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Context: Competency-based education (CBE) is entrenched in educating health professionals in Canada. CBE is a framework that identifies desired performance characteristics in training competent, entry-level health professionals. Objective: To update, develop, and validate a new Canadian Athletic Therapists Association (CATA) framework for athletic therapy education. Design: Framework development occurred in 4 phases and was developed through a multistage process that involved a scoping review (phase 1) and consensus methodology (ie, a blending of modified Ebel and modified Delphi consensus methods; phases 2-4). Patients or Other Participants: Phase 2: a total of 7 experts (program directors) from each Canadian accredited institution. Phase 3: a total of 14 experts (1 program director and educational expert from each accredited institution). Phase 4: a total of 7 experts (program directors) and 246 certified members of the CATA. Main Outcome Measure(s): Each phase consisted of a systematic process with 80% consensus agreement set a priori. In phase 1, a scoping review was conducted to identify common terminology that could be used to guide the framework development process and to identify competency frameworks used by other health professional organizations. Phase 2 consisted of adopting a common language that would serve to keep the expert group on the task at hand and avoid confusion. In phase 3, frameworks used by other health professional organizations were evaluated and used to determine the validity of the old CATA framework. In phase 4, the old CATA framework was updated and a new framework was developed and validated. Results: In phase 1, the result of the scoping review yielded 368 papers, of which 5 were used to propose a common language for phase 2 and 9 highlighted competency frameworks used by other health professions for comparison in phase 3. In phase 3, the expert group voted unanimously to adopt and adapt the CanMEDS framework (ie, roles). In phase 4, the new CATA competency framework was validated, and most competencies achieved consensus. Competencies that did not achieve consensus in the first round of voting underwent face-to-face discussions via videoconferencing. After discussions, the remaining competencies were revised, and all newly worded competencies achieved consensus. Conclusions: The resultant framework was validated, and most competencies achieved consensus. The new athletic therapy competency framework outlines the 165 competencies resulting from this methodical process and will hopefully facilitate interdisciplinary communication and practice.

In the last decade, doctoral education has undergone a sea change with several global trends increasingly apparent. Drivers of change include massification and professionalization of doctoral education and the introduction of quality assurance systems. The impact of these drivers, and the forms that they take, however, are dependent on doctoral education within a given national context. This paper is frontline in that it contributes to the literature on doctoral education by examining the ways in which these global trends and drivers are being taken up in policies and practices by various countries. We do so by comparing recent changes in each of the following countries: Canada, Colombia, Denmark, Finland, the UK, and the USA. Each country case is based on national education policies, policy reports on doctoral education (e.g., OECD and EU policy texts), and related materials. We use the same global drivers to examine educational policies of each country. However, depending each national context, these drivers are framed in considerably different ways. This raises questions about (1) their comparability at a global level and (2) the universality of the PhD. Also we find that this global-local nexus reveals unresolved tensions within the national doctoral educational frameworks.

The term "Centre of Excellence" is increasingly used by Ontario's colleges with the expectation of portraying a superior level of proficiency, expertise, or investment in a particular academic discipline or program cluster. This paper proposes that the term Centre of Excellence should have a clearer definition so that when one of Ontario's colleges uses it, the reader will have a better sense of its meaning by initiating a discussion as to how this definition might be framed from a measurement perspective. Creating a Centre of Excellence in a college in Ontario can be an important method of enhancing reputation since it differentiates a college from other colleges and universities in its catchment area. As such, it is an important strategic asset. The purpose of this paper is to broaden the discussion about the casual and possible over trivialization of the use of the term "Centre of Excellence" by forwarding measures and categories of measures that will help determine whether such a condition has developed or is emerging.

Background Core to competency-based medical education (CBME) is the use of frequent low-stakes workplace-based assessments. In the Canadian context, these observations of performance are framed around entrustable professional activities (EPAs). Objective We aimed to explore residents' real-world perspectives of EPAs and their perceived impact on learning, because assessments perceived to be "inauthentic," or not truly reflective of their lived experiences, may interfere with learning. Methods Using constructivist grounded theory, we conducted 18 semistructured interviews in 2021 with residents from all programs that had implemented CBME at one tertiary care academic center in Canada. Participants were recruited via email through respective program administrators. Data collection and analysis occurred iteratively, and categories were identified using constant comparative analysis. Results Residents were strikingly polarized, perceiving EPAs as either a valuable opportunity for professional growth or as an onerous requirement that interfered with learning. Regardless of what view participants held, all perspectives were informed by: (1) the program administration and the perceived messaging from program to residents; (2) faculty assessors and their perceived degree of engagement, or "buy-in" with the EPA system; and ultimately (3) learner behavior. We theorized from these findings that all 3 aspects must be working in tandem for the assessment system to function as intended. Conclusions From the learners' perspective, there exists a dynamic, interdependent relationship between the 3 CBME stakeholders. As such, the perceived value of the EPA assessment system can only be as strong as the weakest link in the chain. [ABSTRACT FROM AUTHOR]

Rationale: Limited information exists about the epidemiology, outcomes, and predictors of weaning from mechanical ventilation in patients with spinal cord injury. Objectives: Our aim was to investigate predictors of weaning outcomes for patients with traumatic spinal cord injury (tSCI) and develop and validate a prognostic model and score for weaning success. Methods: This was a registry-based, multicentric cohort study including all adult patients with tSCI requiring mechanical ventilation (MV) and admitted to one of the intensive care units (ICUs) of the Trauma Registry at St. Michael’s Hospital (Toronto, ON, Canada) and the Canadian Rick Hansen Spinal Cord Injury Registry between 2005 and 2019. The primary outcome was weaning success from MV at ICU discharge. Secondary outcomes included weaning success at Days 14 and 28, time to liberation from MV accounting for competing risk of death, and ventilator-free days at 28 and 60 days. Associations between baseline characteristics and weaning success or time to liberation from MV were measured using multivariable logistic and competing risk regressions. A parsimonious model to predict weaning success and ICU discharge was developed and validated via bootstrap. A prediction score for weaning success at ICU discharge was derived, and its discriminative ability was assessed using receiver operating characteristic curve analysis and compared with the Injury Severity Score (ISS). Results: Of 459 patients analyzed, 246 (53.6%), 302 (65.8%), and 331 (72.1%) were alive and free of MV at Day 14, Day 28, and ICU discharge, respectively; 54 (11.8%) died in the ICU. Median time to liberation from MV was 12 days. Factors associated with weaning success were Blunt injury (odds ratio [OR], 2.96; P = 0.010), ISS (OR, 0.98; P = 0.025), Complete syndrome (OR, 0.53; P = 0.009), age in Years (OR, 0.98; P = 0.003), and Cervical LEsion (OR, 0.60; P = 0.045). The BICYCLE score showed a greater area under the curve than the ISS (0.689 [95% confidence interval (CI), 0.631–0.743] vs. 0.537 [95% CI, 0.479–0.595]; P, 0.0001). Factors predicting weaning success also predicted time to liberation. Conclusions: In a large multicentric cohort, 72% of patients with tSCI were weaned and discharged alive from the ICU. Readily available admission characteristics can reasonably predict weaning success and help prognostication. [ABSTRACT FROM AUTHOR]

Viewed through a market paradigm, universities can appear as the aggregation of numerous and varied markets. While universities' primary markets focus on teaching and research, they are active in many other markets, most of which support and contribute to their smooth, effective and efficient operation. Using financial and real estate markets as examples, the purpose of this article is to articulate some details that further validate the deepening complexity of the modern multiversity and to help clarify the extent to which market-like activities have infiltrated the institution, creating opportunities and posing threats. The cultural impact of the trend towards marketisation increases the need to protect the academic core of the academy.

