Sites In Ontario Research Articles

Does prey availability affect the reproductive performance of Barn Swallows (Hirundo rustica) breeding in Ontario, Canada?

Animal populations are often limited by food availability, particularly during the breeding season. In birds, food limitation can impact several components of the reproductive cycle, including the timing of reproduction and reproductive output. Barn Swallows (Hirundo rustica Linnaeus, 1758) have experienced a population decline over the past 40 years in North America that is thought to be related to changes in prey availability. We monitored Barn Swallow reproductive behaviour and prey availability throughout two breeding seasons at 10 sites in Ontario, Canada, to test the hypothesis that limited prey availability during the breeding season affected reproductive behaviour. We found no relationship between food availability and number of eggs laid or number of young fledged. Neither did we observe higher rates of second brooding or more pairs nesting at breeding sites with higher food availability. Barn Swallows did not time their reproductive effort to maximize prey availability during the nesting period, but any mismatch in phenology of prey and bird reproduction at a breeding site was not associated with lower reproductive success. The results of this study did not support our hypothesis and suggest that Barn Swallow reproductive behaviour was not negatively affected by limited prey availability on the breeding grounds.

Evidence for spring stopover refuelling in migrating silver-haired bats (Lasionycteris noctivagans)

Migrating animals must acquire sufficient fuel to sustain migratory movement, but how time is allocated to achieve this can vary greatly. The fuel strategies used by migrating bats are not well understood and have not been investigated during the spring when insectivorous bats face low food abundance. Migrating silver-haired bats (Lasionycteris noctivagans (Le Conte, 1831)) were captured at a stopover site in Long Point, Ontario, Canada, in April and May of 2012–2014. We followed the movements of 40 bats outfitted with radio transmitters using an automated telemetry array and examined the effects of ambient temperature, fat stores, and sex on stopover duration. As seen previously in autumn, most bats departed the evening following capture, but one-third of bats used multiday stopovers. Extended stopover was associated with lower ambient temperature. There was no effect of sex or fat at capture on stopover departure probability. Bats captured closer to dawn had greater fat mass and lean mass than those captured early in the night, a trend indicative of fuel deposition at this site. This is the first study to provide evidence that bats use stopover habitat for refuelling.

Effect on Treatment Adherence of Distributing Essential Medicines at No Charge

Nonadherence to treatment with medicines is common globally, even for life-saving treatments. Cost is one important barrier to access, and only some jurisdictions provide medicines at no charge to patients. To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence. A multicenter, unblinded, parallel, 2-group, superiority, outcomes assessor-blinded, individually randomized clinical trial conducted at 9 primary care sites in Ontario, Canada, enrolled 786 patients between June 1, 2016, and April 28, 2017, who reported cost-related nonadherence. Follow-up occurred at 12 months. The primary analysis was performed using an intention-to-treat principle. Patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care (n = 395) or usual medicine access and usual care (n = 391). The primary outcome was adherence to treatment with all medicines that were appropriately prescribed for 1 year. Secondary outcomes were hemoglobin A1c level, blood pressure, and low-density lipoprotein cholesterol levels 1 year after randomization in participants taking corresponding medicines. Among the 786 participants analyzed (439 women and 347 men; mean [SD] age, 51.7 [14.3] years), 764 completed the trial. Adherence to treatment with all medicines was higher in those randomized to receive free distribution (151 of 395 [38.2%]) compared with usual access (104 of 391 [26.6%]; difference, 11.6%; 95% CI, 4.9%-18.4%). Control of type 1 and 2 diabetes was not significantly improved by free distribution (hemoglobin A1c, -0.38%; 95% CI, -0.76% to 0.00%), systolic blood pressure was reduced (-7.2 mm Hg; 95% CI, -11.7 to -2.8 mm Hg), and low-density lipoprotein cholesterol levels were not affected (-2.3 mg/dL; 95% CI, -14.7 to 10.0 mg/dL). The distribution of essential medicines at no charge for 1 year increased adherence to treatment with medicines and improved some, but not other, disease-specific surrogate health outcomes. These findings could help inform changes to medicine access policies such as publicly funding essential medicines. ClinicalTrials.gov identifier: NCT02744963.

