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Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. Method: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. Results: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. Conclusion: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

Occupational therapy practitioners are uniquely positioned to address the needs of cancer survivors. This study aimed to understand the complex needs of survivors using The Canadian Occupational Performance Measure and in-depth interviewing. A convergent, mixed methods approach was utilized with a purposive sample of 30 cancer survivors. The results indicate that while the COPM can be a practical tool to address basic occupational performance problems, the in-depth interviews exposed these challenges are intricately connected to identity, relationships, and roles. Implications for occupational therapy practitioners include a critical approach to evaluation and interventions to capture the complex needs of survivors. [ABSTRACT FROM AUTHOR]

A crosslinguistic study is underway concerning children's protracted phonological development (i.e. speech sound disorders). The current article reports pilot Spanish data for this study from two 4-year-old boys with protracted phonological development. The purposes of the pilot study were to: (1) develop and evaluate a word list for elicitation that could be used across Spanish dialects and that sufficiently sampled Spanish word lengths, stress patterns, word shapes and phonemes; and (2) to derive hypotheses for the larger study, based on patterns found in these children's speech, and a review of the literature. The two speakers showed some developmental patterns reported for other languages (e.g. constraints on production of liquids and word-initial consonants in unstressed syllables) but also patterns that may reflect Spanish phonological inventories, allophony and frequencies. These data helped consolidate the Spanish word list for elicitation and led to questions for the ongoing study concerning word structure, multisyllabic words, liquids, fricatives and vowel sequences. (Contains 4 tables and 7 notes.)

We evaluated a novel, computerized feelings assessment instrument (MAAC) in 54 children with anxiety disorders and 35 nonanxious children ages 5 to 11. They rated their feelings relative to 16 feeling animations. Ratings of feelings, order of feeling selection, and correlations with standardized anxiety measures were examined. Positive emotions were rated more highly and visited earlier by nonanxious children. Children with anxiety disorders explored fewer emotions. MAAC ratings on several positive emotions showed inverse correlations with state anxiety. Although needing further evaluation, MAAC may facilitate feelings assessment in young children and may distinguish children with anxiety disorders from nonanxious children. (Contains 2 tables.)

Objective: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by experienced CBT therapists from an academic center. Methods: Twenty-two practitioners from four community mental health agencies completed the training in four groups (one for each agency); one group was trained by videoconference. The authors assessed outcomes immediately after the training and at 6-month follow-up using a mixed-method design including quantitative and qualitative methods to ensure a comprehensive evaluation. Results: Participants' knowledge on a multiple-choice test of child CBT increased with training, as did their self-reported confidence using CBT and desire to do further child CBT. Therapist age and use of an intake diagnostic screen related to positive outcomes, and participants advocated for more structured training. Conclusion: Child CBT can be successfully taught to community practitioners using this training model, but refinement based on participant feedback and further studies that include direct observation of CBT skills are needed.

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech-language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school-aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target /[image omitted]/ after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi-experimental clinic-based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy. (Contains 2 figures and 4 tables.)

Purpose: Ultrasound can provide images of the tongue during speech production. The present study set out to examine the potential utility of ultrasound in remediation of North American English /r/. Method: The participants were 2 Canadian English-speaking adolescents who had not yet acquired /r/. The study included an initial period without ultrasound and 13 treatment sessions, each 1 hr long, using ultrasound. Speech samples were recorded at screening and immediately before and after treatment. Samples were analyzed acoustically and with listener judgments. Ultrasound images were obtained before, during, and after the treatment period. Results: Three speech-language pathologists unfamiliar with the participants rated significantly more posttreatment tokens as accurate [r]s in single words and some phrases. Acoustic analyses showed an expected lowering of the third formant after treatment. A qualitative observation of posttreatment ultrasound images for accurate [r] tokens showed tongue shapes to be more similar to those of typical adults than had been observed before treatment. Participants needed continued practice of their newly acquired skills in sentences and conversation. Conclusion: Two-dimensional dynamic ultrasound appears to have potential utility for remediation of /r/ in speakers with residual /r/ impairment. Further research is needed with larger numbers of participants to establish the relative efficacy of ultrasound in treatment. (Contains 4 tables, 4 figures and 2 footnotes.)

