Power of Connections: How a Novel Canadian Men’s Wellness Program is Improving the Health and Well-Being of Indigenous and Non-Indigenous Men

Determination of neonicotinoids and butenolide residues in avian and insect pollinators and their ambient environment in Western Canada (2017, 2018)

Though men's health promotion has attracted increased research attention, conspicuously absent have been empirical insights to health literacy levels within and across male subgroups. Recent advancements in the measurement of health literacy have made available avenues for evaluating individual and social determinants of health literacy. Important insights can be drawn to detail patterns and diversity among men as a means to informing the design, implementation, and evaluation of tailored health promotion programs. Drawing on 2000 Canada-based men's responses to the Health Literacy Questionnaire, correlations between demographic variables and six health literacy scales are described. Low income, low education, and living alone were associated with men's low health literacy, with the strongest effect sizes for the "Social support for health" and "Actively engaged with health care professionals" scales. Multiple linear regressions confirmed low income as the strongest predictor of men's low health literacy in all the scales except "Appraisal of health information." Low income, self-identifying as gay, bisexual, or other, and living alone were strongly predictive of low scores on the "Social support for health" scale. The findings affirm the importance of considering men's health literacy and inequities to advance effective men's health promotion programs.

Patterns and trends of chlorinated hydrocarbons were assessed in bald eagle nestling plasma from sites along the west coast of North America. Eagle plasma was sampled from four areas in southwestern British Columbia (BC), a reference site in northern BC, and from Santa Catalina Island, off the coast of California. Sites were chosen to reflect variation in contaminant exposure due to differing recent and/or historic anthropogenic activities. Santa Catalina Island had significantly greater mean concentrations of p,p'-DDE, 41.3 microg/kg wet weight (ww), than other sites, and Nanaimo/Crofton, BC had the greatest mean concentration of total PCBs, 28.9 microg/kg ww. Contaminant levels measured in 2003 in BC were compared to levels measured in 1993; over that ten year span, concentrations and patterns of chlorinated hydrocarbons have not significantly changed. There were no significant differences in levels of p,p'-DDE or hexachlorobenzene between 1993 and 2003, but significant decreases were found for trans-nonachlor and PCBs at BC sites. Levels of total PCBs and trans-nonachlor in the central Fraser Valley and Nanaimo/Crofton area have significantly decreased. Mean concentrations of p,p'-DDE measured in bald eagle nestling plasma samples in 2003 exceeded published criteria for effects on bald eagle reproduction at Santa Catalina Island and Barkley Sound, more than 30 years since heavy usage restrictions were imposed.

Samples of invertebrates, primary producers, seawater and cores were taken surrounding several aquaculture sites in coastal British Columbia, Canada. Analysis of dissolved organic carbon (DOC) showed a significant decrease (P = 0.027) over 1 km and an overall average of 290 ± 40 μM at 1 m depth. At 10 m, the decrease was not significant and DOC averaged 81 ± 3 μM. The essential fatty acid 22:6ω3 (docosahexaenoic acid, DHA) was significantly lower nearer to the farm sites for all mollusc taxa as well as for mussels alone (P < 0.01). However, mussel wet weight as well as the zooplankton fatty acid marker (ZFA; Σ 20:1ω9, 22:1ω11, 22:1ω9) and 20:1ω9 individually, decreased significantly with distance from the farms (P < 0.03). Principal components analysis showed a similar trend with DHA being higher in molluscs further from the farm. Mussels had significantly higher amounts of DHA compared with other molluscs indicating their potential in multi-trophic, co-culturing systems. Bacterial fatty acid markers increased in molluscs with distance from the farms; however, 18:1ω7, which is representative of methane-oxidizing bacteria, remained higher closer to the farm. In addition, DHA proportions in mussels showed a significant breakpoint at 339 m from the farm suggesting co-cultured mussels would benefit from placement further than 339 m from farms where DHA would be optimized.

Background The University of British Columbia (UBC) Brighter Smiles Program, initiated in 2001, consists of a unique partnership between UBC health care professionals and remote aboriginal communities in northern British Columbia, Canada, and is now seen to be a successful community-based health and education program. The combination of implementing a school-based health program aimed to improve the oral health of children and also providing pediatric resident trainees with community clinical experience provides value to both the aboriginal communities and the specialty trainees. Purpose The purpose of this project was to produce and distribute an educational video to describe the value of the program for other remote aboriginal communities in British Columbia considering joining the program and to highlight aspects of the pediatric trainees9 experience for other university residency programs to review. The aboriginal community of Hartley Bay, British Columbia, Canada, being first to join the program and enrol all their school-age children in the oral health part of the program and first to complete the 3-year follow-up for the oral health program, was selected as the site for the video filming. Methods During a preplanned visit to the Hartley Bay community in September 2006, broadcast-quality footage for the video was filmed by Response Productions Inc. Interviews were obtained from aboriginal band council and community members, the school principal, teachers, the health director and the health coordinator of the Hartley Bay Nursing Station, and the UBC Brighter Smiles Team: pediatric resident trainees, program coordinator, and program director. In addition to documenting the oral health program for children, the video also describes the pediatric resident clinic and educational school session presentations by residents on various health and prevention topics. The completed video will be distributed in DVD format and a shortened version will be available on the Internet. Results Feedback of the video has been positive from both the Hartley Bay community participants and the Brighter Smiles team; the video is in postproduction and will be released in November 2006. Conclusions The continued success of the UBC Brighter Smiles Program partnering university and remote aboriginal communities in British Columbia is highlighted in this educational video to become available as a health education program resource.

