Nova Scotia Research Articles

Institutions of Care: A Qualitative Study with Ancestral Black Nova Scotian Nurses in Healthcare.

Ancestral Black Nova Scotian (ABNS) nurses are a culturally distinct group yet, little is known about their experiences. Available literature suggests that ABNS nurses are underrepresented in nursing and that they encounter discrimination throughout the health system. Understanding the experiences of ABNS nurses facilitates addressing antiBlack racism in nursing and healthcare. This study sought to critically examine the leadership experiences of ABNS nurses in healthcare. This qualitative study was guided by Black feminist theory and involved one-on-one semi-structured telephone interviews with eighteen ABNS nurses. Critical Discourse Analysis was applied in the reading of interview transcripts to examine words used by participants in relation to nursing and healthcare. The findings are presented in two conceptual themes. Black Tax in Nursing captures the added physical, mental, and spiritual strain experienced by ABNS nurses navigating nursing and healthcare. Black Tax encompassed everyday microaggressions and systemic processes, including intra-profession tensions. Integrating into nursing was made increasingly difficult by a reinforcing network of gatekeepers, policies, and structural design. Nova Scotia Healthcare as an Archaic Institution depicts an antiquated "broken" paternalistic system that did not empower patients nor promote health. Additionally, nursing education was accused of reinforcing negative stereotypes, competency gaps, and mistrust with patients. Institution of Care show how ABNS nurses challenge institutional standards and norms in their approach to nursing. ABNS nurses navigate nursing and the health system by maintaining a community-oriented approach to health. Addressing anti-Black racism in nursing and healthcare requires attention to multi-level processes within institutions.

The alongshore tilt of mean dynamic topography and its implications for model validation and ocean monitoring

Abstract. Mean dynamic topography (MDT) plays an important role in the dynamics of shelf circulation. Coastal tide gauge observations in combination with the latest generation of geoid models are providing estimates of the alongshore tilt of MDT with unprecedented accuracy. Additionally, high-resolution ocean models are providing better representations of nearshore circulation and the associated tilt of MDT along their coastal boundaries. It has been shown that the newly available geodetic estimates can be used to validate model predictions of coastal MDT variability on global and basin scales. On smaller scales, however, there are significant variations in alongshore MDT that are of the same order of magnitude as the accuracy of the geoid models. In this study, we use a regional ocean model of the Gulf of Maine and Scotian Shelf (GoMSS) to demonstrate that the new observations of geodetically referenced coastal sea level can also provide valuable information for the validation of such high-resolution models. The predicted coastal MDT is in good agreement with coastal tide gauge observations referenced to the Canadian Gravimetric Geoid 2013 – Version A (CGG2013a), including a significant tilt of alongshore MDT along the coast of Nova Scotia. Using the validated GoMSS model and two idealized models, we show that this alongshore tilt of MDT can be interpreted in two complementary, and dynamically consistent, ways: in the coastal view, the tilt of MDT along the coast can provide a direct estimate of the average alongshore current. In the regional view, the tilt provides a measure of area-integrated nearshore circulation. This highlights the value of using geodetic MDT estimates for model validation and ocean monitoring.

Spatial and temporal analyses of Dermacentor variabilis (Say) (Acari: Ixodidae) in central and eastern Canada.

Dermacentor variabilis (Say) (Acari: Ixodidae) is a vector for pathogens that can impact human and animal health. The geographic range of this species is expanding, but there are some areas with limited up-to-date information on the distribution of D. variabilis. Therefore, the objective of this study was to describe the spatial and temporal patterns of adult D. variabilis activity in central and eastern Canada. Ticks were collected from companion animals by veterinary clinic staff. Suspected locations of tick acquisition were spatially projected, and a spatial scan statistic was used to identify statistically significant clusters of frequent submissions from veterinary clinics. Submissions were categorised by calendar week to evaluate temporal trends. In total, 1198 adult D. variabilis, one nymphal D. variabilis and one Dermacentor albipictus (Packard) were collected from the provinces of Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia and Prince Edward Island from April 2019 through March 2020. Peaks in adult D. variabilis submissions occurred in May and June. Most of the submissions were received from south-eastern Manitoba, eastern Ontario and central and western Nova Scotia. A statistically significant cluster of frequent submissions that included seven veterinary clinics was identified in Nova Scotia. These findings can be used to determine the locations and times at which humans and their companion animals should be considered at an increased risk of exposure to D. variabilis and the pathogens they carry.

