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Overdose mortality and the legitimacy crisis facing policing have propelled momentum for drug law reform. Yet, resulting reforms and associated protections are often functionally undermined by enforcement practices and the legal environment faced by people who use drugs. To explore this tension, we conducted a community-based study in Ontario, Canada. Our findings show that people's experiences of policing at overdose events reflect a legal regime characterized by their ambiguous legal status and uncertain protections. We argue that the resulting state of liminal legality is enacted in large part through police discretion and the uneven distribution of enforcement practices across spaces and populations; individuals compensate for this legal environment by mobilizing their knowledge of legal risks. Together, these expressions of law and drug enforcement generate substantial moral injury among people who use drugs. [ABSTRACT FROM AUTHOR]

Background: Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues. Methods: An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program. Results: Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores. Conclusion: In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout. [ABSTRACT FROM AUTHOR]

Background/Objective: The purpose of this study was to investigate the impact of the COVID-19 pandemic on mortality rates in a community-dwelling spinal cord injury (SCI) population in Ontario. Methods: Using health administrative databases, monthly mortality rates were evaluated pre-pandemic, during the pandemic, and post-pandemic from March 2014 to May 2024. Data were stratified by sex, injury etiology, and mental health status. Group differences were evaluated using t-tests. Autoregressive integrated moving average (ARIMA) models evaluated the pandemic's impact on mortality rates. Results: A significant increase of 21.4% in mortality rates during the pandemic was found for the SCI cohort. With the exception of the traumatic group, all subgroups also experienced a significant increase in mortality rates (males: 13.9%, females: 31.9%, non-traumatic: 32.3%, mental health diagnoses: 19.6%, and mental health diagnoses: 29.4%). During the pandemic, females had a significantly higher mortality rate than males. The non-traumatic group had higher mortality rates than the traumatic group at all time periods. Individuals with mental health diagnoses had higher mortality rates than those without at the pre-pandemic and pandemic periods. Conclusions: The variation in mortality rates across groups highlights inequitable access to medical care in the SCI population, with further research and interventions needed. [ABSTRACT FROM AUTHOR]

Recent studies have linked ecosystem warming to decreased mean body size in aquatic ectotherms but have often relied on experimental approaches. This study explores how climate change modifies adult body sizes in natural communities for five culturally, commercially, and recreationally important freshwater fish species that vary in thermal preferences (lake trout (Salvelinus namaycush), lake whitefish (Coregonus clupeaformis), walleye (Sander vitreus), yellow perch (Perca flavescens), and smallmouth bass (Micropterus dolomieu)). Using data for >170 000 sampling records from >600 lakes spanning the entire province of Ontario, Canada, we employ a spatial analysis technique based on Integrated Nested Laplace Approximation to detect body size changes due to warming lake conditions. With warming conditions, cold-adapted species (lake whitefish) decreased in adult body size, while cool- and warm-adapted species (walleye and smallmouth bass) increased in adult body size. Our study, like others recently conducted in marine and freshwater systems, demonstrates that the responses of fish body sizes to warming are not a unidirectional shift and may be linked to the habitat and thermal preferences of individual fish species. [ABSTRACT FROM AUTHOR]

Background: Understanding what promotes or hinders a community's capacity to serve the priorities of its residents is essential for the alignment of citizen needs and governance. Participatory approaches that engage community residents on the topic of community wellbeing are useful methods for defining outcomes that reflect a community's goals and priorities. Using qualitative focus group methods, the aim of this study was to outline bottom-up definitions of community wellbeing from a diverse pool of community residents in Ontario, Canada. Methods: Semi-structured, two-hour group interviews were conducted with adult (≥18 years) participants (N = 15) residing in four communities across Canada's largest province of Ontario. Participants were purposively selected from a pool of screening questionnaires to ensure diverse group compositions based on race, gender, age, and educational attainment. Interviews were thematically analysed using descriptive and interpretive methods to characterize resident conceptions of community wellbeing. Results: Focus group participants were between 18 and 75 years of age and most had lived in their local community for 5 or more years. Four major themes emerged: (1) a sense of community belonging is cultivated through shared spaces, routines, support, and identities; (2) a community constitutes the amenities and social contexts that enable residents to thrive; (3) effective regional decision-making must be community-informed; and (4) the wellbeing of a community relies on equal opportunities for engagement and participation. Conclusions: Residents described their communities and their associated wellbeing as a combination of accessible amenities and opportunities to engage without marginalization. This study underscores the value of participatory approaches in community wellbeing research, where the viewpoint and life experience of residents is used to inform local decision-making and service delivery. Future research will capture more diverse perspectives towards community belonging, particularly from community newcomers, for the development of regionally appropriate indicators of community wellbeing. [ABSTRACT FROM AUTHOR]

Background: Outcomes of diabetes screening in contemporary, multi-ethnic populations are unknown. We examined the association of prior outpatient diabetes screening with the risks of cardiovascular events and mortality in Ontario, Canada. Methods: We conducted a population-based cohort study using administrative databases among adults aged ≥ 20 years with incident diabetes diagnosed during 2014–2016. The exposure was outpatient diabetes screening performed within 3 years prior to diabetes diagnosis. The co-primary outcomes were (1) a composite of all-cause mortality and hospitalization for myocardial infarction, stroke, coronary revascularization, and (2) all-cause mortality (followed up until 2018). We calculated standardized rates of each outcome and conducted cause-specific hazard modelling to determine the adjusted hazard ratio (HR) of the outcomes, adjusting for prespecified confounders and accounting for the competing risk of death. Results: We included 178,753 Ontarians with incident diabetes (70.2% previously screened). Individuals receiving prior screening were older (58.3 versus 53.4 years) and more likely to be women (49.6% versus 40.0%) than previously unscreened individuals. Individuals receiving prior screening had relatively lower standardized event rates than those without prior screening across all outcomes (composite: 12.8 versus 18.1, mortality: 8.2 versus 11.1 per 1000 patient-years). After multivariable adjustment, prior screening was associated with 34% and 32% lower risks of the composite (HR 0.66, 0.63–0.69) and mortality (0.68, 0.64–0.72) outcomes. Among those receiving prior screening, a result in the prediabetes range was associated with lower risks of the composite (0.82, 0.77–0.88) and mortality (0.71, 0.66–0.78) outcomes than a result in the normoglycemic range. Conclusions: Previously screened individuals with diabetes had lower risks of cardiovascular events and mortality versus previously unscreened individuals. Better risk assessment tools are needed to support wider and more appropriate uptake of diabetes screening, especially among young adults. [ABSTRACT FROM AUTHOR]

