Canadian Landscape Research Articles

Keratinocyte Carcinoma: Canadian Landscape and an Evidence-based Approach to Follow-up

Dermatologists play a vital role in the early detection, prevention and effective management of skin cancer in patients with a prior history of the disease. Regular monitoring and timely interventions greatly enhance the overall prognosis and quality of life for patients with skin cancer. Dermatologists possess the requisite expertise to accurately diagnose and oversee the management of cutaneous skin cancers. Skin cancer screening via total body skin exam (TBSE) is often considered one of the safest, easiest, and most cost-effective tests in medicine. Despite dermatologists’ ability to offer such invaluable care for this patient population, offering routine skin checks for all patients with a prior history of skin cancer becomes exceptionally challenging given the high demand for dermatology care across Canada. It is important for dermatologists to maximize the efficiency of care during TBSEs by adhering to evidence-based guidelines when determining the frequency and duration of follow-up. These guidelines also provide a solid foundation for discussions with patients regarding the rationale for discharge back to their primary care provider.

Peat profile database from peatlands in Canada.

Peatlands cover approximately 12% of the Canadian landscape and play an important role in the carbon cycle through their centennial- to millennial-scale storage of carbon under waterlogged and anoxic conditions. In recognizing the potential of these ecosystems as natural climate solutions and therefore the need to include them in national greenhouse gas inventories, the Canadian Model for Peatlands module (CaMP v. 2.0) was developed by the Canadian Forest Service. Model parameterization included compiling peat profiles across Canada to calibrate peat decomposition rates from different peatland types, to define typical bulk density profiles, and to describe the hydrological (i.e., water table) response of peatlands to climatic changes. A total of 1217 sites were included in the dataset from published and unpublished sources. The CORESITES table contains site location and summary data for each profile, as well as an estimate of total carbon mass per unit area (in megagrams of C per hectare). Total carbon mass per unit area at each location was calculated using bulk density and carbon content through each profile. The PROFILES table contains data for depth (in centimeters), bulk density (in grams per cubic meter), ash and carbon content (in percentage), and material descriptions for contiguous samples through each peat profile. Data gaps for bulk density and C content were filled using interpolation, regression trees, and assigned values based on material description and/or soil classification to allow for the estimation of total carbon mass per unit area. A subset of the sites (N = 374) also have pH and pore water trace-elemental geochemistry data and are found in the WATER table. The REFERENCES table contains the full citation of each source of the data and is linked to each core location through the SOURCEDATA table. The LOOKUP table defines codes in the database that required more space that what was sufficient in the metadata tables. The data can be accessed on Open Government Canada and will be useful for future work on carbon stock mapping and ecosystem modeling. All metadata and data are provided © Her Majesty the Queen in Right of Canada, 2023 and information contained in this publication may be reproduced for personal or public noncommercial purposes with attribution, whereas commercial reproduction and distribution are prohibited except with written permission from NRCan; complete details are noted in the Supporting Information file Metadata S1 (see Class III.B.3: Copyright restrictions).

The Need for Decolonized Education: A Textual Analysis of Existing Literature in the Public Domain in Support of the Canadian National Inquiry Documents Calls for Education

The significance of this study sits in the importance of restorying for decolonial education. The textual analysis of literature in public domain in support of the Canadian national inquiry documents (2015, Truth and Reconciliation Calls (TRC) and the Murdered and Missing Indigenous Women and Girls (MMIWG) Calls, 2019) highlighted the magnitude of story to curriculum and Indigenous culture. Barriers included contemporary issues in mainstream schooling. The prominence of culture within the interconnected relationship with land-based learning in curriculum development and programming for wellness/well-being on Turtle Island (North America) are paramount. The present-day state of affairs in the mainstream educational Canadian landscape is not aligned with Indigenous appropriate methodologies and culture as a subjective measure and therefore falls short. Cultural, societal and land-linked factors must be considered as indicators.

Artificial intelligence and social accountability in the Canadian health care landscape: A rapid literature review.

