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The COVID-19 pandemic has disrupted our collective normal patterns of behavior in almost all aspects of our personal and professional lives. While many K-12 and post-secondary subject area curricula lend themselves more easily to a migration to online and remote learning, technology education faces unique challenges. This research paper sought to understand the challenges, benefits, and lessons learned through an analysis of the process of re-organizing a pre-service technology education diploma for remote, blended, and face-to-face learning during the early stages of the COVID-19 pandemic. The investigation followed a collaborative autoethnographic methodology as the authors constructed two narratives based on their roles of administering and instructing in a pre-service technology education diploma program. An interpretive descriptive analysis suggests a number of challenges associated with the organizational changes, but also a number of positive outcomes related to the instructional shifts. Challenges included maintaining equitable access to physical materials and technologies for all students, scheduling issues related to changing pandemic rules and regulations, and a loss of social presence with students. Benefits included more student autonomy, less dependence on group work for technical skill development, and the development of alternative delivery models for pre-service technology education that could be used to expand program offerings to non-traditional students.

This project report describes an internal scan of library staff involved in instruction in a large academic library system. 64 semi-structured interviews were conducted and qualitatively analysed in order to produce a summary of instruction across the library system, and both the challenges faced and supports desired by these instructors. The most often mentioned challenges included the wide variety of students and class characteristics encountered, limitations around time, and navigating faculty expectations. The supports described with greatest frequency were professional development opportunities to support instruction practice, a greater sense of community among those doing instruction, and increased awareness of instruction practices both across the library system and in the institution at large. These finding allowed the authors to form recommendations for the library system to help advance instruction in support of teaching and research in the institution.

This paper outlines the findings of a study focused on the impact an expert teacher's pedagogical and technical knowledge and skill may have on the pedagogical and technical development of pre-service technology education teachers. Specifically, this inquiry falls within the context of traditional wooden boat building in Newfoundland and Labrador, Canada. Understanding the relationship between an expert's knowledge and skill, and the development of a novice's knowledge and skill is vitally important for institutions charged with graduating technology education teachers. Exploring the impact of pre-service teachers' pedagogical and technical development was considered in relation to an expert teacher's pedagogical content knowledge, and the nuance between declarative and procedural knowledge within technological activity. Data were collected from semi-structured interviews, workshop session observations, and researcher/participant journal entries. The sample was purposeful as the participants were recruited from boat building workshops between 2017 and 2019 and the 2017-2018 technology education diploma program cohort from Memorial University. Thematic analysis was used to identify major themes within the data. A descriptive visual framework based on the data analysis was constructed to highlight the complexities of teaching and learning within the multifaceted setting of a technical activity. An analysis of the data indicates that fostering and maintaining reciprocal interpersonal relationships between experts, novices, and peers are critical for the development of pre-service teacher technical and pedagogical knowledge and skill.

Indigenous communities demonstrate immense cultural strengths despite being impacted by mental health and academic disparities due to ongoing systemic racism and historical trauma. Given that schools are a context in which indigenous youths' needs have potential to be met through preventive intervention, this scoping review explores and summarizes the cultural relevance of school-based prevention interventions that have been implemented with students from indigenous backgrounds. We included articles published between January 2010 and February 2021 that included descriptive, outcome, and/or program development data on school-based prevention programs used with indigenous students in the USA and Canada. The initial search yielded 2131 articles for review, and ultimately 35 articles describing 27 interventions were included in the final sample. The majority of the programs (n = 20) were focused on substance use prevention or sexual and reproductive health and targeted adolescents in middle and high school; only five programs focused on mental health, social-emotional learning, and academics. All interventions were culturally consonant, but the program development process differed: 11 interventions were culturally grounded (i.e., developed based on values and beliefs of a specific cultural group) with one being community initiated (i.e., grassroots development), and 17 were culturally adapted (i.e., the tailoring of an existing intervention for a specific cultural group). We describe each intervention and its cultural components and provide commentary on how school-based prevention and social-emotional learning interventions can promote academic success for indigenous students in the USA and Canada. [For the corresponding grantee submission, see ED624651.]

How are we preparing teachers to design and foster learning through making where disciplinary knowledge and skills are applied and developed? One approach that addresses this question can be found from the International Maker Educational Network (IMEN); an online professional learning community built upon shared interests in educational making. Members meet regularly to share their maker context and experiences and what can be gleaned to help support developing capacity to design and facilitate learning through making. In further studying their professional practice using a self-study methodology, four IMEN members shared their respective maker contexts, illustrating examples of making in formal and informal learning environments and what is being learned from their experiences. These cases provide examples of strategies and approaches that are being used to support learning through making and provide insight into developing and utilizing knowledge and skills in fostering learning through making in P-16 educational contexts. The article concludes with three recommendations for practice to support educators and teacher educators in fostering learning through making.

Many peer mentorship programs in academia train senior students to guide groups of incoming students through the rigors of postsecondary education. The mentorship program's structure can influence how mentors develop from this experience. Here, we compare how two different peer mentorship programs have shaped mentors' experiences and development. The curricular peer mentorship program was offered to mentors and mentees as credited academic courses. The non-curricular program was offered as a voluntary student union service to students and peer mentors. Both groups of peer mentors shared similar benefits, with curricular peer mentors (CMs) greatly valuing student interaction, and non-curricular peer mentors (NCMs) greatly valuing leadership development. Lack of autonomy and lack of mentee commitment were cited as the biggest concerns for CMs and NCMs, respectively. Both groups valued goal setting in shaping their mentorship development, but CMs raised concerns about its overemphasis. Implications for optimal structuring of academic mentorship programs are discussed.

