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We evaluate the effects of rapidly changing Arctic sea ice conditions on sea salt aerosols (SSA) produced by oceanic wave‐breaking and the sublimation of wind‐lofted salty blowing snow on sea ice. We use the GEOS‐Chem chemical transport model to assess the influence of changing extent of the open ocean, multi‐year sea ice (MYI), first‐year sea ice (FYI), and snow depths on SSA emissions for 1980–2017. We combine snow depths from the Lagrangian snow‐evolution model (SnowModel‐LG) together with an empirically‐derived snow salinity function of snow depth to derive spatially and temporally varying snow surface salinity over Arctic FYI. We find that pan‐Arctic SSA surface mass concentrations have increased by 6%–12% decade−1 during the cold season (November–April) and by 7%–11% decade−1 during the warm season (May–October). The cold season trend is due to increasing blowing snow SSA originating from FYI: as MYI is replaced by FYI with thinning snow depths, snow surface salinity increases by more than 11% decade−1. During the warm season, rapid sea ice loss and thus increasing open ocean SSA are the cause of modeled SSA trends. Observations of SSA mass concentrations at Alert, Canada display positive trends during the cold season (10%–12% decade−1), consistent with our pan‐Arctic simulations. During fall, Alert observations show a negative trend (−18% decade−1), due to locally decreasing wind speeds and thus lower open ocean emissions. These significant changes in SSA concentrations could potentially affect past and future bromine explosions and Arctic climate feedbacks. Plain Language Summary: Suspended sea salt particles affect the climate and chemistry of the atmosphere. The main source of these particles is ocean wave breaking. In polar regions an additional source is the wind lofting of salty snow that is present on top of sea ice. Here we use model simulations to examine how changing Arctic conditions have impacted sea salt particles in the atmosphere. Our simulations show that the concentrations of sea salt particles have increased by more than 6% per decade over the 1980–2017 period. During cold months, this increase is due to saltier blowing snow particles as older sea ice with less salty snow is being replaced by younger sea ice with more salty snow. During warmer months, this increase is the result of larger open ocean emissions as sea ice is melting. These changes in sea salt particles could potentially affect Arctic bromine activation and climate. Key Points: Model predicts pan‐Arctic increase in sea salt aerosol (SSA) concentrations by 6%–12% decade−1 for 1980–2017Younger Arctic sea ice with thinner and saltier snow cause increasing blowing snow SSA emissions in winter‐springDuring summer‐fall, rapidly diminishing sea ice extent results in increasing open ocean SSA emissions [ABSTRACT FROM AUTHOR]

Abstract: Background: Dietary habits formed during youth may result in the development of obesity and chronic diseases in adulthood. We aimed to determine the frequency of the consumption of foods and beverages and the degree of adherence to Canada's Food Guide recommendations among multi‐ethnic youths. Methods: Participants were recruited from 12 schools in the Edmonton, Alberta area by use of posters, school newsletters and advertisements. A 30‐item food frequency questionnaire was administered by a trained interviewer to assess dietary intake in a convenience sample of 557 (328 females and 229 males) youths aged 11–23 years; for the purpose of the present study, only the 14–18 years age group was considered in the analysis. Participants were divided by sex and self‐identified ethnicity into four groups [Indigenous, African & Middle Eastern (AME), Asian, and European]. Statistical analysis of the data was undertaken using t‐tests, Welch's analysis of variance and Games‐Howell tests. P < 0.05 was considered statistically significant. Results: Vegetables and Fruit recommendations were the least likely to be followed, with 90.7–96.8% of participants in all groups not consuming the recommended number of servings day–1. The mean frequency of fruit consumption was lower among Indigenous youths compared to Asian youths (0.90 versus 1.37 times day–1). A greater proportion of males than females (55.9% versus 44.3%) did not meet the minimum recommendations for Meat and Alternatives (P = 0.016). The percentage of youths not adhering to recommendations for Milk and Alternatives was 81.7% for Indigenous, 73.3% for AME, 78.6% for Asian and 63.5% for European youths. Indigenous youths more frequently consumed potato chips and soft drinks compared to other ethnic youths. The most frequently consumed beverage was milk (1.25 times day–1). Conclusions: The majority of youths did not consume minimum daily recommended servings of Vegetables and Fruit, Milk and Alternatives, and/or Meat and Alternatives food groups. Evidence‐based dietary interventions and public health strategies are needed. [ABSTRACT FROM AUTHOR]

Background Traditionally, the Arctic diet has been derived entirely from locally harvested animal and plant species; however, in recent decades, imported foods purchased from grocery stores have become widely available. The present study aimed to examine Inuvialuit, traditional or nontraditional dietary patterns; nutrient density of the diet; dietary adequacy; and main food sources of energy and selected nutrient intakes. Methods This cross-sectional study used a culturally appropriate quantitative food frequency questionnaire to assess diet. Traditional and nontraditional eaters were classified as those consuming more or less than 300 g of traditional food daily. Nutrient densities per 4184 kJ (1000 kcal) were determined. Dietary adequacy was determined by comparing participants' nutrient intakes with the Dietary Reference Intakes. Results The diet of nontraditional eaters contained, on average, a lower density of protein, niacin, vitamin B12, iron, selenium, zinc, omega-3 fatty acids ( P ≤ 0.0001), vitamin B6, potassium, thiamin, pantothenic acid ( P ≤ 0.001), riboflavin and magnesium ( P ≤ 0.05). Inadequate nutrient intake was more common among nontraditional eaters for calcium, folate, vitamin C, zinc, thiamin, pantothenic acid, vitamin K, magnesium, potassium and sodium. Non-nutrient-dense foods (i.e. high fat and high sugar foods) contributed to energy intake in both groups, more so among nontraditional eaters (45% versus 33%). Traditional foods accounted for 3.3% and 20.7% of total energy intake among nontraditional and traditional eaters, respectively. Conclusions Diet quality and dietary adequacy were better among Inuvialuit who consumed more traditional foods. The promotion of traditional foods should be incorporated in dietary interventions for this population. [ABSTRACT FROM AUTHOR]

Background Healthy Foods North ( HFN) is a community-based intervention designed to promote a healthy diet and lifestyle of Inuit and Inuvialuit populations in Arctic Canada. The objective of the present study was to determine the effects of HFN on the nutrient intake of women of childbearing age. Methods Six communities in Nunavut ( n = 3) and the Northwest Territories ( n = 3) were selected for programme implementation; four received a 12-month intervention and two served as controls. Quantitative food frequency questionnaires were used to assess dietary intake at baseline and 1 year post-intervention. Among women participants aged 19-44 years ( n = 136), 79 were exposed to the intervention and 57 were not. Mean daily energy and nutrient intake and density were determined. Dietary adequacy was assessed by comparing the women's daily nutrient intakes with dietary reference intakes ( DRI). Results Main outcomes were the pre- to post-intervention changes between intervention and control groups for energy and selected nutrient intakes, nutrient density and dietary adequacy. Among the participants, the intervention had a beneficial effect on vitamin A and D intake. The percentage of individuals with nutrient intakes below the DRI increased from pre- to post-intervention for vitamin A and D in the control group but only for vitamin A in the intervention group. The programme did not have a significant impact on calorie, sugar, or fat consumption. Conclusions The HFN programme is effective in mitigating some of the negative impacts of the nutrition transition on dietary adequacy among Inuit and Inuvialuit women of childbearing age. [ABSTRACT FROM AUTHOR]

Background Inuit in Nunavut, Canada, are currently undergoing a nutritional transition that may contribute to an increased prevalence of chronic disease. Information is lacking about the extent to which contemporary Inuit diets are meeting current dietary recommendations. Methods A culturally appropriate quantitative food frequency questionnaire ( QFFQ) developed and validated for Inuit in Nunavut, Canada, was used to assess food and nutrient intake in a cross-sectional sample of adults. Results Participants included 175 women and 36 men with mean (SD) ages of 42.4 (13.2) and 42.1 (15.0) years, respectively. The response rate for those who completed the study was 79% with 208 QFFQs included for analysis. Reported mean daily energy intakes were: men 15 171 kJ (3626 kcal); women 11 593 kJ (2771 kcal). Dietary inadequacy was expressed as the percentage of participants reporting intakes below the sex- and age-specific estimated average requirements ( EARs). For nutrients without EARs, adequate intakes were used. Energy and sodium intakes exceeded the recommendations. Less than 10% of participants met recommendations for dietary fibre intake. Vitamin E intakes were below EARs for ≥97% of participants, whereas >20% reported inadequate vitamin A, folate and magnesium intakes. Among women, >50% reported inadequate calcium and vitamin D intakes. Non-nutrient-dense foods contributed 30% of energy, 73% of sugars and 22% of fat. Traditional foods contributed 56% of protein and 49% of iron. Conclusions The present study demonstrates a relatively high prevalence of inadequate nutrient intakes among Inuit. The results may be used to monitor the nutrition transition among Inuit, evaluate nutritional interventions, and inform public health policy decision-making. [ABSTRACT FROM AUTHOR]