Size spectra are used to assess the status and functioning of marine and freshwater ecosystems worldwide. Their use is underpinned by theory linking the dynamics of trophic interactions to a power-law decline of abundance with body size in ecological communities. Recent papers on empirical size spectrum estimation have argued for Maximum Likelihood Estimation of power-law probability distributions as a more accurate alternative to traditional linear regression approaches. One major limitation of currently used size spectrum estimators from Maximum Likelihood Estimation is that they cannot account for the use of multiple sampling protocols, nor the distortions caused by gear size selectivity, and therefore they become restricted to a relatively narrow taxonomic group and size range. Further progress in the field requires new methods that are flexible enough to combine multiple trophic groups and sampling gears into a single size spectrum estimate, while taking advantage of more accurate distributional approaches. The method we propose in this paper fills this gap by deriving the distribution of observed sizes explicitly from the underlying power-law spectrum and gear selectivity functions. It specifies likelihoods as a product of two components: (i) the probability of belonging to a given group and (ii) the probability distribution within the group. Using Bayesian estimation, we applied the method to surveys of phytoplankton, zooplankton, and fishes in lakes of Quetico Provincial Park, northwestern Ontario, using Van Dorn samplers, zooplankton nets, gillnets, and hydroacoustics. The results show that the spectra estimated from subsets of trophic groups or gears are weak predictors of more complete spectra, highlighting the importance of using more inclusive community data. The two-component partitioning of likelihoods also helped demonstrate the existence of between-group spectrum slopes that were overall steeper than within-group slopes, indicating that heterogeneity of trophic transfers across the size spectrum is an important factor structuring these ecosystems. [ABSTRACT FROM AUTHOR]

Objective: Individuals with Type 2 Diabetes are likely to experience multimorbidity and accumulate multiple chronic conditions over their life. We aimed to identify causes of death and chronic conditions at the time of death in a population-based cohort, and to analyze variations in the presence of diabetes at the time of death overall and across income and immigrant status. Research design and methods: We conducted a retrospective cohort study of 2,199,801 adult deaths from 1992 to 2017 in Ontario, Canada. We calculated the proportion of decedents with chronic conditions at time of death and causes of death. The risk of diabetes at the time of death was modeled across sociodemographic variables with a log binomial regression adjusting for sex, age, immigrant status, area-level income. comorbiditiesand time. Results: The leading causes of death in the cohort were cardiovascular and cancer. Decedents with diabetes had a higher prevalence of most chronic conditions than decedents without diabetes, including hypertension, osteo and other arthritis, chronic coronary syndrome, mood disorder, and congestive heart failure. The risk of diabetes at the time of death was 19% higher in immigrants (95%CI 1.18–1.20) and 15% higher in refugees (95%CI 1.12–1.18) compared to long-term residents, and 19% higher in the lowest income quintile (95%CI 1.18–1.20) relative to the highest income quintile, after adjusting for other covariates. Conclusions: Individuals with diabetes have a greater multimorbidity burden at the time of death, underscoring the importance of multiple chronic disease management among those living with diabetes and further considerations of the social determinants of health. [ABSTRACT FROM AUTHOR]

Background: The increased use of telemedicine to provide virtual outpatient visits during the pandemic has led to concerns about potential increased emergency department (ED) admissions and outpatient service use prior to such admissions. We examined the frequency of virtual visits use prior to ED admissions and characterized the patients with prior virtual visit use and the physicians who provided these outpatient visits. Methods: We conducted a retrospective, population-based, cross-sectional analysis using linked health administrative data in Ontario, Canada to identify patients who had an ED admission between July 1 and September 30, 2021 and patients with an ED admissions during the same period in 2019. We grouped patients based on their use of outpatient services in the 7 days prior to admission and reported their sociodemographic characteristics and healthcare utilization. Results: There were 1,080,334 ED admissions in 2021 vs. 1,113,230 in 2019. In 2021, 74% of these admissions had no prior outpatient visits (virtual or in-person) within 7 days of admission, compared to 75% in 2019. Only 3% of ED admissions had both virtual and in-person visits in the 7 days prior to ED admission. Patients with prior virtual care use were more likely to be hospitalized than those without any outpatient care (13% vs 7.7.%). Interpretation: The net amount of ED admissions and outpatient care prior to admission remained the same over a period of the COVID-19 pandemic when cases were relatively stable. Virtual care seemed to be able to appropriately triage patients to the ED and virtual visits replaced in-person visits ahead of ED admissions, as opposed to being additive. [ABSTRACT FROM AUTHOR]

Aim: The spatial distribution of ectotherms is strongly dependent on the temperature of their environments. In temperate lakes, fishes with different thermal optima can become spatially segregated during summer stratification. This habitat partitioning, or niche complementarity, may play a role in the coexistence of trophically similar species; however, the extent of partitioning is dependent on the resources available within each habitat. Although habitat partitioning of fish thermal guilds has been studied in individual lakes, broad‐scale patterns of spatial overlap and segregation are not yet understood. In this study, we explore the patterns and drivers of spatial overlap among thermal guilds (cold‐, cool‐, and warm‐water) at a broad scale. Location: Ontario, Canada. Methods: We built a multivariate regression tree to explore patterns and environmental drivers of spatial overlap in freshwater fishes across three thermal guilds from 438 lakes. Results: We identified five clusters of lakes exhibiting different patterns of spatial overlap among the three thermal guilds. Temperature (growing degree days) and maximum lake depth were strong drivers of the spatial overlap patterns. Main Conclusions: These findings provide a better understanding of broad‐scale patterns of spatial overlap and allow us to predict how spatial overlap, and ultimately species interactions and competition, may change under a warming climate. [ABSTRACT FROM AUTHOR]

The Fish and Fish Habitat Protection Program (FFHPP) in Ontario and Prairie Region has requested science advice on approaches that can be used to define classification schemes and associated thresholds for reporting on the State of Fish and Fish Habitat (SOFFH) in the Lower Great Lakes and East Slopes of Alberta reporting areas. Science advice for quantifying and assessing the SOFFH in these reporting areas was also requested. This document describes approaches that can be used to develop classification schemes, including schemes based on (i) functional relationships with management objectives, (ii) established thresholds, (iii) relative ranking and (iv) expert elicitation. A decision tree for selecting among the approaches, based on the availability of different types of information, is presented. In addition, we consider how information from multiple Metrics can be synthesized to report on the status of overarching Indicators, as well as how classification schemes can be established for the quality of data used in SOFFH reporting. Finally, key uncertainties related to the development of classifications schemes, are also discussed. [ABSTRACT FROM AUTHOR]

Brook trout (Salvelinus fontinalis) are an iconic freshwater salmonid native to northeastern North America. They prefer cold, clean rivers and lakes, and have been culturally, socially and economically valued for decades. Overharvest and deforestation associated with European settlement in southern Ontario, Canada led to notable declines in brook trout abundance in rivers and streams by the late 1800s. Today, they are threatened by further habitat degradation, non‐native species, and climate change. In this study, we document brook trout occupancy in rivers and streams of the Mixedwood Plains Ecozone in southern Ontario, between 1970–1980 and 2000–2010. We used generalised linear models to determine occupancy variation between the two time periods at five spatial scales spanning multiple watershed levels. We detected a decline in occupancy between time periods for the tertiary (from 23% to 17%) and quaternary (from 35% to 22%) watershed scales. In the Credit River‐Sixteen Mile Creek watershed, mean occupancy decreased to a third of past estimate (from 31% to 10%). For a subset of 86 sites with overlapping sampling in both periods no temporal trend was detected, but a post‐hoc analysis indicated low statistical power (0.07), which suggested that more intensive sampling would be needed to better quantify brook trout occupancy changes at this scale. The occupancies quantified for the past period in our study may serve as benchmarks for brook trout restoration efforts. [ABSTRACT FROM AUTHOR]

