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Background The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030. Methods The number and full-time equivalents (FTEs) of geriatricians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements. Results Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase. Discussion The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integration of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity. [ABSTRACT FROM AUTHOR]

In an "ideal" democratic society, publicly funded schools serve many purposes. Aside from its educational mandate, schools are places for neighbourhood integration, social capital formation and the fostering of civil society. For newly arrived immigrants, especially those with young children, schools are important sites of settlement experiences. During the past near decade, however, rapid restructuring of the public education system in Ontario has led to many changes in these ideals. Within the landscape of this wider transformation, this article critically explores how different forms of social capital are produced in schools and accessed by recent immigrants. Based on a spatial-network framework developed earlier this article examines not only how immigrants participate in the daily life of their local institutions; but whether these links are powerful enough to translate into purposeful political effects as well. The outcomes that arise from this neighbourhood-based exercise are crucial in reflecting on a larger ethical question--how do states determine who is and who is not entitled to membership in society? (Contains 7 tables, 1 figure and 1 note.)

Since the onset of the COVID-19 pandemic, community-dwelling people living with dementia and their family caregivers have experienced many challenges. The unanticipated consequences of public health measures have impacted these families in a myriad of ways. In this interpretive policy analysis, which used a longitudinal, qualitative methodology, we purposively recruited 12 families in British Columbia, Canada, to explore the impacts of pandemic public health measures over time. Semi-structured interviews were conducted every 3 months and participants completed diary entries. Twenty-eight interviews and 34 diary entries were thematically analyzed. The findings explore ways that families adopted and adapted to public health measures, loss of supports, both formal and informal, and the subsequent consequences for their mental and physical well-being. Within the ongoing context of the pandemic, as well as potential future wide-spread emergencies, it is imperative that programs and supports are restarted and maintained to avoid further harm to these families. [ABSTRACT FROM AUTHOR]

Hazardous chemicals are one of the greatest environmental challenges facing our planet, testing governments in the face of economic and social development. Chemical risks are often complex systemic risks, which require particular governance processes, stakeholder participation mechanisms, and communication procedures to manage. In this article we explore how such processes, mechanisms, and procedures could offer more effective pathways for international chemical risk assessment and management. Combining document analysis with 69 key informant interviews and four focus groups with experts from across government, non-governmental organizations (NGOs) and industry in Canada, the USA and Europe (n = 24), the results highlight the importance of increasing stakeholder participation and risk communication in existing chemical risk assessment and management frameworks. Similarities and differences between the three jurisdictions are discussed with a view to inform future risk governance strategies. The contemporary insights are of relevance to decision-makers seeking to improve the effectiveness of chemical risk governance in practice. [ABSTRACT FROM AUTHOR]

Increased use of phosphorus (P) fertilizers and detergents and intensified livestock production have more than doubled P inputs to human‐impacted watersheds over pre‐industrial levels. While P fertilizer use and manure application help to maximize crop yields, excess P is lost to runoff, leading to eutrophication of downstream waters. Excess P also accumulates across the landscape, leading to legacies that serve as long‐term sources of P to surface waters, even after inputs to the watershed are reduced. Here, we have developed, for the first time, a process‐based model, Exploration of Long‐tErM Nutrient Trajectories‐Phosphorus, designed to capture legacy P accumulation and depletion trajectories along the land‐aquatic continuum. To drive the model, we have developed a more than 100‐year trajectory of watershed P inputs to the Grand River Watershed (GRW), Canada's largest watershed draining directly to Lake Erie. Our results first show that net P inputs to the watershed approximately tripled between 1900 and the late‐1970s, when P surplus magnitudes peaked at approximately 15 kg ha−1 y−1. During this same period, stream P loads have increased more than fourfold, from 0.11 kg ha−1 y−1 in 1900 to 0.80 kg ha−1 y−1 in the 1970s. Since 1900, the GRW has served as a net P sink, with approximately 96% of net P inputs having been retained within the basin. Future simulations suggest that while 40% reductions in P loading in Lake Erie watersheds are possible under aggressive management scenarios, legacy P will continue to elevate P loads to Lake Erie for many decades to come. Plain Language Summary: Phosphorus is a major driver of algal blooms and water quality challenges throughout the Great Lakes region. Excess phosphorus from crop and livestock production is a particular problem in agricultural areas, and much of the phosphorus applied to the landscape is accumulating as legacy within our watersheds. We have developed a model demonstrating that watershed phosphorus legacies continue to degrade water quality over many decades and can make it difficult to meet water quality goals. Our modeling results show that we must take legacy phosphorus into account when setting policy goals for water quality improvement. Our results also show that better manure management can provide relatively fast improvements and should therefore be emphasized when implementing conservation measures. Key Points: More than 95% of surplus phosphorus has been retained within the watershed since 1900Legacy phosphorus is a major contributor to current watershed phosphorus loadsReducing manure handling losses can provide substantial reductions in watershed P loads [ABSTRACT FROM AUTHOR]

The Aamjiwnaang First Nations community is located in Canada's 'Chemical Valley' situated in southwest Ontario near Sarnia. Mercury pollution in the region has been known since the 1940s but little is known about levels in the environment and area residents. The current study, using ecological and human exposure assessment methods, was conducted at the community's request to help fill these gaps. First, Canada's National Pollutant Release Inventory and the U.S. Toxics Release Inventory were queried to investigate mercury releases from area facilities. In 2010, 700 pounds of mercury were emitted into the air, 25 pounds were released into water bodies, and 93 thousand pounds were disposed of on-site via underground injections or into landfills, and together these show continued releases into the region. Second, mercury levels were measured in stream sediment and nearby soil from sites at Aamjiwnaang ( n = 4) and off Reserve ( n = 19) in Canada and the U.S. during three seasons that spanned 2010-2011. Total mercury in sediment across all sites and sampling seasons ranged from 5.0 to 398.7 µg/kg, and in soils ranged from 1.2 to 696.2 µg/kg. Sediment and soil mercury levels at Aamjiwnaang were higher than the reference community, and Aamjiwnaang's Talfourd Creek site had the highest mercury levels. Third, a biomonitoring study was performed with 43 mother-child pairs. Hair (mean ± SD of all participants: 0.18 ± 0.16 µg/g) and blood (1.6 ± 2.0 µg/L) mercury levels did not differ between participants studied on- and off-Reserve, likely because of limited seafood intake (<1 serving/week). Urine mercury levels (0.5 ± 0.8 µg/L) were significantly higher (1.5-2.5 times) in mother-child pairs living on-Reserve versus those living off-Reserve. In general, the study links evidence of mercury sources, environmental fate, and human exposures, and in doing so it shows that mercury levels in ecological and human samples are similar to values found in other areas, though there are some trends and evidence of contamination at Aamjiwnaang that warrant attention. [ABSTRACT FROM AUTHOR]