Background Previous studies highlight a possible association between alcohol-drinking patterns and dietary inadequacies, which may have negative implications, particularly for women of child-bearing age. The present study aimed to compare dietary adequacy among alcohol drinkers versus nondrinkers in Inuvialuit women of child-bearing age. Methods A cross-sectional survey of 92 randomly selected women of childbearing age (19-44 years) was conducted in three communities in the Northwest Territories of Arctic Canada, using a validated quantitative food frequency questionnaire. Data were analysed to compare mean daily energy and nutrient intakes, dietary adequacy and nutrient densities (per 4184 kJ) between alcohol drinkers and nondrinkers, as well as heavy drinkers and nonheavy drinkers, using the nonparametric Wilcoxen rank sum test. Results The response rate was between 65% and 85% depending on the community sampled. Of the study participants, 54% ( n = 49) were drinkers and 46% ( n = 42) were nondrinkers. Of the drinkers, 45% ( n = 22) were heavy drinkers. Mean energy intakes were high among all women, although they were significantly higher among drinkers [17 179 kJ (4106 kcal)] compared to nondrinkers [13 317 kJ (3183 kcal)]. There were no significant differences in nutrient intake between the two groups; however, drinkers had a lower nutrient density for most nutrients. Heavy drinkers had a significantly lower nutrient density for all nutrients, except protein, iron, and vitamins B6, C and D, compared to nonheavy drinkers. Conclusions The findings of the present study provide evidence of inadequate dietary intake among Inuvialuit of child-bearing age, regardless of alcohol-drinking behaviour. [ABSTRACT FROM AUTHOR]

Background Inuvialuit of Arctic Canada are at high risk for inadequate vitamin D status as a result of rapid dietary transitions and a lack of solar ultraviolet B exposure. This may have implications for the development of adverse skeletal diseases, cardiovascular diseases and cancers. Data are limited regarding supplement use in Arctic Aboriginal populations. The present study aimed to describe the type and extent of supplement use, emphasising vitamin D, and to identify differences between supplement users and non-users. Methods Supplement information was collected from a population-specific quantitative food frequency questionnaire in three communities in the Northwest Territories, Canada, as part of a cross-sectional study. Data were analysed for frequency of supplementation and types of supplements. Users and non-users were compared in terms of age, sex, body mass index, education, marital status, income support, employment and chronic disease diagnosis using nonparametric tests and the chi-squared test. Results Response rates ranged from 65% to 85%. Included in the analysis were 192 Inuvialuit (45 males, 147 females) with a mean (SD) age of 43.6 (13.9) years. Twenty-three percent reported using a supplement, with multivitamins being the most common. Three percent indicated taking a vitamin D-containing supplement. No significant differences between supplement users and non-users were found. Conclusions Despite limited sun exposure for many months of the year, a small proportion of Inuvialuit adults were using supplements, and specifically vitamin D-containing supplements. Future population-based intervention strategies should promote consumption of vitamin D rich foods and encourage the use of vitamin D supplements if diet alone is unable to meet recommendations. [ABSTRACT FROM AUTHOR]

Inuit in Nunavut (NU) and Inuvialuit in the Northwest Territories (NWT), Canada, were traditionally nomadic peoples whose culture and lifestyle were founded on hunting and gathering foods from the local environment, primarily land and marine mammals. Lifestyle changes within the last century have brought about a rapid nutrition transition, characterised by decreasing consumption of traditional foods and an associated increase in the consumption of processed, shop-bought foods. This transition may be attributed to a multitude of factors, such as acculturation, overall food access and availability, food insecurity and climate change. Obesity and risk for chronic disease are higher in the Canadian Arctic population compared with the Canadian national average. This present review describes the study population and methodologies used to collect data in order to study the nutrition transition amongst Aboriginal Arctic populations and develop Healthy Foods North (HFN), a novel, multi-institutional and culturally appropriate programme that aims to improve dietary adequacy and reduce risk of chronic disease. Included in this special issue of the Journal of Human Nutrition and Dietetics are papers describing dietary intake patterns, physical activity levels, dietary behaviours, chronic disease prevalence and psychosocial factors that potentially mediate behaviour. A further paper describes how these data were utilised to inform and develop Healthy Foods North. [ABSTRACT FROM AUTHOR]

Background: Validation of a quantitative food frequency questionnaire (QFFQ) developed specifically for Inuit is necessary to determine its usefulness in assessing dietary intake and adequacy and in identifying dietary risk factors for chronic disease in this population. Methods: Seventy-five randomly selected Inuit adults in Nunavut, Canada, were recruited. Mean daily intake of nutrients from one to three 24-h recalls was used as the reference to measure QFFQ validity. Crude and energy-adjusted Spearman rank correlations (ρ), cross classification and weighted kappa were computed as measures of concordance. Bland–Altman plotting was used for additional assessment. Results: Excluding four participants with daily energy intake of >25.1 MJ, 71 participants were included in the analysis. For all nutrients, mean daily intake from the QFFQ was higher than the recall. ρ’s for macronutrients were in the range 0.71 for carbohydrate to 0.25 for protein. The best ρ amongst micronutrients was observed for vitamin C (0.66). Overall correlation between the two dietary tools improved after correction for within-person variance (from 0.46 to 0.49), although adjusting for energy did not improve the overall coefficient. When nutrient intakes were categorised into quartiles, the QFFQ and 24-h recalls indicated relative agreement proportion (same or adjacent quartiles) of 83% for energy, 94% for total sugar, 83% for macronutrients and 77% for micronutrients. Bland–Altman plots showed a tendency for increased scatter of the differences in nutrients at higher intakes. Conclusions: The QFFQ developed is valid and can be used to assess usual dietary intake and dietary adequacy, determine the contribution of foods to specific nutrient intakes, and identify dietary risk factors for chronic disease amongst this population. [ABSTRACT FROM AUTHOR]

Background: The estimation of dietary intake in population-based studies is often assessed by a food frequency questionnaire (FFQ). This present study aimed to establish the validity of a 142-item quantitative FFQ (QFFQ) developed to assess dietary intake in a population living in the Northwest Territories, Canada, and undergoing rapid nutrition transition. Methods: Sixty-four randomly selected Inuvialuit adults were recruited. The mean of one to three 24-h recalls was used as the reference to measure the validity of the QFFQ. Spearman rank correlations (ρ), cross-classification and weighted kappa were computed as measures of concordance, adjusting for the daily dietary intake variations in the recalls. Bland – Altman plots were used for additional assessment. Results: Four participants with daily energy intake of >25.1 MJ were not included in the analysis. For all nutrients, mean daily intake estimations were higher from the QFFQ than from the recalls. De-attenuated ρ’s for macronutrients ranged from 0.33 (protein) to 0.45 (carbohydrate). The best de-attenuated ρ amongst micronutrients was observed for vitamin C (0.53). Overall correlation between the two dietary tools improved after correction for within-person variance (from 0.32 to 0.35). When nutrient intakes were categorised into quartiles, the QFFQ and 24-h recalls indicated relative agreement (same or adjacent quartiles) for 77% for energy and macronutrients, 86% for total sugar and 72% for micronutrients. Bland–Altman plots showed a tendency for increased scatter of the differences at higher intakes. Conclusions: The QFFQ developed is valid and can be used to assess usual dietary intake and dietary adequacy, determine the contribution of foods to specific nutrient intakes, and identify dietary risk factors for chronic disease amongst Inuvialuit. [ABSTRACT FROM AUTHOR]

Dietary inadequacies, low levels of physical activity, excessive energy intake and high obesity prevalence have placed Inuit and Inuvialuit populations of the Canadian Arctic at increased risk of chronic disease. An evidence-based, community participatory process was used to develop Healthy Foods North (HFN), a culturally appropriate nutrition and physical activity intervention programme that aimed to reduce risk of chronic disease and improve dietary adequacy amongst Inuit/Inuvialuit in Nunavut and the Northwest Territories. HFN was implemented over the course of 12 months in a series of seven phases between October 2008 and 2009 (Nunavut) and June 2008 and 2009 (Northwest Territories). Combining behaviour change and environmental strategies to increase both the availability of healthful food choices in local shops and opportunities for increasing physical activity, HFN promoted the consumption of traditional foods and nutrient-dense and/or low energy shop-bought foods, utilisation of preparation methods that do not add fat content, decreased consumption of high-energy shop-bought foods, and increased physical activity. Messages identified in the community workshops, such as the importance of family eating and sharing, were emphasised throughout the intervention. Intervention components were conducted by community staff and included working with shops to increase the stocking of healthy foods, point of purchase signage and promotion in shops and community settings, pedometer challenges in the workplace and use of community media (e.g. radio and cable television advertisements) to reinforce key messages. HFN represents an innovative multilevel approach to the reduction of chronic disease risk factors amongst Inuit and Inuvialuit, based on strong collaboration with local agencies, government and institutions. [ABSTRACT FROM AUTHOR]

