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Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving. [ABSTRACT FROM AUTHOR]

The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average. [ABSTRACT FROM AUTHOR]

Opioid prescriptions for chronic pain and subsequent opioid-related complications have risen dramatically in the US. Recent data suggest that medical marijuana laws have been associated with lower state-level opioid overdose mortality. In a national survey, we examined the prevalence of substitution of marijuana for opioids among US adults taking opioids for pain.Using GfK’s KnowledgePanel, we conducted an Internet-based survey of a nationally representative sample of 16,280 adults in 2017 about individual perceptions and use of marijuana. We developed questions designed to assess the extent and reasons for substitution of marijuana for opioids. We examined opioid substitution among respondents with a history of ever using marijuana who used opioids in the past 12 months. There were 9,003 respondents, corresponding to a 55.3% response rate. The mean age was 48 years. Among the 5% (n = 486) who reported ever using marijuana and using opioids in the past year, 43% used opioids daily, and 23% reported current (past 30 day) marijuana use. Forty-one percent reported a decrease or cessation of opioid use due to marijuana use; 46% reported no change in opioid use; and 8% reported an increase in opioid use. We found that a substantial number of US adults reported that they substituted marijuana for opioids. [ABSTRACT FROM AUTHOR]

Threatened species are increasingly dependent on conservation investments for persistence and recovery. Information that resource managers could use to evaluate investments–such as the public benefits arising from alternative conservation designs–is typically scarce because conservation benefits arise outside of conventional markets. Moreover, existing studies that measure the public benefits of conserving threatened species often do not measure the benefits from partial gains in species abundance that fall short of official recovery, or the benefits from achieving gains in species abundance that happen earlier in time. We report on a stated preference choice experiment designed to quantify the non-market benefits for conservation investments aimed at threatened Pacific Coho salmon (Oncorhynchus kisutch) along the Oregon Coast (OC). Our results show that a program aimed at increasing numbers of returning salmon can generate sizable benefits of up to $518 million/y for an extra 100,000 returning fish, even if the species is not officially declared recovered. Moreover, while conservation investment strategies expected to achieve relatively rapid results are likely to have higher up-front costs, our results show that the public attaches substantial additional value of up to $277 million/y for achieving conservation goals quickly. Our results and approach can be used to price natural capital investments that lead to gains in returning salmon, and as inputs to evaluations of the benefits and costs from alternative conservation strategies. [ABSTRACT FROM AUTHOR]

With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess the alignment of HIV care settings with the CCM. We conducted a mixed methods study to explore structures, organization and care processes of Canadian HIV care settings. The quantitative results of phase one are published elsewhere. For phase two, we conducted semi-structured interviews with key informants from 12 HIV care settings across Canada. Irrespective of composition of the care setting or its location, HIV care in Canada is well aligned with several components of the CCM, most prominently in the areas of linkage to community resources and delivery system design with inter-professional team-based care. We propose the need for improvements in the availability of electronic clinical information systems and self-management support services to support better care delivery and health outcomes among people living with HIV in Canada. [ABSTRACT FROM AUTHOR]

Introduction: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. Methods: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. Results: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women’s intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. Conclusion: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country. [ABSTRACT FROM AUTHOR]

Downscaled climate projections need to be linked to downscaled projections of population and economic growth to fully develop implications for land, natural resources, and ecosystems for future scenarios. We develop an empirical spatiotemporal approach for jointly projecting population and income at the county scale in the United States that is consistent with neoclassical economic growth theory and overlapping labor markets and that accounts for labor migration and spatial spillovers. Downscaled projections generated for the five Shared Socioeconomic Pathways used to support global scenario analysis generally show growth focused around relatively few centers especially in the southeast and western regions, with some areas in the Midwest and northeast experiencing population declines. Results are consistent with economic growth theory and with historical trends in population change and convergence of per capita personal income across US counties. [ABSTRACT FROM AUTHOR]

Residential segregation into spatial neighborhoods and boroughs is a well-known spatial dynamic process that characterise complex urban environments. Existing models of segregation, including the pioneering Schelling ones, often do not consider all the factors that can contribute to this process. Segregation as well as aggregation emerges from local interactions among individuals, and is rooted in the complexity of social, economic and environmental interactions. The main objective of this study is to develop and implement a geospatial agent-based model to simulate the decision-making process of location of new household for incoming immigrant populations. Particularly this study aims to simulate and analyse the dynamics of the new immigrant populations arriving in the bilingual cities and boroughs of the island of Montreal. The model was implemented in NetLogo software, using real geospatial datasets. The obtained simulation results indicate realistic spatial patterns of spatial composition of the ethnographic fabric on the island of Montreal. The proposed model has the potential to be used as part of the city planning purposes. [ABSTRACT FROM AUTHOR]