A Deterministic Model for Harmful Algal Bloom (HAB) Patterns Under Turing’s Instability Perspective

Turing’s instability has been widely introduced to explain the formation of several biological and ecological patterns, such as the skin patterning of fish or animals, wings of butterflies, pigmentation, and labyrinth patterns of the cerebral cortex of mammals. Such a mechanism may occur in the ecosystem due to the differential diffusion dispersal that happen if one of the constituent species results in the activator or the prey, showing a tendency to undergo autocatalytic growth. The diffusion of the constituent species activator is a random mobility function called passive diffusion. If the other species in the system (the predator/inhibitor) disperses sufficiently faster than the activator, then the spatially uniform distribution of species becomes unstable, and the system will settle into a stationary state. This paper introduced Turing’s mechanism in our reaction–taxis–diffusion model to simulate the harmful algal bloom (HAB) pattern. A numerical approach, the Runge–Kutta method, was used to deal with this system of reaction–taxis–diffusion equations, and the findings were qualitatively compared to the aerial patterns obtained by a drone flying over Torment Lake in Nova Scotia (Canada) during the bloom season of September 2023.

P0281 Comparison of disease characteristics and disease course between paediatric and adult onset Primary Sclerosing Cholangitis and Inflammatory Bowel Disease

Abstract Background Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease that frequently coexists with inflammatory bowel disease (IBD). Data comparing the paediatric- and adult-onset PSC-IBD are lacking. We compared disease characteristics and the clinical course of PSC-IBD between Canadian children and adults. Methods This was a multi-center retrospective cohort study including eight paediatric centers from different provinces across Canada including (Ontario, Alberta, Nova Scotia, Manitoba) and four adult centers from the province of Ontario, including patients diagnosed with PSC-IBD from 1985-2023. Patient and disease characteristics and outcome data were extracted from the clinical charts. We compared patient demographics, disease course, laboratory and imaging results, and complications including liver transplant among paediatric- and adult-onset PSC-IBD. Continuous data were reported as median (Q1-Q3) and compared with the Wilcoxon Rank Sum test, and categorical data were reported as number (%) and compared with chi-square or Fisher exact tests. We compared the time to transplant with the log-rank test. Results We included 521 patients (228 children, median follow-up 3.3 (Q1-Q3 1.5-5.8) years; 293 adults, median follow-up 9.8 (Q1-Q3 4.3-16.0) years (Table-1). The interval between PSC and IBD diagnosis was longer in adults. Small duct disease and PSC with autoimmune hepatitis (AIH) features were more common in children, with corresponding higher ALT and more frequently positive autoantibodies. Rates of portal hypertension at PSC diagnosis were similar in both groups. Ulcerative colitis predominated in both groups with more IBD-unclassified in children. Colitis was most severe in the right colon in a third of children and adults. Children were more often treated with ursodeoxycholic acid, vancomycin, corticosteroids and immunomodulators. Adult patients experienced a higher proportion of adverse liver events over the entire follow-up duration, but time to event analysis showed similar rates of progression to liver transplant (log-rank p=0.075; 2- and 5-year survival with native liver in paediatric vs. adult: 97% and 90% vs. 94% and 84%). (Figure-1) Conclusion In this large Canadian multi-center cohort of PSC-IBD, paediatric-onset disease was characterized by more frequent small duct disease and features of AIH. The interval between IBD and PSC diagnosis was far longer in adults. Although a greater proportion of adult-onset patients experienced adverse liver outcomes overall, rates of transplant at 2 and 5 years were similar between groups, suggesting that PSC progression may in fact be similar.

