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Youth-Creative Action Research (Y-CAR) is a variant of participatory action research specifically suited for exploring and developing evidence-informed innovations to address complex social challenges such as climate change. In this paper, we present an overview of Y-CAR and explore its core defining features, potential for application in research and action, and connection to other action-oriented research methodologies. We draw on a range of examples of this emergent methodology that illustrates its evolution and core principles in action and show how it has been implemented in research. We conclude the paper by examining key learnings, future leverage points, and limitations to applying Y-CAR in practice.

Chlorofluorocarbons (CFCs) are harmful ozone depleting substances and greenhouse gases. CFC production was phased-out under the Montreal Protocol, however recent studies suggest new and unexpected emissions of CFC-11. Quantifying CFC emissions requires accurate estimates of both atmospheric lifetimes and ongoing emissions from old equipment (i.e. ‘banks’). In a Bayesian framework we simultaneously infer lifetimes, banks and emissions of CFC-11, 12 and 113 using available constraints. We find lifetimes of all three gases are likely shorter than currently recommended values, suggesting that best estimates of inferred emissions are larger than recent evaluations. Our analysis indicates that bank emissions are decreasing faster than total emissions, and we estimate new, unexpected emissions during 2014-2016 were 23.2, 18.3, and 7.8 Gg/yr for CFC-11, 12 and 113, respectively. While recent studies have focused on unexpected CFC-11 emissions, our results call for further investigation of potential sources of emissions of CFC-12 and CFC-113, along with CFC-11., The production of chlorofluorocarbons (CFC) was phased-out under the Montreal, but renewed emissions of CFC-11 have been reported recently. Here, the authors present a joint analysis of multiple factors and find that emissions of CFC-11, but also CFC-12 and CFC-113 are higher than expected, indicating renewed emissions.

Background Pre-existing gender-based disparities in academia may have worsened during the COVID-19 pandemic. Being cited as an expert source in newspaper articles about COVID-19 may increase an individual’s research or leadership profile. In addition, visibility in a newspaper article is an important component of representation in academia. Objective To determine whether women were underrepresented as COVID-19 expert sources in print newspapers in the USA. Design We undertook a cross-sectional study of English-language newspaper articles that addressed the COVID-19 pandemic and that were published in the top 10 most widely read newspapers in the USA between April 1 and April 15, 2020. Main Measures We extracted the names of all people cited as expert sources and categorized the gender of each expert source based on pronoun usage within the article or on a business, university, or organization website. The professional role of each expert was assigned based on their description in the article. Key Results Of 2297 expert sources identified, 35.9% (95% confidence interval [CI] 33.9–37.8%; n = 824) were women and 63.7% were men (95% CI 61.8–65.7%; n = 1464). This result was similar when considering unique experts in each newspaper and for all included newspapers; of the 1738 unique experts per newspaper, 34.6% were women (95% CI 32.3–36.8%; n = 601), and of the 1593 unique experts in all newspapers, 36.5% were women (95% CI 34.1–38.9%; n = 581). Of articles with multiple experts referenced (n = 374), 102 cited only men experts (27.3%) and 44 cited only women experts (11.8%). Women were underrepresented as experts as Healthcare Workers and Professionals, Non-STEM Experts, Public Health Leaders, and STEM Scientists. There were no differences in the proportion of women experts between newspapers or between different regions of the USA. Conclusions Altogether, our findings support that men academics outnumber women as COVID-19 experts in newspaper articles. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-020-06579-3.

BackgroundWalk-in clinics are non-hospital based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provides urgent, but not emergent care during extended hours. This study identifies publicly-reported access characteristics for episodic primary care in BC, and provides a clinic-level comparison between walk-in clinics and UPCCs.MethodologyThis cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services.ResultsIn total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offer the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offer the majority (889.3/ 53.7%) of their service hours after 17:00.ConclusionMost walk-in clinics are associated with a longitudinal family practice and provide the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary health care delivery.

OBJECTIVE The objective of this scoping review is to map and identify the symptoms, adverse events, and outcomes in the use of medicinal cannabis in children and adolescents with autism spectrum disorder. INTRODUCTION Autism spectrum disorder is a neurodevelopmental disorder that impacts social communication and social interaction, and is associated with restrictive and repetitive behaviors and interests. Medicinal cannabis has become a potential area of interest for parents for the treatment of autism spectrum disorder symptoms in their children. There is some evidence that cannabinoids may be involved in autism spectrum disorder, laying a potential foundation for medicinal cannabis utility; however, previous reviews did not identify any clinical research on this topic. INCLUSION CRITERIA This scoping review will consider all published and unpublished studies that investigate the use of medicinal cannabis in autism spectrum disorder, where at least 50% of the participants have a diagnosis of autism spectrum disorder and at least 50% of the study population is 0 to 18 years of age, or where pediatric data are reported separately. Studies undertaken in any context (hospital or community) and in any geographic location will be included. METHODS We will search MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar, and the gray literature sources for studies. Two independent team members will screen titles and abstracts, review full texts for potential inclusion, and extract data for all studies. The results will be presented as a narrative synthesis and in tabular form.