Background: Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment duration.Methods: We conducted a retrospective observational cohort study in six pediatric intensive care units (PICUs) across Canada. Associations between treatment duration and patient-, infection- and pathogen-related characteristics were explored using multivariable regression analyses.Results: Among 187 critically ill children with BSIs, the median duration of antimicrobial treatment was 15 (IQR 11-25) days. Median treatment durations were longer than two weeks for all subjects with known sources of infection: catheter-related 16 (IQR 11-24), respiratory 15 (IQR 11-26), intra-abdominal 20 (IQR 14-26), skin/soft tissue 17 (IQR 15-33), urinary 17 (IQR 15-35), central nervous system 33 (IQR 15-46) and other sources 29.5 (IQR 15-55) days. When sources of infection were unclear, the median duration was 13 (IQR 10-16) days. Treatment durations varied widely within and across PICUs. In multivariable linear regression, longer treatment durations were associated with severity of illness (+ 0.4 days longer [95% confidence interval (CI), 0.1 to 0.7, p = 0.007] per unit increase in PRISM-IV) and central nervous system infection (+ 17 days [95% CI, 6.7 to 27.4], p = 0.001). Age and pathogen type were not associated with treatment duration.Conclusions: Most critically ill children with BSIs received at least two weeks of antimicrobial treatment. Further study is needed to determine whether shorter duration therapy would be effective for selected critically ill children. [ABSTRACT FROM AUTHOR]

Purpose: Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada.Methods: We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP).Results: In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children.Conclusion: Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups. [ABSTRACT FROM AUTHOR]

Understanding how risk factors affect populations across their annual cycle is a major challenge for conserving migratory birds. For example, disease outbreaks may happen on the breeding grounds, the wintering grounds, or during migration and are expected to accelerate under climate change. The ability to identify the geographic origins of impacted individuals, especially outside of breeding areas, might make it possible to predict demographic trends and inform conservation decision‐making. However, such an effort is made more challenging by the degraded state of carcasses and resulting low quality of DNA available. Here, we describe a rapid and low‐cost approach for identifying the origins of birds sampled across their annual cycle that is robust even when DNA quality is poor. We illustrate the approach in the common loon (Gavia immer), an iconic migratory aquatic bird that is under increasing threat on both its breeding and wintering areas. Using 300 samples collected from across the breeding range, we develop a panel of 158 single‐nucleotide polymorphisms (SNP) loci with divergent allele frequencies across six genetic subpopulations. We use this SNP panel to identify the breeding grounds for 142 live nonbreeding individuals and carcasses. For example, genetic assignment of loons sampled during botulism outbreaks in parts of the Great Lakes provides evidence for the significant role the lakes play as migratory stopover areas for loons that breed across wide swaths of Canada, and highlights the vulnerability of a large segment of the breeding population to botulism outbreaks that are occurring in the Great Lakes with increasing frequency. Our results illustrate that the use of SNP panels to identify breeding origins of carcasses collected during the nonbreeding season can improve our understanding of the population‐specific impacts of mortality from disease and anthropogenic stressors, ultimately allowing more effective management. [ABSTRACT FROM AUTHOR]

This essay examines how culinary infrastructure encouraged and impeded immigrant entrepreneurship in provisioning Toronto before Canada adopted an official policy of multiculturalism in the 1970s. Culinary infrastructure refers broadly to facilities and technologies – both physical and knowledge-based – that undergird food systems. The Anglo-dominated infrastructural hub of the St. Lawrence market provided the central food retailing space during the Victorian era, then became a wholesale depot in the first half of the twentieth century, and finally gentrified into a tourist market in the 1970s. Nevertheless, until the belated rise of supermarkets, most residents purchased food from immigrant entrepreneurs, largely pushcart vendors in the nineteenth century, and increasingly small shopkeepers and street markets such as Kensington in the twentieth. This essay concludes that although the allocation and regulation of markets were intended to assimilate immigrant foodways into an idealized Anglo city, newcomers actively shaped Toronto's culinary geography. [ABSTRACT FROM AUTHOR]

Listeria monocytogenes, a resilient and ubiquitous foodborne pathogen, is associated with a high case-fatality rate in humans. This study investigated the culturable microbiota of low-moisture foods (LMFs) imported into Canada to see how well bacteria isolated from these foods could inhibit or inactivate the growth of L. monocytogenes. Imported LMFs were acquired from various supermarkets in the Greater Toronto Area (Ontario, Canada). The foods included dried apples, bee pollen, cumin seeds, date fruits, fennel seeds, pistachios, raisins, and seaweed. Bacterial strains were isolated from the foods using blood agar and then screened using an in-house-designed growth inhibition plate assay against L. monocytogenes. The inhibitory strains detected were then identified using 16S rRNA sequencing. Diverse bacteria were recovered from the foods; 236 isolates belonging to 122 observed phenotypes were obtained. From the inhibition plate assays, 10 of the 11 imported LMFs harbored inhibitory strains against L. monocytogenes, whereby 48 of the collected isolates (20%) were found to produce a zone of inhibition against this pathogen. The inhibitory strains belonged to six genera (Acinetobacter, Aerococcus, Bacillus, Lysinibacillus, Paenibacillus, and Sporosarcina) and 15 unique species. Among all foods tested, the date fruit microbiota displayed the greatest number and diversity of anti–L. monocytogenes inhibitory strains. Overall, it was found that the culturable microbiota of LMFs, imported into Canada, possess bacterial members that can inhibit the growth of L. monocytogenes. These results could lead to the discovery of either novel antimicrobial metabolites or beneficial anti–L. monocytogenes bacteria that could be added to foods to inactivate and/or control L. monocytogenes. Modification to an inhibition plate assay detects anti-Listeria bacteria more rapidly. Unconventional anti-Listeria genera, such as Lysinibacillus, were discovered. Date fruit microbiota warrants further investigation for anti-Listeria applications. Isolated bacteria from low-moisture foods are diverse and can inhibit L. monocytogenes growth. [ABSTRACT FROM AUTHOR]