The participation of diverse demographics in higher education has risen over the last half-century; meanwhile, different political and social tiers have been assigning a more active role to institutions in terms of equality and social justice. This change in circumstances has led to the roll out of processes to institutionalise diversity outreach. This study was conducted for the clear purpose of assessing the current institutionalisation status of diversity outreach in 127 key universities from the Academic Ranking of World Universities based on the opinions of diversity outreach managers and the information published on institutional websites, in turn measuring compliance with various indicators. A qualitative analysis of the institutional statements, the goals sought through strategic plans and the definitions of diversity itself was also conducted. The evidence reveals the early stage of the institutionalisation process in universities on account of the low percentage obtained for the proposed indicators. Furthermore, the study failed to exhibit significant differences in this process in terms of the institutional ownership or position held in the ranking; however, more prominent progress was noted in the North-American region when geographical differences were taken into account, likely as a result of the historical background in the advocacy for equal opportunities. Lastly, a change of approach to the conceptualisation of diversity is suggested in favour of equality and social justice. [ABSTRACT FROM AUTHOR]

Despite an overwhelming scientific consensus that climate change poses severe risks to human and natural systems, many young Canadian adults do not view it as a major issue. We analyzed secondary science curricula in each province for their coverage of climate change according to six core topics: physical climate mechanisms (“It’s climate”), observed increase in temperature (“It’s warming”), anthropogenic causes of warming (“It’s us”), scientific consensus (“Experts agree”), negative consequences associated with warming (“It’s bad”), and the possibility for avoiding the worst effects (“We can fix it”). We found that learning objectives tend to focus on knowledge of the first three elements, with little or no emphasis on scientific consensus, climate change impacts, or ways to address the issue. The provinces of Saskatchewan and Ontario provide the most comprehensive standards for climate change education, while Nova Scotia and New Brunswick provide the least. We conducted interviews with individuals responsible for curriculum design in six different provinces to understand how curriculum documents are developed and whether political controversies influence the writing process. Interviewees described a process relying on input from professionals, institutions, and members of the public where curriculum developers made decisions independent of political concerns. In some cases, efforts to provide balance may have led to a focus on social controversy, contrary to overwhelming scientific consensus. Curriculum documents are the basis for teacher instruction and textbook content; aligning these documents with the best possible evidence can improve student learning and engage the next generation of Canadians on the critical issue of climate change. [ABSTRACT FROM AUTHOR]

Non-consensual condom removal (NCCR) is the removal of a condom before or during sexual intercourse without one’s partner's consent. Despite considerable news and media attention devoted to the trend (as stealthing), little empirical research to date has examined people’s views of the practice. The present study aimed to contribute toward generating empirical evidence to guide the discussion surrounding NCCR. We asked participants about whether or not they felt NCCR is wrong, whether there should be consequences for its perpetration, and contextualized responses within legal context. A total of 592 undergraduate students took part in an online survey inquiring about their experiences with and views of NCCR. We used descriptive statistics to determine sample prevalence and outcomes of NCCR and qualitatively analyzed responses to open-ended questions asking about perceptions of NCCR. Of participants who had engaged in penetrative sexual intercourse with a male partner using an external condom, 18.7%, 95% CI [14.4, 22.7] reported that they had NCCR perpetrated against them. The majority of these participants reported that they experienced NCCR negatively and encountered related consequences; several reported contracting an STI, experiencing an unplanned pregnancy, or both. Nearly all participants expressed that NCCR is wrong, citing reasons that included the lack of consent, possibility of unplanned or unwanted outcomes, and a betrayal of trust. In this study, we found that there was agreement that NCCR is wrong, but variability in responses regarding the circumstances under which there should be consequences for the action. These perceptions reflect the current uncertainty in law. We recommend researchers refer to the phenomenon as NCCR (rather than stealthing) and discuss related issues to encourage future research to adopt consistent and accurate labels and definitions for NCCR. We hope that our findings will guide future research and spur public and legal discussion on NCCR. [ABSTRACT FROM AUTHOR]