The present paper comprises an overview of techniques using ultrasound in speech (re)habilitation. Ultrasound treatment techniques have been developed for English lingual stops, vowels, sibilants, and liquids. These techniques come from a series of small "n" studies with adolescents and adults with severe hearing impairment, residual speech impairment or accented speech at the Interdisciplinary Speech Research Laboratory at the University of British Columbia. Ultrasound allows excellent visualization of tongue shape features, which is especially useful for feedback during speech (re)habilitation. Further research is needed to evaluate the efficacy of ultrasound in speech (re)habilitation. (Contains 6 figures.)

Purpose: Bullying is a specific pattern of repeated victimization explored with great frequency in school-based literature, but receiving little attention within sport. The current study explored the prevalence of bullying in sport, and examined whether bullying experiences were associated with perceptions about relationships with peers and coaches. Method: Adolescent sport team members (n = 359, 64% female) with an average age of 14.47 years (SD = 1.34) completed a pen-and-paper or online questionnaire assessing how frequently they perpetrated or were victimized by bullying during school and sport generally, as well as recent experiences with 16 bullying behaviors on their sport team. Participants also reported on relationships with their coach and teammates. Results: Bullying was less prevalent in sport compared with school, and occurred at a relatively low frequency overall. However, by identifying participants who reported experiencing one or more act of bullying on their team recently, results revealed that those victimized through bullying reported weaker connections with peers, whereas those perpetrating bullying only reported weaker coach relationships. Conclusion: With the underlying message that bullying may occur in adolescent sport through negative teammate interactions, sport researchers should build upon these findings to develop approaches to mitigate peer victimization in sport. [ABSTRACT FROM AUTHOR]

Objective: This study describes the first use of a robotic walker in youth and young adults with cerebral palsy (CP) Gross Motor Function Classification (GMFCS) IV. Methods: Semi-structured interviews were conducted before and after each robotic walker trial. Interviews were recorded, then transcribed and subjected to thematic analysis. Results: Five participants (4 male, 13–22 years of age) with quadriplegia secondary to CP were recruited. Four individuals with mixed tone quadriplegia GMFCS IV were able to independently walk with the device. One individual with significant dyskinesia was unable to utilize the device. The assessment team included two physiotherapists, an occupational therapist, a physiatrist and three engineers. Major themes related to physical and social impacts were identified. Some physical advantages include the ability to walk hands-free and promotion of physical fitness. Examples of physical barriers include limited harness design and large device size. Social advantages include increased independence and peer engagement. Finally, a social disadvantage identified was limited use on uneven terrains. Discussion: Suggestions for modifications for identified challenges and disadvantages include decreasing the size of the robotic walker, more harness designs, decreasing the force required to take an initial step, adding a joy stick for user control and creating a more versatile base that can be used on different terrains such as ice or baseball fields. Conclusion: Robotics holds great hope for individuals with CP where mobility options are limited. Physical and social advantages are evident. Recommendations for future improvement and studies of use in exercise and participation are provided. As youth and young adults with cerebral palsy age, options for mobilization can become limited with challenges in placing them in a walking device due to size and numerous other physical limitations. A robotic walker with a built-in mechanical lift is available for individuals with cerebral palsy. This study was able to gather important information and recommendations to tailor a new robotic walker prototype specifically for individuals with cerebral palsy. [ABSTRACT FROM AUTHOR]

Studied the re-entry process of corporate and governmental employees (N=200) returning to Canada after working overseas. Research found re-entry into the original culture was a more difficult transition than moving to the foreign culture. Home-country managers tended to exhibit xenophobia in assessing the potential and actual effectiveness of returnees. (Author)