Information is a key issue for people who use health services and their families and friends. In the UK, this was raised consistently by those involved in a national ‘listening exercise’, in 2005.1 The resulting White Paper Our Health, Our Care Our Say2 reinforced much of the government information strategy published in the previous year.3 The Brain and Spine Foundation is a UK-based charity that aims to improve the quality of life for people with neurological conditions (http://www.brainandspine.org.uk). The organization was awarded a grant by the Department of Health to produce a toolkit to help health and social care professionals providing information to people affected by neurological conditions. The project forms part of the implementation of The National Service Framework (NSF) for Long-term Conditions, published last year.4 The toolkit is being developed in association with the Neurological Alliance (http://www.neural.org.uk) and the Long-term Medical Conditions Alliance (LMCA; http://www.LMCA.org.uk). A series of small discussion groups were held last year throughout England and Wales to explore: (i) current obstacles in the provision of and access to information, (ii) how a toolkit might be used and (iii) to refine the toolkit's content and shape. Discussions were held with groups of people affected by neurological conditions, with voluntary sector organizations concerned with neurological conditions and with mixed groups of health and social care professionals from a variety of settings. In addition, a questionnaire survey of health and social care professionals was conducted. Care for people with neurological conditions in the UK has been very patchy. While there are some world-class centres of expertise, there are also areas of the country where there is little specialist provision.5 Traditionally, for people with neurological conditions, the majority of input has been provided by specialists (e.g. neurologists and rehabilitation consultants). However, because of shortages in these workforces, and the long-term nature of many of the conditions, people have often been left without specialist support. Access to information has become a major issue for these people who may have little contact with health and social care professionals after initial diagnosis of their condition. This is consistently reported both by individuals affected by neurological conditions as well as organizations representing them.5 A key issue explored in developing the toolkit relates to why people do not get the information they want, despite much information apparently being available, and from a proliferation of sources. Two explanations were found. First, information provided by health professionals does not always match with the information sought after by people with neurological, and other long-term conditions. Secondly, people often want very local information, whereas what is generally available is not specific to their geographical location or situation. These issues are explored further below. Another issue that became evident was that health and social care professionals did not always recognize their role in relation to providing information to people with whom they came into contact. There is a need to encourage health-care professionals to view every consultation as an opportunity to assess information needs and ensure that these are met directly or by referral to a dependable alternative source. The toolkit will, therefore, aim to signpost to sources of information on the issues of concern to people with neurological conditions. It was found that there are four key areas consistently identified by people affected by neurological conditions where they want more information. Interestingly, the groups of health and social care professionals consulted also identified these issues as a problem area for information giving. The lack of information related to benefits, employment and finance was an issue raised repeatedly by people with neurological conditions when they discussed information. When asked what information requests they found difficult to address, health professionals also identified information about benefits. This is not a new issue and surveys from the neurological charities have been reporting this for years.6 It is possible that the reason this issue has not been addressed is that health professionals do not see such issues as within their remit. These ‘social care issues’ are often seen as being the province of those working outside health-care settings. There may be a tendency to see people with a diagnosis of a long-term condition as having a continuum of needs; starting with medical needs, and medical information needs, at the diagnostic phase and progressing to ‘social’ needs later on as someone adapts to their illness or disability, and particularly if it progresses/degenerates. However, when people with neurological conditions talk about their information needs, it is clear that some of their first concerns on diagnosis are their employment and financial status –Should I go back to work tomorrow? What should I tell my employer? If I leave work how will I support myself and my family? What support will my partner get if they need to look after me? Should I move house? The health professional is more likely at this time to be focused on providing information about possible treatment options or a drug regime. Concerns about sex and relationship issues were often raised (even in focus groups where people who did not know each other). People had found information on sources of support very hard to access. Health and social care professionals were similarly at a loss to know where to go for such information. There seemed to be a tendency to hope the questions were not asked and very few health-care professionals said that they would ever raise the issue as they would not know how to deal with this or whom to refer to. This is a significant quality of life issue for people affected by many neurological, and other long-term conditions, including cancer. There is a need to address it and ensure that health and social care professionals are signposted to sources of information and advice. Complementary therapies have played a large part in the management of neurological conditions, partly because of the fact that there are often very few surgical or drug treatments available. Many health professionals find it difficult to provide information about treatments that they feel do not have a robust evidence base and that have not been traditionally available in the National Health Service (NHS). While for some conditions this is changing, it is likely that people with a life-long illness for which there is no cure will continue to seek both ‘wonder cures’ and palliative treatments. Using the toolkit health professionals will be able to signpost people to information about various complementary therapies and information about which therapies people with a similar condition have found helpful. This kind of information is often available through local and national voluntary sector organizations. Providing a diagnosis and prognosis is clearly within the domain of health-care professionals, yet all agree it is a difficult area to address. People affected by neurological conditions often report that they do not get adequate information about what to expect. Again this possibly stems from the fact that there was, and still is for many, very little that can be offered in the way of treatment and cure. Neurological conditions can also be very unpredictable. If health-care professionals view their domain as providing information about treatment options and medicines there may well be limited information they can give. There are, however, as outlined above, a range of other information needs that people with neurological conditions have at diagnosis. If these needs are addressed it is likely both that people would feel more able to manage their condition and also report that their information needs had been met. The information people often valued the most, and which they found hard to access, was about local services and sources of support. For example, people talked about finding someone who could help them fill in their benefit form, the local rehabilitation service that accepted self-referrals, the MS support group that met two streets away, yet had taken 18 months to discover. Addressing local information presents a challenge for a toolkit that has been designed for health and social care professionals across England and which will necessarily be focused at a countrywide level. As noted above, however, this is a crucial finding of the work conducted with people affected by neurological conditions. Those working on the Better Information3 strategy also identified the need for local information and the Department of Health has recently announced their intention to pilot a local integrated approach to information in order that local health and social care organizations jointly maintain an accessible database of all services and support groups in their local area.2 The project will provide a template for local information in the toolkit outlining what information should be available, based on issues that people affected by neurological conditions have raised as information needs, and indicating possible local sources of information and support locally. The ground work will necessarily be conducted at a local level, but it is hoped by providing a template and sources list we will avert excessive duplication of effort, whilst ensuring that the content of local directories and databases are focused on the needs of people affected by neurological conditions. In addition, it will be very important to ensure local voluntary organizations supporting and representing people with neurological conditions are involved in commissioning local information databases. This will be essential; to ensure firstly that the resource is focused on local needs; secondly, that the very valuable services and support provided by voluntary sector groups are included and thirdly, because of the local knowledge they have about sources of health and social care support in its widest sense. Often, during the discussions with people affected by neurological conditions, they talked about eventually tracking down the information, or service or person, through contact with a local support group or voluntary organization. For example, if you wanted to know who could help you fill out a benefit form, how to get a wheelchair, where to get hydrotherapy, who to talk to about a relationship problem the local branch of the Parkinson's Disease Society or MS Society would be a very good starting point. At national level, voluntary sector organizations produce the information often reported to be the most useful by people affected by neurological conditions. Most include in their information portfolios fact sheets and booklets about the issues raised above (complementary therapies, sex and relationships, prognosis, benefits) and about many other aspects of living with a neurological condition. There is reluctance, however, amongst health and social care professionals to provide information about these organizations to people affected by neurological conditions. A survey by the Motor Neurone Disease Association7 in 2002 found that 44% of people diagnosed with motor neurone disease that year had not been told of the Association or given contact details. In the discussions to develop the toolkit people often reported stumbling on a local or national voluntary organization ‘by accident’. The toolkit will need to make it easier for health professionals to signpost to these sources of information and support. Health professionals may feel better assured about directing people to voluntary sector sources of information if they could guarantee the quality. The Department of Health have also recently announced the intention to develop an Information Accreditation Scheme (IAS).3 It will be very important that voluntary sector providers of information are enabled to participate in this scheme in order that they can continue to disseminate the information that people affected by neurological, and other long-term conditions find so useful. A pilot version of the toolkit is currently being produced. This will be a signposting tool with generic checklists and templates. It is anticipated there will be a launch towards the end of 2006. Nikki Joule is an independent health policy consultant and Project Officer at the Brain and Spine Foundation (http://www.brainandspine.org.uk). She is also on the Steering Group of the Patient Information Forum (http://www.pifonline.org.uk).