Background: Changing food behaviours amongst Canadian Inuit may contribute to rising chronic disease prevalence, and research is needed to develop nutritional behaviour change programmes. The present study examined patterns of food acquisition and preparation behaviours amongst Inuit adults in Nunavut and associations with psychosocial and socioeconomic factors. Methods: Developed from behavioural theories and community workshops, Adult Impact Questionnaires were conducted with adult Inuit (≥19 years) from randomly selected households in three remote communities in Nunavut, Canada, to determine patterns of healthy food knowledge, self-efficacy and intentions, frequencies of healthy and unhealthy food acquisition and healthiness of preparation methods. Associations between these constructs with demographic and socioeconomic factors were analysed using multivariate linear regressions. Results: Amongst 266 participants [mean (SD) age 41.2 (13.6) years; response rates 69–93%], non-nutrient-dense foods were acquired a mean (SD) of 2.9 (2.3) times more frequently than nutrient-dense, and/or low sugar/fat foods. Participants tended to use preparation methods that add fat. Intentions to perform healthy dietary behaviours was inversely correlated with unhealthy food acquisition (β = −0.25, P < 0.001), and positively associated with healthy food acquisition (β = 0.22, P < 0.001) and healthiness of preparation methods (β = 0.15, P = 0.012). Greater healthy food knowledge and self-efficacy were associated with intentions (β = 0.21, P = 0.003 and β = 0.55, P < 0.001, respectively). Self-efficacy was associated with healthier preparation (β = 0.14, P = 0.025) and less unhealthy food acquisition (β = −0.27, P < 0.001), whilst knowledge was associated with acquiring healthy foods (β = 0.13, P = 0.035). Socioeconomic status was positively associated with healthy preparation and food acquisition behaviours. Conclusions: Interventions to improve diet in Nunavut Inuit should target healthy food intentions, knowledge and self-efficacy. Behaviour change strategies emphasising economic benefits of a healthy diet should be employed to target individuals of low socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: With increasing chronic disease amongst Inuvialuit in the Canadian Arctic, research on dietary behaviours and their determinants in this population is needed to develop nutritional behaviour change intervention strategies. The present study aimed to assess the knowledge, self-efficacy and intentions towards healthy eating and healthy eating behaviours of Inuvialuit adults in the Northwest Territories (NWT), Canada. Methods: The Adult Impact Questionnaire was developed from behavioural theories and workshops held in the communities. It was conducted with adult Inuvialuit (≥19 years) from randomly selected households in three NWT communities to collect data on the psychosocial constructs of healthy food knowledge, self-efficacy and intentions, and the dietary behaviours of healthy and unhealthy food acquisition and preparation. Associations between demographic, socioeconomic, psychosocial constructs and behaviours were analysed using multivariate linear regression. Results: The 228 participants [mean (SD) age 43.4 (13.6) years; response rates 65–85%] acquired non-nutrient-dense foods a mean (SD) of 2.7 (3.0) times more frequently than nutrient-dense, low sugar and low fat foods. Increased intention was associated with a greater frequency of acquiring healthy foods (β = 0.17, P = 0.012) and a lower frequency of acquiring unhealthy foods (β = −0.18, P = 0.008). Overall, participants reported using food preparation methods that reduce fat content slightly more than methods that add fat [mean (SD) score 0.3 (1.9)]. Use of healthier food preparation methods was associated with higher levels of healthy food knowledge (β = 0.26, P < 0.001), self-efficacy (β = 0.29, P < 0.001) and intentions (β = 0.22, P = 0.001). Conclusions: Healthy food intention was the construct most significantly associated with all three healthier dietary behaviours. Interventions that target intentions to change food choice and preparation may be effective strategies to improve dietary intake in Inuvialuit populations. [ABSTRACT FROM AUTHOR]

Background: Chronic disease prevalence amongst Canadian Arctic populations is increasing, but the literature amongst Inuvialuit is limited. The present study aimed to provide baseline data that could be used to monitor changes in chronic disease risk factors and long-term health in the Arctic by determining prevalence and risk factors of self-reported chronic disease amongst adult Inuvialuit in remote communities. Methods: Self-reported demographics and history of chronic disease (hypertension, heart disease, diabetes and cancer) were collected in three communities between July 2007 and July 2008 in the Northwest Territories. Food frequency questionnaires recorded dietary intake, International Physical Activity Questionnaires recorded physical activity and anthropometric measures of height and weight were obtained. Results: Response rates ranged from 65–85%. More than 20% of the 228 participants aged 19–84 years reported having a chronic disease. Age-adjusted prevalence was 28, 9, 9 and 6 per 100 for hypertension, heart disease, diabetes and cancer, respectively. Compared with non-cases, participants reporting hypertension were more likely to have a higher body mass index and a lower level of education. Hypertension was more common amongst participants reporting heart disease and diabetes than Inuvialuit not reporting these morbidities. Conclusions: Inuvialuit participants in this study were most affected by hypertension and diabetes compared with heart disease or any cancer. Female participants had a higher prevalence of heart disease compared with the Canadian average. Primary preventive strategies are necessary to mitigate the increasing rates of chronic disease risk factors in this population. Further studies with a larger sample size and measured chronic disease are necessary to confirm the findings obtained in the present study. [ABSTRACT FROM AUTHOR]

Background: Existing evidence indicates that Inuit in Arctic Canada are undergoing a lifestyle transition leading to decreased physical activity (PA) and increased body mass index (BMI). Data specific to PA and BMI amongst Inuit in Nunavut, Canada, are currently limited. The present study aimed to characterise current PA and BMI levels in a sample of Inuit adults. Methods: Inuit adults randomly selected from a cross-sectional survey of three communities in Nunavut, Canada, completed an adapted International Physical Activity Questionnaire (IPAQ) and an anthropometric survey. Data were analysed by gender and age group using standardised IPAQ protocol. Results: Response rates ranged from 69–93%. Two hundred and eighteen Inuit adults [180 women, 38 men; mean (standard deviation (SD)) ages 42.3 (13.0) and 42.4 (14.8) years respectively; age range 19–89 years] completed the IPAQ. All men and 97% of women allowed height and weight measurements; the remainder were self-reported. Mean (SD) BMI was 27.7 (6.3) kg/m2 for males and 30.3 (8.0) kg/m2 for females. The largest proportion of women and participants in both age groups had a BMI in the obese category; males were evenly split between the normal and obese categories. Self-reported PA was high, with most men, women and participants ≤50 years in the high category of PA. Participants >50 years were evenly split across the medium and high categories. Most participants (72%) were classified as being overweight or obese, yet reported medium or high levels of PA (89%). Conclusions: The findings obtained in the present study indicate the co-existence of high BMI and high self-reported PA amongst Inuit adults. [ABSTRACT FROM AUTHOR]

Background: Inuvialuit in the Canadian Arctic have been experiencing a nutrition transition resulting in a decrease in nutrient-dense food consumption, which may, in part, explain this population’s increasing chronic disease rates. Because the available literature is limited, the present study aimed to document the extent of this transition by examining current dietary patterns and socioeconomic factors affecting food group consumption. Methods: This cross-sectional study was conducted in three Inuvialuit communities in the Northwest Territories between 2007 and 2008. A validated food frequency questionnaire determined intake frequency of fruit and vegetables (FV), traditional foods (TF) and non-nutrient-dense foods (NNDF). Socioeconomic status (SES) was assessed by questions on education, ownership of items in working condition used to create a Material Style of Life (MSL) scale and residents in household employed/on income support. Daily intake frequencies were compared by gender and age group using Wilcoxon rank sum test. SES association with food group intake was determined using logistic regression. Results: The response rate was 65–85%. One hundred and seventy-five participants were female and 55 were male, aged 19–84 years [mean (SD) 44 (14)]. Mean frequencies of FV and TF consumption were 1.6 (1.5) and 1.6 (1.7) times per day, respectively. NNDF were reported 9.2 (3.0) times per day. The highest MSL score (>12) was significantly associated with higher fruit (≥0.7 times per day) and higher TF intake (≥1.1 times per day) compared with the lowest score (≤7). An intermediate MSL score (8–12) was related to higher vegetable consumption (≥0.4 times per day). Conclusions: NNDF were consumed approximately seven times more frequently than TF in the present study, indicating that the dietary transition is well underway amongst Inuvialuit. Participants with higher SES were more likely to consume nutrient-dense foods, suggesting possible cost barriers. [ABSTRACT FROM AUTHOR]