Although field education is considered the signature pedagogy of social work education, there is a paucity of research examining how Bachelors of Social Work (BSW) and foundation year-Masters of Social Work (FY-MSW) students perceive strategies designed to prepare them for field placement. To enhance readiness for practicum, an interactive role play activity was introduced to BSW and FY-MSW students, and their perspectives of the activity were elicited using focus groups. A thematic analysis of the transcripts resulted in five themes: enhanced perspective-taking, "we have a voice", reflections on supervisory relationship, pressure to excel in student role, and opportunity to practice in a safe space. The findings provide guidance for implementing pre-practicum activities appropriate to students' level of education and training.

This article examined the psychometric properties and validity of a new self-report instrument for assessing the social norms that coordinate social relations and define self-worth within three normative systems. A survey that assesses endorsement of honor, face, and dignity norms was evaluated in ethnically diverse adolescent samples in the U.S. (Study 1a) and Canada (Study 2). The internal structure of the survey was consistent with the conceptual framework, but only the honor and face scales were reliable. Honor endorsement was linked to self-reported retaliation, less conciliatory behavior, and high perceived threat. Face endorsement was related to anger suppression, more conciliatory behavior, and, in the U.S., low perceived threat. Study 1b examined identity-relevant emotions and appraisals experienced after retaliation and after calming a victimized peer. Honor norm endorsement predicted pride following revenge, while face endorsement predicted high shame. Adolescents who endorsed honor norms thought that only avenging their peer had been helpful and consistent with the role of good friend, while those who endorsed face norms thought only calming a victimized peer was helpful and indicative of a good friend. Implications for adolescent welfare are discussed.

An increasingly large number of courses in Canadian postsecondary institutions are taught by contingent instructors who hold full- or part-time positions for contractually limited time periods. Despite strong commitments to advancing teaching and learning, the labour and employment conditions for contingent instructors affect the incentives and possibilities for them to engage in the scholarship of teaching and learning (SoTL). Through a collaborative writing inquiry, the 9 authors examine the influences of three key conditions of contingency: institutional knowledge, status, and role; invisibility and isolation; and precarity. Four composite stories demonstrate the ways varied conditions of contingency may play out in contingent instructors' lives and typically undermine the possibilities for them to pursue SoTL. Institutions present contingent instructors with a mixed message: research and SoTL are desirable and frequently encouraged, yet contingent instructors are often ineligible or hindered from engagement.

Adolescents with Fetal Alcohol Spectrum Disorder (FASD) experience a range of cognitive, behavioral, and physical difficulties, including difficulties with self-regulation. We investigated self-regulation strategy use in adolescents with FASD who completed a self-regulation intervention program. The intervention was an adapted version of the Alert Program®, and it was delivered in hospital settings in two Canadian cities. We explored the types of strategies chosen by adolescents in the intervention, reported strategy use outside of the intervention, and feedback from adolescent participants about the program. We used both descriptive statistics and qualitative data to examine self-regulation strategy use in adolescents with FASD. Adolescents with FASD were found to use both sensory and non-sensory strategies to help them regulate at the beginning of each intervention session. Participants reported increasingly using the information they learned from the intervention program outside of the intervention, and the majority of participants reported using the information to help them at school. Overall, 96% of participants reported that they enjoyed the program, and 91% of participants reported that the things they learned in the program are helpful in their daily lives. Three themes emerged from a qualitative analysis of data gathered on the adolescents' experiences in the program: increasing capacity, sharing knowledge, and connecting meaningfully. These themes highlight important components of the intervention program. Implications for the use of a self-regulation intervention for adolescents with FASD are discussed. We specifically note the importance of differentiating between sensory and non-sensory regulation strategies, and the need for more research to increase our understanding of the use and impact of self-regulation strategies in adolescents with FASD.

Key Points: Question: Do normotensive living kidney donors, compared with nondonors, have a higher risk of hypertension in the first 7 years following donation? Findings: In this 17-center prospective cohort study that included 924 living kidney donors and 396 nondonors, there were no significant between-group differences in the risk of hypertension and no significant between-group differences in mean blood pressure or the change in blood pressure during a median follow-up of 7.3 years. Meaning: After accounting for differences in baseline risk, living donors had a similar risk of hypertension as nondonors in the 7 years following donation and no significant difference in mean blood pressure. Importance: Recent guidelines call for better evidence on health outcomes after living kidney donation. Objective: To determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared. Design, Setting, and Participants: Prospective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. Exposure: Living kidney donation. Main Outcomes and Measures: Hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]). Results: Among the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors' eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19). Conclusions and Relevance: In this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up. Trial Registration: ClinicalTrials.gov Identifier: NCT00936078 This cohort study aims to determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. [ABSTRACT FROM AUTHOR]