Background: Few academic and clinical institutions identifying systematic methods of creating and subsequently evaluating the impact of youth-driven research programs. Little is known about the impact of a participatory approach in adolescent health research and the specific benefits youth derive from such experiences. This study evaluates the feasibility, benefits and limitations of an international participatory health research (PHR) project involving young patients as co-researchers. Methods: Youth co-researchers collaborated over the course of one year in a PHR project. A standardized feedback survey and qualitative interview were employed to evaluate the impact of co-researchers' personal and academic growth. Limitations were documented by the Council Chair in real time and included limiting events or identified challenges. Feasibility was determined by the percentage of youth members who actively participated, defined as 75% or more, and the outcome of a completed project. Findings: Sixteen adolescents aged 13-23 years representing 9 global academic institutions from the International Children's Advisory Network Youth Council participated as youth co-researchers (YCR). A difference was seen in the impact they believe youth can have in healthcare prior to and after involvement. 81% of participants reported interest in health research and 100% stating that they felt that their participation made an impact on pediatric healthcare. 75% of youth were interested in pursuing a career in healthcare prior to the project with no significant difference in results after participation. Interpretation: Youth reported growth in areas of cooperative learning and advocacy with tangible examples of improvements in leadership skill. This shift in roles from patient to research partner is echoed in the strong conviction of the newfound possibilities of accomplishment as a group. Further work is required in this area to more clearly define the impact of youth as PHR researchers. Funding Statement: The authors state: "No sources of funding to declare." Declaration of Interests: The authors state: "No conflict declared." Ethics Approval Statement: All materials were reviewed and approved by the Connecticut Children’s Medical Centre Institutional Review Board #18-081.

The team mapping method engages participants in rapid, facilitated co-creation workshops to help groups explore how to work together in a primary care team. It uses patient personas (local evidence-based simulated cases) to explore team structure through paper prototyping circles of care (the persona's healthcare system). Roles and tasks are collectively defined through the discussion. Team mapping builds on three foundational methods and, through a three-stage process, facilitates the formation and strengthening of new and existing relationships, fostering team development through the process. This paper describes team mapping, outlines when it can be applied and highlights the benefits for teams.

ObjectiveEvidence is needed to guide organisational decision making about workplace accommodations for pregnant physicians. Our objective was to characterise the strengths and limitations of current research examining the association between physician-related occupational hazards with pregnancy, obstetrical and neonatal outcomes.DesignScoping review.Data sourcesMEDLINE/PubMed, EMBASE, CINAHL/ EBSCO, SciVerse Scopus and Web of Science/Knowledge were searched from inception to 2 April 2020. A grey literature search was performed on 5 April 2020. The references of all included articles were hand searched for additional citations.Eligibility criteriaEnglish language citations that studied employed pregnant people and any ‘physician-related occupational hazards’, meaning any relevant physical, infectious, chemical or psychological hazard, were included. Outcomes included any pregnancy, obstetrical or neonatal complication.Data extraction and synthesisPhysician-related occupational hazards included physician work, healthcare work, long work hours, ‘demanding’ work, disordered sleep, night shifts and exposure to radiation, chemotherapy, anaesthetic gases or infectious disease. Data were extracted independently in duplicate and reconciled through discussion.ResultsOf the 316 included citations, 189 were original research studies. Most were retrospective, observational and included women in any occupation rather than healthcare workers. Methods for exposure and outcome ascertainment varied across studies and most studies had a high risk of bias in data ascertainment. Most exposures and outcomes were defined categorically and results from different studies could not be combined in a meta-analysis due to heterogeneity in how these categories were defined. Overall, some data suggested that healthcare workers may have an increased risk of miscarriage compared with other employed women. Long work hours may be associated with miscarriage and preterm birth.ConclusionsThere are important limitations in the current evidence examining physician-related occupational hazards and adverse pregnancy, obstetrical and neonatal outcomes. It is not clear how the medical workplace should be accommodated to improve outcomes for pregnant physicians. High-quality studies are needed and likely feasible.