Objective: There are currently three licensed human papillomavirus (HPV) vaccines that protect against cervical cancer. Here we compare the prevalence of bi-, quadri-, and nonavalent vaccine-related HPV genotypes in a multi-ethnic sample of non-Hispanic white, non-Hispanic black, Hispanic, and Asian women. Design: Patients in this analysis (n = 419) represent a subset of women with a previous abnormal Pap test participating in a clinical trial. HPV genotyping was conducted using the Roche Linear Array. Prevalent HPV genotypes were grouped according to their inclusion in each of the vaccines: bivalent (16, 18), quadrivalent (16, 18, 6, 11), and nonavalent (16, 18, 31, 33, 45, 52, 58, 6, 11). Results: The prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines was lowest among non-Hispanic black (15%) and Hispanic women (20%), compared to non-Hispanic white (38%) and Asian women (38%). Across all racial/ethnic groups, a large proportion of infections (38%–49%) were with genotypes included in the nonavalent vaccine. However, the prevalence of HPV genotypes not covered by any vaccine was significantly higher among non-Hispanic black (36%) and Hispanic women (42%), compared to non-Hispanic white (24%) and Asian women (16%) (p < 0.001). Racial/ethnic differences in HPV genotype prevalence were observed when controlling for demographic and sexual behavior characteristics, as well as when restricting the analysis to women with CIN 2+. Conclusion: Our data suggest racial/ethnic differences in the prevalence of vaccine-related HPV genotypes. In particular, non-Hispanic black and Hispanic women had the lowest prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines. While a large proportion of their infections were covered by the nonavalent vaccine, non-Hispanic black and Hispanic women also had the highest prevalence of HPV genotypes not covered by any vaccine. [ABSTRACT FROM AUTHOR]

This article presents a discussion on the role of women in international management, primarily in regards to the disproportionate amount of male executives to female executives. The author believes that in order for corporations to achieve success in the global marketplace, firms cannot continue to rely primarily on men. This article provides a map of the distribution of female international managers for U.S. and Canadian corporations and indicates the types of enterprises which have and have not commissioned women for work abroad.

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates and determines the genetic mutation frequency of the gene encoding of the transient outward current (Ito) of patients who died of sudden cardiac arrest in Canada. Researchers carried out different types of tests, including mutation analysis, mutagenesis and cloning, of 51 patients who had J-wave syndrome. Moreover, they found that the potassium voltage-gated channel (KCND2) gene is the prime cause of the J-wave syndrome and death of patients.

Countries around the globe are investing in health information and communications technologies (ICTs) as critical tools for improving care for chronically ill patients. We profiled four high-income nations with varied health ICT strategies—Australia, Canada, Denmark, and the United States—to describe their use of ICTs to improve chronic care. Our goal was to identify common challenges and opportunities for cross-national learning. We found four key themes. First, although all four countries have a national strategy for health ICT adoption, strategies are implemented and adapted to chronic care needs regionally, which creates the challenge of spreading successful efforts across regions. Second, each country struggles with how to ensure that clinical information follows patients seamlessly between care settings. Third, although each nation is pursuing telehealth solutions as a component of chronic care, the telehealth initiatives are usually stand-alone efforts that are not well integrated into other ICT solutions, such as electronic health records. Finally, countries have made progress in improving patients' access to their clinical data but have not fully succeeded in engaging patients to apply the data to improve care. These common themes suggest that although the four nations have different health care systems and ICT strategies, all of them face a similar set of challenges, creating an opportunity for cross-national learning. [ABSTRACT FROM AUTHOR]