The ever-changing narrative: Supervised injection site policy making in Ontario, Canada

BackgroundWe analyze the ongoing debate surrounding supervised injection sites in Ontario, Canada and changing policies that impact host communities. Despite a plethora of evidence proving the effectiveness of supervised injection sites on harm reduction strategy, the topic remains highly controversial with constantly changing rhetoric in the Ontario drug policy landscape. MethodsWe reviewed government reports, policies, and media sources spanning from prior to the establishment of the first Canadian supervised injection site in 2000 to early 2019, adopting an advocacy coalition framework approach to this policy analysis. Various advocacy coalitions emerge from this analysis, including all three levels of government, law enforcement, health practitioners, and community groups. We describe the narratives constructed by these coalitions, analyzing the supervised injection site model as a harm reduction strategy within a continually shifting socio-political landscape. ResultsEmerging from the analysis are competing narratives put forward by various stakeholders within the policy subsystem. We find policy-makers tend to leverage scientific uncertainty as a tool to defend the interests of the most powerful actor in the subsystem. Despite an increase in the number of deaths due to the opioid crisis and evidence highlighting the efficacy of supervised injection sites as a harm reduction tool, various stakeholders are locked in a battle of claims and counter-claims about the appropriate policy response to opioids. ConclusionsThese findings have broad implications for drug policy in other contexts. Our case study demonstrates the strength of stopgap measures, like supervised injection, to reduce harm from controlled substances.

Wastewater impacts on groundwater at a fractured sedimentary bedrock site in Ontario, Canada: implications for First Nations’ source-water protection

The impacts of wastewater on Indigenous drinking water sources is an issue of concern across Canada. This study investigated the wastewater impacts on groundwater resources at a First Nations reserve located on a vulnerable fractured sedimentary bedrock aquifer in southern Ontario. The objectives were to examine the spatiotemporal variability of a variety of tracers of wastewater and their movement to groundwater. The tracers included nitrate, E. coli, total coliforms, and the artificial sweeteners sucralose, acesulfame, and cyclamate. Isotopes in the groundwater were also examined, including tritium and the isotopes of oxygen and nitrogen in dissolved inorganic nitrate. Three multilevel monitoring systems (seven-channel continuous multi-channel tubing) were retrofitted in unused drinking-water wells on the reserve and monitored from December 2015 to November 2016. Results indicate that groundwater at various depths has been impacted by the septic systems on the reserve. The fractures intersected by the three retrofitted wells contain a mix of newly recharged and older water, and contaminant peaks do not always correspond with ports aligned with higher hydraulic conductivity, showing variable travel times for the constituents. The selection of wastewater management systems that are appropriate for the particular hydrogeological setting on the reserves is critical to providing safe, clean drinking water to Indigenous communities. In particular, special consideration should be made for communities situated on fractured sedimentary bedrock aquifers with thin overburden.

Round-fruited St. John’s-wort (<i>Hypericum sphaerocarpum</i>, Hypericaceae) in Canada

Round-fruited St. John’s-wort (Hypericum sphaerocarpum), a native North American herbaceous, perennial vascular plant, is reported from four sites in southern Ontario, Canada. All four sites are along abandoned railway lines. Although the rich association of native flora suggests native status at one site, H. sphaerocarpum is believed to be introduced elsewhere in its Canadian range in Ontario.

Archaeological reconnaissance through multi-method geophysical and geochemical survey at two Iroquoian village sites, southern Ontario, Canada

Only in the last decade have archaeologists working on Iroquoian sites in Ontario, Québec, and New York State begun to seize upon the potential of geophysical prospection and soil chemistry for identifying settlement features. Recent studies employing magnetic gradiometry, magnetic susceptibility, and soil phosphate analysis demonstrate that multi-method approaches have the potential to overcome the limitations imposed by intrusive historic features, soil composition, and underlying geology. We consider how specific aspects of the Iroquoian built environment, such as longhouses, palisades, and middens, might be visible in datasets produced by magnetic gradiometry, magnetic susceptibility, and soil phosphate analyses and apply these methods to two Iroquoian sites: Trent-Foster (BcGr-5), a late 16th-century Wendat village and Hamilton-Lougheed (BbHa-10), an early-to-mid 17th-century Tionontate village. At Trent-Foster, we interpret certain anomalies as potential longhouses, but suggest that a band of low magnetism cutting through the site may be due to underlying geology. At Hamilton-Lougheed, we identify a potential palisade and a likely habitation area. We conclude by acknowledging that the biggest imperative moving forward is the need for more ground-truthing to verify the presence or absence of built environment features suggested by geophysical and soil chemistry methods. We advocate for continued use and development of geophysical and geochemical methods on Iroquoian sites, particularly in the cultural resource management context, as they strike an important balance between preserving archaeological heritage and learning from that which is preserved, issues that are of the utmost importance to descendant communities and First Nations research partners.