Background: The erythrocytic protozoan parasite Babesia microti, the cause of human babesiosis, is transmitted not only by tick bites but also via blood transfusion. B. microti is endemic in the northeastern/upper midwestern United States, where partial screening of blood donations has been implemented. In Canada, a 2013 study of approximately 14,000 donors found no B. microti antibody-positive samples, suggesting low risk at that time.Methods: Between June and October 2018, 50,752 Canadian donations collected from sites near the US border were tested for Babesia nucleic acid by transcription-mediated amplification (TMA). Reactive donations were tested for B. microti by IgG immunofluorescence assay and polymerase chain reaction. A subset of 14,758 TMA nonreactive samples was also screened for B. microti antibody. Donors who tested reactive/positive were deferred, asked about risk factors, and were requested to provide a follow-up sample for supplemental testing.Results: One sample from Winnipeg, Manitoba, was TMA and antibody reactive. Of the 14,758 TMA-nonreactive donations tested for antibody, four reactive donations were identified from southwestern Ontario near Lake Erie. None of the interviewed donors remembered any symptoms, likely tick exposure, or relevant travel within Canada or the United States.Conclusions: This is the largest B. microti prevalence study performed in Canada. The results indicate very low prevalence, with only one TMA-confirmed-positive donation of 50,752 tested. This donor was from the only region in Canada where autochthonous infection has been reported. Seropositive donations in southwestern Ontario suggest low prevalence; travel should not be ruled out given the proximity to the US border. [ABSTRACT FROM AUTHOR]

The Canadian Diptera fauna is updated. Numbers of species currently known from Canada, total Barcode Index Numbers (BINs), and estimated numbers of undescribed or unrecorded species are provided for each family. An overview of recent changes in the systematics and Canadian faunistics of major groups is provided as well as some general information on biology and life history. A total of 116 families and 9620 described species of Canadian Diptera are reported, representing more than a 36% increase in species numbers since the last comparable assessment by JF McAlpine et al. (1979). Almost 30,000 BINs have so far been obtained from flies in Canada. Estimates of additional number of species remaining to be documented in the country range from 5200 to 20,400. [ABSTRACT FROM AUTHOR]

Background: The fundamentals of endoscopic surgery (FES) examination measures the knowledge and skills required to perform safe flexible endoscopy. A potential limitation of the FES skills test is the size and cost of the simulator on which it was developed (GI Mentor II virtual reality endoscopy simulator; Simbionix LTD, Israel). A more compact and lower-cost alternative (GI Mentor Express) was developed to address this issue. The purpose of this study was to obtain evidence for the validity of scores obtained on the Express platform, so that it can be used for testing.Study Design: General surgery residents at various levels of training and practicing endoscopists at five institutions participated. Each completed the five FES tasks on both simulator platforms in random order, with 3-14 days between tests. Scores were calculated using the same standardized computer-generated algorithm and compared using Pearson's correlation coefficient.Results: There were 58 participants (mean age 32; 76% male) with a broad range of endoscopic experience. The mean (95% confidence interval) FES scores were 72 (67:77) on the GI Mentor II and 66 (60:71) on the Express. The correlation between scores on the two platforms was 0.86 (0.77:0.91; p < 0.0001).Conclusion: There is a high correlation between FES manual skills scores measured on the original platform and the new Express, providing evidence to support the use of the GI Mentor Express for FES testing. [ABSTRACT FROM AUTHOR]

The article discusses the Investment Industry Regulatory Organisation of Canada (IIROC) and its publication of final guidance on underwriting due diligence, and it mentions how the publication gives underwriters an opportunity to internal practices in light of the IIROC's due diligence-related expectations. Canadian regulatory bodies are addressed, along with information about Canadian securities laws, material contracts, and business plans and budgets.

Parasitic diseases are of considerable public health significance in Canada, particularly in rural and remote areas. Food- and waterborne parasites contribute significantly to the overall number of parasitic infections reported in Canada. While data on the incidence of some of these diseases are available, knowledge of the true burden of infection by the causative agents in Canadians is somewhat limited. A number of centers of expertise in Canada study various aspects of parasitology, but few formal societies or networks of parasitologists currently exist in Canada, and previously none focused specifically on food or environmental transmission. The recently established Food and Environmental Parasitology Network (FEPN) brings together Canadian researchers, regulators and public health officials with an active involvement in issues related to these increasingly important fields. The major objectives of the Network include identifying research gaps, facilitating discussion and collaborative research, developing standardized methods, generating data for risk assessments, policies, and guidelines, and providing expert advice and testing in support of outbreak investigations and surveillance studies. Issues considered by the FEPN include contaminated foods and infected food animals, potable and non-potable water, Northern and Aboriginal issues, zoonotic transmission, and epidemiology. [ABSTRACT FROM AUTHOR]

Abstract: As part of a larger project to determine if there are animal-welfare-related values shared by some commercial food–animal producers and non-producers in Canada, open-ended, semi-structured interviews were conducted to elicit opinions about animal welfare among 24 urban and rural residents not involved in commercial animal production. All participants possessed a self-described interest in food animal well-being and were therefore assumed to represent the views of Canadian non-producers most apt to engage in efforts to shape the animal welfare policies of governments and businesses. Participants described animal welfare in moral or ethical terms, expressed virtually unanimous support for animals having access to “natural” living conditions, and (somewhat less often) linked animal welfare to positive affective states. Maintaining reasonable health and biological functioning was seen as important but was not to take precedence over the benefits of natural living. Participants favoured small family farms and unanimously objected to confinement housing. Participants did, however, offer qualified support for intensive practices and were unanimous in not assigning blame to producers, whom they regarded sympathetically. Predictably perhaps, given our sample, most were critical of industries preoccupied with profits and of consumers who unthinkingly seek cheap food. Recommended ways of improving welfare included instilling in consumers a greater appreciation for the intrinsic value of humanely reared animals, and better education of children regarding the connection between animals and food. Disagreements arose over the welfare implications of organic production and approaches to animal advocacy. Differing demographic backgrounds, experiential involvement with food animals and knowledge of food animal production practices may have influenced the nature or specificity of welfare concerns. Many participants admitted a lack of knowledge about contemporary production practices and some expressed an interest in obtaining additional knowledge. These findings contribute to a broader effort to identify shared values among different stakeholder groups as a basis for formulating widely acceptable, farm animal care and handling polices. [Copyright &y& Elsevier]

The article presents a study survey which discussed trends in antimicrobial prescribing among Canadian physicians. Many respondents did not prescribe amoxicillin, and a substantial proportion underdosed, among those who did. In one scenario, increased proportion of respondents selecting oral cephalosporins or amoxicillin/clavulanate was seen. Macrolides were often prescribed, maybe because they offer excellent coverage of Mycoplasma pneumoniae and Chlamydophila pneumoniae.

