 1.9 Ga) depleted mantle derived source, along with metamorphic reactivation at both ca. 1.45 Ga and during the Grenville Orogeny (1.2–1.0 Ga). The quartzite has a bimodal Paleoproterozoic (2.1–1.8 Ga) and Archean (> 2.5 Ga) detrital zircon age spectrum. The Paleoproterozoic detrital zircon grains have a wide range of Hf(t) compositions (εHf(t) = −12.5 to 10) reflecting co-eval interaction of Archean and depleted Paleoproterozoic sources, contrasted by a more restricted range for the Archean population (εHf(t) = −7 to 4). The new data support the presence of reworked ca. 1.9 Ga depleted mantle sources in the Paleoproterozoic Parautochthon, which extend further east than previously thought. They also identify correlations amongst detrital zircon age spectra and Hf isotope compositions in quartzites from different locations of the Archean Parautochthon. • Juvenile Penokean sources (∼1.9 Ga) extend into the SW Grenville Province. • Penokean (∼1.9 Ga) crust-mantle mixing recorded by detrital zircon Lu Hf isotopes. • Erosion and redeposition of sedimentary sinks can mask orogen detrital systematics. [ABSTRACT FROM AUTHOR]

New whole-rock Sr-Nd-Pb-O isotope data are combined with previously published results for Sr and Nd isotopes and major and trace element chemistry to examine the petrogenetic and tectonic environments of a suite of ca. 980 Ma potassic to ultrapotassic dykes (PUD) from the Canyon domain, central Grenville Province in Canada. The PUD suite can be divided into two geochemically distinct groups that exhibit characteristic source mineralogy, depth of partial melting, and multi-stage metasomatism of heterogeneous mantle sources. Major and trace element data suggest involvement of both fertile and depleted sources involving spinel and garnet peridotite, while trace element and isotope data indicate long-term LREE and LILE enrichments and HFSE depletions in ancient subduction settings. Low time-integrated Rb/Sr, Sm/Nd, and U/Pb ratios suggest enriched mantle EM-I metasomatized by ancient subduction of continental upper crust and/or carbonate sediments. A latest phase of fluid/melt metasomatism is attributed to a late-Grenvillian intracontinental subduction and limited lithospheric extension. The late-Grenvillian tectonic setting is proposed here to be characterized by shallow-angle underthrusting of the foreland beneath the Grenvillian hinterland, where SCLM, initially of Proterozoic age and eventually of Late Archean age, became transported beneath the orogenic core. The intracontinental collision was short-lived and probably terminated because of buoyancy constraints related to the refractory character of the subducted Archean lithospheric mantle. • Late Grenvillian potassic to ultrapotassic dykes from the orogenic hinterland in Canada are geochemically and isotopically characterized. • Late Archean and Proterozoic lithospheric mantle sources record ancient subduction metasomatism and late fluid metasomatism prior to dyke emplacement. • Tectonic setting characterized by shallow-angle or flat underthrusting of the foreland lithosphere beneath the hinterland. [ABSTRACT FROM AUTHOR]

• There is a relatively increased rate of A1AT genotype diagnoses in Alberta. • The relatively higher rate increases with the severity of the A1AT genotype. • There is a younger age at the time of A1AT diagnosis in Alberta males. • The differential rate of diagnosis may be explained by lifestyle differences. The diagnosis of alpha-1-antitrypsin (A1AT) deficiency has been hindered by obscurity concerning the testing process and treatment implications. In this study, we aimed to identify regional differences in the diagnostic rates for A1AT deficiency in the western Canadian provinces of British Columbia (BC) and Alberta (AB). The number of A1AT deficiency variant genotype (ZZ, SZ, MZ, SS, and MS) diagnoses were reviewed for BC and AB. The regional diagnostic rates for A1AT deficiency variants in these two provinces, normalized for the predicted population prevalence of each variant genotype, was defined as the annual provincial diagnostic rate (APDR) for a given variant genotype. Sex specific variations in the mean age at diagnosis for the five variant genotypes were compared both within and between provinces. The SZ and MZ genotype APDRs were significantly increased in the AB population compared to the BC population. The SS and MS APDRs were similar between AB and BC. There was a significantly decreased mean age of diagnosis for AB males, as compared to BC males (for the SZ, MS, and MZ genotypes) and as compared to AB females (for the MS, MZ, and SS genotypes). There were no significant differences in the mean age of diagnosis between the females and males in BC, or between females in AB and BC, for any genotype. The notably higher APDR for more severe A1AT deficiency genotypes, and lower mean age of diagnosis for most variant genotypes in AB males, deserves further investigation to determine the explanation(s) for these differences. [ABSTRACT FROM AUTHOR]

Background: Frailty is a geriatric syndrome that leaves people vulnerable to adverse outcomes. In cardiac surgery, minimal data describe associations between frailty and patient-centred outcomes. Our objective was to estimate the association between frailty and days alive at home after cardiac surgery.Methods: We conducted a population-based cohort study using linked health administrative data in the Canadian province of Ontario. All individuals >65 yr at the time of cardiac surgery were assigned a frailty score using a validated frailty index. Days alive and at home in the 30 and 365 days after surgery were calculated. The unadjusted and adjusted associations between frailty and days alive at home were calculated.Results: We identified 61 389 patients from 2009 to 2015. Frailty was associated with reduced days at home within 30 days (adjusted ratio of means for every 10% increase in frailty=0.79; 95% confidence interval [CI], 0.78-0.81; P<0.0001) and 365 days (adjusted ratio of means for every 10% increase in frailty=0.92; 95% CI, 0.91-0.93; P<0.0001) of surgery. Results were consistent in sensitivity analyses (5.0 fewer days alive at home [95% CI, 4.8-5.2] within 30 days and 9.0 fewer days alive at home [95% CI, 8.7-9.2] within 365 days after surgery).Conclusion: Frailty is associated with a reduction in days alive at home after major cardiac surgery. This information should be considered in prognostic discussions before surgery and in care planning for vulnerable older patient groups. Days alive at home may be a useful outcome for routine measurement in quality, reporting, and studies using routinely collected data. [ABSTRACT FROM AUTHOR]