Situated within a larger project entitled "Exploring the Need for a Uniquely Different Approach in Northern Ontario: A Study of Socially Accountable Artificial Intelligence," this rapid review provides a broad look into how social accountability as an equity-oriented health policy strategy is guiding artificial intelligence (AI) across the Canadian health care landscape, particularly for marginalized regions and populations. This review synthesizes existing literature to answer the question: How is AI present and impacted by social accountability across the health care landscape in Canada? A multidisciplinary expert panel with experience in diverse health care roles and computer sciences was assembled from multiple institutions in Northern Ontario to guide the study design and research team. A search strategy was developed that broadly reflected the concepts of social accountability, AI and health care in Canada. EMBASE and Medline databases were searched for articles, which were reviewed for inclusion by 2 independent reviewers. Search results, a description of the studies, and a thematic analysis of the included studies were reported as the primary outcome. The search strategy yielded 679 articles of which 36 relevant studies were included. There were no studies identified that were guided by a comprehensive, equity-oriented social accountability strategy. Three major themes emerged from the thematic analysis: (1) designing equity into AI; (2) policies and regulations for AI; and (3) the inclusion of community voices in the implementation of AI in health care. Across the 3 main themes, equity, marginalized populations, and the need for community and partner engagement were frequently referenced, which are key concepts of a social accountability strategy. The findings suggest that unless there is a course correction, AI in the Canadian health care landscape will worsen the digital divide and health inequity. Social accountability as an equity-oriented strategy for AI could catalyze many of the changes required to prevent a worsening of the digital divide caused by the AI revolution in health care in Canada and should raise concerns for other global contexts.

An Inventory of Rare Disease Registries in the Canadian Landscape

What Was the Question? There is a lack of centralized information about rare disease registries (RDRs) in Canada. To address this, we created an inventory of RDRs in Canada and international RDRs that include patients living in Canada. What Did We Do? Information about RDRs was identified through a search of published literature, grey literature, consultations with members of the rare disease community, and a survey with the registry holders. What Did We Find? We identified 148 RDRs, of which 66 are RDRs in Canada and 82 international RDRs. In total, 21% of RDRs in Canada and 11% of international RDRs capture rare cancer(s). About a half of RDRs in Canada (53%) and international RDRs (46%) collaborate with other national or international registries or networks. Most RDRs in Canada (73%) and international RDRs (86%) identify patients for RDR enrollment through health care provider referrals. Electronic medical records (68%), clinician-reported data (68%), and medical chart abstraction (60%) are the most common sources of data for RDRs in Canada compared to international RDRs, for which patient (79%) and caregiver (61%) surveys are most common. Most RDRs in Canada collect clinical data (95%), laboratory and diagnostic data (85%), health outcomes data (83%), and treatment data (78%), and less commonly patient-generated data (55%) and caregiver data (15%). What Does This Mean? The information in the inventory will help guide future initiatives for improving the RDR landscape in Canada. Most RDRs in Canada source data from electronic health records, clinician-reported data, and medical charts. Fewer RDRs in Canada implement patient and caregiver surveys. RDRs in Canada include information relevant to decision-makers as most collect clinical data, health outcomes data, and treatment data, and about half collect health resource utilization data. This inventory will support future initiatives to assess the suitability of RDRs for generating decision-grade real-world evidence.

Introduction: Special Issue on Teaching Academic Writing in Canada

This article introduces a Special Issue of Discourse and Writing/Rédactologie: Teaching Academic Writing in Canada. It contextualizes the research and pedagogical discussions contained herein, and it underlines how these contributions emphasize two major trends on the Canadian landscape of academic writing: the movement toward decolonizing academic writing and diverse approaches to writing in the disciplines and writing centre practices.

Strategies for Achieving Better Cognitive Health in Individuals with Schizophrenia Spectrum: A Focus on the Canadian Landscape: Stratégies pour atteindre une meilleure santé cognitive chez les personnes souffrant du spectre de la schizophrénie : un regard sur le paysage canadien.

Schizophrenia spectrum disorders (SSDs) are a group of psychiatric disorders characterized by positive and negative symptoms as well as cognitive impairment that can significantly affect daily functioning. We reviewed evidence-based strategies for improving cognitive function in patients with SSDs, focusing on the Canadian landscape. Although antipsychotic medications can address the positive symptoms of SSDs, cognitive symptoms often persist, causing functional impairment and reduced quality of life. Moreover, cognitive function in patients with SSDs is infrequently assessed in clinical practice, and evidence-based recommendations for addressing cognitive impairment in people living with schizophrenia are limited. While cognitive remediation (CR) can improve several domains of cognitive function, most individuals with SSDs are currently not offered such an intervention. While the development of implementation strategies for CR is underway, available and emerging pharmacological treatments may help overcome the limited capacity for psychosocial approaches. Furthermore, combining pharmacological with non-pharmacological interventions may improve outcomes compared to pharmacotherapy or CR alone. This review highlights the challenges and discusses the potential solutions related to the assessment and management of cognitive impairment to help mental health-care practitioners better manage cognitive impairment and improve daily functioning in individuals with SSDs.

