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• Canadian E-waste recycling data from 2012 to 2020 are systematically assessed. • Regression and Mann-Kendall analyses are used to quantify the temporal trends. • Both collection points and stewardship organizations have grown exponentially. • The role of public awareness on e-waste recycling varied between provinces. • Operational expenditure and revenue on stewardship resilience should be monitored. Electronic waste recycling companies have proliferated in many countries due to valuable materials present in end-of-life electronic and electrical equipment. This article examined the business characteristics and management performance of Electronic Products Recycling Association (EPRA), a Canadian nationwide electronic product stewardship organization. The organization's annual performance reports, from 2012 to 2020, for nine Canadian provinces in which it currently operates were aggregated and analyzed. Temporal analysis using regression and Mann-Kendall tests were employed, and five characteristics of EPRA's business were analyzed, including e-waste products collected, number of drop-off locations, efforts to build public awareness, operating expenses, and growth of e-waste stewardship. Results show a decline in the amount of e-waste collected across the provinces, except in New Brunswick, which started its program in 2017. The Mann-Kendall test revealed declining temporal trends in most provinces. Although the collection/drop off sites and stewardship organizations increased astronomically over the study period in Canada, the amounts of e-waste collected decreased. We found that public awareness generally did not increase the amount of e-waste collected, and these campaigns only appeared to be effective in jurisdictions with good accessibility of e-waste recycling. Processing cost accounted for the majority of the e-waste management budget in Canada, and different factors affected the financial success of the stewards differently. [ABSTRACT FROM AUTHOR]

Venetoclax is a first-in-class B-cell lymphoma-2 (BCL-2) inhibitor approved as continuous monotherapy and in combination with rituximab as fixed-treatment duration for relapsed and refractory chronic lymphocytic leukemia (R/R CLL). DEVOTE was a 24-week, multicenter observational study (NCT03310190) evaluating the safety, healthcare resource utilization (HCRU) and health-related quality of life (HRQoL) of patients initiating venetoclax for R/R CLL in Canada. Overall, 89 patients received 1 dose of venetoclax; 80% had prior exposure (42% resistant) to ibrutinib. Biochemical tumor lysis syndrome (TLS) occurred in five patients. We observed differences in hospitalization across Canadian provinces including in patients at low risk for TLS with no clear impact on TLS incidence. Additionally, a rapid and sustained improvement in several domains of HRQoL was observed during venetoclax initiation. Early adoption of venetoclax was mainly for R/R CLL patients with few treatment options; nonetheless, acceptable toxicity and a positive impact on HRQoL were observed. [ABSTRACT FROM AUTHOR]

Understanding the phenology of migration is fundamental to management of migratory gamebirds, in part because of the role migratory timing plays in setting harvest regulations. Migratory timing is particularly important for determining appropriate dates for hunting seasons, which may be selected to coincide with major periods of migration, according to local management objectives. We used global positioning system (GPS)‐transmitters to track American woodcock (Scolopax minor), characterize the timing of woodcock migration, and identify sources of variation in timing relative to current hunting season structures in eastern North America. We captured 304 woodcock in 3 Canadian provinces and 12 states from 2017 to 2020, primarily within the Eastern Woodcock Management Region. Using locations collected every 1.7 days on average, we assessed whether initiation, termination, or stopover timing of woodcock migration during fall and early spring varied geographically, differed among age and sex classes, or was influenced by individual body condition. During fall, woodcock migrating from summer use areas farther north and west (e.g., Ontario, Quebec, Canada) initiated and terminated migration earlier than woodcock migrating from areas farther south and east (e.g., Rhode Island, USA). Adult woodcock made multiday stopovers that were 3 days longer on average than juveniles and females made more stopovers on average (8.0 stopovers) compared to males (6.1 stopovers). During the onset of spring migration, woodcock that wintered farther west initiated migration before birds that spent the winter farther east, and males initiated migration on average 6 days earlier than females. Under the current 45‐day harvest regulatory framework in the United States, hunting seasons in northern breeding and southern wintering areas are generally consistent with migration phenology. At more intermediate latitudes, however, periods of migration are generally longer than 45 days, resulting in many circumstances where migrating woodcock are present during periods when hunting seasons are closed. Managers in mid‐latitude states could consider opening hunting seasons later, allowing hunters to harvest more migrant woodcock. [ABSTRACT FROM AUTHOR]

Background: The drug toxicity crisis continues to accelerate across Canada, with rapid increases in opioid-related harms following the onset of the COVID-19 pandemic. We sought to describe trends in the burden of opioid-related deaths across Canada throughout the pandemic, comparing these trends by province or territory, age, and sex. Methods: We conducted a repeated cross-sectional analysis of accidental opioid-related deaths between Jan. 1, 2019, and Dec. 31, 2021, across 9 Canadian provinces and territories using aggregated national data. Our primary measure was the burden of premature opioid-related death, measured by potential years of life lost. Our secondary measure was the proportion of all deaths attributable to opioids; we used the Cochrane–Armitage test for trend to compare proportions. Results: Between 2019 and 2021, the annual number of opioid-related deaths increased from 3007 to 6222 and years of life lost increased from 126 115 to 256 336 (from 3.5 to 7.0 yr of life lost per 1000 population). In 2021, the highest number of years of life lost was among males (181 525 yr) and people aged 30–39 years (87 045 yr). In 2019, we found that 1.7% of all deaths among those younger than 85 years were related to opioids, rising to 3.2% in 2021. Significant increases in the proportion of deaths related to opioids were observed across all age groups (p < 0.001), representing 29.3% and 29.0% of deaths among people aged 20–29 and 30–39 years in 2021, respectively. Interpretation: Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults. The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts. [ABSTRACT FROM AUTHOR]

This study investigated the diagnostic capacity for Fetal Alcohol Spectrum Disorder (FASD) in multidisciplinary clinics across several provincial and one territorial jurisdictions of Canada: Alberta, British Columbia, Manitoba, Ontario and Northwest Territories. The data were collected directly from clinics capable of providing diagnoses of FASD and examined annual capacity for the assessment and diagnosis of FASD per year from 2015 to 2019. In total, 58 FASD diagnostic clinics were identified and 33 clinics participated in this survey. The study identified inadequate FASD diagnostic capacity in all participating jurisdictions. Based on the findings and the current population sizes, it is estimated that 98% of individuals with FASD are undiagnosed or misdiagnosed in Canada. Wait times for FASD diagnosis ranged from 1 month to 4.5 years across participating jurisdictions. The annual FASD diagnostic capacity in the select provinces and territories require at least a 67-fold increase per year. [ABSTRACT FROM AUTHOR]