Although the current low workforce availability of care of the elderly (COE) physicians, geriatric medicine specialists, and geriatric psychiatrists is undeniable, the ongoing demographic shift means this situation will only worsen. This evolving crisis is outlined clearly in the article "Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics" by Basu et al. [ABSTRACT FROM AUTHOR]

Background: Critics of free trade agreements have argued that they threaten public health, as they eliminate barriers to trade in potentially harmful products, such as sugar. Here we analyze the North American Free Trade Agreement (NAFTA), testing the hypothesis that lowering tariffs on food and beverage syrups that contain high-fructose corn syrup (HFCS) increased its use in foods consumed in Canada.Methods: We used supply data from the Food and Agriculture Organization of the United Nations to assess changes in supply of caloric sweeteners including HFCS after NAFTA. We estimate the impact of NAFTA on supply of HFCS in Canada using an innovative, quasi-experimental methodology - synthetic control methods - that creates a control group with which to compare Canada's outcomes. Additional robustness tests were performed for sample, control groups and model specification.Results: Tariff reductions in NAFTA coincided with a 41.6 (95% confidence interval 25.1 to 58.2) kilocalorie per capita daily increase in the supply of caloric sweeteners including HFCS. This change was not observed in the control groups, including Australia and the United Kingdom, as well as a composite control of 16 countries. Results were robust to placebo tests and additional sensitivity analyses.Interpretation: NAFTA was strongly associated with a marked rise in HFCS supply and likely consumption in Canada. Our study provides evidence that even a seemingly modest change to product tariffs in free trade agreements can substantially alter population-wide dietary behaviour and exposure to risk factors. [ABSTRACT FROM AUTHOR]

Abstract Following the terror attacks on the United States in September 2001, the country briefly closed all borders. The consequences for cross-border trade with Canada were swift and immediate. Following more than a decade of efforts by trade and transportation policymakers in both countries to facilitate greater economic integration and cross-border trade since 9/11, the US administration under Donald Trump may again seek to thicken its border with Canada. This systematic review evaluates 13 years of research on the consequences of post-9/11 border thickening on Canada-US trade and commercial relations. Applying rigorous methods for the conduct of systematic reviews, 19 studies were included in the final analysis and grouped into four analytic themes: aggregate trade, sector, region, and passenger flows. We find that overall bilateral trade was negatively impacted following 9/11 but Canadian economic interests were harmed more seriously than those of the US. We also find differing consequences for cross-border flows according to region, sector and firm size. In addition, efforts focused on border transport policies to mitigate these consequences were effective but underutilized, especially in regions and sectors that did not depend on cross-border integration. Our findings offer important long-term lessons for policymakers on both sides of the border. Highlights • This systematic review synthesizes 13 years of research on post 9/11 border thickening between Canada and the US. • Canadian economic interests were more negatively impacted, varying by sector, region and level of cross-border integration. • Bilateral initiatives designed to simplify border crossing processes following 9/11 were helpful but underutilized. • Border thickening can have major consequences for both economies. Policy suggestions to mitigate such effects are offered. [ABSTRACT FROM AUTHOR]

Torrefaction of some non-lignocellulose waste biomass was attempted to examine if such materials could benefit from this process as conventional lignocellulose biomass does. Experiments were conducted on chicken litter, digested sludge, and undigested sludge from a municipality in Canada. Effects of two important torrefaction process parameters: temperature and residence time on the torrefaction yield were studied. For reference, torrefaction of three lignocellulose biomass (switch grass, coffee husk, and wood pellet) was also carried out in the same apparatus under identical conditions. A comparison of torrefaction yield and other properties of these biomass showed that in spite of the large difference in their constitution the torrefaction behaviour of non-lignocellulose and lignocellulose biomass were similar. The increase in energy density after torrefaction and the effect of temperature and residence time on torrefaction were also similar for these two types. The present research made an important addition to the existing database on torrefaction of biomass by adding missing information on torrefaction of sludge and poultry litter. Additionally, this work unearthed a potential option for production of composite pellets of waste (e.g., sludge) mixed with biomass (e.g., switch grass). © 2011 Canadian Society for Chemical Engineering [ABSTRACT FROM AUTHOR]

The Prairie provinces of Canada have about 80% of Canada's agricultural land and contribute to more than 90% of the nation's wheat and canola production. A future change in the surface water balance over this region could seriously affect Canada's agro-economy. In this study, we examined 25 ensemble members of historical (1975 to 2005), near future (2021–2050), far future (2050–2080), and end of the century (2080–2100) simulations of the Canadian Earth System Model version 5 (CanESM5) from the Coupled Model Intercomparison Project Phase 6 (CMIP6). A comprehensive analysis of a new Net Water Balance Index (NWBI) indicates an increased growing season dryness despite increased total precipitation over the Prairie provinces. Evapotranspiration increases by 100–300 mm with a 10–20% increase in moisture loss due to transpiration. Total evaporation decreases by 15–20% as the fractional contribution of evaporation from soil decreases by 20–25%. Total evaporation from vegetation increases by 10–15%. These changes in the surface water balance suggest enhanced plant productivity when soil moisture is sufficient, but evaporative water loss that exceeds precipitation in most years. [ABSTRACT FROM AUTHOR]

The Great Lakes Water Quality Agreement stipulates that the Governments of Canada and the United States are responsible for restoring and maintaining the chemical, physical and biological integrity of the waters of the Great Lakes Basin Ecosystem. Due to varying mandates and areas of expertise, monitoring to assess progress towards this objective is conducted by a multitude of Canadian and U.S. federal and provincial/state agencies, in cooperation with academia and regional authorities. This paper highlights selected long-term monitoring programs and discusses a number of documented ecological changes that indicate the present state of the open and nearshore waters of the Great Lakes. [ABSTRACT FROM AUTHOR]

The article discusses mercury exposure affecting the breeding grounds of yellow-billed loons in Alaska and Canada, based on an experimental study to determine the risks posed by mercury originating from waters in eastern Asia. Study results show that mercury concentrations in blood, feather, and egg tissues from live loons and museum specimens have lowered the species' productivity. Findings also indicate that mercury is an environmental stressor for yellow-billed loons in the Arctic habitats.

