Search

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians. Key words: comprehensive health care; scope of practice; primary care; family medicine; cohort effect; Canada https://doi.org/10.1370/afm.2945, INTRODUCTION Declining comprehensiveness of family physician practice has been documented across multiple jurisdictions, (1-8) with accompanying speculation that this is driven by lack of interest or inadequate training among more [...]

Niraparib was recently funded in Canada for the maintenance treatment of ovarian cancer following platinum-based chemotherapy. However, the drug's safety profile in the real world remains uncertain. We conducted a cohort study to describe the patient population using niraparib and the proportion that experienced adverse events between June 2019 and December 2022 in four Canadian provinces (Ontario, Alberta, British Columbia [BC], and Quebec). We used administrative data and electronic medical records from Ontario Health, Alberta Health Services, and BC Cancer, and registry data from Exactis Innovation. We summarized baseline characteristics using descriptive statistics and reported safety outcomes using cumulative incidence. We identified 514 patients receiving niraparib. Mean age was 67 years and most were initiated on a daily dose of 100 or 200 mg/day. Grade 3/4 anemia, neutropenia, and thrombocytopenia occurred in 11–16% of the cohort. In Ontario, the three-month cumulative incidence of grade 3/4 thrombocytopenia was 11.6% (95% CI, 8.3–15.4%), neutropenia was 7.1% (95% CI, 4.6–10.4%), and anemia was 11.3% (95% CI, 8.0–15.2%). Cumulative incidences in the remaining provinces were similar. Initial daily dose and proportions of hematological adverse events were low in the real world and may be related to cautious prescribing and close monitoring by clinicians. [ABSTRACT FROM AUTHOR]

Background Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. Methods This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Results Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Conclusions Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization. [ABSTRACT FROM AUTHOR]

NaTi2(PO4)3 (NTP) and Na0.44MnO2 (NMO), and their derivatives, have emerged as the most promising materials for aqueous Na‐ion batteries. For both, NTP and NMO, avoiding the evolution of hydrogen and oxygen is found to be mandatory in order to mitigate material dissolution. Intriguingly, however, no direct determination of the hydrogen and oxygen evolution reactions (HER and OER) has yet been carried out. Using differential electrochemical mass spectrometry (DEMS) we directly identify the onset potentials for the HER and OER. Surprisingly, the potential window is found to be significantly smaller than suggested by commonly employed cyclic voltammetry measurements. CO2 evolution, upon decomposition of carbon black, is observed at an onset potential of 1.61 VRHE, which is 0.25 V more cathodic than the OER for the NMO electrode. Our results show that the state‐of‐the‐art carbon additive plays a crucial role in the stability of the positive NMO electrode in the ion battery. [ABSTRACT FROM AUTHOR]

NaTi2(PO4)3 (NTP) is known as a promising insertion‐type anode material for aqueous and non‐aqueous sodium‐ion batteries (SIBs), due to its NASICON‐type open 3D framework which makes a zero‐strain insertion mechanism possible. NTP is considered to be an environmentally friendly, low‐cost and high safety material. However, the electrochemical performance of NTP is limited due to its poor electrical conductivity. In this work a solvothermal synthesis method is used to synthesize NTP with a nanocube (NC) morphology. In a one‐step synthesis rutile titanium dioxide (TiO2) and carbon coating of NTP are achieved (NTP/C‐RT), simultaneously, which significantly improves the poor electrical conductivity of NTP. Additional rutile coating is used to further improve the electrochemical performance compared to simple carbon coating. Rate capabilities of 301 mAh/g are achieved for NTP/C‐RT compared to 248 mAh/g for NTP/C at 0.1 C. That is, to the best of our knowledge, the highest gravimetric capacity reported for SIBs using NTP as anode material up to now. The results prove that NTP, which is itself already a promising anode material for SIBs, can be further enhanced with a combined approach of NC morphology, carbon and rutile coating, leading to superior capacities, higher than anywhere else reported in literature. [ABSTRACT FROM AUTHOR]

Plume downwash at a large oil-gathering facility in the Prudhoe Bay, Alaska oil-field reservation was simulated in a series of numerical experiments. The model is a three-dimensional, Cartesian coordinate, finite difference code that solves the nonhydrostatic, time-averaged equations for the conservation of momentum and energy. The code uses a modified form of the standard first-order, two-equation (k-ε) engineering turbulence closure model. We have used the numerical model to simulate directly the mean features of the flow field and dispersion from a buoyant source at an industrial site. The flow features varied depending on the size, number, and orientation of the buildings. The results generally reproduce the plume downwash and dispersion observed in wind tunnel and field investigations. -from Authors