During 1985-2005, a total of 91 laboratory-confirmed outbreaks of foodborne botulism occurred in Canada; these outbreaks involved 205 cases and 11 deaths. Of the outbreaks, 75 (86.2%) were caused by Clostridium botulinum type E, followed by types A (7, 8.1%) and B (5, 5.7%). Approximately 85% of the outbreaks occurred in Native communities, particularly the Inuit of Nunavik in northern Quebec and the First Nations population of the Pacific coast of British Columbia. These populations were predominantly exposed to type E botulinum toxin through the consumption of traditionally prepared marine mammal and fish products. Two botulism outbreaks were attributed to commercial ready-to-eat meat products and 3 to foods served in restaurants; several cases were attributed to non-Native home-prepared foods. Three affected pregnant women delivered healthy infants. Improvements in botulism case identification and early treatment have resulted in a reduction in the case-fatality rate in Canada. [ABSTRACT FROM AUTHOR]

Abstract: In 2008, Canada experienced one of its most serious outbreaks of foodborne listeriosis. During this outbreak, which was eventually traced back to contaminated deli-meat, there were 57 cases of illness and 23 deaths. As a result of the outbreak, the Canadian Food Inspection Agency (CFIA) has developed new Directives for the registered meat and poultry sector. Under the new requirements, production facilities must implement food contact surface testing for Listeria spp. and/or Listeria monocytogenes. The enhanced requirements focus on early detection and control of L. monocytogenes by introducing new testing and reporting requirements for industry, e.g., positive test results from all food contact surface testing must now be immediately reported to the CFIA and companies must perform trend analysis on their test results. In addition, work has begun on updating the current Health Canada policy on L. monocytogenes. The Canadian approach to Listeria control stresses the importance of environmental sampling. In addition to government agencies and food industries working diligently at minimizing the exposure to L. monocytogenes, consumers also have an important role to play in the farm-to-fork continuum. That role calls for Canadians to learn and adopt safe food handling, avoidance of certain high-risk foods, and preparation practices. To this effect, Health Canada has and will continue to undertake the development of science-based consumer education material which will help create an understanding of food safety issues within the context of the public’s right to know about the potential dangers in food, and industry’s responsibility for producing safe food. A combination of all these approaches are currently being adopted and/or developed to improve the control of L. monocytogenes in RTE foods sold in Canada. [Copyright &y& Elsevier]

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Abstract: Although the number of reported cases of Cronobacter infection in Canada is low, Health Canada has been actively studying this organism since 1991. After reviewing the situation at the national level and due to health concerns with powdered formulae and its international trade, in 2003, Health Canada raised this issue at the international level by proposing to revise the Code of Practice for Powdered Formulae for Infants and Young Children at the Codex Alimentarius Committee of Food Hygiene. Canada volunteered to chair the Working Group that would be developing the Code, and the Code was completed in four years. The Code contributed to an improvement in the hygienic conditions in plants manufacturing Powdered Infant Formula (PIF), resulting in a lower level of product contamination with Cronobacter species. Canada has produced a document detailing Good Manufacturing Practices (GMPs) for Infant Formula in Canada. Health Canada uses the GMPs as a basis for assessing the manufacturing information received in pre-market notifications for new or changed infant formulas. Health Canada does not have microbiological criteria for Cronobacter spp. in PIF; however, we are currently working on developing these criteria. At present, there are no active or passive surveillance systems for Cronobacter spp. in Canada, although this has been discussed. Health Canada has recently adapted and condensed FAO/WHO guidelines to develop a draft guidance document for the hygienic preparation and handling of PIF in home and hospitals/care settings, which outline requirements for parents, caregivers, and staff in hospitals and day-care centres. Health Canada''s Bureau of Microbial Hazards conducts research on the ecology, biology and pathogenesis of Cronobacter spp. Some of the research projects include specific aspects of molecular typing, virulence studies involving animal models, as well as in vitro tissue culture work to examine adhesion and invasion. Collaborative research is also being done with the Canadian National Research Council, using NMR and mass spectroscopy to reveal the structure of the O-polysaccharide of the various Cronobacter species. This review summarizes and discusses current activities that are being undertaken in Canada with respect to Cronobacter spp. [Copyright &y& Elsevier]

The occurrence of Campylobacter spp. in a variety of foods from Ottawa, Ontario, Canada, and raw milk samples from across Canada was determined over a 2-year period. The samples consisted of 55 raw foods (chicken, pork, and beef), 126 raw milk samples from raw milk cheese manufacturers, and 135 ready-to-eat foods (meat products, salads, and raw milk cheeses). Campylobacter jejuni was detected in 4 of the 316 samples analyzed: 1 raw beef liver sample and 3 raw chicken samples. An isolation rate of 9.7% was observed among the raw chicken samples tested. This study also investigated the role of cross-contamination in disseminating Campylobacter from raw poultry within a food service operation specializing in poultry dishes. Accordingly, kitchen surfaces within a restaurant in Ottawa, Ontario, were sampled between March and August 2001. Tests of the sampling method indicated that as few as 100 Campylobacter cells could be detected if sampling was done within 45 min of inoculation; however, Campylobacter spp. were not detected in 125 swabs of surfaces within the kitchens of this food service operation. Despite the reported high prevalence of Campylobacter spp. in raw poultry, this organism was not detected on surfaces within a kitchen of a restaurant specializing in poultry dishes. [ABSTRACT FROM AUTHOR]

The article analyzes the use of Internet technology against the initiatives of the Free Trade Area of the America (FTAA). The Hemispheric Social Alliance (HSA), a transnational coalition of hundreds of western hemisphere's civil society organizations that opposed the Free Trade of the United States' accord, applied Internet to communicate, plan, instruct and pressure state authorities in an attempt to promote an alternative social-development vision. Internet made the struggle sophisticated and it has been escalating since 1997, when the HSA was conceptualized. The effect of the protest was visible in the second People's summit of the Americas which held in Quebec City, Quebec in the year 2001. The anti-FTAA mobilization that the HSA has been planning is limited largely to its North American partners in Canada, in the United States and Mexico. Internet technologies are used creatively by the HSA for the development of a discourse critical of the FTAA. Movement activists have worked hard to overcome the geographical and language barriers by planning, cooperating and crafting policy. Internet activism is changing the way of struggle against the power and challenging the initiatives.

This article focuses on a political process approach for assessing the mobilization potential of civil society groups especially engaged in a campaign against deep integration. National politics still matters in considerations of contentious civic politics. It has become increasingly common to connect unfolding contentious activity to rapidly evolving international trends. The general trend in Canadian public opinion reflects both growing acceptance of previous trade agreements, as well as support for the negotiation of new trade agreements, such as the FTAA, with other countries.