Slave Province in Canada is an Archean granite–supracrustal terrane at the northwestern corner of the Canadian Shield. It is bordered by the Thelon–Taltson orogen (2.0 to 1.9 Ga) to the southeast and the Wopmay orogen (1.9 to 1.8 Ga) to the west. Acasta gneisses, exposed in the westernmost Slave Province, and the Wopmay rocks, located close to the gneisses, were systematically collected for K–Ar and laser step-heating 40Ar/39Ar single-crystal analyses of the biotite and amphibole. The K–Ar biotite ages of the four Wopmay samples range from 1816 ± 18 Ma to 1854 ± 26 Ma. The 40Ar/39Ar biotite analyses of the three Wopmay samples yield plateau ages of 1826 ± 21 Ma, 1886 ± 13 Ma, and 1870 ± 18 Ma. These ages fall within the reported U–Pb zircon age range of the Wopmay orogen. The K–Ar biotite ages of the fifteen Acasta gneisses range from 1779 ± 25 Ma to 1877 ± 26 Ma, except for one younger sample (1711 ± 25 Ma). The 40Ar/39Ar analyses of the biotite crystals from three samples give the plateau ages of 1877 ± 8 Ma, 1935 ± 14 Ma, and 1951 ± 11 Ma. The K–Ar amphibole ages from twelve samples range from 1949 ± 19 Ma to 1685 ± 25 Ma. Two samples of them give ages older than the zircon U-Pb age of Hepburn plutons. The 40Ar/39Ar analyses of the amphibole crystals show varied age relations. The two samples give plateau ages of 1814 ± 22 Ma and 1964 ± 12 Ma. Some samples exhibit apparent old ages of ~2000 Ma in the middle temperature fractions. These old fractions result from the amphibole crystals, originally formed in the Archean, being affected by the thermal events during the Wopmay orogeny but not fully resetting. These observations suggest that the K–Ar system ages of the biotite and amphibole in the Archean Acasta gneiss were rejuvenated during the Paleoproterozoic ages. The Discussion explores the possibility that the heat source rejuvenating the K–Ar system ages may have arisen due to asthenospheric extrusion into the wedge mantle, a process likely triggered by subduction rollback. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of the concept of the complete community or neighborhood in Canadian planning practice and the recent spread of the idea in the United States, few scholars have examined the idea's development and implications. Based on a content and thematic analysis of 102 plans and policies representing all Canadian provinces and territories, along with 205 planner interviews, I argue that the complete community represents an integrative, scalable, and flexible planning theory originating from practice. Borrowing principles from other theories (such as smart growth and sustainable development), practitioners built the complete community idea bottom-up, as a persuasive rhetorical vehicle for describing planning intentions and justifying higher densities in positive ways. Contemporary planning values increasing urban densities, mix, and walkability. Here I illustrate how planners adapted to community resistance to ideas generated by external experts—and to efforts to increase growth and densities—by articulating a socially and politically positive option for urban transformation. The complete community concept places a halo over density, promising vibrancy and livability. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hearing loss in Canada is high, with many patients requiring implantable hearing devices (IHDs) as treatment for their disease severity. Despite this need, many eligible patients do not pursue these interventions. The objective of this study was to examine rates of IHD based on geographic location to understand locoregional variation in access to care. Study Design: This was a retrospective population-based cohort study. Setting: All hospitals in the Canadian province of Ontario. Methods: Of all patients with IHD between April 1, 1992, and March 31, 2021, cochlear implants (CIs) (4,720) and bone-anchored hearing aids (BAHA) (1,125) cohorts were constructed. Place of residence was categorized based on Local Health Integrated Network (LHIN). Summary statistics for place of surgical institution based on LHIN at first surgery, name of institution of first surgery and "as the crow flies" distance (in km) between place of residence and surgical institution were calculated. Rate of implantations was calculated for LHIN regions based on number of surgeries per 1,000,000 persons/years. Results: Toronto Central, Central, Central East, and Champlain regions had >10% of patients undergoing BAHA and CI. 1,019 (90.6%) and 4,232 (89.7%) of patients receiving BAHA and CI, respectively, resided in urban/suburban regions and 94 patients (8.4%) and 436 (9.2%) resided in rural regions. The median distance between residential location and the institution was 46.4 km (interquartile range [IQR], 18.9–103.6) and 44.7 km (IQR, 15.7–96.9) for BAHA and CI, respectively. From 1992 to 2021, the number of CI and BAHA performed across Ontario increased by 17 folds and 6 folds, respectively. Conclusion: This large comprehensive population study provides longitudinal insight into the access to care of IHD based on geographic factors. Our findings of the present population-based study indicate an overall increase in access to devices with disproportionate access to care based on geographic locations. Further work is needed to characterize barriers to IHD access to align with demands. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) can improve the physical and psychosocial health of individuals with cancer, yet PA levels remain low. Technology may address PA maintenance barriers in oncology, though the intervention effectiveness to date remains mixed. Qualitative research can reveal the nuances of using technology-based PA maintenance tools. The present study aimed to understand the perspectives of individuals with cancer on using an app to support PA maintenance. Methods: Individuals were interviewed after using a self-monitoring app for 24 weeks, asking about their app use, ease of use, and perceived value for supporting PA. Analyses were guided by an interpretive description. Results: Eighteen individuals were interviewed. The participants were 37–75 years old; lived in seven Canadian provinces/territories; identified as White, South Asian, or Indigenous; and had eight different cancers. Four themes were developed: some did not need the app to stay physically active, some valued the app for helping them maintain their PA, the user experience ranged from intuitive to confusing, and the time burden of app use ranged from acceptable to overwhelming. Conclusions: The participants provided insights on using a self-monitoring app to improve PA maintenance in oncology. Work is needed to capture additional perspectives and apply findings to the development of technology-based PA maintenance tools. [ABSTRACT FROM AUTHOR]

Background:Child and youth mental health problems represent a substantial burden of illness in Canada, with appropriate services only inconsistently available. Charitable organizations, such as Kids Help Phone (KHP), are, therefore, crucial to filling system gaps by offering 24/7 phone, chat, texting, and peer-to-peer services. Methods:We describe the services provided by KHP, the volume of use for each service, and compare usage across Canada's provinces and territories for a 5-year period from January 2018 to December 2022. Trends seen during the COVID-19 pandemic are highlighted. Results:More than 1.5 million total number of conversations were held across texting, chat, and phone services over 5 years. Considerable growth is demonstrated between 2018 and 2022, and many of the highest peaks in volume occurred in March or April of 2020, the onset of the COVID-19 pandemic. The highest proportional volumes were consistently from the northern territories. Discussion:KHP cannot provide specialized or repeat services, nor can it alone meet the scale of unmet youth mental health needs across the country. Nonetheless, KHP plays a pivotal role in the Canadian mental health system. Efforts to understand the role that KHP and other e-mental health services like it play within the national mental health landscape should be intensified to aid in understanding unmet needs, identify system gaps, and make needed enhancements. [ABSTRACT FROM AUTHOR]

Background: The incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations. Methods: A national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center‐level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web‐based database that tracks postoperative outcomes was presented. The top two performing centers with regards to these metrics were chosen and surgeons from these hospitals discussed elements of their treatment pathways that contributed to these outcomes. Consensus recommendations were then identified with participants independently rating their level of agreement. Results: Twenty‐eight surgeons form 8 centers took part in the seminar across 5 Canadian provinces. Of the 680 included patients included, Clavien‐Dindo grade I and II/III/IV/V complications occurred in 121/39/12/2 patients (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied significantly between institutions (1 day, range 1‐3 vs. 7 days, 3‐8, p < 0.001). A strong level of agreement was achieved for 10/12 of the consensus statements generated. Conclusion: PD seminars provide a supportive forum for centers to review best evidence and experience and generate recommendations based on expert opinion. Further research is ongoing to determine if this approach effectively accomplishes this objective. [ABSTRACT FROM AUTHOR]