P1203 Spatial mapping and geographic variation of inflammatory bowel disease in Canada: A population-based study using Statistics Canada data

Abstract Background Crohn’s Disease (CD) and Ulcerative Colitis (UC) pose significant challenges to patients and healthcare systems, with a rising incidence and prevalence globally1,2. To address the challenges of health resource allocation and understand the geographic distribution of these conditions in Canada, we conducted the spatial mapping of IBD across Canada using national population survey data available from Statistics Canada. Methods We utilized data from the 2009-2018 Canadian Community Health Survey (CCHS) to identify individuals with CD or UC. Prevalence rates, both crude and adjusted for age and sex, were calculated for each health region in Canada. Spatial dependencies between health regions were estimated using global Moran’s I and local indicators of spatial association (LISA) were used to identify clusters of health region (hot-spots) where the prevalence was significantly higher than in other areas. We further applied spatial simultaneous autoregressive lag models to explore the influence of region-level sociodemographic factors on identified spatial dependencies. Results A total of 492,560 individuals from 2010-2018 CCHS were included, representing 29,846,350 Canadians across 109 health regions. Survey data revealed that 0.38% of Canadians self-reported having CD and 0.47% reported having UC. The majority of respondents reported being urban-residing, middle-aged, and white. Across Canadian provinces, the age and sex-standardized prevalence of IBD ranged from 742 per 100,000 in Quebec to 1267 per 100,000 in Nova Scotia (Figure 1). Spatial analysis identified significant dependencies among health regions, but these spatial associations were explained by the differing distributions of sociodemographic characteristics in each health region (Table 1). Increased health region-level prevalence of CD and UC was associated with a larger proportion of individuals 30+ years, identifying as a female, immigrants, or as white (p<0.05 for each). Conclusion Data from this large, population-based Canadian national survey demonstrated significant geographic variation in the prevalence of CD and UC. However, after adjusting for patient demographic characteristics, the spatial dependency became non-significant. Key characteristics related to urbanization including the age distribution and proportion of immigrants in a health region were associated with increased prevalence rates. These results suggest that differences in CD and UC prevalence between geographic areas are primarily driven by individual demographics rather than differences in characteristics of local healthcare delivery systems and further support the notion that characteristics of urbanization increase the prevalence of IBD in an area1.

Un/heard, un/informed, un/involved: Meaningful participation for young people receiving child welfare services

Abstract Children have the right to be heard in child protection proceedings. However, in social work, young people receiving protective services are often perceived as vulnerable and in need of protection, an attitude which prevents young people from participating in making important decisions that affect their lives. In this article, child participation in child welfare services (CWS) is explored through qualitative interviews with thirty-three young people aged fourteen to nineteen, receiving CWS in Nova Scotia, Canada. A thematic analysis of the findings highlighted four overarching themes—un/heard, un/informed, un/involved, and coping strategies—to describe youths’ experiences with service providers. The findings suggest that involving children in casework, including decisions regarding placement, has the potential to foster trust in care providers, improve cooperation and access to formal and informal supports, and enhance child well-being during and after receiving CWS.

An Integrated Strategy to Treat and Control Acid Mine Drainage from Waste Rock and Underground Workings at the Former Franklin Mine in Nova Scotia, Canada: Field Performance Monitoring

An Integrated Strategy to Treat and Control Acid Mine Drainage from Waste Rock and Underground Workings at the Former Franklin Mine in Nova Scotia, Canada: Field Performance Monitoring

Glacial dispersal of indicator minerals from the Brazil Lake LCT pegmatites, southwest Nova Scotia, Canada

The Brazil Lake lithium-cesium-tantalum (LCT)-type pegmatites (North, South, and Army Road pegmatites) in eastern Canada, were the focus of a detailed till study to document glacial dispersal of LCT pegmatite indicator minerals from bedrock. A total of 84 bulk (7-20 kg) till samples were collected from 77 sites around and down ice of the three pegmatites. The <2.0 mm fraction of the till samples was processed using shaking table and heavy liquid methods to produce 2.8-3.2 and >3.2 specific gravity (SG) non-ferromagnetic heavy mineral concentrates for visual identification and counting of indicator minerals in the 0.25-0.5 mm, 0.5-1.0 mm and 1-2 mm fractions. Glacial dispersal from the pegmatites is best defined by spodumene (the primary ore mineral) in the 0.25-0.5 mm fraction of the 2.8-3.2 SG concentrates, and its presence in the till (100s to 1000s of grains per sample) is visual confirmation of the existence of nearby LCT pegmatites. Glacial dispersal of spodumene forms a fan-shaped exploration target 12 km down ice that is considerably larger than the pegmatite subcrop areas. Other useful LCT pegmatite indicator minerals in the local till include apatite and tourmaline (10s to 100s of grains) and lesser amounts of columbite-tantalite, cassiterite, and scheelite (1s to 10s of grains), however, their abundances and spatial distributions are much less/smaller than that for spodumene. The results clearly demonstrate that indicator mineral methods are useful for Li exploration in the glaciated terrains of southwest Nova Scotia, across Canada, and other prospective glaciated terrains globally.