Background: Traditional foods are rich sources of essential nutrients, but Inuvialuit in the Northwest Territories (NWT), Canada, have been undergoing a nutrition transition, characterised by an increased consumption of non-nutrient-dense foods. The present study aimed to characterise energy, nutrient and food intakes amongst adult Inuvialuit. Methods: The study collected up to three 24-h dietary recalls on nonconsecutive days for each participant in spring/summer of 2008 in one remote community in the NWT. Recall data were analysed for energy and nutrient intake, dietary adequacy, most commonly reported foods, and food contributors to energy and nutrients. Results: Participants included 14 men and 50 women (response rate 79%). Median daily energy intake was 9.4 (interquartile range = 5.7) MJ for men and 8.3 (3.6) MJ for women. The majority of adult Inuvialuit did not meet the recommendation for vitamins A [median intake = 344.7 (246.3) μg-RAE in men, 248.9 (213.8) μg-RAE in women], B6 [0.9 (0.8) mg in men, 1.0 (0.5) mg in women] and E [2.4 (2.1) mg in men, 1.8 (1.0) mg in women], dietary fibre [7.7 (5.7) g in men, 8.7 (4.4) g in women], calcium [779.6 (842.0) mg in men, 610.4 (431.5) mg in women] and total folate [222.6 (57.7) μg in men, 264.6 (127.5) μg in women]. Vitamin D intake was below the recommendation for most women [median intake = 100.0 (119.2) IU]. Traditional foods contributed substantially to protein and iron intake. Juices were the main contributors to energy, carbohydrate and calcium. Conclusions: The present study revealed an inadequate consumption of essential nutrients in an Inuvialuit population. If these nutrient deficiencies continue, this population will face an increased burden of chronic diseases and malnutrition. [ABSTRACT FROM AUTHOR]

Background: Increasing consumption of non-nutrient-dense foods (NNDF), decreasing consumption of traditional foods (TF) and low consumption of fruit and vegetables (FV) may contribute to increasing chronic disease rates amongst Inuit. The present study aimed to assess the daily frequency and socioeconomic and demographic factors influencing consumption of TF, FV and NNDF amongst Inuit adults in Nunavut, Canada. Methods: Using a cross-sectional study design and random household sampling in three communities in Nunavut, a food frequency questionnaire developed for the population was used to assess frequency of NNDF, TF and FV consumption amongst Inuit adults. Socioeconomic status (SES) was assessed by education level, ownership of items in working condition, and whether or not people in the household were employed or on income support. Mean frequencies of daily consumption were compared across gender and age groups, and associations with socioeconomic indicators were analysed using logistic regression. Results: Two hundred and eleven participants (36 men, 175 women; mean (standard deviation) ages 42.1 (15.0) and 42.2 (13.2) years, respectively; response rate 69–93%) completed the study. Mean frequencies of consumption for NNDF, TF and FV were 6.3, 1.9 and 1.6 times per day, respectively. On average, participants ≤50 years consumed NNDF ( P = 0.003) and FV ( P = 0.01) more frequently and TF ( P = 0.01) less frequently than participants >50 years. Education was positively associated with FV consumption and negatively associated with TF consumption. Households on income support were more likely to consume TF and NNDF. Conclusions: These results support the hypothesis that the nutrition transition taking place amongst Inuit in Nunavut results in elevated consumption of NNDF compared with TF and FV. [ABSTRACT FROM AUTHOR]

Background: The extent to which awareness of chronic disease (CD) diagnosis affects one’s healthy food knowledge, self-efficacy and intentions or healthy dietary and physical activity (PA) behaviours remains unexplored among Inuit in Canada. Methods: A food frequency questionnaire and an adult impact questionnaire were used in a cross-sectional study to collect self-reported data on daily energy and nutrient intake, PA and the diagnosis of hypertension, diabetes, heart disease and cancer amongst adult Inuit and their family members. Associations between awareness of personal and family CD status and healthy food knowledge, self-efficacy and intentions, percentage of energy consumed from non-nutrient-dense foods and PA were assessed via ordinal logistic regression. Results: Of the 266 participants, those who self-reported CD for both themselves and their relative(s) were more likely to have high healthy food knowledge [odds ratio (OR) = 2.45] than those who did not. Reporting hypertension and heart disease amongst only relatives increased the likelihood of high knowledge (OR = 5.20) and intentions (OR = 5.10) for healthy eating. Heart disease in both participants and their relatives was associated with high levels of PA (OR = 12.24). However, there were no associations when only participants (but not their relatives) reported having CD. A joint effect between a high level of education and awareness of CD was positively related to high food knowledge (OR = 38.93). An inverse association between awareness of CD and unhealthy eating was not observed. Conclusions: Awareness of a relative having a CD was a more important factor in increasing knowledge and, to a lesser degree, self-efficacy or intentions to eat healthy than participants’ awareness of personal CD. However, awareness was not associated with lower non-nutrient-dense food intake. [ABSTRACT FROM AUTHOR]

Background: Nutritional inadequacies and increasing chronic disease prevalence amongst Inuit in the Canadian Arctic highlight the need to address dietary practices. Research is needed to investigate the individual and environmental factors impacting diet to guide interventions. The present study aimed to explore multiple community perspectives of key factors affecting food choice and availability in Inuit communities in Nunavut, Canada. Methods: Semi-structured in-depth interviews were conducted with Inuit adults ( n = 43) in two communities in Nunavut, Canada, and included community members, community leaders, elders, health staff and food shop staff. The interviewer transcribed the audio-taped interviews. Data were analysed using codes and the constant comparative method to determine categories and emergent themes. Results: Thirty-three Inuit (27 females and six males) and 10 non-Inuit (four females and six males) adults participated. Traditional foods procured through hunting and gathering were considered the healthiest by community members, although multiple factors inhibited their procurement, including high petrol cost and decrease in traditional knowledge about hunting and gathering practices. Cost and quality were the main barriers to purchasing healthy foods at the shops. Community leaders and health staff identified multiple barriers to healthy eating in the community, such as skills to prepare some shop-bought foods. Shop managers identified several challenges to providing fresh produce and other perishable foods, such as long transportation routes that increase costs and harsh climatic conditions that may cause spoilage. They also cited factors influencing their decisions regarding whether to stock/discontinue certain foods, such as customers’ requests, food cost and shelf-life. Conclusions: An intervention to reduce chronic disease risk and improve dietary adequacy amongst Nunavut Inuit may be effective by supporting individual behaviour modifications with food environment changes. [ABSTRACT FROM AUTHOR]

Background: Food intake amongst Canadian Inuit is currently in transition with a concurrent increase in diet-related chronic disease. There is a lack of current data on nutrient intake and dietary adequacy in this population. The present study aimed to assess dietary intake and adequacy amongst Inuit adults in a community in Nunavut, Canada. Methods: Random sampling of 130 households in a remote Inuit community in the Kitikmeot region of Nunavut, Canada, was used for this cross-sectional study. Up to three 24-h dietary recalls were collected on nonconsecutive days, capturing weekday and weekend consumption. Data were analysed to estimate energy and nutrient intake, to determine dietary adequacy, and to summarise the most commonly reported foods and the top food contributors to selected nutrients. Results: The response rate was 69%, with 75 Inuit adults participating (mean (standard deviation (SD)) age 44 (SD = 17) years). Mean (SD) daily energy intake was 9.3 (4.4) MJ and 8.7 (3.5) MJ for men and women, respectively. Intakes of dietary fibre, calcium, total folate and vitamins A, D and E were below the Dietary Reference Intakes (Estimated Average Requirements where available) for 60–100% of all men and women. Traditional foods contributed substantially to protein and iron intake, whilst shop-bought foods were primary contributors to total fat, carbohydrate and sugar intake. Conclusions: The present study reports an in-depth assessment of total dietary quality amongst Inuit adults in Nunavut, Canada. The results obtained indicate inadequate intakes of several essential nutrients, as well as a reliance on a nontraditional diet. A nutrition intervention is needed to prevent a continued rise in diet-related chronic disease incidence. [ABSTRACT FROM AUTHOR]

