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This study addresses a new electric vehicle routing problem with time windows and recharging strategies (EVRPTW-RS), where two recharging policies (i.e., full or partial recharging) and three recharging technologies (i.e., normal, rapid, and ultra-rapid) are considered. For this problem, we first develop a mixed-integer linear programming model defined in a series of vertices including a depot, a series of recharging stations, and a set of customers. Due to the strong NP-hardness of EVRPTW-RS, a tailored adaptive large neighborhood search heuristic (ALNS) which contains a number of advanced efficient procedures tailored to handle the proposed problem is developed. Numerical experiments for benchmark instances generated based on the Greater Toronto Area and Ontario in Canada are conducted to evaluate the performance of the proposed model and ALNS. Computational results demonstrate that the ALNS is highly effective in solving EVRPTW-RS and outperforms commercial solver CPLEX. Moreover, the advantages of the proposed recharging strategies are illustrated and some recommendations are provided for stakeholders when using electric vehicles for delivery. [ABSTRACT FROM AUTHOR]

There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi‐structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person‐centered; (2) provided by PSW with dementia‐specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia‐specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front‐line workers' perspectives and how they can help revise current healthcare policies and inform future policy development. [ABSTRACT FROM AUTHOR]

Background: Population studies have shown that rates of depressive and anxious symptoms have increased as a result of COVID‐19. We analyzed trends in the dispensing rates of antidepressants and benzodiazepines in Canada to determine whether the pandemic has caused changes in rates of pharmacological treatment for depression and anxiety. Methods: We conducted a population‐based, cross‐sectional time‐series analysis of antidepressants and benzodiazepines dispensed monthly by Canadian community pharmacies between January 2017 and December 2020. We used March 2020 as the intervention month to determine if there were any significant changes in the national rate of antidepressant and benzodiazepine tablets dispensed as the result of the COVID‐19 pandemic. Results: There was a temporary reduction in the dispensing rate of antidepressants in April 2020 (from 489 tablets per 100 in March 2020 to 356 tablets per 100 in April 2020; p ≤.0001); however, the rate returned to its previous level by August 2020. There were no detectable deviations in benzodiazepine dispensing after the declaration of the state of emergency in Ontario. Conclusions: Despite the increased reporting of depressive and anxious symptoms during the COVID‐19 pandemic, there have been no changes in the dispensing trends of medications used to treat these disorders. As the pandemic continues to evolve, future research is needed to monitor the prevalence of depression and anxiety, and associated medication use, in the Canadian population. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this paper was to examine leadership practices in effective schools located in economically disadvantaged areas of three Canadian provinces: Ontario, Qu'ebec, and New Brunswick. Research Design. Our study was conducted in five successful schools selected on the basis of student outcomes on province-wide standardized exams, as well as on some risk factors such as rural area, low socioeconomic level, and proportion of Francophones (Ontario and New Brunswick). To increase the study's validity, we used triangulation and various data sources: (1) individual interviews; (2) observation of school principals; (3) field documentation; (4) student essays; (5) internal school documents such as mission statement, rules, and directives. Participants. Participants included Department of Education heads and school board administrators, school principals and vice principals, teachers, school counsellors, educational psychologists, parent school board members, and students. Findings. Results show that leadership practices in effective schools can be grouped together around five dimensions: establishing goals and expectations; strategic resourcing; curriculum planning, coordination, and evaluation; promoting and participating in teacher supervision and development; ensuring order and support. [ABSTRACT FROM AUTHOR]