The HealtheSteps\u2122 lifestyle prescription program to improve physical activity and modifiable risk factors for chronic disease: a pragmatic randomized controlled trial

BackgroundOur objective was to determine the influence of the HealtheSteps™ lifestyle prescription program on physical activity and modifiable risk factors for chronic disease in individuals at risk.MethodsOne hundred eighteen participants were recruited from 5 sites in Southwestern Ontario, Canada and randomized to either the intervention (HealtheSteps™ program, n = 59) or a wait-list control group (n = 59). The study comprised three phases: an Active Phase (0 to 6 months) consisted of bi-monthly in-person lifestyle coaching with access to a suite of eHealth technology supports (Heathesteps app, telephone coaching and a private HealtheSteps™ social network) followed by a Minimally-Supported Phase I (6 to 12 months), in which in-person coaching was removed, but participants still had access to the full suite of eHealth technology supports. In the final stage, Minimally-Supported Phase II (12 to 18 months), access to the eHealth technology supports was restricted to the HealtheSteps™ app. Assessments were conducted at baseline, 6, 12 and 18 months. The study primary outcome was the 6-month change in average number of steps per day. Secondary outcomes included: self-reported physical activity and sedentary time; self-reported eating habits; weight and body composition measures; blood pressure and health-related quality of life. Data from all participants were analyzed using an intent-to-treat approach. We applied mixed effects models for repeated measurements and adjusted for age, sex, and site in the statistical analyses.ResultsParticipants in HealtheSteps™ increased step counts (between-group [95% confidence interval]: 3132 [1969 to 4294], p < 0.001), decreased their sitting time (− 0.08 [− 0.16 to − 0.006], p = 0.03), and improved their overall healthful eating (− 1.5 [− 2.42 to − 0.58], p = 0.002) to a greater extent compared to control at 6 months. Furthermore, exploratory results showed that these individuals maintained these outcomes 12 months later, after a minimally-supported phase; and retained improvements in sedentary time and improved healthful eating after 18 months. No differences in self-reported physical activity, health-related quality of life, weight, waist circumference or blood pressure were observed between groups at 6 months.ConclusionsOur findings suggest that HealtheSteps™ is effective at increasing physical activity (i.e., step counts per day), decreasing weekday sitting time, and improving healthful eating in adults at increased risk for chronic disease after 6 months; however, we did not see change in other risk factors. Nonetheless, the maintenance of these behaviours with minimal support after 12 and even 18 months indicates the promise of HealtheSteps™ for long-term sustainability.Trial registrationThe trial was registered on April 6, 2015 with ClinicalTrials.gov (identifier: NCT02413385).

Detection of Organohalide-Respiring Enzyme Biomarkers at a Bioaugmented TCE-Contaminated Field Site.

RNA-based biomarkers have been successfully detected at field sites undergoing in situ bioremediation, but the detection of expressed enzymes is a more direct way to prove activity for a particular biocatalytic process of interest since they provide evidence of potential in situ activity rather than simply confirming presence and abundance of genes in a given population by measurement of DNA copies using qPCR. Here we successfully applied shotgun proteomics to field samples from a trichloroethene (TCE)-contaminated industrial site in southern Ontario, Canada that had been bio-augmented with the commercially available KB-1TM microbial culture. The KB-1TM culture contains multiple strains of Dehalococcoides mccartyi (D. mccartyi) as well as an organohalide respiring Geobacter species. The relative abundances of specific enzymatic proteins were subsequently compared to corresponding qPCR-derived levels of DNA and RNA biomarkers in the same samples. Samples were obtained from two wells with high hydraulic connectivity to the KB-1TM-bioaugemented enhanced in situ bioremediation system, and two control wells that showed evidence of low levels of native organohalide respiring bacteria (OHRB), Dehalococcoides and Geobacter. Enzymes involved in organohalide respiration were detected in the metaproteomes of all four field samples, as were chaperonins of D. mccartyi, chemotaxis proteins, and ATPases. The most highly expressed RDase in the bioaugmentation culture (VcrA) was the most highly detected enzyme overall in the bioaugmented groundwater samples. In one background groundwater well, we found high expression of the Geobacter pceA RDase. The DNA and RNA biomarkers detected using qPCR-based assays were a set of orthologs of Dehalococcoides reductive dehalogenases (VcrA, TceA, BvcA, dehalogenase “DET1545”), and the Ni-Fe uptake hydrogenase, HupL. Within a sample, RNA levels for key enzymes correlated with relative protein abundance. These results indicate that laboratory observations of TCE-bioremediation biomarker protein expression are recapitulated in field environmental systems and that both RNA and protein biomarker monitoring hold promise for activity monitoring of in situ populations of OHRB.

