Search

The critically endangered Southern Resident killer whale (SRKW) population is at a conservation crossroads. The SRKW's range extends from California to southern Alaska, but the core habitat of the species is the inland Salish Sea. The principal threats to the population are the decline in Chinook salmon abundance, physical and acoustic disturbance, and environmental contamination. Effective management must respond to the cumulative impact of these threats. The SRKW population has been protected as an endangered species in Canadian and U.S. waters for more than a decade, and emergency conservation measures have been produced in both jurisdictions. Unfortunately, these conservation measures have failed to stabilize the population or advance cooperative ecosystem-based conservation. The United Nations Convention on the Law of the Sea (UNCLOS) legally obligates states to cooperate in marine mammal conservation and, with respect to cetaceans, specifically requires states to work through an appropriate institution for their conservation and management. This article examines ongoing efforts by Canada and the United States to stabilize and recover the SRKW population in view of UNCLOS and the objective of long-term stewardship. This assessment includes ad hoc cooperative mechanisms and possible developments under existing cooperative forums. Although the base legal obligations created by UNCLOS are likely met, the objective of institutionalized cooperative cetacean conservation and management in UNCLOS is not met; moreover, existing cooperative forums are insufficient to effect SRKW recovery. Canada and the United States continue to approve projects without properly assessing the cumulative transboundary impact on the SRKW population or quantifying their contribution to important ecosystem-based thresholds, which reveals the true extent of management dissonance in the Salish Sea. This analysis concludes that enhanced bi-lateral cooperation and long-term co-existence with the SRKW population requires the creation of a new institutional forum, analogous to the International Joint Commission, that coordinates SRKW recovery measures and assesses future projects in view of cumulative effects management. [ABSTRACT FROM AUTHOR]

Life cycle greenhouse gas (GHG) emissions from the production of nuclear power (in g CO2e/kWh) are uncertain due partly to a paucity of data on emissions from individual phases of the nuclear fuel cycle. Here, we present the first comprehensive life cycle assessment of GHG emissions produced from the mining and milling of uranium in Canada. The study includes data from 2006--2013 for two uranium mine-mill operations in northern Saskatchewan (SK) and data from 1995--2010 for a third SK mine-mill operation. The minemill operations were determined to have GHG emissions intensities of 81, 64, and 34 kg CO2e/kg U3O8 at average ore grades of 0.74%, 1.54%, and 4.53% U3O8, respectively. The production-weighted average GHG emission intensity is 42 kg CO2e/kg U3O8 at an average ore grade of 3.81% U3O8. The production-weighted average GHG emission intensity drops to 24 kg CO2e/kg U3O8 when the local hydroelectric GHG emission factor (7.2 g CO2e/kWh) is substituted for the SK grid-average electricity GHG emission factor (768 g CO2e/kWh). This results in Canadian uranium mining-milling contributing only 1.1 g CO2e/kWh to total life cycle GHG emissions from the nuclear fuel cycle (0.7 g CO2e/kWh using the local hydroelectric emission factor). [ABSTRACT FROM AUTHOR]

Describes a "mutual benefit" arrangement that expanded the school-business partnership model. Westfall Secondary School and an industrial operation in Owen Sound Ontario, Canada, linked their strengths and needs to offer students actual work and project experiences and to give the company useful information, services, and adult basic skills instruction. (CJH)

We present a statistical representation of the aggregate effects of deep convection on the chemistry and dynamics of the upper troposphere (UT) based on direct aircraft observations of the chemical composition of the UT over the eastern United States and Canada during summer. These measurements provide unique observational constraints on the chemistry occurring downwind of convection and the rate at which air in the UT is recycled. These results provide quantitative measures that can be used to evaluate global climate and chemistry models. [ABSTRACT FROM AUTHOR]

