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Background and aims: Public health concerns regarding pregnant women's health after the enactment of the Cannabis Act in Canada (CAC) (a law that allowed non‐medical cannabis use), and the potential impact of the COVID‐19 pandemic, call for a contemporary assessment of these two events. Our study measured associations between the CAC, the COVID‐19 pandemic and the monthly prevalence rates of cannabis‐, all drug‐ and alcohol‐related diagnosed disorders among pregnant women in the province of Quebec. Design, setting and participants: This was a quasi‐experimental design applying an interrupted time‐series methodology in the province of Quebec, Canada. The participants were pregnant women aged 15–49 years, between January 2010 and July 2022. Measurements: Administrative health data from the Québec Integrated Chronic Disease Surveillance System were used to classify pregnant women according to cannabis‐, all drug (excluding cannabis)‐ and alcohol‐related disorders. The CAC (October 2018) and the COVID‐19 pandemic (April 2020) were evaluated as (1) slope changes and (2) level changes. Cannabis‐, all drug (excluding cannabis)‐ and alcohol‐related disorders were measured by total monthly age‐standardized monthly prevalence rate of each disorder for pregnant women aged 15–49 years. Findings Before the CAC, the prevalence rate of cannabis‐related diagnosed disorders significantly increased each month by 0.5% [95% confidence interval (CI) = 0.3–0.6] in the pregnant population. After the CAC, there were significant increases of 24% (95% CI = 1–53) of cannabis‐related diagnosed disorders. No significant changes were observed for all drug (excluding cannabis)‐ and alcohol‐related diagnosed disorders associated with the CAC. A non‐significant decrease of 20% (95% CI = −38 to 3) was observed during the COVID‐19 pandemic in alcohol‐related disorders. Conclusions: The monthly incidence rates of diagnosed cannabis‐related disorders in pregnant women in Quebec increased significantly following the enactment of the Cannabis Act in Canada. Diagnoses of all drug (excluding cannabis)‐ and alcohol‐related disorders remained relatively stable. [ABSTRACT FROM AUTHOR]

Introduction: In the past decade, a group of studies has begun to explore the association between cannabis recreational use policies and traffic crashes. After these policies are set in place, several factors may affect cannabis consumption, including the number of cannabis stores (NCS) per capita. This study examines the association between the enactment of Canada's Cannabis Act (CCA) (18 October 2018) and the NCS (allowed to function from 1 April 2019) with traffic injuries in Toronto. Methods: We explored the association of the CCA and the NCS with traffic crashes. We applied two methods: hybrid difference‐in‐difference (DID) and hybrid‐fuzzy DID. We used generalised linear models using CCA and the NCS per capita as the main variables of interest. We adjusted for precipitation, temperature and snow. Information is gathered from Toronto Police Service, Alcohol and Gaming Commission of Ontario, and Environment Canada. The period of analysis was from 1 January 2016 to 31 December 2019. Results: Regardless of the outcome, neither the CCA nor the NCS is associated with concomitant changes in the outcomes. In hybrid DID models, the CCA is associated with non‐significant decreases of 9% (incidence rate ratio 0.91, 95% confidence interval 0.74,1.11) in traffic crashes and in the hybrid‐fuzzy DID models, the NCS are associated with nonsignificant decreases of 3% (95% confidence interval − 9%, 4%) in the same outcome. Discussion and Conclusions: This study observes that more research is needed to better understand the short‐term effects (April to December 2019) of NCS in Toronto on road safety outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Basal duct-like recess (DR) sign serves as a specific marker of papillary craniopharyngiomas (PCPs) of the strictly third-ventricular (3 V) topography. Origins of this sign are poorly understood with limited validation in external cohorts. Methods: In this retrospective study, MRIs of pathologically proven PCPs were reviewed and evaluated for tumor topography, DR sign prevalence, and morphological subtypes. Results: Twenty-three cases with 24 MRIs satisfied our inclusion criteria. Median age was 44.5 years with a predominant male distribution (M/F ratio 4.7:1). Overall, strictly 3 V was the commonest tumor topography (8/24, 33.3%), and tumors were most commonly solid-cystic (10/24, 41.7%). The prevalence of DR sign was 21.7% (5/23 cases), all with strictly 3 V topography and with a predominantly solid consistency. The sensitivity, specificity and positive and negative predictive value of the DR sign for strict 3 V topography was 62.5%, 100%, 100% and 84.2% respectively. New pertinent findings associated with the DR sign were observed in our cohort. This included development of the cleft-like variant of DR sign after a 9-year follow-up initially absent at baseline imaging. Additionally, cystic dilatation of the basal tumor cleft at the pituitary stalk-tumor junction and presence of a vascular structure overlapping the DR sign were noted. Relevant mechanisms, hypotheses, and implications were explored. Conclusion: We confirm the DR sign as a highly specific marker of the strictly 3 V topography in PCPs. While embryological and molecular factors remain pertinent in understanding origins of the DR sign, non-embryological mechanisms may play a role in development of the cleft-like variant. [ABSTRACT FROM AUTHOR]

Naming speed (NS) refers to how quickly and accurately participants name a set of familiar stimuli (e.g., letters). NS is an established predictor of reading ability, but controversy remains over why it is related to reading. We used three techniques (stimulus manipulations to emphasize phonological and/or visual aspects, decomposition of NS times into pause and articulation components, and analysis of eye movements during task performance) with three groups of participants (children with dyslexia, ages 9-10; chronological-age [CA] controls, ages 9-10; reading-level [RL] controls, ages 6-7) to examine NS and the NS-reading relationship. Results indicated (a) for all groups, increasing visual similarity of the letters decreased letter naming efficiency and increased naming errors, saccades, regressions (rapid eye movements back to letters already fixated), pause times, and fixation durations; (b) children with dyslexia performed like RL controls and were less efficient, had longer articulation times, pause times, fixation durations, and made more errors and regressions than CA controls; and (c) pause time and fixation duration were the most powerful predictors of reading. We conclude that NS is related to reading via fixation durations and pause times: Longer fixation durations and pause times reflect the greater amount of time needed to acquire visual/orthographic information from stimuli and prepare the correct response.

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This study investigated the sensitivity of the positive matrix factorization (PMF) model using concentrations of PM2.5-bound elements in Windsor, Ontario, Canada. Five scenarios were devised to assess impacts of input data on source identification, source contributions, and model performance. The study found that the model outcomes and performance were not sensitive to data below method detection limits (MDLs) being replaced with ½ MDLs, nor whether brown carbons (BrCs) data were excluded. By analyzing two episodic events individually, unique factors of fireworks and mineral dust were identified for each of the two episodes. Moreover, PMF model performance was improved greatly for event markers of the episodes and elements with less variability in concentration when compared with the base case scenario. Excluding the two episodes from the entire dataset had little impact on factor identification and source contributions but improved the model performance for three out of twelve elements unique to the two episodes. Overall, the PMF model outcomes and performance were sensitive to percentages of concentrations below MDLs and element concentrations with large variability due to high concentrations observed in episodes. Our findings are useful for dealing with data below MDLs and episodic events in conducting future PMF source apportionment of PM2.5-bound elements. [ABSTRACT FROM AUTHOR]

Background: Parents seek support on behalf of their transgender and gender nonconforming (TGNC) children. Previous qualitative studies explore the types of support parents seek inside and outside of healthcare settings. Healthcare providers often remain unprepared to effectively provide gender-affirming services to TGNC children and their accompanying parents and may benefit from learning about the support seeking experiences of parents with TGNC children. Aims: This paper summarized qualitative research studies that address the topic of parents seeking support on behalf of their TGNC children. We produced this report for healthcare providers to review to enhance gender-affirming services for parents and TGNC children. Methods: This paper outlines a qualitative metasummary of studies from the United States or Canada with data collected from parents of TGNC children. Data collection included the steps of journal runs, database searches, reference checks, and area scans. Data analysis involved the steps of extracting, editing, grouping, abstracting, and calculating the intensity and frequency effect sizes for finding statements from qualitative research study articles. Results: The results of this metasummary yielded two primary themes, six subthemes, and 24 total findings. The first primary theme of seeking guidance had three subthemes: educational resources, community networks, and advocacy efforts. The second primary theme of seeking healthcare had three subthemes: healthcare providers, mental healthcare, and general healthcare. Discussion: These findings provide information healthcare providers can use to inform their practice. These findings also highlight the importance of providers working collaboratively with parents when serving TGNC children. This article concludes with practical tips for providers. [ABSTRACT FROM AUTHOR]