Background: Anecdotally there are reports of newly diagnosed SARS-CoV-2 infection shortly after vaccination. This has led some to speculate that vaccination itself might inadvertently increase the short-term risk of COVID potentially due to airborne spread at mass vaccination clinics or relaxation of precautions following vaccination. We explored whether receipt of vaccination was associated with a short-term increase in the risk of being diagnosed with COVID-19 and if differences exist between vaccination settings. Methods: We conducted a cohort study in Ontario, Canada to compare the risk of SARS-CoV-2 infection within 21 days of receiving a first vaccination, according to the setting in which vaccines were administered between March 1, 2021 and May 6, 2021. We used linked population-wide vaccination, laboratory testing, and health administrative databases. We created a 1:1 matched comparison group of unexposed individuals. We reported the overall risk of infection calculated at 3, 7, 10, 14, 18, and 21 days. This was completed overall and by setting of vaccine receipt. Results: We identified 4,798,430 Ontario residents who received their first dose of a COVID-19 vaccine. In the primary analysis, the rate of SARS-CoV-2 infection was significantly lower among vaccine recipients vs non-recipients at all the post-vaccination time points. Analysis stratified by vaccination setting found that mass vaccination clinics, pharmacies, and physician offices were consistent with the main findings. Individuals who received their first vaccine dose in congregate residential settings had a higher rate of SARS-CoV-2 infection at 7 days (HR 1.35, 95% CI 1.00–1.83) and 10 days (HR 1.49, 95% CI 1.03–2.15). Conclusion: In this population-based cohort study, we found that there was no increased risk of SARS-CoV2 infection after vaccination suggesting no broad transmission of disease at time of vaccination. Some evidence of increased risk among those vaccinated in congregate settings, highlighting the need to consider opportunities for supporting safe vaccine administration in these settings. Given ongoing and future immunization programs, the results support the need for continued vigilance during any mass vaccination processes and education regarding the delayed nature of protection following vaccination. [ABSTRACT FROM AUTHOR]

Introduction: This paper aims to explore the care processes that best exemplify person‐centred care during physical activity (PA) for long‐term care (LTC) residents with dementia from the perspectives of substitute decision‐makers (SDMs) and LTC home staff. Little is known about how person‐centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person‐centred care during PA. Methods: Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person‐centred care during PA from two LTC homes in Canada. The McCormack and McCance person‐centredness framework was used to guide thematic content analysis of responses. Results: SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person‐centredness framework as most reflecting person‐centred care. Benefits of person‐centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person‐centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression. Significance: Understanding the care processes that are most recognized as person‐centred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person‐centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia. Patient and Public Contribution: Study participants were not involved in the development of research questions, research design or outcome measures of this study. [ABSTRACT FROM AUTHOR]

Background: The overall satisfaction of patients after total knee arthroplasty (TKA) is approximately 80%, and current studies have demonstrated that patients with depression may have lower patient satisfaction. The purpose of this study was to determine whether perioperative psychological intervention in patients with depression improves the clinical outcomes and patient satisfaction in patients undergoing TKA.Methods: Six hundred patients who underwent primary TKA from May 2016 to January 2018 were prospectively screened for eligibility. A preoperative psychological evaluation was conducted by a psychiatrist to evaluate each patient's psychological status. Patients who were diagnosed with depression were randomly divided into 2 groups: the intervention group (patients received psychological interventions that were administered by a psychiatrist at the first visit before surgery and from then on) and the control group (patients received routine TKA care without psychological interventions). The primary outcome was patient satisfaction at 6 months postoperatively. The secondary outcomes were patient satisfaction at 2 years postoperatively as well as the Hospital for Special Surgery (HSS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and range of motion at 6 months and 2 years postoperatively.Results: Fifty-three patients with depression were identified. Fifty-one patients were enrolled in the randomized controlled trial. Two patients were lost to follow-up at 6 months after surgery. Therefore, 49 patients (25 in the intervention group and 24 in the control group) remained in the final analysis. At 6 months postoperatively, statistical differences in patient satisfaction were identified between the 2 groups (88.0% in the intervention group compared with 62.5% in the control group; odds ratio = 4.40; 95% confidence interval, 1.02 to 18.99). There was a significant improvement in the Self-Rating Depression Scale (SDS) score (the reduction rate was 51.97% in the intervention group compared with 17.35% in the control group) and the Symptom Checklist 90 Revised (SCL-90-R) subscore for depression (the reduction rate was 44.66% in the intervention group compared with 15.73% in the control group). The clinical outcomes, including the WOMAC scores, the HSS scores, and maximal range of motion, in the intervention group had improved significantly more compared with those in the control group.Conclusions: Psychological interventions during the perioperative period can improve patient satisfaction in patients with depression who undergo TKA. Therefore, psychological intervention and management may be beneficial for patients with depression who are planning to undergo TKA.Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Inland fisheries have a significant cultural and economic value around the globe, providing dietary protein, income, and recreation. Consequently, methods for monitoring and managing these important fisheries are continually being refined. In marine systems, multispecies size spectrum models have been increasingly used to explore management scenarios of important fish stocks within an ecosystem‐based fisheries management framework; however, these models have not been applied as extensively in freshwater systems. In this study, we developed a multispecies size spectrum model for the fish community of Lake Nipissing, a large, productive lake in Ontario, Canada. To the best of our knowledge, this is the first fully calibrated multispecies size spectrum model for an inland fishery. Using this model, we explored the impacts of potential fishing regimes and management scenarios on fish community dynamics while taking species interactions into account. Specifically, we examined how changes in fishing mortality affect (1) species biomass, (2) community size structure, and (3) stock recovery times. We found that community dynamics following changes in fishing mortality were driven by complex interactions among species, including competition and predation. The greatest changes in biomass and community size structure were observed following changes in fishing mortality of top predators, with community size structure most strongly influenced by changes in the mortality of the largest species. Counter to predictions based on generation time, the smallest species in our model exhibited the longest time to recovery due to strong competition and predation. Our results demonstrate the importance of considering species interactions in the management of inland fisheries and highlight the potential of size spectrum model use in freshwater systems. [ABSTRACT FROM AUTHOR]

We aimed to determine whether early public health interventions in 2020 mitigated the association of sociodemographic and clinical risk factors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a population-based cohort study of all adults in Ontario, Canada who underwent testing for SARS-CoV-2 through December 31, 2020. The outcome was laboratory-confirmed SARS-CoV-2 infection, determined by reverse transcription polymerase chain reaction testing. Adjusted odds ratios (ORs) were determined for sociodemographic and clinical risk factors before and after the first-wave peak of the pandemic to assess for changes in effect sizes. Among 3,167,753 community-dwelling individuals, 142,814 (4.5%) tested positive. The association between age and SARS-CoV-2 infection risk varied over time (P-interaction < 0.0001). Prior to the first-wave peak, SARS-CoV-2 infection increased with age whereas this association reversed thereafter. Risk factors that persisted included male sex, residing in lower income neighborhoods, residing in more racially/ethnically diverse communities, immigration to Canada, hypertension, and diabetes. While there was a reduction in infection rates after mid-April 2020, there was less impact in regions with higher racial/ethnic diversity. Immediately following the initial peak, individuals living in the most racially/ethnically diverse communities with 2, 3, or ≥ 4 risk factors had ORs of 1.89, 3.07, and 4.73-fold higher for SARS-CoV-2 infection compared to lower risk individuals in their community (all P < 0.0001). In the latter half of 2020, this disparity persisted with corresponding ORs of 1.66, 2.48, and 3.70-fold higher, respectively. In the least racially/ethnically diverse communities, there was little/no gradient in infection rates across risk strata. Further efforts are necessary to reduce the risk of SARS-CoV-2 infection among the highest risk individuals residing in the most racially/ethnically diverse communities. [ABSTRACT FROM AUTHOR]