Waste seaweed that is collected at coastal regions of maritime provinces in Canada is creating ecological problems as it promotes an anoxic event, which produces nearly zero dissolved oxygen in water along with hydrogen sulfide emission. The work done in this study attempts to address this issue by producing a coal-like solid hydrochar and nutritious liquid slurry (processed water) by employing a rather recent thermo-chemical process called hydrothermal carbonization (HTC) on the seaweed. The HTC was carried out in a batch reactor system for three different reaction temperatures, 180 °C, 200 °C, 220 °C, and three different reaction times, 30, 60, and 120 min. Each of the produced hydrochars was characterized by different analytical methods. The effects of the process conditions on the yield and the properties of the hydrochar and process water were examined. The hydrochar produced at 220 °C and 120 min showed the highest carbon content (48.5%) and heating value (18.93 MJ/kg). The energy density and carbon to nitrogen (C/N) ratio in the hydrochar increased significantly as compared to raw seaweed. Moreover, HTC reduced the ash yield and volatile compounds of the seaweed. Thus, hydrochar can be used as a fuel for direct combustion, in soil remediation, or in carbon sequestration applications. [ABSTRACT FROM AUTHOR]

How to sustain spaces of peace and non-violence is a central concern of many refugee and immigrant groups arriving in their adopted homelands. Because these groups may have fled war-torn countries; political oppression; or economic, social or cultural hardships, the sustenance of community cohesion, everyday living, and the negotiation of life itself are paramount. The role of public spaces and institutions in host societies builds on the notion of nimmathi, the Tamil term for "peace." In order to understand marginalized groups' perceptions of public spaces and institutions, and the ways in which these perceptions diverge from mainstream uses and expectations, this paper explores the everyday practices, friendships and relationships, and barriers and struggles faced by new immigrant and refugee communities. The communities we are working with are predominantly new immigrants and refugees of South Asian, African, Caribbean, and Latin American origin, and their service providers. Of particular interest are the strategies and tactics that marginalized groups resort to, to redefine the meanings and uses of various kinds of public spaces. Building on census data gathered for neighbourhoods across the city of Toronto, we present some focus group results that offer a particularly powerful and critical perspective on the way spaces are defined and imagined. Community participants' knowledge and use of the city was highly localized, with service agencies providing an essential anchor and rootedness to associational relationships and ties to the city. Access and mobility were repeatedly raised by participants as key factors influencing choices of where it was safe and comfortable to go. Community members use available resources to counter the isolation and exclusion they feel, but their access and mobility are nevertheless affected by insufficient built infrastructure (e.g., public transit, facilities) and by personal discomfort and social boundaries. The knowledge provided by participants has led us to rethink the nature of the policy recommendations that would address these issues of access and mobility. Specifically, we need to reconsider the role of personal and emotional connections in underpinning successful networks (such as by establishing trust), and the community mobilization necessary to create sustainable and socially just public spaces--towards what communities envision as a City of Nimmathi. [ABSTRACT FROM AUTHOR]

This paper explores the possibilities of discovering, sharing, and transforming school-community linkages through proactive outreach programs that are of particular relevance to public elementary schools catering to a large refugee and immigrant population. The authors argue that community-school linkages, as currently understood and discussed in the literature, are primarily focused on unidirectional relations, but certainly have the potential of furthering the particular needs of these children and their families in more productive ways. A wealth of untapped opportunities and creative capacities exist in the community that provide the potential for 'bridging and bonding' social capital where the response is sensitive to power relations that can arise from hegemonic interactions. School-community linkages are crucial for displaced communities further isolated and stigmatized in underserved and deprived pockets of the city. These are particularly evident in Toronto's post-war suburbs, such as Scarborough, where the concentration of neighbourhood poverty is well documented, but where the energy and creativity in the production of its social and cultural landscape, and the commitment of its citizens, are less noted. Based on an outreach workshop held in one such school, the potential of a sustainable emancipatory school-community framework is explored. [ABSTRACT FROM AUTHOR]

We measured the levels of ortho-substituted polychlorinated biphenyls (PCB), organochlorinated pesticides (OCP), and polybrominated diphenyl ethers (PBDE) in the cerebral cortex of river otters (Lontra canadensis) trapped from Ontario and Nova Scotia between 2002 and 2004. The mean concentration of total PCBs was 70.9±12.1ng/g l.w., and congeners 153, 180 and 138 accounted for nearly 60% of the sum. The mean concentration of total OCPs was 21.2±3.7ng/g l.w., and hexachlorobenzene (32.6% of total) and DDE (28.1%) accounted for the majority. The mean concentration of total PBDEs was 3.2±0.6ng/g l.w., and congeners 99 (44.9%), 153 (30.5%), and 100 (24.7%) were measured at the indicated percentages. There was no relationship between these residue data and concentrations of brain mercury or neurochemical receptors and enzymes as determined in earlier studies on these same animals. [Copyright &y& Elsevier]

The globalization of neo-liberal policy solutions to education problems has gained increasing dominance in recent years. In Ontario, Canada the success of this ideological discourse, particularly during the past decade, has been hard to combat due to the ideal message that it conveys to the general electorate, that is one based on efficiency, accountability and equity of resources across different school boards in the province. Despite protests from many activist groups (i.e. unions, educators, parent-groups) the implementation of such policies has been largely successful. By tracking education policies, statements and events, newspaper articles and other policy reports from 1995 to 2000, this paper seeks to understand the nature of its success during the early years of restructuring. I argue that part of the success lies in understanding the techniques and strategies of implementation or the process of rationalization. I argue that policies formulated at one spatial level operate quite differently at another and the spatial disjunctures that arise as a result of this process lead to the continued success of neo-liberal ideologies and inequalities in education. [Copyright &y& Elsevier]

The notion of social capital in contemporary societies is viewed as being necessary for the rejuvenation of civil society. However, such assumptions are based on inclusionary democratic practices; the heterogeneity of societal needs and the underlying power structures are often not taken into account. The author explores the possibility of examining neighbourhood-based social capital along the lines of ‘intrinsic’ (within neighbourhood) and ‘extrinsic’ (neighbourhood-city) relations. A spatial comparison of such preexisting, dense, dynamic networks of everyday mundane activities often leads to a better understanding of how power is created, maintained, and eventually used in times of neighbourhood crises. More specifically, by using a Flyvbjergian perspective of rationality and power, the author combines the notion of social capital as proposed by Putnam with Epstein's framework of participation within schools, to identify variations in civic activities within Public Elementary School Districts in Toronto (TDSB). Drawing from a unique descriptive dataset on parental and community participation available from the TDSB, and by combining it with enumeration-area data aggregated at the school-district level, this framework is empirically tested to gain an understanding of how such links relate to school-closure decisions. Within the context of education reform in Ontario, the results reveal the paradoxical nature of social capital in promoting and subjugating notions of democracy and civil society. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems rely heavily upon human resources to ensure high-quality access to care for the general population. With significant health worker shortages predicted worldwide in the coming decades, maximizing the current workforce by means of a physician resource planning (PRP) strategy that ensures the right number, mix, and distribution of physicians to meet population needs is warranted. In Canada, there is an insufficient number of primary care providers, and disproportionately low numbers of specialist physicians in rural compared to urban regions. Currently, Canadian medical students are not effectively included in PRP strategy and lack the required information for career orientation to help rebalance the population's workforce needs. This paper present the Health Human Resource (HHR) Platform, a comprehensive web tool that includes relevant workforce data to empower medical students in choosing a discipline based on both personal interests and social accountability.Results: Physician workforce data, comments from Canadian residency program directors, and career planning resources were collected by the Canadian Federation of Medical Student's (CFMS) HHR Task Force. This information was consolidated to create a national interactive platform that uses a map, comparison table, and trend graphs to illustrate over 500,000 unique data points from 37 datasets, including specific information and resources spanning 62 medical specialties from 2015 onwards. There was a 24.6% response rate for program director comments. During the first 4 months of the HHR Platform launch, there were 2434 different users, of which 985 were returning, with an average of 20.0 users per day spending on average 3 min on the platform.Conclusions: The HHR Platform constitutes a national approach to PRP informing medical students on the mix and distribution of physicians needed to meet the future healthcare demands of the Canadian population. [ABSTRACT FROM AUTHOR]

