ABSTRACT In light of Canada’s goal of achieving net-zero emissions by 2050 and conditions in increasingly deeper mines, the trend in Canadian mines is to move away from conventional internal combustion engine vehicles and toward battery electric vehicles (BEVs). However, the limited driving range and the longer time required to recharge a battery than refuel a tank could reduce BEV availability and negatively affect production targets. Understanding the differences between these two technologies is critical when designing a new mine or transforming an existing fossil fuel-based fleet into an electric fleet. Thus, the primary objective of this study was to compare diesel cassette trucks (DCTs) and electric cassette trucks (ECTs) in terms of net fuel and energy consumption, respectively. MacLean Engineering heavy-duty DCTs and ECTs were field-tested at Vale’s North Mine surface ramp at 5 and 15 km/h and loaded with the same weight. The controlled 2.5-km test route comprised 10 sections of 0, 5, 10, and 20% uphill and downhill inclination grades. This paper compares DCT and ECT performance in terms of ability to maintain the target speed under different operational conditions and fuel and energy consumption. The energy captured through regenerative braking and charging information was also evaluated for the ECT. An energy to fuel ratio (kWh/L) was calculated for various operating conditions. Furthermore, the data were used in a hypothetical duty cycle to estimate DCT and ECT availability within a work shift.

To update the 2015 clinical practice guideline and provide a simplified approach to lipid management in the prevention of cardiovascular disease (CVD) for primary care. Following the Institute of Medicine's Clinical Practice Guidelines We Can Trust, a multidisciplinary, pan-Canadian guideline panel was formed. This panel was represented by primary care providers, free from conflicts of interest with industry, and included the patient perspective. A separate scientific evidence team performed evidence reviews on statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, fibrates, bile acid sequestrants, niacin, and omega-3 supplements (docosahexaenoic acid with eicosapentaenoic acid [EPA] or EPA ethyl ester alone [icosapent]), as well as on 11 supplemental questions. Recommendations were finalized by the guideline panel through use of the Grading of Recommendations Assessment, Development and Evaluation methodology. All recommendations are presented in a patient-centred manner designed with the needs of family physicians and other primary care providers in mind. Many recommendations are similar to those published in 2015. Statins remain first-line therapy for both primary and secondary CVD prevention, and the Mediterranean diet and physical activity are recommended to reduce cardiovascular risk (primary and secondary prevention). The guideline panel recommended against using lipoprotein a, apolipoprotein B, or coronary artery calcium levels when assessing cardiovascular risk, and recommended against targeting specific lipid levels. The team also reviewed new evidence pertaining to omega-3 fatty acids (including EPA ethyl ester [icosapent]) and proprotein convertase subtilisin-kexin type 9 inhibitors, and outlined when to engage in informed shared decision making with patients on interventions to lower cardiovascular risk. These updated evidence-based guidelines provide a simplified approach to lipid management for the prevention and management of CVD. These guidelines were created by and for primary health care professionals and their patients.