An overview of the Canadian landscape on the use of restorative therapies for erectile dysfunction and Peyronie’s disease

Introduction: Restorative therapies (RT(s)), including low-intensity shockwave therapy (Li-SWT) and platelet-rich plasma (PRP), aim to restore natural erectile function. Many clinics offer these therapies for erectile dysfunction (ED) and Peyronie’s disease (PD) with direct-to-consumer (DTC) marketing. This study sought to investigate the landscape of RTs within Canadian clinics. Methods: Online searches were made to identify clinics offering Li-SWT and/or PRP as an RT for treating ED and PD in Canada. Public websites were analyzed, followed by calling clinics for data on cost, treatment protocols, clinic ownership, success rates, and adjunctive therapies. Results: A total of 107 clinics were identified online, with a 68.2% call response rate (n=73). Of the respondents, 56 and 40 clinics provided Li-SWT and PRP therapies, respectively, with 23 clinics offering both. All clinics reported using RTs for ED, with 21 clinics offering Li-SWT and 22 clinics providing PRP for PD. Forty-three clinics provided costs and protocols for Li-SWT, while 33 clinics did so for PRP. The average cost + standard deviation (CAD) of six sessions of Li-SWT was $2167.24+936.11 and one shot of PRP was $1478.68+591.98. Most (60.3%, n=44) clinics reported physician ownership, with a majority (n=28) being family medicine trained. Seven clinics did not provide data and 22 were non-MD-owned. Ten clinics provided success rates, with an average of 87.3%. Conclusions: Despite limited data supporting their routine clinical use, many clinics across Canada offer RTs for ED and PD with varying treatment protocols and increased costs. Further research is required to evaluate the efficacy of RT for ED and PD.

Evaluation of weather and environmental factors and their association with cutaneous melanoma incidence: A national ecological study

BackgroundCutaneous melanoma (CM) is a significant contributor to skin cancer-related mortality globally and in Canada. Despite the well-established link between ultraviolet (UV) radiation exposure and skin cancer risk, there remains a gap in population-level interventions and persistent misconceptions about sun exposure and impact of environment on individual behavior. ObjectiveThe current study provides an ecological analysis using latest available data (2011-2017) to define geographic/environmental contributors to the CM landscape in Canada. MethodsUtilizing Canadian Cancer Registry (CCR) and Canadian Urban Environmental Health Research Consortium (CANUE) data, we analyzed 39,605 CM cases occurring in Canada from 2011-2017. Environmental data, including UV radiation, greenspace (NDVI), temperature, heat events, and precipitation was used to evaluate the effect of environment on CM incidence rates across Forward Sortation Area (FSA) postal codes. ResultsFSAs with increased CM incidence were associated with higher annual average temperature, snowfall, heat events, NDVI, and vitamin D-weighted UV exposure. Conversely, factors associated with decreased incidence included an increased annual highest temperature, rain precipitation, and a longer duration of heat events. LimitationsThis study is subject to ecological bias and findings should be interpreted with caution ConclusionThis study further substantiates associations between specific environmental factors and CM incidence.

Oak genomics for nature-based solutions: shaping future forests and resilient landscapes in Canada

Oak genomics for nature-based solutions: shaping future forests and resilient landscapes in Canada

Systemic Mastocytosis: Diagnosis and Management in 2024

Mastocytosis is a group of clonal disorders characterized by an accumulation of neoplastic mast cells (MCs) in one or more organ systems. The clinical presentation of mastocytosis is heterogenous as are the clinical outcomes. For example, some variants are associated with near normal life expectancy, while others are amongst the most aggressive known malignancies. Mastocytosis can occur in both pediatric and adult populations and can be classified into three major groups: systemic mastocytosis (SM), cutaneous mastocytosis (CM), and localized mast cell sarcoma. This review will focus on SM in adults with the aim of providing a general overview of the (1) pathophysiology, (2) diagnostic approach, and (3) current treatment landscape in Canada.