Background There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice of first-practice location for new geriatricians in the context of an aging Canadian population. Methods We distributed an online survey to geriatric medicine subspecialty residents and recently licensed geriatricians in Canada. The survey was developed through expert opinions, career planning sessions, and a literature review. There were nine survey sections: general characteristics, location determinants, practice determinants, colleague determinants, support and space, non-clinical opportunities, income models, lifestyle factors, and recruitment determinants. The data were analyzed descriptively. Results A total of 61 respondents (51 English, 10 French) completed the survey. The respondents were new practicing geriatricians (37) and geriatric medicine residents (24). Most planned to practice in Ontario (26.2%) or Quebec (27.9%), and 75.4% were women. Flexibility in work-life balance (95.1%), collegiality (93.4%) and reasonable call schedules (93.4%) were the most important factors influencing first practice location. Income did not rank among the highest priorities for choosing the first practice location relative to other factors but was mentioned in open-ended responses to recruitment questions. Conclusions This is the first survey identifying the determinants of first practice location in geriatric medicine in Canada. Work-life balance and collegial support are a priority for new geriatricians and may be the strongest incentives a program can provide. For recruitment, income incentives may be beneficial to building new specialized geriatric services. Future research will examine determinants of first practice location among Care of the Elderly clinicians. [ABSTRACT FROM AUTHOR]

Background Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's preparedness to meet the social and healthcare needs of an aging population, the increasing incidence of food insecurity is particularly affecting vulnerable groups, such as older Canadians, with implications for their healthcare service utilization. Despite this observation, there are nascent studies examining the role of household food insecurity status on unmet health-care needs among older people in Canada. The main objective of our study is to assess the association between household food insecurity and unmet health-care needs among older Canadians. Methods We used data from a selected sample of 21,178 participants as part of the 2017--18 Canadian Community Health Survey and applied logistic regression analysis. Results Our findings indicate that older people experiencing any type of food insecurity, that is, either moderate (OR=3.07, p<.01) or severe (OR=4.09, p<.01) were more likely to have reported unmet health-care needs compared to their counterparts in food secure households, even after controlling for a range of demographic, socioeconomic, and health and health-care variables. Our finding is concerning, considering that older people in Canada who are in most need of health-care services due to their food insecurity status are instead reporting unmet health-care needs. Conclusion This revelation calls for urgent policy attention to reduce the episodes of household food insecurity among older people in Canada. Specifically, to improve their access to health-care services, providing them with periodic grocery rebates as part of the social protection package for seniors in Canada would help mitigate the problem of food insecurity among them. [ABSTRACT FROM AUTHOR]

An ARIMA (1, 1, 0) model for the Canadian union membership growth from 1911 to 1985 is introduced. Predictions for the period 1986-91 are made, and the actual figures for 1986-88 are compared to assess the predictability of the model. Diagnostic checks of the validity of this ARIMA model are also performed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Folic acid (FA) supplementation may attenuate the associations between gestational exposure to certain chemicals and autism or autistic-like behaviors, but to our knowledge, this has not been assessed for lead. OBJECTIVES: We examined whether the relationship between gestational blood-lead levels (BLLs) and autistic-like behaviors was modified by gestational plasma total folate concentrations, FA supplementation, and maternal methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype. METHODS: We used data from the Maternal–Infant Research on Environmental Chemicals study (2008–2011), a Canadian pregnancy and birth cohort study. Childhood autistic-like behaviors were documented in 601 children 3–4 y of age with the Social Responsiveness Scale-2 (SRS-2), where higher scores denote more autistic-like behaviors. We measured BLLs and plasma total folate concentrations during the first and third trimesters of pregnancy. We also estimated gestational FA supplementation via surveys and genotyped the maternal MTHFR 677C>T single nucleotide polymorphism (SNP). We estimated the confounder-adjusted associations between log2-transformed BLLs and SRS-2 scores by two indicators of folate exposure and maternal MTHFR 677C>T genotype using linear regression. RESULTS: Third-trimester BLLs were associated with increased SRS-2 scores [β[sub 푎푑푗] = 3.3; 95% confidence interval (CI): 1.1, 5.5] among participants with low (<10th percentile), third-trimester, plasma total folate concentrations, but BLL-SRS-2 associations were null (β[sub 푎푑푗] = -0.3; 95% CI: -1.2, 0.5) among those in the middle category (≥10th and <80th percentiles) (푝-interaction <0.001). FA supplementation also attenuated these associations. Both folate indicators modified first-trimester BLL-SRS-2 associations, but to a lesser extent. Third-trimester BLL-SRS-2 associations were slightly stronger among participants who were homozygous for the T (minor) allele of the MTHFR 677C>T SNP (β[sub 푎푑푗]= 0.9; 95% CI: -1.2, 3.1) than those without the T allele (β[sub 푎푑푗] = -0.3; 95% CI: -1.3, 0.7), but the difference was not statistically significant (푝-interaction = 0.28). DISCUSSION: Folate may modify the associations between gestational lead exposure and childhood autistic-like behaviors, suggesting that it mitigates the neurotoxic effects of prenatal lead exposure. [ABSTRACT FROM AUTHOR]