Purpose: It is currently unclear how the shift towards virtual care during the 2019 novel coronavirus (COVID-19) pandemic may have impacted chronic disease management at a population level. The goals of our study were to provide a description of the levels of use of virtual care services relative to in-person care in patients with chronic disease across Ontario, Canada and to describe levels of healthcare utilization in low versus high virtual care users. Methods: We used linked health administrative data to conduct a population-based, repeated cross-sectional study of all ambulatory patient visits in Ontario, Canada (January 1, 2018 to January 16, 2021). Further stratifications were also completed to examine patients with COPD, heart failure, asthma, hypertension, diabetes, mental illness, and angina. Patients were classified as low (max 1 virtual care visit) vs. high virtual care users. A time-series analysis was done using interventional autoregressive integrated moving average (ARIMA) modelling on weekly hospitalizations, outpatient visits, and diagnostic tests. Results: The use of virtual care increased across all chronic disease patient populations. Virtual care constituted at least half of the total care in all conditions. Both low and high virtual care user groups experienced a statistically significant reduction in hospitalizations and laboratory testing at the start of the pandemic. Hospitalization volumes increased again only among the high users, while testing increased in both groups. Outpatient visits among high users remained unaffected by the pandemic but dropped in low users. Conclusion: The decrease of in-person care during the pandemic was accompanied by an increase in virtual care, which ultimately allowed patients with chronic disease to return to the same visit rate as they had before the onset of the pandemic. Virtual care was adopted across various chronic conditions, but the relative adoption of virtual care varied by condition with highest rates seen in mental health. [ABSTRACT FROM AUTHOR]

Background: In Canada, published outcome data for COVID-19 come largely from the first 2 waves of the pandemic. We examined changes in demographics and 30-day outcomes after SARS-CoV-2 infection during the first 3 pandemic waves in Alberta and Ontario; for wave 3, we compared outcomes between those infected with a variant of concern and those infected with the original "wild-type" SARS-CoV-2. Methods: We conducted a population-based retrospective cohort study using linked health care data sets in Alberta and Ontario. We identified all-cause hospitalizations or deaths within 30 days after a positive result on a reverse transcription polymerase chain reaction test for SARS-CoV-2 in individuals of any age between Mar. 1, 2020, and June 30, 2021, with genomic confirmation of variants of concern. We compared outcomes in wave 3 (February 2021 to June 2021) with outcomes in waves 1 and 2 combined (March 2020 to January 2021) after adjusting for age, sex and Charlson Comorbidity Index score. Using wave 3 data only, we compared outcomes by vaccination status and whether or not the individual was infected with a variant of concern. Results: Compared to those infected with SARS-CoV-2 during waves 1 and 2 (n = 372 070), we found a shift toward a younger and healthier demographic in those infected during wave 3 (n = 359 079). In wave 3, patients were more likely to be hospitalized (adjusted odds ratio [aOR] 1.57, 95% confidence interval [CI] 1.46–1.70) but had a shorter length of hospital stay (median 6 days v. 7 days, p < 0.001) and lower 30-day mortality (aOR 0.73, 95% CI 0.65–0.81). The 217 892 patients in wave 3 who were infected with a variant of concern (83.5% confirmed to have the Alpha variant, 1.7% confirmed to have the Delta variant) had a higher risk of death (Alpha: aOR 1.29, 95% CI 1.16–1.44; Delta: aOR 2.05, 95% CI 1.49–2.82) and hospitalization (Alpha: aOR 1.59, 95% CI 1.53–1.66; Delta: aOR 1.88, 95% CI 1.64–2.15) than those infected with wild-type SARS-CoV-2. Interpretation: We observed a shift among those infected with SARS-CoV-2 toward younger patients with fewer comorbidities, a shorter length of hospital stay and lower mortality risk as the pandemic evolved in Alberta and Ontario; however, infection with a variant of concern was associated with a substantially higher risk of hospitalization or death. As variants of concern emerge, ongoing monitoring of disease expression and outcomes among vaccinated and unvaccinated individuals is important to understand the phenotypes of COVID-19 and the anticipated burdens for the health care system. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic led to a dramatic shift in the delivery of outpatient medicine with reduced in-person visits and a transition to predominantly virtual visits. We sought to understand trends in visit patterns for ambulatory care sensitive conditions (ACSCs) commonly seen in internal medicine clinics.Methods: We included adult outpatients seen for an ACSC between March 15th, 2017 and March 14th, 2021 at a single-centre in Ontario, Canada. Monthly visits were assessed by visit type (new consultation, follow-up), diagnosis, and clinic. Time series analyses compared visit volumes pre- and post-pandemic. Proportion of virtual visits were compared before and during the pandemic. Patient and visit factors were compared between in-person and virtual visits.Results: 8274 patients with 34,021 visits were included. Monthly visits increased by 15% during the pandemic (p <  0.0001). New consultations decreased by 10% (p = 0.0053) but follow-up visits increased by 21% (p <  0.0001). Monthly heart failure visits increased by 43% (p <  0.0001) whereas atrial fibrillation visits decreased. Pre- pandemic, < 1% of visits were virtual compared to 82% during the pandemic (p <  0.0001). Less than half of heart failure visits were virtual whereas > 95% of diabetes visits were virtual.Conclusions: We found a significant increase in overall visits to internal medicine clinics driven by increased volumes of follow-up visits, which more than offset decreased new consultations. There was variability in visit trends and uptake of virtual care by visit diagnosis, which may indicate challenges with delivery of virtual care for certain conditions. [ABSTRACT FROM AUTHOR]

Aim: Recurrent species assemblages integrate important biotic interactions and joint responses to environmental and spatial filters that enable local coexistence. Here, we applied a bipartite (site–species) network approach to develop a natural typology of lakes sharing distinct fish faunas and provide a detailed, hierarchical view of their bioregions. We then compared the roles of key biogeographical factors to evaluate alternative hypotheses about how fish communities are assembled from the regional species pool. Location: Ontario, Canada and the Upper Midwest, USA. Time period: 1957–2017. Major taxa studied: Freshwater fishes. Methods: Bipartite modularity analysis was performed on 90 taxa from 10,016 inland lakes in the Southwestern Hudson Bay, Mississippi River and St. Lawrence River drainages, uncovering bioregionalization of North American fishes at a large, subcontinental scale. We then used a latent variable approach, pairing non‐metric partial least‐squares structural equation modelling with multiple logistic regression, to show differences in the biogeographical templates of each type of community. Indicators of contemporary and historical connectivity, climate and habitat constructs were estimated using a geographical information system. Results: Fish assemblages reflected broad, overlapping patterns of postglacial colonization, climate and geological setting, but community differentiation was most linked to temperature, precipitation and, for certain groups, lake area and water quality. Bioregions were also marked by non‐native species, showing broad‐scale impacts of introductions to the Great Lakes and surrounding basins. Main conclusions: The dominant effects of climate across broad spatial gradients indicate differing sensitivities of fish communities to rapidly accelerating climate change and opportunities for targeted conservation strategies. By assessing biological variation at the level of recurrent assemblages, we accounted for the non‐stationarity of macroecological processes structuring different sets of species on the landscape and offer novel inference on the assembly of inland fish communities. [ABSTRACT FROM AUTHOR]