How gender shapes practice choices among family medicine residents and early career family physicians: a Canadian qualitative study.

The practice choices of family medicine residents and early career family physicians shape access to primary care. A growing proportion of family physicians are women. This study examined how gender operates in shaping family physician practice choices and subsequent practice patterns. Qualitative interview data were analyzed. Family medicine residents and early-career family physicians from three Canadian provinces (Nova Scotia, Ontario, and British Columbia) participated in interviews. Qualitative interview data was collected as part of a larger mixed methods study. Eighty-eight interviews were transcribed verbatim and coded into several node reports including one on gender. Reflexive thematic analysis was conducted to identify themes related to how gender impacts physician practice choices. Many participants described multiple intersecting pathways through which it was apparent that gender shaped their career and practice choices. Others did not identify the impact of gender in this regard. Parenthood and caregiving were commonly discussed, as were clinical interests specific to women's health, however, gendered expectations of patients and colleagues were also seen to shape choices. In this way, gender shaped choices directly, but also indirectly in response to gendered experiences and expectations. Findings support the need for structural reforms including: increased availability of collaborative team based models, flexible work schedules, closure of gendered wage gaps, and integration of gender awareness training through academic and healthcare institutions. Consideration of how primary care policies differentially impact across clinician gender is key to future planning to support a changing workforce that meets patient needs.

Exploring the Orton-Gillingham Approach to Teaching Reading from the Perspective of Tutors at the Scottish Rite Learning Centre for Children - Halifax

Research indicates that individuals with poor reading skills are more at risk of dropping out of school and having fewer career options than their peers who are proficient readers (Castles at al., 2018; Jamieson, 2009). The Scottish Rite Learning Centre for Children - Halifax (SRLCC-H) in Nova Scotia offers tuition-free tutoring services based on the Orton-Gillingham approach, to students with reading-based learning disabilities, such as dyslexia. Through individual interviews, this study explores the perspectives and experiences of the volunteer tutors and tutors-in-training at the SRLCC-H. The findings indicate that OG tutoring improved their students’ reading abilities and increased their levels of confidence.

Developing a decision support tool to predict delayed discharge from hospitals using machine learning

BackgroundThe growing demand for healthcare services challenges patient flow management in health systems. Alternative Level of Care (ALC) patients who no longer need acute care yet face discharge barriers contribute to prolonged stays and hospital overcrowding. Predicting these patients at admission allows for better resource planning, reducing bottlenecks, and improving flow. This study addresses three objectives: identifying likely ALC patients, key predictive features, and preparing guidelines for early ALC identification at admission.MethodsData from Nova Scotia Health (2015-2022) covering patient demographics, diagnoses, and clinical information was extracted. Data preparation involved managing outliers, feature engineering, handling missing values, transforming categorical variables, and standardizing. Data imbalance was addressed using class weights, random oversampling, and the Synthetic Minority Over-Sampling Technique (SMOTE). Three ML classifiers, Random Forest (RF), Artificial Neural Network (ANN), and eXtreme Gradient Boosting (XGB), were tested to classify patients as ALC or not. Also, to ensure accurate ALC prediction at admission, only features available at that time were used in a separate model iteration.ResultsModel performance was assessed using recall, F1-Score, and AUC metrics. The XGB model with SMOTE achieved the highest performance, with a recall of 0.95 and an AUC of 0.97, excelling in identifying ALC patients. The next best models were XGB with random oversampling and ANN with class weights. When limited to admission-only features, the XGB with SMOTE still performed well, achieving a recall of 0.91 and an AUC of 0.94, demonstrating its effectiveness in early ALC prediction. Additionally, the analysis identified diagnosis 1, patient age, and entry code as the top three predictors of ALC status.ConclusionsThe results demonstrate the potential of ML models to predict ALC status at admission. The findings support real-time decision-making to improve patient flow and reduce hospital overcrowding. The ALC guideline groups patients first by diagnosis, then by age, and finally by entry code, categorizing prediction outcomes into three probability ranges: below 30%, 30-70%, and above 70%. This framework assesses whether ALC status can be accurately predicted at admission or during the patient’s stay before discharge.