82 Newborn Screening for Severe Combined Immune Deficiency: The Canadian Landscape

82 Newborn Screening for Severe Combined Immune Deficiency: The Canadian Landscape

The potential for Indigenous-led conservation in urbanized landscapes in Canada

Indigenous Protected and Conserved Areas (IPCAs) are an important pathway and governance system for area-based conservation led by Indigenous Peoples. While IPCAs have been established across rural and northern regions of Canada, they have received little attention in urbanized landscapes, even though all of Canada’s urban areas coincide with First Nations, Inuit, and Métis territory (and thereby underlying Indigenous jurisdiction) and the majority of Indigenous Peoples in the country live in urban centers. Canada’s federal government is in the process of establishing six new urban national parks and has committed to working with local Indigenous governments and organizations in parks planning. This study examined the potential for strengthening Indigenous participation in urban parks planning, governance, and management, including the establishment of new urban Indigenous Protected and Conserved Areas (UIPCAs). The results of spatial analyses of urban Indigenous territory, a review of relevant domestic and international policy and interviews with local Indigenous conservation leaders illuminate the potential for new forms of urban conservation governance that are grounded in Indigenous rights and responsibilities and reflective of Indigenous knowledge systems and biocultural priorities. However, it remains to be seen how urban Indigenous-led conservation, such as UIPCAs, can fit and operate within proposed government urban conservation initiatives, such as Canada’s Urban National Parks Program, which do not currently foreground Indigenous-led conservation in the governance of urban green space.

Landscape of Métis health and wellness: protocol for a scoping review

IntroductionIn Canada, Métis people are one of three distinct Indigenous peoples whose rights are recognised and affirmed in Section 35 of the federal Constitution Act, 1982. In line with Métis...

Assessing support for mental health policies among policy influencers and the general public in Alberta and Manitoba, Canada

BackgroundThere is a need to improve mental health policy in Canada to address the growing population burden of mental illness. Understanding support for policy options is critical for advocacy efforts to improve mental health policy. Our purpose was to describe support for population-level healthy public policies to improve mental health among policy influencers and the general public in Alberta and Manitoba; and, identify associations between levels of support and sociodemographic variables and relative to the Nuffield Bioethics Intervention Ladder framework.MethodsWe used data from the 2019 Chronic Disease Prevention Survey, which recruited a representative sample of the general public in Alberta (n = 1792) and Manitoba (n = 1909) and policy influencers in each province (Alberta n = 291, Manitoba n = 129). Level of support was described for 16 policy options using a Likert-style scale for mental health policy options by province, sample type, and sociodemographic variables using ordinal regression modelling. Policy options were coded using the Nuffield Council on Bioethics Intervention Ladder to classify support for policy options by level of intrusiveness.ResultsPolicy options were categorized as ‘Provide Information’ and ‘Enable Choice’ according to the Nuffield Intervention Ladder. There was high support for all policy options, and few differences between samples or provinces. Strong support was more common among women and among those who were more politically left (versus center). Immigrants were more likely to strongly support most of the policies. Those who were politically right leaning (versus center) were less likely to support any of the mental health policies. Mental health status, education, and Indigenous identity were also associated with support for some policy options.ConclusionsThere is strong support for mental health policy in Western Canada. Results demonstrate a gap between support and implementation of mental health policy and provide evidence for advocates and policy makers looking to improve the policy landscape in Canada.

From religious citizen to multicultural citizen: Changing conceptualizations of citizenship and belonging in Canada

The religious landscape in Canada has shifted dramatically during the past 50 years, from a country whose population and social institutions were inextricably entangled with Christianity to one which has an increasing number of people who do not identify with a religion at all. Citizenship in this context has shifted from a nation whose imaginary was predominantly Christian, with diversity conceptualized in rather limited ways to one characterized by (non)religious diversity and a multicultural reality. Yet, there are growing pains as majoritarian religion confronts a changing power dynamic and the new diversity. These growing pains have potentially negative implications for education. This article considers the new diversity, the articulation of religious symbols and practices as culture, and the implications of these for citizenship and living well together.