Forests contain substantial carbon stores, including above and belowground biomass and living and non-living biomass. Different management regimes produce different outcomes related to stored and sequestered carbon in forests. The geographic focus of this study is the Wabanaki-Acadian Forest of the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island). This study reviews the literature to evaluate the carbon impacts of (1) intensive forest management for fiber products, (2) unharvested (or conservation) forest, and (3) climate-focused, ecological forestry. Each of these forest management strategies and concomitant silviculture regimes sequester and store carbon at varying rates and across different carbon pools in the forest. The literature suggests that unharvested (conservation) forests store and sequester the most carbon, and traditional, intensive fiber management stores and sequesters the least. Ecological forestry may provide the best balance between carbon sequestration and storage and climate adaptability, while also allowing for the provision of some timber/fiber products. This study also discusses the co-benefits offered by forests under each of the three management regimes. New research, in general and in the region, needs to examine further belowground carbon dynamics in soil as most efforts to document carbon focus on aboveground carbon pools. [ABSTRACT FROM AUTHOR]

Objective: To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs. Methods: We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence. Results: We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup. Conclusions: Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD. [ABSTRACT FROM AUTHOR]

Introduction: Wildfires impact large populations worldwide with increasing frequency and severity. In Canada, the fire season has affected more areas this year with potential implications for individuals' well-being and quality of life (QoL). Objective: This study aimed to explore data related to the well-being and QoL of individuals living in areas impacted by wildfires in two Canadian provinces. Methodology: A cross-sectional survey was used to collect data from the residents in the two provinces who subscribed to the Text4Hope mental health support service. Descriptive and inferential statistics were applied using World Health Organization Well-Being Index (WHO-5). Results: Out of 1802 Text4Hope subscribers, 298 responded to the baseline surveys, yielding a response rate of (16.5%). The mean score of QoL was (40.8/100 ± 20.7). Most respondents were from Alberta (84.2%), 40 years old or below (28.3%), females (85.2%), Caucasian (83.5%), in a relationship (56.4%), employed (63.6%), received diagnoses of depression (56.6%), and anxiety (52.9%).The overall prevalence of low QoL was (67.3%; 95% CI: 61.2–73.1%) that was mostly reported among subscribers who were from Nova Scotia (70.5%), 40 years old or younger (71.2%), other gender (83.3%), Black/Hispanic and other ethnicity (85.7% each), having high-school or less education (70.3%), not in a relationship (74.1%), and unemployed (73.6%). In terms of clinical factors, low QoL was most prevalent among those who received the diagnoses of depression (74%) and anxiety (74.3%), and those who have been receiving antidepressants (71.8%) or benzodiazepines (93.3%). Regarding wildfire-related factors, the highest prevalence of low QoL was reported among those living in a region that has recently been impacted by the wildfires (74.7%) and those who have been less frequently watching television images about the devastation caused by the recent wildfires (72.6%). The multivariate logistic regression analysis model predicting the low QoL including the various variables was statistically significant; Χ2 (df = 19; n = 254) = 31.69, p = 0.03. It was found that living in a region impacted by wildfires (37.9%) was the only significant predictor of low QoL (adjusted OR: 1.96; 95% CI: 1.05–3.65). Conclusions: The impact of wildfire on the QoL and well-being among people living in impacted regions is significant. It is empirical for the health authorities to support those who are disadvantaged by wildfire via running of screening programs to early identify mental health symptoms and addressing the living conditions of the survivors, along with the provision of innovative means of mental health support. This necessitates enhanced planning of the governments and health authorities to overcome such adverse psychological consequences of these events. [ABSTRACT FROM AUTHOR]

Background: The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2lineages have been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Variants of concern (VOCs) and SARS-CoV-2 lineages associated with increased transmissibility and/or severity are of particular interest. Method: Here, we consider clinical and wastewater data sources to assess the emergence and spread of VOCs in Canada retrospectively. Results: We show that, overall, wastewater-based VOC identification provides similar insights to the surveillance based on clinical samples. Based on clinical data, we observed synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. Conclusion: In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence. In contrast, VOC Omicron achieved the same contribution in less than one month. This study provides significant benchmarks to enhance planning for future VOCs, and to some extent for future pandemics caused by other pathogens, by quantifying the rate of SARS-CoV-2 VOCs invasion in Canada. [ABSTRACT FROM AUTHOR]

Canadian provinces are required to regulate their power sectors using carbon pricing systems that meet national minimum stringency standards, which are set by the federal government. A diverse set of systems has emerged as a result. However, there has been limited assessment of how different pricing mechanisms impact the evolution of Canada's electricity system. To address this gap, we use an electricity system planning model called COPPER and a scenario-based approach to assess if, and to what extent, different policy regimes impact power sector greenhouse gas emissions and costs. Our results show that carbon pricing systems currently in place lead to significant carbon reductions over the long term, provided that free emissions allocations are reduced. However, the cost-optimal pathway for the power sector differs across provinces depending on the carbon pricing mechanism. Some provinces achieve least-cost emissions reductions by switching from high-carbon technologies to renewables, while others are better served by replacing high-carbon technologies with low-carbon fossil fuel alternatives. Further, provinces that implement cap-and-trade systems may affect the transitions of interconnected jurisdictions. Power sector climate policy design should reflect the heterogeneity of available assets, resources, and neighbouring approaches. [ABSTRACT FROM AUTHOR]

With limited phosphorus (P) supplies, increasing P demand, and issues with P runoff and pollution, developing an ability to reuse the large amounts of residual P stored in agricultural soils is increasingly important. In this study, we investigated the potential for residual soil P to maintain crop yields while reducing P applications and losses in Canada. Using a P cycling model coupled with a soil P dynamics model, we analyzed soil P dynamics over 110 years across Canada's provinces. We found that using soil residual P may reduce mineral P demand as large as 132 Gg P year−1 (29%) in Canada, with the highest potential for reducing P applications in the Atlantic provinces, Quebec, Ontario, and British Columbia. Using residual soil P would result in a 21% increase in Canada's cropland P use efficiency. We expected that the Atlantic provinces and Quebec would have the greatest runoff P loss reduction with use of residual soil P, with the average P loss rate decreasing from 4.24 and 1.69 kg ha−1 to 3.45 and 1.38 kg ha−1, respectively. Ontario, Manitoba, and British Columbia would experience relatively lower reductions in P loss through use of residual soil P, with the average runoff P loss rate decreasing from 0.44, 0.36, and 4.33 kg ha−1 to 0.19, 0.26, and 4.14 kg ha−1, respectively. Our study highlights the importance of considering residual soil P as a valuable resource and its potential for reducing P pollution. [ABSTRACT FROM AUTHOR]

The package PbIso is a free and open R toolbox for commonly used calculations and plots of Pb–Pb isotope data and for generating Pb evolution models. In this paper, we review Pb isotope systematics and the calculations that are commonly used, such as model age, model source μ (238U/204Pb), time-integrated κ (232Th/238U), and initial Pb isotope ratios. These equations are implemented into R functions in the package PbIso. In addition, functions are provided for generating Pb evolution models, paleoisochrons, and isochrons. This allows users to apply calculations to their data in a straightforward way while providing transparency and flexibility of the calculations used. We have implemented some basic features of the PbIso package into an online shiny R application (see https://shereearmistead.github.io/software/pbiso), which makes it easy for users without any R experience to use these calculations with their own data and to generate plots. We have provided a case study from the Superior Province in Canada, showing how different Pb evolution models can be generated in PbIso and compared to Pb isotope data. [ABSTRACT FROM AUTHOR]

Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada. [ABSTRACT FROM AUTHOR]

Legg Calve Perthes disease is a pediatric hip condition that leads to early hip degeneration. The efficacy of operative and nonoperative treatment is not well defined in the literature. Using the rate of total hip arthroplasty as a surrogate measure for symptomatic hip degeneration, the rate of total hip arthroplasty was compared in Legg Calve Perthes disease patients with and without previous surgical intervention in the province of Manitoba, Canada. A retrospective review was conducted using de-identified, individual-level administrative records of health services for the entire population of Manitoba. Codes for Legg Calve Perthes disease, femoral osteotomies, pelvic osteotomies, adductor tenotomies, and total hip arthroplasty were searched from 1984 to 2018. The rate of total hip arthroplasty in patients with Legg Calve Perthes disease was determined for two groups: (1) patients with earlier surgical intervention and (2) patients with no previous surgical intervention. Of the 202 patients included in the study, 180 had no prior surgery and 22 had prior surgery. The rate of total hip arthroplasty between the previous operative and nonoperative groups was found to be 32% and 40%, respectively (p = 0.458). There was no significant difference in rates of total hip arthroplasty in the operative and nonoperative groups. Further prospective studies are required to elucidate the differences in outcomes between operative and nonoperative treatment groups in patients with Legg Calve Perthes disease. [ABSTRACT FROM AUTHOR]

Elementary physical and health education (PHE) teachers play key roles in establishing inclusive learning environments. However, how they attend to inclusive pedagogy are not fully highlighted in the research literature. This study examined how elementary PHE teachers understand their roles in inclusion and how they attend to day-to-day inclusive pedagogy. Overall, 11 elementary PHE teachers from a province in Eastern Canada were invited to participate in an exploratory qualitative research study. Data were collected through one-on-one interviews and analysed thematically. Participants highlighted four areas where they attend day-to-day to enhance inclusiveness in their teaching: (1) plan universally from the beginning; (2) share ownership with students by providing students with leadership roles, responsibilities, and choices in learning; (3) create positive relationships and partnerships with students and co-educators; and (4) be responsive and reflexive in teaching. This study highlighted the experiences and insights of Canadian elementary PHE teachers in pursuing and enacting inclusive pedagogy. The findings will provide other in-service and pre-service elementary PHE teachers with pragmatic ideas of ensuring and/or strengthening inclusive PHE. The acquired empirical knowledge may also inform teachers in other disciplines, as well as school administrators, policy-makers, and stakeholders when developing/implementing future policies and actions concerning inclusion. [ABSTRACT FROM AUTHOR]

Although switching to antipsychotic monotherapy improves patient outcomes in schizophrenia, antipsychotic deprescribing is rarely performed, and its use varies between countries, as do psychotropic prescribing patterns. This study aimed to determine factors associated with antipsychotic deprescribing at discharge after a psychiatric hospitalization and to compare psychotropic prescribing patterns between Belgium and Québec, Canada. Data on adult inpatients with schizophrenia were collected retrospectively in seven hospitals. At discharge, the number of antipsychotics had decreased in 22.2% of the 63 Canadian patients and 9.9% of the 516 Belgian patients. A number of factors increased the likelihood of antipsychotic deprescribing: a hospitalization in the Canadian hospital (aOR = 4.13, 95% CI 1.48–11.5), living in a residential facility (aOR = 2.51, 95% CI 1.05–4.39), ≥2 previous antipsychotic trials (aOR = 15.38, 95% CI 3.62–65.36), having an antipsychotic side effect (aOR = 1.86, 95% CI 1.01–3.44) and being in a general hospital (aOR = 2.28, 95% CI 1.09–4.75). Patients on a long‐acting injectable antipsychotic (aOR = 0.51, 95% CI 0.26–0.98), with prior clozapine use (aOR = 0.36, 95% CI 0.13–0.95), greater antipsychotic exposure (aOR = 0.35, 95% CI 0.2–0.61) and more hypno‐sedatives (aOR = 0.65, 95% CI 0.43–0.98), were less likely to be deprescribed. Specific deprescribing interventions could target patients who are less likely to be deprescribed. [ABSTRACT FROM AUTHOR]

This Special Section explores the interplay between Indigenous peoples, industry, and the state in five proposed and active mining projects in Canada and Sweden. The overall aim is to identify factors shaping the quality of Indigenous community-industry-state interactions in mining and mine development. An ambition underlying the research is to develop knowledge to help manage mining related land-use conflicts in Sweden by drawing on Canadian comparisons and experience. This paper synthesizes the comparative research that has been conducted across jurisdictions in three Canadian provinces and Sweden. It focuses on the interplay between the properties of the governance system, the quality of interaction and governance outcomes. We combine institutional and interactive governance theory and use the concept of governability to assess how and why specific outcomes, such as mutually beneficial interaction, collaboration, or opposition, occurred. The analysis suggests there are measures that can be taken by the Swedish Government to improve the governability of mining related issues, by developing alternative, and more effective, avenues to recognize, and protect, Sámi rights and culture, to broaden the scope and increase the legitimacy and transparency of the EIAs, to raise the quality of interaction and consultation, and to develop tools to actively stimulate and support collaboration and partnerships on equal terms. Generally, we argue that Indigenous community responses to mining must be understood within a larger framework of Indigenous self-determination, in particular the communities' own assessments of their opportunities to achieve their long-term objectives using alternative governing modes and types of interactions. [ABSTRACT FROM AUTHOR]

The development and implementation of extended producer responsibility (EPR) policies to manage e‐waste provide multilevel governance frameworks for achieving greater material circularity. However, the roles and responsibilities that are allocated to various stakeholders under these policies, which are crucial for program effectiveness, often vary across jurisdictions, and consensus is lacking about the best types of relationships and collaboration that should govern municipalities' contributions to EPR programs. Against this backdrop, and since this issue is poorly researched, we conducted an empirical investigation to identify the main drivers and barriers influencing municipalities' collaboration with an e‐waste EPR program in a Canadian province where municipalities are free to decide whether or not to engage with the program. Based on our study, we explore policy implications for similar programs in other jurisdictions, and propose questions for further research. Our findings identify key motivations for collaboration, including perceived program legitimacy, program funding, and logistical efficiencies. Conversely, a lack of program transparency, failure to support local employment, a focus on recycling instead of reuse, and limited program scope are identified as disincentives to program participation. Policymaking for e‐waste management and circularity need to consider municipalities' interests and contributions to ensure successful implementation. [ABSTRACT FROM AUTHOR]