Pertussis remains poorly controlled relative to other diseases targeted by childhood vaccination programs. We combined estimates from four population-based studies of pertussis vaccine effectiveness (VE) in three Canadian provinces using a meta -analytic approach to improve precision and explore regional variation in VE and durability of protection. Studies were conducted in Alberta, Manitoba, and Ontario over periods ranging from 1996 to 2015. Adjusted log odds ratios (OR; VE = 100*[1-OR]) of the effect of vaccination on pertussis risk were estimated by time since last vaccination in each study and pooled using DerSimonian and Laird random-effects models. We used the I2 statistic to estimate between-study heterogeneity and assessed methodological and clinical heterogeneity through subgroup analyses of study design and age. Data on 3,270 pertussis cases and 23,863 controls were available. Pertussis VE declined from 86% (95% CI 79%-90%, I2 = 81.5%) at < 1 year since last vaccination to 51% (11%-74%, I2 = 80.9%) by ≥ 8 years. Effect estimates were the most heterogeneous in the least and most elapsed time periods since last vaccine dose. This was attributable mostly to variation between provinces in the distribution of age groups and number of vaccine doses received within time periods, as well as study design and small numbers in the most elapsed time period. Interpretation : Consistent trends of decreasing pertussis VE with increasing time since last vaccination across three Canadian provinces indicate the need for immunization schedules and vaccine development to optimize protection for all individuals, especially for adolescents and young adults at greatest risk of infection. [ABSTRACT FROM AUTHOR]

• Comparison of vaccine uptake in 2 and 7 year-old children with and without epilepsy. • Vaccine coverage is similar between children with and without epilepsy. • Children diagnosed early have slightly lower vaccine coverage at age 2 years. Children with epilepsy are at increased risk of complications from vaccine-preventable infections, yet information on vaccine coverage in these children is scarce. We aimed to compare vaccine coverage among children with epilepsy to children without epilepsy. We conducted a retrospective cohort study including all 2005–2013 births in Manitoba and Ontario, Canada, creating two cohorts: 2-year-olds and 7-year-olds (followed to age 2 and 7 years). We split each cohort into epilepsy and non-epilepsy subcohorts. We assessed vaccination coverage based on provincial schedules and determined timeliness of MMR (measles, mumps, rubella) dose 1 (recommended at 12 months) and DTaP (diphtheria, tetanus, pertussis) dose 4 (recommended at 18 months). We used logistic regression to calculate adjusted odds ratios (aORs) of the association between epilepsy and vaccination, combining both provincial estimates using random effects meta -analysis. We included 16,558 2-year-olds (Manitoba, 653; Ontario, 15,905) and 13,004 7-year-olds (Manitoba, 483; Ontario, 12,521) with epilepsy. At age 2 years, the aOR for up-to-date vaccination among children with versus without epilepsy was 0.9 (95% confidence interval 0.8–1.1); at age 7 years it was 1.0 (0.9–1.1). Infants diagnosed with epilepsy before age 6 months were less likely to be up-to-date at age 2 years (0.9; 0.8–0.9), although this difference disappeared by age 7 years. Vaccine timeliness was similar between children with and without epilepsy for MMR dose 1 and DTaP dose 4. Overall, this study suggests that children with epilepsy are not significantly under-vaccinated compared to their peers without epilepsy. As children with epilepsy are at a higher risk of complications from vaccine-preventable diseases, vaccination in children with epilepsy should be optimized, especially early in life, as these children may not be able to rely on herd protection. [ABSTRACT FROM AUTHOR]

Feeding high-quality colostrum is essential for calf health and future productivity. Therefore, accurate assessment of colostrum quality is a key component of dairy farm management plans. Direct and indirect methods are available for assessment of colostrum quality; however, the indirect methods are rapid, inexpensive, and can be performed under field settings. A hierarchical latent class model fit within a Bayesian framework was used to estimate the sensitivity (Se) and specificity (Sp) of the radial immunodiffusion (RID) assay, transmission infrared (TIR) spectroscopy, and digital Brix refractometer for the assessment of low-quality bovine colostrum in Atlantic Canada dairy herds. The secondary objective of the study was to describe the distribution of herd prevalence of low-quality colostrum. Colostrum quality of 591 samples from 42 commercial Holstein dairy herds in 4 Atlantic Canada provinces was assessed using RID, TIR spectroscopy, and digital Brix refractometer. The accuracy of all tests at different Brix value thresholds was estimated using Bayesian latent class models to obtain posterior estimates [medians and 95% Bayesian credibility intervals (95% BCI)] for each parameter. Using a threshold of <23% for digital Brix refractometer and <50 g/L for RID and TIR spectroscopy, median (95% BCI) Se estimates were 73.2 (68.4–77.7), 86.2 (80.6–91.0), and 91.9% (89.0–94.2), respectively. Median (95% BCI) Sp estimates were 85.2% (81.0–88.9) for digital Brix refractometer, 99.4% (97.0–100) for RID, and 90.7% (87.8–93.2) for TIR spectroscopy. Median (95% BCI) within-herd low-quality colostrum prevalence was estimated at 32.5% (27.9–37.4). In conclusion, using digital Brix refractometer at a Brix threshold of <23% could reduce feeding of low-quality colostrum to calves and improve colostrum and calf management practices in Atlantic Canada dairy herds. The TIR spectroscopy showed high Se in detection of low-quality colostrum. However, the RID assay, which is used as the reference test in several studies, showed limited Se for detection of low-quality colostrum. [ABSTRACT FROM AUTHOR]