Background: Inuvialuit in Arctic Canada are undergoing nutrition and lifestyle transitions that encourage decreased physical activity (PA) and increased body mass index (BMI), although data specific to PA and BMI within this unique population are not currently available. The present study aimed to characterise current PA and BMI levels in a sample of Inuvialuit adults. Methods: Inuvialuit adults randomly selected from a cross-sectional survey of three communities in the Northwest Territories, Canada, completed an adapted International Physical Activity Questionnaire (IPAQ) and an anthropometric questionnaire to obtain height and weight. Data were analysed using the standardised IPAQ protocol, and the results are presented by gender and age group (≤50 and >50 years). Results: One hundred and ninety-six Inuvialuit adults [148 women, 48 men; mean (standard deviation (SD)) ages 45 (14) and 41 (14) years, respectively; age range 19–84 years] completed the IPAQ (response rates 65–85%). Seventy-one percent of men and 74% of women allowed height measurements, whilst 81% and 84% allowed weight measurements, respectively; the remainder provided self-reported anthropometrics. Mean (SD) BMIs were 28.6 (7.7) kg/m2 for males and 30.5 (8.8) kg/m2 for females. The greatest percentage of participants in both gender and age groups fell into the obese BMI category. Self-reported PA was high, with means for men and participants ≤50 years in the high category of PA and means for women and participants >50 years in the medium category. Almost two-thirds (65%) of participants were classified as being overweight or obese, although 89% reported medium or high levels of PA. Conclusions: The results obtained in the present study indicate widespread overweight/obesity accompanying high levels of self-reported PA. [ABSTRACT FROM AUTHOR]

The Timiskaming Paleozoic oudier on the central Canadian Shield preserves a thin distal portion of the once extensive Taconic deep-water shale succession that extended across eastern Laurentia. Within this succession, a thin (5 cm) lithic and phosphatic sandstone occurs a few meters above the top of the buried shallow-water carbonate platform, and contains abundant (40-60%) euhedral dolomite, rare fluorite, pyrite-cemented shale microbreccia, and crystal mosaics of subhedral dolomite with pyritic veinlets. The dolomite formed local cement, and precipitated very near the sediment-water interface as illustrated by a relatively uncompacted sandstone framework and a 3-dimensional fabric of clay particles trapped by dolomite growth. The majority of dolomite has planar crystal faces, with ferroan (4.1 ± 0.3 mol% FeCO3) crystal cores and non-ferroan (0.9 ± 0.2 mol% FeCO3) rims. Fluid inclusions, too small (< 2 µm) for reliable microthermic analysis, are mostly liquid, which, in keeping with interpreted near-surface diagenesis, as well as temperature-controlled dolomite-crystal roughening models, may indicate that formation temperatures were no more than ~60 to 80°C. δ13CPDB values (~1.2 %) are similar to a Late Ordovician seawater composition, but δ18OPDB values (-4.8 to -5.2 %) are too negative compared to the expected values for contemporary deep-marine dolomite. Combining the regional paleoceanographic framework with diagenetic constraints and revised models for Late Ordovician seawater temperature and δ18O compositions, the dolomite is interpreted to be a proxy for a low-temperature (at least ~50°C) hydrothermal anomaly near the sediment-water interface. Fragments of shale microbreccia, pyrite veinlets, and subhedral dolomite, along with the region's structural history, allow speculation that this event coincided with local reactivation of a Precambrian fault, part of an ancestral fault system now manifest regionally by an extension of the Ottawa-Bonnechère Graben. Late Ordovician craton-interior tectonism, in a region previously considered tectonically stable at this time, is defined by local response of inherited Precambrian structure driven by, but distal to, Taconic orogenesis. [ABSTRACT FROM AUTHOR]

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities. [ABSTRACT FROM AUTHOR]

Background/aims: To report patient based utilities, using the time trade-off technique, associated with visual loss secondary to diabetic retinopathy in a sample of Canadian patients. In addition, to compare these utility values with a sample collected in a similar manner in a tertiary care practice in the United States. Methods: A cross sectional study of eligible patients with diabetic retinopathy presenting to a tertiary facility was performed. Demographic and clinical variables (including Snellen visual acuity), and utilities were collected both through chart review and standardised interviews with diabetic patients. Results: 221 patients with diabetic retinopathy were eligible for this study and completed the interview. The mean age was 63.5 (SD 12.5) years, and 48.4% were female. Over 35% of the sample had visual acuity in the affected eye of 6/60 or worse. The mean utility for the sample was 0.79 (SD 0.23). The mean utility from this sample did not differ significantly from that obtained from a series of patients with diabetic retinopathy who were referred to a tertiary facility in the United States (mean 0.77, SD 0.21, p=0.313). Our cross border comparison had a power of 95% to detect a difference in utility of 0.1 between the two groups. Conclusion: On average, Canadian patients with diabetic retinopathy were willing to trade off over 20% of their remaining lifespan in order to eliminate their ocular disease. The mean utility obtained from our sample of Canadian patients with diabetic retinopathy was not statistically different from that obtained from a similar sample of American patients. [ABSTRACT FROM AUTHOR]

Objective: Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen., Methods: This was a secondary analysis of a prospective observational cohort study conducted in 11 hospital emergency departments (EDs) in Canada and the United States. The primary study enrolled patients who were 65 years and older who presented to the ED after a fall. The analysis evaluated treating physician gender adjusted for multiple clinical variables. Primary analysis used a hierarchical logistic regression model to evaluate the association between treating physician gender and the patient receiving a head CT scan. Secondary analysis reported the adjusted odds ratio (OR) for diagnosing intracranial bleeding by physician gender., Results: There were 3663 patients and 256 physicians included in the primary analysis. In the adjusted analysis, women physicians were no more likely to order a head CT than men (OR 1.26, 95% confidence interval 0.98-1.61). In the secondary analysis of 2294 patients who received a head CT, physician gender was not associated with finding a clinically important intracranial bleed., Conclusions: There was no significant association between physician gender and ordering head CT scans for older emergency patients who had fallen. For patients where CT scans were ordered, there was no significant relationship between physician gender and the diagnosis of clinically important intracranial bleeding., (© 2024 Society for Academic Emergency Medicine.)

The COVID-19 pandemic is having a profound impact on the health, social and economic well-being of people in Canada and around the world. To address vaccine disparity among vulnerable populations facing social-structural challenges, it is crucial to provide evidence-based information on the importance of completion of the recommended vaccination schedule. In this study, we investigated vaccination rates and variables as facilitators or barriers to COVID-19 vaccination among vulnerable populations living in Vancouver's inner-city residents. On a weekly basis, a team (including health care providers [HCPs] and support staff) conducts a Community Pop-up Clinic (CPC) event at single room occupancy dwellings in Vancouver's inner city to provide COVID-19 vaccine and/or related information. Participants also completed a survey about their COVID-19 vaccination status and COVID knowledge, including knowledge about COVID vaccination. We collected data from 892 CPC participants between January 2021-August 2023. The median age at baseline was 45 (IQR 36-55) years, with 317 (35.5 %) female and 285 (31.9 %) self-identified as Indigenous. Within the population, 512 (57.4 %) reported unstable housing and 441 (49.5 %) were active injection drug users. Regarding COVID-19 vaccinations, 235 (26.3 %) were unvaccinated, 119 (13.3 %) had received one dose of the COVID-19 vaccine, 432 (48.4 %) had received 2 doses, and 106 (11.8 %) had received at least 3 doses. Variables such as age (AOR 2.28, 95 % CI 1.37-3.80, p < 0.001) and HCV seropositivity (AOR 1.91, 95 % CI 1.20-3.04, p = 0.005) were significantly associated with higher odds of vaccination uptake. Conversely, unstable housing was significantly associated with a lower odds of vaccination uptake (AOR 0.53, 95 % CI 0.35-0.79, p = 0.002). Results from this study suggest that targeted community focused initiatives are crucial to address vaccine disparity among vulnerable populations living in Vancouver's inner city facing unstable housing and drug use injection., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: BC has received research grants, honoraria and/or acted as a remunerated advisor for AbbVie, Astra Zeneca, Gilead Sciences, GSK, Indivior Canada, Merck, Moderna, Sanofi Pasteur, Seqirus, and ViiV Healthcare. In particular, AbbVie and Gilead Sciences have funded the community pop-up clinic program in a direct way. SB, SY, SS, and RY has no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