The capacity for inhibitory control is an important cognitive process that undergoes dynamic changes over the course of the lifespan. Robust characterization of this trajectory, considering age continuously and using flexible modeling techniques, is critical to advance our understanding of the neural mechanisms that differ in healthy aging and neurological disease. The interleaved pro/anti-saccade task (IPAST), in which pro- and anti-saccade trials are randomly interleaved within a block, provides a simple and sensitive means of assessing the neural circuitry underlying inhibitory control. We utilized IPAST data collected from a large cross-sectional cohort of normative participants (n = 604, 5–93 years of age), standardized pre-processing protocols, generalized additive modeling, and change point analysis to investigate the effect of age on saccade behavior and identify significant periods of change throughout the lifespan. Maturation of IPAST measures occurred throughout adolescence, while subsequent decline began as early as the mid-20s and continued into old age. Considering pro-saccade correct responses and anti-saccade direction errors made at express (short) and regular (long) latencies was crucial in differentiating developmental and aging processes. We additionally characterized the effect of age on voluntary override time, a novel measure describing the time at which voluntary processes begin to overcome automated processes on anti-saccade trials. Drawing on converging animal neurophysiology, human neuroimaging, and computational modeling literature, we propose potential frontal-parietal and frontal-striatal mechanisms that may mediate the behavioral changes revealed in our analysis. We liken the models presented here to "cognitive growth curves" which have important implications for improved detection of neurological disease states that emerge during vulnerable windows of developing and aging. [ABSTRACT FROM AUTHOR]

Background Echocardiography is the primary imaging modality for diagnosis of infective endocarditis (IE) in prosthetic valve endocarditis (PVE) including IE after transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the characteristics and clinical outcomes of patients with absent compared with evident echocardiographic signs of TAVI-IE. Methods Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudo-aneurysm, intracardiac fistula, or valvular perforation or aneurysm. Results Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device and had higher rates of peri-interventional complications (eg, stroke, major vascular complications) during the TAVI procedure (P <.05 for all). IE-neg had higher rates of IE caused by Staphylococcus aureus (33.7% vs 23.2%; P =.038) and enterococci (37.2% vs 23.8%; P =.009) but lower rates of coagulase-negative staphylococci (4.7% vs 20.0%, P =.001). IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (odds ratio: 1.51; 95% confidence interval [CI]:.55–4.12) as well as a for 1-year mortality in Cox regression analysis (hazard ratio: 1.10; 95% CI:.67–1.80). Conclusions Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation. [ABSTRACT FROM AUTHOR]

Avulsions change river courses and transport water and sediment to new channels impacting infrastructure, floodplain evolution, and ecosystems. Abrupt avulsion events (occurring over days to weeks) are potentially catastrophic to society and thus receive more attention than slow avulsions, which develop over decades to centuries and can be challenging to identify. Here, we examine gradual channel changes of the Peace‐Athabasca River Delta (PAD), Canada using in situ measurements and 37 years of Landsat satellite imagery. A developing avulsion of the Athabasca River is apparent along the Embarras River–Mamawi Creek (EM) distributary. Its opening and gradual enlargement since 1982 are evident from multiple lines of observation: Between 1984 and 2021 the discharge ratio between the EM and the Athabasca River more than doubled, increasing from 9% to 21%. The EM has widened by +53% since 1984, whereas the Athabasca River channel width has remained stable. The downstream Mamawi Creek delta is growing at a discharge‐normalized rate roughly twice that of the Athabasca River delta in surface area. Longitudinal global navigation satellite systems field surveys of water surface elevation reveal the EM possesses a ∼2X slope advantage (8 × 10−5 vs. 4 × 10−5) over the Athabasca River, and unit stream power and bed shear stress suggest enhanced sediment transport and erosional capacity through the evolving flow path. Our findings: (a) indicate that a slow avulsion of the Athabasca River is underway with potentially long‐term implications for inundation patterns, ecosystems, and human use of the PAD; and (b) demonstrate an observational approach for identifying other slow avulsions at river bifurcations globally. Plain Language Summary: Avulsions shift river courses and move water and sediment to new channels, which affect infrastructure, floodplains, and ecosystems. Slow avulsions take decades to develop and are more difficult to identify. Using on‐the‐ground measurements and 37 years of Landsat satellite imagery, we analyze gradual channel changes in the Peace‐Athabasca River Delta (PAD), Canada. The Athabasca River is changing course such that more of its water enters its westernmost outlet, the Embarras River–Mamawi Creek (EM) channel. Multiple lines of evidence demonstrate that the EM channel has been gradually opening since 1982. Between 1984 and 2021, the water entering the EM channel increased from 9% to 21% of the river's total flow. Since 1984, the EM channel has widened by 53%, while the Athabasca River channel has remained stable. The delta forming at the EM mouth (i.e., Mamawi Creek delta) has grown twice as fast as the Athabasca River delta. Field measurements of water surface elevation show the slope of the EM channel is twice as steep as the slope of the lower Athabasca River (8 × 10−5 vs. 4 × 10−5). Because water tends to flow down the steepest slope, we expect more water to flow down the EM channel in the future. Our findings indicate a slow capture of Athabasca River water into its EM channel, with potential long‐term implications for the delta's inundation pattern, ecosystems, and traditional Indigenous activities. Key Points: We assess a potential avulsion of the Athabasca River in the Peace‐Athabasca Delta, Canada using field measurements and remote sensingAnalysis of hydrological and morphological observations affirm that a slow avulsion is currently underwayThe avulsion may accelerate in the future and cause transformative effects on the delta's vegetation, habitat, and ecosystems [ABSTRACT FROM AUTHOR]

An interview with Manitoba Fairness Commissioner Ximena Munoz is presented. She explains the responsibility of the Office of the Manitoba Fairness Commissioner (OMFC) which centers on the implementation of the Fair Registration Practices in Regulated Professions Act and recognition on the expertise of skilled immigrants in the work place. She points out that OMFC is providing support to the principle of gender equality. She also explains the nature of a regulated profession.

Background The COVID-19 pandemic has challenged health services and governments in Canada and around the world. Our research aims to evaluate the effect of domestic and international air travel patterns on the COVID-19 pandemic in Canadian provinces and territories. Methods Air travel data were obtained through licensed access to the 'BlueDot Intelligence Platform', BlueDot Inc. Daily provincial and territorial COVID-19 cases for Canada and global figures, including mortality, cases recovered and population data were downloaded from public datasets. The effects of domestic and international air travel and passenger volume on the number of local and non-local infected people in each Canadian province and territory were evaluated with a semi-Markov model. Provinces and territories are grouped into large (>100 000 confirmed COVID-19 cases and >1 000 000 inhabitants) and small jurisdictions (≤100 000 confirmed COVID-19 cases and ≤1 000 000 inhabitants). Results Our results show a clear decline in passenger volumes from March 2020 due to public health policies, interventions and other measures taken to limit or control the spread of COVID-19. As the measures were eased, some provinces and territories saw small increases in passenger volumes, although travel remained below pre-pandemic levels. During the early phase of disease introduction, the burden of illness is determined by the connectivity of jurisdictions. In provinces with a larger population and greater connectivity, the burden of illness is driven by case importation, although local transmission rapidly replaces imported cases as the most important driver of increasing new infections. In smaller jurisdictions, a steep increase in cases is seen after importation, leading to outbreaks within the community. Conclusions Historical travel volumes, combined with data on an emerging infection, are useful to understand the behaviour of an infectious agent in regions of Canada with different connectivity and population size. Historical travel information is important for public health planning and pandemic resource allocation. [ABSTRACT FROM AUTHOR]