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Salvelinus namaycush (Lake Trout) occur in the Canadian Maritime Provinces of New Brunswick and Nova Scotia, and are absent in Prince Edward Island. Lake Trout are assumed to be native in parts of New Brunswick, but their ancestry in Nova Scotia is unknown. Starting in 1886, stocking was used to spread Lake Trout across lakes in the Maritime Provinces to bolster existing populations and to create new fishing opportunities. The success of most stocking efforts was not well documented, and it is presumed that many of these efforts failed. After the early stocking from which some populations persist, little effort has been made to understand the distribution, stock structure, or ancestry of Lake Trout in this region. This review is a synthesis of Lake Trout distribution in the Canadian Maritime Provinces, including a comprehensive account of stocking history, proposed native population occurrence, and identification of populations with variable ancestry. At present, Lake Trout occur in 20 lakes in New Brunswick (19 confirmed and 1 potential), and 4 lakes in Nova Scotia (2 confirmed and 2 potential). Native Lake Trout may persist in 12 of 15 New Brunswick lakes and 3 of 9 Nova Scotia lakes that historically contained ancestral Lake Trout populations. Of these lakes with historical populations that persist to this day, 10 in New Brunswick and 1 in Nova Scotia were supplemented with introduced stock; therefore, only 2 lakes in New Brunswick and 2 in Nova Scotia are likely to still contain purely native Lake Trout. By improving the understanding of population structure and origins, this synthesis provides information that is critical for the effective management and conservation of native Lake Trout in the eastern Maritime region. [ABSTRACT FROM AUTHOR]

Simple Summary: The whitemarked tussock moth is a pest of balsam fir in the Maritime provinces of Canada, and also poses a threat to human health because the hairs on the larvae are urticating (i.e., they irritate the skin). In this manuscript, we improve a known lure, based on the pheromone of this insect, with the aim to use it as a widespread monitoring/detection method. Because the female-produced sex pheromone of this moth is unstable, lures containing this pheromone only last a day or two in the field; however, our detection method takes advantage of a synthetic propheromone, or pheromone precursor, that is converted to the pheromone by acid within the lure and releases it over time, circumventing the problem of its instability. We found that our lure formulation and pheromone delivery method is more effective as a lure for whitemarked tussock moth than the control treatments in our field study. The whitemarked tussock moth (WMTM), Orgyia leucostigma (J.E. Smith) (Lepidoptera: Erebidae), is an economic pest in Nova Scotia, Canada, where it undergoes periodic outbreaks defoliating several tree species of economic value, including balsam fir, Abies balsamea (L.) Miller (Pinaceae). Herein is described a releasing device for the WMTM sex pheromone (Z,Z)-6, 9-heneicosadien-11-one based on a rubber septum, which converts pheromone precursors, such as acetals, namely (Z,Z)-11,11-dimethoxy-6,9-heneicosadiene and (Z,Z)-6,9-heneicosadien-11-one ethylene ketal, to the pheromone itself by the action of acetic acid and releases it over time. The pheromone is unstable in nature and, consequently, lures made with this compound will only attract WMTM for a day or two. The two pheromone precursors, however, are more stable, and are converted slowly into the pheromone by acetic acid impregnated in the releasing device, or by acidic conditions in the environment. The two pheromone precursors were synthesized in 2019 using a modified, previously published approach. Field trapping studies conducted from 2019–22 showed that traps baited with rubber septa loaded with either (Z,Z)-11,11-dimethoxy-6,9-heneicosadiene by itself or (Z,Z)-6,9-heneicosadien-11-one ethylene ketal plus acetic acid consistently caught significantly more WMTM than traps baited with blank septa in most experiments. [ABSTRACT FROM AUTHOR]

The intersecting identities of those identifying with multiple minorities, such as 2SLGBTQ + and ethnolinguistic minorities, bring individuals to have unique experiences, especially concerning health and wellness. This topic is particularly poorly understood among French-speaking official language minority 2SLGBTQ + populations in Canada. Hence, this study was conducted to generate insights into their needs and experiences, through the lens of intersectionality. This quantitative community-based study, a first of its kind in Western Canada, describes the sociodemographic profile, experiences of discrimination and stigmatisation, and needs and challenges pertaining to mental health and social supports of this double minority group. Data were obtained by an online survey conducted in the Canadian province of Manitoba in June 2020. The participant sample was largely homogenous: most were under the age of 55 years, white, educated, and from urban areas. Many reported experiencing dual marginalisation, feeling unaccepted by both of their minority communities (Francophone and 2SLGBTQ+). A sense of isolation, as well as a lack of social connectedness and psychological support, were often reported. Social initiatives and mental health support within environments proactively affirming of the official language of the minority and inclusive of diverse 2SLGBTQ + identities are needed. [ABSTRACT FROM AUTHOR]

Background: Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians' practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods: We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant's data were summarized by code. Results: Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal). Conclusions: This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care. [ABSTRACT FROM AUTHOR]

