Province Of Newfoundland Research Articles

Toward a public outreach and community engagement strategy on cancer in Newfoundland and Labrador: an initial road map and recommendations

Abstract Background: The province of Newfoundland and Labrador has one of the highest incidence and mortality rates for cancer among the Canadian provinces. Sharing accessible knowledge on cancer is an important part of cancer control and population health efforts. However, bringing useful health information and knowledge exchange events to residents requires an efficient and accessible system. Objectives: We aimed to create a road map and recommendations for effective public outreach and community engagement on cancer in Newfoundland and Labrador. Methods: We used the following information, experience, or public engagement tools to gather information to inform our work: discussions with the members of the Public Interest Group on Cancer Research, researchers' experiences with recruitment and knowledge translation activities, feedback provided to 2 public conferences delivered (Public Conference on Genetics delivered in 2020 and Public Conference on Cancer delivered in 2022—where the target audience was general public), and 2 public town halls (one in-person, one virtual) and 2 individual consultation sessions with key stakeholders. Information gathered was then summarized. Results: We identified a rich set of cancer-related topics for which to organize public events on cancer. In addition, a large number of public outreach and engagement options were identified, emphasizing the fragmented, inefficient, and resource-intensive nature of public outreach and community engagement efforts in the province. Based on the information collected, we developed an initial road map and recommendations to inform future public engagement activities and strategies. In addition, our group has started to implement the road map for our current and future public engagement activities. Conclusions: We present key cancer-related topics that are of public interest and issues and opportunities for recruitment and delivery of knowledge and events to residents of Newfoundland and Labrador. This information can be useful for researchers, organizations, and the health care system in the province. However, more inclusive consultations, larger collaborations, funding, and systematic data collection are needed to build a province-wide public outreach network on cancer and to identify more comprehensive public engagement options. The work presented here can potentially guide these efforts. Our work is also expected to inspire other provinces, states, and communities to assess their public outreach status and help develop road maps co-led by patients to progress their public engagement efforts in cancer.

Population-level cascade of care for hepatitis C in Newfoundland and Labrador

Background: Global elimination of hepatitis C virus (HCV) is feasible using existent tools. Reporting the provincial HCV care cascade will contribute to national and global HCV elimination efforts. Methods: This observational study was a secondary use of population-level medical record data, including laboratory results for HCV testing and prescription data for HCV treatment in the province of Newfoundland and Labrador (NL). All patients with HCV antibody testing performed between Jan 1, 2017 and Jan 1, 2022 were included. All prescriptions dispensed from a community pharmacy in NL for any HCV treatment during the same period were included. Results: There were 84,252 antibody tests included. Of these, 3,626 (4.3%) tests were positive for HCV antibodies. Seventy eight percent (1,377/1,766) of the individuals with positive antibody tests were tested for HCV RNA. Only 377/1,061 (35.5%) individuals with a positive RNA test were treated, and 257/395 (65.1%) achieved sustained virological response at 12 weeks. Conclusions: NL has successfully identified and treated HCV, but treatment access is low. Targets for improvement include increased screening, reflex testing of positive antibody with RNA, increased linkage to care, change in treatment funding policy, and quicker treatment funding decision.

Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line.

Sustainable implementation of new professional services into clinical practice can be difficult. In 2019, a population-wide initiative called SaferMedsNL was implemented across the province of Newfoundland and Labrador (NL), to promote appropriate medication use. Two evidence-based interventions were adapted to the context of NL to promote deprescribing of proton pump inhibitors and sedatives. The objective of this study was to identify and prioritize which actions supported the implementation of deprescribing in community practice for pharmacists, physicians and nurse practitioners across the province. Community pharmacists, physicians and nurse practitioners were invited to participate in virtual focus groups. Nominal Group Technique was used to elicit responses to the question: "What actions support the implementation of deprescribing into the daily workflow of your practice?" Participants prioritized actions within each group while thematic analysis permitted comparison across groups. Five focus groups were held in fall 2020 involving pharmacists (n = 11), physicians (n = 7) and nurse practitioners (n = 4). Participants worked in rural (n = 10) and urban (n = 12) settings. The different groups agreed on what the top 5 actions were, with the top 5 receiving 68% of the scores: (1) providing patient education, (2) allocating time and resources, (3) building interprofessional collaboration and communication, (4) fostering patient relationships and (5) aligning with public awareness strategies. Pharmacists, physicians and nurse practitioners identified similar actions that supported implementing evidence-based deprescribing into routine clinical practice. Sharing these strategies may help others embed deprescribing into daily practice and assist the uptake of medication appropriateness initiatives by front-line providers. Can Pharm J (Ott) 2024;157:xx-xx.