The main objective of this study was to evaluate the effect of peripartal administration of a commercially available nonspecific immune stimulant (mycobacterium cell wall fraction; MCWF [Amplimune, NovaVive Inc. Napanee, ON, Canada]) on the incidence of disease during early lactation and subsequent fertility of dairy cows. A second objective was to characterize the dynamics of circulating white blood cells (WBC) and metabolic markers following treatment administration. Cows in an United States Department of Agriculture (USDA) organic-certified dairy herd were blocked by parity and, based on sequential calving dates, randomly assigned to receive two injections (5 mL s.c.) of either a placebo (saline solution) as a control (CON ; n = 71) or MCWF (n = 65) at enrollment (7 d before expected calving) and within 24 h after calving. Blood samples were collected from a subsample of the study population (MCWF = 16; CON = 18) for WBC count at enrollment, at day 2 post enrollment, and at days 1, 3, 7, and 14 after calving. Serum fatty acids, beta-hydroxybutyrate, and Ca concentrations were determined at days 1 and 7 postpartum (MCWF = 21; CON = 21). Main outcome variables included incidence risk of peripartal and early lactation health disorders and pregnancy at first artificial insemination (AI), at 100, and at 150 days in milk (DIM). In addition, the average daily milk yield up to 90 DIM and death and live culling before 305 DIM were compared. Treatment effects were assessed using multivariable logistic regression, time-to-event analyses, and repeated measures analysis of variance (ANOVA). A treatment effect on the incidence risk of some of the health disorders in the study was established. Incidence risk of metritis and clinical mastitis <28 DIM was smaller in MCWF than in CON cows (36.9% vs. 50.7% and 6.3% vs. 19.7%, respectively). On the contrary, the incidence risk of respiratory disease <28 DIM was smaller in CON (0%) than in MCWF (7.7%). Reproductive performance of multiparous cows was affected by MCWF administration: pregnancy at first AI and pregnancy at 100 and 150 DIM were greater in MCWF than in CON (35.6% vs. 19.2%; 51.1% vs. 25.0%; and 64.4% vs. 40.4%, respectively). Overall, median intervals from calving to pregnancy were 90 vs. 121 d in MCWF and CON cows, respectively. No treatment effects on the dynamics of circulating WBC or in postpartum metabolic status were established. No differences for milk yield or for the proportion of cows that survived up to 305 DIM were determined, although cows in MCWF left the herd earlier than cows in CON. In conclusion, incidence risks of metritis and mastitis in early lactation were smaller in cows receiving MCWF, whereas the incidence risk of respiratory disease was smaller in CON. Fertility significantly improved in MCWF compared with CON cows. As this study was performed in an organic-certified dairy, specific health and reproductive management practices may affect the external validity of the current findings. [ABSTRACT FROM AUTHOR]

Large mineral deposits have been discovered in Ontario's Far North and are being considered for further development. Particulate matter and trace elements can be emitted from potential mining activities and these air pollutants are associated with health risks and harmful to the sensitive ecosystem. An air monitoring station, powered by solar panels and a wind turbine, was established in this near-pristine area to monitor baseline levels of fine particulate matter (PM2.5) and trace elements downwind of a proposed mine site. Levels of PM2.5 and trace elements observed from 2015 to 2018 were much lower than measurements observed in southern Ontario, suggesting minimal influence of primary emissions in the study area. One episodic PM2.5 event in July 2015 was attributable to wildfire emissions in northern Ontario. Only 8 out of the 31 target elements were detected in 25% or more of the samples. Good correlations among As, Se, Pb, and Sb, between Mn and Fe, as well as between Ce and La indicated they originated from long-range atmospheric transport from the south. Ontario's Ambient Air Quality Criteria were not exceeded for any target air pollutants. Four years of air measurements filled the data gap of baseline information in this near-pristine study area and can be used to assess impacts of potential mining activities in the future. Field operations during this study period indicated that the battery-powered air instruments and meteorological sensors worked well in the harsh environment of Ontario's Far North even in cold winter months. The field experiences gained in this study can be applied to future air monitoring activities in harsh environments where no direct power supply is available and site access is limited. [ABSTRACT FROM AUTHOR]

Background Therapeutic inertia refers to the delay or failure to escalate treatment in patients who are not achieving adequate disease control and poses a challenge in the management of moderate-to-severe atopic dermatitis (AD). Despite the availability of conventional (CST) and advanced systemic therapies (AST) currently utilized for the treatment of moderate to severe AD, many patients do not achieve treatment success. However, the extent of this inadequacy in realworld clinical practice remains underexplored. Objectives: This study aims to evaluate the occurrence therapeutic inertia (assessed as non-escalation of therapy despite limited disease control) and the proportion of patients with moderate-to-severe AD who continue to show an inadequate response after receiving systemic therapies for a duration ranging from 3 to 12 months. Methods: We conducted a longitudinal analysis of patients with moderate-to-severe AD (vIGA-AD≥3) from the TARGET-DERM AD registry, including 3,457 participants from 39 centers in the U.S. and Canada. Eligible patients had documented outcomes at the initiation of systemic therapy and after 3 months up to 12 months of follow up. We assessed clinician- and patient-reported outcomes to identify the proportion of patients not meeting pre-defined targets based on expert consensus. An inadequate response was defined as not achieving a validated Investigator Global Assessment (vIGA-AD) score ≤2, a 50% improvement in Body Surface Area (BSA), and a ≥4-point reduction in the Worst Pruritus Numeric Rating Scale (WP-NRS). An optimal response was defined as a vIGA-AD score ≤1 (clear or almost clear skin), BSA ≤2%, and WP-NRS itch score of 0/1 (complete or almost complete skin resolution). Results: Out of 2,107 patients with moderate-to-severe AD, 445 met the inclusion criteria. The majority were adults (63.8%), female (62.0%), and Non-Hispanic White (45.4%), with an average age of 31 years. Most patients (88.8%) initiated treatment with AST, with dupilumab being the most common (86.5%). The mean vIGA-AD was 3.3 for AST and 3.6 for CST at initiation (P<0.01). At 6 months, 37% and 67% of AST-treated patients had inadequate responses in terms of skin clearance and itch outcomes, respectively, while 82% and 79% did not achieve optimal responses. At 12 months, these figures were approximately 30% and 66% for inadequate responses and 85% and 88% for not achieving optimal responses, respectively. CST-treated patients showed a similar trend. Conclusions: The study reveals a significant portion of moderate-to-severe AD patients fail to achieve adequate disease control with systemic therapies over 12 months, indicating a substantial presence of therapeutic inertia. These findings suggest a need for more proactive management strategies in AD treatment. [ABSTRACT FROM AUTHOR]