A multi-disciplinary symposium on early-age onset cancer (EAOC) was held in October 2023 to explore challenges experienced by this rapidly growing population. A major outcome of the symposium was recognition of the remarkable similarities of EAOC patients' journeys across cancer sites. Prevention and early detection of cancer are hindered by a lack of awareness among patients and family doctors that cancer can and does occur in younger persons. Distinct characteristics of the disease—such as a later stage at diagnosis and more aggressive tumor biology—require more potent treatments, which result in profound physical and psychosocial consequences that are unique to this age group. EAOC patient empowerment emerged as another key theme of the symposium. The development of a greater number of specialized clinics was called for, and patient support groups were recognized for the vital role they play in empowering patients and their families. Leading-edge medical advancements hold tremendous hope across the spectrum of EAOC care. New technologies based on genomic profiling, immunotherapy and microbiome alteration contribute to the development of highly effective, personalized approaches to treatment. All symposium participants expressed their commitment to speak with one resounding voice to advocate for equitable access to leading care practices for EAOC patients; thus, a fourth symposium is planned for November 2024. [ABSTRACT FROM AUTHOR]

There is a lack of clarity concerning the capability and capacity of intermediate technology education teachers within the Newfoundland and Labrador, Canada context. This article presents the technology education teaching framework (TETF) which was developed from the analysis of data related to factors that are helping and hindering the teaching of technology education at the intermediate level in Newfoundland and Labrador. A qualitative exploratory case study utilizing an online teacher questionnaire, semi-structured teacher and administrator interviews, and classroom observations allowed the development of the thick rich descriptions necessary to formulate the framework. The TETF focuses on the relationship between classroom teachers, their experiences, professional development opportunities, and leadership perspectives within the context of teaching intermediate technology education. The role of professionalism and systemic marginalization are also highlighted in the framework in relation to what is helping and hindering the teaching of intermediate technology in Newfoundland and Labrador, Canada.

Coercive control is an ongoing pattern of abuse that is intended to isolate, humiliate, degrade, and micro-regulate the everyday life of a victim; often found amongst intimate partner violence (IPV) situations yet may not present with physical evidence. Police officers are called to respond to these conditions, yet are limited by training, legislation, and risk assessment tools that often concentrate primarily on the presence of physical violence alone. An online survey was distributed to police officers across Canada to understand how they explore, and respond to IPV and coercive control, and what they consider to be the most pertinent risk factors when assessing the severity of a situation. Findings reveal that police officers continue to emphasise perpetrator behaviours that involve physical violence and serious physical harm. As Canada is currently considering the possibility of criminalising coercive control, results highlight that further training and improved risk assessment tools will be necessary in order for police to be able to effectively respond. [ABSTRACT FROM AUTHOR]

Background: The risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group. Methods: We conducted a population‐based, propensity‐matched retrospective cohort study using data from linked administrative databases in Ontario, Canada. All community‐dwelling individuals aged 66 years and older who underwent one of five major elective surgeries between April 1, 2007 and March 31, 2011 were included. Each surgical patient was matched 1:1 on surgical specialty of the surgeon at consultation, age, sex, fiscal year of entry, and propensity score with a patient who attended an outpatient visit with a surgeon of the same surgical specialty but did not undergo surgery. Patients were followed for up to 5 years after cohort entry for the occurrence of a new dementia diagnosis, defined from administrative data. Cause‐specific hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between surgery and the hazard of incident dementia. Subgroup and sensitivity analyses were performed. Results: A total of 27,878 individuals (13,939 matched pairs) were included in the analysis. A total of 640 (4.6%) individuals in the surgical group and 965 (6.9%) individuals in the control group developed dementia over the 5‐year follow‐up period. Individuals who underwent surgery had a reduced rate of incident dementia compared with their matched nonsurgical controls (HR 0.88; 95% CI 0.80–0.97; p = 0.01). This association was persistent in most subgroups and after sensitivity analyses. Conclusions: Elective surgery did not increase the rate of incident dementia when compared with matched nonsurgical controls. This could be an important consideration for patients and surgeons when elective surgery is considered. See related editorial by Tammy Hshieh and article by Tang et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Although HIV‐related deaths among people with HIV have dramatically decreased, deaths from other medical conditions and non‐medical events have increased. The location of death among people with HIV remains underreported. Objectives: We reviewed the deaths, causes of death, and reported location of death (i.e. within or outside of medical settings) of all people with HIV with the Southern Alberta Cohort, Calgary, Canada, between 1 January 2010 and 1 January 2022. Methods: This was a retrospective longitudinal cohort study reviewing all deaths within a comprehensive geographically defined HIV cohort over 11 years. Results: Deaths from HIV‐related causes decreased from 52% of all deaths in 2010 to 14% in 2021. In 2021, non‐HIV medical deaths increased from 38% to 44%, and non‐medical deaths (e.g. violence, suicide, drug overdose) increased from 0.5% to 39%. Of non‐medical deaths, 67% resulted from substance use/overdose. Overall, deaths in any medical setting decreased from 91% in 2010 to 39% in 2021; 61% of all deaths occurred in a medical setting (e.g. hospital/emergency department or supported/long‐term/hospice care), 27% in a residence, and 9% in the community. Conclusion: The shifting causes of death (i.e. fewer HIV‐related deaths, more overdose deaths) and location of death (i.e. fewer in medical settings, more at home/in the community) requires close monitoring so future resources can be matched to predicted patient needs. [ABSTRACT FROM AUTHOR]