Introduction: Adult respiratory syncytial virus (RSV) burden is underestimated due to non-specific symptoms, limited standard-of-care and delayed testing, reduced diagnostic test sensitivity—particularly when using single diagnostic specimen—when compared to children, and variable test sensitivity based on the upper airway specimen source. We estimated RSV-attributable hospitalization incidence among adults aged ≥ 18 years in Ontario, Canada, using a retrospective time-series model-based approach. Methods: The Institute for Clinical Evaluative Sciences data repository provided weekly numbers of hospitalizations (from 2013 to 2019) for respiratory, cardiovascular, and cardiorespiratory disorders. The number of hospitalizations attributable to RSV was estimated using a quasi-Poisson regression model that considered probable overdispersion and was based on periodic and aperiodic time trends and viral activity. As proxies for viral activity, weekly counts of RSV and influenza hospitalizations in children under 2 years and adults aged 60 years and over, respectively, were employed. Models were stratified by age and risk group. Results: In patients ≥ 60 years, RSV-attributable incidence rates were high for cardiorespiratory hospitalizations (range [mean] in 2013–2019: 186–246 [215] per 100,000 person-years, 3‒4% of all cardiorespiratory hospitalizations), and subgroups including respiratory hospitalizations (144–192 [167] per 100,000 person-years, 5‒7% of all respiratory hospitalizations) and cardiovascular hospitalizations (95–126 [110] per 100,000 person-years, 2‒3% of all cardiovascular hospitalizations). RSV-attributable cardiorespiratory hospitalization incidence increased with age, from 14–18 [17] hospitalizations per 100,000 person-years (18–49 years) to 317–411 [362] per 100,000 person-years (≥ 75 years). Conclusions: Estimated RSV-attributable respiratory hospitalization incidence among people ≥ 60 years in Ontario, Canada, is comparable to other incidence estimates from high-income countries, including model-based and pooled prospective estimates. Recently introduced RSV vaccines could have a substantial public health impact. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders (SUDs) and mental health disorders (MHDs) are significant public health challenges with far-reaching consequences on individuals and society. Dual diagnosis, the coexistence of SUDs and MHDs, poses unique complexities and impacts treatment outcomes. A research landscape analysis was conducted to explore the growth, active countries, and active journals in this field, identify research hotspots, and emerging research topics. Method: A systematic research landscape analysis was conducted using Scopus to retrieve articles on dual diagnosis of SUDs and MHDs. Inclusion and exclusion criteria were applied to focus on research articles published in English up to December 2022. Data were processed and mapped using VOSviewer to visualize research trends. Results: A total of 935 research articles were found. The number of research articles on has been increasing steadily since the mid-1990s, with a peak of publications between 2003 and 2012, followed by a fluctuating steady state from 2013 to 2022. The United States contributed the most articles (62.5%), followed by Canada (9.4%). The Journal of Dual Diagnosis, Journal of Substance Abuse Treatment, and Mental Health and Substance Use Dual Diagnosis were the top active journals in the field. Key research hotspots include the comorbidity of SUDs and MHDs, treatment interventions, quality of life and functioning, epidemiology, and the implications of comorbidity. Emerging research topics include neurobiological and psychosocial aspects, environmental and sociocultural factors, innovative interventions, special populations, and public health implications. Conclusions: The research landscape analysis provides valuable insights into dual diagnosis research trends, active countries, journals, and emerging topics. Integrated approaches, evidence-based interventions, and targeted policies are crucial for addressing the complex interplay between substance use and mental health disorders and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Canada’s care systems are ill-equipped to support its aging population, and this crisis intertwines with an acute shortage of affordable housing. Immigrants to Canada have a higher propensity to cohabitate multi-generationally, an arrangement that is sometimes romanticized as an ideal form of senior care. This article contributes to scholarship exploring intergenerational cohabitation as a practice of care, using life course research to consider how class and migration timing shape experiences of intergenerational living and senior care. Based on 19 in-depth interviews with immigrant seniors from Latin America and the Caribbean (n=10) and family caregivers (n=9) living in the Greater Toronto Area, this study uncovers two central findings. First, intergenerational living should not be viewed as an ideal form of senior care since (1a) some seniors resist intergenerational living, preferring independence and downtown residence nearer to culturally relevant communities and (1b) cohabitation does not always provide sufficient or better care. Second, access to smooth multigenerational cohabitation is inequitable, as housing arrangements are structured by class and migration timing, with middle-class families who have been in Canada longer facing fewer barriers to positive experiences of intergenerational living, compared to more recent migrants with lower incomes. This article challenges culturally essentializing assumptions about immigrant intergenerational cohabitation and argues that access to affordable housing is a senior care issue. [ABSTRACT FROM AUTHOR]

This article examines a popularized term, the Global Education Reform Movement (GERM), and its underlying paradigm of neoliberalism. It elucidates neoliberalism's maddening effects on the education sector, especially public education. To analyze these effects, I draw from and adapt Michel Foucault's analytical approach to madness. My analysis focuses on the following maddening effects of neoliberalism on education: (1) it obstructs us from seeing inequalities; (2) it creates a desperate passion amid the rise of school choice; and (3) it eliminates reason and creates unreason in the school selection and admissions processes. My analysis is based on reflections on my decade-long research on school marketization and school choice in Canada. I conclude by suggesting that collective visions and concrete steps are needed to move toward equitable educational structures, discourses, and practices that resist or challenge the neoliberal education reform madness (NERM). [ABSTRACT FROM AUTHOR]

Countries face challenges in paying for new drugs. High prices are driven in part by exploding drug development costs, which, in turn, are driven by essential but excessive regulation. Burdensome regulation also delays drug development, and this can translate into thousands of life-years lost. We need system-wide reform that will enable less expensive, faster drug development. The speed with which COVID-19 vaccines and AIDS therapies were developed indicates this is possible if governments prioritize it. Countries also differ in how they value drugs, and generally, those willing to pay more have better, faster access. Canada is used as an example to illustrate how "incremental cost-effectiveness ratios" (ICERs) based on measures such as gains in "quality-adjusted life-years" (QALYs) may be used to determine a drug's value but are often problematic, imprecise assessments. Generally, ICER/QALY estimates inadequately consider the impact of patient crossover or long post-progression survival, therapy benefits in distinct subpopulations, positive impacts of the therapy on other healthcare or societal costs, how much governments willingly might pay for other things, etc. Furthermore, a QALY value should be higher for a lethal or uncommon disease than for a common, nonlethal disease. Compared to international comparators, Canada is particularly ineffective in initiating public funding for essential new medications. Addressing these disparities demands urgent reform. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence suggests that prenatal air pollution exposure alters DNA methylation (DNAm), which could go on to affect long-term health. It remains unclear whether DNAm alterations present at birth persist through early life. Identifying persistent DNAm changes would provide greater insight into the molecular mechanisms contributing to the association of prenatal air pollution exposure with atopic diseases. OBJECTIVES: This study investigated DNAm differences associated with prenatal nitrogen dioxide (NO2) exposure (a surrogate measure of trafficrelated air pollution) at birth and 1 y of age and examined their role in atopic disease. We focused on regions showing persistent DNAm differences from birth to 1 y of age and regions uniquely associated with postnatal NO2 exposure. METHODS: Microarrays measured DNAm at birth and at 1 y of age for an atopy-enriched subset of Canadian Health Infant Longitudinal Development (CHILD) study participants. Individual and regional DNAm differences associated with prenatal NO2 (푛= 128) were identified, and their persistence at age 1 y were investigated using linear mixed effects models (푛= 124). Postnatal-specific DNAm differences (푛= 125) were isolated, and their association with NO2 in the first year of life was examined. Causal mediation investigated whether DNAm differences mediated associations between NO2 and age 1 y atopy or wheeze. Analyses were repeated using biological sex-stratified data. RESULTS: At birth (푛= 128), 18 regions of DNAm were associated with NO2, with several annotated to HOX genes. Some of these regions were specifically identified in males (푛= 73), but not females (푛= 55). The effect of prenatal NO2 across CpGs within altered regions persisted at 1 y of age. No significant mediation effects were identified. Sex-stratified analyses identified postnatal-specific DNAm alterations. DISCUSSION: Regional cord blood DNAm differences associated with prenatal NO2 persisted through at least the first year of life in CHILD participants. Some differences may represent sex-specific alterations, but replication in larger cohorts is needed. The early postnatal period remained a sensitive window to DNAm perturbations. [ABSTRACT FROM AUTHOR]