Preliminary assessment of underground hydrogen storage sites in Ontario, Canada

The replacement of coal-fired power plants with increasing proportions of renewable and nuclear energies in the province of Ontario highlights the need to balance seasonal energy demands. This can be achieved through power-to-gas technology, where excess energy is used to generate hydrogen gas through electrolysis, and the generation is coupled with underground hydrogen storage. This article presents a preliminary assessment regarding the potential for underground hydrogen storage in geological formations including salt and hard rock caverns, depleted oil and gas fields, and saline aquifers in Ontario, highlighting potential locations where future storage could be feasible. Southern Ontario presents many potential storage options, including Silurian bedded salts, depleted Ordovician natural gas reservoirs, saline aquifers in Cambrian sandstone and hard rock caverns in argillaceous limestones. Hard rock caverns in Precambrian crystalline rocks of the Canadian Shield are also discussed, in addition to the potential for the use of lined rock caverns. This work aims to provide a basis for further research regarding the appropriate location of underground hydrogen gas storage facilities in Ontario.

Effects of Biomass Removal Levels on Soil Carbon and Nutrient Reserves in Conifer‐Dominated, Coarse‐Textured Sites in Northern Ontario: 20‐Year Results

Core Ideas Biomass removal trials targeted soils sensitive to nutrient removal (shallow to bedrock and infertile sands). 14 long‐term sites (42 plots per treatment) were used to evaluate C and nutrient reserves 20 years post‐harvest. After 20 years, soil C, N, and K reserves did not differ between pre‐harvest levels and SO and FT. Soil reserves of FTB treatments remained significantly lower than the pre‐harvest levels. Jack pine and black spruce declined in height on FTB on sandy sites; there were no differences between SO and FT. Here we report on 20‐yr soil (forest floor plus the upper 20 cm of mineral soil) carbon and nutrient reserves from 14 biomass removal trials established on coarse‐textured, nutrient poor sites. Harvest treatments included stem only (SO, delimbed at the stump), full‐tree (FT, entire trees with boles and branches removed), and full‐tree plus forest floor blading (FTB, full‐tree harvest followed by removal of the forest floor and approximately the upper 5 cm of mineral soil). After 20 yr, there were no significant differences in soil C, N, and K reserves between pre‐harvest levels and the SO and FT treatments. Only the soil reserves of the FTB treatment remained significantly lower than the pre‐harvest levels. Extractable soil Ca and Mg reserves increased in Year 5 in all treatments, followed by slow declines, but all treatments remained comparable to or exceeded pre‐harvest levels at Year 20. For P, harvesting (SO and FT) resulted in significant declines that remain after 20 yr. Both jack pine and black spruce showed reduced top height growth on FTB, but only on some of the sandy sites. There were no differences in top height for either species between SO and FT across all 14 study sites. Current results suggest there is no need for restrictions on full‐tree harvesting for traditional wood products on these nutrient poor sites. However, from a cautionary perspective, it seems prudent at this time to restrict more intensive bioenergy harvests to deep, finer‐textured sites that have larger soil C and nutrient reserves.