Brachytherapy (BT) target dose and coverage are critical to the cure of locally advanced cervical cancer (CC). Advances in imaging, volumetric definitions, and BT planning aims/constraints have collectively been associated with improved tumor control outcomes over traditional practices. But some historic conventions remain in BT, such as applying uniform radiobiological parameters (RbP). Having previously generated a/b and T 1/2 from CC cell lines, we explored the potential impact of differing RbP against population-based outcomes in an era of MR-BT boost. All CC patients seen 1/2013 - 12/2015 in the Canadian province of Alberta (AB), and treated with radical (chemo)radiotherapy (external beam (EBRT) + BT), were identified. From health records, demographic, clinicopathologic, treatment and outcomes data were abstracted. Descriptive and Kaplan-Meier methods were supplemented by Cox-regression multivariable analysis (MVA), factoring in experimentally derived (exp) RbP for BT tumor doses (in addition to treated doses using conventional a/b and T 1/2 (10 Gy, 1.5 h)). 127 women (median age 50.5 y [23-82]) received curative (chemo)EBRT+BT in AB's 2 tertiary cancer centers (2:1), after exclusions (such as n=12 oligometastatic). Over half (73/125) were smokers. Squamous (SCC) predominated (76.4%) over adenocarcinoma-containing (ADC, 16.5%) or higher-risk (3.1%) histologies, with 3.9% incompletely characterized carcinoma. Primaries were mainly FIGO(2009) clinical stage IIB (37.8%, with the remainder IB 29.9%, IIA 10.2%, IIIA 2.4%, IIIB 15.0%, and IVA 3.9%); 61.4% were node(LN)-positive (pelvic and/or para-aortic (PA)) on imaging. Most (n=102) had weekly cisplatin (median 5 cycles [1-6]) with usual pelvic±PA EBRT (45-50.8 Gy EQD2 in 25-28 fx) and image-based intracavitary BT (67.7% PDR 1-2 fx, vs HDR 1-3 fx; 96.9% MRI; 15% hybrid interstitial). N=12 had initial hemostatic 1-2 fx (5-7.2 Gy); EBRT boost was sequential (3.6-21 Gy in 1.8-4 Gy/fx, to LN/parametria/pelvis) in n=26, simultaneous integrated in n=2. Median overall treatment time (OTT) was 48 days [38-112]. 9 of 127 had no chemotherapy. At BT, median HR-CTV volume was 29.8 cm3 [9.6-212.1], with median treated D90, 88.3 Gy EQD2 [53.4-122.1] (Point A 79.6 [56.3-146.2]). Applying a/b 5.6 Gy and T 1/2 3.4 h for SCC (4.3 Gy and 1.0 h for ADC), exp HR-CTV D90 and Point A medians were 102.0 [54.6-177.9] and 86.9 [57.7-225.8] Gy EQD2. Median follow-up was 83 months [4-115], with 5y-OS of 69.3% and pelvic LC, 79.9%. Clinical stage group (p=0.001) and OTT (p=0.008) were associated with OS (LN or chemotherapy status did not reach statistical significance). Exp target dose (Point A, p=0.029; D90, p=0.028) but not treated HR-CTV D90 or volume (trend only) also showed association. For ADC (not SCC), 5y-OS varied by exp, not treated, dose (Point A 79.5% vs 61.2%, p=0.013; D90 54.7% vs 80.3%, p=0.006). On MVA, OTT and exp Point A dose were significant predictors of OS after adjusting for age, chemo, stage, HR-CTV volume and smoking status. Pelvic LC differed, on univariate analysis, by stage (p=0.025), LN status (p=0.021), and exp D90 (p=0.022), with trends observed for OTT and HR-CTV volume but not histology, chemotherapy, BT imaging or center. 5y-LC of ADC also differed by exp Point A (93.2% vs 72.4%, p=0.062) and exp D90 (68.5% vs. 92.3%, p=0.019) doses, but not on MVA. Real-world late outcomes for a province-wide CC cohort are reflective of treatment factors, more so than disease burden. Further understanding of RbP is needed for optimum application in CC and outcomes-informed EBRT+BT dosing. [ABSTRACT FROM AUTHOR]

• Local optimality is suggested as a criterion to characterize route choice candidates. • Locally optimal routes have a mechanistic justification and require minimal data. • An algorithm to find locally optimal routes is presented and tested. • The approach is efficient in large systems, facilitates comprehensive traffic models. • Locally optimal routes yield good predictions of where travellers can be observed. Route choice is often modelled as a two-step procedure in which travellers choose their routes from small sets of promising candidates. Many methods developed to identify such choice sets rely on assumptions about the mechanisms behind the route choice and require corresponding data sets. Furthermore, existing approaches often involve considerable complexity or perform many repeated shortest path queries. This makes it difficult to apply these methods in comprehensive models with numerous origin-destination pairs. In this paper, we address these issues by developing an algorithm that efficiently identifies locally optimal routes. Such paths arise from travellers acting rationally on local scales, whereas unknown factors may affect the routes on larger scales. Though methods identifying locally optimal routes are available already, these algorithms rely on approximations and return only few, heuristically chosen paths for specific origin-destination pairs. This conflicts with the demands of route choice models, where an exhaustive search for many origins and destinations would be necessary. We therefore extend existing algorithms to return (almost) all admissible paths between a large number of origin-destination pairs. We test our algorithm and its applicability in route choice models on the road network of the Canadian province British Columbia and empirical data collected in this province. [ABSTRACT FROM AUTHOR]

Objectives: Although a body of research has focused on violence, disruption, and harassment targeting abortion clinics and clinic staff, little research has explored Canadian abortion patients' experiences with protesters. Through this national qualitative study we aimed to address this gap.Methods: Between 2012 and 2016, we conducted in-depth interviews with 305 Canadian women who had an abortion in the previous five years. Thirty participants reported encountering protesters when seeking abortion care. We focused on this sub-set of interviews and analyzed these data for content and themes using inductive and deductive techniques.Results: Across the country, participants reported encountering protesters holding signs, chanting slogans, and shouting insults. These interactions were concentrated at clinics in New Brunswick, Newfoundland and Labrador, and Ontario. Although no participants reported that these encounters made them reconsider their decision, they did report that seeing and interacting with protesters was at times unsettling, stigmatizing, and frustrating. Participants who struggled with the decision to have an abortion and those who made the decision in the context of health issues or violence found these encounters especially upsetting. Participants discussed how their interactions with protesters and the additional security measures put in place by clinics contrasted with their experiences accessing other kinds of health care and they wished that the protesters had not been there.Conclusions: For some Canadian abortion patients, encountering protesters is upsetting and stigmatizing. Exploring ways to minimize interactions between protesters and those seeking abortion care, such as enacting and enforcing safe access zone legislation, appears warranted.Implications: Although several Canadian provinces have enacted safe access zone laws, these do not currently exist across all jurisdictions. In addition to protecting clinics and clinic staff, implementation of these buffer zones have the potential to improve some patients' experiences obtaining a medically necessary and essential service. [ABSTRACT FROM AUTHOR]