Abstract Foodborne pathogens account for about 4 million illnesses in Canada annually. Unsafe handling, chilling, cooking and cleaning/sanitation procedures in the household contribute to a significant proportion of these infections. As such, it is important to practice safe food behaviors to prevent incidence of illness and cross-contamination. One way to provide food safety education and guidance to the consumer is through media including magazines, cooking shows, online recipes and cookbooks. Therefore, this study reviewed and analyzed the food safety knowledge of Canadian cooks and chefs by reviewing meat and seafood recipes in Canadian cookbooks published from 2015 to 2017. Of the 30 cookbooks examined, only 19 were included in the study as they focused on meat and seafood. Overall, this study found that cookbooks are not a good source of reliable food safety information or safe food handling practices, and they do not encourage the reader to practice safe food handling during preparation. Furthermore, thermometer use is not encouraged and the majority of recipes (approximately 96%) provided the incorrect temperature or was lacking a minimum internal temperature. Instead, subjective indicators such as a timeframe, colour and/or texture were given to indicate the degree of doneness. In addition, cookbook recipes were deficient in relaying safe preparation, serving and storage instructions. Thus, Canadian cookbooks are not being used effectively for the purposes of informing consumers on safe food handling and preparation techniques, and cannot be relied upon as a reliable source of food safety information. Efforts should be made to educate Canadian chefs (authors of the recipes) on safe food handling practices so that they can promote positive behavior messages conducive to promoting food safety to consumers. As such, currently, cookbook recipes cannot be relied upon as a tool for food safety education. In fact, a number of the cookbooks either lack information on food safety, and/or provide misleading or inaccurate information to consumers. Highlights • Cookbooks provided misleading/inaccurate food safety information. • Cookbooks are not a good source of safe food handling practices. • Recipes lacked safe preparation, serving and storage instructions. • Cookbooks do not encourage the reader to use thermometers. • 96% of recipes provided incorrect/lacked minimum internal temperature for doneness. [ABSTRACT FROM AUTHOR]

The article discusses the development of a new HPLC/MS/MS method that can separate and quantify perfluoroalkyl carboxylate, sulfonate, and sulfonamide isomers with a single liquid chromatography (LC) injection by Jonathan Martin and graduate student Jonathan Benskin of the University of Alberta Edmonton in Canada. It has noted that the new method separates different perfluorinated acids (PFA) isomers by using a linear perfluorooctyl LC stationary phase and an acidic mobile phase. The researchers were able to assign structural identities to many peaks by using collision-induced dissociation patterns, abundance, and elution time.

Informs that the Senate of Canada established a Special Senate Committee on Euthanasia and Assisted Suicide on February 23, 1994, to report on legal, social and ethical issues related to euthanasia and assisted suicide. Its findings to be presented by December 15; The Supreme Court decision concerning amyotrophic lateral sclerosis (ALS) patient Sue Rodriguez.

Abstract: Cryptosporidium spp. are common intestinal protozoan parasites that infect a wide range of hosts, including humans and livestock, worldwide. The objective of this study was to determine the prevalence of Cryptosporidium spp. in dairy calves in Prince Edward Island, Canada, and the potential for transmission of this parasite between dairy calves and humans. Fecal samples were collected from 183 dairy calves from 11 farms in Prince Edward Island. The prevalence of Cryptosporidium spp. infections in these animals was determined by examining for the presence of oocysts in the fecal samples, using immunofluorescence microscopy. Molecular characterization was done using a nested-PCR protocol to amplify fragments of the Cryptosporidium heat-shock protein 70 gene, followed by DNA sequencing. Ten calves (6.2%), representing 4 out of 11 farms tested, were positive for Cryptosporidium spp. DNA sequence analysis on five PCR positive samples demonstrated that Cryptosporidium parvum was the only species present in the calves tested, suggesting that there is a potential risk of zoonotic transmission between dairy calves and humans in this region. [Copyright &y& Elsevier]

The use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients. (Funded by the Canadian Institutes of Health Research.). [ABSTRACT FROM AUTHOR]

The predominance of automobile dependency in North America is associated with a host of negative health and environmental impacts and has sparked the promotion of low-carbon and active modes of transportation. Encompassing both priorities, electric-bicycles have become a popular mode of transportation in some parts of the world. While multiple studies have suggested older adult populations may be most likely to benefit from e-bike technology, few studies have exclusively focused on this demographic to identify the factors that may promote or inhibit e-bike adoption amongst this group. This study explores the potential for e-bikes to support independent mobility and active aging among the older adult population in Canada's auto-dependent context. Guided by a conceptual framework for older adult mobility, this study used qualitative methods to gather perceptual and experiential data from 17 community stakeholders and 37 older adults in the Region of Waterloo, Ontario. The findings highlight the importance of cycling life histories, social connection and physical limitations to adopting cycling later in life. Specific individual and structural factors were discussed in relation to e-bike adoption including facilitators such as increased convenience, reduced physical exertion, reduced reliance on a vehicle and fun. Barriers included cycling infrastructure and road safety, regulation, and stigmatization barriers. E-bikes as a more convenient and supportive mode of transit for older adults is discussed alongside the importance of e-bikes as a replacement for traditional bicycles in a subset of this population. [ABSTRACT FROM AUTHOR]

Objectives: Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary antimicrobial consumption. Evidence has been limited to short, single-center studies. We evaluated whether antimicrobial stewardship in ICUs could reduce antimicrobial consumption and costs.Design: We conducted a phased, multisite cohort study of a quality improvement initiative.Setting: Antimicrobial stewardship was implemented in four academic ICUs in Toronto, Canada beginning in February 2009 and ending in July 2012.Patients: All patients admitted to each ICU from January 1, 2007, to December 31, 2015, were included.Interventions: Antimicrobial stewardship was delivered using in-person coaching by pharmacists and physicians three to five times weekly, and supplemented with unit-based performance reports. Total monthly antimicrobial consumption (measured by defined daily doses/100 patient-days) and costs (Canadian dollars/100 patient-days) before and after antimicrobial stewardship implementation were measured.Measurements and Main Results: A total of 239,123 patient-days (57,195 patients) were analyzed, with 148,832 patient-days following introduction of antimicrobial stewardship. Antibacterial use decreased from 120.90 to 110.50 defined daily dose/100 patient-days following introduction of antimicrobial stewardship (adjusted intervention effect -12.12 defined daily dose/100 patient-days; 95% CI, -16.75 to -7.49; p < 0.001) and total antifungal use decreased from 30.53 to 27.37 defined daily doses/100 patient-days (adjusted intervention effect -3.16 defined daily dose/100 patient-days; 95% CI, -8.33 to 0.04; p = 0.05). Monthly antimicrobial costs decreased from $3195.56 to $1998.59 (adjusted intervention effect -$642.35; 95% CI, -$905.85 to -$378.84; p < 0.001) and total antifungal costs were unchanged from $1771.86 to $2027.54 (adjusted intervention effect -$355.27; 95% CI, -$837.88 to $127.33; p = 0.15). Mortality remained unchanged, with no consistent effects on antimicrobial resistance and candidemia.Conclusions: Antimicrobial stewardship in ICUs with coaching plus audit and feedback is associated with sustained improvements in antimicrobial consumption and cost. ICUs with high antimicrobial consumption or expenditure should consider implementing antimicrobial stewardship programs. [ABSTRACT FROM AUTHOR]