To assess the benefits and harms of lipid-lowering therapies used to prevent or manage cardiovascular disease including bile acid sequestrants (BAS), ezetimibe, fibrates, niacin, omega-3 supplements, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, and statins. MEDLINE, the Cochrane Database of Systematic Reviews, and a grey literature search. Systematic reviews of randomized controlled trials published between January 2017 and March 2022 looking at statins, ezetimibe, PCSK9 inhibitors, fibrates, BAS, niacin, and omega-3 supplements for preventing cardiovascular outcomes were selected. Outcomes of interest included major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, and adverse events. A total of 76 systematic reviews were included. Four randomized controlled trials were also included for BAS because no efficacy systematic review was identified. Statins significantly reduced MACE (6 systematic reviews; median risk ratio [RR]=0.74; interquartile range [IQR]=0.71 to 0.76), cardiovascular mortality (7 systematic reviews; median RR=0.85, IQR=0.83 to 0.86), and all-cause mortality (8 systematic reviews; median RR=0.91, IQR=0.88 to 0.92). Major adverse cardiovascular events were also significantly reduced by ezetimibe (3 systematic reviews; median RR=0.93, IQR=0.93 to 0.94), PCSK9 inhibitors (14 systematic reviews; median RR=0.84, IQR=0.83 to 0.87), and fibrates (2 systematic reviews; mean RR=0.86), but these interventions had no effect on cardiovascular or all-cause mortality. Fibrates had no effect on any cardiovascular outcomes when added to a statin. Omega-3 combination supplements had no effect on MACE or all-cause mortality but significantly reduced cardiovascular mortality (5 systematic reviews; median RR=0.93, IQR=0.93 to 0.94). Eicosapentaenoic acid ethyl ester alone significantly reduced MACE (1 systematic review, RR=0.78) and cardiovascular mortality (2 systematic reviews; RRs of 0.82 and 0.82). In primary cardiovascular prevention, only statins showed consistent benefits on MACE (6 systematic reviews; median RR=0.75, IQR=0.73 to 0.78), cardiovascularall-cause mortality (7 systematic reviews, median RR=0.83, IQR=0.81 to 0.90), and all-cause mortality (8 systematic reviews; median RR=0.91, IQR=0.87 to 0.91). Statins have the most consistent evidence for the prevention of cardiovascular complications with a relative risk reduction of about 25% for MACE and 10% to 15% for mortality. The addition of ezetimibe, a PCSK9 inhibitor, or eicosapentaenoic acid ethyl ester to a statin provides additional MACE risk reduction but has no effect on all-cause mortality.

Family medicine physicians manage the highest complexity of conditions in their practices.[1][1] Family physicians must actively stay up to date on new advances and recent evidence; care for patients of all ages and throughout many stages of their lives; share patients’ struggles and triumphs

To develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care. The guideline was developed with an emphasis on best available evidence and shared decision-making principles. Ten health professionals (4 generalist family physicians, 1 pain management-focused family physician, 1 anesthesiologist, 1 physical therapist, 1 pharmacist, 1 nurse practitioner, and 1 psychologist), a patient representative, and a nonvoting pharmacist and guideline methodologist comprised the Guideline Committee. Member selection was based on profession, practice setting, and lack of financial conflicts of interest. The guideline process was iterative in identification of key questions, evidence review, and development of guideline recommendations. Three systematic reviews, including a total of 285 randomized controlled trials, were completed. Randomized controlled trials were included only if they reported a responder analysis (eg, how many patients achieved a 30% or greater reduction in pain). The committee directed an Evidence Team (composed of evidence experts) to address an additional 11 complementary questions. Key recommendations were derived through committee consensus. The guideline and shared decision-making tools underwent extensive review by clinicians and patients before publication. Physical activity is recommended as the foundation for managing osteoarthritis and chronic low back pain; evidence of benefit is unclear for neuropathic pain. Cognitive-behavioural therapy or mindfulness-based stress reduction are also suggested as options for managing chronic pain. Treatments for which there is clear, unclear, or no benefit are outlined for each condition. Treatments for which harms likely outweigh benefits for all or most conditions studied include opioids and cannabinoids. This guideline for the management of chronic pain, including osteoarthritis, low back pain, and neuropathic pain, highlights best available evidence including both benefits and harms for a number of treatment interventions. A strong recommendation for exercise as the primary treatment for chronic osteoarthritic and low back pain is made based on demonstrated long-term evidence of benefit. This information is intended to assist with, not dictate, shared decision making with patients.