Increased respiratory syncytial virus-associated hospitalizations and ambulatory visits in very preterm infants in the first year of life following discontinuation of access to palivizumab.

From 2002 to 2023, palivizumab was the only intervention to reduce RSV-associated hospitalizations in high-risk infants in Canada, but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The national professional pediatric association (Canadian Paediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia (NS) followed these recommendations the next season. To determine if the removal of access to palivizumab in these previously infants was associated with a change in hospital admissions, deaths or ambulatory visits associated with RSV. We identified a retrospective cohort of NS infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking 6 population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization, ambulatory visits or death were identified by International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV- associated diagnostic codes. Of 4835 infants born during the study period, 250 were 30-32 WG were eligible for the cohort. RSV-H increased about 10-fold following restricted access to palivizumab (0/123, to 9.4%; (95% CI 5.0, 15.9, risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7% to 17.3% (risk difference 11.6). Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of healthcare policy change on patient well-being is essential to assess impact and guide future decision making at the population level.

Population genomics and connectivity of Vazella pourtalesii sponge grounds of the northwest Atlantic with conservation implications of deep sea vulnerable marine ecosystems

Sponges are key ecosystem engineers that shape, structure and enhance the biodiversity of marine benthic communities globally. Sponge aggregations and reefs are recognized as vulnerable marine ecosystems (or VMEs) due to their susceptibility to damage from bottom-contact fishing gears. Ensuring their long-term sustainability, preservation, and ecosystem functions requires the implementation of sound scientific conservation tools. Here, the genetic diversity, structure, and connectivity of the deep-sea glass sponge, Vazella pourtalesii (Schmidt, 1870), was investigated using 1,102 neutral SNPs obtained in RADseq. This species is distributed across the northwest Atlantic from Florida, USA to Nova Scotia, Canada and we sequenced samples covering this full distribution and provided evidence of strong genetic structure with two distinct clusters: Florida together with the Carolina Shelves and the Scotian Shelf. We estimated moderate levels of diversity with low migration across large distances (> 1000 kms) and high connectivity at smaller scales (< 300 kms). Further, fishing pressure on genetic diversity was evaluated, within two Sponge Conservation Areas (SCAs) on the Scotian Shelf. Those areas have different disturbance histories, and cumulative fishing pressure. Slightly lower levels of genetic diversity were found inside the SCAs, and yet they encompassed a high proportion of the diversity observed within the Scotian Shelf. We provide baseline data for future monitoring of the SCAs, discussing our findings in the light of existing area-based management tools.

Determinants of Socioeconomic Inequalities in Well-being in Canada: Evidence for Nova Scotia Quality of Life Survey

There are relatively few studies that have measured and explained socioeconomic inequalities in the wellbeing of populations. Using unique information available in the 2019 Nova Scotia Quality of Life Survey (NSQL, n=9,388), this study provides analysis of the determinants of socioeconomic inequalities in wellbeing of adults aged 18 and above in Nova Scotia, Canada. The population's wellbeing was measured using the Canadian Index of Wellbeing (CIW), which encompasses quality of life across eight domains. The Concentration index (C) approach was utilized to quantify and identify factors explaining socioeconomic inequality in wellbeing. A positive value of the C (0.0294; 95% confidence interval: 0.0267 to 0.0321) indicated pro-rich inequality in wellbeing among Nova Scotian residents. Results of the decomposition analysis indicated that the concentration of favorable mental health, education levels, and income among high socioeconomic status groups accounted for over 86% of the observed socioeconomic inequality in the population's wellbeing. Our findings demonstrated that inequalities in mental health, education, and income are significant obstacles to reducing inequality in wellbeing in Nova Scotia, Canada. Thus, policies aimed at alleviating inequalities in these factors may help to reduce socioeconomic inequality in wellbeing in Nova Scotia, Canada.