Objectives To conceptualize new methods for integrating patient-centered measurement into team-based care. Methods A standalone portal was introduced into a rural clinic to support conceptualization of new methods for integration of patient-centered measurement in team-based care. The portal housed mental health-related online resources, three patient-reported measures and a self-action plan. Six providers and four patients used the portal for four months. Our data collection techniques included clinic discussions, one-on-one interviews, workflow diagrams and data generated through the portal. Analysis was supported through coding interview transcripts, looking across multiple sources of research data and research team discussions. Results Our research team conceptualized five team-based patient-centered measurement methods through this study. Patient-centered measurement Team Mapping offfers a technique to provide greater clarity of care-team roles and responsibilities in data collected through patient-centered measurement. Longitudinal Care Alignment can guide the care-team on incorporating patient-centered measurement into ongoing provider–patient interactions. Digital Tool Exploration can be used to evaluate a team's readiness toward digital tool adoption, and the impact of these tools. Team-based quality improvement serves as a framework for engaging teams in patient-centered quality improvement. Shared learning is a method that promotes patientprovider interactions that validate patient's perspectives of their care. Conclusion The portal illuminated new methods for the integration of patient-centered measurement in team-based care. The first three proposed patient-centered measurement methods provides ways to assess how a clinic can incorporate patient-centered measurement methods into team-based care. The latter two methods focus on the aim of patient-generated data in which patient's values and perspectives are represented and quality of patient-centered care can be evaluated. Further testing is needed to assess the utility of these patient-centered measurement methods across different clinical settings and domains.

An enormous global effort is being made to study SARS-CoV-2 and develop safe and effective treatments. Studying the entire virus replication cycle of SARS-CoV-2 is essential to identify host factors and treatments to combat the infection. However, quantification of released virus often requires lengthy procedures, such as endpoint dilution assays or reinfection with engineered reporter viruses. Quantification of viral RNA in cell supernatant is faster and can be performed on clinical isolates. However, viral RNA purification is expensive in time and resources and often unsuitable for high-throughput screening. Here, we show a direct lysis RT-qPCR method allowing sensitive, accurate, fast, and cheap quantification of SARS-CoV-2 in culture supernatant. During lysis, the virus is completely inactivated, allowing further processing in low containment areas. This protocol facilitates a wide array of high- and low-throughput applications from basic quantification to studying the biology of SARS-CoV-2 and to identify novel antiviral treatmentsin vitro.

BACKGROUND Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. OBJECTIVE The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). METHODS The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. RESULTS The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. CONCLUSIONS The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.

Infectious diseases of farmed and wild animals pose a recurrent threat to food security and human health. The macrophage, a key component of the innate immune system, is the first line of defence against many infectious agents and plays a major role in shaping the adaptive immune response. However, this phagocyte is a target and host for many pathogens. Understanding the molecular basis of interactions between macrophages and pathogens is therefore crucial for the development of effective strategies to combat important infectious diseases. We explored how pluripotent stem cells (PSCs) can provide a limitlessin vitrosupply of genetically and experimentally tractable macrophages from livestock. Porcine and bovine PSC-derived macrophages (PSCdMs) exhibited molecular and functional characteristics ofex vivoprimary macrophages. Pig PSCdMs were productively infected by Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) and African Swine Fever Virus (ASFV), two of the most economically important and devastating viruses in pig farming. Moreover, Pig PSCdMs were readily amenable to genetic modification by CRISPR/Cas9 gene editing applied in parental stem cells, or directly by lentiviral vector transduction. PSCs and differentiated derivatives therefore provide a useful and ethical experimental platform to investigate the genetic and molecular basis of host-pathogen interactions in livestock.

Background Autism spectrum disorder (ASD) is a neurodevelopmental condition estimated to affect 1 in 66 children in Canada, and 1 in 270 individuals worldwide. As effective therapies for the management of ASD core and associated symptoms are limited, parents are increasingly turning to clinicians for advice regarding the use of medicinal cannabis to manage behavioural disturbances. Objective The objective of this scoping review was to identify and map symptoms, outcomes and adverse events related to medicinal cannabis treatment for ASD-related behaviours. Methods Ovid MEDLINE, Embase, CINAHL, PsycInfo, Web of Science Core Collection, Google Scholar, and grey literature sources were searched up to January 5, 2020 for studies. Included studies met the following criteria: 1) investigate the use of medicinal cannabis, 2) at least 50% participants had ASD, 3) at least 50% of the study population was 0-18 years old, and 4) any study design (published or unpublished). Results We identified eight completed and five ongoing studies meeting the inclusion criteria. All studies reported substantial behaviour and symptom improvement on medicinal cannabis, with 61-93% of subjects showing benefit. In the three studies reporting on concomitant psychotropic medication usage and with cannabis use, up to 80% of participants observed a reduction in concurrent medication use. Adverse events related to cannabis use were reported in up to 27% of participants related, and two participants had psychotic events. Conclusions Early reports regarding medicinal cannabis in pediatric ASD symptom management are presented as positive; the evidence, however, is limited to very few retrospective cohort and observational studies. Evidence of safety and efficacy from prospective clinical trials is needed.