Forest Site and Type Variability in ALS-Based Forest Resource Inventory Attribute Predictions over Three Ontario Forest Sites

Over the last decade, spatially-explicit modeling of landscape-scale forest attributes for forest inventories has greatly benefitted from airborne laser scanning (ALS) and the area-based approach (ABA) to derive wall-to-wall maps of these forest attributes. Which ALS-derived metrics to include when modeling forest inventory attributes, and how prediction accuracies vary over forest types depends largely on the structural complexity of the forest(s) being studied. Hence, the purpose of this study was to (i) examine the usefulness of adding texture and intensity metrics to height-based ALS metrics for the prediction of several forest resource inventory (FRI) attributes in one boreal and two Great Lakes, St. Lawrence (GLSL) forest region sites in Ontario and (ii) quantify and compare the site and forest type variability within the context of the FRI prediction accuracies. Basal area (BA), quadratic mean diameter-at-breast height (QMD), and stem density (S) were predicted using the ABA and a nonparametric Random Forests (RF) regression model. At the site level, prediction accuracies (i.e., expressed as RMSE (Root Mean Square Error), bias, and R2) improved at the three sites when texture and intensity metrics were included in the predictor set, even though no significant differences (p &gt; 0.05) could be detected using the nonparametric RMANOVA test. Stem density benefitted the most from the inclusion of texture and intensity, particularly in the GLSL sites (% RMSE improved up to 6%). Combining site and forest type results indicated that improvements in site level predictions, due to the addition of texture and intensity metrics to the ALS predictor set, were the result of changes in prediction accuracy in some but not all forest types present at a site and that these changes in prediction accuracy were site and FRI attribute specific. The nonparametric Kruskal–Wallis test indicated that prediction errors between the different forest types were significantly different (p ≤ 0.01). In the boreal site, prediction accuracies for conifer forest types were higher than for deciduous and mixedwoods. Such patterns in prediction accuracy among forest types and FRI attributes could not be observed in the GLSL sites. In the Petawawa Research Forest (PRF), we did detect the impact of silvicultural treatments especially on QMD and S predictions.

Conservation Conundrum: At-risk Bumble Bees (Bombus spp.) Show Preference for Invasive Tufted Vetch (Vicia cracca) While Foraging in Protected Areas.

In recent decades, some bumble bee species have declined, including in North America. Declines have been reported in species of bumble bees historically present in Ontario, including: yellow bumble bee (Bombus fervidus) (Fabricus, 1798), American bumble bee (Bombus pensylvanicus) (DeGeer, 1773), and yellow-banded bumble bee (Bombus terricola) (Kirby, 1837). Threats contributing to bumble bee population declines include: land-use changes, habitat loss, climate change, pathogen spillover, and pesticide use. A response to the need for action on pollinator preservation in North America has been to encourage ‘bee-friendly’ plantings. Previous studies show differences in common and at-risk bumble bee foraging; however, similar data are unavailable for Ontario. Our research question is whether there is a difference in co-occurring at-risk and common bumble bee (Bombus spp.) floral use (including nectar and pollen collection) in protected areas in southern Ontario. We hypothesize that common and at-risk species forage differently, predicting that at-risk species forage on a limited selection of host plants. We conducted a field survey of sites in southern Ontario, using observational methods to determine bumble bee foraging by species. The results of a redundancy analysis show a difference in foraging between common and at-risk bumblebee species. At-risk bumble bee species show a preference for foraging on invasive, naturalized Vicia cracca (tufted vetch). This finding raises the question of how to preserve or provide forage for at-risk bumble bees, when they show an association with an invasive species often subject to control in protected areas.

Babesia odocoilei and zoonotic pathogens identified from Ixodes scapularis ticks in southern Ontario, Canada

Cervid babesiosis, caused by the protozoan hemoparasite Babesia odocoilei and transmitted by the blacklegged tick Ixodes scapularis, is an emerging disease of Canadian cervids. This pathogen has not yet been described in humans. Data are lacking on the role of migratory birds in the adventitious spread of Ba. odocoilei-infected ticks, as well as on the infection status of I. scapularis in environments used by susceptible wildlife hosts. Following a high-mortality outbreak of cervid babesiosis at the Toronto Zoo [TZ], the present study was initiated to investigate Ba. odocoilei and other tick-borne pathogens of veterinary and public health importance (Borrelia burgdorferi sensu stricto (s.s.), Anaplasma phagocytophilum, Borrelia miyamotoi, and Babesia microti) in I. scapularis at three sites in southern Ontario, Canada. Blanket dragging for questing ticks yielded I. scapularis from the three sites evaluated: TZ, Point Pelee National Park, and Long Point Bird Observatory [LPBO]. Babesia odocoilei was identified in I. scapularis collected by dragging at the TZ and at LPBO. Borrelia burgdorferi s.s. was identified in I. scapularis at all three sites. Anaplasma phagocytophilum was identified in I. scapularis collected from the TZ. During the springs of 2016 and 2017, 1102 northward-migrating birds were examined for ticks at LPBO. One or more I. scapularis were found on 3.2% of birds (n = 595) in 2016, and 6.7% (n = 507) of birds in 2017. Overall, across both years, 0.2% and 0.5% of birds carried one or more I. scapularis ticks that tested PCR-positive for Ba. odocoilei and Bo. burgdorferi s.s., respectively. These data indicate that Ba. odocoilei-positive I. scapularis are found in southern Ontario, and suggest that bird-borne ticks have the potential to contribute to range expansion of both Ba. odocoilei and Bo. burgdorferi s.s. in Canada.