Background Therapeutic inertia, defined as the delay or reluctance in modifying treatment when goals are unmet, is a significant challenge in managing chronic diseases, including atopic dermatitis (AD). This inertia can lead to suboptimal control of the disease, affecting patient outcomes. Objectives: This study aims to evaluate the effect of therapeutic inertia on patient-reported outcomes (PROs) in individuals with moderate-to-severe AD undergoing systemic treatment over 3 to 12 months. Methods: We analyzed longitudinal data from the TARGET-DERM AD registry, which includes 3,457 patients with moderate-to-severe AD from 39 centers across the U.S. and Canada. Eligible patients had documented outcomes at the initiation of systemic therapy and at subsequent 3-month intervals up to 12 months of follow-up. We assessed patient-reported outcomes (PROs) to determine the proportion of patients not meeting predefined treatment targets for PROs based on expert consensus. Patients had a validated Investigator Global Assessment (vIGA-AD) score of 3 or more at initiation of either an advanced systemic therapy (AST) such as biologics or JAK inhibitors or a conventional systemic therapy (CST) such as cyclosporine, methotrexate, or prednisone. PROs were evaluated at 3-month intervals up to 12 months, assessing achievement against predefined treatment targets based on expert consensus. PRO measures included Worst-Itch (PROMIS Itch-Severity), POEM, PO-SCORAD, NRS-sleep, and NRS-pain with specific moderate and optimal target levels established for each. Itch-Severity (range: 0-10; moderate target: ≥4-point reduction, optimal target: score ≤1), POEM (range: 0-28; moderate target: ≥4-point reduction, optimal target: score ≤2), PO-SCORAD (range: 0-103; moderate target: score ≤24; optimal target: score ≤10), NRS-sleep and NRS-pain (range: 0-10; moderate target: reduction ≥3-points; optimal target: score ≤1). Results: Out of 2107 patients with moderate-to-severe AD, 445 qualifying participants were included (63.8% adult, 62.0% female, 45.4% Non-Hispanic White, mean age of 31 years). Most patients (88.8%) initiated AST, with dupilumab being the most common (86.5%). At 6 months, significant proportions of AST-treated patients failed to reach moderate and optimal targets for itch (67% and 79%, respectively), POEM (46% and 69%), and NRS-sleep (59% and 47%). By 12 months, these figures were similar, with 66% and 88% failing to meet itch targets, 53% and 73% failing to meet POEM targets, and 62% and 45% failing to meet NRS-sleep targets, respectively. A similar pattern was observed for other PROs. CST-treated patients exhibited similar trends. Conclusions: The study highlights the profound impact of therapeutic inertia on the quality of life of patients with moderate-to-severe AD. Despite systemic therapy, a considerable proportion failed to meet treatment targets over a 12-month period, underscoring the need for more proactive and responsive treatment strategies in AD management. [ABSTRACT FROM AUTHOR]

Background Saccades are rapid eye movements that bring an image of interest onto the retina. Previous research has found that in healthy individuals performing eye movement tasks, the location of a previous visual target can influence performance of the saccade on the next trial. This rapid behavioral adaptation represents a form of immediate neural plasticity within the saccadic circuitry. Our studies have shown that children with fetal alcohol spectrum disorder ( FASD) are impaired on multiple saccade measures. We therefore investigated these previous trial effects in typically developing children and children with FASD to measure sensory neural plasticity and how these effects vary with age and pathology. Methods Both typically developing control children ( n = 102; mean age = 10.54 ± 3.25; 48 males) and children with FASD ( n = 66; mean age = 11.85 ± 3.42; 35 males) were recruited from 5 sites across Canada. Each child performed a visually guided saccade task. Reaction time and saccade amplitude were analyzed and then assessed based on the previous trial. Results There was a robust previous trial effect for both reaction time and amplitude, with both the control and FASD groups displaying faster reaction times and smaller saccades during alternation trials (visual target presented on the opposite side to the previous trial). Children with FASD exhibited smaller overall mean amplitude and smaller amplitude selectively on alternation trials compared with controls. The effect of the previous trial on reaction time and amplitude did not differ across childhood and adolescent development. Conclusions Children with FASD did not display any significant reaction time differences, despite exhibiting numerous deficits in motor and higher level cognitive control over saccades in other studies. These results suggest that this form of immediate neural plasticity in response to sensory information before saccade initiation remains intact in children with FASD. In contrast, the previous trial effect on amplitude suggests that the motor component of saccades may be affected, signifying differential vulnerability to prenatal alcohol exposure. [ABSTRACT FROM AUTHOR]

Severity of atopic dermatitis (AD) itch and lesions is associated with poor quality of life. However, there is limited evidence describing the combined impact of itch and skin severity on patient outcomes in AD. This study aims to assess the independent and combined effects of itch and skin severity on patient-reported symptoms and quality-of-life outcomes. The study included adult participants (age ≥18 years) with AD enrolled in TARGET-DERM AD, an observational, longitudinal study of more than 3158 participants across 43 academic/community centers in the USA and Canada. Itch severity was assessed by the Patient-Reported Outcome Measurement Information System Itch-Severity, specifically the item evaluating 'itch at its worst', a 0–10 numeric rating scale. A score of 0 or 1 was interpreted as no/minimal itch. Skin severity was assessed by the validated Investigators Global Assessment of AD (vIGA-AD), with a score of 0 or 1 representing clear/almost clear skin (vIGA-AD 0/1). The association of AD symptoms representing patient-reported clear/almost clear disease [Patient-Oriented Eczema Measure (POEM) 0–2] and no impact of AD on quality of life [Dermatology Life Quality Index (DLQI) 0/1] with itch and skin severity was assessed using descriptive statistics and logistic regression models that included main and interaction effects for itch and skin severity. Among adult participants (n = 1795; 59% female; 60% non-Hispanic White; mean age 44.5 years), vIGA-AD, POEM, Worst Itch and DLQI data at enrollment were available for 95% (1702), 44% (792), 43% (783) and 43% (783) of participants, respectively. The proportion reporting POEM 0–2 and DLQI 0/1 was highest among those with no/minimal worst itch (73% POEM 0–2; 72% DLQI 0/1) and clear/almost clear skin (46% POEM 0–2; 45% DLQI 0/1), with decreasing proportions observed at greater itch and skin severity levels. Among those with both no/minimal itch and clear/almost clear skin, 87.5% (42/48) and 95.8% (46/48) reported POEM 0–2 and DLQI 0/1, respectively. Logistic regression results suggest that no/minimal itch and clear/almost clear skin are significantly associated with POEM 0–2 and DLQI 0/1, though the interaction effect was not statistically significant in despite all models assessed. Relative to those who did not have either no/minimal itch or clear/almost clear skin, the odds ratio of reporting POEM 0–2 and DLQI 0/1 was highest among those with both no/minimal itch and clear/almost clear skin (82.9 for POEM 0–2; 35.4 for DLQI 0/1), followed by no/minimal itch only (15.9 for POEM 0–2; 10.5 for DLQI 0/1) and clear/almost clear skin only (5.9 for POEM 0–2; 3.8 for DLQI 0/1). Complete or almost complete relief of itch and skin lesions is associated with greater odds of achieving ideal states in PROs (POEM and DLQI) with itch relief exhibiting a relatively higher impact than skin clearance. These results underscore the importance of assessing and documenting both itch severity and skin clearance to support shared decision-making. Moreover, clearance of both itch and skin lesions should be considered when setting treatment goals in patients with AD. Future research should include analyzing discrepant data (e.g. patients with no/minimal itch, but some skin lesions) to more precisely identify which aspect drives the patient-reported outcomes. [ABSTRACT FROM AUTHOR]

The neurotoxin β-N-methylamino-L-alanine (BMAA), suspected to trigger neurodegenerative diseases, can be produced during cyanobacterial bloom events and subsequently affect ecosystems and water sources. Some of its isomers including β-amino-N-methylalanine (BAMA), N-(2-aminoethyl) glycine (AEG), and 2,4-diaminobutyric acid (DAB) may show different toxicities than BMAA. Here, we set out to provide a fast and sensitive method for the monitoring of AEG, BAMA, DAB and BMAA in surface waters. A procedure based on aqueous derivatization with 9-fluorenylmethyl chloroformate (FMOC-Cl) was investigated for this purpose. Under optimized conditions, a small aqueous sample aliquot (5 mL) was spiked with BMAA-d3 internal standard, subjected to FMOC-Cl derivatization, centrifuged, and analyzed. The high-throughput instrumental method (10 min per sample) involved on-line pre-concentration and desalting coupled to ultra-high-performance liquid chromatography high-resolution mass spectrometry (UHPLC-HRMS). Chromatographic gradient and mobile phases were adjusted to obtain suitable separation of the 4 isomers. The method limits of detection were in the range of 2–5 ng L-1. In-matrix validation parameters including linearity range, accuracy, precision, and matrix effects were assessed. The method was applied to surface water samples (n = 82) collected at a large spatial scale in lakes and rivers in Canada. DAB was found in >70% of samples at variable concentrations (<3–1,900 ng L-1), the highest concentrations corresponding to lake samples in cyanobacterial bloom periods. BMAA was only reported (110 ng L-1) at one HAB-impacted location. This is one of the first studies to report on the profiles of AEG, BAMA, DAB, and BMAA in background and impacted surface waters. [ABSTRACT FROM AUTHOR]