Restricted access and advanced disease in post-pandemic testicular cancer.

Urologists observed reduced cancer consultations and surgeries during the SARS-CoV-2 pandemic, raising concern about treatment delays. Testicular cancer serves as a particularly sensitive marker of this phenomenon, as the clinical stage of testicular cancer at presentation is predictive of cancer-specific survival. We aimed to investigate whether COVID-related restrictions to primary care access resulted in increased incidence of metastatic germ cell testis cancer. A retrospective chart review was conducted on all cases of testicular cancer managed surgically at our center from March 1, 2018, to February 28, 2023. Patients were categorized into temporal cohorts, representing before, during, and following the implementation of COVID-19 public health restrictions in the province of Newfoundland and Labrador. Forty-one cases of testicular germ cell tumors were identified during the study period. The mean age at diagnosis was 40.8 years (standard deviation ±13.7). Demographics did not vary across the cohorts. Clinical stage 3 disease remained stable before and during the pandemic at 10.5% and 9.1% of cases, respectively. In the post-pandemic period, there was an increase to 27.3% (p=0.617). Surgical wait times remained stable across the pandemic (p=0.151). There was a 16.8% rise in clinical stage 3 disease from the pre-pandemic to post-pandemic period. Our study failed to identify a statistically significant increase in metastatic testis cancer incidence upon lifting of pandemic restrictions. Further study is necessary to confirm suspicions that pandemic restrictions contributed to increased incidence of metastatic testis cancer.

Redeployment Among Primary Care Nurses During the COVID-19 Pandemic: A Qualitative Study.

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area.

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.

Impact of the COVID-19 pandemic on diagnosis of renal cell carcinoma and disease stage at presentation.

Renal cell carcinoma (RCC) is often associated with significant morbidity and mortality, with overall survival contingent on multiple factors - most importantly, disease stage at diagnosis. Disruptions in healthcare delivery during the COVID-19 pandemic have resulted in various reported diagnostic and treatment delays, which have had detrimental impacts on malignancies such as RCC. Surgically managed cases of RCC at our center were identified using a retrospective chart review of all nephrectomies conducted from March 1, 2018, to February 28, 2023. Examination of disease characteristics in three time period cohorts (before, during, and following the COVID-19 pandemic) was undertaken. Timeframes were consistent with implementation and abolition of public health restrictions in the province of Newfoundland and Labrador. A total of 483 surgically managed RCC cases were identified during the study period. The median age was 65 years (interquartile range [IQR] 56-71), and 62.3% of patients were male. Demographics did not vary across timeframes. Before and during the pandemic, pathologic stage 3 (pT3) disease was reported in 38.9% and 35.4% of cases, respectively, whereas the post-pandemic period saw this presentation in 50.0% of patients. Surgical wait times increased significantly across study timeframes (p=0.003). The first year following the COVID-19 pandemic saw an 11.1% increase in patients presenting with pT3 RCC. These findings are suggestive of a clinically significant stage migration, which paired with prolonged wait times for surgery, provide critical consideration in the urgency of diagnostic and treatment decisions for RCC in the immediate future.

Description of spatiotemporal patterns of infectious salmon anemia virus (ISAV) detections in marine Atlantic Salmon farms in Newfoundland and Labrador.