Modeling Performance of Sediment Control Wet Ponds at Two Construction Sites in Ontario, Canada

AbstractOne of the most uncertain hydraulic designs in urban stormwater management concerns sediment control wet ponds as the event mean total suspended sediment concentration that is discharged in...

Groundwater recharge, flow and stable isotope attenuation in sedimentary and crystalline fractured rocks: Spatiotemporal monitoring from multi-level wells

The use of stable isotopes from precipitation as tracers in unconsolidated porous media can be limited due to attenuation in the unsaturated zone, yet this process has been poorly constrained in fractured rock. The complexities of fractured rock systems necessitate the use of multi-level monitoring wells for the measurement of isotopic tracers with depth. These methods, however, are rarely employed in groundwater flow and recharge studies, particularly involving temporal isotope measurements in multiple rock types. To understand the attenuation of isotopic snowmelt tracers in fractured rock and explore surface connections and recharge, an investigation was undertaken at three geologically-distinct field sites in south-eastern Ontario, Canada. Results of constant head injection tests at 2-m intervals were used to identify and isolate high transmissivity zones (2–3 in each well) for the construction of eight multi-level wells (22 intervals) used for groundwater sampling. Deuterium and oxygen-18 were measured in rain (n = 64), snow (n = 67), soil water (n = 118) and groundwater (n = 594) on a bi-weekly to monthly basis over two seasonal snowmelt cycles (>1.5 years). In combination with stable isotopes, measurements of hydraulic head, groundwater temperature, specific conductance and two rounds of tritium sampling contributed to the development of a conceptual model for snowmelt recharge and flow in sandstone, limestone and crystalline rock. Seasonal variation of δ2H and δ18O was observed in all rock types indicating recent recharge and strong surface connections. The dampening and residence time of the snowmelt tracer increased with depth in crystalline rock. Tracer attenuation was highest in higher-porosity sedimentary rock and strong confining conditions were observed to inhibit recent recharge. Substantial isotopic attenuation measured in the overburden indicated that the strong snowmelt signal measured in groundwater stemmed from water infiltrating through areas with thin or no overburden. Identification of the periodic trends and distinct isotopic horizons in this study would not have been possible without the use of multi-level wells.

Demonstrating a Technology-Mediated Intervention to Support Medication Adherence in Community-Dwelling Older Adults in Primary Care: A Feasibility Study

Background: Medication non-adherence can lead to significant morbidity and mortality. This 4-week feasibility study aims to demonstrate that the eDosette intervention can be implemented with older adults in primary care. Method: Fifty-six older adults from four primary care sites in Southwestern Ontario, Canada participated. The intervention involved generating, for pharmacist review, weekly medication administration records based on transmitted data captured by the eDosette. The primary outcome is implementation feasibility defined by recruitment, adherence rates, frequency of captured missed and late doses, descriptions of clinical work resulting from the intervention, and participant feedback. Results: The recruitment rate was 24% (57/240); one withdrew due to personal reasons. The mean observed adherence rate was 82% (range 49%-100%). Overall, participants missed 505 and took 2,105 doses late; 118 clinical decisions occurred with 72 unique medication changes in 31 participants. Participants found the eDosette easy to use and did not feel that they were viewed negatively because of their potential non-adherence. Conclusion: The eDosette intervention could be feasibly implemented in primary care with older adults. Providing information about when an older adult takes their medications could play a role in medication adherence by prompting more informed discussions between the older adult and primary care clinicians.