Objectives: To implement an early rehabilitation bundle in two Canadian PICUs., Design and Setting: Implementation study in the PICUs at McMaster Children's Hospital (site 1) and London Health Sciences (site 2)., Patients: All children under 18 years old admitted to the PICU were eligible for the intervention., Interventions: A bundle consisting of: 1) analgesia-first sedation; 2) delirium monitoring and prevention; and 3) early mobilization., Measurements and Main Results: Primary outcomes were the duration of implementation, bundle compliance, process of care, safety, and the factors influencing implementation. Secondary endpoints were the impact of the bundle on clinical outcomes such as pain, delirium, iatrogenic withdrawal, ventilator-free days, length of stay, and mortality. Implementation occurred over 26 months (August 2018 to October 2020). Data were collected on 1,036 patients representing 4,065 patient days. Bundle compliance was optimized within 6 months of roll-out. Goal setting for mobilization and level of arousal improved significantly (p < 0.01). Benzodiazepine, opioid, and dexmedetomidine use decreased in site 1 by 23.2% (95% CI, 30.8-15.5%), 26.1% (95% CI, 34.8-17.4%), and 9.2% (95% CI, 18.2-0.2%) patient exposure days, respectively, while at site 2, only dexmedetomidine exposure decreased significantly by 10.5% patient days (95% CI, 19.8-1.1%). Patient comfort, safety, and nursing workload were not adversely affected. There was no significant impact of the bundle on the rate of delirium, ventilator-free days, length of PICU stay, or mortality. Key facilitators to implementation included institutional support, unit-wide practice guidelines, dedicated PICU educators, easily accessible resources, and family engagement., Conclusions: A rehabilitation bundle can improve processes of care and reduce patient sedative exposure without increasing patient discomfort, nursing workload, or harm. We did not observe an impact on short-term clinical outcomes. The efficacy of a PICU-rehabilitation bundle requires ongoing study. Lessons learned in this study provide evidence to inform rehabilitation implementation in the PICU setting., Competing Interests: Drs. Choong’s and Cupiodo’s institutions received funding from the Alternate Funding Plan (AFP) Innovation Fund: Hamilton Academic Health Sciences Organization. Drs. Fraser’s and Martin’s institutions received funding from the AFP Innovation Fund: Academic Medical Organization of Southwestern Ontario. Dr. Choong’s institution received funding from Hamilton Health Sciences Foundation. Drs. Choong and Kennedy received funding from McMaster University. Dr. Cameron received funding from London Health Sciences Center. Dr. Kennedy received funding from Pediatric Critical Care Medicine; he disclosed work for hire. Dr. Kho’s institution received funding from the Canadian Institutes of Health Research, Canada Research Chairs, and Canada Foundation for Innovation; she disclosed that Restorative Therapies loaned three RT300 supine cycle ergometers for an ongoing research project. Dr. Simpson received funding from Hamilton Health Sciences-McMaster Children’s Hospital. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Objective: Create a language-independent, ecologically valid auditory processing assessment and evaluate relative stimuli intelligibility in native and non-native English speakers., Design: The Language-Independent Speech in Noise and Reverberation Test (LISiNaR) targets comprised consonant-vowel (CVCV) pseudo-words. Distractors comprised CVCVCVCV pseudo-words. Stimuli were presented over headphones using an iPad either face-to-face or remotely. Scoring occurred adaptively to establish a participant's speech reception threshold in noise (SRT). The listening environment was simulated using reverberant and anechoic head-related transfer functions. In four test conditions, targets originated from 0°. Distractors originated from either ±90°, ±67.5° and ±45° (spatially separated) or 0° azimuth (co-located). Reverberation impact (RI) was calculated as the difference in SRTs between the anechoic and reverberant conditions and spatial advantage (SA) as the difference between the spatially separated and co-located conditions., Study Sample: Young adult native speakers of Australian ( n  = 24) and Canadian (25) and non-native English speakers (34)., Results: No significant effects of language occurred for the test conditions, RI or SA. A small but significant effect of delivery mode occurred for RI. Reverberation impacted SRT by 5 dB relative to anechoic conditions., Conclusion: Performance on LISiNaR is not affected by the native language or accent of groups tested in this study.