<b>PB-PG-1207-15081 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>The development of a decision tool to improve the management of urinary incontinence in women in the community<br /> <br /> <b>Authors</b>: Professor Dawn Dowding - University of Leeds<br /> Professor Francine Cheater - Glasgow Caledonian University<br /> Professor Joanne Booth - Glasgow Caledonian University<br /> Professor Ian Watt - Hull York Medical School/University of York<br /> Mrs Rosemary Horseman - North Yorkshire and York Primary Care Trust<br /> Professor John Martin Bland - University of York<br /> Professor David Torgerson - University of York<br /> Mrs Anne Siddle - Leeds Community Healthcare<br /> <br /> <b>Plain language summary</b><br /> Background<br /> Urinary Incontinence (UI) affects about 15% of the general population and is more common in women.&nbsp; It is a condition that can cause a great deal of distress to sufferers, and costs the NHS about &pound;563 million a year.&nbsp; Whilst there are different types of UI, each with its own way of being treated, many women with urinary incontinence currently don’t seem to be getting the best treatment for their condition. The aim of this study was to design and develop a decision tool to help health care professionals identify which type of UI people have more effectively, with the aim of improving management of the condition.<br /> <br /> Findings<br /> In the first stage of the study we developed three different versions of the tool based on existing research evidence. We carried out interviews with groups of health care professionals who work in the community (General Practitioners, Practice Nurses and Community (district) Nurses). We asked them to discuss how they currently assess and manage UI in women, and also got them to evaluate the different versions of the tool. At the end of this stage of the study we had a decision tool that health care professonals thought they could use when treating a woman with UI.<br /> <br /> In the second stage of the study we developed 25 fictional descriptions of women with different bladder symptoms and asked doctors and nurses to use the tool to say how they would treat the women.&nbsp; We then examined what they decided to identify whether or not the tool helped health care professionals agree on what treatment would be appropriate, and whether or not it improved their ability to identify the type of incontinence.&nbsp; We found that health care professionals who used the tool were more likely to identify the type of UI correctly than professionals who did not use the tool.<br /> In the third stage of the study we tested the tool in real General Practice settings, to see whether or not it was useful to health care professionals in practice and what effect it may have on the type of care that women with UI receive. We found that it was used mainly by practice nurses, who felt that it helped to improve the care that women received.<br /> <br /> Conclusions<br /> The tool that has been developed in this study has the potential to help health care professionals assess and manage UI in women in community settings more effectively. It could be translated into an electronic tool for all community practitioners to access.&nbsp;<br /> &nbsp;<br /> <b>Keywords</b><br /> Urinary incontinence, evidence based practice, clinical decision tool, decision algorithm, primary care.<br /> <br /> <b>Summary of research findings</b><br /> Background<br /> Urinary incontinence (UI), defined as ‘the complaint of any involuntary leakage of urine’ is a common symptom and represents a major public health concern. Evidence suggests that most UI symptoms in women are treatable or can be ameliorated in primary care settings by conservative measures such as lifestyle advice and behavioural strategies. However, adherence to guidance is very variable and women are frequently referred to secondary care without an adequate trial of these interventions.&nbsp;<br /> <br /> Identifying the type of incontinence that a woman may have is based on a judgement. Judgement processes commonly involve the integration of information from a variety of sources, which are then evaluated to reach a conclusion; in this case evaluating information about the characteristics of a woman’s urinary symptoms, to identify what type of UI (stress, urgency, mixed, functional and overflow) is the most probable. On the basis of this judgement a decision would be taken regarding what treatment to recommend. Using formal, structured tools to assist with the judgement process may reduce the likelihood of errors, as they encourage clinicians to focus on relevant information in a consistent fashion. Decision tools to assist primary/community health care clinicians in diagnosing the type of UI and that are accurate, acceptable and cost-effective to use in practice do not currently exist.<br /> <br /> Aims and Objectives<br /> The aim of this study was to develop and validate a decision tool to assist health care practitioners identify the type of urinary incontinence (UI) experienced by women living in the community, leading to improved management of a woman’s UI.<br /> It addressed the following research questions:<br /> Does the use of a decision tool to assist with the assessment and management of UI in women in the community:<br /> i) Increase the accuracy with which health care practitioners identify the type of UI a woman is experiencing?<br /> ii) Improve the appropriateness of subsequent management of a woman’s UI?<br /> iii) Lead to better outcomes for women such as improved quality of life and amelioration of urinary symptoms?<br /> <br /> The study had the following research objectives:<br /> 1. To develop an evidence based decision tool to assist health practitioners working in primary care/community to identify the type of UI experienced by women and appropriate management strategies for the woman’s UI.<br /> 2. To test the decision tool for reliability and validity with practitioners working in primary care/community who treat women with UI.<br /> 3. To carry out a feasibility study to assess the acceptability of the tool in clinical practice, and the feasibility of carrying out any further research studies.<br /> <br /> Methods<br /> The study was in three stages;<br /> <br /> Stage 1: Development of the decision tool.<br /> Prototypes for possible decision tools were developed with the assistance of two continence specialists, based on evidence based guidance and systematic review evidence. The content and format of the tools were then evaluated using focus groups and in-depth interviews with 52 primary and community health care professionals (6 GPs; 3 practice nurses; 38 community nurses, 3 health care assistants) whose role includes the assessment and management of women with symptoms of urinary incontinence. Interviews and focus groups were audio-recorded and transcribed. Transcripts were analysed using the ‘Framework’ approach, based on a series of sequential steps: familiarisation with the data; thematic analysis to develop the coding scheme; systematic coding and charting of data to develop a coding matrix; mapping and interpretation of the data in order to explore relationships between the codes.<br /> <br /> Stage 2: Testing of the tool for reliability and validity<br /> The decision tool derived from stage 1 was then tested for reliability and validity using 25 clinical scenarios portraying cases of women with symptoms of urinary incontinence. The scenarios were evaluated for face validity by continence specialist nurses. Health care practitioners who consented to take part in the study were randomised either to receive or not receive the decision tool; they were then asked to record their decisions about assessment and management for each of 17 cases presented to them in the first round of testing. Four weeks later, each participant was sent a second set of 17 cases (including 9 repeat cases to test for intra-rater reliability).