(232) The Use of Restorative Therapies for Erectile Dysfunction: A Review of the Current Canadian Landscape

Abstract Introduction Erectile dysfunction (ED) is the inability to achieve or maintain an erection that is sufficient for sexual performance. Restorative therapies are heralded as options to restore one’s natural, spontaneous erection without the need for pharmacologic therapy. There is a growing interest in these therapies including low-intensity shockwave therapy (Li-EST), platelet-rich plasma (PRP) and stem cells for the treatment of ED. However, limited data exists to support their routine clinical use. With direct-to-consumer marketing, numerous clinics across Canada now offer this therapy. We sought to investigate the landscape of restorative therapies for ED across Canada. Objective The objective is to evaluate how restorative therapies for ED are being marketed and administered to patients. Our study hopes to analyze cost, indications for treatment, equipment utilized, treatment protocol, clinic ownership, level of training for staff, and whether a urologic consult is required prior to treatment. Methods Searches were made on a private Google browser with queries that include phrases “Shockwave therapy for erectile dysfunction in Province/Territory”, “PRP therapy for erectile dysfunction in Province/Territory”, among others. Searches were also made to include any stem cell regenerative therapies for ED. Clinics advertising their services online had their public website analysed for preliminary data collection. Our team captured data on costs, treatment duration, success rates, adjuvant therapies administered and more. Data obtained was then compared against existing literature to assess the accuracy of marketing towards patients. Results To date, we have obtained preliminary results from 107 clinics across Canada offering a form of restorative therapy for ED. We hope to contact every clinic offering these services in Canada by the end of the study period in August of 2023. Out of the identified clinics thus far, 72.9% are offering SWT and 49.5% are offering PRP treatment for ED, with 27.1% of clinics offering both. Our team was unable to identify any clinics providing stem cell therapy for ED. The average cost of SWT from the data we have collected thus far is $1701.92, ranging from $500 to $3500 for a six-treatment protocol that a majority of clinics opt for. Similarly, the average cost of PRP is $1458.22, ranging from $875 to $2000 per treatment. 15% of clinics reported a success rate for SWT, with a mean of 76.81% (ranges 50-100%). A singular clinic has quoted the success rate of PRP at 75% currently. Out of the 107 clinics contacted, 74 of them listed their ownership and staff. 12.2% of the clinics that listed their staff had a urologist present, 56.8% of them had a non-urologist MD employed on staff, and 31.1% did not have an MD present at the clinic. Conclusions Our study has so far found that Li-SWT and PRP for restorative therapies are being largely marketed directly-to-consumer with very little urologic intervention prior to treatment throughout Canada. The study highlights similar trends found in the US, taking advantage of the psychosocial burden faced by patients that suffer from ED, tacking on substantial financial costs for restorative therapies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

POLARIZATION AND INTERVENTION-BASED P/CVE PROGRAMS IN CANADA

On November 13th, 2023, Dr. Sara K. Thompson presented Polarization and Intervention-based P/CVE Programs in Canada for this year’s West Coast Security Conference. The key points discussed were the typology of extremist violence, the processes of radicalization and mobilization to violence, the threat landscape in Canada, past and present (and the impact of social polarization), and the somewhat recent incorporation of prevention/intervention programming into the broader national security apparatus.
 
 Received: 12-12-2023
 Revised: 01-29-2024

Inuit autonomy in the Canadian Arctic: comparing treaty federalism in Nunavut and Nunatsiavut

ABSTRACT When examining the institutional landscape in Canada’s Arctic regions, one thing that is particularly striking is the diversity of autonomy regimes that have emerged through the negotiation of treaties with Indigenous Peoples. This article contrasts the experiences of the Nunavut government (a public government administering a territory with an Inuit majority) and the Nunatsiavut government (an Inuit-only government nested within the province of Newfoundland and Labrador). What explains the development of these two different types of institutional arrangements that emerged out of similar processes of treaty negotiation? And what are the political consequences of these diverging paths? We first discuss the historical foundations of treaty-based Indigenous autonomy regimes in Northern Canada. We then argue that two factors are particularly relevant to understanding the different trajectories of Nunavut and Nunatsiavut. First is the timing of treaty negotiations, which opened different institutional possibilities at critical junctures, and second is the geopolitical context specific to the two regions. Lastly, we look at some of the political implications of these two models, focusing on the way identity is mediated and on the distinctive multilevel governance dynamics they induce.

The changing agricultural landscape in Canada’s Mixedwood Plains Ecozone (2011–2022) and the implications for biodiversity

The changing agricultural landscape in Canada’s Mixedwood Plains Ecozone (2011–2022) and the implications for biodiversity