In recent years, there has been a rapid increase in the number of herbicide-resistant weeds, including glyphosate-resistant (GR) biotypes in Ontario, Canada. A total of six field experiments were conducted over a two-year period (2018 and 2019) to determine the control of GR Canada fleabane (Conyza canadensis (L.) Cronq.) with currently available herbicides for winter wheat in Ontario. Winter wheat was not injured with any of the herbicides evaluated. Among herbicides evaluated, pyrasulfotole/bromoxynil (preformulated), 2,4-D ester, halauxifen, fluroxypyr/halauxifen (preformulated) + MCPA, pyrasulfotole/bromoxynil/fluroxypyr (preformulated), pyrasulfotole/bromoxynil/thiencarbazone (preformulated), pyrasulfotole/bromoxynil/thiencarbazone + MCPA, and fluroxypyr/halauxifen + pyroxsulam + MCPA controlled GR Canada fleabane 94–100% at 8 weeks after application (WAA) and reduced density 95–100% and biomass 97–100%. Reduced GR Canada fleabane interference with pyrasulfotole/bromoxynil/thiencarbazone + MCPA increased winter wheat yield 27% compared to the weedy control. GR Canada fleabane interference had no adverse effect on winter wheat yield with all other treatments. Based on these results, herbicide treatments that include 2,4-D, pyrasulfotole, or halauxifen can adequately control GR Canada fleabane in winter wheat. [ABSTRACT FROM AUTHOR]

Limited information exists on the efficacy of pethoxamid for annual grass and broadleaf control in corn and soybean in Ontario. A total of 10 field experiments (5 with corn and 5 with soybean) were conducted during 2015 to 2017 in Ontario, Canada, to compare the weed control efficacy of dimethenamid-P at 544 g·ai·ha−1, pethoxamid at 840 g·ai·ha−1, pyroxasulfone at 100 g·ai·ha−1, and S-metolachlor at 1050 g·ai·ha−1 applied preemergence (PRE). Reduced weed interference with pyroxasulfone and dimethenamid-P resulted in corn yield that was similar to the weed-free control; however, weed interference with pethoxamid and S-metolachlor reduced corn yield 28 and 33%, respectively. Reduced weed interference with pyroxasulfone resulted in soybean yield that was similar to the weed-free control; however, weed interference with pethoxamid, dimethenamid-P, and S-metolachlor reduced soybean yield 27, 27, and 30%, respectively. At 4 and 8 weeks after application (WAA), all VLCFA inhibitor herbicides (Group 15) provided excellent redroot pigweed control (90 to 99%) in corn. There were no differences in common ragweed control, density, and dry weight among the VLCFA inhibitor herbicide evaluated; pyroxasulfone provided highest numeric common ragweed control and lowest numeric density and dry weight. At 4 and 8 WAA, pyroxasulfone provided the best common lambsquarters and wild mustard control and lowest numeric density and dry weight in corn and soybean. At 8 WAA, the VLCFA inhibitor herbicides controlled green foxtail 91 to 96% in corn; dimethenamid-P provided better control of green foxtail than pethoxamid in soybean. There were no differences in barnyard grass control among the VLCFA inhibitor herbicides evaluated. [ABSTRACT FROM AUTHOR]

Aim Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. Background Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. Methods Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. Results Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. Conclusions Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. Implications for nursing management Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential. [ABSTRACT FROM AUTHOR]

Retinal vein occlusion (RVO) is an obstruction of the retinal venous system, and macular edema (ME) is a complication of RVO that can lead to blindness. The Canadian incidence of visual impairment (VI) due to ME secondary to RVO is unknown. This observational, retrospective study used records from the Southwestern Ontario database to observe the annual incidence, demographics, and comorbidity characteristics of patients with VI due to ME secondary to RVO. From 47,166 patients, 73 with RVO (>40 years old) were identified: 53 with branch retinal vein occlusion (BRVO), 20 with central retinal vein occlusion (CRVO). The annual incidence of VI (visual acuity <20/40 in Snellen equivalent) due to ME secondary to BRVO was (mean (95%CI)) 0.056% (0.011-0.072), and to CRVO was 0.021% (0.008-0.081). Furthermore, a greater proportion of RVO patients had hypertension (68% versus 14%) or dyslipidemia (16% versus 10%), when compared to a healthy control cohort of 76,077 subjects (P < 0.05). This study presents a description of the characteristics of patients with VI due to ME secondary to RVO in a real-world Canadian setting. The results demonstrate that BRVO was more frequent than CRVO, and that RVO in this patient population was associated with several vascular comorbidities. [ABSTRACT FROM AUTHOR]