<br /> &nbsp;&nbsp;<br /> Stage 3: Feasibility study&nbsp;<br /> Two General Practices consented to take part in the feasibility study. In each practice GPs and practice nurses were trained to use the decision tool. In each practice, 600 women who met the inclusion criteria (over 18 years and not pregnant), stratified by age, were sent information about the study and asked to contact the research team if they had symptoms of UI. They were then sent them further information and a consent form. Patients were asked to make an appointment with a relevant practitioner, who then used the decision tool during the consultation to assess and manage their UI. Outcome data for impact of UI symptoms and quality of life were collected from all patients using the ICIQ-SF and IQoL and EQ-5D questionnaires. Interviews were carried out with health care professionals and patients to evaluate the acceptability of the tool in practice.<br /> <br /> Key Findings<br /> 1. Four main themes were identified from the focus group data, relating to patient reporting of UI symptoms to clinicians and patterns of referral, health care professionals’ perceptions about adequacy of their knowledge and training to assess and manage UI symptoms in women, implementation of (NICE) clinical guidance and health care professionals’ perceptions regarding the need for a decision tool.<br /> <br /> Current care pathways in the UK mean that the first port of call for most women with incontinence will be their GP or practice nurse/ nurse practitioner. Despite this most practice nurses and GPs highlighted their lack of up to date knowledge in this area. None of the study participants, mentioned having seen, or used, the NICE ‘Quick Reference Guide’, none of the practice nurses or GPs reported using validated instruments to assess UI symptom severity and impact on quality of life and most were unaware of the existence of these tools. All groups of practitioners welcomed an easy to use tool that could assist them with the process of assessing and managing UI. The tool developed on the basis of the focus group interviews was a one page decision algorithm.<br /> <br /> 2.&nbsp; 94 health care professionals were sent copies of the scenarios for completion; 30 GPs; 44 Community Nurses; 20 Practice Nurses. Thirty-one completed sets of scenarios were returned in the first round of testing (12 GPs, 12 Community Nurses, 7 Practice Nurses) and another 24 completed sets at the second round (11 GPs, 10 Community Nurses, 3 Practice Nurses), providing 24 sets for intra-rater reliablity analysis. Participants using the tool had a higher level of agreement and identified the type of UI more accurately (Kappa range without tool 0.2-0.65; with tool 0.69-0.84).&nbsp;<br /> <br /> 3. 1200 patients were included in the mail out; 236 returned a 'decline' form, mainly because they did not have UI symptoms; 58 women contacted the research team, of whom 15 were eligible and assessed by a health care professional. All GPs and practice nurses in both practices were trained in the use of the decision tool, but practice nurses carried out the consultations. Training comprised a 45 minute long session and a pack with information for every individual member of staff.&nbsp; Interviews with practice nurses suggested the tool was a useful guide to taking a relevant history/increasing confidence in managing UI symptoms.&nbsp; The ICIQ-Short Form was new to all HCPs in the study; they appreciated its comprehensiveness and brevity and the direct link to the related website.&nbsp; Nurses reported bladder diaries were often incomplete and difficult to interpret. They commented that the decision tool would need to be supplemented by written material relating to pelvic floor muscle and bladder training (sourced by links to websites). The need for the tool to be electronically available was strongly emphasised.&nbsp;<br /> HCP's decisions: women's symptoms were accurately categorised according to UI symptoms; recommended treatments (mainly PFMT) / referrals were appropriate.<br /> Patient completion rates for ICIQ-SF, EQFD and IQoL were high, with some attrition over time&nbsp;<br /> <br /> Overall feasibility: the decision tool functioned well in practice; feedback suggested participants would find an electronic version more user friendly.&nbsp;<br /> <br /> Findings from 10 patient interviews indicated the ICIQ-SF was seen as quick and easy to complete, and the bladder diary inconvenient; patients found leaflets on PFMT and bladder training useful.&nbsp;<br /> <br /> Expected Impact<br /> The tool developed and tested in this study has the potential to improve the assessment and management of UI in women in community settings. It has been shown to be useful for GPs and practice nurses who highlighted their lack of education and training in the management of UI in women. It also has the potential to be transferred into electronic format and added to existing EHR systems in primary care; where it can be available to all health care staff for the initial assessment and management of UI in women.&nbsp;<br /> <br /> Conclusions<br /> This study has developed and tested a decision tool for the initial assessment and management of UI in women in the community.&nbsp; It has produced a tool that practitioners find easy to use, with minimal training, that is acceptable in practice and improves the accuracy of identification of the type of UI. The feasibility study identified that it would be practical to test the tool further in GP practice settings. Further evaluation of the tool with other areas of community nursing practice (who proved difficult to recruit to this study) and using it in electronic format, would be beneficial.&nbsp;<br /> <br /> <b>Patient and public involvement</b><br /> We identified a group of service users who expressed a willingness to participate in the study through existing continence services.&nbsp; We have met with this group at various points throughout the project to gain their views on the content and format of the decision tool.&nbsp; The group also commented on the content and presentation of the 'patient pictures' representated in the clinical scenarios in stage 2 of the study. Their input and advice was used to design the pilot tools for the focus groups in stage 1, and in the content of scenarios for stage 2. The group were also asked to evaluate the symptom questionnaires used to assess patient outcomes during the feasibility study for 'user-friendliness'.<br /> <br /> Input of service users has been extremely useful during the conduct of this study, and ensured that at all stages our process used tools that patients found easy to use and understand.&nbsp;&nbsp;<br /> <br /> The next stage of our work with the user group is to discuss the findings of the feasibility study with them, and ask their advice regarding dissemination of the tool to relevant user groups.&nbsp; We will also contact the Bowel and Bladder Foundation, to ask for their input into further dissemination of the tool.<br /> <br /> Part of our planned trajectory is to further develop the tool in an electronic format (with links to information such as guidance on bladder training, UI symptom scores online). We would then plan to evaluate the implementation of the tool in practice, in a larger study, using the lessons learned from our feasibility study.&nbsp; The user group will be involved in all of these developments, with one member of the group potentially being a co-applicant on further grant applications.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1207-15081). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between May 2009 and October 2011. This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