Lewis's Woodpecker (Melanerpes lewis) has experienced population declines in both Canada and the United States and in 2010 was assigned a national listing of threatened in Canada. We conducted a two-year study (2004-2005) of this species at its northern range limit, the South Okanagan Valley in British Columbia, Canada. Our main objective was to determine whether the habitat features that influenced nest-site selection also predicted nest success, or whether other factors (e.g. cavity dimensions, clutch initiation date or time of season) were more important. Nest tree decay class, density of suitable cavities and total basal area of large trees were the best predictors of nest-site selection, but these factors were unrelated to nesting success. Estimates of demographic parameters (mean ± SE) included daily nest survival rate (0.988±0.003, years combined), nest success (0.52±0.08), clutch size (5.00±0.14 eggs), female fledglings per successful nest (1.31±0.11), and annual productivity (0.68±0.12 female fledglings per nest per year). Although higher nest survival was associated with both early and late initiated clutches, early-initiated clutches allowed birds to gain the highest annual productivity as early clutches were larger. Nests in deep cavities with small entrances experienced lower predation risk especially during the peak period of nest predation. We concluded that nest-site selection can be predicted by a number of easily measured habitat variables, whereas nest success depended on complicated ecological interactions among nest predators, breeding behaviors, and cavity features. Thus, habitat-based conservation strategies should also consider ecological factors that may not be well predicted by habitat. [ABSTRACT FROM AUTHOR]

This article focuses on the concept of materiality and materiality assessments regarding franchise disclosure requirements in the U.S. and Canada. Franchise disclosure jurisdictions in Canada obligate franchisors to provide disclosure to prospective franchisees in the form of a disclosure document. In the U.S., the U.S. Federal Trade Commission's (FTC) franchise disclosure rule (FTC Rule) requires disclosure of information that is likely to affect a prospective franchisee's investment decision.

The article presents information on the code of ethics in franchising. Franchise associations have some established ethical values that the members need to accept. It mentions the ethical obligations apart from legal obligations in franchising. It compares the various codes and applications of the same and their interplay with the duty of good faith. It discusses fair dealing in Canada and the U.S. It concludes that the codes used for promoting ethical practices should not be adopted blindly.

The HPC2/ELAC2 gene on chromosome 17p11 was identified as a candidate gene for hereditary prostate cancer (HPC) susceptibility. Two HPC2 gene missense variants, Ser217Leu (Leu217) and Ala541Thr (Thr541) have been associated with incident prostate cancer cases in some studies, but not in others. We tested for possible associations between the two HPC2 gene variants and prostate cancer risk in incident prostate cancer cases (199) and healthy male controls (525) from the Calgary region. The Thr541 variant showed linkage disequilibrium with the Leu217 variant. The number of Leu217 homozygotes in the case and control groups (8.6versus 8.5%) was not statistically different. Leu217 carrier status was associated with prostate cancer risk (cases 61.8% versus controls 50.3%) (OR 1.6, 95% CI 1.15–2.23). Additional analysis found that this association was not due to the co-existence of Thr541 variant (OR1.59, P=0.009). Logistic regression found that the relationship between the log odds of being a Thr541carrier and age depends on case/control status. Thr541 carriers had an increased risk for late-onset prostate cancer (P=0.028). Prostate intraepithelial neoplasia (PIN) was more common in the Leu217 allele carriers compared to non-carriers (42.3 versus 26.7%) (OR 2.05, 95% CI 1.10–3.83), and in the Thr541 carriers compared to non-carriers (50.0 versus 34.6%) (OR 1.89, 95% CI 0.75–4.78). In summary, the HPC2 gene variants Leu217 and Thr541 were associated with an increased risk for prostate cancer and for PIN in males undergoing radical prostatectomies in the Calgary region. [ABSTRACT FROM AUTHOR]

This paper seeks to forge a link between Canadian macro and micro data relating to the household sector. The analysis is in three parts. The first part begins with National Accounts data on the personal sector. These data are adjusted to remove transactions relating to non-biological persons, so that the result is income and expenditure for the household sub-sector. The second part starts with the annual household survey used to collect income distribution data. These survey data are augmented in various ways to account for under-reporting and to add information from other micro data sets— particularly the periodic survey of household expenditure patterns and a sample of individual income tax returns. The result is a comprehensive, albeit partially synthetic, household micro data set. In the final part of the paper these two largely independent data sets are compared, and the general quality of the results is discussed. [ABSTRACT FROM AUTHOR]