COVID-19 disrupted cancer control worldwide, impacting preventative screening, diagnoses, and treatment services. This modelling study estimates the impact of disruptions on colorectal cancer cases and deaths in Canada and Australia, informed by data on screening, diagnosis, and treatment procedures. Modelling was used to estimate short- and long-term effects on colorectal cancer incidence and mortality, including ongoing impact of patient backlogs. A hypothetical mitigation strategy was simulated, with diagnostic and treatment capacities increased by 5% from 2022 to address backlogs. Colorectal cancer screening dropped by 40% in Canada and 6.3% in Australia in 2020. Significant decreases to diagnostic and treatment procedures were also observed in Australia and Canada, which were estimated to lead to additional patient wait times. These changes would lead to an estimated increase of 255 colorectal cancer cases and 1,820 colorectal cancer deaths in Canada and 234 cases and 1,186 deaths in Australia over 2020–2030; a 1.9% and 2.4% increase in mortality, respectively, vs a scenario with no screening disruption or diagnostic/treatment delays. Diagnostic and treatment capacity mitigation would avert 789 and 350 deaths in Canada and Australia, respectively. COVID-related disruptions had a significant impact on colorectal cancer screening, diagnostic, and treatment procedures in Canada and Australia. Modelling demonstrates that downstream effects on disease burden could be substantial. However, backlogs can be managed and deaths averted with even small increases to diagnostic and treatment capacity. Careful management of resources can improve patient outcomes after any temporary disruption, and these results can inform targeted approaches early detection of cancers. [ABSTRACT FROM AUTHOR]

Lettuce is an economically major leafy vegetable that is affected by numerous diseases. One of the most devastating diseases of lettuce is white mold caused by Sclerotinia sclerotiorum. Control methods for this fungus are limited due to the development of genetic resistance to commonly used fungicides, the large number of hosts and the long-term survival of sclerotia in soil. To elaborate a new and more sustainable approach to contain this pathogen, 1,210 Pseudomonas strains previously isolated from agricultural soils in Canada were screened for their antagonistic activity against S. sclerotiorum. Nine Pseudomonas strains showed strong in vitro inhibition in dual-culture confrontational assays. Whole genome sequencing of these strains revealed their affiliation with four phylogenomic subgroups within the Pseudomonas fluorescens group, namely Pseudomonas corrugata, Pseudomonas asplenii, Pseudomonas mandelii, and Pseudomonas protegens. The antagonistic strains harbor several genes and gene clusters involved in the production of secondary metabolites, including mycin-type and peptin-type lipopeptides, and antibiotics such as brabantamide, which may be involved in the inhibitory activity observed against S. sclerotiorum. Three strains also demonstrated significant in planta biocontrol abilities against the pathogen when either inoculated on lettuce leaves or in the growing substrate of lettuce plants grown in pots. They however did not impact S. sclerotiorum populations in the rhizosphere, suggesting that they protect lettuce plants by altering the fitness and the virulence of the pathogen rather than by directly impeding its growth. These results mark a step forward in the development of biocontrol products against S. sclerotiorum. [ABSTRACT FROM AUTHOR]

This paper examines the impact of the United Nations sustainable development goals (SDGs) on community investment (CI), otherwise known as corporate philanthropic expenditures, among Canada's leading private sector companies. The study investigates whether there have been discernible shifts in CI relative to net profit after tax (NPAT) before and after the introduction of the SDGs in 2015, and whether corporations' commitment to the SDGs and/or membership in the United Nations Global Compact (UNGC) have resulted in material increases to CI expenditures. The analysis is based on descriptive statistics, comparing the mean and standard deviation of CI as a percentage of NPAT across 58 firms included in our study. The findings reveal a minor decrease in CI as a percentage of NPAT following the introduction of the SDGs and lower average CI amounts among corporations committed to the SDGs and firms with UNGC membership. This paper offers an interpretive analysis of the results, highlighting the implications of potential greenwashing and the importance of corporate transparency. Further, we emphasize the need for policies to ensure genuine corporate financial commitment to socioeconomic and environmental causes. [ABSTRACT FROM AUTHOR]

The heat-related health burden is expected to persist and worsen in the coming years due to an aging global population and climate change. Defining the breadth and depth of our understanding of age-related changes in thermoregulation can identify underlying causes and strategies to protect vulnerable individuals from heat. We conducted the first systematic quantitative literature review to provide context to the historical experimental research of healthy older adults – compared to younger adults or unhealthy age matched cases – during exogenous heat strain, focusing on factors that influence thermoregulatory function (e.g. co-morbidities). We identified 4,455 articles, with 147 meeting eligibility criteria. Most studies were conducted in the US (39%), Canada (29%), or Japan (12%), with 71% of the 3,411 participants being male. About 71% of the studies compared younger and older adults, while 34% compared two groups of older adults with and without factors influencing thermoregulation. Key factors included age combined with another factor (23%), underlying biological mechanisms (18%), age independently (15%), influencing health conditions (15%), adaptation potential (12%), environmental conditions (9%), and therapeutic/pharmacological interventions (7%). Our results suggest that controlled experimental research should focus on the age-related changes in thermoregulation in the very old, females, those with overlooked chronic heat-sensitive health conditions (e.g. pulmonary, renal, mental disorders), the impact of multimorbidity, prolonged and cumulative effects of extreme heat, evidence-based policy of control measures (e.g. personal cooling strategies), pharmaceutical interactions, and interventions stimulating protective physiological adaptation. These controlled studies will inform the directions and use of limited resources in ecologically valid fieldwork studies. [ABSTRACT FROM AUTHOR]