Background: Adverse events (AE) are common for hospitalized Canadians, and lead to worse patient outcomes. Monitoring patient safety is logistically challenging. We aimed to validate the use of our electronic health record (EHR) to monitor important patient safety. Methods: EHR data was used to identify patients who were exposed to one of four high-priority safety outcomes: venous thromboembolism, dysglycemia, Clostridium difficile(C. difficile) infection, and prolonged nil per os(NPO) orders. A manual chart review was performed to determine the sensitivity and specificity of the EHR for each patient safety outcome. Results: The sensitivity and specificity ranged from 38.4% to 78.1% and 88.1 to 99.2%, respectively, for the prespecified patient safety outcomes. Conclusion: The EHR is reasonably sensitive and specific to monitor rates of dysglycemia, C. difficileinfection, and prolonged NPO in medical inpatients, but does not have adequate sensitivity to be used to capture venous thromboembolism safety outcomes.

Water resources planning requires decision-making about infrastructure development under uncertainty in future regional climate conditions. However, uncertainty in climate change projections will evolve over the 100-year lifetime of a dam as new climate observations become available. Flexible strategies in which infrastructure is proactively designed to be changed in the future have the potential to meet water supply needs without expensive over-building. Evaluating tradeoffs between flexible and traditional static planning approaches requires extension of current paradigms for planning under climate change uncertainty which do not assess opportunities to reduce uncertainty in the future. We develop a new planning framework that assesses the potential to learn about regional climate change over time and therefore evaluates the appropriateness of flexible approaches today. We demonstrate it on a reservoir planning problem in Mombasa, Kenya. This approach identifies opportunities to reliably use incremental approaches, enabling adaptation investments to reach more vulnerable communities with fewer resources., Water resources planning requires infrastructure development consider regional climatic uncertainties. Here the authors introduce a new dynamic planning framework that captures opportunities to learn about climate change over time. By applying it to reservoir planning in Kenya, they show the value of flexible approaches in responding to learning.

Increasingly frequent and severe droughts are jeopardizing urban water security in water stressed regions, but cities also struggle to justify the costs and energy consumption of some drought-resilient technologies. Previous literature in urban water modeling developed strategies to expand and diversify urban water supply portfolios to enhance water resilience cost effectively. This literature has also demonstrated that high-resolution, household-level modeling is necessary to represent the real energy footprint of different water technologies and the integration of centralized and decentralized water solutions. This urban-focused modeling scale, however, does not support the characterization of water availability at extra-urban sources resulting from watershed-wide hydrological processes. Conversely, watershed-scale water resources planning characterizes water variability and stress, supports climate change analysis, but overlooks key distributional and technological aspects. This project develops a watershed-to-end-user decision support tool for cost-effective, adaptive water augmentation pathways to ensure robustness in many climate futures. The novelty of our work lies in a true multiscale modeling framework that captures the complex system dynamics that link climate impacts to household water security. A robust, multi-objective, evolutionary-based optimization framework (i.e., EMODPS) is used to derive the technology portfolio, deployment location, and construction timing that defines a city’s Pareto frontier of water resilience and cost. This work informs urban water resource planners, as well as guides technology innovation by explicitly valuing technology attributes that enable resilience to droughts of varying duration, severity, and intensity. We apply this model to the City of Santa Barbara, California, given the time relevance to city planning efforts, the diversified water supply mix, and the relative isolation of the community, enclosed between the ocean and a mountain range.

A striking feature of severe COVID-19 is thrombosis in large as well as small vessels of multiple organs. This has led to the assumption that SARS-CoV-2 virus directly infects and damages the vascular endothelium. However, endothelial expression of ACE2, the cellular receptor for SARS-CoV-2, has not been convincingly demonstrated. Interrogating human bulk and single-cell transcriptomic data, we found ACE2 expression in endothelial cells to be extremely low or absent in vivo and not upregulated by exposure to inflammatory agents in vitro. Also, the endothelial chromatin landscape at the ACE2 locus showed presence of repressive and absence of activation marks, suggesting that the gene is inactive in endothelial cells. Finally, we failed to achieve infection and replication of SARS-CoV-2 in cultured human endothelial cells, which were permissive to productive infection by coronavirus 229E that uses CD13 as the receptor. Our data suggest that SARS-Cov-2 is unlikely to infect endothelial cells directly; these findings are consistent with a scenario where endothelial injury is indirectly caused by the infection of neighbouring epithelial cells and/or due to systemic effects mediated by immune cells, platelets, complement activation, and/or proinflammatory cytokines.