The paper presents some estimates of the imputed dollar value of household work (HW) for Canada in 1961 and 1971, finding this to be about $16 and $38 billion respectively, equal to 40 percent of GNP. From the results we derive some implications about five questions raised in the relevant literature. First, no clear evidence of a downward trend for the ratio HW/GNP is found, contrary to U.S. results. Second, addition of HW to GNP as a welfare measure does not affect the general pattern of past growth estimates. Third, a cost-by-function method of estimating HW is found superior in its theoretical support and the detail it provides, but the opportunity-cost method, despite doubts on its theoretical validity, gives a good approximation in the aggregate, and, being simpler, is likely to remain popular. Fourth, disaggregation does matter if detail by region or family type is required, in which case data by number and ages of children and market-employment status of females are needed; for the total, a reasonable estimate (6-7 percent error) is given by further aggregated data. Fifth, sensitivity of HW to accuracy in the data used is large only for female wages chosen, in particular for the function “cooking”. Finally, though available data must be manipulated to fit the needs of HW, especially for earlier years, the extent of this is not all that much more than is commonly found for GNP estimations. [ABSTRACT FROM AUTHOR]

In the introduction of the paper. Economic Accounts are defined as a set of statistics useful in economic analysis and reason is defined as a province. The paper is divided into four sections the first of which contains a brief historical outline of the development of demands for provincial economic accounts and the Dominion Bureau of Statistics' response to these needs. Apart from a description of the more well-known conceptual difficulties, some of the fundamental problems of the usefulness and applicability of a national accounting framework to the regional scene are discussed. The resource problems of constructing analytically meaningful and reliable as well as spatially reconcilable regional accounts are described. Section II outlines the impact of present policies and problems on the development of regional statistics. It describes the reasons for the Bureau's desire to strengthen its data base in regional terms and the decision to await possible construction of regional accounts till the regional data base has been fleshed out in a more systematic manner. With the development of the latter, the ability, advantages and disadvantages of the provinces undertaking their own estimates must also be more fully explored. The third part of the paper deals with an overview of work in Canada on provincial accounts carried out by organizations other than the Dominion Bureau of Statistics. Section IV gives a very summary description of the data gaps which exist in presently available regional statistics. [ABSTRACT FROM AUTHOR]

The article presents a paper presenting an overview of the quarterly national accounts in Canada compiled as of March 1965. A critical appraisal of a country's national accounts could easily entail examination of the whole structure of economic statistics, because the quality of the estimates in the accounts are to a large extent determined by the quality of the underlying data on which they are based. The first aspect of presenting this paper deals mainly with the quarterly accounts as a system of organizing current data--the arranging of available economic statistics into a balancing set of income and expenditure accounts employing conventions that have become generally acceptable during the last twenty years. The discussion on reliability is cast in general terms and is designed to place the question in perspective--in relation to the main uses the accounts are expected to serve and the character of the underlying raw material on which the end-products included in the accounts are necessarily structured.

A cytological and morphological survey of the black flies of Prince Edward Island revealed 20 species of which 13 represent new provincial records. An additional three species have been recorded in the literature but were not found in this study. All 20 species are widely distributed on the North American mainland. Three species are significant pests of humans, six feed on birds, two species do not take blood, and the remaining species feed on non-human mammals. [ABSTRACT FROM AUTHOR]