Machine learning assisted geophysical characterization of deep-seated Upper Jurassic carbonate deposits in Penobscot Field, Nova Scotia

Machine learning assisted geophysical characterization of deep-seated Upper Jurassic carbonate deposits in Penobscot Field, Nova Scotia

Foraminiferal denitrification and deep bioirrigation influence benthic biogeochemical cycling in a seasonally hypoxic fjord

Benthic macro- and micro-biota often play significant roles in controlling the biogeochemical dynamics in sediments. Their activity can be influenced by oxygen availability and impacted by the rise in global hypoxia in coastal regions over the last decades. To understand how these organisms interact with coastal hypoxia and influence sediment biogeochemistry, we undertook a study of early diagenesis in Bedford Basin, a seasonally hypoxic fjord on the West Atlantic coast in Nova Scotia, Canada, using a combination of observations and reaction-transport modeling. We observed that the seafloor was a source of ammonium and sink of nitrate with average fluxes of 2.2 ± 1.8 and −0.9 ± 0.7 mmol m−2 d−1 respectively. The diffusive oxygen uptake was 14 ± 4.6 mmol m−2 d−1 and the total organic carbon content in collected sediment cores was 5–7 % with a C/N ratio of ∼10. The pyrite content increased steadily from 0.5 wt% Fe at surface to ∼2 wt% Fe at 20 cm depth. Hydrogen sulfide was negligible down to 25 cm depth most of the time. The sediment was inhabited by tube-forming polychaete Spiochaetopterus sp. that formed tubes up to ∼30 cm in length. The living foraminiferal assemblage in the top 5 cm sediment was found to be dominated (>85 %) by nitrate-storing and denitrifying benthic foraminifera Stainforthia fusiformis. These observations were used to develop and constrain a biogeochemical reaction-transport model. The model results suggest that the observed decrease in porewater concentrations of ammonium and dissolved inorganic carbon below 5 cm depth, was due to deep bioirrigation by tubeworms, accounting for almost 50 % of the benthic efflux. The model further revealed that the deep bioirrigation along with bioturbation and iron cycling prevented accumulation of free sulfide in the top 25 cm sediment despite oxygen penetration depths of ∼1 mm. Modelled organic carbon and nitrogen deposition was 25.2 and 2.9 mmol m−2 d−1 with burial efficiencies of 23 % and 17 %, respectively. The model indicated a total denitrification rate of 1.3 mmol N m−2 d−1 that was largely (∼70 %) driven by benthic foraminifera. This study reports the first evidence of foraminiferal denitrification in western Atlantic coastal sediments, and suggests that eukaryote mediated denitrification is an important driver of sediment N-loss in seasonally hypoxic environments, a process that has been traditionally assumed to be carried out by prokaryotic microbes.

Optimizing Prescribing for Individuals With Type 2 Diabetes and Chronic Kidney Disease Through the Development and Validation of Algorithms for Community Pharmacists.