In patients with multiple myeloma (MM), the presence of high-risk cytogenetic abnormalities is associated with worse disease control and survival. Autologous stem cell transplant (ASCT) does benefit these patients. Tandem transplantation has been explored as a means to deepen responses and further improve survival however, its role remains controversial. This is particularly true in the era of novel agent induction and post-transplant maintenance therapy. The aim of this study was to use the Canadian Myeloma Research Group database and examine a large cohort of real-world patients comparing the outcomes of tandem versus single ASCT specifically in high-risk patients receiving novel agent-based induction and post-transplant maintenance. The data for this study was derived retrospectively from a comprehensive national-level database of Canadian patients with MM. High-risk cytogenetics was defined as presence of del17p, t(4;14), or t(14;16). Those receiving allogeneic transplant were excluded. Tandem transplantation was defined as a second ASCT performed consecutively without interim relapse or progression after first ASCT. Those with relapse or progressive disease within 3 months of completing a first transplant were excluded. We compared response depth, progression-free, and overall survival (OS) based on single or tandem transplantation procedures. The impact of covariates of interest was also assessed. A total of 381 patients with high-risk cytogenetics were identified. A total of 242 received single and 139 patients received tandem transplants. All received post-transplant maintenance. The most common induction regimen for these patients was cyclophosphamide, bortezomib, and steroids (CyBorD, 87%). Forty-one patients (10.8%) required reinduction prior to first ASCT. The best overall responses at any time were 98.3% (90.5% ≥ very good partial response [VGPR]) and 98.6% (89.9% ≥ VGPR) in the single and tandem ASCT groups, respectively. Survival outcomes were similar with the median progression-free survival for single or tandem ASCT of 35.2 and 35.3 months (P = .88) and the median OS were 92.6 and 88.9 months, respectively (P = .72). No statistically significant differences were seen based on type of cytogenetic abnormality or type of maintenance. This was confirmed on multivariate analysis. In the real-world setting, tandem ASCT does not improve outcomes for MM patients with high-risk cytogenetics. This may be driven by the use of effective pre- and post-ASCT therapies. The development of more potent induction and consolidation along with current nearly ubiquitous continuous maintenance therapies until disease progression does not support the use of a second high-dose procedure., (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This toolkit presents a comprehensive framework for a toolkit intended to increase equity, diversity, and inclusion (EDI) within the medical field and recommendations. We advocate for clear, comprehensive definitions and interpretations of fundamental EDI terms, laying the groundwork necessary for initiating and maintaining EDI initiatives. Furthermore, we offer a systematic approach to establishing EDI committees within medical departments, accentuating the pivotal role these committees play as they drive and steer EDI strategies. This toolkit also explores strategies tailored for the recruitment of a diverse workforce. This includes integral aspects such as developing inclusive job advertisements, implementing balanced search methods for candidates, conducting unbiased appraisals of applications, and structuring diverse hiring committees. The emphasis on these strategies not only augments the diversity within medical institutions but also sets the stage for a more holistic approach to healthcare delivery. Therefore, by adopting the recommended strategies and guidelines outlined in this framework, medical institutions and specifically radiology departments can foster an environment that embodies inclusivity and equity, thereby enhancing the quality of patient care and overall health outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The STRAT-PARK initiative aims to provide a platform for stratifying Parkinson's disease (PD) into biological subtypes, using a bottom-up, multidisciplinary biomarker-based and data-driven approach. PD is a heterogeneous entity, exhibiting high interindividual clinicopathological variability. This diversity suggests that PD may encompass multiple distinct biological entities, each driven by different molecular mechanisms. Molecular stratification and identification of disease subtypes is therefore a key priority for understanding and treating PD. STRAT-PARK is a multi-center longitudinal cohort aiming to recruit a total of 2000 individuals with PD and neurologically healthy controls from Norway and Canada, for the purpose of identifying molecular disease subtypes. Clinical assessment is performed annually, whereas biosampling, imaging, and digital and neurophysiological phenotyping occur every second year. The unique feature of STRAT-PARK is the diversity of collected biological material, including muscle biopsies and platelets, tissues particularly useful for mitochondrial biomarker research. Recruitment rate is ∼150 participants per year. By March 2023, 252 participants were included, comprising 204 cases and 48 controls. STRAT-PARK is a powerful stratification initiative anticipated to become a global research resource, contributing to personalized care in PD., Competing Interests: Declaration of Competing Interest none, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Equity, diversity and inclusion (EDI) in the medical field is crucial for meeting the healthcare needs of a progressively diverse society. A diverse physician workforce enables culturally sensitive care, promotes health equity, and enhances the comprehension of the various needs and viewpoints of patients, ultimately resulting in more effective treatments and improved patient outcomes. However, despite the recognized benefits of diversity in the medical field, certain specialties, such as Radiology, have struggled to achieve adequate equity, diversity and inclusion, which results in a discrepancy in the demographics of Canadian radiologists and the patients we serve. In this review, we propose strategies from a committee within the Canadian Association of Radiologists (CAR) EDI working group to improve EDI in the CaRMS selection process. By adopting these strategies, residency programs can foster a more diverse and inclusive environment that is better positioned to address the health needs of a progressively diverse patient population, leading to improved patient outcomes, greater patient satisfaction, and advancements in medical innovation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Shifts in hydroclimatic regimes associated with global climate change may impact freshwater availability and quality. In high latitudes of the northern hemisphere, where vast quantities of carbon are stored terrestrially, explaining landscape-scale carbon (C) budgets and associated pollutant transfer is necessary for understanding the impact of changing hydroclimatic regimes. We used a dynamic modelling approach to simulate streamflow, DOC concentration, and DOC export in a northern Canadian catchment that has undergone notable climate warming, and will continue to for the remainder of this century. The Integrated Catchment model for Carbon (INCA-C) was successfully calibrated to a multi-year period (2012-2016) that represents a range in hydrologic conditions. The model was subsequently run over 30-year periods representing baseline and two future climate scenarios. Average discharge is predicted to decrease under an elevated temperature scenario (22-27 % of baseline) but increase (116-175 % of baseline) under an elevated temperature and precipitation scenario. In the latter scenario the nival hydroclimatic regime is expected to shift to a combined nival and pluvial regime. Average DOC flux over 30 years is predicted to decrease (24-27 % of baseline) under the elevated temperature scenario, as higher DOC concentrations are offset by lower runoff. Under the elevated temperature and precipitation scenario, results suggest an increase in carbon export of 64-81 % above baseline. These increases are attributed to greater connectivity of the catchment. The largest increase in DOC export is expected to occur in early winter. These predicted changes in DOC export, particularly under a climate that is warmer and wetter could be part of larger ecosystem change and warrant additional monitoring efforts in the region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: COVID-19 disease is accompanied by a dysregulated immune response and hypercoagulability. The Anti-Coronavirus Therapies (ACT) inpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with the combination of rivaroxaban and aspirin for prevention of disease progression in patients hospitalised with COVID-19., Methods: The ACT inpatient, open-label, 2 × 2 factorial, randomised, controlled trial was done at 62 clinical centres in 11 countries. Patients aged at least 18 years with symptomatic, laboratory confirmed COVID-19 who were within 72 h of hospitalisation or worsening clinically if already hospitalised were randomly assigned (1:1) to receive colchicine 1·2 mg followed by 0·6 mg 2 h later and then 0·6 mg twice daily for 28 days versus usual care; and in a second (1:1) randomisation, to the combination of rivaroxaban 2·5 mg twice daily plus aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome, assessed at 45 days in the intention-to-treat population, for the colchicine randomisation was the composite of the need for high-flow oxygen, mechanical ventilation, or death; and for the rivaroxaban plus aspirin randomisation was the composite of major thrombosis (myocardial infarction, stroke, acute limb ischaemia, or pulmonary embolism), the need for high-flow oxygen, mechanical ventilation, or death. The trial is registered at www., Clinicaltrials: gov, NCT04324463 and is ongoing., Findings: Between Oct 2, 2020, and Feb 10, 2022, at 62 sites in 11 countries, 2749 patients were randomly assigned to colchicine or control and the combination of rivaroxaban and aspirin or to the control. 2611 patients were included in the analysis of colchicine (n=1304) versus control (n=1307); 2119 patients were included in the analysis of rivaroxaban and aspirin (n=1063) versus control (n=1056). Follow-up was more than 98% complete. Overall, 368 (28·2%) of 1304 patients allocated to colchicine and 356 (27·2%) of 1307 allocated to control had a primary outcome (hazard ratio [HR] 1·04, 95% CI 0·90-1·21, p=0·58); and 281 (26·4%) of 1063 patients allocated to the combination of rivaroxaban and aspirin and 300 (28·4%) of 1056 allocated to control had a primary outcome (HR 0·92, 95% CI 0·78-1·09, p=0·32). Results were consistent in subgroups defined by vaccination status, disease severity at baseline, and timing of randomisation in relation to onset of symptoms. There was no increase in the number of patients who had at least one serious adverse event for colchicine versus control groups (87 [6·7%] of 1304 vs 90 [6·9%] of 1307) or with rivaroxaban and aspirin versus control groups (85 [8·0%] vs 91 [8·6%]). Among patients assigned to colchicine, 8 (0·61%) had adverse events that led to discontinuation of study drug, mostly gastrointestinal in nature. 17 (1·6%) patients assigned to the combination of rivaroxaban and aspirin had bleeding compared with seven (0·66%) of those allocated to control (p=0·042); the number of serious bleeding events was two (0·19%) versus six (0·57%), respectively (p=0·18). No patients assigned to rivaroxaban and aspirin had serious adverse events that led to discontinuation of study drug., Interpretation: Among patients hospitalised with COVID-19, neither colchicine nor the combination of rivaroxaban and aspirin prevent disease progression or death., Funding: Canadian Institutes for Health Research, Bayer, Population Health Research Institute, Hamilton Health Sciences Research Institute, Thistledown Foundation., Translations: For the Portuguese, Russian and Spanish translations of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests JWE reports grant or in-kind support from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Janssen, Sanofi-Aventis and honoraria from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myer-Squibb, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, Merck, Pfizer, Janssen, Sanofi-Aventis, Servier. SSJ reports grant support from Boston Scientific, honoraria from Medtronic, Penumbra. EPB-C reports grant support from Bayer, Roche, BMS-Pfizer. RPW reports grant support from Bayer, Roche, BMS-Pfizer, grant and honorarium from Boehringer-Ingelheim, and consultancy fees from Atricure and Phasebio. MLD reports grant support from the Population Health Research Institute (PHRI) to manage the ACT study in Argentina. RD reports grant support from PHRI to manage the ACT study in Argentina. AA reports institutional grant support from Bayer and EMS, and lecture fees from Bayer and Sanofi-Aventis. SW reports grant support from NIH, honoraria from Pfizer, and safety monitoring committee of an AIDS Clinical Trial Group. RDL reports institutional grant support from Bristol Myers Squibb, Glaxo Smith Kline, Medtronic, Pfizer, and Sanofi, consulting fees from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, Sanofi, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Merck, and Portola, honoraria from Pfizer and meeting travel support from IQVIA. OB reports grant support from Astra Zeneca, Bayer, Amgen, Novartis, Servier, Pfizer. SSA reports grants from CIHR and PHAC, honoraria and consulting fees from Bayer and Janssen Pharma, meeting support from Heart and Stroke Canada, is committee member at the American Heart Association, the Canadian Cardiovascular Society, and Heart and Stroke Canada. JB reports consulting fees from Bayer. SC reports ACT study funding from Bayer, owns Bayer stock, is a board member of Canadian Arrhythmia Network, is an institutional advisory board member at the Institute of Circulatory and Respiratory Health, Canadian Institutes for Health Research. MEF reports institutional grants from Amgen, Astra Zeneca, Novartis, and Novo Nordisk and consulting fees from Otitopic. ML reports participation in vaccine advisory boards for Medicago, Pfizer, and Sanofi and is on the data safety and monitoring board for CanSino Biologics. SY reports institutional grant support from Bayer and honoraria, and travel costs for lectures from Bayer. SR, LX, LH, SIB, AY, SKS, WMT, MH, WH, AA, OD, CF, and PL-J have no disclosures to report., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: H-index has historically functioned as a metric of academic success for acquisition of research grants, awards, and faculty appointments. Our objective was to characterize the landscape of Canadian academic ophthalmology on the basis of research productivity and impact-as measured by H-index-with gender, subspecialty, and faculty appointment., Design: Cross-sectional study based on data abstracted from publicly available databases., Participants: Academic ophthalmologists from all schools in Canada with an ophthalmology residency program., Methods: Academic ophthalmologists and their faculty appointments were identified from university websites. gender was determined from available provincial College of Physicians and Surgeons or ophthalmology society databases. H-indices were collected from Scopus and Web of Science. Descriptive, univariate, and multivariate statistics were used to analyze the relationship of H-index with gender, faculty appointment, and subspecialty., Results: We included data from 696 academic ophthalmologists. The mean H-indices for lecturers and assistant, associate, and full professors were 4.0 (±5.6), 5.6 (±5.0), 8.8 (±6.3), and 15 (±12), respectively. H-index had a significant positive correlation with faculty appointment (0.521, 95% confidence interval 0.469-0.579, p = 1.77e-41). The mean H-index was 6.7 (±8.2) for women and 8.1(±8.4) for men (p = 0.0635). Women comprised 27% of faculty positions, and men were more likely to have a higher faculty appointment than women (p = 0.0073). The top subspecialties for underrepresentation of women were surgical retina, medical retina, and oculoplastics., Conclusions: Faculty appointments are associated with research productivity, as measured by H-index. There are significant gender disparities in faculty appointments and subspecialty representation. Future directions include exploring other contributory factors to success in academic ophthalmology., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: Individuals with prior experience in international disaster response represent an essential source of expertise to support disaster response in their home countries. Our objective was to explore the experiences of personnel involved in international emergency health response regarding their perceptions of essential disaster response attributes and capacities and determine how these competencies apply to the Canadian context., Methods: For this qualitative study, we conducted semistructured interviews with key informants in person or over the telephone from May to December 2018. Participants were delegates deployed as part of the Canadian Red Cross medical response team in a clinical or technical, or administrative role within the last 5 years. Interviews were audio-recorded and transcribed. Conventional content analysis was performed on the transcripts, and themes were developed., Results: Eighteen key informants from 4 Canadian provinces provided perspectives on individual attributes acquired during international deployments, such as agility and stress management, and team capacities developed, including collaboration and conflict management. Key informants, including administrators ( n = 5), technicians ( n = 4), nurses ( n = 4), physicians ( n = 3) and psychosocial support workers ( n = 2), described these experiences as highly relevant to the Canadian domestic context., Interpretation: Canadian physicians and health care workers involved with international disaster response have already acquired essential capacities, and this experience can be vital to building efficient disaster response teams in Canada. These findings complement the Canadian Medical Education Directives for Specialists (CanMEDS) roles and can inform course design, competency and curriculum development for physician and professional training programs related to disaster response and preparedness., Competing Interests: Competing interests: Lynda Redwood-Campbell has acted as a contracted delegate with Canadian Red Cross. Lisa Schwartz declares COVID research support from the World Health Organization, consulting fees from the Ontario Regional Blood Coordinating Network (ORBCoN), payment for guest lectures from McMaster University and a salary award from the Arnold L. Johnson Chair in Health Care Ethics at McMaster University; she is a member of the Canadian Cancer Trials Group and of the Médecins Sans Frontières ethics review board. Salim Sohani is an employee of the Canadian Red Cross. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Introduction: Falling on level ground is now the most common cause of traumatic intracranial bleeding worldwide. Older adults frequently present to the emergency department (ED) after falling. It can be challenging for clinicians to determine who requires brain imaging to rule out traumatic intracranial bleeding, and often head injury decision rules do not apply to older adults who fall. The goal of our study is to derive a clinical decision rule, which will identify older adults who present to the ED after a fall who do not have clinically important intracranial bleeding., Methods and Analysis: This is a prospective cohort study enrolling patients aged 65 years or older, who present to the ED of 11 hospitals in Canada and the USA within 48 hours of having a fall. Patients are included if they fall on level ground, off a chair, toilet seat or out of bed. The primary outcome is the diagnosis of clinically important intracranial bleeding within 42 days of the index ED visit. An independent adjudication committee will determine the primary outcome, blinded to all other data. We are collecting data on 17 potential predictor variables. The treating physician completes a study data form at the time of initial assessment, prior to brain imaging. Data extraction is supplemented by an independent, structured electronic medical record review. We will perform binary recursive partitioning using Classification and Regression Trees to derive a clinical decision rule., Ethics and Dissemination: The study was initially approved by the Hamilton Integrated Research Ethics Committee and subsequently approved by the research ethics boards governing all participating sites. We will disseminate our results by journal publication, presentation at international meetings and social media., Trial Registration Number: NCT03745755., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Canada has a long tradition of leading practice-changing clinical trials in oncology. Here, we describe methodology, results, and interpretation of oncology RCTs with Canadian involvement compared to RCTs from other high-income countries (HICs). A literature search identified all RCTs evaluating anti-cancer therapies published 2014-2017. RCTs were classified based on the country affiliation of first authors. The study cohort included 636 HIC-led RCTs; 155 (24%) had Canadian authors. Three-quarters (112/155, 72%) of Canadian RCTs were conducted in the palliative setting, compared to two thirds (299/481, 62%) of RCTs from other HICs ( p = 0.022). Canadian RCTs were more likely than those from other HICs to be supported by industry (85% vs. 69%, p < 0.001). The proportion of positive Canadian trials that met the ESMO-MCBS threshold for substantial clinical benefit was comparable to RCTs without Canadian authors (29% vs. 32%, p = 0.137). Thirteen percent (20/155) of all Canadian trials were affiliated with the Canadian Cancer Trials Group (CCTG). Canada plays a meaningful role in the global cancer research ecosystem but is overly reliant on industry support. The very low proportion of trials that identify a new treatment with substantial clinical benefit is worrisome. A renewed investment in cancer clinical trials is needed in Canada.