Background The cascade of care, commonly used to assess HIV and hepatitis C (HCV) health service delivery, has limitations in capturing the complexity of individuals' engagement patterns. This study examines the dynamic nature of engagement and mortality trajectories among people with HIV and HCV. Methods We used data from the Canadian HIV-HCV Co-Infection Cohort, which prospectively follows 2098 participants from 18 centers biannually. Markov multistate models were used to evaluate sociodemographic and clinical factors associated with transitioning between the following states: (1) lost-to-follow-up (LTFU), defined as no visit for 18 months; (2) reengaged (reentry into cohort after being LTFU); (3) withdrawn from the study (ie, moved); (4) death; otherwise remained (5) engaged-in-care. Results A total of 1809 participants met the eligibility criteria and contributed 12 591 person-years from 2003 to 2022. LTFU was common, with 46% experiencing at least 1 episode, of whom only 57% reengaged. One in 5 (n = 383) participants died during the study. Participants who transitioned to LTFU were twice as likely to die as those who were consistently engaged. Factors associated with transitioning to LTFU included detectable HCV RNA (adjusted hazards ratio [aHR], 1.37; 95% confidence interval [CI], 1.13–1.67), evidence of HCV treatment but no sustained virologic response result (aHR, 1.99; 95% CI, 1.56–2.53), and recent incarceration (aHR, 1.94; 95% CI, 1.58–2.40). Being Indigenous was a significant predictor of death across all engagement trajectories. Interpretation Disengagement from clinical care was common and resulted in higher death rates. People LTFU were more likely to require HCV treatment highlighting a priority population for elimination strategies. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. Methods: As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. Results: Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. Conclusions: Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms. [ABSTRACT FROM AUTHOR]

Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients' access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival. [ABSTRACT FROM AUTHOR]

Over the last two decades, patient engagement in cancer research has evolved significantly, especially in addressing the unique challenges faced by adolescent and young adult (AYA) cancer populations. This paper introduces a framework for meaningful engagement with AYA cancer patient research partners, drawing insights from the "FUTURE" Study, a qualitative study that utilizes focus groups to explore the impact of cancer diagnosis and treatment on the sexual and reproductive health of AYA cancer patients in Canada. The framework's development integrates insights from prior works and addresses challenges with patient engagement in research specific to AYA cancer populations. The framework is guided by overarching principles (safety, flexibility, and sensitivity) and includes considerations that apply across all phases of a research study (collaboration; iteration; communication; and equity, diversity, and inclusion) and tasks that apply to specific phases of a research study (developing, conducting, and translating the study). The proposed framework seeks to increase patient engagement in AYA cancer research beyond a supplementary aspect to an integral component for conducting research with impact on patients. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods: A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results: Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results: The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC. [ABSTRACT FROM AUTHOR]

Interest in AYA cancer care has increased globally over the recent past; however, most of this work disproportionately represents white, heterosexual, middle-income, educated, and able-bodied people. There is recognition in the literature that cancer care systems are not structured nor designed to adequately serve people of colour or other equity-denied groups, and the structural racism in the system prevents prevention, treatment, and delivery of care. This work seeks to examine structural racism and the ways that it permeates into the lived experiences of AYAs in their cancer care. This article represents the first phase of an 18-month, patient-oriented, Participatory Action Research project focused on cancer care for racialized AYAs that is situated within a broader program of research focused on transforming cancer care for AYAs. Semi-structured interviews were completed with 18 AYAs who self-identify as racialized, have lived experiences with cancer, and have received treatment in Canada. Following participant review of their transcripts, the transcripts were de-identified, and then coded by three separate authors. Five main themes were identified using thematic analysis, including the need to feel supported through experiences with (in)fertility, be heard and not dismissed, advocate for self and have others advocate for you, be in community, and resist compliance. [ABSTRACT FROM AUTHOR]

Octreotide LAR is a long‐acting somatostatin analogue (SSA) used in the management of metastatic gastroenteropancreatic neuroendocrine tumors (GEP NETs). It requires intramuscular (IM) injection. Missed IM injections cause subcutaneous nodules (SCNs) on radiologic images. We reviewed the rates of SCNs in a real‐world cohort of GEP NETs receiving octreotide LAR and explored treatment outcomes. Patients commencing octreotide LAR between August 5, 2010 and March 8, 2018 at a single cancer center in Canada were identified from pharmacy records. Patients were included if they had a computed tomography (CT) scan performed at the time of progression and a preceding CT with pelvis included to enable assessment for the presence of nodules. Fisher's exact test was used to examine predictors of SCNs, and Kaplan–Meier curves summarized differences in progression free (PFS) and overall survival (OS) that were compared with log‐rank tests. Of 243 patients receiving octreotide LAR, 45 had all required CT images available for central review. SCNs were found in 20/45 (44%) of patients on the last scan showing stable disease before progression and were numerically but not statistically more likely in females (OR: 2.36, 95% CI: 0.66–8.29, p =.23). There was an increased risk of SCNs in patients with a skin‐to‐muscle distance >38 mm (the length of an octreotide LAR needle) on CT (OR: 5.09, 95% CI: 1.39–16.6, p =.018) and a trend toward increased risk in obese patients (OR: 5.71, 95% CI: 1.26–23.4, p =.061). PFS (HR: 1.01, 95% CI: 0.56–1.78, p =.98) and OS (HR: 0.86, 95% CI: 0.41–1.8, p =.70) was similar between those with/without SCNs. In conclusion, almost half of patients receiving octreotide LAR had SCNs; however, missed administration of SSA did not appear to result in worse survival in this small study. Factors such as sex, younger age skin‐to‐muscle distance, and obesity may affect SCN development and should be considered when choosing an SSA. [ABSTRACT FROM AUTHOR]