• We apply ERGM using Bayesian techniques to a large multilevel criminal network. • Collaboration across organised criminal groups depends on illicit market overlap. • In general, market overlap between groups makes collaboration less likely. • Outlaw Motorcycle Gangs are more likely to collaborate when their markets overlap. Collaboration between members of different criminal groups is an important feature of crime that is considered organised, as it allows criminals to access resources and skills in order to exploit illicit economic opportunities. Collaboration across criminal groups is also difficult and risky due to the lack of institutions supporting peaceful cooperation in illicit markets. Thus cross-group collaboration has been thought to take place mostly among small and transient groups. This paper determines whether and under what conditions members of different, larger organised crime groups collaborate with one another. To do so we use intelligence data from the Canadian province of Alberta, centering on criminals and criminal groups engaged in multiple crime types in multiple geographic locations. We apply a multilevel network analytical framework and exponential random graph models using Bayesian techniques to uncover the determinants of cross-group criminal collaboration. We find cross-group collaboration depends not only on co-location, but also on the types of groups to which the criminals are affiliated, and on illicit market overlap between groups. When groups are operating in the same geographically-situated illicit markets their members tend not to collaborate with one another, providing evidence for the difficulty or undesirability of cross-group collaboration in illicit markets. Conversely, members of Outlaw Motorcycle Gangs are more likely to collaborate across groups when markets overlap, suggesting the superior capacity and motivation of biker gangs to coordinate criminal activity. Our paper contributes to the understanding of criminal networks as complex, emergent, and spatially embedded market phenomena. [ABSTRACT FROM AUTHOR]

• Blood urea is not routinely necessary with serum creatinine. • Removing urea from a laboratory requisition was associated with a halving of urea orders. • A process of audit and feedback to family doctors on urea test ordering further reduced urea ordering. • Academic detailing with family doctors following the above measures did not further reduce urea orders significantly. Measuring blood urea at the same time as serum creatinine in stable ambulatory patients in family practice is largely unnecessary. The objective was to assess the relative impact of changing the laboratory requisition versus audit and feedback and academic detailing on the volume of orders for blood urea. A natural experiment was observed over the period April 2015 to March 2018 in the Canadian province of Newfoundland where three health regions had different approaches to trying to reduce such urea testing. The Eastern and Western regions removed urea from the standard laboratory requisition but the test could still be ordered by writing it on the requisition. Central region requisitions continued to list urea. Audit and feedback was undertaken with family doctors in Eastern region after the requisition change and that was followed by academic detailing. A nephrologist gave presentations to groups of family doctors on one occasion in Central region. The volume of serum creatinine testing was largely unchanged over time in each region. The volume of urea testing reduced by 73%, 48% and 28% in Eastern, Western and central regions. Interrupted time series analysis showed significant changes in test volume after requisition change in Eastern and Western regions as well as after audit and feedback in Eastern and the presentations in Central region. The incremental impact of academic detailing was not statistically significant. We conclude that removing urea from standard test order menus was the most effective in reducing test volumes, but combination with audit and feedback augmented the impact. [ABSTRACT FROM AUTHOR]

Objectives: The gold standard of medication abortion, mifepristone and misoprostol, became available in Canada in 2017 as a combination pack under the trade name Mifegymiso®. We aimed to document people's experiences deciding to use and accessing medication abortion and generate insights for how information and services could be improved.Methods: We conducted semi-structured, in-depth interviews with 64 people who had used the mifepristone/misoprostol regimen to induce an abortion in seven different Canadian provinces. We used ATLAS.ti to manage our data, which we analyzed for content and themes using inductive and deductive techniques.Results: The overwhelming majority of participants reflected positively on their experience with mifepristone/misoprostol for early abortion. Most people reported that medication abortion offered increased autonomy, privacy, and convenience compared with instrumentation procedures and especially liked being able to have the abortion in a comfortable and familiar environment. The small number of participants who reflected more negatively on their experiences generally did not feel well informed about what to expect. Several participants reported that the media served as a key information source for finding and accessing services.Conclusions: Although our sample of Canadian abortion patients appear to be highly satisfied with the mifepristone and misoprostol regimen, there are several avenues by which medication abortion care could be improved. Providing more detailed information about pain management and the products of conception and lifting up the voices and stories of those who have used mifepristone and misoprostol could help patients manage expectations and would likely be welcomed.Implications: Changes to the Mifegymiso® product monograph since its introduction seem to have addressed a number of barriers described by early users of mifepristone and misoprostol. Continued engagement with clinicians to ensure that the process is not overly medicalized appears warranted. [ABSTRACT FROM AUTHOR]

The United States Food & Drug Administration released an advisory in 2016 that fluoroquinolones be relegated to second-line agents for uncomplicated urinary tract infections (UTIs) given reports of rare but serious side effects; similar warnings have followed from Health Canada and the European Medicines Agency. The objective was to determine whether alternative non-fluoroquinolone agents are as effective as fluoroquinolones in the treatment of UTIs. We conducted a retrospective population-based cohort study using administrative health data from six Canadian provinces. We identified women (n = 1 585 997) receiving antibiotic treatment for episodes of uncomplicated UTIs (n = 2 857 243) between January 1 2005 and December 31 2015. Clinical outcomes within 30 days from the initial antibiotic dispensation were compared among patients treated with a fluoroquinolone versus non-fluoroquinolone agents. High-dimensional propensity score adjustments were used to ensure comparable treatment groups and to minimize residual confounding. Fluoroquinolone use for UTI declined over the study period in five of six Canadian provinces and accounted for 22.3–48.5% of treatments overall. The pooled effect across the provinces indicated that fluoroquinolones were associated with fewer return outpatient visits (OR 0.89, 95%CI 0.87–0.92), emergency department visits (OR 0.74, 95%CI 0.61–0.89), hospitalizations (OR 0.83, 95%CI 0.77–0.88), and repeat antibiotic dispensations (OR 0.77, 95%CI 0.75–0.80) within 30 days. Fluoroquinolones are associated with improved clinical outcomes among women with uncomplicated UTIs. This benefit must be weighed against the risk of fluoroquinolone resistance and rare but serious fluoroquinolone side effects when selecting first-line treatment for these patients. [ABSTRACT FROM AUTHOR]