Objectives: Survey of four stakeholder groups involved in defining and obtaining assent for research in Canadian PICUs to better understand their perspectives and perceived barriers to assent., Design: Cross-sectional survey., Setting: Fourteen tertiary-care pediatric hospitals in Canada., Participants: Research Ethics Board Chairs, pediatric critical care nurses, research coordinators, and researchers., Interventions: None., Measurements and Main Results: A total of 193 participants responded. Thirty-seven percent (59/159) thought it was "Never/Almost Never" (59/159, 37%) feasible to obtain assent during the first 48 hours of PICU admission, and 112 of 170 (66%) indicated there are unique barriers to assent at the time of enrollment in PICU studies. Asking children for assent was most frequently rated as Important/Very Important for interviews/focus groups with the child (138/180, 77%), blood sample collection with a needle poke for research (137/178, 77%), and studies involving genetic testing with results communicated to the child/legal guardian (134/180, 74%). In two scenarios where a child and legal guardian disagreed about study participation, most respondents indicated that whether the child should still be enrolled would depend on the patient's age (34-36%), and/or the risk of the study (24-28%). There was a lack of consensus over how the assent process should be operationalized, and when and for how long children should be followed to seek assent for ongoing study participation. Most stakeholders (117/158, 74%) thought that children should have the opportunity to decide if their samples could stay in a biobank once they are old enough to do so., Conclusions: There was an overall lack of consensus on the feasibility of, and challenges associated with, obtaining assent at the time of study enrollment and on how key aspects of the assent process should be operationalized in the PICU. This highlights the need for guidelines to clarify the assent process in pediatric critical care research., Competing Interests: Ms. O’Hearn’s institution received funding from the Canadian Critical Care Trials Group. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Background: Critical care research in Canada is conducted primarily in academically-affiliated intensive care units with established research infrastructure, including research coordinators (RCs). Recently, efforts have been made to engage community hospital ICUs in research albeit with barriers. Automation or artificial intelligence (AI) could aid the performance of routine research tasks. It is unclear which research study processes might be improved through AI automation., Methods: We conducted a cross-sectional survey of Canadian ICU research personnel. The survey contained items characterizing opinions regarding research processes that may be amenable to AI automation. We distributed the questionnaire via email distribution lists of 3 Canadian research societies. Open-ended questions were analyzed using a thematic content analysis approach., Results: A total of 49 survey responses were received (response rate: 8%). Tasks that respondents felt were time-consuming/tedious/tiresome included: screening for potentially eligible patients (74%), inputting data into case report forms (65%), and preparing internal tracking logs (53%). Tasks that respondents felt could be performed by AI automation included: screening for eligible patients (59%), inputting data into case report forms (55%), preparing internal tracking logs (51%), and randomizing patients into studies (45%). Open-ended questions identified enthusiasm for AI automation to improve information accuracy and efficiency while freeing up RCs to perform tasks that require human interaction. This enthusiasm was tempered by the need for proper AI education and oversight., Conclusions: There were balanced supportive (increased efficiency and re-allocation of tasks) and challenges (informational accuracy and oversight) with regards to AI automation in ICU research.

