Structural determinants of vaccine access: an integrated review of the Canadian literature.

Opioids are acknowledged as a standard of care for post-operative analgesia but with their use comes associated harms. Persistent opioid use rates after surgery are as high as 10%. Overall, opioid prescribing patterns in our region have been declining but there is a relative scarcity of Canadian literature on the use of opioid analgesia following orthopaedic shoulder procedures to guide best practice guidelines. Our study evaluates regional prescribing patterns for opioids after elective orthopaedic shoulder procedures. For this retrospective cohort study, hospital Discharge Abstract Database and National Ambulatory Care Reporting System data were used to identify orthopaedic shoulder surgeries, specifically implant, excision, and repair, from October 2016 to March 2023. The provincial Drug Information System was utilized to calculate rates of any opioids prescribed and morphine milligram equivalency (MME) for prescriptions filled at discharge. Prescribing patterns were compared between hospitals and surgeons and variability was assessed. Three-level hierarchical regression (HLM) models were run to test for associations between patient circumstances and the probability of any opioid prescription at discharge as well as MME levels. Covariance estimates were used to calculate the intraclass correlation (ICC) and test for variability between and within hospitals while t-tests were analyzed to investigate associations with covariates. A 95% confidence level was used for statistical significance. The study included 6885 observations, with repairs being the most common of the three sub-groups and day surgery accounting for 77.7% [CI 76.7%–78.6%]. Overall, 84.8% [CI 83.9%–85.6%] of cases filled an opioid prescription (Rx) at discharge increasing over the study period from 79.1% [CI 75.0%–83.1%] to 84.8% [80.8%–88.8%]. The MME where positive decreased from 276.1 [CI 262.0–290.1] to 165.3 [CI 155.4–175.1]. Variation in opioid Rx varied across hospitals however ICCs indicate 8.9% of the total variation was at the surgeon level (p-value=0.0019) compared to 3.5% across hospitals (p-value=0.1142). Similarly, more of the total variation in the MME was explained by differences across surgeons (ICC=41.8% p-value < 0 .0001) compared to hospitals (ICC=6.8% p-value=0.3092). HLM models including covariates indicated older patients were less likely to fill an opioid at discharge as were emergency cases, but day surgery cases were more likely. MME models showed females and day surgery patients received lower levels of morphine when filling an Rx. Those who live in a rural level had higher MME levels as did those who filled an opioid Rx in the six months before surgery. Variations between surgeons remain in Rxs (ICC 7.5%- p-value 0.0045) and MME (ICC 41.8% p-value < 0.0001) after controlling for patient characteristics. For patients undergoing orthopaedic shoulder surgeries in our province, there was an increasing trend in opioid Rxs provided at discharge while MME decreased. This difference may reflect the tension between appropriate pain management for patients and increasing awareness of the potential harms of opioids by prescribers. Causes for variations in prescribing patterns amongst prescribers require further evaluation. Evidence-based multi-modal pain management pathways offer a strategy to reduce variability in prescribing patterns and further decrease MME levels while still appropriately addressing postoperative analgesia.

English Literature is a linking agent. Looking at the splendid fabric of English Literature, we realize in it a ‘coat of many colors’, reflecting the world’s varied cultures, traditions, and modes of thought. Literature imparts values and creates an awareness of the culture of one’s individuality. Literature as an articulation of life has an intense value. This necessitates the view that literature which does not arouse poignant feelings in humans is not literature. It is unimaginable for true lovers of literature that life without literature would be like salt, the most essential ingredient in cooking which would be incomplete, and tasteless. So human beings will be depriving themselves of the ‘aesthetics of literature’ if they do not read and enjoy the works of literary art. All forms of art and media project life as it truly and really exists. Similarly, every era is a representation of the Zeitgeist spirit in which the literary writers and artists depict the social, historical, cultural, religious, economic, political and linguistic background of that epoch. Hence, every writer becomes one with the existing social group. Their writings are a mirror of society and certainly there is an enormous impact of the prevailing conditions of contemporary life on the writers of that age. Literature has captured the attention of human hearts through its passionate portrayal of themes and subjects applicable to human life. Today we have literature from almost all continents of the globe. Literary Writers from across the globe have proved their caliber by producing mind-blowing artistic pieces of enduring value. World literature is an example to display the lofty ideals and innate talents possessed by the writers. Through their works, the writers have painted life as experienced by people and lay bare to the readers various glimpses of life which cannot be evaded by human beings. Subsequently today these world literatures-American Literature, African Literature, Canadian Literature, New Zealand Literature and South Asian Literature-which encompasses Indian English Literature, have acquired immense value. The article attempts to make a comprehensive evolution of Indian English Literature from a a Cultural and Literary perspective.