Warmer than normal late fall temperatures may change standard fall harvest management of alfalfa (Medicago sativa L.) in western Canada. The objective of this study was to evaluate the forage yield and nutritive value of three types of alfalfa cultivars under different harvest managements. A field experiment was conducted from 2013 to 2017 using rhizomatous type (RR), cv. AC Yellowhead (M. sativa subsp. falcata), tap root type (TR), cv. Equinox (ssp. sativa) and creeping root type (CR), cv. Spredor 4 alfalfa (ssp. sativa), at Melfort, SK, Canada. The five harvest treatments were two 1‐cut systems (early July or late July) and three 2‐cut systems (early July + early or late September, late July + late September). Total forage yield was greater in TR and CR alfalfa than RR alfalfa; however, RR alfalfa had higher total forage yield under dry growing conditions versus CR alfalfa. The three alfalfa cultivars had a similar response to 2‐cut harvest managements. The first cut yield was affected by the timing of the second cut of the previous year with the early September harvest reducing yield more than the late September. Three alfalfa cultivars had similar crude protein (CP), total digestible nutrient (TDN), and acid detergent fiber (ADF) concentrations. There was a significant nutrient yield benefit of TR and CR alfalfa under a 2‐cut system over the RR alfalfa. Although the prairie climate is warming, the findings suggest that a fall rest period until late September is recommended regardless of alfalfa types to maintain high hay yield over multiple years. Core Ideas: Early September harvest in a 2‐cut treatment reduced the July harvest yield in the subsequent year more than the late September harvest.The first killing frost was not an effective indicator for determining onset of the critical rest period.The timing of the first harvest influenced yield of the second cut more than the timing of the second harvest in the fall.M. sativa had significant total nutrient yield advantage over M. falcata under a 2‐cut system.M. falcata produced similar or greater forage yield under dry conditions than M. sativa. [ABSTRACT FROM AUTHOR]

Background Accommodations with shared washing facilities increase the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for people experiencing rough sleeping and evidence on what interventions are effective in reducing these risks needs to be understood. Methods Systematic review, search date 6 December 2022 with methods published a priori. Electronic searches were conducted in MEDLINE, PubMed, Cochrane Library, CINAHL and the World Health Organization (WHO) COVID-19 Database and supplemented with grey literature searches, hand searches of reference lists and publication lists of known experts. Observational, interventional and modelling studies were included; screening, data extraction and risk of bias assessment were done in duplicate and narrative analyses were conducted. Results Fourteen studies from five countries (USA, England, France, Singapore and Canada) were included. Ten studies were surveillance reports, one was an uncontrolled pilot intervention, and three were modelling studies. Only two studies were longitudinal. All studies described the effectiveness of different individual or packages of mitigation measures. Conclusions Despite a weak evidence base, the research suggests that combined mitigation measures can help to reduce SARS-CoV-2 transmission but are unlikely to prevent outbreaks entirely. Evidence suggests that community prevalence may modify the effectiveness of mitigation measures. More longitudinal research is needed. Systematic review registration PROSPERO CRD42021292803. [ABSTRACT FROM AUTHOR]

This paper examines how experiences with a previous pandemic, particularly HIV/AIDS, may have informed approaches to COVID-19, with a focus on sexual orientation. Method: The sample was drawn from an online survey of Canadians 55+ conducted in 2020, comprising 1143 persons (mean age = 67; 88 gay or bisexual (GB) men, 65 lesbian or bisexual (LB) women, 818 heterosexual women, and 172 heterosexual men). Respondents reported if they, or someone close to them, "had been affected by" one or more pandemics and whether COVID-19 led them to "think more about their prior epidemic/pandemic experiences" and/or feel they "couldn't handle it again". Correlated items reflecting feeling "they have been here before"; "prepared for what is happening"; and "like they needed to act or do something" formed a scale named "agentic familiarity". Results: About half of respondents reported thinking about their previous pandemic experience; about 5% reporting feeling like "they couldn't handle it again" with no gender or sexual orientation differences. Higher agentic familiarity scores were found for GB men and for those with experience with HIV/AIDS vs. other pandemics. Discussion: These outcomes speak to resilience and growth experienced by LGBT (and especially GB) persons through shared stigma and trauma—with implications for current pandemic experiences and future actions, like advance care planning. [ABSTRACT FROM AUTHOR]

The second Early-Age-Onset Colorectal Cancer Symposium, convened in October 2022, sought solutions to the barriers to early detection and care for colorectal cancer in Canada. This meeting built on a previous symposium, held in 2021 and reported in this journal. Early-age-onset colorectal cancer (EAOCRC) affects increasing numbers of people under the age of 50 in Canada and throughout the developed world. Two main themes emerged from the meeting: the importance of timely detection, and the need for a tailored approach to the care of EAOCRC. Early detection is crucial, especially in light of the later stage at diagnosis and unique tumour characteristics. Symposium participants were strongly in favour of reducing the age of eligibility for screening from 50 to 45, and promoting the development of non-invasive screening techniques such as testing for circulating tumour DNA and biomarkers. Leading approaches to care were described and discussed, which meet the unique treatment needs of younger CRC patients. Multidisciplinary practices within and outside Canada address such factors as fertility, family roles, education, careers and financial responsibilities. These models can be applied in treatment centres across the country. [ABSTRACT FROM AUTHOR]