&#x0D; &#x0D; &#x0D; The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.&#x0D; &#x0D; &#x0D;

Starting in the 1960s, the flea beetle Longitarsus jacobaeae (Waterhouse) (Coleoptera: Chrysomelidae) has been imported and relocated to North America for the control of the weed tansy ragwort, Jacobaea vulgaris (Asteraceae). Some Longitarsus species are morphologically almost indistinguishable, leading to questions regarding the taxonomic identity of the beetles released. Here, we present the results of a molecular study that addresses these questions and updates a list of the releases of Longitarsus within Canada. Our findings confirm the suspected release of the cryptic species L. flavicornis concurrent with releases of L. jacobaeae at sites in British Columbia, Canada, in the 1970s. However, we find no evidence for the continued presence of L. flavicornis at historical release sites in British Columbia nor in Nova Scotia, Canada, where it might potentially have been redistributed. We confirm the presence of L. gracilis Kutschera in Nova Scotia and British Columbia, the latter population likely established from a 2005 release of Longitarsus from Nova Scotia. To our knowledge, this study provides the first published confirmation of L. gracilis in Canada. Finally, we provide evidence that what were recognised in earlier work as three separate taxa (L. succineus (Foudras), L. near noricus, and Longitarsus sp.) are likely all L. succineus.