Canadian literature has been marked by a type of writing, which grounded in historiographic recollections of immigration and (ethnic) identity, has been generally classified as ethnic (minority) or diasporic writing. Yet, in the 1990s, Janice Kulyk Keefer, Ukrainian-Canadian writer, suggested the term “historiographic ethnofiction” which offers much more than the customarily applied generic labels as it captures the richness of works discussing ethnicity. Thus, the concept, so far unattended by critics, deserves attention as a productive tool of generic classification that sheds new light on how ethnic writing could be approached in a more systemic way. To illustrate its potential, this article aims at reading a recent Asian-Canadian work, Ghost Forest (2021), by Pik-Shuen Fung, as an example of contemporary Canadian historiographic ethnofiction that both follows and extends Kulyk Keefer’s conceptualization of this generic term.

Gérard Étienne (1936-2008), a pivotal figure in Haitian Canadian literature during the latter half of the twentieth century, has received relatively limited critical attention in the early years of the new century. As a journalist, poet, and novelist, Étienne’s work persistently stages a revolt against various forms of oppression – political, social, and familial. This paper focuses on two of Étienne’s novels: Une femme muette (1983) and La Reine soleil levée (1987). While the two protagonists – Marie-Anne and Mathilda – appear to stand in stark contrast to one another in terms of geographic setting, social class, temperament, and modes of resistance, a closer reading reveals significant parallels. This study aims to explore how these women, through resilience and resistance, disrupt a seemingly predetermined fate and forge paths toward self-determination.

Police militarization in Canada is largely framed as a race-neutral crime control strategy in the Canadian literature Much of the existing research omits race as an analytical category and fails to critically engage with how the socially constructed threat of racialized criminality is foundational to legitimizing police militarization. This article offers the first enumeration of racial disproportionality and disparity in use of force incidents involving tactical units. This article analyzes over 1100 use of force reports obtained from seven municipal police services in southern Ontario. The results demonstrate the racially disproportionate impact of police militarization on the Black community, who are overrepresented in use of force incidents across all municipalities in comparison to their overall proportion of the population. The results are further contextualized through applying critical race theory and Wacquant’s work on urban marginality and precarity. The findings challenge the race-neutral portrayal of tactical units, and police militarization, laying the groundwork for more substantive empirical analyses.

Dr. Jenelle Rouse discusses the importance of Black Deaf studies in Canada. She delves into Canada's multicultural identity, highlighting its appreciation for diverse languages and cultures but notes a lack of focus on the Black Deaf community. Dr. Rouse outlines the challenges associated with accessibility in Canada, drawing a parallel with the United States' Americans with Disabilities Act and underscores the late establishment of the Accessible Canada Act. She identifies a significant gap in data and resources related to the Black Deaf community, emphasizing the absence of their history and narratives in Canadian literature and education. Dr. Rouse underscores her journey as a Black Deaf individual, her efforts to uplift the community, and the inception of a collective project of Black Deaf Canada to bridge the existing gaps.

Review of Castellano-Ortolà (2024): Agencies in Feminist Translator Studies: Barbara Godard and the Crossroads of Literature in Canada