Background Telemedicine adoption has grown significantly due to the coronavirus of 2019 pandemic; however, it remains unclear what the impact of widespread telemedicine use is on healthcare utilization among individuals with psychosis. Objectives To investigate the impact of telemedicine use on changes in healthcare utilization among patients with chronic psychotic disorders (CPDs). Study Design We conducted a population-based, retrospective propensity-matched cohort study using healthcare administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a CPD diagnosis any time before March 14, 2020. Telemedicine users (2+ virtual visits after March 14, 2020) were propensity score-matched 1:1 with standard care users (minimum of 1 in-person or virtual ambulatory visit and maximum of 1 virtual visit after March 14, 2020) based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups from 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations (eg, hospitalizations, emergency department [ED] visits, and outpatient physician visits). The slope of change over the study period (ie, rate ratio) as well as a ratio of slopes, were calculated for both telemedicine and standard care groups for each outcome. Study Results A total of 18 333 pairs of telemedicine and standard care patients were identified after matching (60.8% male, mean [SD] age 45.4 [16.3] years). There was a significantly greater decline across time in the telemedicine group compared to the standard care group for ED visits due to any psychiatric conditions (ratio of slopes for telemedicine vs standard care (95% CI), 0.98 (0.98 to 0.99)). However, declines in primary care visit rates (ratio of slopes for telemedicine vs standard care (1.01 (1.01 to 1.02)), mental health outpatient visits with primary care (1.03 (1.03 to 1.04)), and all-cause outpatient visits with primary care (1.01 (1.01 to 1.02)), were steeper among the standard care group than telemedicine group. Conclusions Overall, patients with CPDs appeared to benefit from telemedicine as evidenced by increased outpatient healthcare utilization and reductions in ED visits due to psychiatric conditions. This suggests that telemedicine may have allowed this patient group to have better access and continuity of care during the initial waves of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (AVR) are the 2 most common cardiac surgery procedures in North America. We derived and externally validated clinical models to estimate the likelihood of death within 30 days of CABG, AVR or combined CABG + AVR.Methods: We obtained data from the CorHealth Ontario Cardiac Registry and several linked population health administrative databases from Ontario, Canada. We derived multiple logistic regression models from all adult patients who underwent CABG, AVR or combined CABG + AVR from April 2017 to March 2019, and validated them in 2 temporally distinct cohorts (April 2015 to March 2017 and April 2019 to March 2020).Results: The derivation cohorts included 13 435 patients who underwent CABG (30-d mortality 1.73%), 1970 patients who underwent AVR (30-d mortality 1.68%) and 1510 patients who underwent combined CABG + AVR (30-d mortality 3.05%). The final models for predicting 30-day mortality included 15 variables for patients undergoing CABG, 5 variables for patients undergoing AVR and 5 variables for patients undergoing combined CABG + AVR. Model discrimination was excellent for the CABG (c-statistic 0.888, optimism-corrected 0.866) AVR (c-statistic 0.850, optimism-corrected 0.762) and CABG + AVR (c-statistic 0.844, optimism-corrected 0.776) models, with similar results in the validation cohorts.Interpretation: Our models, leveraging readily available, multidimensional data sources, computed accurate risk-adjusted 30-day mortality rates for CABG, AVR and combined CABG + AVR, with discrimination comparable to more complex American and European models. The ability to accurately predict perioperative mortality rates for these procedures will be valuable for quality improvement initiatives across institutions. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada.Methods: We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses.Results: Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 - July 18. There was a significant increase in crisis calls starting in the week of May 31 - June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 - June 20.Conclusions: Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Drone-delivered defibrillators have the potential to significantly reduce response time for out-of-hospital cardiac arrest (OHCA). However, optimal policies for the dispatch of such drones are not yet known. We sought to develop dispatch rules for a network of defibrillator-carrying drones.Methods: We identified all suspected OHCAs in Peel Region, Ontario, Canada from Jan. 2015 to Dec. 2019. We developed drone dispatch rules based on the difference between a predicted ambulance response time to a calculated drone response time for each OHCA. Ambulance response times were predicted using linear regression and neural network models, while drone response times were calculated using drone specifications from recent pilot studies and the literature. We evaluated the dispatch rules based on response time performance and dispatch decisions, comparing them to two baseline policies of never dispatching and always dispatching drones.Results: A total of 3573 suspected OHCAs were included in the study with median and mean historical ambulance response times of 5.8 and 6.2 min. All machine learning-based dispatch rules significantly reduced the median response time to 3.9 min and mean response time to 4.1-4.2 min (all P < 0.001) and were non-inferior to universally dispatching drones (all P < 0.001) while reducing the number of drone flights by up to 30%. Dispatch rules with more drone flights achieved higher sensitivity but lower specificity and accuracy.Conclusion: Machine learning-based dispatch rules for drone-delivered defibrillators can achieve similar response time reductions as universal drone dispatch while substantially reducing the number of trips. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between stress secondary to residents' responsive behaviours and job satisfaction of nurses and nursing assistants working in nursing homes. To test whether supervisory support, work effectiveness and work empowerment confound this relationship. Background: Understanding how the stress secondary to residents' responsive behaviours influences job satisfaction for staff and determining the factors influencing this relationship are important for retention of staff in nursing homes. The term 'responsive behaviours' refers to the subset of behavioural and psychological symptoms of dementia. Methods: Survey responses from 191 nursing assistants and 81 nurses in five nursing homes in Ontario were analysed. Results: Staff's stress attributed to residents' responsive behaviours was negatively associated with job satisfaction. This direct effect was weakened by more than a third through the confounding net effects of supervisory support, work effectiveness and work empowerment. Conclusion: The work environment created by leaders in nursing homes can lessen the influence of stress secondary to residents' responsive behaviours on staffs' job satisfaction. Implications for Nursing Management: Supervisors need training and education to support and mentor their staff effectively, and to guide their use of evidence‐based practices that integrate the patient‐centred care approach in order to effectively respond and minimize responsive behaviours. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Fisheries & Aquatic Sciences is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cellular mechanisms underpinning the hard-to-cook phenomenon are poorly understood. Navy beans (Phaseolus vulgaris) from the same cultivar but grown in different regions of North America showed different canning characteristics. Up to 46.4% more force was required to disrupt hard beans (HB) grown in Ontario compared with soft beans (SB) grown in Manitoba. HB absorbed 12.5% and 14.7% less water during blanching and canning, respectively. Microscopic assessment revealed that canning led to swelling of middle lamella and cell walls, but preservation of cell adhesion in both types of beans. Immunofluorescence microscopy showed reduced labelling of methyl-esterified homogalacturonan (HG) and more non-methyl-esterified HG and arabinan epitopes in HB. Compositional analysis indicated that the polysaccharides from HB were less water soluble and enriched in neutral sugars, including 46.5% more arabinose and 51.8% more galactose than in SB. ELISA analysis of polymers in the canning medium supported the increased solubility of cell wall polymers in SB. In the same cultivar, growth region affects cell wall properties with consequences for processing, eating and nutritional quality. [ABSTRACT FROM AUTHOR]