Numerous guidelines on the diagnosis and management of hypertrophic cardiomyopathy (HCM) have been published, by learned societies, over the past decade. Although helpful they are often long and less adapted to nonexperts. This writing panel was challenged to produce a document that grew as much from years of practical experience as it did from the peer-reviewed literature. As such, rather than produce yet another set of guidelines, we aim herein to deliver a concentrate of our own experiential learning and distill for the reader the essence of effective and appropriate HCM care. This Clinical Practice Update on HCM is therefore aimed at general cardiologists and other cardiovascular practitioners rather than for HCM specialists. We set the stage with a description of the condition and its clinical presentation, discuss the central importance of "obstruction" and how to look for it, review the role of cardiac magnetic resonance imaging, reflect on the appropriate use of genetic testing, review the treatment options for symptomatic HCM-crucially including cardiac myosin inhibitors, and deal concisely with practical issues surrounding risk assessment for sudden cardiac death, and management of the end-stage HCM patient. Uniquely, we have captured the pediatric experience on our panel to discuss appropriate differences in the management of younger patients with HCM. We ask the reader to remember that this document represents expert consensus opinion rather than dogma and to use their best judgement when dealing with the HCM patient in front of them., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Exome and genome sequencing have been demonstrated to increase diagnostic yield in paediatric populations, improving treatment options and providing risk information for relatives. There are limited studies examining the clinical utility of these tests in adults, who currently have limited access to this technology., Methods: Patients from adult and cancer genetics clinics across Toronto, Ontario, Canada were recruited into a prospective cohort study evaluating the diagnostic utility of exome and genome sequencing in adults. Eligible patients were ≥18 years of age and suspected of having a hereditary disorder but had received previous uninformative genetic test results. In total, we examined the diagnostic utility of exome and genome sequencing in 47 probands and 34 of their relatives who consented to participate and underwent exome or genome sequencing., Results: Overall, 17% (8/47) of probands had a pathogenic or likely pathogenic variant identified in a gene associated with their primary indication for testing. The diagnostic yield for patients with a cancer history was similar to the yield for patients with a non-cancer history (4/18 (22%) vs 4/29 (14%)). An additional 24 probands (51%) had an inconclusive result. Secondary findings were identified in 10 patients (21%); three had medically actionable results., Conclusions: This study lends evidence to the diagnostic utility of exome or genome sequencing in an undiagnosed adult population. The significant increase in diagnostic yield warrants the use of this technology. The identification and communication of secondary findings may provide added value when using this testing modality as a first-line test., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Chest physiotherapy (CPT) and intrathoracic percussion ventilation have been recognised as to encourage dislodging the secretions; nonetheless, the tolerance to the procedure and its efficiency have not been proven to be sufficient., Method and Analyses: This study aims to examine the tolerance, feasibility and physiological effects in airway clearance by using a novel extrathoracic non-invasive oscillating transducer device (NIOD) in critically ill children. A two-stage cross-over randomised controlled study in a paediatric intensive care unit in a Canadian Academic Children's Hospital will be applied. Children under 24 months old, for whom CPT is prescribed for airway clearance, will be included. The study consists of two stages; (1) Stage 1 'Frequency Level': we will apply two different frequencies of the NIOD (40 Hz vs 60 Hz) for 12 min each, on each patient 3 hours apart, and (2) Stage 2 'NIOD versus CPT': we will implement NIOD and CPT alternatingly for 3 hours apart. The order of the procedures will be randomly allocated for each case. We will compare the average Δchanges of tidal lung volume measured by a 3D imaging system and regional lung functions using electrical impedance tomography, between the two different frequencies and between the NIOD periods and the CPT periods. We will also examine tolerance by seeing COMFORT Scales and related complications during the procedures. We estimate necessary sample size as 6 for each arm (Total 12 cases) for stage 1 and 48 cases for Stage 2, with power of 0.8 and alpha of 0.05., Ethics and Dissemination: This study has been approved by the Health Research Ethics Board of University of Montreal, Canada (REB number: 2020-2471). We will disseminate our findings through peer-reviewed publications and conference presentations in paediatric or/and critical care fields., Trial Registration Number: ClinicalTrials.gov Registry (NCT03821389)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations., Competing Interests: The authors have read the journal’s policy and the authors of this manuscript have the following competing interests: AA and LK are paid employees of MEMOTEXT. AA is also a principal of MEMOTEXT. SK and AA have interests in the company App4Independence (A4i), a digital health engagement platform to support people living with schizophrenia, which will house the aforementioned app. MEMOTEXT holds 50% equity interest in A4i Inc. SK is a paid employee of CAMH. CAMH holds a 35% equity interest in A4i Inc. The authors would like to declare the following patents/patent applications associated with this research: US 16/109,394, CDN 3,015,178, and AUS 2018220089; filed for “Tool For Identifying Occurrence of Acute Incident Symptomatic of Mental Condition or Disorder” filed August 22/23; 2018. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials. This does not alter our adherence to PLOS ONE policies on sharing data and materials.