Through the conceit of reincarnation, Ying Chen reprises the narrative representation of animals in Ahimsa (2023), giving voice to a rat, fly and snake. She reveals their mutual connection with “le Maître” in their past life, an enlightened being who is revealed to be Mahatma Gandhi and who lived and preached according to “ahimsa”, the principle of pacificism, compassion and respect for all living things. The individual stories of the creatures’ respective relationships with “le Maître” are interspersed with his teachings of non-violence and cooperation alongside an ecocritical discourse on urban expansion, environmental damage, climate change and the disappearance of species. From the movement between past and present, human and animal, fact and fiction, the importance of margins emerges. The translingual author chooses maligned creatures that are rarely attributed literary agency to be at the heart of her narrative and to represent marginalized people – those who are infirm, or failures and misfits, or from an inferior caste. The first section of the article interrogates this employment of individual animal narrators and examines how the forms, existences and lifeworlds of these creatures are presented, as well as their relationship to humanity. It takes into account recent theories about unnatural narration and current ecocriticism in China, particularly the branch of “spiritual ecology” and the practice of “environing at the margins”. The second section examines Chen’s ecocritical discourse expressed by collective voices and the politics and aesthetics of what/who is included and excluded. After exploring the environmental issues depicted, it investigates how nonhuman subjects are taken into ethical consideration. By coupling unnatural narratology with ecocriticism, this article not only analyses a very recent work of animal narrative fiction in francophone Canadian literature from a perspective on the margins, but also reappraises what we know, or assume, in the West about human-animal relations.

ABSTRACT Kit Dobson’s work focuses on several controversial issues in Canadian Indigenous history. The effects of oil capitalism on the environment is at the core of Field Notes on Listening, while Malled: Deciphering Shopping in Canada addresses the socio-economic impacts of shopping malls in Canada. Transnational Canadas: Anglo-Canadian Literature and Globalization examines Canadian literary traditions in the context of globalization, and We Are Already Ghosts tackles issues of Indigenous identities and the current politics surrounding the Truth and Reconciliation Commission. All these, and Dobson’s edited works – Please, No More Poetry: The Poetry of derek beaulieu; Producing Canadian Literature: Authors Speak on the Literary Marketplace; Transnationalism, Activism, Art; Dissonant Methods: Undoing Discipline in the Humanities Classroom; and All the Feels: Affect and Writings in Canada – serve as a springboard for this interview in tracing his diverse viewpoints about Canada’s evolution from a colonial past.

Conducting research on maternal health care through an intersectional lens is important to me because of the rise of health disparities, specifically racial disparities that exist within the health sector, however, there is limited race-based data in Canadian literature that addresses these disparities and how it affects racialized women.

For over a decade, members of Canada’s creative industries have claimed that Canadian post-secondary institutions are copying and using content without adequately compensating creators; these campaigns have primarily focused on fiction authors. This study aims to address these claims by determining how much Canadian creative literature is actually being used in a representative Canadian university. We analyzed reading materials provided to students as library reserves, textbooks, and course packs for the periods 2010-2012 and 2018-2022 and found that across both periods approximately 1.3% of courses assigned Canadian creative works as readings. An analysis of only the Fall semesters across these periods found that approximately 0.7% of all works – that is, copied excerpts and uncopied (purchased) works – assigned via library reserves, textbooks, and course packs were Canadian creative works. The number of assigned readings that included copied Canadian creative works (generally consisting only of course packs, not textbooks and likely not library reserves) would comprise much less than 0.7%. Therefore, this research suggests that the use and specifically copying of Canadian creative content in Canadian universities is not substantial enough to result in significant potential remuneration for the copying of an author’s work.

This article focuses on the position of the Czech-Canadian immigrant writer Josef Škvorecký and his writing in the Canadian literary field in the 1970s and 1980s. It looks at the contemporary development of Canadian literature as a category and Škvorecký’s role as an ethnic writer through Homi K. Bhabha’s concepts of hybridity and the Third Space while also considering the background of the Cold War and Canadian official policy on multiculturalism. The article discusses the Canadian publication of Škvorecký’s novel The Engineer of Human Souls in 1984, the Governor-General’s Literary Award given to it, the way the novel relates itself to Canada, and the polemic between Škvorecký and Terry Goldie in the journal Canadian Literature. This analysis of the novel and its dissemination and reception demonstrates that Bhabha’s postcolonial terminology cannot cover the case of a Czech exile writer in Canada, but the issues it brings to the debate open up new connections and contexts.

Developing recommendations and actions for integrated services delivery through primary health care teams in Canada: a deliberative dialogue approach for a national knowledge translation event.

Background: The Canadian government uses cultural policy and foreign policy instruments to internationalize Canadian literature through literary diplomacy to increase the understanding of Canada abroad. Analysis: For 60 years, Margaret Atwood has been a force multiplier in Canadian literary diplomacy. This article explores how Atwood’s internationalization in three phases of her career has been leveraged in cultural statecraft to enhance Canada’s image, reinforce bilateral diplomatic relations, increase cultural exports, and promote Canadian values and perspectives globally. Conclusion and implications: Establishing Canadian literature in the international imagination helps to portray Canada accurately and to advance the normative imperative—freedom, inclusion, diversity—in Canada’s soft power.