This work examines Twitter discussion surrounding the 2015 outbreak of Zika, a virus that is most often mild but has been associated with serious birth defects and neurological syndromes. We introduce and analyze a collection of 3.9 million tweets mentioning Zika geolocated to North and South America, where the virus is most prevalent. Using a multilingual topic model, we automatically identify and extract the key topics of discussion across the dataset in English, Spanish, and Portuguese. We examine the variation in Twitter activity across time and location, finding that rises in activity tend to follow to major events, and geographic rates of Zika-related discussion are moderately correlated with Zika incidence (ρ = .398). [ABSTRACT FROM AUTHOR]

Tree cavities provide a critical resource for cavity-nesting animals, and high quality cavities can be difficult for animals to acquire in habitats where competition is high. We investigated the breeding performance of Lewis's Woodpeckers in three habitat types in British Columbia, Canada in 2013 and 2014. We also assessed whether the number of nest competitors and cavity availability influenced the habitat specific breeding performance of this threatened cavity nesting species. We found that daily nest survival rate was lower in burned habitat (0.15 ± 0.08 (0.05–0.37)) than in live pine (0.72 ± 0.10 (0.51–0.87)) or cottonwood (0.69 ± 0.09 (0.51–0.83)) habitats. However, hatching success (the proportion of eggs that hatch) was lower in live pine habitat (0.59 ± 0.09 95% CI) than burned (0.77 ± 0.19 95% CI) or cottonwood (0.80 ± 0.07 95% CI) habitat, and the fledging success of successful nests in live pine and burned habitat (1.86 ± 0.31 and 1.88 ± 0.59 95% CI, respectively) was slightly lower than in cottonwood habitat (2.61 ± 0.45 95% CI). Consequently, Lewis's Woodpeckers in cottonwood habitat produced more fledglings per nesting attempt (2.05 ± 0.49 95% CI) than in live pine (1.53 ± 0.35 95% CI) or burned (0.79 ± 0.49 95% CI) habitat. Habitats differed in the number of nesting competitors and the number of suitable cavities surrounding active Lewis's Woodpecker nests. Our results showed that cavity density best explained breeding performance differences although the mechanisms remain unclear. There was no evidence that the number of heterospecific nest competitors, including the invasive European Starling (Sturnus vulgaris), explained or influenced Lewis's Woodpecker breeding performance. Cavity density influenced the productivity of successful nests but did not explain habitat differences in hatching success or daily nest survival. Further work is required to understand the mechanistic basis for the habitat specific breeding performance of Lewis's Woodpeckers. Habitat differences in breeding performance in British Columbia are not consistent with those in other regions, highlighting the importance of regionally-specific demographic data for managing species at risk. [ABSTRACT FROM AUTHOR]

Introduction: Flavored e-cigarettes are enticing to new users and established cigarette smokers using e-cigarettes to quit smoking due to the wide variety of flavor options. However, specific flavor combinations that are popular among e-cigarette users are understudied. Recently, the Deeming rule extended the US Food and Drug Administration’s authority over all tobacco products, including e-cigarettes. Methods: The Population Assessment of Tobacco and Health Study Wave 2 data were analyzed to assess the prevalence of self-reported flavor categories that are used individually and in combination with other flavor categories among past 30-day youth and adult e-cigarette users in the US. Results: Most youth and adult participants reported using a flavored e-cigarette. Reporting an individual flavor category was more common than reporting a combination of flavor categories. Fruit flavor was the most common flavor category reported among youth, and ‘menthol/mint’ was most common among adults. Fruit and candy/other sweets were the most common flavor categories reported together among both youth and adult past 30-day e-cigarette users. Conclusions: The use of flavored e-cigarettes is very popular among youth and adults. Most consumers reported using a single flavor category, although some consumers did use a combination of flavor categories. Preference for menthol/mint among adults may represent a carryover from associations with tobacco cigarettes. Typically, sweeter flavors, such as fruit, were among the most popular flavor categories reported, both individually and in combination with other flavors, while more bitter flavors (i.e.: clove/spice) were less common. Implications: This study identified predominant flavor categories among past 30-day youth and adult e-cigarette users. Findings indicate that the wide variety of flavors available and the freedom to “mix-and-match” flavors may maintain use of e-cigarettes among youth and adults, and future research should focus on the composition of the ENDS liquid/vapor to disentangle the contributions of sweeteners and flavorants. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries. Methods: We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health. Results: Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93). Interpretation: These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality. [ABSTRACT FROM AUTHOR]