Objectives:This study aims to develop a screening tool that will help first responders identify patients with proximal femur fractures, commonly referred to as hip fractures, on site and direct these patients to hospitals with orthopaedic surgery services.Study Design:Prospective survey.Methods:Literature and expert opinion defined parameters for the Collingwood Hip Fracture Rule (CHFR) which predict a patient's likelihood of hip fracture. The study population included adults presenting to Collingwood General and Marine Hospital with lower extremity injuries between December 1, 2019 and March 10, 2020. Excluded patients had previous hip replacement, previous hip fracture on the side of the injury, or a high energy mechanism of injury. Patients were assessed with the CHFR before receiving x-ray imaging. The parameters were scored based on their predictive powers and analyzed by a receiver operating characteristic curve.Results:The study included 101 patients (mean age 66.3 years), and 25.7% had a hip fracture confirmed on imaging. The sensitivity, specificity, positive predictive value, and negative predictive value helped score each parameter. Factors receiving 1 point are: age 65 to 79 years, female, mechanical fall, unable to weight-bear, knee pain. Factors receiving 2 points are: bruising at greater trochanter, age >80 years. Factors receiving 3 points are: pain with hip rotation, leg shortened and externally rotated. Score is the summation of all the factors’ points. The receiver operating characteristic curve (0.953; P value < .0001) demonstrated scores of 7 had sensitivity:specificity of 84.6%:94.7%.Conclusion:The CHFR screening tool score of 7 can be used by first responders in the prehospital setting to identify patients who sustain a hip fracture and make appropriate triage decisions. This will improve patient outcomes and decrease institutional costs.

Background:Skin-to-skin contact between mother and infant immediately after birth is recommended regardless of delivery method; however, it is less common after cesarean delivery. We aimed to describe and compare women’s experiences of cesarean birth with and without skin-to-skin contact at an urban tertiary care hospital.Methods:In this hermeneutic phenomenologic study, we used semistructured telephone interviews from 2015 to 2018 to interview a convenience sample of women who delivered at term by scheduled skin-to-skin cesarean birth at an urban tertiary care hospital in Toronto, Ontario. Women were invited to participate if they had had a previous planned or unplanned cesarean birth and a scheduled skin-to-skin cesarean birth between 2013 and 2017. Participants were excluded if they had antenatally diagnosed conditions, they delivered before 37 weeks, they had general anesthesia, their condition was unstable at the time of surgery, a skin-to-skin cesarean birth was not possible or they declined skin-to-skin cesarean birth. Interviews were recorded, transcribed and analyzed by means of thematic analysis.Results:Ten women were interviewed 1–19 months postpartum. Four central themes emerged: support for skin-to-skin cesarean birth (women feeling supported by their families and health care providers); control (participants experiencing greater control during their skin-to-skin cesarean birth); connection with the infant, which enabled women to be active participants in their delivery, enhanced bonding and intimacy, facilitated breastfeeding and bolstered confidence during early parenthood; and logistic considerations, with participants recognizing that skin-to-skin cesarean birth required additional resources.Interpretation:These findings refine what is known about skin-to-skin cesarean birth and provide a critical perspective, that of mothers. They support the transformation of traditional operating room dynamics to a more patient-centred environment.

> ‘I’m really sorry, it’s just something we have to ask everyone, but you’ve not had any thoughts of hurting yourself or anything like that, have you?’ I cringed as I read the article by Ford and colleagues1 that had somehow found its way into my Twitter feed, seeing my own half-hearted phrasing reflected back at me. I generally consider myself all right at mental health consultations and often find the need to directly ask these questions quite clunky, preferring to rely on my rapport with the patient, the history of their distress, and an instinctive impression of the seriousness of the presentation. Like a lot of the doctors in the recorded consultations that the research team analysed, I ask them — but I’m not asking them in a way that invites a ‘yes’. We have it drummed into us that asking about self-harm and suicide is one of the key parts of a …

What are the benefits and risks of 3 coronavirus disease 2019 (COVID-19) vaccines? Interim results (2 large RCTs) show the relative efficacy of the Pfizer-BioNTech and Moderna vaccines (about 95%) and the AstraZeneca-Oxford vaccine (about 70%) in preventing COVID-19. Absolute benefits will vary

Your messaging in the January issue of Canadian Family Physician is great[1][1]; we should have a shared decision-making discussion with our patients about mammogram screening. Dr Ed Kucharski, I see that you are Regional Primary Care Cancer Screening Lead at Ontario Health–Cancer Care Ontario. It