Objectives: In Canada, critically ill pediatric patients require transfer to a tertiary care center for definitive medical and surgical management. Some studies suggest that family accompaniment could compromise care; currently, limited research has examined patient safety and outcomes during pediatric critical care transport with family presence, and no Canada-specific data currently exists. The primary objective of this study was to compare the rate of adverse events during the transport of pediatric patients by a specialized pediatric critical care transport team with parental accompaniment to those without parental accompaniment. Secondary objectives included whether geographic or patient-specific factors affected rates of parental accompaniment and if parental presence during transport was related to patient outcomes., Methods: Retrospective cohort study in a pediatric critical care unit convenience sample at an academic children's hospital. Inclusion criteria constituted all patients younger than 18 years who were admitted to the pediatric critical care unit after interfacility transport by the London Health Sciences Center Neonatal Pediatric Transport Team between April 1, 2018, and April 30, 2020, inclusive. Adverse event rates, patient characteristics, and clinical outcomes were compared., Results: There were 357 transports eligible for analysis. Of these, there were 180 transports with, and 177 without, parental accompaniment. The primary outcome was adverse event occurrence using the composite definition of adverse events, previously defined by a Canadian consensus process, which included patient-, transport provider-, laboratory-, and system/vehicle-related safety factors. The occurrence of adverse events was not significantly different between transports with and without parental accompaniment, 49.4% and 54.8%, respectively (odds ratio, 0.80; P = 0.311)., Conclusions: This is the first study to compare the effect on adverse event rate and clinically relevant outcomes between transports with and without parental presence during interfacility pediatric critical care transport. Our study found no significant difference in the adverse event rate between transports with and without parental presence., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Our primary objective was to describe consent models used in Canadian-led adult and pediatric intensive care unit (ICU/PICU) randomized controlled trials (RCTs). Our secondary objectives were to determine the consent rate of ICU/PICU RCTs that did and did not use an alternate consent model to describe consent procedures., Source: Using scoping review methodology, we searched MEDLINE, Embase, and CENTRAL databases (from 1998 to June 2019) for trials published in English or French. We included Canadian-led RCTs that reported on the effects of an intervention on ICU/PICU patients or their families. Two independent reviewers assessed eligibility, abstracted data, and achieved consensus., Principal Findings: We identified 48 RCTs of 17,558 patients. Included RCTs had ethics approval to use prior informed consent (43/48; 90%), deferred consent (13/48; 27%), waived consent (5/48; 10%), and verbal consent (1/48; 2%) models. Fifteen RCTs (15/48; 31%) had ethics approval to use more than one consent model. Twice as many trials used alternate consent between 2010 and 2019 (13/19) than between 2000 and 2009 (6/19). The consent rate for RCTs using only prior informed consent ranged from 54 to 91% (ICU) and 43 to 94% (PICU) and from 78 to 100% (ICU) and 74 to 87% (PICU) in trials using an alternate/hybrid consent model., Conclusion: Alternate consent models were used in the minority of Canadian-led ICU/PICU RCTs but have been used more frequently over the last decade. This suggests that Canadian ethics boards and research communities are becoming more accepting of alternate consent models in ICU/PICU trials., (© 2021. Canadian Anesthesiologists' Society.)

Introduction: Competence committees (CCs) are groups of educators tasked with reviewing resident progress throughout their training, making decisions regarding the achievement of Entrustable Professional Activities and recommendations regarding promotion and remediation. CCs have been mandated as part of competency-based medical education programmes worldwide; however, there has yet to be a thorough examination of the implementation challenges they face and how this impacts their functioning and decision-making processes. This study examined CC implementation at a Canadian institution, documenting the shared and unique challenges that CCs faced and overcame over a 3-year period., Methods: This study consisted of three phases, which were conceptually and analytically linked using Moran-Ellis and colleagues' notion of 'following a thread.' Phase 1 examined the early perceptions and experiences of 30 key informants using a survey and semi-structured interviews. Phase 2 provided insight into CCs' operations through a survey sent to 35 CC chairs 1-year post-implementation. Phase 3 invited 20 CC members to participate in semi-structured interviews to follow up on initial themes 2 years post-implementation. Detailed observation notes from 16 CC meetings across nine disciplines were used to corroborate the findings from each phase., Results: Response rates in each phase were 83% (n = 25), 43% (n = 15) and 60% (n = 12), respectively. Despite the high degree of support for CCs among faculty and resident members, several ongoing challenges were highlighted: adapting to programme size, optimising membership, engaging residents, maintaining capacity among members, sharing and aggregating data and developing a clear mandate., Discussion: Findings of this study reinforce the importance of resident engagement and information sharing between disciplines. Challenges faced by CCs are discussed in relation to the existing literature to inform a better understanding of group decision-making processes in medical education. Future research could compare implementation practices across sites and explore which adaptations lead to better or worse decision-making outcomes., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Objectives: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness., Design: Prospective observational longitudinal cohort study., Setting: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences., Patients: Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded., Interventions: None., Measurements and Main Results: The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay., Conclusions: This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.