Diabetes is the leading cause of kidney disease and contributes to 38% of kidney failure requiring dialysis. A gap in detection and management of type 2 diabetes (T2D) in chronic kidney disease (CKD) exists in primary care. Community pharmacists are positioned to support those not able to access kidney care through traditional pathways. Algorithms were developed and validated to assist community pharmacists in identifying individuals with T2D in CKD and prescribing kidney-protective medications. The objective was to develop and validate pharmacist algorithms to confirm T2D and CKD and to prescribe guideline-directed therapies for individuals with an estimated glomerular filtration rate (eGFR) of 30 to 60 mL/min/1.73 m² in community pharmacy primary care clinics in Nova Scotia. Lynn's method was utilized for algorithm development and content validation. Interview data were analyzed using qualitative descriptive analysis. Pharmacists working in primary care clinic settings completed content and face algorithm validation, and virtual interviews were conducted following each round of validation. The algorithms aim to support individuals with T2D and CKD in primary care by optimizing the resources and capacity of community pharmacists while ensuring safety and quality of care through a team-based approach. Patient partners were not part of algorithm development and validation. Content validity was computed using an item-level content validity index (I-CVI) and scale-level content validity index (S-CVI/Ave) per round. To measure face validity, percentages of those that "agreed" or "strongly agreed" to five statements were calculated. Evidence- and expert-informed algorithms were developed and revised using Lynn's 3-step method (domain identification, item generation per domain, and instrument formation). Best evidence was collated with literature searches, and experts in nephrology, endocrinology, family medicine, nursing, and pharmacy revised the algorithms until there was consensus agreement on 4 final algorithms (detection of T2D and CKD, initiation/titration of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and initiation/management of sodium-glucose cotransporter-2 inhibitors and finerenone). Six community pharmacists per round for 3 rounds were needed to validate the algorithms. A 2-part questionnaire was utilized where pharmacists rated content and face validity using Likert scales. I-CVI and S-CVI/Ave per round and across 3 rounds were determined. Percentages were calculated for the rating level of agreement to 5 statements. Interviews were conducted and analyzed. Revisions were made to the algorithms between rounds. Eighteen community pharmacists (6 per round) participated with a mean ± standard deviation of 18 ±11 years of experience. The I-CVI of each item of the algorithms per round ranged from 0.83 to 1, which met the content validity threshold of 0.83 (P < .05) for at least 6 participants. The overall S-CVI/Ave across 3 rounds was 0.97. The overall percentage of participants across 3 rounds who agreed or strongly agreed to 5 face validity statements ranged from 83% to 100%, which was above the prespecified threshold for face validity consensus. The algorithms are intended for individuals with an eGFR of 30 to 60 mL/min/1.73m². While guideline medications are indicated below this threshold, this cut point was selected as these individuals should typically be referred to a nephrologist. There is a potential for delays in initiation of kidney-protective medications below this threshold while waiting to be seen by nephrology. This is the first study to develop and validate algorithms for a new model of care that utilizes community pharmacists to identify and manage T2D and CKD in primary care. The algorithms achieved high content and face validity. Future implementation and evaluation will determine the effectiveness and safety of the algorithms. Not registered.

Prediction of coastal barren plant species richness and functional diversity by environmental variability across scales

AbstractQuestionsThe relationships between environmental heterogeneity and plant diversity may be negative or neutral at fine spatial scales but positive across broader areas. How do the relationships between spatial environmental variability and mean environmental conditions, plant species richness and functional diversity change across spatial scales?LocationCoastal barrens landscape in Nova Scotia, eastern Canada.MethodsWe sampled plant species composition and environmental variables in nested areas at three scales: 0.25 m2, 1 m2 and 50 m2. At each scale, subsamples of environmental variables (including elevation, soil moisture and depth) were used to calculate average and standard deviation; plant species richness was also determined for each sample. Plant traits at the species level were used to calculate functional dispersion for each of five traits (specific leaf area, leaf dry matter content, leaf thickness, plant height and canopy width) and a combined index of total functional dispersion. Functional dispersion and species richness were predicted at each scale by environmental variables using linear mixed models.ResultsEnvironmental heterogeneity had low predictive power for plant diversity at the 0.25‐m2 scale but was unimodally related to species richness and functional‐diversity variables at the 1‐m2 scale. The shape of the unimodal relationships suggested a leveling off of diversity at higher levels of environmental variability rather than a decline in diversity (monotonic or asymptotic). There was a strong positive relationship between elevation (topographic) variability and species richness at the 50‐m2 scale. Functional dispersion was most strongly related to environmental variables at the 1‐m2 scale.ConclusionsPositive or non‐linear asymptotic relationships between environmental heterogeneity, richness and functional diversity at the 1‐m2 scale provide some support for niche‐based explanations of species coexistence in plant neighborhoods. At broader sampling extents, greater topographic heterogeneity may allow distinct plant communities to co‐occur within a sample, increasing richness but not functional diversity because functional diversity in leaf and canopy traits are already high within each plant community.

Effect of trap soak times on risk of bycatch from offshore lobster (Homarus americanus) fishing operations in southwest Nova Scotia, Canada

Effect of trap soak times on risk of bycatch from offshore lobster (Homarus americanus) fishing operations in southwest Nova Scotia, Canada