• Carrot Rewards is a free, incentive-based, smartphone health app available in participating Canadian provinces. • An in-app quiz educated users about the importance of the influenza vaccine and promoted pharmacy influenza clinics. • The app used novel "push" notifications when the user was within 200 m of the sponsored pharmacy. • The quiz completion rate was high although only a small number visited the pharmacy. • Loyalty point incentives did not appear to influence pharmacy visits. Carrot Rewards is a free, incentive-based, smartphone health app available in participating provinces in Canada. One feature of Carrot was designed to incentivize influenza vaccine education messages and encourage vaccine uptake for users in the province of British Columbia. This study aimed to evaluate the uptake of the Carrot Flu Campaign educational quiz and to determine if mobile "push" notifications, plus loyalty point incentives, resulted in users visiting a sponsored pharmacy to discuss and receive the influenza vaccine. The Carrot Flu Campaign delivered an in-app quiz, educating users on the importance of the influenza vaccine. Push notifications were then sent to users when they came within 200 m of a sponsored pharmacy. Those who visited the pharmacy collected bonus points and completed a follow up quiz tracking influenza vaccine behaviour. A sub-sample of users completed the Flu Campaign between their baseline and follow up Health Risk Assessment (HRA), a survey which asked about influenza vaccine uptake behaviour. Descriptive statistics were summarized. A total of 38.1% (30,538/80,228) registered Carrot users completed the Flu Campaign quiz. Of those in participating cities (n = 21,469), 41% clicked on the map to show the nearest sponsored pharmacy and 78% enabled their smartphone's "locations" feature, allowing them to receive the push notifications. A small number of users spoke to a pharmacist (n = 96) and less than half reported receiving the influenza vaccine (38/96; 39.6%). From the HRA sub-sample (n = 3693), approximately 5% more users reported receiving the influenza vaccine during the 2017 influenza season compared to the previous year. Carrot Rewards used a novel delivery method to educate the general population and showed geolocation could be used to facilitate influenza vaccine uptake. Future iterations could tailor content to target those most at risk and should consider more robust evaluation methods to determine the app's effectiveness. [ABSTRACT FROM AUTHOR]

Background: By linking health and census data, the objective of this study was to determine the effect of a femoral neck fracture on the household income of non-elderly patients.Methods: All individuals aged 18-50 who underwent internal fixation for a femoral neck fracture during the years 2006-2012 in the Canadian Province of British Columbia were included in the study. Patient-level hospital data was linked with patient's after-tax household income decile, as estimated by Statistics Canada Postal Code Conversion Files. The primary endpoint was a decline of ≥2 income deciles following the index fracture. Kaplan-Meier analysis was performed to estimate the probability of income decline during the study period. A Cox regression model was used to study the association between a ≥2 income decline and patient age, sex, reoperation, and pre-injury income decile.Results: Of the 391 femoral neck fracture patients included, the majority of patients were male (61.6%), with a median age of 43 years (IQR: 35-48), and a pre-injury median income in the fifth decile (IQR: decile 3-8). 27.0% of patients sustained a decline of ≥2 income deciles during the study period, with 16.3% declining ≥2 income deciles within 2-years of injury. A pre-injury household income in the top 4 deciles (mean of deciles: $57,000-170,500) was associated with an increased likelihood of a ≥2 drop in household income (HR: 1.38, 95% CI: 1.06-1.79, p = 0.02).Discussion: Over a quarter of the femoral neck fracture patients in this study sustained a decline of ≥2 deciles in their household income following their injury. The income decline was disproportionately absorbed by patients with baseline incomes in the 6th decile or higher. This suggests that the available incapacity programs are limited in providing income protection to patients with higher incomes. [ABSTRACT FROM AUTHOR]

• A novel bridge weigh-in-motion method is presented using parametric dynamic bridge-vehicle interaction formulation. • Modal parameters extracted from ambient vibration tests are used to accurately simulate the bridge structures. • The formulation offers superior computational efficiency since it eliminates the need for calibrated finite element models. • The proposed method resulted in accurate estimations even when the vehicle travel path differs from calibrations. • The Proposed method was validated using a full-scale case-study arterial highway bridge in Canada. Dynamic bridge weigh in motion systems use models that can simulate the dynamic behaviour of a bridge subjected to moving traffic. Currently available models use complex and computationally expensive Moving Force Identification (MFI) methods that utilize finite element models to estimate the bridge torsional and transverse dynamic behaviour. This paper presents a novel dynamic parametric BWIM method that utilizes the experimentally estimated modal parameters for simulating the response of a bridge structure to moving loads. The estimated modes of an in-situ structure inherently capture the true bridge behaviour for any generalized geometry, boundary conditions and load position. Therefore, it enables the complex torsional and transverse bending behaviour of the bridge to be captured. In this paper, the mathematical derivation of the analytical model is presented in detail, then model calibration and weighing procedures are outlined, followed by the validation of the proposed method using a full-scale case study arterial highway bridge in the Canadian Province of New Brunswick. The proposed dynamic BWIM method offers a novel solution for the development of real-time BWIM systems that is efficient to calibrate and accurate in vehicle identification. [ABSTRACT FROM AUTHOR]