Background: Mental health impacts of the COVID-19 pandemic have not been felt equally within populations. Parents with children living at home were early on identified as a population at heightened mental health risk, with concerns about the potential long-term impacts of the pandemic on parents' mental health, family functioning, and children's well-being. This study investigates impacts of the pandemic on parents' psychological distress, contextual sources of distress, and associations with family functioning nearly two years into the pandemic. Methods and findings: Data were drawn from a national cross-sectional survey of adults living in Canada in November and December 2021 that was representative by age, gender, household income, and region. Parents with children < 18 years old living at home (N = 553) reported their experiences of psychological distress, pandemic-related stressors, coping mechanisms, and family functioning (changes in parent-child interactions, children's anxiety). Chi-square tests, logistic regression, and linear regression analyses examined sociodemographic inequities in parents' levels of psychological distress, sources and mitigating mechanisms of distress, and associations between psychological distress and family functioning. Nearly two years into the pandemic, parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress. Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial stressors. Parents with greater psychological distress reported increases in negative parent–child interactions due to the pandemic and higher anxiety among their children. Conclusions: This study identifies sustained negative impacts of the pandemic on parents' mental health and family functioning in Canada nearly two years into the pandemic, despite high vaccine uptake and declining infection rates. Disparities in financial stress, social support structures, and pre-existing mental health were identified as underlying sources of psychological distress. These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequities. [ABSTRACT FROM AUTHOR]

A care cascade is a critical tool for evaluating delivery of care for chronic infections across sequential stages, starting with diagnosis and ending with viral suppression. However, there have been few data describing the hepatitis B virus (HBV) care cascade among people living with HIV infection who have HBV coinfection. We conducted a cross-sectional study among people living with HIV and HBV coinfection receiving care between January 1, 2012 and December 31, 2016 within 13 United States and Canadian clinical cohorts contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). We evaluated each of the steps in this cascade, including: 1) laboratory-confirmed HBV infection, 2) tenofovir-based or entecavir-based HBV therapy prescribed, 3) HBV DNA measured during treatment, and 4) viral suppression achieved via undetectable HBV DNA. Among 3,953 persons with laboratory-confirmed HBV (median age, 50 years; 6.5% female; 43.8% were Black; 7.1% were Hispanic), 3,592 (90.9%; 95% confidence interval, 90.0–91.8%) were prescribed tenofovir-based antiretroviral therapy or entecavir along with their antiretroviral therapy regimen, 2,281 (57.7%; 95% confidence interval, 56.2–59.2%) had HBV DNA measured while on therapy, and 1,624 (41.1%; 95% confidence interval, 39.5–42.6) achieved an undetectable HBV DNA during HBV treatment. Our study identified significant gaps in measurement of HBV DNA and suppression of HBV viremia among people living with HIV and HBV coinfection in the United States and Canada. Periodic evaluation of the HBV care cascade among persons with HIV/HBV will be critical to monitoring success in completion of each step. [ABSTRACT FROM AUTHOR]

On Sunday, 5 August 2012, at approximately 10:00 a.m., an armed Wade Michael Page walked into the Oak Creek, Wisconsin Sikh gurdwara, a place of worship. Page killed six worshippers and injured four others. Although the murderer had links to several white supremacist organizations, authorities would not speculate on the motive of this incident. In fact, the word race was rarely mentioned in relation to this case. The lack of a sustained examination of racism as a motivating factor in this crime was very troubling within the media's portrayal of this incident. Through a critical analysis of structural racism, this article highlights how the silences of racism, racialized identities, and the connections of racist acts such as the Wisconsin gurdwara murders to hate crimes perpetuates racialized and colonized violence on brown bodies. This structural racism absolves many Americans (and we would add many Canadians) of their deeply rooted racist beliefs and ideologies. By providing a counter-hegemonic narrative, this article discusses how the homogenization of brown bodies, such as Sikhs and Muslims, has very real material consequences in a North American context. Finally, this article discusses the problematic framing of this incident as "Domestic Terrorism" and the importance of de-Islamizing Sikhaphobia in the post-9-11-2001 context.

This study focused on the effects of the COVID-19 pandemic on the marginalized populations—specifically Black and Indigenous people as well as People of Color (BIPOC) compared to White older adults and LGBT individuals compared to heterosexual older adults. Data were derived from our national online survey of Canadians aged 55+, conducted from 10 August to 10 October 2020. The survey explored the influence of COVID-19 on lifestyle changes, well-being, and planning for the future. Our sample comprised 4292 respondents. We compared sets of dichotomous variables with White vs. BIPOC, LGBT vs. heterosexual, and LGBT White vs. LGBT BIPOC respondents. Significantly more BIPOC than White individuals reported changes in accessing food (44.3% vs. 33.2%) and in family income (53.9% vs. 38.9%) and fewer reported feeling accepted and happy, and more felt isolated and judged. Significantly more LGBT than heterosexual respondents reported changes in routines and in accessing social support, medical and mental health care and more feeling depressed, lonely, anxious, and sad. More LGBT–BIPOC than LGBT–White respondents reported changes in access to food (66.7 vs. 30.6, p < 0.001); in family income (66.7 vs. 41.5, p < 0.005); and in access to mental health care (38.5 vs. 24.0, p < 0.05). The only difference in emotional response to COVID-19 was that more BIPOC–LGBT than White–LGBT respondents reported feeling judged (25.9 vs. 14.5, p < 0.05). These findings reflect a complex mix of the effects of marginalization upon BIPOC and LGBT older adults, revealing both hardship and hardiness and warranting further research. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. Methods: Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. Results: Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. Conclusion: Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge. [ABSTRACT FROM AUTHOR]