Purpose: Hepatitis B virus (HBV) reactivation is a potentially fatal complication of chemotherapy that can be largely prevented with medication, provided that asymptomatic HBV carriers are identified. We explored the knowledge, beliefs, and practices of Canadian oncologists/hematologists regarding HBV screening before chemotherapy. Methods: A novel questionnaire was mailed to all practicing hematologists/oncologists, where publicly accessible online physician registries facilitated identification of these specialists (71% of the Canadian physician population).Results: Of 504 potentially eligible practitioners, 311 (62%) responded, of whom 246 indicated that they administered chemotherapy and were thus included in final analyses. Respondents tended to underestimate the risk of HBV reactivation, and recognition of the major risk factor for HBV carriage (ie, birth in anendemic area) was low. Forty percent of respondents reported rarely or never testing for HBV before chemotherapy, and 36% reported screening only those patients with HBV risk factors. Inmultivariate analysis, having a predominantly hematologic practice, practitioner experience with HBV reactivation, ability to correctly estimate the risk of HBV reactivation, fewer years inpractice, and female sex were independently associated with an increased likelihood of screening for HBV. Conclusion: Canadian oncologists and hematologists tend to underestimate the risk of HBV reactivation and report relatively low HBV screening rates. Among those practitioners who do screen, the favored strategy is selective screening of patients with HBV risk factors. However, oncologists'/hematologists' knowledge regarding risk factors for HBV carriage seems to be low, potentially undermining the success of a selective screeningstrategy. [ABSTRACT FROM AUTHOR]

The article describe Canada's experience with organ donation after voluntary euthanasia. Topics discussed include information on ethical issues raised by organ donation after euthanasia; need for future research opportunities to improve patient centered practice; and practices related to the legalization of euthanasia, organ donation raises challenging issues.

To date, an affordable, effective treatment for an HIV-1 cure remains only a concept with most "latency reversal" agents (LRAs) lacking specificity for the latent HIV-1 reservoir and failing in early clinical trials. We assessed HIV-1 latency reversal using a multivalent HIV-1-derived virus-like particle (HLP) to treat samples from 32 people living with HIV-1 (PLWH) in Uganda, US and Canada who initiated combined antiretroviral therapy (cART) during chronic infection. Even after 5-20 years on stable cART, HLP could target CD4 + T cells harbouring latent HIV-1 reservoir resulting in 100-fold more HIV-1 release into culture supernatant than by common recall antigens, and 1000-fold more than by chemotherapeutic LRAs. HLP induced release of a divergent and replication-competent HIV-1 population from PLWH on cART. These findings suggest HLP provides a targeted approach to reactivate the majority of latent HIV-1 proviruses among individuals infected with HIV-1.

Background: COVID-19 vaccination has been associated with anaphylaxis and hypersensitivity reactions. Infectious disease physicians and allergists in the Canadian Special Immunization Clinic (SIC) Network developed guidance for evaluating patients with adverse events following immunization (AEFI) including suspected hypersensitivity. This study evaluated management and adverse event recurrence following subsequent COVID-19 vaccinations., Methods: Individuals aged 12 years and older enrolled at participating SICs before February 28, 2023 who were referred for suspected or diagnosed hypersensitivity reaction following COVID-19 vaccination, or for prevaccination assessment of suspected allergy to a COVID-19 vaccine component were included. De-identified clinical assessments and revaccination data, captured in a centralized database, were analyzed. The Brighton Collaboration case definition (BCCD) for anaphylaxis (2023 version) was applied., Results: The analysis included 206 participants from 13 sites: 26 participants referred for pre-vaccination assessment and 180 participants referred for adverse events following COVID-19 vaccination (15/180 [8.3%] with BCCD confirmed anaphylaxis, 84 [46.7%] with immediate hypersensitivity symptoms not meeting BCCD, 33 [18.3%] with other diagnosed hypersensitivity reactions, and 48 [26.7%] participants with a final diagnosis of non-hypersensitivity AEFI). Among participants referred for AEFIs following COVID-19 vaccination, 166/180 (92.2%) were recommended for COVID-19 revaccination after risk assessment, of whom 158/166 (95.2%) were revaccinated (all with a COVID-19 mRNA vaccine). After revaccination, 1/15 (6.7%) participants with prior anaphylaxis, 1/77 (1.3%) with immediate hypersensitivity not meeting criteria for anaphylaxis and 1/24 (4.2%) with other physician diagnosed hypersensitivity developed recurrent AEFI symptoms that met the BCCD for anaphylaxis. All 26 participants referred pre-vaccination, including 9 (34.6%) with history of polyethylene glycol-asparaginase reactions, were vaccinated without occurrence of immediate hypersensitivity symptoms., Conclusions: Most individuals in this national cohort who experienced a hypersensitivity event following COVID-19 vaccination and were referred for specialist review were revaccinated without AEFI recurrence, suggesting that specialist evaluation can facilitate safe revaccination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MS has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, and Sanofi-Pasteur; all funds have been paid to his institute, and he has not received any personal payments. VC received honoraria from Pfizer, Aralez pharmaceuticals and CSL Behring financial support for publication from CSL Behring. JEMU reports advisory board for Pfizer, clinical trials with Sanofi, and other from Novartis, all outside the current work. KZ reports honoraria from AstraZeneca and Regeneron. JMP is an investigator on projects funded by MedImmune and Merck; all funds have been paid to his institute, and he has not received any personal payments. ZA reports honoraria for speaker fees for Pfizer outside of the submitted work. AM received honoraria for presentations from Pfizer and Sanofi. ADR participated in multicentric studies with ALK for sublingual immunotherapy as investigator. AC received honoraria for presentations from Pfizer, AstraZeneca, GlaxoSmithKline and Moderna. JC received honoraria for presentations from Pfizer, AstraZeneca, and GlaxoSmithKline. KAT has received funding to her institution from the Coalition for Epidemic Preparedness Innovations for vaccine safety studies. All other authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI., Methods: We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians., Results: Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, n = 78), but 63% of these (n = 62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, n = 48) and believed that an ICU stay is required to improve confidence (99%, n = 97). Most (96%, n = 94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission., Conclusion: In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation., (© 2024. The Author(s).)