Carbon dioxide (CO 2) emissions from community-based consumption are a major contributor to global greenhouse gas emissions. However, little is understood about how demographic, socioeconomic, and household factors may contribute to community CO 2 emissions variation. Using traditional regression methods to model community emissions does not discriminate which of these factors are responsible for CO 2 emissions in high carbon emitting communities versus low carbon emitting communities, leading to policy development that does not consider emission variation across communities. To address this issue, we used quantile regression to model these effects on different quantiles of community emissions for 1451 communities across Canada and each province in 2015, respectively. The results showed that population, followed by affluence, were the most important variables affecting total community emissions, while affluence was the most important factor affecting per capita community emissions. However, the effect sizes were not consistent across quantiles, decreasing for population and increasing for affluence from low to high emission communities. Population density was significant across all communities except the lowest quantile communities, with the effect size increasing from smaller to larger communities. Additionally, our measure of poverty was significantly associated with increases in total and per capita emissions for all quantiles at the national level. Our finding that factors responsible for CO 2 emissions varied across communities of different quantiles suggests that successful emission reduction policies must account for the diversity of community characteristics, particularly considering variation in population and affluence. Our study also shows poverty alleviation is an effective means for CO 2 emission reduction and should be considered when adopting emission reduction policies. • We used quantile regression to model the variation in community CO 2 emissions. • Factors responsible for CO 2 varied greatly from low to high CO 2 emission quantiles. • Population and affluence affected CO 2 most but were inconsistent across quantiles. • Emission reduction policies must account for these community emission variations. • Poverty alleviation could have the co-benefit of limiting community CO 2 emissions. [ABSTRACT FROM AUTHOR]

This study addresses a gap that exists in studying waste business characteristics and the performance of a waste management system (WMS). Temporal and spatial analyses of the WMS in four Western Canadian provinces are systematically assessed over a 16-year period. The average waste business size in Canada ranged from 13.4 to 22.1 employees per business. Jurisdictions with lower disposal rates generally have larger waste companies. An average employee handled 1098 to 1426 t of waste annually. The diversion rates tended to be higher when less waste is managed per employee, suggesting total employee count may be important to improve WMS sustainability in Canada. Waste transfer costs are substantial during the study period, totaled $1276 million annually, or about 40.7% of the total government waste spending. BC only spent an average of 2.5% of the budget on operation of recycling facilities, but has the highest waste diversion rate. Expenditure distribution alone is unable to explain BC's superior waste diversion performance. Capital expenditures have been increasing from $15.7/t to $26.2/t. In this study, a business with more full-time employees correlates well with higher operating revenues. Part time workers were more predominant in SK, and may be responsible for the subpar diversion rate and operating revenue. More research is needed to determine waste business characteristics given increasing interest in circular economy and WMS efficiency. • Waste management systems (WMS) in Canada are examined over a 16-year period • Capital expenditures increased gradually, with an average of $22.7/t • Total employee count may be vital to improve WMS sustainability in Canada • A business with more full-time employees correlates with higher operating revenues • Studies on business characteristics and their effect on WMS performance are limited [ABSTRACT FROM AUTHOR]

Highlights • We model short and long-term well-to-wheel GHG impacts of plug-in electric vehicles (PEVs). • PEVs offer substantial GHG emissions reductions in all contexts explored. • In short-term (2015), PEVs cut GHGs by 34% to 98%, varying by regional grid mix. • In long-term (2050), PEV GHG intensity is 36% to 74% lower than 2015 levels. • Even the higher-carbon electricity region sees strong PEV GHG benefit in long-term. Abstract Plug-in electric vehicles (PEVs) can contribute to deep greenhouse gas (GHG) reduction targets but their efficacy depends on the sources of electricity. PEV GHG intensity can vary over time (and regionally), making it unclear how policymakers should regulate PEVs in the short and long-term. To explore this uncertainty, we model the short-term (Study 1) and long-term (Study 2) well-to-wheels GHG intensity of PEVs in three regions with very different electricity grid profiles: the Canadian provinces of British Columbia, Alberta, and Ontario. Study 1 uses empirical data on vehicle preferences, driving patterns, and recharge access from a representative survey of new vehicle buyers in Canada (n = 1754) to construct a temporally-explicit model of PEV usage in 2015. Fleet-wide emissions intensity of PEVs varies substantially between regions, with the greatest reduction potential relative to conventional gasoline vehicles seen in British Columbia (78–98%), followed by Ontario (58–92%) and Alberta (34–41%). Study 2 simulates the potential long-term dynamics of technology, behavior, and emissions with the CIMS energy-economy model. With the emissions intensity of electricity decreasing by at least one-third by 2050 and vehicle energy efficiency improving over time, simulation results find that, compared to 2015, 2050 fleet average PEV emissions are 40–52% lower in British Columbia, 57–74% lower in Alberta, and 36–46% lower in Ontario. Overall, we find that PEVs offer substantial GHG emissions benefits compared to conventional vehicles in all scenarios explored. Policy makers seeking deep GHG cuts may want to support PEV adoption, even in jurisdictions that presently use relatively carbon-intensive electricity. [ABSTRACT FROM AUTHOR]

Introduction: Delays to surgery after hip fracture have been associated with mortality Uncertainty remains as to what timing benchmark should be utilized as a marker of quality of care and how other patient factors might also influence the impact of time to surgery on mortality. The goal of this study was to determine how time to surgery affects 30- and 90-day mortality by age and to explore the impact of preoperative comorbid burden and sex.Participants: We used population-based administrative data from a Canadian province collected from 01April2008 to 31March2015. Of 12,713 Albertans 50-years and older who experienced a hip fracture and underwent surgery within 100 h of admission, 11,996 (94.8%) provided data.Methods: Time to surgery was analyzed in hours from admission to surgery. Age and the interaction between age and time to surgery were evaluated using logistic regression. Charlson co-morbidity score and sex were also considered in the analysis. Survival was evaluated at 30-and 90-days post hip fracture using a provincial registry.Results: The average age of the cohort was 79.6 ± 11.2 years and 8,412 (70.1%) were female. Overall, 586 (4.9%) patients died within 30-days and 1,023 (8.5%) died within 90-days of hip fracture. Mortality increased significantly with increasing time to surgery (30-day mortality odds ratio [OR] = 1.03; 95%CI 1.01-1.05: 90-day mortality OR = 1.03; 95% CI 1.01-1.04). Mortality also increased substantially with increasing age; those ≥85 years were 19.63 (95% CI 6.83-67.33) and 15.66 (95%CI 7.20-37.16) times the odds more likely to die relative to those between 50-64 years of age at 30-days and 90-days postoperatively respectively. Further, those who were ≥85 years were more significantly affected by increasing time to surgery than those who were 50-64 years of age at both 30-days (p = 0.04) and 90-days (p = 0.025) post-fracture. Males and those with a higher comorbid burden also had higher odds of dying after controlling for time to surgery (p < 0.001) CONCLUSION: Time to surgery following hip fracture may have a differential effect on 30- and 90-day survival dependent on age. Older patients appear to be at higher risk of dying with surgical delays than younger patients. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to estimate the number of illicit retailers and the average price of cannabis in the largest municipality in each province and territory in Canada by obtaining information from retailers.Methods: Online search engines were used to identify retailers in each municipality. The advertised prices for various volumes of the least expensive, most expensive, and most popular dry herb were determined using the retailer's website, Weedmaps, or Leafly. Data was collected between October 2017 and May 2018, including two waves in Toronto to examine changes over a five-month period.Results: Across the 13 municipalities, 997 cannabis retailers were identified, including 215 physical storefronts. The average price per gram of cannabis was $10.02, $7.80, and $12.30 for the most popular, least expensive, and most expensive strains, respectively. The price-per-gram decreased as purchase volume increased: purchasing one-eighth of an ounce and one ounce of cannabis led to savings of up to 9% and 27%, respectively. Prices were consistent across municipalities, although the number of outlets varied greatly. Prices were similar between storefronts and delivery-only services; however, delivery services offered larger discounts for cannabis purchased by the ounce. The five-month comparison in Toronto revealed modest changes in the number of retailers and more pronounced changes in the price of the most popular and least expensive strains.Conclusion: The findings depict a well-established retail cannabis market in Canada in the year prior to legalization. The average advertised price of the most popular cannabis varieties was approximately $10, which aligns with the projected retail price of cannabis from licensed sources following legalization in Canada. [ABSTRACT FROM AUTHOR]