The objectives of this study were to describe spatiotemporal patterns of infectious salmon anemia virus (ISAV) detections in marine salmonid production sites in the province of Newfoundland and Labrador in Canada. Infectious salmon anemia virus surveillance data between 2012 and 2020 from the province of Newfoundland and Labrador were used. Data comprised a total of 94 sampling events from 20 Atlantic Salmon Salmo salar production sites in which ISAV was detected. Using linear regression models, factors influencing time to detection (days from stocking to first ISAV detection) and time to depopulation (days from first detection to production site depopulation) were investigated. Based on 28 unique cases, site-level annual incidence risk of ISAV detection ranged from 3% to 29%. The proportion of ISAV detection by PCR in fish samples ranged from 2% to 45% annually. Overall, ISAV variants from the European clade were more common than variants from the North American clade. The type of ISAV clade, detections of ISAV in nearest production sites based on seaway distances, and year of infectious salmon anemia cases were not associated with time to first ISAV detection. Time to depopulation for sites infected with the ISAV-HPRΔ variant was not associated with ISAV North American or European clades. Our results contribute to the further understanding of the changing dynamics of infectious salmon anemia detections in Newfoundland and Labrador since its first detection in 2012 and will likely assist in the design of improved disease surveillance and control programs in the province.

A Population Description of Young Women with Breast Cancer in Newfoundland and Labrador.

It has been well established in the literature that young women tend to carry more aggressive subtypes of breast cancer than their older-aged counterparts. The objective of this study was to describe the characteristics and outcomes of young women with breast cancer. In this retrospective analysis, data were collected for women under the age of 40 years who were diagnosed with breast cancer between 2008 and 2018 in the province of Newfoundland and Labrador. Specifically, data were collected on demographics, staging, pathological characteristics, treatment, and survival outcomes for young women with this disease. Results demonstrate that most of these women were diagnosed between the age of 35 and 39 years (91.2%). Most women presented with early-stage disease (stage I and II-66.4%), while 24% were stage III and 9.6% presented with stage IV metastatic disease. The prevalence of hormone-receptor-positive disease represented 41.9% of the cohort, with triple-negative and HER2+ measuring 27.7% and 30.4%, respectively. Five-year disease-free survival was 80.5% and overall survival was 82.7%. These findings provoke discussion regarding the intersecting roles of genetics, environment, and lifestyle in a region with some of the highest rates of malignancy in the country.

“There should be one spot that you can go:” BRCA mutation carriers’ perspectives on cancer risk management and a hereditary cancer registry

Individuals who carry BRCA1 or BRCA2 pathogenic variants are recommended to have extensive cancer prevention screening and risk-reducing surgeries. Uptake of these recommendations is variable, and there remains room for improvement in the risk management of BRCA carriers. This paper explores female BRCA carriers’ experiences with the current model of care and their perspectives on (and interest in) an inherited cancer registry. Findings can inform the development of a dedicated high-risk screening and management program for these patients. Quantitative and qualitative data were gathered through a provincial descriptive survey and semi-structured qualitative interviews to assess BRCA carriers’ opinions toward risk management services in the province of Newfoundland and Labrador (NL), Canada. Survey (n = 69) and interview data (n = 15) revealed continuity and coordination challenges with the current system of care of high-risk individuals. Respondents suggested an inherited cancer registry would help identify high-risk individuals and provide a centralized system of risk management for identified carriers. Respondents identified concerns about the privacy of their registry data, including who could access it. Findings suggest BRCA carriers see great value in an inherited cancer registry. Specifically, participants noted it could provide a centralized system to help improve the coordination of burdensome, life-long risk management. Important patient concerns about protecting their privacy and their health data confidentiality must be addressed in patient and public information and informed consent documents about a registry.

A population-based analysis of the epidemiology of penile cancer in Newfoundland and Labrador.

Penile cancers are a rare subset of carcinomas accounting for <1% of all diagnosed malignancies. There have been recent reports of increasing incidence globally; however, there is limited Canadian literature pertaining to these neoplasms. The province of Newfoundland and Labrador (NL ) represents an important entity to study, possessing the highest national incidence of cancer, along with a plethora of relevant risk factors for penile cancer. A retrospective chart analysis of all patients with a diagnosis of penile cancer in NL between the years of 2006 and 2018 was conducted. The main outcomes included overall incidence, proportion with metastatic disease, tumor demographics, and overall survival (OS ). Incidence among the male population was calculated using Statistics Canada annual reports. An identified 81 cases satisfied the inclusion criteria, with a median age at diagnosis of 65 (interquartile range 20) years. Crude incidence of penile cancer ranged from 1.20-4.27/100 000 males in 2007 and 2010, respectively, while the average age-standardized incidence was 2.34/100 000 males across the study timeframe. Metastatic disease was noted in 17 (21.0%) patients, with a five-year OS of 74% for all penile malignancies, decreasing to 66% in those with invasive squamous cell carcinoma. The incidence of penile cancer in our population was higher than reported Western jurisdictions and showed frequent rates of metastatic spread. These observations are likely multifactorial, resultant of chronic inflammation paired with high rates of modifiable risk factors and diagnostic delays. An evident need for greater examination and improved reporting of these malignancies in the province was identified.