Background: As the first point of contact in health care, primary care providers play an integral role in pandemic response. Despite this, primary care has been overlooked in previous pandemic plans, with a lack of emphasis on ways in which the unique characteristics of family practice could be leveraged to create a more effective response. Aim: To explore family physicians' perceptions of the integration of primary care in the COVID-19 pandemic response. Design and setting: Descriptive qualitative approach examining family physician roles during the COVID-19 pandemic across four regions in Canada. Method: Semi-structured qualitative interviews were conducted with family physicians and participants were asked about their roles during each pandemic stage, as well as facilitators and barriers they experienced in performing these roles. Interviews were transcribed and a thematic analysis approach was employed to develop a unified coding template across the four regions and identify recurring themes. Results: In total, 68 family physicians completed interviews. Four priorities for integrating primary care in future pandemic planning were identified: 1) improve communication with family physicians; 2) prioritise community-based primary care; 3) leverage the longitudinal relationship between patients and family physicians; and 4) preserve primary care workforce capacity. Across all regions, family physicians felt that primary care was not well incorporated into the COVID-19 pandemic response. Conclusion: Future pandemic plans require greater integration of primary care to ensure the delivery of an effective and coordinated pandemic response. Strengthening pandemic preparedness requires a broader reconsideration and better understanding of the central role of primary care in health system functioning. [ABSTRACT FROM AUTHOR]

Introduction: Hearing loss (HL) is considered a potentially modifiable risk factor for dementia. We aimed to examine the relationship between HL and incident dementia diagnosis in a province-wide population-based cohort study with matched controls. Methods: Administrative healthcare databases were linked to generate a cohort of patients who were aged ≥40 years at their first claimed hearing amplification devices (HAD) between April 2007 and March 2016 through the Assistive Devices Program (ADP) (257,285 with claims and 1,005,010 controls). The main outcome was incident dementia diagnosis, ascertained using validated algorithms. Dementia incidence was compared between cases and controls using Cox regression. Patient, disease, and other risk factors were examined. Results: Dementia incidence rates (per 1,000 person-years) were 19.51 (95% confidence interval [CI]: 19.26–19.77) and 14.15 (95% CI: 14.04–14.26) for the ADP claimants and matched controls, respectively. In adjusted analyses, risk of dementia was higher in ADP claimants compared with controls (hazard ratio [HR]: 1.10 [95% CI: 1.09–1.12, p < 0.001]). Subgroup analyses showed a dose-response gradient, with risk of dementia higher among patients with bilateral HADs (HR: 1.12 [95% CI: 1.10–1.14, p < 0.001]), and an exposure-response gradient, with increasing risk over time from April 2007-March 2010 (HR: 1.03 [95% CI: 1.01–1.06, p = 0.014]), April 2010-March 2013 (HR: 1.12 [95% CI: 1.09–1.15, p < 0.001]), and April 2013-March 2016 (HR: 1.19 [95% CI: 1.16–1.23, p < 0.001]). Conclusion: In this population-based study, adults with HL had an increased risk of being diagnosed with dementia. Given the implications of HL on dementia risk, understanding the effect of hearing interventions merits further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Significant center‐to‐center variation in attitudes and management of delayed graft function (DGF) remains common. Methods: A survey to describe current DGF practices was developed by workgroup members sponsored by the National Kidney Foundation (NKF) and was distributed to both the NKF DGF workgroup members, kidney transplant program directors and the transplant community within the United States and Canada. Seventy‐one percent of NKF workgroup members completed the survey along with 70 unique the United States and three Canadian kidney transplant programs. All Organ Procurement and Transplantation Network (OPTN) regions were represented. Results: DGF was reported to occur at rate of 20%–40% for most centers with 3.9% indicating their incidence to be >60%. Most centers reported longer hospital lengths of stay and more frequent outpatient visits. Despite the commonality of DGF, only half of centers reported having an established protocol to manage DGF. Kidney allograft biopsies were the only consistent DGF management strategy observed, although use of machine perfusion was also heavily favored. Other DGF management strategies voiced by a minority included having established outpatient practices to care for DGF patients and administering outpatient community‐based hemodialysis. Conclusion: Although approximately a third of survey responders indicated that risk of DGF played a role in their willingness to accept organs, most did not feel that increased cost or clinical impact on outcomes was a deterrent. Future strategies, including broader sharing of best practices, redefining terminology specific to DGF, the establishment of DGF dialysis guidelines and improving access to machine perfusion across OPOs may help reduce discard and improve utilization of kidneys at risk for DGF. [ABSTRACT FROM AUTHOR]