In British Columbia, the Black Swift (Cypseloides niger) is thought to breed throughout the southern half of the province (Campbell and others 1990); however, relatively few Black Swift nests have been located and described. Grant (1966) located the 1st active Black Swift nest in the province 29 km north of Vernon at Harlan Creek. Tyson (2004) located the 2nd active nest at Cascade Falls 16 km northeast of Mission. In 2004, I located an active nest at Brandywine Falls 14 km south of Whistler. There are additional accounts that suggest nesting, but active nests have not been located or described. The 1st breeding evidence of Black Swifts was a developing egg in a bird collected on 16 June 1901 near Chilliwack (Brooks 1917). Jobin (1955) reported breeding colonies of Black Swift on cliffs near the north arm of Quesnel Lake, and 10 km northwest of Kleena Kleene. During wildlife inventories in Kootenay National Park, Black Swifts were observed flying near Helmut Falls, Sinclair Canyon, and Marble Canyon; nesting was suspected at the latter site (Poll and others 1984). In June 2001, during a cave inventory west of Prince George, a dead juvenile Black Swift was found at the entrance of Redemption Cave; Black Swifts were observed entering the cave in July, but active nests were not located (Northern BC Caving Club 2015). Black Swifts have been observed flying from sea caves near Hotsprings Cove (Campbell and others 1990) and near Port Renfrew (Tyson 2004). Given the limited number of known Black Swift nest sites in British Columbia, each of the known nest sites are increasingly valuable to the conservation of the species and determining the status of unconfirmed sites should be a priority. Beebe (1959) provided the 1st evidence of Black Swift nesting in British Columbia. On 16 August 1958, a flightless Black Swift nestling was delivered to Beebe’s home in Victoria. Apparently, the nestling was 1 of 2 Black Swift nestlings that were collected by a teenage boy on 15 August from a single nest located 4.57 m on a vertical rock face adjacent to a waterfall, approximately 2 mi north of Clinton, British Columbia. Beebe cared for the nestling by feeding the bird goat’s milk, termites, and crickets; the nestling survived and was successfully released in Victoria, British Columbia on 25 August. There is no indication that Beebe attempted to relocate the nest site, nor that it has ever been relocated (Campbell and others 1990). There are a number of reasons that would deter readers of Beebe’s account from attempting to relocate the Clinton nest site: (1) the site location is a second-hand account from an unnamed teenage boy; (2) the waterfall is unnamed; and (3) the area surrounding Clinton is generally not known for waterfalls. The mention of 2 nestlings being removed from a single nest raises doubt of Beebe’s account. It is now well established that Black Swifts lay a single egg per nest (Lowther and Collins 2002; Hirshman and others 2007); therefore, if 2 nestlings were collected in 1958, this would suggest 2 active nests were involved. In 2014, 56 years after Beebe’s nest account, I relocated what is presumed to be the original nesting site described by Beebe (1959). On 29 July 2014, I visited a series of waterfalls located approximately 6.4 km north of Clinton (Fig. 1), and conducted a 2-h search for evidence of nesting Black Swifts. I found 1 active Black Swift nest, but it was immediately clear that a more thorough inventory of the site was needed. I revisited the site on 3 August, and conducted a 7-h inventory over the approximately 500-m length of the Clinton Creek waterfall complex. No additional active Black Swift nests were located; however, I observed 4 empty nest structures that appeared to be Black Swift nests from previous years. The active Black Swift nest was beside the southern edge GENERAL NOTES