The adverse effects of thawing permafrost on transportation infrastructure in northern regions are exacerbated by climate change. To address this issue, remote sensing techniques can be employed to track deformations in these structures over time. This will allow us to identify regions that are most vulnerable to permafrost degradation, and implement climate adaptation strategies accordingly. The Sentinel-2 mission provides highly suitable data for multitemporal analysis due to its high temporal resolution and multispectral coverage. However, the geometrical misalignment of Sentinel-2 imagery presents a significant challenge for such analysis. In this study, we propose an automatic sub-pixel coregistration algorithm for satellite image time series, specifically focusing on estimating the deformation of linear infrastructure in northern Canada. Our approach involves utilizing a deep learning model to generate binary masks of roads, which are then used to match and align the images. We demonstrate the feasibility of achieving sub-pixel coregistration through road alignment on a small dataset of high-resolution Sentinel-2 images from the town of Gillam in northern Canada. This represents an initial step toward training a road deformation prediction model, which can ultimately contribute to improved infrastructure resilience and adaptation to changing climatic conditions. [ABSTRACT FROM AUTHOR]

Background: The Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals. Results: Forty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from.72 to.97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not. Conclusion: The BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions. [ABSTRACT FROM AUTHOR]

In an increasingly human- and road-dominated world, the preservation of functional ecosystems has become highly relevant. While the negative ecological impacts of roads on ecosystems are numerous and well documented, roadless areas have been proposed as proxy for functional ecosystems. However, their potential remains underexplored, partly due to the incomplete mapping of roads. We assessed the accuracy of roadless areas identification using freely available road-data in two regions with contrasting levels of anthropogenic influence: boreal Canada and temperate Central Europe (Poland, Slovakia, Czechia, and Hungary). Within randomly selected circular plots (per region and country), we visually examined the completeness of road mapping using OpenStreetMap 2020 and assessed whether human influences affect mapping quality using four variables. In boreal Canada, roads were completely mapped in 3% of the plots, compared to 40% in Central Europe. Lower Human Footprint Index and road density values were related to greater incompleteness in road mapping. Roadless areas, defined as areas at least 1 km away from any road, covered 85% of the surface in boreal Canada (mean size ± s.d. = 272 ± 12,197 km2), compared to only 0.4% in temperate Central Europe (mean size ± s.d. = 0.6 ± 3.1 km2). By visually interpreting and manually adding unmapped roads in 30 randomly selected roadless areas from each study country, we observed a similar reduction in roadless surface in both Canada and Central Europe (27% vs 28%) when all roads were included. This study highlights the urgent need for improved road mapping techniques to support research on roadless areas as conservation targets and surrogates of functional ecosystems. [ABSTRACT FROM AUTHOR]

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time. [ABSTRACT FROM AUTHOR]

Background: Here, the perspective of patients with primary and secondary immunodeficiency receiving subcutaneous immunoglobulin (SCIg) via introductory smaller size pre-filled syringes (PFS) or vials were compared. Methods: An online survey was conducted in Canada by the Association des Patients Immunodéficients du Québec (APIQ) (10/2020–03/2021). Survey questions included: reasons for choosing SCIg packaging and administration methods, training experiences, infusion characteristics, and switching methods. The survey captured structured patient-reported outcomes: treatment satisfaction and its sub-domains, symptom state, general health perception, and physical and mental function. Respondents using PFS were compared with vial users, overall and stratified by their administration method (pump or manual push). Results: Of the 132 total respondents, 66 respondents used vials, with 38 using a pump and 28 using manual push. PFS (5 and 10 mL sizes) were being used by 120 respondents, with 38 using a pump and 82 using manual push. PFS users were associated with a 17% lower median (interquartile range) SCIg dose (10 [8, 12] vs. 12 [9, 16] g/week, respectively), a significantly shorter infusion preparation time (15 [10, 20] vs. 15 [10, 30] mins, respectively), and a trend for shorter length of infusion (60 [35, 90] vs. 70 [48, 90] mins, respectively) compared with those on vials. Patient-reported treatment satisfaction scores were overall similar between vial and PFS users (including on the domains of effectiveness and convenience), except for a higher score for vials over PFS on the domain of global satisfaction (p=0.02). Conclusions: Consistent with prescribing that reflects a recognition of less wastage, PFS users were associated with a significantly lower SCIg dose compared with vial users. PFS users were also associated with shorter pre-infusion times, reflecting simpler administration mechanics compared with vial users. Higher global satisfaction with treatment among vial users compared with PFS users was consistent with users being limited to smaller PFS size options in Canada during the study period. Patient experience on PFS is expected to improve with the introduction of larger PFS sizes. Overall, treatment satisfaction for SCIg remains consistently high with the introduction of PFS packaging compared with vials. [ABSTRACT FROM AUTHOR]

Background Fluoride may be a developmental neurotoxicant at elevated exposures. We merged new data from a prospective Odense Child Cohort (OCC) with results from two previous birth cohort studies from Mexico and Canada to characterize the dose–effect relationship in greater detail. Methods The OCC contributed 837 mother–child pairs to the total of >1500. We measured creatinine-adjusted urine-fluoride concentrations in maternal urine samples obtained during late pregnancy. Child IQ was determined at age 7 years using an abbreviated version of the Wechsler Intelligence Scales for Children. Findings from the three cohorts were used to calculate the joint benchmark concentration (BMC) and the lower confidence limit (BMCL) after adjustment for covariables. Results In the OCC, urine-fluoride concentrations varied between 0.08 and 3.04 mg/l (median 0.52 mg/l) but were not significantly associated with full-scale IQ at age 7 years (β = 0.08; 95% confidence interval −1.14 to 1.30 for a doubling in exposure). No difference was apparent between boys and girls. In the OCC, the BMC was 0.92 mg/l, with a BMCL of 0.30 mg/l. The joint analysis of all three cohorts showed a statistically significant association between urine-fluoride and IQ, with a BMC of 0.45 mg/l (BMCL, 0.28 mg/l), slightly higher than the BMC previously reported for the two North American cohorts alone. Conclusions As the BMCL reflects an approximate threshold for developmental neurotoxicity, the results suggest that pregnant women and children may need protection against fluoride toxicity. [ABSTRACT FROM AUTHOR]