Background: Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. Methods: We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. Results: We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. Conclusion: Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma, cancer of the biliary tract, is a rare malignancy with a poor prognosis. However, the incidence of cholangiocarcinoma is on the rise globally. Currently, complete surgical resection is the only curative treatment for localized disease while there is no cure for more advanced cholangiocarcinoma. In recent years, there have been several developments of adjuvant and palliative chemotherapies, especially with regards to targeted molecular therapies. Some of these treatments are now approved and funded in Canada. The purpose of the review is to provide a general overview of current cholangiocarcinoma systemic therapies, with a focus on Canadian standards of care. [ABSTRACT FROM AUTHOR]

This paper presents a review of the literature relating to hard-to-reach families which has been published over the last 12 years in the UK, USA, Canada and Australia. The purpose of the review was twofold: to gain insights to understandings of the term "hard-to-reach" within these services--education, health and social--which might be aiming to access such families in order to help them improve their life chances and to explore the ways in which services have been successful in engaging the families. A consistent message to emerge from the review is that complex issues need complex solutions which in turn need time to implement. Additionally, it is clear that services need to develop diversity of support provision in order to meet the varying needs of families and that services need to develop a shared script for working with them. (Contains 1 table and 5 figures.)

This article documents a two-year journey developing and implementing a teacher education programme that required preservice teachers and teachers, administrators, and students in six cooperating schools to address issues of diversity, multi-/transculturalisms, inclusion, anti-racism/anti-oppression and social justice. We describe approaches and analyse changing attitudes, commitment and activism among those who participated in this "Diversity" cohort initiative--a collaboration between the University of British Columbia's Faculty of Education and the Vancouver School Board. We profile the courage and commitment of those who began to see themselves as important allies and agents of change in Canada's most multicultural environment. We acknowledge the less successful aspects, and generate implications for teacher education partnerships that seek to embrace "critical" multicultural, inclusive, and social justice education.

The authors, library practitioners from either side of the Atlantic Ocean, embarked on a dialogue about the ethical challenges encountered in providing library services to distance learners. Unable to find an existing, appropriate ethical framework for their discussion, they agreed to devise their own, informed by relevant professional codes and guidelines. They propose 10 ethical principles for the provision of library services to distance learners. Drawing on their own experience, they highlight the challenges these principles present in practice and the responsibilities of librarians and their institutions to meet them.

Background: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. Results: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. Conclusions: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic. [ABSTRACT FROM AUTHOR]

Translocation and captivity are important tools for conservation biology and wildlife management. Understanding the movement ecology of animals following their release in novel terrain is critical to predicting the success of wildlife restoration efforts. Mountain caribou have high conservation value – efforts to restore their populations across western Canada involve hundreds of millions of dollars in science, monitoring, and management activity. Here, we examined the movements of adult female caribou (N = 36) following their translocation to, and release from, a maternity pen ('penned caribou') and compared these movements to animals that were not translocated ('unpenned caribou', N = 22). A maternity pen is a temporary holding facility, within the animals' existing range, that enables them to bear and raise their young in the absence of predators and with augmented resources. Penned and unpenned animals had similar home range sizes (1052.2 and 1314.6 km2, respectively, P = 0.46) though penned animals moved through the landscape in a faster yet less directed manner. We found some evidence that memory may improve the efficiency of space use. Home ranges with higher quality habitats tended to be smaller than home ranges with poorer quality habitats irrespective of penning status. Penned animals ranged at lower elevation (~150 m) than unpenned animals, particularly in spring and early winter. For penned animals, we did not detect evidence of homing back to the original capture site. The best predictor of how caribou will use the landscape appears to be proximity to the location of the release site. To maximize the fitness of released caribou, future plans for maternity pens and captive breeding programs need to consider the management of food, predators, and habitat across the 1000–2000 km2 that will form the home range near the release site. [ABSTRACT FROM AUTHOR]

Background Depression is common in people with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), with biological and psychosocial mechanisms at play. Direct acting antivirals (DAA) result in high rates of sustained virologic response (SVR), with minimal side-effects. We assessed the impact of SVR on presence of depressive symptoms in the HIV-HCV coinfected population in Canada during the second-generation DAA era (2013–2020). Methods We used data from the Canadian CoInfection Cohort (CCC), a multicenter prospective cohort of people with a HIV and HCV coinfection, and its associated sub-study on food security. Because depression screening was performed only in the sub-study, we predicted Center for Epidemiologic Studies Depression Scale-10 classes in the CCC using a random forest classifier and corrected for misclassification. We included participants who achieved SVR and fit a segmented modified Poisson model using an interrupted time series design, adjusting for time-varying confounders. Results We included 470 participants; 58% had predicted depressive symptoms at baseline. The median follow-up was 2.4 years (interquartile range [IQR]: 1.0–4.5.) pre-SVR and 1.4 years (IQR: 0.6–2.5) post-SVR. The pre-SVR trend suggested depressive symptoms changed little over time, with no immediate level change at SVR. However, post-SVR trends showed a reduction of 5% per year (risk ratio: 0.95 (95% confidence interval [CI]:.94–.96)) in the prevalence of depressive symptoms. Conclusions In the DAA era, predicted depressive symptoms declined over time following SVR. These improvements reflect possible changes in biological pathways and/or better general health. If such improvements in depression symptoms are durable, this provides an additional reason for treatment and early cure of HCV. [ABSTRACT FROM AUTHOR]