Background: Cannabis poisonings among children are of public health concern. Existing evidence from the US and from four provinces in Canada (Quebec, Ontario, Alberta, British Columbia) indicate an increase in pediatric cannabis-related poisonings since the legalization of cannabis. This study evaluates trends in cannabis-related poisoning pediatric emergency department (ED) visits and hospitalizations in Canada and addresses a gap in literature by describing trends and context around cannabis edible-related poisoning cases using data from a Canadian sentinel surveillance system. Methods: Mixed-methods using data from two administrative data sources and one injury/poisoning sentinel surveillance system to estimate age-specific rates of cannabis-related poisonings ED visits (Ontario and Alberta), edible-related events (sentinel surveillance Canada), and hospitalizations (Canada with the exception of Quebec) among children between the ages of 0 to 11 from 2015/2016 to 2021. Annual absolute changes were calculated to quantify the magnitude of change between each age-specific rate. Joinpoint regression was used for trend analysis. A thematic analysis was completed to gain a better understanding of cannabis edible-related poisoning cases in the ED. Results: The pediatric age-specific rates for cannabis-related poisoning ED visits (average annual percent change (AAPC) Ontario: 98.2%, 95% CI: 79.1, 119.2; AAPC Alberta: 57.4%, 95% CI: 36.7, 81.2), hospitalizations (AAPC: 63.4%, 95% CI: 42.0, 87.9) and cannabis edible-related events (AAPC: 122.8%, 95% CI: 64.0, 202.6) increased significantly from 2015 to 2021. Almost half of all pediatric edible-related events involved gummy edible products (48.8%, n = 143). Based on the thematic analysis, 88% cannabis edible-related events were attributed to inadvertent ingestion due to access to such products or lack of safe storage practices. Conclusion: Age-specific rates of cannabis-related poisoning ED visits (Ontario and Alberta) and hospitalizations (Canada with the exception of Quebec) have increased since cannabis legalization, with the largest increase in rates occurring from 2019 to 2020. A similar increase in the rate of cannabis edible-related cases from sentinel surveillance data underscores the importance of monitoring this outcome. Public health messaging and national public health promotion strategies targeted towards raising awareness on the risks associated with consuming illegal cannabis and safe storage of cannabis could help mitigate cannabis poisonings among children. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae serotype 19A is a highly diverse, often antimicrobial-resistant Gram-positive bacterium which can cause invasive pneumococcal disease (IPD). In 2021, public health authorities in the Canadian province of Québec observed an increase of serotype 19A IPD in children <5 years. The purpose of this study was to determine the clonal composition of serotype 19A isolates collected from this age group in Québec, from 2016 to 2021. Forty-one and 37 IPD isolates from children <5 years from Québec and the remainder of Canada, respectively, were sequenced using the Illumina NextSeq platform. Phylogenetic analysis using SNVPhyl identified three clusters, corresponding to three common clones of serotype 19A: CC199, CC320 and ST695. CC199, predominantly represented by ST416, accounted for similar proportions of serotype 19A isolates collected from children in Québec (19.5 %) and other Canadian jurisdictions (OCJs, 21.6 %), with significant presence of ermB (62.5 % and 60 % of ST416 isolates, respectively). CC320 was more commonly identified from OCJs in comparison to Québec (18.9 % vs. 7.3 %, respectively), but were highly antimicrobial-resistant regardless of region. ST695 was the most common clone of serotype 19A collected in Québec from children <5 years, representing 65.9 % of isolates collected over the study period (40.5 % of isolates collected in OCJs). Phylogenetic analysis identified geographical differences in ST695 across Canada; including a large clade specific to Québec (with both susceptible and macrolide-resistant [ ermB ] subclades), and a separate macrolide-resistant (mefA) clade associated with OCJs. The Québec-specific ermB -ST695 clone represented 48.1 % of ST695 collected from the province. Continued genomic surveillance of S. pneumoniae serotype 19A is required to: i) track the prevalence and clonal composition of serotype 19A in Québec in future years; ii) characterize the clonal distribution of serotype 19A in adult populations; and iii) monitor whether the currently geographically restricted ermB -ST695 clone observed in Québec expands to OCJs. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure. • NACI made many strategic adaptations to facilitate timely vaccine advice in Canada. • The pandemic highlighted critical roles for NITAGs in vaccine program design. • Learning from COVID-19 pandemic adaptations, we see a roadmap for future pandemics. The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure and frameworks, and added urgency and complexity to the operation of National Immunization Technical Advisory Groups (NITAGs). Canada's National Advisory Committee on Immunization (NACI) provides immunization guidance to the Public Health Agency of Canada (PHAC) who publicly shares expert and evidence-informed guidance with Canadian provinces and territories. Throughout the pandemic, NACI and PHAC implemented many adaptations to meet urgent needs for pandemic vaccine guidance. In this paper, we describe: structural adaptations in response to the accelerated pace and amount of work required to issue recommendations that were timed around product authorizations and dynamic epidemiology; technical adaptations in response to rapidly evolving evidence of variable quality which required close monitoring, and which promoted reliance on basic vaccine principles due to incomplete direct evidence; the need to provide nimble advice (e.g., off-label recommendations, preferential recommendations); communications adaptations (e.g. identify sustainable spokespeople for the committee, receive stakeholder feedback, and ensure urgent nuanced advice was communicated to a diverse audience); and research adaptations focussing on solutions to constrained supply (e.g. prioritisation, extended intervals, and heterologous schedules). The early pandemic vaccine experience has created a roadmap of lessons and adaptations that should be leveraged in future pandemic vaccine programs, and has highlighted the essential role of NITAGs to complement regulatory structures during pandemics to ensure timely, impactful, and evidence-informed public health vaccine guidance. [ABSTRACT FROM AUTHOR]

The selective use of potato crop models is a key factor in increasing potato production. This requires a better understanding of the synergies and trade-off of crop management while accounting for the controlling effects of potato genetic and agro-climatic factors. Over the years, crop modeling for potato has relied on historical data and traditional management approaches. Improved modeling techniques have recently been exploited to target specific yield goals based on historical climatic records, future climate uncertainties and weather forecasts. However, climate change and new sources of information motivate better modeling strategies that might take advantage of the vast sources of information in the spectrum of actual, optimal and potential yield and potato management methodologies in a more systematic way. In this connection, two questions warrant interest: (i) how to deal with the variability of crop models relevant to their structure, data requirement and crop-soil-environmental factors, (ii) how to provide robustness to the selection process of a model for specific applications under unexpected change of their structure, data requirement and climatic factors. In this review, the different stages of potato model development are described. Thirty-three crop growth models are reviewed and their usage and characteristics are summarized. An overview of the literature is given, and a specific example is worked out for illustration purposes to identity key models suitable for potato management in the Atlantic provinces of Canada. Based on a categorical principal component analysis (CatPCA) procedure three potato models representing three principal components (PCs) were identified which will be useful for future potato production and yield simulation in this geographic area. [ABSTRACT FROM AUTHOR]

Infections with antimicrobial resistant pathogens are a major threat to human and animal health worldwide. Further, reduction of livestock-associated antimicrobial use (AMU) is often identified as an area of focus. Selective dry cow therapy (DCT) warrants consideration as an important way to decrease AMU on Canadian dairy farms. In addition, teat sealants (TS) are a nonantimicrobial alternative for prevention of intramammary infection during the dry period. Therefore, objectives of this study were to determine how antimicrobials and TS are used at dry-off on Canadian dairy farms to determine selective DCT uptake and enacted selection protocols. It was expected that these data will provide a baseline understanding of DCT practices and highlight areas for future intervention to further reduce AMU. An observational study was conducted utilizing 2 in-person questionnaires conducted between July 2019 and September 2021 on 144 participating dairy farms in 5 Canadian provinces (British Columbia = 30, Alberta = 30, Ontario = 31, Québec = 29, and Nova Scotia = 24). Overall, 45 farms (31%) reported adopting selective DCT, 95 (66%) enacted blanket DCT, and 4 (3%) did not provide antimicrobial DCT. Farms enacting selective DCT had approximately 50% less intramammary antimicrobials used at dry-off compared with blanket DCT farms. Cow somatic cell count history was the most common criterion for selective DCT decision-making, followed by previous clinical mastitis history, bacteriological culture, and milk production. A slight majority of farms (56%) applied TS to all cows at dry-off, whereas 17 farms (12%) used TS selectively, and 46 farms (32%) did not use TS. Larger herds more often used TS, and farms with an automatic milking system more often used TS selectively than applied to all cows. Results highlighted the variability in antimicrobial treatment and TS use protocols at dry-off on Canadian dairy farms, and the potential for further antimicrobial reduction with increased adoption of selective DCT. [ABSTRACT FROM AUTHOR]

Despite the greater visibility of sexual and gender minorities, due to data limitations, the quantitative literature on their citizenship outcomes is very limited. Using a large original survey of Canadian sexual and gender minorities and the Canadian General Social Survey, this article first examines the extent of political inclusion of sexual and gender minorities, as measured by sense of belonging to Canada and the province of residence, likelihood of voting, and confidence in the police and the justice system. Sexual and gender minorities are generally found to have a markedly weaker sense of belonging to Canada and confidence in its institutions. Next, these patterns are re‐examined accounting for the degree of outness. The results indicate considerable discrepancies across sexual and gender minorities in how outness affects their citizenship outcomes. In particular, it seems that the sociopolitical profile of these groups plays an important mediating role in the effects of outness on their citizenship outcomes. Related Articles: Burnett, Craig M., and Aaron S. King. 2015. "The Personal Politics of Same‐Sex Marriage." Politics & Policy 43(4): 586–610. https://doi.org/10.1111/polp.12126. Lewis, Gregory B., Marc A. Rogers, and Kenneth Sherrill. 2011. "Lesbian, Gay, and Bisexual Voters in the 2000 US Presidential Election." Politics & Policy 39(5): 655–77. https://doi.org/10.1111/j.1747‐1346.2011.00315.x. Winburn, Jonathan, and Amanda Winburn. 2020. "The Role of Political Ideology in Public Opinion toward Enumerated Antibullying Policies in Public Schools." Politics & Policy 48(3): 442–63. https://doi.org/10.1111/polp.12355. [ABSTRACT FROM AUTHOR]