Rising temperatures are leading to permafrost thaw over vast areas of the northern hemisphere. In the Canadian Arctic, permafrost degradation is causing significant changes in surface water quality due to the release of solutes that can alter conductivity, water clarity, and nutrient levels. For this study, we examined how changes in water quality associated with permafrost thaw might impact zooplankton, a group of organisms that play an important role in the food web of Arctic lakes. We conducted a biological and water quality survey of 37 lakes in the Mackenzie Delta region of Canada's Northwest Territories. We then used this data set to develop models linking variation in the abundance, diversity, and evenness of zooplankton communities to physicochemical, biological, and spatial variables. Subsequently, we used these models to predict how zooplankton communities might respond as water quality is altered by permafrost thaw. Our models explained 47%, 68%, and 69% of the variation in zooplankton abundance, diversity, and evenness, respectively. Importantly, the most parsimonious models always included variables affected by permafrost thaw, such as calcium and conductivity. Predictions based on our models suggest significant increases in zooplankton abundance (1.6-3.6 fold) and decreases in diversity (1.2-1.7 fold) and evenness (1.1-1.4 fold) in response to water quality changes associated with permafrost thaw. These changes are in line with those described for significant perturbations such as eutrophication, acidification, and the introduction of exotic species such as the spiny water flea (Bythotrephes). Given their important role in aquatic food webs, we expect these changes in zooplankton communities will have ramifications for organisms at higher (fish) and lower (phytoplankton) trophic positions in Arctic lakes., (© 2020 by the Ecological Society of America.)