Using Google Classroom as Assistive Technology in Universally Designed Classrooms

This study focuses on the use of Google Classroom as assistive technology in inclusive classrooms. Findings were based on data collected through single-case study methodology in semi-structured formal and informal interviews with eight teachers and a focus group with six students at one junior high school in the province of Newfoundland and Labrador in Canada. This study is designed to better understand the benefits and challenges associated with the use of Google Classroom within the framework of universal design for learning. The findings showed that Google Classroom was perceived by both teachers and students as effective classroom technology in meeting the needs of each learner in the classroom.

News media framing of correctional officers: “Corrections is so Negative, we don’t get any Good Recognition”

The work of correctional officers (COs) is essential yet remains largely hidden from society. As such, media framing plays an important role in shaping public perceptions of COs and their work. COs encounter adverse events over the course of their occupational work and are legally—and sometimes publicly—held accountable. In the current study, we first present a text-based frame analysis of local news media published between January 2019 and December 2019 to see how COs are represented in the province of Newfoundland and Labrador (NL). We then draw from 25 interviews with COs employed at Her [His] Majesty’s Penitentiary in St. John’s, NL, to learn how the officers interpret the media’s framing of their occupation. Grounded emergent theme analyses of interview data reveal officers share concerns about what they perceived as unfair negative media framing. COs more often feel like objects of media framing with little agency to shape media narratives about their work. COs’ lay theories about their representation in mainstream news media illuminate a misalignment between media framing and their own work experience. This misalignment is a source of anxiety and additional job strain.

Genomic epidemiology of Mycobacterium avium subsp. paratuberculosis isolates from Canadian dairy herds provides evidence for multiple infection events.

Mycobacterium avium subsp. paratuberculosis (MAP) is the pathogen responsible for paratuberculosis or Johne's Disease (JD) in ruminants, which is responsible for substantial economic losses worldwide. MAP transmission primarily occurs through the fecal-oral route, and the introduction of an MAP infected animal into a herd is an important transmission route. In the current study, we characterized MAP isolates from 67 cows identified in 20 herds from the provinces of Quebec and Ontario, Canada. Whole genome sequencing (WGS) was performed and an average genome coverage (relative to K-10) of ∼14.9 fold was achieved. The total number of SNPs present in each isolate varied from 51 to 132 and differed significantly between herds. Isolates with the highest genetic variability were generally present in herds from Quebec. The isolates were broadly separated into two main clades and this distinction was not influenced by the province from which they originated. Analysis of 8 MIRU-VNTR loci and 11 SSR loci was performed on the 67 isolates from the 20 dairy herds and publicly available references, notably major genetic lineages and six isolates from the province of Newfoundland and Labrador. All 67 field isolates were phylogenetically classified as Type II (C-type) and according to MIRU-VNTR, the predominant type was INMV 2 (76.1%) among four distinct patterns. Multilocus SSR typing identified 49 distinct INMV SSR patterns. The discriminatory index of the multilocus SSR typing was 0.9846, which was much higher than MIRU-VNTR typing (0.3740). Although multilocus SSR analysis provides good discriminatory power, the resolution was not informative enough to determine inter-herd transmission. In select cases, SNP-based analysis was the only approach able to document disease transmission between herds, further validated by animal movement data. The presence of SNPs in several virulence genes, notably for PE, PPE, mce and mmpL, is expected to explain differential antigenic or pathogenetic host responses. SNP-based studies will provide insight into how MAP genetic variation may impact host-pathogen interactions. Our study highlights the informative power of WGS which is now recommended for epidemiological studies and to document mixed genotypes infections.

Results of a mixed-methods study on barriers to physician recruitment in Newfoundland and Labrador.