Background: The number of patients with sickle cell disease in Ontario, Canada, is unknown. In the absence of a formal registry, we performed a study to determine an approximate census via analysis of health administrative databases. Methods: We identified Ontario patients with a diagnosis of sickle cell disease through queries of the Discharge Abstract Database, National Ambulatory Care Reporting System and Newborn Screening Ontario database. The period of inquiry was Apr. 1, 2007, through Mar. 31, 2017. We identified repeat interactions by the same patient by cross-referencing provincial health insurance plan numbers. Results: We documented health care system interactions for 3418 unique patients (1912 [55.9%] female, median age at the time of identification 24 yr). Over the 10-year study period, patients visited the emergency department a median of 2 (interquartile range [IQR] 1--7) times and an average of 6.69 (standard deviation [SD] 26.71) times, and were admitted to hospital a median of 1 (IQR 1--5) time and an average of 4.38 (SD 8.53) times for treatment related to sickle cell disease. A total of 229 patients (6.7%) died during the study period, with an average age at death of 55 years. Even without accounting for the effects of immigration, the rate of natural increase slowed slightly over the study period owing to a decrease in the annual number of affected births. Interpretation: The estimated prevalence of patients with sickle cell disease in Ontario in 2007/08--2016/17 was 1 in 4200, and affected patients' need for hospital-based care was substantial, although highly variable. Similar queries of health administrative databases may be feasible in other Canadian provinces. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). Methods: This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16–22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. Results: The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. Conclusions: Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems. [ABSTRACT FROM AUTHOR]

The 1790 pantomime The Provocation!'s intervention into the Nootka Crisis may signal that what was to crystalize by 1871, when British Columbia entered Canadian Confederation as a settler colony, was already taking shape: the confluence of the development of a series of extractive industries, the establishment of settler colonies, and persistent imperial ambivalence about the territory that would eventually become a Canadian province. Given that the Nootka Sound Crisis is now relatively unknown, this article begins by briefly summarizing the crisis. After describing Nootka Sound and The Provocation!, The Provocation!'s apparent intervention in British diplomacy is discussed. Finally, after outlining how the public appearance of six Cherokee Chiefs at one of The Provocation!'s final performances was deployed by the press, the article addresses how the two plays built on pre-circulating British understandings of Indigeneity and of the Pacific Northwest, recycling and activating these performative and visual genealogies to lay the groundwork for the settler-colonial structures that followed in the nineteenth century. [ABSTRACT FROM AUTHOR]

Saltmarsh (Ammospiza caudacuta) and Nelson's (A. nelsoni) sparrows are sister taxa that breed in tidal marshes along the coast of the Northeastern United States and Canada. The Saltmarsh Sparrow breeds from mid‐coast Maine south to Virginia, while the Acadian Nelson's Sparrow breeds from the Canadian maritime provinces south to northern Massachusetts. Here, we present three extralimital observations of breeding Saltmarsh (n = 2) and Nelson's (n = 1) sparrows. In 2021 and 2022, we observed Saltmarsh Sparrow females attending nests at Mendall Marsh, ME, and Milbridge, ME, respectively, approximately 60 and 110 km beyond the documented northern extent of the Saltmarsh Sparrow breeding range. In 2022, we observed a breeding‐condition male Nelson's sparrow singing in the upriver portion of a marsh on Cape Cod, Massachusetts, approximately 115 km beyond the previously documented southern extent of the Nelson's Sparrow breeding range. We confirmed morphological species identification using a panel of microsatellite DNA loci. Due to both the well‐documented population declines of these species in the region and the intensity of sampling effort undertaken in recent years, we suggest that these observations likely are not indicative of range expansion. However, they do indicate that these 2 taxa have the capacity to use and successfully reproduce in marshes well beyond their established breeding limits. Our findings provide novel insight into the potential for these taxa to occur and successfully breed outside their documented breeding ranges. Given increased interest in their conservation, these results support the idea that management actions aimed at creating or maintaining nesting habitat across both species ranges could benefit both taxa. [ABSTRACT FROM AUTHOR]

Negative social and ecological trends are putting essential life-support systems at risk. Necessary responses include sustainability transformations in diverse sectors to enhance the planetary capacity to deliver more positive effects to all. Sustainability-based assessment frameworks are tools to guide the evaluation of initiatives in different human sectors and promote decisions that enhance overall social and ecological well-being. However, advancing sustainability remains difficult, in part because it must be pursued in a world of complex interactions and must respect the specifics of each case and context. This paper reports the process of building a sustainability-based assessment framework for electrical energy systems carried out by Aguilar. This work further specified the framework for electrical energy systems for application in the case and context of the electrical energy system in the Canadian province of Ontario. The illustrative application revealed that Ontario's electrical energy system has made some progress towards contributions to sustainability but requires improved efforts to be on a path to adequate transformation. The research found that the sustainability-based assessment framework for electrical energy systems is promising and well-suited for further application to particular electricity-related initiatives. However, more applications are needed to further test the utility of the framework and refine the proposed criteria. [ABSTRACT FROM AUTHOR]

In the management of most chronic conditions characterized by the lack of universally effective treatments, adaptive treatment strategies (ATSs) have grown in popularity as they offer a more individualized approach. As a result, sequential multiple assignment randomized trials (SMARTs) have gained attention as the most suitable clinical trial design to formalize the study of these strategies. While the number of SMARTs has increased in recent years, sample size and design considerations have generally been carried out in frequentist settings. However, standard frequentist formulae require assumptions on interim response rates and variance components. Misspecifying these can lead to incorrect sample size calculations and correspondingly inadequate levels of power. The Bayesian framework offers a straightforward path to alleviate some of these concerns. In this paper, we provide calculations in a Bayesian setting to allow more realistic and robust estimates that account for uncertainty in inputs through the 'two priors' approach. Additionally, compared to the standard frequentist formulae, this methodology allows us to rely on fewer assumptions, integrate pre‐trial knowledge, and switch the focus from the standardized effect size to the MDD. The proposed methodology is evaluated in a thorough simulation study and is implemented to estimate the sample size for a full‐scale SMART of an internet‐based adaptive stress management intervention on cardiovascular disease patients using data from its pilot study conducted in two Canadian provinces. [ABSTRACT FROM AUTHOR]