Biomass burning activities can produce large quantities of smoke and result in adverse air quality conditions in regional environments. In Canada, the Environment and Climate Change Canada (ECCC) operational FireWork (v1.0) air quality forecast system incorporates near-real-time biomass burning emissions to forecast smoke plumes from fire events. The system is based on the ECCC operational Regional Air Quality Deterministic Prediction System (RAQDPS) augmented with near-real-time wildfire emissions using inputs from the Canadian Forest Service (CFS) Canadian Wildland Fire Information System (CWFIS). Recent improvements to the representation of fire behaviour and fire emissions have been incorporated into the CFS Canadian Forest Fire Emissions Prediction System (CFFEPS) v2.03. This is a bottom-up system linked to CWFIS in which hourly changes in biomass fuel consumption are parameterized with hourly forecasted meteorology at fire locations. CFFEPS has now also been connected to FireWork. In addition, a plume-rise parameterization based on fire-energy thermodynamics is used to define the smoke injection height and the distribution of emissions within a model vertical column. The new system, FireWork v2.0 (FireWork–CFFEPS), has been evaluated over North America for July–September 2017 and June–August 2018, which are both periods when western Canada experienced historical levels of fire activity with poor air quality conditions in several cities as well as other fires affecting northern Canada and Ontario. Forecast results were evaluated against hourly surface measurements for the three pollutant species used to calculate the Canadian Air Quality Health Index (AQHI), namely PM 2.5 , O3 , and NO2 , and benchmarked against the operational FireWork v1.0 system (FireWork-Ops). This comparison shows improved forecast performance and predictive skills for the FireWork–CFFEPS system. Modelled fire-plume injection heights from CFFEPS based on fire-energy thermodynamics show higher plume injection heights and larger variability. The changes in predicted fire emissions and injection height reduced the consistent over-predictions of PM 2.5 and O3 seen in FireWork-Ops. On the other hand, there were minimal fire emission contributions to surface NO2 , and results from FireWork–CFFEPS do not degrade NO2 forecast skill compared to the RAQDPS. Model performance statistics are slightly better for Canada than for the US, with lower errors and biases. The new system is still unable to capture the hourly variability of the observed values for PM 2.5 , but it captured the observed hourly variability for O3 concentration adequately. FireWork–CFFEPS also improves upon FireWork-Ops categorical scores for forecasting the occurrence of elevated air pollutant concentrations in terms of false alarm ratio (FAR) and critical success index (CSI). [ABSTRACT FROM AUTHOR]

The occurrence and spatial distribution of selected pesticides were investigated along a 200-km reach of the St. Lawrence River (SLR) and tributaries in Quebec, Canada. Surface water samples (n = 68) were collected in the summer 2017 and analyzed for glyphosate, atrazine (ATZ), 8 systemic insecticides (acetamiprid, clothianidin, dinotefuran, fipronil, imidacloprid, nitenpyram, thiacloprid, and thiamethoxam) and some metabolites. Overall, 99% of the surface water samples were positive to at least one of the targeted pesticides. The most recurrent compounds were glyphosate (detection frequency: 84%), ATZ (82%), thiamethoxam (59%), desethylatrazine (DEA: 47%), and clothianidin (46%). Glyphosate displayed variable levels (4–3,000 ng L−1), with higher concentrations in south tributaries (e.g., Nicolet and Yamaska). In positive samples, the sum of ATZ and DEA varied between 5 and 860 ng L−1, and the sum of 6 priority neonicotinoids between 1.5 and 115 ng L−1. From Repentigny to the Sorel Islands, the spatial distribution of pesticides within the St. Lawrence River was governed by the different upstream sources (i.e., Great Lakes vs. Ottawa River) due to the limited mixing of the different water masses. Cross-sectional patterns revealed higher concentrations of glyphosate and neonicotinoids in the north portions of transects, while the middle and south portions showed higher levels of atrazine. In Lake St. Pierre and further downstream, cross-sections revealed higher levels of the targeted pesticides near the southern portions of the SLR. This may be due to the higher contributions from south shore tributaries impacted by major agricultural areas, compared to north shore tributaries with forest land and less cropland use. Surface water samples were compliant with guidelines for the protection of aquatic life (chronic effects) for glyphosate and atrazine. However, 31% of the samples were found to surpass the guideline value of 8.3 ng L−1 for the sum of six priority neonicotinoids. Image 1 • Herbicides and insecticides were investigated in the St. Lawrence River & tributaries. • Glyphosate (84%), atrazine (82%), and thiamethoxam (59%) were recurrently detected. • Cross-section profiles allowed to match specific contaminants with water masses. • 31% of surface water samples exceeded the criterion for neonicotinoids (8.3 ng L−1). • Chemical loads of atrazine were estimated at 250–350 kg/month for July 2017. Glyphosate, atrazine, and neonicotinoid pesticides showed systematic spatial patterns along a 200 km reach of the St. Lawrence River and tributaries, in relation with their agricultural sources. [ABSTRACT FROM AUTHOR]

Biomass burning activities can produce large quantities of smoke and result in adverse air quality conditions in regional environments. In Canada, Environment and Climate Change Canada's (ECCC) operational FireWork air quality forecast system incorporates near-real-time biomass burning emissions to forecast smoke plumes from fire events. The system is based on the ECCC operational Regional Air Quality Deterministic Prediction System (RAQDPS) augmented with near-real-time wildfire emissions using inputs from the Canadian Forest Service's (CFS) Canadian Wildland Fire Information System (CWFIS). Recent improvements to the representation of fire behaviour and fire emissions have been incorporated into the CFS Canadian Forest Fire Emissions Prediction System (CFFEPS). This is a bottom-up system linked to CWFIS in which hourly changes in biomass fuel consumption are parameterized with hourly forecasted meteorology at fire locations. CFFEPS has now also been connected to FireWork. In addition, a plume-rise parameterization based on fire energy thermodynamics is used to define the smoke injection height and the distribution of emissions within a model vertical column. The new system, FireWork-CFFEPS, has been evaluated over North America for July-September 2017 and June-August 2018, both periods when western Canada experienced historical levels of fire activity with poor air quality conditions in several cities as well as other fires affecting northern Canada and Ontario. Forecast results were evaluated against hourly surface measurements for the three pollutant species used to calculate the Canadian Air Quality Health Index (AQHI), namely PM2.5, O3, and NO2, and benchmarked against the operational FireWork system (FireWork-Ops). This comparison shows improved forecast performance and predictive skills for the FireWork-CFFEPS system. Modelled fire plume injection heights from CFFEPS based on fire energy thermodynamics show higher plume injection heights and larger variability. The changes in predicted fire emissions and injection height reduced the consistent over-predictions of PM2.5 and O3 seen in FireWork-Ops. On the other hand, there were minimal fire emission contributions to surface NO2, and results from FireWork-CFFEPS do not degrade NO2 forecast skill compared to the RAQDPS. Model performances statistics are slightly better for Canada than for the U.S., with lower errors and biases. The new system is still unable to capture the hourly variability of the observed values for PM2.5, but it captured the observed hourly variability for O3 concentration adequately. FireWork-CFFEPS also improves upon FireWork-Ops categorical scores for forecasting the occurrence of elevated air pollutant concentrations in terms of false alarm ratio (FAR), and critical success index (CSI). [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Background Prenatal exposure to alcohol is a major, preventable cause of neurobehavioral dysfunction in children worldwide. The measurement and quantification of saccadic eye movements is a powerful tool for assessing sensory, motor, and cognitive function. The quality of the motor process of an eye movement is known as saccade metrics. Saccade accuracy is 1 component of metrics, which to function optimally requires several cortical brain structures as well as an intact cerebellum and brain-stem. The cerebellum has frequently been reported to be damaged by prenatal alcohol exposure. This study, therefore, tested the hypothesis that children with fetal alcohol spectrum disorder ( FASD) will exhibit deficits in the accuracy of saccades. Methods A group of children with FASD ( n = 27) between the ages of 8 and 16 and typically developing control children ( n = 27) matched for age and sex, completed 3 saccadic eye movement tasks of increasing difficulty. Eye movement performance during the tasks was captured using an infrared eye tracker. Saccade metrics (e.g., velocity, amplitude, accuracy) were quantified and compared between the 2 groups for the 3 different tasks. Results Children with FASD were more variable in saccade endpoint accuracy, which was reflected by statistically significant increases in the error of the initial saccade endpoint and the frequency of additional, corrective saccades required to achieve final fixation. This increased variability in accuracy was amplified when the cognitive demand of the tasks increased. Children with FASD also displayed a statistically significant increase in response inhibition errors. Conclusions These data suggest that children with FASD may have deficits in eye movement control and sensory-motor integration including cerebellar circuits, thereby impairing saccade accuracy. [ABSTRACT FROM AUTHOR]