Background: Increased overcrowding in the emergency department is a potential threat to the quality and safety of patient care. Innovative ways are needed to explore overcrowding, the variables affecting patient flow and interventions necessary for future flow improvement., Aims and Objectives: The aim of this review is to explore nurses' role(s) and their contribution to maintaining patient flow in acute hospitals through emergency departments., Methodology: A systematic review of mixed studies (qualitative, quantitative and mixed-method) using narrative synthesis was undertaken. Five major databases-PubMed, CINHAL, BNI, ASSIA and SCOPUS-were searched to identify appropriate primary and secondary studies. Selected studies were critically appraised with a modified CASP tool. Data extraction and analysis was undertaken using narrative synthesis., Results: In total, 34 articles (31 primary studies and three systematic reviews) met the inclusion criteria. This systematic review is informed by studies from several countries, including the UK, US, Australia, Canada, and the Netherlands. The qualitative arm of this review explored both the role and function of nurses, as well as their experiences and perspectives of the patient flow process, while the quantitative arm investigated nurses' contribution to patient flow in terms of length of stay (LOS), triage time, and other associated performance data., Findings: Nurses' contribution to patient flow spanned their operational, strategic, and expanded roles. Strategic and expanded nursing roles offered the possibility of reducing LOS, triage time, and ED crowding in addition to improving the experience of patients and staff. Nurses in operational roles deployed experiential knowledge pertaining to several invisible aspects of patient flow challenges thereby facilitating decision-making for strategic flow improvement. The experiential knowledge and skills of these nursing roles are central to the success of flow-related interventions. However, the effects of emotional labour (e.g. conflicts, frustrations) of patient flow processes on nurses are significant and may have unaccounted for transaction costs and consequences that need acknowledging in order to be addressed by managers and policy makers., Conclusions and Recommendations: Policy-makers and senior managers need to capitalise on nurses' experiential knowledge and skills to enhance the strategic design and development of flow management in acute hospitals. Recommendations from this review have potential to deploy those skills and knowledge in flow improvement., Competing Interests: Declaration of Competing Interest Anne Marie Rafferty is Co-Director of the NIHR funded Health and Social Care Workforce Policy Research Unit., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province., Design: A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews., Participants: 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results., Results: Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care., Conclusions: Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Healthcare services are increasingly being provided in the home. At the same time, these home contexts are changing as global migration has brought unprecedented diversity both in the recipients of care, and home health workers. In this paper, we present findings of a Canadian study that examined the negotiation of religious and ethnic plurality in home health. Qualitative analysis of the data from interviews and observations with 46 participants-clients, administrators, home healthcare workers-revealed how religion is expressed and 'managed' in home health services.

Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada®-funded Saving Brains® ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a 'theory of change' based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity., Design: We used the Delphi method., Setting: A multiquestion electronic survey., Participants: Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice., Interventions: After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%., Main Outcome Measures: Not applicable., Results: When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections., Conclusions: These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: People with major depressive disorder frequently exhibit increasing persistence of major depressive episodes. However, evidence for neuroprogression (ie, increasing brain pathology with longer duration of illness) is scarce. Microglial activation, which is an important component of neuroinflammation, is implicated in neuroprogression. We examined the relationship of translocator protein (TSPO) total distribution volume (V T ), a marker of microglial activation, with duration of untreated major depressive disorder, and with total illness duration and antidepressant exposure., Methods: In this cross-sectional study, we recruited participants aged 18-75 years from the Toronto area and the Centre for Addiction and Mental Health (Toronto, ON, Canada). Participants either had major depressive episodes secondary to major depressive disorder or were healthy, as confirmed with a structured clinical interview and consultation with a study psychiatrist. To be enrolled, participants with major depressive episodes had to score a minimum of 17 on the 17-item Hamilton Depression Rating Scale, and had to be medication free or taking a stable dose of medication for at least 4 weeks before PET scanning. Eligible participants were non-smokers; had no history of or concurrent alcohol or substance dependence, neurological illness, autoimmune disorder, or severe medical problems; and were free from acute medical illnesses for the previous 2 weeks before PET scanning. Participants were excluded if they had used brain stimulation treatments within the 6 months before scanning, had used anti-inflammatory drugs lasting at least 1 week within the past month, were taking hormone replacement therapy, had psychotic symptoms, had bipolar disorder (type I or II) or borderline antisocial personality disorder, or were pregnant or breastfeeding. We scanned three primary grey-matter regions of interest (prefrontal cortex, anterior cingulate cortex, and insula) and 12 additional regions and subregions using 18 F-FEPPA PET to measure TSPO V T . We investigated the duration of untreated major depressive disorder, and the combination of total duration of disease and duration of antidepressant treatment, as predictor variables of TSPO V T , assessing their significance., Findings: Between Sept 1, 2009, and July 6, 2017, we screened 134 participants for eligibility, of whom 81 were included in the study (current major depressive episode n=51, healthy n=30). We excluded one participant with a major depressive episode from the analysis because of unreliable information about previous medication use. Duration of untreated major depressive disorder was a strong predictor of TSPO V T (p<0·0001), as were total illness duration (p=0·0021) and duration of antidepressant exposure (p=0·037). The combination of these predictors accounted for about 50% of variance in TSPO V T in the prefrontal cortex, anterior cingulate cortex, and insula. In participants who had untreated major depressive disorder for 10 years or longer, TSPO V T was 29-33% greater in the prefrontal cortex, anterior cingulate cortex, and insula than in participants who were untreated for 9 years or less. TSPO V T was also 31-39% greater in the three primary grey-matter regions of participants with long duration of untreated major depressive disorder compared with healthy participants (p=0·00047)., Interpretation: Microglial activation, as shown by TSPO V T , is greater in patients with chronologically advanced major depressive disorder with long periods of no antidepressant treatment than in patients with major depressive disorder with short periods of no antidepressant treatment, which is strongly suggestive of a different illness phase. Consistent with this, the yearly increase in microglial activation is no longer evident when antidepressant treatment is given., Funding: Canadian Institutes of Health Research and Neuroscience Catalyst Fund., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Sudden cardiac death (SCD) in a young seemingly healthy athlete is a tragic and often highly publicized event. Preparticipation screening aims to identify those affected by cardiovascular diseases who may be at higher risk of SCD during sports participation. There are conflicting recommendations from the American Heart Association and the European Society of Cardiology regarding screening electrocardiograms (ECGs) before participation in sports. The use of an ECG as a screening strategy has been questioned, with a large number of abnormal test results observed in athletes resulting from the electrocardiographic changes that occur in a highly trained individual overlapping with findings suggestive of a pathologic condition. An abnormal 12-lead ECG triggers further examinations, which are expensive given the low diagnostic yield of most abnormal electrocardiographic patterns. Universal screening of young athletes poses logistic and financial challenges. There are currently no Canadian guidelines regarding preparticipation screening of athletes. Screening of athletes ignores the much larger group of young nonathletes who participate in vigorous recreational activity and who collectively represent a population in which a much larger number of SCDs can be predicted to occur. While waiting for the best screening approach in Canada, increased awareness of and access to automated external defibrillators, along with training in cardiopulmonary resuscitation, can help reduce the number of SCDs. In some jurisdictions, electrocardiographic screening has been eschewed in favour of such an approach. Specific physician training in the field of sports cardiology with availability of experts throughout Canada may be a useful start. We provide suggestions and call for the development of Canadian guidelines by appropriate organizations., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)