Purpose: Variations in customer expectations pose a challenge to service quality improvement in the airline industry. Understanding airline customers' expectations and satisfaction help service providers improve their offerings. The extant literature examines airline passengers' expectations in isolation, neglecting the overall impact of online reviews on service quality improvement. This paper systematically evaluates the airline industry's passengers' expectations and satisfaction using expectation confirmation theory (ECT) and the SERVQUAL framework. The paper analyzes online reviews to examine the relationship between airline service quality attributes and passengers' satisfaction. Design/methodology/approach: The SERVQUAL framework was employed to examine the effects of customer culture, the reason for traveling, and seat type on customer's expectations and satisfaction across a large sample of airline customers. Findings: A total of 17,726 observations were gathered from the Skytrax review website. The lowest satisfaction ratings were from passengers from the USA, Canada and India. Factors that affect perceived service performance include customer service, delays and baggage management. Empathy and reliability have the biggest impact on the perceived satisfaction of passengers. Research limitations/implications: This research increases understanding of the consumer expectations through analysis of passengers' online reviews. Results are limited to a small sample of airline industries. Practical implications: This study provides airlines with valuable information to improve customer service by analyzing online reviews. Social implications: This study provides the opportunity for airline customers to gain better services when airline companies utilize the findings. Originality/value: This paper offers insights into passengers' expectations and their perceived value for money in relation to seat types. Previous studies have not investigated value for money as a construct for passengers' expectations and satisfaction relative to service quality dimensions. This paper addresses this need. [ABSTRACT FROM AUTHOR]

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

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first‐line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in‐person delivery, few studies have assessed the role of therapist‐guided, manual‐based CBT for OCD delivered in real‐time via videoconferencing methods. The present study sought to fill this gap by comparing in‐person and online delivery of group‐based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group‐based CBT that was provided in‐person (pre‐COVID‐19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID‐19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2‐h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in‐person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post‐treatment. Videoconferenced, clinician‐led CBT may be a promising alternative to in‐person delivery for those with moderate to severe OCD symptoms. [ABSTRACT FROM AUTHOR]

Background: Currently, there are no standardized approaches to care or evaluation for tone dysfunction in Canada. The study authors hypothesize that there is significant practice variation across the country. This environmental scan is aimed to describe the current practice for management of paediatric patients with hypertonia across Canada. Methods: A web‐based survey was developed by the authors with a multi‐disciplinary approach and sent to representative paediatric rehabilitation sites in each province in Canada. Disciplines at the rehabilitation sites surveyed included all or some of the following disciplines: physiatry, neurology, neurosurgery, plastic surgery, orthopaedic surgery, physiotherapy and occupational therapy. All statistical analyses were performed using the R statistical software version 4.0. Fifteen rehabilitation sites were contacted, and 12 sites were used for the final analysis. Results: Cerebral palsy was found to be the most common diagnosis for tone dysfunction, with 58% of sites diagnosing greater than 20 new patients per year. In 67% of sites, patients were seen within a formal multidisciplinary clinic to manage hypertonia. All 12 sites utilized oral baclofen and gabapentin, and 92% of sites utilized trihexyphenidyl. Botulinum toxin injections were offered at 50% of sites. Upper and lower extremity surgical procedures were offered in 83% of the sites. Conclusion: The information gained from this study provides some insight into the current practice across Canada for children with hypertonia. This study may assist in the development of a national, standardized strategy to tone management, potentially facilitating more equitable access to care for patients. [ABSTRACT FROM AUTHOR]

Background: Transferring from paediatric to adult care can be challenging. Adolescents and young adults (AYAs) with chronic health conditions need to develop a specific set of skills to ensure lifelong medical follow‐up due to the chronicity of their condition. The Transition Readiness Assessment Questionnaire—French version (TRAQ‐FR) is a 19‐item questionnaire measuring such skills. The aims of the study were to (1) describe participant characteristics and (2) identify constructs related to, and predictors of, having learned domain‐specific transition readiness skills. Methods: Participants included 216 AYAs aged 14–20 years (M = 15.93; SD = 1.35; 54.1% male) recruited from five outpatient clinics in a Canadian tertiary hospital. AYAs completed the TRAQ‐FR, the Pediatric Quality of Life Inventory 4.0 (PedsQL) and a sociodemographic questionnaire. Descriptive, bivariate and binary logistic regression analyses were conducted. Results: Overall, participants reported significantly higher scores on the Talking with Providers, Managing Daily Activities and Managing Medications subscales than on the Appointment Keeping and Tracking Health Issues subscales (F[41075] = 168.970, p <.001). At the item level, median scores (on a 5‐point Likert scale) suggest that AYAs had begun practising five of the 19 skills (median scores ≥4; 'Yes, I have started doing this'), while a median score of 1 ('No, I don't know how') was found for one item ('Do you get financial help with school or work?'). At the subscale level, TRAQ‐FR skills and skill gaps were related to AYAs' age, sex and PedsQL scores (ps <.05). Conclusion: Older and female AYAs were more likely to have begun practising specific TRAQ‐FR subscale skills. Better psychosocial functioning was also related to having learned specific transition readiness skills. AYAs show several gaps in transition readiness. Targeted intervention in transition readiness skill development could take into account AYAs' age, sex and psychosocial functioning for a successful transfer to adult care. [ABSTRACT FROM AUTHOR]

Mustard seeds have been used since ancient times contributing great economic value to global agriculture. Canada, one of the world's top producers, grows three main mustard varieties, white /yellow, (Brassica hirta/Sinapis alba), black (Brassica nigra) and Oriental (Brassica juncea). Besides their high protein and lipid content, mustard varieties are a rich source of phenolic compounds. This review will cover mustard seed components including lipids, glucosinolates, and sinapates. The latter are the main phenolic compounds in mustard and include sinapine, sinapic acid and its conversion to canolol. The important bioactivities associated with mustard phenolics, has led to efforts to improve the methods for their extraction. The use of green technology is crucial for producing these phenolics while minimizing any detrimental effects to the environment. The important antioxidant and anticancer activities of these phenolics will also be reviewed. [ABSTRACT FROM AUTHOR]

In the last three decades, a cohort of genomicists have intentionally sought to include more racially diverse people in their research in human genomics and precision medicine. How such efforts to be inclusive in human genomic research and precision medicine are modeled and enacted, specifically if the terms of inclusion are equitable for these communities remains to be explored. In this commentary, we review the historical context in which issues of racial inclusion arose with early genome and genetics projects. We then discuss attempts to include racialized peoples in more recent human genomics research. In conclusion, we raise critical issues to consider in the future of equitable human genomics and precision medicine research involving racialized communities, particularly as it concerns working towards what we call Precision Health Equity (PHE). Specifically, we examine issues of genetic data governance and the terms of participation in inclusive human genomics and precision health research. We do so by drawing on insights and protocols developed by researchers investigating Indigenous Data Sovereignty and propose exploring their application and adaptation to precision health research involving racialized communities. [ABSTRACT FROM AUTHOR]