Background: Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective., Objective: We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians., Methods: A survey in Canada and the United States involved families currently enrolled in food OIT programs., Results: Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a "very significant" barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with a slower buildup (P = .02) and a reduction in dose (P = .002). Taste aversion was a strongly age-dependent barrier for initiation (P < .001) and continuation (P < .002), with older children over 6 years of age reporting it as a very significant barrier (P < .001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (P < .05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (P < .001)., Conclusions: Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objective: The inherent pressures of high-acuity, critical illness in the emergency department create a unique environment whereby acute goals-of-care discussions must be had with patients or substitute decision makers to rapidly decide between divergent treatment paths. Among university-affiliated hospitals, resident physicians are often conducting these highly consequential discussions. This study aimed to use qualitative methods to explore how emergency medicine residents make recommendations regarding life-sustaining treatments during acute goals-of-care discussions in critical illness., Methods: Using qualitative methods, semistructured interviews were conducted with a purposive sample of emergency medicine residents in Canada from August to December 2021. Inductive thematic analysis of the interview transcripts was conducted using line-by-line coding, and key themes were identified through comparative analysis. Data collection continued until thematic saturation was reached., Results: Seventeen emergency medicine residents from 9 Canadian universities were interviewed. Two factors guided residents' treatment recommendations (a duty to provide a recommendation and the balance between disease prognosis and patient values). Three factors influenced residents' comfort when making recommendations (time constraints, uncertainty, and moral distress)., Conclusion: While conducting acute goals-of-care discussions with critically ill patients or their substitute decision makers in the emergency department, residents felt a sense of duty to provide a recommendation informed by an intersection between the patient's disease prognosis and the patient's values. Their comfort in making these recommendations was limited by time constraints, uncertainty, and moral distress. These factors are important for informing future educational strategies., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: Individuals and healthcare providers may be uncertain about the safety of revaccination after an adverse event following immunization (AEFI). We identified factors associated with physician recommendation for revaccination and participant intention to be revaccinated among patients with adverse events following immunization (AEFIs) assessed in the Canadian Special Immunization Clinic (SIC) Network from 2013 to 2019., Methods: This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 for an AEFI who required additional doses of the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Physician recommendations regarding revaccination and participant intent for revaccination were recorded. AEFI impact on daily activities and need for medical attention was captured as low, moderate, high impact and serious (e.g., requiring hospitalization). Multivariable logistic regression analysis identified factors associated with physician recommendation and participant intention for revaccination, controlling for province of assessment., Results: Physician recommendation was significantly associated with the type of AEFI and AEFI impact. Compared to large local reaction, physician recommendation for revaccination was reduced for immediate hypersensitivity (aOR: 0.24 [95% CI: 0.08-0.76]) and new onset autoimmune disease (aOR: 0.16; 95% CI: 0.04-0.69). Compared to low impact AEFIs, physician recommendation was reduced for moderate (aOR: 0.22 [95% CI: 0.07-0.65]), high impact (aOR: 0.08 [95% CI: 0.02-0.30]), and serious AEFIs (aOR: 0.11 [95% CI: 0.03-0.37]). Participant intention for revaccination was significantly associated with AEFI impact, with reduced odds for high versus low impact AEFIs (aOR: 0.12 [95% CI: 0.04-0.42])., Conclusion: Physicians appear to use AEFI type and impact to guide recommendations while patients use primarily AEFI impact to form intentions for revaccination. The findings may help inform counselling for patients with AEFIs., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Karina A Top reports financial support was provided by Canadian Institutes of Health Research. Manish Sadarangani reports financial support was provided by Michael Smith Foundation for Health Research. Caroline E Munoz reports financial support was provided by Dalhousie Medical Research Foundation. Karina A Top reports a relationship with the Coalition for Epidemic Preparedness Innovations that includes: funding grants. Honoraria for speaker fees for GlaxoSmithKline, Merck all outside of the submitted work and grants as co-investigator from GSK and Merck - CC Grants outside the submitted work from Pfizer - GDS Served on ad hoc advisory committees and received contracts for undertaking clinical trials from multiple vaccine manufacturers outside the submitted work - SAH Served on an advisory board for Pfizer and Viiv outside of the submitted work - AM co-PI on an investigator led grant from Pfizer, has served on ad hoc advisory boards for Pfizer and Sanofi Pasteur, and has received speaker’s fees from GSK, all outside of the submitted work - SKM Reports grants from MedImmune outside the submitted work - JMP Has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo and VBI Vaccines; all funds have been paid to his institute, and he has not received any personal payments - MS Research grants from GSK, Merck and Pfizer all outside of the submitted work - BT Served on an advisory board for Sanofi outside the submitted work - WV]., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To describe children hospitalized with community-acquired pneumonia complicated by effusion (cCAP)., Design: Retrospective cohort study., Setting: A Canadian children's hospital., Participants: Children without significant medical comorbidities aged < 18 years admitted from January 2015-December 2019 to either the Paediatric Medicine or Paediatric General Surgery services with any pneumonia discharge code who were documented to have an effusion/empyaema using ultrasound., Outcome Measures: Length of stay; admission to the paediatric intensive care unit; microbiologic diagnosis; antibiotic use., Results: There were 109 children without significant medical comorbidities hospitalized for confirmed cCAP during the study period. Their median length of stay was 9 days (Q1-Q3 6-11 days) and 35/109 (32%) were admitted to the paediatric intensive care unit. Most (89/109, 74%) underwent procedural drainage. Length of stay was not associated with effusion size but was associated with time to drainage (0.60 days longer stay per day delay in drainage, 95%CI 0.19-1.0 days). Microbiologic diagnosis was more often made via molecular testing of pleural fluids (43/59, 73%) than via blood culture (12/109, 11%); the main aetiologic pathogens were S. pneumoniae (40/109, 37%), S. pyogenes (15/109, 14%), and S. aureus (7/109, 6%). Discharge on a narrow spectrum antibiotic (i.e. amoxicillin) was much more common when the cCAP pathogen was identified as compared to when it was not (68% vs. 24%, p < 0.001)., Conclusions: Children with cCAP were commonly hospitalized for prolonged periods. Prompt procedural drainage was associated with shorter hospital stays. Pleural fluid testing often facilitated microbiologic diagnosis, which itself was associated with more appropriate antibiotic therapy., (© 2023. The Author(s).)