Objectives Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes. Methods This was a secondary analysis of a prospective cohort of injured children and adults with hypotension or Glasgow Coma Scale score ≤ 8, injured by one of four primary injury mechanisms (firearm, stabbing, assault, and motor vehicle collision [ MVC]) who were transported by emergency medical services to a Level I or II trauma center in 10 regions of the United States and Canada from January 1, 2010, through June 30, 2011. We used descriptive statistics and geospatial analyses to compare the injury groups, distance from home, outcomes, and spatial clustering. Results There were 2,079 persons available for analysis, including 506 (24.3%) firearm injuries, 297 (14.3%) stabbings, 339 (16.3%) assaults, and 950 (45.7%) MVCs. Firearm injuries resulted in the highest proportion of serious injuries (66.3%), early critical resources (75.3%), and in-hospital mortality (53.5%). Injury events occurring within 1 mile of a patient's home included 53.9% of stabbings, 49.2% of firearm events, 41.3% of assaults, and 20.0% of MVCs; the non- MVC events frequently occurred at home. While there was geospatial clustering, 94.4% of firearm events occurred outside of geographic clusters. Conclusions Severe firearm events tend to occur within a patient's own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence. [ABSTRACT FROM AUTHOR]

Traffic emissions contribute significantly to urban air pollution. Measurements were conducted over Highway 401 in Toronto, Canada, with a long-path Fourier transform infrared (FTIR) spectrometer combined with a suite of micrometeorological instruments to identify and quantify a range of air pollutants. Results were compared with simultaneous in situ observations at a roadside monitoring station, and with output from a special version of the operational Canadian air quality forecast model (GEM-MACH). Elevated mixing ratios of ammonia (0-23 ppb) were observed, of which 76% were associated with traffic emissions. Hydrogen cyanide was identified at mixing ratios between 0 and 4 ppb. Using a simple dispersion model, an integrated emission factor of on average 2.6 g km-1 carbon monoxide was calculated for this defined section of Highway 401, which agreed well with estimates based on vehicular emission factors and observed traffic volumes. Based on the same dispersion calculations, vehicular average emission factors of 0.04, 0.36, and 0.15 g km-1 were calculated for ammonia, nitrogen oxide, and methanol, respectively. [ABSTRACT FROM AUTHOR]

Ambient fine particulate matter (PM 2.5) data were collected in the lower City of Hamilton, Ontario to apportion the sources of this pollutant over an 18-month period. Hamilton has complex topographical features that may result in worsened air pollution within the lower city, thus, dispersion-normalized, multi-time resolution factor analysis (DN-MT-FA) was used to identify and quantify contributions of factors in a manner that reduced the influence of local meteorology. These factors were secondary organic aerosols type 1 (SOA_1), particulate nitrate (pNO3), particulate sulphate (pSO4), primary traffic organic matter (PTOM), Steel/metal processing and vehicular road dust emissions (Steel & Mobile) and, secondary organic aerosols type 2 (SOA_2) with origins ranging from mainly regional to mainly local. Factors that were mainly local (PTOM, Steel & Mobile, SOA_2) contributed up to 17% of the average PM 2.5 mass while mixed local/regional factors (pNO3, pSO4) made up 43% on average, indicating the potential for further reduction of harmful PM concentrations locally. Of particular interest from a health protection perspective, was the composition of PM 2.5 on days when an exceedance of the 24-hr WHO air quality guideline for this pollutant was observed. In general, SOA_1 was found to drive summer exceedances while pNO3 dominated in the winter. During the summer period, SOA_1 was attributable to wildfires in the northern parts of Canada while local traffic sources in winter contributed to the high levels of pNO3. While local, industrial factors only had minor relative mass contributions during exceedances, they are high in highly oxidized organic species (SOA_2) and toxic metals (Steel & Mobile). Thus, they are likely to have more impacts on human health. The methods and results described in this work will be useful in understanding prevalent sources of particulate matter pollution in the ambient air in the presence of complex topography and meteorological effects. [Display omitted] • DN-MT-FA apportioned sources of PM 2.5 in a city with complex topography. • Dispersion-normalization helps to understand local/regional origins of factors. • Industrially sourced factors had most PM 2.5 metals and unique organic species. • Summer exceedance of WHO AQG for PM 2.5 mainly driven by secondary organic aerosols. • Winter exceedance of WHO AQG for PM 2.5 largely driven by particulate nitrate. [ABSTRACT FROM AUTHOR]

This article discusses certain arm's-length business combinations that involve the utilization of a corporation's accumulated losses against income from a new, unrelated source. These transactions commonly avoid the application of the loss-streaming rules contained in subsection 111(5) and other provisions of the Income Tax Act, by ensuring that the corporation is not subject to an acquisition of control by any person or group of persons. The focus of the article is whether avoidance of an acquisition of control in the context of loss-utilization transactions should constitute abusive tax avoidance under the general anti-avoidance rule (GAAR) in section 245 of the Act. The author discusses the concept of control and the meaning of the phrase "group of persons," and describes several typical transactions that are structured so as to avoid an acquisition of control of a loss-generating corporation. He then reviews the provisions of section 245 as applied in recent court decisions, and examines the potential application of GAAR to these transactions, using principles and observations drawn from those decisions. [ABSTRACT FROM AUTHOR]

The universality of the health system in Canada is often emphasised to contrast the differences between the Canadian and American systems of access to care. However, changes in migration patterns and tightening of administrative procedures around undocumented persons are beginning to challenge this Canadian image. Currently, there is a lack of data to support the existence and the consequences of this shift. This pilot project documents health care professionals' and community organisation workers' perceptions of the problems faced by recent migrants in accessing health care, and the health consequences of such barriers. Results confirm the existence of numerous health care access problems for both completely undocumented migrants and legal migrants who fall into the cracks of the provincial and federal health systems. The data suggests that these barriers may have important unrecognised morbidity and mortality consequences, and that they are a source of severe stress and psychological distress. To protect recent immigrant families, there is a need not only to revise the articulation between the provincial and federal health mandates but also to address the strong societal perception linking universality of health care to the notion of citizenship. Further research is warranted on this emerging social problem, but the institutional sensitivity of these issues may constitute an obstacle to a more comprehensive understanding. [ABSTRACT FROM AUTHOR]