Background: Rates of cardiovascular disease among people with diabetes have declined over the last 20-30 years. To determine whether First Nations people have experienced similar declines, we compared time trends in rates of cardiac event and disease management among First Nations people with diabetes and other people with diabetes in Ontario, Canada.Methods: We conducted a retrospective cohort study of patients aged 20 to 105 years with diabetes between 1996 and 2015, using linked health administrative databases. Outcomes compared were the annual incidence of each admission to hospital for myocardial infarction and heart failure, and death owing to ischemic heart disease. Management indicators were coronary revascularization and prescription rates for cardioprotective medications. Overall rates and annual percent changes were compared using Poisson regression.Results: Incidence rates for all cardiac outcomes decreased over the study period. The greatest relative annual decline among First Nations men and women were observed in ischemic heart disease death (4.4%, 95% confidence interval [CI] 3.0 to 5.9) and heart failure (5.4%, 95% CI 4.5 to 6.4), respectively. Among other men and women, the greatest annual declines were seen in ischemic heart disease death (6.3%, 95% CI 6.1 to 6.5 and 7.3%, 95% CI 7.1 to 7.6, respectively). However, all absolute cardiac event rates were higher among First Nations people (p < 0.001). Coronary artery revascularization procedures and prescriptions for cardioprotective medications increased among First Nations people, while only prescriptions increased among other people.Interpretation: Over the last 20 years, the incidence of cardiac events has declined among First Nations people with diabetes, but remains higher than other people with diabetes in Ontario. For continued reductions in incidence, future efforts need to recognize First Nations people's unique social and cultural determinants of health. [ABSTRACT FROM AUTHOR]

Protected areas are one of the hammers in conservation toolkits, yet few protected areas exist that were designed to protect freshwater ecosystems. This is problematic as freshwater ecosystems are among the most threatened systems on earth. Nonetheless, terrestrial protected areas (TPAs) may afford spill‐over benefits to freshwater ecosystems included within their boundaries, but evaluations of these potential benefits for the protection of freshwater fish diversity are lacking.Using fish community data from 175 lakes inside, outside, or bordering TPAs in Ontario, Canada, we sought to determine if TPAs preserve fish functional diversity. We focused on functional diversity because previous work indicated no taxonomic differences between these lakes, but a difference in normalised‐length size‐spectra slopes inside versus outside TPAs (indicator of unique predator–prey ratios and trophic energy transfer). We expected that communities inside TPAs would show greater functional diversity (i.e. functional dispersion and functional richness) and have more extreme trait combinations (i.e. functional divergence) than communities outside or bordering TPAs. We also tested for differences in the rarity of species‐specific functional traits between fish communities inside, outside, or bordering TPAs, between thermal guilds, and across average body size and overall prevalence of the species.Our results indicated no significant differences in functional diversity among lake fish communities inside, outside, or bordering TPAs. However, fish communities inside TPAs had more extreme trait combinations than outside TPAs because abundant species in lake communities outside TPAs had more ubiquitous trait combinations than abundant fishes inside TPAs.Small‐bodied species showed greater functional rarity than large‐bodied species, indicating that small‐bodied fishes fill functionally unique roles while the most prevalent, large‐bodied species possess a more generalist set of traits.Overall, the similarity of functional diversity metrics for lake fish communities inside, outside, or bordering TPAs in Ontario suggests that TPAs capture the functional diversity of Ontario's lake fish communities. However, we encourage similar evaluations in regions where environmental conditions and stressors are more distinct across TPA boundaries than they are in Ontario, as these types of evaluations will inform guidelines for the design of freshwater protected areas and monitoring of their effectiveness in the future. [ABSTRACT FROM AUTHOR]

Introduction: Radium-223 (Ra223) prolongs the survival and improves the quality of life of men with metastatic, castration-resistant prostate cancer (mCRPC) to bones. However, compared to other mCRPC therapies, using Ra223 comes with its unique challenges. Hence, we aimed to identify Ra223 utilization patterns under real-world conditions, as well as factors predicting treatment completion and outcome. Methods: In this retrospective chart analysis, 198 mCRPC patients were identified that had received Ra223 outside of clinical trials or access programs from January 2015 to October 2016 at four cancer centres in Ontario. The main outcomes studied were Ra223 completion rate, reasons for early treatment discontinuation, overall survival, and survival differences in patients completing Ra223 therapy versus patients receiving <6 cycles of Ra223. In addition, patient and disease characteristics were analysed to identify predictors of treatment completion and survival. Results: In this cohort of patients mostly pretreated with abiraterone and/or enzalutamide (92.4%), almost half of which had also received docetaxel (48.5%), the Ra223 completion rate was 46.5%, and the actuarial median survival was 13.3 months. The main reason for early Ra223 discontinuation was disease progression, and Ra223 non-completion was associated with poorer outcome (median survival 8.1 months [6.0–12.2] versus 18.7 months [15.3–22.3] in men completing Ra223, p<0.0001). Lymph node metastases and a high baseline prostate-specific antigen (PSA) were independent predictors of early treatment discontinuation. Multivariable Cox proportional hazards models revealed early Ra223 discontinuation, baseline anemia, high PSA, prior skeletal-related events, visceral metastases, and being referred to another centre for Ra223 therapy as predictors of worse outcome. Conclusion: Despite a lower completion rate than observed under clinical trial conditions, the real-world results achieved with Ra223 are encouraging. If prospectively validated, predictive patient and disease characteristics identified in our cohort might become instrumental to identify mCRPC patients likely to complete and to most benefit from Ra223 therapy. [ABSTRACT FROM AUTHOR]

Background and Objectives To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, a network of integrated health and social care providers (East Toronto Health Partners - ETHP) leveraged a distributed leadership model to design and execute an effective local response for our 300,000 local residents. Our approach included working with non-traditional partners, such as schools. At least 20 of our 81 publiclyfunded schools were located in high priority neighbourhoods hit hardest by the pandemic. A proactive plan was initiated by partners to provide urgent access to infection prevention and control and build a community of practice with school leadership, supported by hospital-based specialists and local primary care. Aims, Objectives, Theory or Methods: This presentation will showcase ETHP's distributed leadership approach to COVID-19 testing and vaccine distribution, including a multi-pronged approach that combined mass clinics and hyper-local community-based outreach. We will review the design and application of our distributed leadership approach that empowered physician and clinical leaders from our family practice network and our acute care hospital to co-lead an outreach and support strategies for local schools. This will include an overview of our distributed leadership model at a system and organizational level and how this was leveraged to create a nimble, proactive response to supporting local schools during the pandemic. Highlights or Results or Key Findings: The distributed leadership model in ETHP empowered local physicians and hospital specialists to play a leading role in reducing the spread of COVID-19 in schools. This was primarily achieved through early identification and intervention in school outbreaks, including timely closures of schools to contain spread of the virus across neighbourhoods. The school-based strategy included connecting schools to local primary care resources and hospital-based infection prevention/control specialists to provide education and support for school principals and staff. Strategies to build relationships and trust include hosting COVID testing and vaccination information forums with schools for principals, staff, and parents. These connections between. ETHP and schools resulted in the first school-based COVID testing strategy in the province of Ontario and pioneered the roll-out of home-based testing kits for parents so that they would not have to travel to testing sites with their children. These innovations have since been spread across the province. Conclusions: Overall enablers for success had a consistent theme which is that a distributed and collaborative leadership approach within and across different sectors (health, social and education systems) was an essential factor in better protecting local communities from COVID-19 in East Toronto. Implications for Applicability/Transferability, Sustainability and Limitations: As COVID-19 transitions from a global pandemic to an ongoing issue, a distributed leadership approach will be helpful in the success of COVID-19 testing and vaccinations. It also has potential for expanding the interactions between healthcare providers and schools to proactively address other population health needs for children. [ABSTRACT FROM AUTHOR]