There are two anatomic formulations of death by neurologic criteria accepted worldwide: whole-brain death and brainstem death. As part of the Canadian Death Definition and Determination Project, we convened an expert working group and performed a narrative review of the literature. Infratentorial brain injury (IBI) with an unconfounded clinical assessment consistent with death by neurologic criteria represents a nonrecoverable injury. The clinical determination of death cannot distinguish between IBI and whole-brain cessation of function. Current clinical, functional, and neuroimaging assessments cannot reliably confirm the complete and permanent destruction of the brainstem. No patient with isolated brainstem death has been reported to recover consciousness and all patients have died. Studies suggest a significant majority of isolated brainstem death will evolve into whole-brain death, influenced by time/duration of somatic support and impacted by ventricular drainage and/or posterior fossa decompressive craniectomy. Acknowledging variability in intensive care unit (ICU) physician opinion on this matter, a majority of Canadian ICU physicians would perform ancillary testing for death determination by neurologic criteria in the context of IBI. There is currently no reliable ancillary test to confirm complete destruction of the brainstem; ancillary testing currently includes evaluation of both infratentorial and supratentorial flow. Acknowledging international variability in this regard, the existing evidence reviewed does not provide sufficient confidence that the clinical exam in IBI represents a complete and permanent destruction of the reticular activating system and thus the capacity for consciousness. On this basis, IBI consistent with clinical signs of death by neurologic criteria without significant supratentorial involvement does not fulfill criteria for death in Canada and ancillary testing is required., (© 2023. The Author(s).)

A series of landmark experiments conducted throughout the 20 th century progressively localized the regions involved in consciousness to the reticular activating system (RAS) and its ascending projections. The first description of the RAS emerged in 1949 through seminal experiments performed by Moruzzi and Magoun in feline brainstems; additional experiments in the 1950s revealed connections between the RAS and the thalamus and neocortical structures. This knowledge has allowed for the explanation of disorders of consciousness with exquisite anatomic precision. The clinical relevance of the RAS is further apparent in modern definitions of brain death/death by neurologic criteria (BD/DNC), which require demonstration of the complete and permanent loss of capacity for consciousness as one of their core criteria. BD/DNC is currently understood across jurisdictions in terms of "whole brain" and "brainstem" formulations. Although their clinical examination between formulations is indistinguishable, policies for BD/DNC declaration may differ in the rare scenario of patients with isolated infratentorial brain injuries, in which ancillary testing is advised in the whole brain formulation but not the brainstem formulation. Canadian guidelines acknowledge that the distinction between whole brain and brainstem formulations is unclear with respect to clinical implications for patients with isolated infratentorial injuries. This has led to variability in Canadian clinicians' use of ancillary testing when the mechanism of BD/DNC is suspected to be an isolated infratentorial injury. The present narrative review highlights these concepts and explores implications for determination of BD/DNC in Canada, with specific emphasis on the RAS and its relevance to both formulations., (© 2023. The Author(s).)

Introduction: Evidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there are no clinical criteria that reliably discriminate between viral and bacterial disease, and so the majority of children diagnosed with CAP are given antibiotics-even though these will often not help and may cause harm. We have developed a novel care pathway that incorporates point-of-care biomarkers, radiographic patterns, microbiological testing and targeted follow-up. The primary study objective is to determine if the care pathway will be associated with less antimicrobial prescribing., Methods and Analysis: A prospective, before-after, study. Previously well children aged≥6 months presenting to a paediatric emergency department (ED) that have at least one respiratory symptom/sign, receive chest radiography, and are diagnosed with CAP by the ED physician will be eligible. Those with medical comorbidities, recently diagnosed pulmonary infection, or ongoing fever after≥4 days of antimicrobial therapy will be excluded. In the control (before) phase, eligible participants will be managed as per the standard of care. In the intervention (after) phase, eligible participants will be managed as per the novel care pathway. The primary outcome will be the proportion of participants in each phase who receive antimicrobial treatment for CAP. The secondary outcomes include: clinical cure; re-presentation to the ED; hospitalisation; time to resolution of symptoms; drug adverse events; caregiver satisfaction; child absenteeism from daycare/school; and caregiver absenteeism from work., Ethics and Dissemination: All study documentation has been approved by the Hamilton Integrated Research Ethics Board and informed consent will be obtained from all participants. Data from this study will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines., Trial Registration Number: NCT05114161., Competing Interests: Competing interests: JMP’s institution has received grant funding from MedImmune for an RSV research study. ML is on the WHO EML Working group, a Paladin Labs advisory board, and a Sunovion Pharmaceuticals advisory board., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The fungal kingdom represents an extraordinary diversity of organisms with profound impacts across animal, plant, and ecosystem health. Fungi simultaneously support life, by forming beneficial symbioses with plants and producing life-saving medicines, and bring death, by causing devastating diseases in humans, plants, and animals. With climate change, increased antimicrobial resistance, global trade, environmental degradation, and novel viruses altering the impact of fungi on health and disease, developing new approaches is now more crucial than ever to combat the threats posed by fungi and to harness their extraordinary potential for applications in human health, food supply, and environmental remediation. To address this aim, the Canadian Institute for Advanced Research (CIFAR) and the Burroughs Wellcome Fund convened a workshop to unite leading experts on fungal biology from academia and industry to strategize innovative solutions to global challenges and fungal threats. This report provides recommendations to accelerate fungal research and highlights the major research advances and ideas discussed at the meeting pertaining to 5 major topics: (1) Connections between fungi and climate change and ways to avert climate catastrophe; (2) Fungal threats to humans and ways to mitigate them; (3) Fungal threats to agriculture and food security and approaches to ensure a robust global food supply; (4) Fungal threats to animals and approaches to avoid species collapse and extinction; and (5) Opportunities presented by the fungal kingdom, including novel medicines and enzymes., (© The Author(s) 2022. Published by Oxford University Press on behalf of Genetics Society of America.)

Objectives: To estimate the risk of recurrence of adverse events following immunization (AEFIs) upon revaccination and to determine among patients with suspected vaccine allergy whether allergy skin test positivity was associated with AEFI recurrence., Study Design: This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 with AEFIs who required revaccination with the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Special Immunization Clinic physicians used guidelines to inform their recommendations. Participants were followed up after revaccination to capture AEFI recurrences. Data were transferred to a central database for descriptive analysis., Results: Overall, 588 participants were assessed for 627 AEFIs; 570 (91%) AEFIs occurred in children <18 years of age. AEFIs included immediate hypersensitivity (130/627; 21%), large local reactions (110/627; 18%), nonurticarial rash (51/627; 8%), seizures (26/627; 4%), and thrombocytopenia (11/627; 2%). Revaccination was recommended to 513 of 588 (87%) participants. Among participants recommended and due for revaccination during the study period, 63% (299/477) were revaccinated. AEFI recurrence was 10% (31/299) overall, 31% (15/49) for large local reactions, and 7% (5/66) for immediate hypersensitivity. No recurrence was serious. Among 92 participants with suspected vaccine allergy who underwent skin testing and were revaccinated, the negative predictive value of skin testing for AEFI recurrence was 96% (95% CI 92.5%-99.5%)., Conclusions: Most individuals with AEFIs were safely revaccinated. Among those with suspected vaccine allergy, skin testing may help determine the safety of revaccination., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)