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The proliferation of harmful cyanobacterial algal blooms is of concern due to the associated release of toxins affecting ecosystems and human health. The paralytic shellfish poison saxitoxin (STX) is a small polar alkaloid that can occur in inland and marine aquatic environments. Here, we optimized a fast and sensitive analytical method for the determination of STX, neosaxitoxin (NeoSTX), and their decarbamoyl analogues in surface waters. The method involves a simple filtration, addition of isotope-labelled internal standard (ILIS), and analysis by on-line solid-phase extraction coupled to hydrophilic interaction liquid chromatography high-resolution mass spectrometry (on-line SPE–HILIC-HRMS). Except glass fiber filters, other tested materials (e.g., nylon, nitrocellulose) provided suitable filtration performance. Time-dependent adsorptive losses occurred during the LC-MS batch sequence if glass autosampler vials were used, while no such effect was observed for polypropylene autosampler vials. Matrix effects were evaluated for 4 different quantification scenarios, including external vs. internal curves and neat reagent water vs. matrix-matched curves. Matrix-matched calibration with ILIS correction (NeoSTX-15N 7) provided the best performance overall. The analytical method was validated in freshwater lake water and estuarine brackish water (30‰ salinity), with suitable determination coefficients (R2 > 0.9975), matrix spike accuracy (90–107%), and intraday/interday precision (RSD of 0.61–16%). Method limits of detection (LOD in lake water: 0.72–3.9 ng/L) are also improved over most of the recent literature. The method was applied to a set of 302 surface water samples collected in Canada, France, and the United Kingdom, and positive detections were reported for STX (max: 98 ng/L), decarbamoyl-STX (max: 15 ng/L), and NeoSTX (max: 87 ng/L). [Display omitted] • A rapid method to analyze paralytic shellfish toxins in surface water is reported. • On-line SPE coupled to HILIC-HRMS yielded LODs of 0.72–3.9 ng/L in lake water. • Glass was avoided for filters & HPLC autosampler vials due to adsorptive losses. • Saxitoxins were screened in 302 samples of Canada, France, and the United Kingdom. • Saxitoxin and neosaxitoxin were detected in freshwater and saltwater field samples. [ABSTRACT FROM AUTHOR]

Surface-level ozone (O3) continues to be a significant health risk in the Greater Toronto Hamilton Area (GTHA) of Canada even though precursor emissions in the area have decreased significantly over the past two decades. In July 2015, Environment and Climate Change Canada (ECCC) led an intensive field study coincident with Toronto hosting the 2015 Pan American Games. During the field study, the daily 1-h maximum O3 standard (80 ppbv) was exceeded twice at a measurement site in North Toronto, once on July 12 and again on July 28. In this study, ECCC's 2.5-km configuration of the Global Environmental Multi-scale (GEM) meteorological model was combined with the Modelling Air-quality and CHemistry (MACH) on-line atmospheric chemistry model and the Town Energy Balance (TEB) urban surface parameterization to create a new urban air quality modelling system. In general, the model results showed that the nested 2.5-km grid-spaced urban air quality model performed better in statistical scores compared to the piloting 10-km grid-spaced GEM-MACH model without TEB. Model analyses were performed with GEM-MACH-TEB for the two exceedance periods. The local meteorology for both cases consisted of light winds with the highest O3 predictions situated along lake-breeze fronts. For the July 28 case, O3 production sensitivity analysis along the trajectory of the lake-breeze circulation showed that the region of most efficient O3 production occurred in the updraft region of the lake-breeze front, as the precursors to O3 formation underwent vertical mixing. In this updraft region, the ozone production switches from volatile organic compound (VOC)-sensitive to NOx-sensitive, and the local net O3 production rate reaches a maximum. This transition in the chemical regime is a previously unidentified factor for why O3 surface-level mixing ratios maximize along the lake-breeze front. For the July 12 case, differences between the model and observed Lake Ontario water temperature and the strength of lake-breeze opposing wind flow play a role in differences in the timing of the lake-breeze, which impacts the predicted location of the O3 maximum north of Toronto. [ABSTRACT FROM AUTHOR]

Even though regular engagement in physical activity (PA) among children can support their development and encourage the adoption of healthy lifelong habits, most do not achieve their recommended guidelines. Active travel (AT), or any form of human-powered travel (e.g., walking), can be a relatively accessible, manageable, and sustainable way to promote children's PA. One common barrier to children's engagement in AT, however, is a reported lack of education and training. To support children's participation in AT, this paper presents the development of a comprehensive 4-module online road safety education intervention designed to improve children's knowledge and confidence regarding AT. Using a qualitative integrated knowledge translation (iKT) approach undertaken with community collaborators (n = 50) containing expertise in health promotion, public safety, school administration, and transportation planning, our inductive thematic analysis generated fourth themes which constituted the foundation of the intervention modules: Active Travel Knowledge: Awareness of Benefits and Participation; Pedestrian Safety and Skills: Roles, Responsibilities, and Rules; Signs and Infrastructure: Identification, Literacy, and Behaviour; Wheeling Safety and Skills: Technical Training and Personal Maneuvers. Each theme/module was then linked to an explicit learning objective and connected to complementary knowledge activities, resources, and skill development exercises. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. Methods: To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Results: Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Conclusion: Key policy, training and practice implications are discussed. [ABSTRACT FROM AUTHOR]

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Purpose: Refugee and immigrant youth (RIY) experience multifaceted challenges, but also have the potential to become resilient. Most of the existing literature focuses on the challenges these RIY face with limited attention to their agency and resilience. This study aims to assess the factors that predict RIY's resilience among refugee and immigrant youth in Montreal, Canada. Design/methodology/approach: A sample of 93 RIY in Montreal was surveyed. A questionnaire consisting of validated scales was used for data collection. Findings: The study found a positive correlation between educational level, personal resilience and relational resilience (p < 0.001). However, ethnicity did not have a significant correlation with the participant's general level of resilience (p > 0.001). Cultural, religious, family, community ties, age and time lived in Montréal were found to be predictors of general resilience, relational resilience and personal resilience of the RIY (p < 0.001). Originality/value: The study concluded that factors such as cultural, religious and community ties are major predictors of the resilience of RIY in Montreal. Hence, the need for mental health practitioners and resettlement organizations that work with RIY to focus on reconceptualizing resilience to incorporate the cultural, religious and community ties of RIY. This will help in developing services and programs that are culturally sensitive and effective in fostering the resilience of RIY. [ABSTRACT FROM AUTHOR]

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Background: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. Objective: This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2018 to 2022 (Candida auris, 2012-2022) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial and territorial laboratories to the National Microbiology Laboratory. Methods: Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for Clostridioides difficile infections (CDIs), carbapenemaseproducing Enterobacterales (CPE) infections, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2017 (retrospectively to 2012) by the National Microbiology Laboratory. Trend analysis for case counts, rates, outcomes, molecular characterization and AMR profiles are presented. Results: From 2018 to 2022, decreased rates per 10,000 patient days were observed for CDIs (7% decrease; 5.42-5.02) and MRSA BSIs (2.9% decrease; 1.04-1.01). Infection rates for VRE BSIs increased by 5.9% (0.34-0.36). Infection rates for CPE remained low but increased by 133% (0.06-0.14). Forty-three C. auris isolates were identified in Canada from 2012 to 2022, with the majority in Western and Central Canada (98%). Conclusion: From 2018 to 2022, the incidence of MRSA BSIs and CDIs decreased and VRE BSI and CPE infections increased in the Canadian acute care hospitals participating in a national sentinel network (CNISP). Few C. auris isolates were identified from 2012 to 2022. Reporting standardized surveillance data to inform the application of infection prevention and control practices in acute care hospitals is critical to help decrease the burden of HAIs and AMR in Canada. [ABSTRACT FROM AUTHOR]