Background. In Ontario, Canada, pneumococcal conjugate vaccine (PCV) was approved for infants in 2001 and became part of the publicly funded routine immunization schedule in 2005. We assessed the population-level impact of PCV on pneumonia hospitalizations and related costs. Methods. We used the difference-in-differences approach to evaluate the impact of pneumococcal vaccination on pneumonia hospitalizations and related costs, using nonpneumonia hospitalization as the control condition. We extracted monthly hospitalization costs, stratified by age group, from population-based health administrative data between April 1992 and March 2014. The study period was divided into 5 intervals: prevaccine period, availability of 7-valent PCV (PCV7) for private purchase, public funding for PCV7, replacement of PCV7 with 10-valent PCV (PCV10), and replacement of PCV10 with 13-valent PCV (PCV13). Results. A total of 1 063 700 pneumonia hospitalizations were recorded during the study period. In the vaccine-eligible age group, pneumonia hospitalizations declined by 34% (95% confidence interval, 32%-37%), 38% (32%-43%), and 45% (40%-51%) and hospitalization-related costs declined by 38% (25%-51%), 39% (33%-45%), and 46% (41%-52%) after public funding for PCV7, PCV10, and PCV13, respectively. Pneumonia hospitalizations and related costs also declined substantially for PCV-ineligible older children and elderly persons (aged >65 years). Conclusions. Our results suggest that the publicly funded PCV immunization program is responsible for substantial reductions in pneumonia hospitalizations and related healthcare costs, among both young children eligible for publicly funded vaccination and other age groups not included in the publicly funded program. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates.Methods: We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province's 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates.Results: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone.Interpretation: Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Accelerated by demands of the pandemic, Connected Care innovates across the paediatric health sector to leverage virtual solutions in addressing the pressing need for capacity building among home and community care (HCC) providers of children with medical complexity. Connected Care services supports a highly specialized and scarce paediatric home care workforce to deliver evidence-based nursing care when children transition from hospital to home. Family caregivers of children who depend on medical technology are integral to informing program development and guiding integration of new technologies and service lines. Aims Objectives Theory or Methods: Virtual care delivered by Connected Care aims to promote confidence and competence among home care providers of children with medical complexity through uptake of standardized, paediatric best practice. Connected Care engages hospital and home care administrators, interprofessional providers, and family advisors to inform integration of emerging technologies, testing of new virtual solutions, and usability of Connected Care's information technology platforms. Services delivered by Connected Care from hospital to home undergo continuous quality improvement and include: 1) nurse led-24/7 eConsultative services, 2) virtual simulation-based nursing education, and 3) crosssector interprofessional virtual visits. Highlights or Results or Key Findings: Connected Care's virtual community of practice has grown to include >800 homecare providers from >50 homecare organizations. In 2021, Connected Care will deliver >1000 paediatric virtual education sessions, across highly-accessible virtual platforms. The development of virtual simulation-based training modules for paediatric home ventilation have received very positive feedback among partners who describe appreciating the opportunity to practice their skills remotely. This year, Connected Care technologies will support remote access to >400 eConsultations and >1,500 self-directed resources. Consult types from homecare nurses vary with the majority reflecting their questions about medical technology trouble shooting. Real-time feedback indicates homecare nurses are highly satisfied with the eConsultation service giving it 'thumbs up' 99% of the time. Growth has been rapid in conduct of post-discharge virtual visits. In 2021, Connected Care will deliver >600 Virtual Visits bringing together hospital providers, family caregivers and homecare providers. Conclusions: Demand for Connected Care continues to build, aligned with recovery of paediatric homecare workforce and transition care gaps heightened through and beyond the pandemic. Experience with implementation of technologies linking hospital to home and community signal a high rate of acceptance and usability among diverse end-users across the sector. Implications for applicability/transferability sustainability and limitations: Connected Care is well positioned to innovate in the use of cutting edge technologies to promote system integration. Leveraging partnerships and sharing resources will promote best practice and be scaled to build capacity in delivery of paediatric home care across expanding partnerships and geographies. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Rural Medicine (Joule Inc.) is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI). Methods: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using χ2 tests and Wilcoxon rank-sum tests. Results: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p<0.001) and those in the private sector (p<0.001) were more interested in ordering DI. Respondents preferred a DI course that combined face-to-face and Web-based components and one that was specific to their area of practice. Most respondents perceived minimal barriers to the uptake of ordering DI, and most agreed that support from other health care professionals would facilitate uptake. Conclusion: The majority of Ontario physiotherapists are interested in ordering DI. For successful implementation of a health care change, such as physiotherapists' ability to order DI, educational needs and barriers to and facilitators of the uptake of the authorized activity should be considered. [ABSTRACT FROM AUTHOR]

All transcatheter aortic valve implantation (TAVI) cases are done in our hybrid operating room with a multidisciplinary team and a primed cardiopulmonary bypass (CPB) circuit on pump stand-by. We decided that we would resuscitate all patients undergoing a TAVI procedure via a transfemoral, transapical or transaortic approach, if required. Perfusion plays an essential role in providing rescue CPB for patient salvage when catastrophic complications occur. To coordinate the multidisciplinary effort, we have developed a written safety checklist that assigns a pre-determined role for team members for the rapid sequence initiation of CPB. Although many TAVI patients are not candidates for conventional aortic valve replacements, we feel strongly that rescue CPB should be offered to all TAVI patients to allow the correction of potentially reversible complications. This protocol is included in every surgical “Time Out” involving a TAVI procedure (Figure 1). The protocol has led to rapid and safe CPB initiation in less than five minutes of cardiac arrest. It has also led to a coordinated and consistent team, with pre-specified roles and improved communication.We discuss a case series of four TAVI patients who required emergent use of CPB. The first few cases did not have a written protocol. The experience from these cases led to the development of our protocol. We identified a lack of coordination, wasted movements, unnecessary delayed resuscitation and overall chaos, each of which was targeted for correction with the protocol. We will discuss the merits of the protocol in two recent TAVI cases which required emergent CPB. [ABSTRACT FROM PUBLISHER]