An accurate estimate of length of stay is necessary to derive passage population size for birds using a migration stopover site. In this study, we used VHF tags and a Motus automated telemetry array to estimate the length of stay of 385 Western Sandpipers (Calidris mauri) migrating through two stopover sites in British Columbia, Canada (Tofino and Fraser River Estuary) over the course of seven migration periods (three northward and four southward) from 2018 to 2021. The average length of stay of Western Sandpipers at the Tofino site on the west coast of Vancouver Island varied from 2 to 6 days and was shorter than the length of stay at the Fraser River Estuary, where the average length of stay varied from 4 to 8 days. At both sites, adult birds had shorter stopovers during southward migration, juvenile birds had longer stopovers compared to adults, and birds with lower mass at capture had longer stopovers. Morphology of adults and juveniles varied between the two sites. Birds captured at Tofino had shorter tarsi, as well as higher mass during southward migration compared to Western Sandpipers captured at the Fraser River Estuary. We also assessed prey availability at the two stopover sites, and we found that invertebrate density was greater in Tofino compared to the Fraser River Estuary during northward migration. Variation in minimum stopover length and morphology between sites suggests that individuals from different overwintering populations may use different routes along the west coast of North America. Western Sandpipers stopping at Tofino have a shorter length of stay during both migration periods and arrive heavier during southward migration, characteristics typical of "hop" migrants who travel shorter distances between stopover sites. Different stopover sites offer a unique set of site characteristics used by birds exhibiting varying migration strategies, highlighting the importance of conserving a diversity of migration stopover locations.