Like many rural and remote parts of Canada, the province of Newfoundland and Labrador (NL) struggles to maintain a skilled healthcare workforce. As many as 20% of people in the province are thought to be without a primary care physician. The purpose of this study was to determine the barriers recent Memorial University of Newfoundland medical alumni have faced in establishing medical practice in NL. An online survey followed by question-standardised focus group sessions. Two hundred and ninety-one physicians who graduated from Memorial University of Newfoundland medical school between the years of 2003 and 2018 completed the survey. Nearly 80% of respondents recalled that NL was their preferred practice location at some point during training: 79.4% (n = 231) at the beginning of medical school and 77.7% (n = 226) at the beginning of residency training. However, at the time of the survey, only 160 (55.0%) respondents were working in NL. Respondents reported significant cultural and systemic barriers in trying to work in NL, including ineffective recruitment offices, lack of transparency in communication with health authorities, inequitable distribution of resources and workloads, lack of appropriate resources to support new positions, and return-of-service agreements that are not honoured or followed-up. Our study outlines a number of ways in which recruitment and retention could be improved, ultimately improving provincial health care and helping to fulfil the mandate of the medical school.

Cancer prevention in cancer predisposition syndromes: A protocol for testing the feasibility of building a hereditary cancer research registry and nurse navigator follow up model.

Monogenic, high penetrance syndromes, conferring an increased risk of malignancies in multiple organs, are important contributors to the hereditary burden of cancer. Early detection and risk reduction strategies in patients with a cancer predisposition syndrome can save their lives. However, despite evidence supporting the benefits of early detection and risk reduction strategies, most Canadian jurisdictions have not implemented programmatic follow up of these patients. In our study site in the province of Newfoundland and Labrador (NL), Canada, there is no centralized, provincial registry of high-risk individuals. There is no continuity or coordination of care providing cancer genetics expertise and no process to ensure that patients are referred to the appropriate specialists or risk management interventions. This paper describes a study protocol to test the feasibility of obtaining and analyzing patient risk management data, specifically patients affected by hereditary breast ovarian cancer syndrome (HBOC; BRCA 1 and BRCA 2 genes) and Lynch syndrome (LS; MLH1, MSH2, MSH6, and PMS2 genes). Through a retrospective cohort study, we will describe these patients' adherence to risk management guidelines and test its relationship to health outcomes, including cancer incidence and stage. Through a qualitative interviews, we will determine the priorities and preferences of patients with any inherited cancer mutation for a follow up navigation model of risk management. Study data will inform a subsequent funding application focused on creating and evaluating a research registry and follow up nurse navigation model. It is not currently known what proportion of cancer mutation carriers are receiving care according to guidelines. Data collected in this study will provide clinical uptake and health outcome information so gaps in care can be identified. Data will also provide patient preference information to inform ongoing and planned research with cancer mutation carriers.

Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador

Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3-60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001-2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency.

Bayesian analysis of diagnostic sensitivity and specificity for detecting infectious salmon anaemia virus (ISAV) using IFAT and real-time RT-PCR testing from laboratories in Atlantic Canada

Infectious Salmon Anaemia virus (ISAV) is the causative agent of Infectious Salmon Anaemia (ISA), an economically important disease in farmed Atlantic salmon (Salmo salar L.). Immunofluorescence antibody test (IFAT) and real-time reverse transcription polymerase chain reaction (qRT-PCR) are commonly used diagnostic tests for ISAV active surveillance in Atlantic Canada; however, their diagnostic accuracy is not well reported. In the absence of a reference test, we used Bayesian latent class analysis methods to estimate diagnostic sensitivity (DSe) and specificity (DSp) of IFAT and qRT-PCR. We compared diagnostic performance of qRT-PCR, performed at two laboratories, and IFAT (performed at another laboratory) using field samples obtained from two separate salmon populations (total n = 130) in province of Newfoundland and Labrador, Canada. Conditional independence models for two tests (IFAT and qRT-PCR) and two populations (low and high prevalence) were run separately on datasets from each laboratory. Informative priors were used for DSe and DSp of qRT-PCR and IFAT based on prior knowledge, while flat priors (beta 1,1) were used for prevalence. qRT-PCRs had similarly high DSe (>91%). IFAT was the least sensitive method (DSe range, 56.9%–60.4%). Both IFAT (DSp > 98.8%) and qRT-PCRs (DSp > 97.9%) showed high DSp. Real-time RT-PCR provided the greatest DSe for routine surveillance of Atlantic salmon farms while not sacrificing DSp. Sample size for the study was not likely adequate to estimate all parameters with very high confidence, which could have influenced the posterior probability interval calculated for DSe, resulting in less diagnostic confidence in the results (posterior probability for Sensitivities for the tests within 10% of the true population value instead of 5%). Although IFAT provided a high DSp, the qRT-PCR performed similarly in this regard. The findings indicate that the qRT-PCR is fit for ISAV surveillance programs.