Aims To describe the relationship between nursing staff turnover in long-term care ( LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. Background The turnover of regulated nursing staff [ Registered Nurses ( RNs) and Registered Practical Nurses ( RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. Methods The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. Results Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. Conclusion Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. Implications for Nursing Management Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover. [ABSTRACT FROM AUTHOR]

Introduction: Ascending and aortic arch surgery is associated with higher levels of blood loss and subsequent need forallogeneic blood transfusions. We hypothesized that aggressive, comprehensive blood conservation strategies may limitthe need for transfusions and, subsequently, improve postoperative outcomes.Methods: Over a five-year period, 189 patients underwent proximal aortic surgery at our institution. Fifty-one patientsunderwent surgery using a comprehensive blood conservation strategy (BCS), including preoperative hemoglobin optimization,antifibrinolytic therapy, intraoperative acute normovolemic hemodilution, cell salvage and meticulous surgicaltechnique. The remaining 138 patients underwent surgery using conventional techniques (CONV).Results: Patients in the BCS group required fewer transfusions during their hospital stay compared to the conventionalgroup (56.9% vs. 72.5%, p=0.041). When examining elective cases, this trend widens, with 40.0% of BCS patients requiringany transfusions compared to 72.9% patients in the conventional group (p=0.001). Red cell (47.1% vs. 62.3%, p=0.06),plasma (43.1% vs. 61.6%, p=0.02) and platelets (27.5% vs. 47.8%, p=0.01) were also less frequently required in the BCSgroup than the conventional group, respectively. When a transfusion was required, patients in the BCS group receivedsignificantly fewer units of red blood cells (2.8 ± 7.0 units) than the conventional group (5.81 ± 9.5 units; p=0.039). Mortalitywas similar in both groups (BCS 7.8%, conventional 10.9%, p=0.54); however, there was significantly less morbidityin the BCS group, using a composite of any of 10 major postoperative complications (23.5% vs. 39.1%; p=0.046). Medianintensive care unit (ICU) and hospital lengths of stay were 2 and 7 days in the BCS group and 2 and 8 days in the CONVgroup (p=0.15), respectively.Conclusions: The aggressive use of a comprehensive blood conservation strategy in ascending and aortic arch surgery cansignificantly reduce the need for blood transfusions and is associated with less postoperative morbidity. Further evaluationwith a randomized, controlled trial is warranted. [ABSTRACT FROM AUTHOR]

This article reports some main findings of a year-long participatory action research study of critical literacy (CL) practices with middle school recent immigrant English language learners (ELLs) in Ontario, Canada. The CL program followed an integrated instructional model informed by Cummins' (2001)Academic Expertise Frameworkand Janks' (2010) synthesis model of CL as well as the poststructuralist/feminist advocacy for emotional engagement and self-reflexivity in CL education. The researcher and the teacher collaboratively developed an emergent curriculum based on the ELLs' concerns about discrimination and cultural adjustment. Through these transformative literacy practices, students gained not only language skills but also a sense of efficacy for social change. The research challenges the linear and segregated view of literacy and CL development, and points to the need to position ELLs as competent learners and to structure classroom conditions and practices to facilitate their gradual development as critical language users. [ABSTRACT FROM AUTHOR]

Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9±2.6 post circulatory arrest to 3.4±2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3±3.5 mmol/L, intra-operatively, which normalized to 28.4±2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25±0.10, corrected to 7.43±0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361±104 and 253±85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50±35 minutes, respectively. The mean time required for systemic rewarming was 95±66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body protection strategy for complex aortic arch surgery. This additive perfusion strategy may attenuate visceral and lower body ischemia that normally develops during periods of deep hypothermic circulatory arrest. [ABSTRACT FROM PUBLISHER]

Background Despite the growing popularity of syndromic surveillance, little is known about if or how these systems are accepted, utilized and valued by end users. This study seeks to describe the use of syndromic surveillance systems in Ontario and users' perceptions of the value of these systems within the context of other surveillance systems. Methods Ontario's 36 public health units, the provincial ministry of health and federal public health agency completed a web survey to identify traditional and syndromic surveillance systems used routinely and during the pandemic and to describe system attributes and utility in monitoring pandemic activity and informing decision-making. Results Syndromic surveillance systems are used by 20/38 (53%) organizations. For routine surveillance, laboratory, integrated Public Health Information System and school absenteeism data are the most frequently used sources. Laboratory data received the highest ratings for reliability, timeliness and accuracy (‘very acceptable’ by 92, 51 and 89%). Hospital/clinic screening data were rated as the most reliable and timely syndromic data source (50 and 43%) and ED visit data the most accurate (48%). During the pandemic, laboratory data were considered the most useful for monitoring the epidemiology and informing decision-making while ED screening and visit data were considered the most useful syndromic sources. Conclusions End user perceptions are valuable for identifying opportunities for improvement and guiding further investments in public health surveillance. [ABSTRACT FROM PUBLISHER]

Surgical treatment of patients who present with large aneurysms of the ascending aorta, transverse arch and descending aorta, including the thoracic and abdominal aorta typically consists of a two-staged elephant trunk procedure. Typically, these operations are lengthy, requiring long cardiopulmonary bypass times, deep hypothermic circulatory arrest and multiple anastamotic suture lines, which increases the risks for coagulopathic bleeding and the need for massive transfusions. The purpose of this report is to describe our approach, involving advanced surgical techniques and the innovative perfusion considerations as well as modified blood management strategies to minimize perioperative blood loss and the need for transfusions. All of the above will highlight critical cardiac team communications. An ever-evolving case requires forward thinking, revised judgments, open discussion and the continued involvement of all team members. In turn, this ensures evidence-based medical and perfusion practices that lead to achieving a positive peri-operative course, with optimal blood conservation. [ABSTRACT FROM AUTHOR]

Antidepressants are a widely prescribed group of pharmaceuticals that can be biotransformed in humans to biologically active metabolites. In the present study, the distribution of six antidepressants (venlafaxine, bupropion, fluoxetine, sertraline, citalopram, and paroxetine) and five of their metabolites was determined in a municipal wastewater treatment plant (WWTP) and at sites downstream of two WWTPs in the Grand River watershed in southern Ontario, Canada. Fathead minnows (Pimephales promelas) caged in the Grand River downstream of a WWTP were also evaluated for accumulated antidepressants. Finally, drinking water was analyzed from a treatment plant that takes its water from the Grand River 17 km downstream of a WWTP. In municipal wastewater, the antidepressant compounds present in the highest concentrations (i.e., >0.5 µg/L) were venlafaxine and its two demethylation products, O- and N-desmethyl venlafaxine. Removal rates of the target analytes in a WWTP were approximately 40%. These compounds persisted in river water samples collected at sites up to several kilometers downstream of discharges from WWTPs. Venlafaxine, citalopram, and sertraline, and demethylated metabolites were detected in fathead minnows caged 10 m below the discharge from a WWTP, but concentrations were all <7 µg/kg wet weight. Venlafaxine and bupropion were detected at very low (<0.005 µg/L) concentrations in untreated drinking water, but these compounds were not detected in treated drinking water. The present study illustrates that data are needed on the distribution in the aquatic environment of both the parent compound and the biologically active metabolites of pharmaceuticals. Environ. Toxicol. Chem. 2010;29:79–89. © 2009 SETAC [ABSTRACT FROM AUTHOR]