Fertilizer was applied on snow in January 1981 at 100 kg N•ha−1 as [15N]urea, 15NH4NO3, and NH415NO3 to 11-year-old lodgepole pine (Pinuscontorta Dougl. var. latifolia Engelm.) at Spillimacheen in the British Columbia interior and as [15N]urea (200 kg N•ha−1) to 13-year-old Douglas-fir (Pseudotsugamenziesii (Mirb.) Franco) at Green Mountain, a coastal site in British Columbia. Recovery of labelled N after one growing season was determined in soil and biomass at both sites, and it was also monitored during the growing season in snow and soil at Spillimacheen. At Green Mountain, 5.5% of urea N was recovered in tree biomass, 10.8% in understory, and 33.4% in soil organic N (total recovery 49.7%). Leaching may have contributed to N losses at Green Mountain, but was probably not a direct consequence of the application on snow. At Spillimacheen, total recovery of [15N]urea was 93.3%, with 10.1% in tree biomass, 2.4% in understory, and 80.8% in soil. For 15NH4NO3, recoveries were 5.3% in tree biomass, 2.9% in understory, and 87.0% in soil, for a total of 95.2%. For NH415NO3, recoveries were 1.9% in tree biomass, 3.4% in understory, and 39.1% in soil, for a total of 44.4%. At Spillimacheen, the performance of 15NH4NO3 was comparable to that of urea in tree uptake and soil retention. There were large losses with the NH415NO3 source, however, most likely due to leaching and denitrification during snowmelt. For this reason, fertilization with nitrate on snow is not recommended because of nitrate's susceptibility to leaching, but urea and ammonium sources may be applied under these conditions.

Growth response of lodgepole pine ( Pinus contorta Dougl.ex. Loud var. latifolia Engelm.ex S. wats.) to N fertilization is limited by insufficient S on certain sites in British Columbia. This study was conducted to document differences in soil and foliar S fractions between sites with either adequate or insufficient S as determined by foliar nutrient data and growth response information obtained from previously established fertilization research trials with N and N + S application, and to examine relationships among soil S fractions, foliar S status, and growth response to N fertilization. Mineral soil total S concentrations were very low (∼65 mg kg −1 ) at both S‐sufficient and S‐deficient sites, and were not different between the sites. Soluble inorganic SO 4 concentration was significantly greater in B horizon soil at the S‐sufficient sites than at the S‐deficient sites. Soluble inorganic SO 4 was significantly and positively correlated with organic SO 4 ( r 2 = 0.24; P = 0.03) and organic C ( r 2 = 0.76; P &lt; 0.001). Foliar SO 4 ‐S was significantly greater at the S‐sufficient sites, and was significantly and positively correlated with B‐horizon soluble inorganic SO 4 ( r 2 = 0.84; P &lt; 0.001), organic SO 4 ( r 2 = 0.46; P = 0.032), and organic C ( r 2 = 0.72; P = 0.002). The highest R 2 for a regression model between soil or foliar properties and response to N fertilization was for a model containing foliar N, foliar SO 4 ‐S, and B horizon organic C ( R 2 = 0.81; P = 0.004). Cycling of soluble inorganic SO 4 through organic SO 4 in mineral soil appears to be the process limiting S availability on S‐deficient sites. Organic SO 4 and soluble inorganic SO 4 concentrations at the S‐sufficient sites are maintaining foliar SO 4 ‐S at levels required for response to N fertilization.

Sex and gender matter

ObjectivesTo identify barriers and facilitators to receiving pediatric rheumatology care for families navigating juvenile idiopathic arthritis (JIA) and other childhood rheumatic diseases (CRD) in Northern British Columbia (BC).MethodsParents/Caregivers of children with CRD living in Northern BC and receiving care at the 2 BC Children’s Hospital Rheumatology Outreach clinics located in Prince George and Terrace BC were invited to participate in an online survey and a subsequent semi-structured interview. Survey and interview questions focused on health needs and gaps relating to rheumatology care and were developed based on previous community engagement work in these clinics. Through in vivo coding, data was thematically analyzed and summarized into actionable themes.ResultsNine families completed the survey, and 2 families participated in the interviews. Their children had a median age of 6 y. Distance to the rheumatology outreach clinic varied, with 45% of participants (n = 4) reported traveling less than 10 km, 10% (n = 1) traveling between 100 km-200 km, and 45% of respondents (n = 4) traveling more than 200 km. 70% of participants (n = 7) described: feeling that their child’s symptoms were initially dismissed by local health care providers, feeling that their child did not receive adequate medical attention from their general practitioners, feeling that their family’s case was overlooked multiple times, and ultimately resorting to emergency care. Helpful supports identified by participants following their child’s diagnosis included: 50% (n = 5) affirming that connection with other parents and families as helpful and 80% (n = 8) described or recommended examples of self-advocacy to support the journey to diagnosis. The thematic coding resulted in 4 actionable recommendations for the pediatric rheumatology health team and Cassie + Friends to take forward (Table 1).ConclusionOur findings demonstrate the emotional toll that children and families may experience while reaching a diagnosis and navigating CRD when living in Northern and rural BC. Connections to other local families, and encouragement for parental advocacy, were highlighted as positive actions for families. This community-based needs assessment allowed for the development of actionable solutions including disease-specific education for general practitioners, increased mental health services, regionally accessible supports, and local parent navigators which may promote a greater sense of support and well-being for Northern BC families impacted by CRD.