What is the knowledge of Newfoundland and Labrador Coaches’ regarding recognition of and response towards sports related concussive injury in the adolescent?

Objective: To examine coaches’ knowledge, recognition of, and response to, concussion in the adolescent athlete population.Methods: Using a non-experimental correlational design, adult coaches (N = 120) responsible in the coaching of adolescent junior high and high school athletes were recruited from sports associations and schools in the province of Newfoundland and Labrador (NL). A 28 item questionnaire called Coaches’ Knowledge of Sports Related Concussive Injury in the Adolescent Athlete Survey was provided online.Results: Majority of participants were knowledgeable of what is a concussion, its causes, and what visual clues observed that indicate a possible concussion in a player. In relation to the Age of coach category, only the 55+ age group responded correctly to what is an example of sport specific activity with body contact. Years of coaching and return-to-play knowledge after a concussion showed incorrect responses for both the step wise approach and the 20-30 minute player participation with no contact. Having attended an education concussion session or not showed no difference on return-to-play knowledge in the step wise approach progression as the majority responded incorrectly with 71.4% (attended an education session) versus 91.7% of participants (no attendance on concussion education), respectively.Conclusions: Benefits gained through this research study will serve to evaluate coaches’ knowledge and improve standardized concussion knowledge. Such preparation can assist in better recognizing and effectively managing a sports related concussion (SRC) and the potential to facilitate sport policy changes. Actions by coaches can impact preventative education, encourage safe behaviors and the reporting of concussive symptoms by the adolescent, therefore reducing burden on overall long term negative health outcomes.

Climate Autobiography Timeline: Adapting Timeline Research Methods to the Study of Climate Perceptions

Abstract Climate perception is a growing area of study in the social sciences and one that has implications on the tools and strategies we use to communicate climate change risk information. However, the range of climate perception studies remains limited, focused primarily on perceptions of day-to-day weather, sudden-onset severe events, or long-term permanent change. Phenomena situated between these extremes (e.g., annual- to decadal-scale variability) are largely missing from social science of climate research. Whether this is due to limited perception by research participants, is due to limited research attention, or is a reflection of the methods commonly applied to human dimensions of climate research, this gap precludes analysis of the full range of complex climate experiences and their influence on climate perception and understanding. In this paper, we offer a proof of concept for the climate autobiography timeline (CAT), a visual timeline tool developed to assess climate perception while prompting an ordered consideration of time, with the goal of eliciting insights into complex and long-term climate experiences such as low-frequency climate variability. Results are based off a preliminary application of the CAT across focus groups conducted in Newfoundland and Labrador, a province of Canada that is subject to low-frequency climate variability and frequent high-impact weather. Results reveal three key findings: 1) weather and climate narratives are commonly anchored to two time periods, potentially obscuring perceptions of variability; 2) narratives focus on socially important weather and climate phenomena; and 3) the social and visual coconstruction of weather and climate narratives may yield more holistic representations of local climate knowledge. Significance Statement The purpose of this work is to highlight the utility of timeline research methods to the study of climate perception research. Specifically, the climate autobiography timeline (CAT) serves as a tool that can address limitations of research tools commonly applied to the study of climate perceptions, notably the inability for current methods to elicit and organize complex climate experiences. Failure to capture these experiences may prevent a holistic and socially grounded understanding of climate perceptions. Drawing from a preliminary application of CATs in the province of Newfoundland and Labrador in Canada, we highlight how the tool can provide information complementary to, but distinct from, data collected through more commonly used methods such as interviews or surveys. This approach holds promise for analyses of long-term climate history, impacts of historical severe events, and cultural impact of weather and climate.