Background: Cancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. Methods: We obtained data on new cancer cases (i.e., incidence, 1984–2019) and deaths from cancer (i.e., mortality, 1984–2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. Results: In 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). Interpretation: Although the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada. [ABSTRACT FROM AUTHOR]

People with visual impairments (those who are blind or who have low vision) continue to experience an unemployment rate of 70% or higher across all sectors but remain especially under-represented within higher education and the research ecosystem. Among the barriers emphasized by people with visual impairments are those related to accessibility and inclusion. It is within this socio-historical context that we began our interactions as a blind graduate student (Martiniello) and a sighted PhD. supervisor (Wittich) in the process of completing a doctoral program in vision science. Utilizing duoethnography as a methodological approach, we juxtapose two perspectives on a shared experience. Over a period of five years, we explored the ways in which our interactions as a trainee with lived experience and sighted ally have shaped our perspectives on disability inclusion in (and while doing) disability research and the role of allyship in the context of academia. We use examples from our lived experiences to illustrate the ways in which we negotiated the role of allyship throughout the research process, including the impact of accessibility and inclusion while completing a scoping review, semi-structured interviews and thematic content analysis. These collective experiences set the stage for new forms of advocacy and allyship to emerge. To the best of our knowledge, Dr Martiniello remains the first and only blind person to graduate in Canada with a PhD in Vision Science. Hopefully, she will not be the last. [ABSTRACT FROM AUTHOR]

People living with HIV (PLWH) can exhibit impaired immune responses to vaccines. Accumulating evidence indicates that PLWH, particularly those receiving antiretroviral therapy, mount strong antibody responses to COVID-19 vaccines, but fewer studies have examined cellular immune responses to the vaccinations. Here, we used an activation-induced marker (AIM) assay to quantify SARS-CoV-2 spike-specific CD4+ and CD8+ T cells generated by two and three doses of COVID-19 vaccines in 50 PLWH receiving antiretroviral therapy, compared to 87 control participants without HIV. In a subset of PLWH, T-cell responses were also assessed after post-vaccine breakthrough infections and/or receipt of a fourth vaccine dose. All participants remained SARS-CoV-2 infection-naive until at least one month after their third vaccine dose. SARS-CoV-2 infection was determined by seroconversion to a Nucleocapsid (N) antigen, which occurred in 21 PLWH and 38 control participants after the third vaccine dose. Multivariable regression analyses were used to investigate the relationships between sociodemographic, health- and vaccine-related variables, vaccine-induced T-cell responses, and breakthrough infection risk. We observed that a third vaccine dose boosted spike-specific CD4+ and CD8+ T-cell frequencies significantly above those measured after the second dose (all p < 0.0001). Median T-cell frequencies did not differ between PLWH and controls after the second dose (p > 0.1), but CD8+ T-cell responses were modestly lower in PLWH after the third dose (p = 0.02), an observation that remained significant after adjusting for sociodemographic, health- and vaccine-related variables (p = 0.045). In PLWH who experienced a breakthrough infection, median T-cell frequencies increased even higher than those observed after three vaccine doses (p < 0.03), and CD8+ T-cell responses in this group remained higher even after a fourth vaccine dose (p = 0.03). In multivariable analyses, the only factor associated with an increased breakthrough infection risk was younger age, which is consistent with the rapid increase in SARS-CoV-2 seropositivity that was seen among younger adults in Canada after the initial appearance of the Omicron variant. These results indicate that PLWH receiving antiretroviral therapy mount strong T-cell responses to COVID-19 vaccines that can be enhanced by booster doses or breakthrough infection. [ABSTRACT FROM AUTHOR]

Throughout history, the pursuit of diagnosing and predicting crop yields has evidenced genetics, environment, and management practices intertwined in achieving food security. However, the sensitivity of crop phenotypes and genetic responses to climate still hampers the identification of the underlying abilities of plants to adapt to climate change. We hypothesize that the PiAnosi and WagNer (PAWN) global sensitivity analysis (GSA) coupled with a genetic by environment (GxE) model built of environmental covariance and genetic markers structures, can evidence the contributions of climate on the predictability of maize yields in the U.S. and Ontario, Canada. The GSA-GxE framework estimates the relative contribution of climate variables to improving maize yield predictions. Using an enhanced version of the Genomes to Fields initiative database, the GSA-GxE framework shows that the spatially aggregated sensitivity of maize yield predictability is attributed to solar radiation, followed by temperature, rainfall, and relative humidity. In one-third of the individually assessed locations, rainfall was the primary responsible for maize yield predictability. Also, a consistent pattern of top sensitivities (Relative Humidity, Solar Radiation, and Temperature) as the main or the second most relevant drivers of maize yield predictability shed some light on the drivers of genetic improvement in response to climate change. [ABSTRACT FROM AUTHOR]

Harmful algal blooms of cyanobacteria (CyanoHABs) can lead to the release of potent toxins that can seriously affect ecosystem integrity. Some freshwater watersheds are particularly at risk considering the threats to already imperiled wildlife. The consumption of tainted drinking water and contaminated food also raises concerns for human health. In the present study, a pilot survey was conducted in the riverine ecosystem of the Pike River Ecological Reserve (QC, Canada) near Missisquoi Bay, Lake Champlain. We examined the occurrence of multiclass cyanotoxins including 12 microcystins, anatoxins, cylindrospermopsin (CYN), anabaenopeptins (AP-A, AP-B), and cyanopeptolin-A in surface waters and wild-caught fish during the summer 2018. Out of the 18 targeted cyanotoxins, 14 were detected in bloom-impacted surface water samples; toxins peaked during early-mid September with the highest concentrations for MC-LR (3.8 μg L−1) and MC-RR (2.9 μg L−1). Among the 71 field-collected fish from 10 species, 30% had positive detections to at least one cyanotoxin. In positive samples, concentration ranges in fish muscle were as follows for summed microcystins (∑MCs: 0.16–9.2 μg kg−1), CYN (46–75 μg kg−1), AP-A (1.1–5.4 μg kg−1), and AP-B (0.12–5.0 μg kg−1). To the best of our knowledge, this is one the first reports of anabaenopeptins occurrence in wildlife. The maximum ∑MCs in fish was 1.15-fold higher than the World Health Organization (WHO) daily intake recommendation for adults and nearly equated the derived value for young children. The concentration of CYN was also about 3-fold higher than the limit derived from the human health guideline values. [Display omitted] • The occurrence of 18 cyanotoxins was studied in a freshwater ecosystem (QC, Canada). • MC-LR and MC-RR were predominant in HAB-impacted surface water. • Anabaenopeptins (AP-A, AP-B) were detected across several fish species. • MCs exceeded the WHO guideline (TDI = 0.04 μg kg−1) in some fish muscle samples. • Samples from the study area containing MC and CYN may pose a risk to human health. [ABSTRACT FROM AUTHOR]

Precise estimates of Snow Water Equivalent (SWE) are crucial for informed decision-making in regions like Northern Canada, where snow cover significantly contributes to springtime discharge. However, the sparse nature of the existing SWE monitoring network poses a challenge to comprehensively understanding the SWE distribution and variability. Reanalysis products like ERA5-Land provide long-term continuous SWE estimates, but our evaluation identified a negative bias (-61 mm) in the estimated SWE and maximum underestimation was observed at high elevation (>1500 m) areas. To correct these biases, we applied four correction methods: Mean Bias Subtraction (MBS), Simple Linear Regression (SLR), Multiple Linear Regression (MLR), and Random Forest (RF). RF exhibited the highest performance, reducing the Root Mean Square Error (RMSE) by 78 % and minimizing the annual mean bias from 61.2 mm to 0.01 mm. However, RF did not produce reliable SWE estimates for unseen spatial and temporal domains due to its limitation of not extrapolating beyond the training data. [ABSTRACT FROM AUTHOR]