BackgroundPatients who maintain longitudinal provider-patient relationships experience better overall health outcomes. However, most older adults in Canada lose contact with their family physician when they enter long-term care (LTC) as new providers assume responsibility for their care. There is relatively little known about the contextual factors, processes, knowledge, and health professions education antecedents that promote the benefits of relational, management, and informational care continuity during LTC transitions.MethodsUsing a rigorous scoping review method, we searched multiple databases systematically to identify and scrutinize peer-reviewed articles pertaining to continuity of care during LTC transitions in Canada. Guided by Transitions Theory, two independent reviewers screened citations and extracted data. A descriptive analytical method was employed to categorize content into themes.ResultsEight articles met the inclusion criteria. Our findings confirm that instances of relational continuity are very few during LTC transitions, suggesting barriers associated with practice models and the influence of physician characteristics. Notably, the review also highlights that the involvement of interprofessional team members, patients, and their partners-in-care in transition planning could improve informational and management care continuity for patients as they move into LTC.ConclusionPatient and family involvement, provider training, and practice and funding arrangements are all critical to improving relational, management, and informational care continuity during LTC transition. We recommend more studies to understand processes and policies to optimize informational continuity as a panacea for the often-disrupted relational continuity.

BackgroundLynch syndrome (LS) is an autosomal dominant cancer predisposition syndrome caused by a germline pathogenic variant, or epigenetic silencing, of a mismatch repair (MMR) gene, leading to a wide cancer...

Police tactical teams, referred to in Canada as Emergency Response Teams (ERT), are a specialized team of police officers who receive additional training, equipment, and support to mitigate dangerous, high-risk, life-threatening, and violent calls for service general duty officers may be challenged to mitigate effectively. Researchers suggest repeated and over-exposure to intentional acts of violence or elevated levels of aggression can lead to experiences (or symptoms) of anxiety, depression, hostility, burnout, and sleeping problems. Yet, very little research reveals the potential mental wellness of ERT members resultant from their public safety role. As media, academics, and stakeholders continue to express concerns regarding police militarization (both for and against), and research continues to dispute ERT normalization, police militarization, or ERT deployments, little evidence has unpacked the potential mental health implications resulting from ERT membership. To do so, the current study uses a scoping review to analyze the state of the literature to reveal how police ERTs are likely to experience stress. Findings from the current article suggest a serious dearth in Canadian and qualitative literature surrounding police ERT wellness and concludes with a discussion on directions for future qualitative research in Canada.

ABSTRACT This article revaluates Canadian Arctic literature through the imperial discourse lens, highlighting the need to reconceptualize the coloniality and postcoloniality of Canadian literature beyond the scope of Indigenous writing. It emphasizes the marginalization of Arctic Canadian literature within postcolonial discourse despite its deep connections with British imperialism. By employing Edward Said’s methodology of contrapuntal reading, the article explores the imperial narratives within Canadian literary identity, comparing Erika Behrisch Elce’s Lady Franklin of Russell Square with Joseph Conrad’s Heart of Darkness. It investigates how settler colonialism and the dynamics of cartography – emphasized by Baudrillard’s theory of the map preceding the territory – play into the construction of literary and national identities. The analysis challenges the glorification of Arctic exploration in Canadian identity and reveals its complex relations with British imperialism, thus broadening the scope of postcolonial critique to include underexplored imperial dimensions.

This research, grounded in Asian Critical Theory (AsianCrit), sheds light on the experiences of Asian educators and students within a large district school board in Ontario, Canada. Through a mixed-methods approach, involving surveys and focus groups conducted in Fall 2022, data was collected from over 1,300 Asian-identifying respondents including students in Grades 7 to 12, teachers, and administrators. Data analysis identified three major findings: (a) the need for empowering Asian representation in the curriculum; (b) the lack of belonging in schools, and; (c) the underrepresentation of diverse Asian identities among staff, especially in senior leadership positions. This research addresses a significant gap in the Canadian literature examining anti-Asian racism in schools and through a series of recommendations advocates for more equitable and inclusive educational environments.