The heavy reliance on information and communication technology (ICT) has prompted the importance of cyber security more than ever in history. Although there are various studies that explored the importance of cybersecurity solutions, the impact of production and usage of these solutions on the natural environment and their economic impact has been rarely researched. The objective of this research is to investigate the environmental and economic impact of cybersecurity solutions. An extensive Life Cycle Assessment (LCA) has been performed on three cybersecurity solutions to assess and compare their environmental impact. Based on global warming potential, the embodied carbon footprint was determined. Carbon footprint and operational costs were used to calculate Life Cycle Cost (LCC) analysis and these data were then used to compare the eco-efficiency of the three cybersecurity solutions. This research compares three cybersecurity solutions: Next Generation DataGuard (NGD), Current State of Art Solution (CSAS), and a Generic Cybersecurity Solution (GCS), to identify an economically viable and environmentally friendly cybersecurity solution. The result of the analysis indicated that NGD was approximately 58% and 88% more energy-efficient than CSAS and GCS, respectively. Also, the LCC of NGD was approximately 6%- 12% lower than CSAS and 22%- 40% lower than GCS in selected provinces in Canada. The eco-efficiency of CSAS was approximately 60% less than NGD. Next Generation DataGuard is found to be a successful solution in this research among the three solutions. This study will be useful to researchers, cybersecurity industries, and policymakers to develop informed decisions on cybersecurity solutions. [Display omitted] • The life cycle environmental and economic performance of three cybersecurity solutions were compared. • Next Generation DataGuard (NGD) was approximately 58% and 88% more energy-efficient than current state of art solution and generic cybersecurity solution, respectively. • The NGD displayed superior environmental and economic performance for all Canadian cities. [ABSTRACT FROM AUTHOR]

The vast coastline provides Canada with a flourishing seafood industry including bivalve shellfish production. To sustain a healthy bivalve molluscan shellfish production, the Canadian Shellfish Sanitation Program was established to monitor the health of shellfish harvesting habitats, and fecal coliform bacteria data have been collected at nearly 15,000 marine sample sites across six coastal provinces in Canada since 1979. We applied Functional Principal Component Analysis and subsequent correlation analyses to find annual variation patterns of bacteria levels at sites in each province. The overall magnitude and the seasonality of fecal contamination were modelled by functional principal component one and two, respectively. The amplitude was related to human and warm-blooded animal activities; the seasonality was strongly correlated with river discharge driven by precipitation and snow melt in British Columbia, but such correlation in provinces along the Atlantic coast could not be properly evaluated due to lack of data during winter. • Sparse fecal pollution data were collected across ~15,000 sites along Canada's coast. • Longitudinal geospatial distributions of bacterial levels over decades were studied. • Functional Principal Component Analysis revealed two major annual patterns. • Human and wild-life activities related to the geospatial bacterial amplitudes. • River discharge and precipitation related to the temporal changes of fecal bacteria. [ABSTRACT FROM AUTHOR]

The presence of in-feed anti-sea lice drugs and their relationship with organic enrichment is poorly understood in sediment surrounding salmon farms. Using data from an aquaculture monitoring program (2018–2020), we describe this relationship at ten sites in four Canadian provinces. Three anti-sea lice pesticides (lufenuron, teflubenzuron, emamectin benzoate and metabolite desmethyl emamectin benzoate), and one antibiotic (oxytetracycline) were detected. Concentrations were often below limits of quantification. Values are also lower than those reported in other aquaculture salmon-producing countries. Highest concentrations, along with organic enrichment, were observed ~200 m of cages with lower concentrations detected up to 1.5 km away. Most samples had at least two drugs present: 75.2 % (British Columbia), 91.4 % (Newfoundland), and 54.8 % (New Brunswick/Nova Scotia) highlighting the potential for cumulative effects. Emamectin benzoate and oxytetracycline were detected four and three years respectively after last known treatments, demonstrating the need for research on overall persistence of compounds. [Display omitted] • Sediment data collected through an aquaculture monitoring program were used. • Three anti-sea lice drugs and one antibiotic were detected at ten salmon sites. • The highest concentrations and organic enrichment were observed within 200 m of cages. • Most sediment samples had at least two drugs present. • There is a significant patchiness in drug presence and organic matter enrichment. [ABSTRACT FROM AUTHOR]