Understanding microhabitat use is needed to make sound conservation decisions for at-risk, patchy-habitat specialists, such as rock-habitat specialists. Rock habitats offer unique microclimatic refugia for reptiles and mammals. Eastern small-footed bats (Myotis leibii (Audubon and Bachman, 1842)) use rock roosts during the summer, but data on these summer roosts are lacking for this species classified as (critically) imperiled in several US states and Canadian provinces and globally endangered. Our goal was to characterize the structure and microclimate of Myotis leibii roosts at the southwestern periphery of their range. We predicted that Myotis leibii roost temperatures would be warmer and less variable than ambient temperatures and that solitary bats would use horizontal roosts cooler at night, whereas maternity group roosts would be vertical and warmer at night. During summers of 2019 and 2020, we recorded physical (e.g., width) and temperature attributes of 58 Myotis leibii roosts at 16 sites in the Ouachita Mountains. Crevice roosts of Myotis leibii had narrow dimensions like elsewhere in their range and roost temperatures (measured with iButtons) were warmer and more variable than ambient temperatures. Group roosts were larger and had more stable temperatures than solitary roosts. These findings may be useful for assessing population threats, monitoring roost suitability, identifying roost-rich areas that need protection, and even planning artificial roost structures where natural roosts are limited. [ABSTRACT FROM AUTHOR]

In the era of (re)legalisation of medicinal and recreational cannabis, accidental and intentional exposure to edibles, cannabis-infused food products, has increased substantially. However, there is particular concern regarding younger age groups. Most concerning is the increase in hospitalisations. According to a study by Myran et al. (1), provinces in Canada, where the sale of edibles is permitted, saw an increase in paediatric poisonings due to unintentional consumption of edibles. Similar trends have been observed in "legalised states" in the US, such as Colorado (2). The impact of using cannabis at an early age, but particularly the impact of accidental exposure to high THC quantities, may have negative mental or physical health outcomes. Whilst regulatory restrictions vary significantly from one legalised region to another, it is difficult to identify a best practice. The aim of this study is to identify and discuss new and existing risk mitigation strategies to give guidance to policymakers. Furthermore, practical aspects, such as compliance (e.g. audits by authorities), are discussed. It is noted that edibles have been around much longer than recent political attempts to regulate them. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes. Patients and Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD < 16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes. Results: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥ 1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥ 1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis. Conclusion: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care. Plain Language Summary: Inflammatory bowel disease (IBD) is a chronic health condition of the gastrointestinal system, which is becoming more common in children. They require lifelong treatment and receiving high quality care is important for preventing complications. We determined if outcomes of children with IBD was different across Canada. We also tested if differences in care at diagnosis was related to outcomes. More than three-quarters of children with IBD were treated at pediatric hospitals. Children treated at some hospitals were more likely to be hospitalized and visit the emergency room when compared to children treated at other hospitals. Children with Crohn's disease (one type of IBD) were more likely to have surgery at some hospitals when compared to children treated at other hospitals. We should improve care to make sure children living with IBD have timely access to high quality specialist care. [ABSTRACT FROM AUTHOR]

Background: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies. This protocol outlines a comprehensive research study aimed at evaluating an implementation approach for the uptake of the Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders across Canada. Eating disorders (EDs) have a significant impact on mental and physical health, necessitating evidence-based and timely interventions. To address gaps in service, we propose to use focus groups to identify barriers, facilitators, and implementation strategies for guideline uptake. We will engage stakeholders, including clinicians, administrators, and individuals with lived experience, to co-create tailored educational materials which will then be disseminated. The impact of the implementation approach will be evaluated through pre- and post-implementation surveys. This study aims to enhance the availability and utilization of evidence-based treatments for children and adolescents with EDs, ensuring equitable and improved care nationwide. [ABSTRACT FROM AUTHOR]

The Canadian boreal forest biome has been subjected to a long history of management for wood production. Here, we examined the cumulative impacts of logging on older forests in terms of area, distribution and patch configuration in the managed forest zones of the Eastern Canadian provinces of Ontario and Quebec. We also examined the consequences of these cumulative impacts on a once widely distributed and now threatened species, the woodland caribou (Rangifer tarandus caribou). The cumulative area of recently logged forest (since ~1976) was 14,024,619 ha, with 8,210,617 ha in Quebec and 5,814,002 ha in Ontario. The total area of older forests was 21,249,341 ha, with 11,840,474 ha in Quebec and 9,408,867 ha in Ontario. Patch statistics revealed that there were 1,085,822 older forests with core patches < 0.25 ha and an additional 603,052 < 1.0 ha. There were 52 > 10,00–50,000 ha and 8 < 50,000 ha. Older forest patches (critical caribou habitat) in the 21 local population ranges totalled 6,103,534 ha, distributed among ~387,102 patches with 362,933 < 10 ha and 14 > 50,000 ha. The median percentage of local population ranges that was disturbed was 53.5%, with Charlevoix having the maximum (90.3%) and Basse Côte-Nord the least (34.9%). Woodland caribou local population ranges with disturbed suitable habitats >35% are considered unable to support self-sustaining populations. We found that for the 21 caribou local population ranges examined, 3 were at very high risk (>75% area disturbed), 16 at high risk (>45 ≤ 75% area disturbed), and 2 at low risk (≤35% area disturbed). Major changes are needed in boreal forest management in Ontario and Quebec for it to be ecologically sustainable, including a greater emphasis on protection and restoration for older forests, and to lower the risks for caribou populations. [ABSTRACT FROM AUTHOR]

Introduction: Heated tobacco products (HTPs) are novel tobacco products that may appeal to youth. This study explored whether HTP retailer proximity and density to secondary schools were associated with youth use of HTPs in four Canadian provinces. Methods: An online search between November 2020 and March 2021 identified retailers selling IQOS devices and HEETS (tobacco sticks used in IQOS) within 500 m, 1000 m and 1500 m radius circular buffer zones around high schools (N = 120) participating in the COMPASS study in 2020-2021. Retailer proximity/density data were linked to crosssectional student-level data (N = 40 636 students), and multilevel regression models examined the association between HTP retailer proximity and density and current HTP use, controlling for relevant covariates. Results: While only 10.0% of schools had at least one retailer selling IQOS devices within 1000 m of the school, 65.0% of schools had at least one retailer selling HEETS. The school a student attended accounted for 23.7% of the variability in the likelihood of currently using an HTP. However, HTP retailer proximity to and density around schools were not significantly associated with the likelihood of students currently using HTPs. Conclusion: While the school a student attended accounted for a significant amount of variability in HTP use, these findings suggest that students may be obtaining HTPs through other, non-retail sources. Continued monitoring is warranted as HTP use among youth may change. [ABSTRACT FROM AUTHOR]

The study of Shakespeare in secondary school literature classes remains a global phenomenon across L2 contexts. Understanding said spaces is important, as the study of Shakespeare is known to expand learner knowledge of normative conventions of academic literacy – this, in service of building the cultural and linguistic capital necessary for learners to succeed on their own terms. However, little is known about how best to research this context so as to assist language learners with their academic literacy needs. To address this gap, this study employs thought modeling – an analytic tool informed by complex dynamic systems theory – to investigate the teaching and learning environment of seven secondary school ESL programs in the Canadian province of Ontario. Mining the educational experiences of 106 participants, this research explores five primary components of the educational landscape: conditions, timescales, interactions, artifacts, and agents. Thematic analyses and descriptive statistical analyses were performed on a dataset comprised of surveys and interviews. This study initiates a framework for continuing research into L2 secondary school Shakespeare studies by identifying and describing substantive avenues of research (i.e., control parameters) informing conditions for best practice and highlights thought modeling as an effective analytic framework for understanding educational dynamics. [ABSTRACT FROM AUTHOR]