Problem Addressed: Patients have to wait too long to see their family physicians. Open access, a new approach to office scheduling, has shown promise in reducing patient wait times to see primary care physicians., Objective of Program: To offer same-day appointments to most patients who call the office, thus reducing wait times as measured by the third available appointment. Reductions in no-show rates have also been reported by those who have adopted the open-access system., Program Description: Following extensive preparation, a 2-site academic practice in Halifax, NS, adopted open-access booking in October 2008. Data on third available appointment times, no-show appointments, and patient volumes were tracked before and during the yearlong implementation., Conclusion: The clinics recorded a substantial, sustained reduction in third available appointment time, indicating improved patient access. There was also a decline in no-show appointments. Patient volumes were unaffected.

Unlabelled: Pain is the most common reason for emergency department (ED) use, and oligoanalgesia in this setting is known to be common. The Joint Commission on Accreditation of Healthcare Organizations has revised standards for pain management; however, the impact of these regulatory changes on ED pain management practice is unknown. This prospective, multicenter study assessed the current state of ED pain management practice. After informed consent, patients aged 8 years and older with presenting pain intensity scores of 4 or greater on an 11-point numerical rating scale completed structured interviews, and their medical records were abstracted. Eight hundred forty-two patients at 20 US and Canadian hospitals participated. On arrival, pain intensity was severe (median, 8/10). Pain assessments were noted in 83% of cases; however, reassessments were uncommon. Only 60% of patients received analgesics that were administered after lengthy delays (median, 90 minutes; range, 0 to 962 minutes), and 74% of patients were discharged in moderate to severe pain. Of patients not receiving analgesics, 42% desired them; however, only 31% of these patients voiced such requests. We conclude that ED pain intensity is high, analgesics are underutilized, and delays to treatment are common. Despite efforts to improve pain management practice, oligoanalgesia remains a problem for emergency medicine., Perspective: Despite the frequency of pain in the emergency department, few studies have examined this phenomenon. This study documents high pain intensity and suboptimal pain management practices in a large multicenter ED network in the United States and Canada. These findings suggest that there is much room for improvement in this area.

The purpose of this study was to compare health-promoting practices of Canadian (n = 49) and Jordanian (n = 44) first-year nursing students using the revised Health-Promoting Lifestyle Profile II. Results indicated significant differences between the groups on three subscales: health responsibility, physical activity, and interpersonal relations; however, both groups had similarly low scores. Implications for nurse educators are discussed from both curricular and cross-cultural perspective that focuses on health-promotion activities and programs.

Background: An international collaborative project between Jordanian and Canadian University nursing faculty was developed to enhance staff development for practicing nurses in Jordan. A needs assessment indicated a lack of knowledge and performance among staff nurses in emergency situations., Method: Using the "train-the-trainer" concept, cardiopulmonary resuscitation (CPR) workshops were organized and implemented in three government and one military hospital. University faculty developed and conducted the first workshops when local trainers were prepared to provide the program in their institutions., Results: Local trainers currently provide CPR workshops on an ongoing basis in their institutions. To date, 10 hospitals and one health center have requested CPR workshops for nursing staff., Conclusion: The CPR workshops met the needs of the hospital nursing community and strengthened the partnership between the university faculty and local community staff nurses.

We compared the determinants and consequences of burnout for Canadian (N = 586) and Jordanian (N = 263) registered nurses working in a hospital setting. LISREL 7 software was used to perform a path analysis testing hypothesized relationships between job satisfaction dimensions (supervision, hospital identification, kind of work, amount of work, physical work conditions, rewards, and career future) and burnout and intention to quit. For both Canadian and Jordanian nurses, kind of work, amount of work, and career future were important determinants of burnout. Career future and burnout (emotional exhaustion) were associated with intention to quit on the basis of the highly similar results across the two samples, we propose that a universal theoretical model of the determinants and consequences of burnout among nurses may be plausible.

A collaborative education program between Schools of Nursing at the Jordan University of Science and Technology and the University of Windsor, funded by the Canadian International Development Agency (CIDA), provides advanced clinical and theoretical education for Jordanian faculty and thus enriches the education of nursing students. This article describes the preparation of the faculty development proposal and the implementation of the project in a transcultural context, and identifies strengths and limitations of the project. Recommendations for effective strategies regarding international development in nursing education are made and a discussion of the benefits that ensued to both faculties is included.