Background: The current study established baseline nutrient intakes of youth and examined the potential for sustainability of a pilot school snack program in the remote First Nation of Kashechewan, Ontario, Canada. Methods. Twenty-four-hour dietary recalls established baseline intakes in grade 6-8 students (n = 43). Subsequently, a pilot healthy school snack program was initiated. Dietary recalls were completed one week (n = 43) and one year after the program (n = 67). Paired Wilcoxon signed-ranks tests were used to detect changes in intakes. Impressions of the teachers (n = 16), principal, and students were collected qualitatively. Results; Most youth had dietary intakes below current standards. Although vitamin C (P = 0.024) and fibre (P = 0.015) intakes improved significantly after one week, these improvements were not sustained over the following year. Program impressions were positive. Conclusion. The need for a nutrition program is clear. While benefits were realized in the short term, improvements could not be maintained. Policy changes are needed to address barriers to sustainability. [ABSTRACT FROM AUTHOR]

Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs ( n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike. [ABSTRACT FROM AUTHOR]

Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers’ decisional process was one of a clinician–broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making. [ABSTRACT FROM AUTHOR]

Policy diffusion is a process whereby political bodies ‘learn’ policy solutions to public health problems by imitating policy from similar jurisdictions. This suggests that diffusion is a critical element in the policy development process, and that its role must be recognised in any examination of policy development. Yet, to date, no systematic work on the diffusion of smoke-free spaces bylaws has been reported. We examined the diffusion of municipal smoke-free bylaws over a 30-year period in the provinces of Alberta and Ontario, Canada, to begin to address this gap and to determine whether spatial patterns could be identified to help explain the nature of policy development. Bylaw adoption and change were analysed within local, regional, and provincial contexts. Geographical models of hierarchical and expansion diffusion in conjunction with the diffusion of innovations framework conceptually guided the analyses. Study findings contribute to a broader understanding of how and why health policies diffuse across time and place. Policy development can be a powerful mechanism for creating environments that support healthy decisions; hence, an understanding of policy diffusion is critical for those interested in policy interventions aimed at improving population health in any jurisdiction. [ABSTRACT FROM AUTHOR]

Ontario cancer patients’ monthly out-of-pocket costs (OOPC) were assessed to determine whether these costs were problematic. A self-administered questionnaire was administered to breast ( n = 74), colorectal ( n = 70), lung ( n = 68) and prostate ( n = 70) cancer patients between October 2001 and April 2003. It measured categorical OOPC, which were analysed using linear regression modelling, to determine whether any of a variety of independent variables influenced OOPC. Monthly OOPC (mean, range) were: parking/fares ($47, $0–450), devices ($46, $0–2350), prescription drugs ($45, $0–1400), accommodation ($43, $0–1500), complementary and alternative medicine ($29, $0–5000), vitamins ($25, $0–400), homemaking ($14, $0–1000), family care ($12, $0–1200), homecare ($2, $0–330) and other ($8, $0–250), with the total averaging $213 ($0–5230). Imputed travel mileage costs added $372 ($0–6180). Most patients were well served by the current healthcare programmes. In multivariate analysis, variables influencing several OOPC categories were: tumour site, hospitalization, age, and number of clinic trips. Travel costs proved the most problematic, with patients under 65 years and without insurance more likely to have high OOPC. Education and income were not reliable predictors for high OOPC. Many of these costs were for items not traditionally covered by public healthcare financing systems, raising important issues around defining ‘medically necessary’ care and the role of government. [ABSTRACT FROM AUTHOR]

Reports on the contributions to open heart surgery that came from the University of Toronto in Ontario. Advances in the purification of a commercially available and safe extract of heparin in the 1930s; Experimental and clinical work in the late 1940s and 1950s by cardiac surgeons William Mustard and Wilfred Bigelow; Origin of the key elements of mechanical assist in heart surgery.