Heart transplantation is the definitive management for select patients with end-stage heart failure. Owing to an ongoing organ donor shortage, organs are sometimes allocated from distant locales. These organs may be perceived as less desirable because of donor risk factors and ischemic times. We compared survival after heart transplantation by donors originating from British Columbia (BC), other Canadian provinces, and the United States. This retrospective cohort analysis included all patients transplanted in BC between December 1, 1988, and October 21, 2014, and excluded those with missing data or retransplantation. Among 382 patients, 297 (77.7%) recipients and 238 (62.3%) donors were male. The median recipient age was 54.6 years (interquartile range, 46.0-61.0 years) and the median donor age was 33 years (interquartile range, 22-46 years). Overall 10-year survival was 62.1% (95% confidence interval, 56.3-67.4). There was no difference in 10-year survival when comparing donors from BC, other Canadian provinces, and the United States despite significantly lower median ischemic times in donors from BC. Donor location was not predictive of mortality after controlling for recipient age, donor age, and cold ischemic time. Donor origin did not impact 10-year survival after heart transplantation despite increased ischemic time, suggesting that distant donors result in similar outcomes in BC. • Overall survival of heart transplant recipients in British Columbia at 10 years is 62.1%. • Cold ischemic times were significantly higher when comparing donors from British Columbia vs other Canadian provinces and the United States. • There was no difference in 10-year survival when comparing local donors vs distant donors. • Further study is required to determine if these results are applicable to other jurisdictions and may inform extended criteria for donor selection. [ABSTRACT FROM AUTHOR]

Background and purpose: Varicella disease is a risk factor for pediatric Arterial Ischemic Stroke (AIS). Isolated case reports have emerged suggesting that varicella vaccination may also pose a risk for AIS. Methods: This retrospective population-based cohort study assessed the risk of AIS in children who received a varicella-containing vaccine, as compared to those who did not. The study cohort consisted of children born between January 1, 2006 and December 31, 2013, in the Canadian province of Alberta, where all routine childhood vaccinations are publicly-funded, and recorded in a central immunization repository. These data were linked with hospital discharge abstract data to identify children diagnosed with AIS. A Cox proportional hazard model assessed the risk of AIS in the 12 months following vaccination for children receiving a varicella vaccine between 11 and 23 months of age, as compared to non-vaccinated children. Results: Of the 368,992 children in the cohort, 325,729 were vaccinated with a varicella-containing vaccine between 11 and 23 months of age. The rate of AIS was 7.8 (95% CI 4.8–10.9) per 100,000 person years at risk in the 12 months following varicella vaccination, as compared to 6.8 (95% CI 1.3–12.2) for children who did not receive a varicella vaccine. The adjusted Hazard Ratio for the risk of AIS, controlling for other AIS risk factors, in vaccinated children as compared to non-vaccinated children was 1.6 (95% CI 0.7–3.7) in the 12 months following vaccination and 1.7 (95% CI 0.5–4.9) in the 30 days following vaccination. Conclusions: Our study found no evidence of an increased risk of AIS following varicella vaccination. This population-based cohort study provides reassurance to parents and clinicians regarding the safety of varicella vaccination. [ABSTRACT FROM AUTHOR]

In one of two otherwise similar adjacent regions in a Canadian province, the price of electricity changed abruptly, substantially, and permanently. That natural experiment allows for a simple differences-in-differences calculation of the long-run price elasticity of residential demand for electricity. This analysis is of interest for two reasons. First, it is a rare circumstance when such a methodology can be used. Secondly, the magnitude of the elasticity estimate has substantial implications for utilities, regulators, and policymakers. [ABSTRACT FROM AUTHOR]

Tidal power developments occurring in the Canadian province of Nova Scotia provide an informative case study of a natural resource management issue occurring in a coastal zone involving many stakeholders in several sectors. Research has shown that bridger organizations are important vehicles for forging connections and encouraging communication across sectoral boundaries in complex networks. Using a mixed-methods approach encompassing participatory mapping and social network analysis, this study examined stakeholder communication networks in the region, with a particular focus on identifying “bridger” organizations. The results show that communication within the tidal power network does cross sectors, and that bridger organizations are vital in connecting organizations across sectoral boundaries. Bridging activities are multifaceted with three distinct, yet complementary roles: coordinators, connectors, and information mediators. Numerous bridger organizations can co-exist within a network and they often specialize by working within specific sectors. Organizations from the NGO, research, and government sectors, in particular, feature prominently as bridgers within this network, in part because they are often seen as neutral brokers of information. By identifying the functions of bridgers and the sectors well-suited to perform these activities, this paper provides guidance to coastal and ocean managers, NGOs, government bodies, and research groups on where to deploy resources to support bridger organizations within natural resource development networks. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the most important characteristics of fresh pork that determine consumer choice in five Canadian provinces. Within-consumer preference replication and systematic image manipulation in surveying showed differences in strategies for pork choice in lean colour (P < 0.001) and marbling (P = 0.006). High proportions of Nova Scotians (29%) chose light red pork, Albertans (42%) dark red and Quebecers (29%) non-marbled pork. Overall, the most important choice criteria were fat cover (57% preferred lean, 8% fatty) and lean colour (35% dark red, 18% light red). Marbling and drip were less used, but are important noting that 26% of consumers used three or four characteristics to make their choice. The preferences are readily met by the industry, but unfortunately, preferences for minimal or no marbling and fat cover likely result in a compromised gustative experience for many Canadian consumers. [ABSTRACT FROM AUTHOR]

In the first decade of the twenty-first century the Canadian province of Alberta was enjoying vigorous economic and demographic growth. To address concerns with cumulative impacts on the landscape and rising user conflicts the provincial government introduced a policy that articulated the need for regional planning and the greater use of market-based instruments to incent land stewardship. This was followed by enabling legislation called the Alberta Land Stewardship Act (ALSA). The policy instruments of conservation easements, conservation offsets, and transfer of development credits were identified as being of special interest and were enabled by ALSA. We review the development of policy for each of these instruments subsequent to the legislation and suggest that implementation has faltered in marked departure from the initial enthusiasm for the policy direction. • In 2008-2009 the Canadian province of Alberta introduced new policy and legislation for regional planning and the use of market-based instruments (MBIs) for land stewardship. • MBIs of interest include conservation easements, conservation offsets and transfer of development credits • Despite years of discussions and consultations, there has been little progress made on implementation of the MBIs. • The laggard implementation of MBIs in Alberta may be explained by recent economic and political turns as well as obstacles previously described in the literature. [ABSTRACT FROM AUTHOR]