Non‐stationary intensity‐duration‐frequency curves integrating information concerning teleconnections and climate change

Rainfall intensity‐duration‐frequency (IDF) curves are commonly used for the design of water resources infrastructure. Numerous studies reported non‐stationarity in meteorological time series. Neglecting to incorporate non‐stationarities in hydrological models may lead to inaccurate results. The present work focuses on the development of a general methodology that copes with non‐stationarities that may exist in rainfall, by making the parameters of the IDF relationship dependent on the covariates of time and climate oscillations. In the recent literature, non‐stationary models are generally fit on data series of specific durations. In the approach proposed here, a single model with a separate functional relation with the return period and the rainfall duration is instead defined. This model has the advantage of being simpler and extending the effective sample size. Its parameters are estimated with the maximum composite likelihood method. Two sites in Ontario, Canada and one site in California, USA, exhibiting non‐stationary behaviours are used as case studies to illustrate the proposed method. For these case studies, the time and the climate indices Atlantic Multi‐decadal Oscillation (AMO) and Western Hemisphere Warm Pool (WHWP) for the stations in Canada, and the time and the climate indices Southern Oscillation Index (SOI) and Pacific Decadal Oscillation (PDO) for the stations in United States are used as covariates. The Gumbel and the generalized extreme value distributions are used as the time‐dependent functions in the numerator of the general IDF relationship. Results show that the non‐stationary framework for IDF modelling provides a better fit to the data than its stationary counterpart according to the Akaike information criterion. Results indicate also that the proposed generalized approach is more robust than the common approach especially for stations with short rainfall records (e.g., R2 of 0.98 compared to 0.69 for duration of 30 min and a sample size of 27 years).

Impacts of Educating for Equity Workshop on Addressing Social Barriers of Type 2 Diabetes With Indigenous Patients.

Health education about Indigenous populations in Canada (First Nations, Inuit, and Métis people) is one approach to enable health services to mitigate health disparities faced by Indigenous peoples related to a history of colonization and ongoing social inequities. This evaluation of a continuing medical education workshop, to enhance family physicians' clinical approach by including social and cultural dimensions within diabetes management, was conducted to determine whether participation in the workshop improved self-reported knowledge, skills, and confidence in working with Indigenous patients with type 2 diabetes. The workshop, developed from rigorous national research with Indigenous patients, diabetes care physicians, and Indigenous health medical educators, was attended by 32 family physicians serving Indigenous populations on three sites in Northern Ontario. A same-day evaluation survey assessed participants' satisfaction with workshop content and delivery. Preworkshop and postworkshop surveys consisting of 5-point Likert and open-ended questions were administered 1 week before and 3 month after the workshop. Descriptive statistics and t test were performed to analyze Likert scale questions; thematic analysis was used to elicit and cluster themes from open-ended responses. Participants reported high satisfaction with all aspects of the workshop. Reporting improved understanding of socioeconomic (P = .002), psychosocial, and cultural factors (P = .001), participants also described adapting their clinical approach to more actively incorporating social and cultural factors and focusing on patient-centered care. The workshop was effective in shifting physician's self-reported knowledge, attitudes, and skills resulting in clinical approach modifications within social, psychosocial, and cultural domains for their Indigenous patients with diabetes.

Increasing Incidence and Prevalence of Pathologic Hemoglobinopathies Among Children in Ontario, Canada from 1991-2013

Abstract Background: In Ontario, Canada's largest province, population-based health administrative data represents an accessible and useful tool for population surveillance of people with chronic diseases. While hemoglobinopathies can be identified using data from universal hemoglobinopathy screening, which was implemented in November 2006, these data would not contain information on affected immigrants (21.9% of the population). We validated algorithms using provincial health administrative data and newborn screening data to identify children with hemoglobinopathies whether or not they were born in Ontario, thereby creating a population-based surveillance cohort. Objectives: (1) Validate algorithms to identify children with sickle cell disease, thalassemia and other hemoglobinopathies from within health administrative data; and (2) Determine incidence and prevalence of hemoglobinopathies in Ontario children. Methods: For the validation study, a positive reference cohort was established using lists of known hemoglobinopathy patients who were followed at five pediatric hemoglobinopathy treatment sites in Ontario and born between November 24, 2006 and March 31, 2013. Health card numbers of these patients were linked deterministically to unique identification numbers in administrative data, which included data on hospitalizations, physician claims, sociodemographic characteristics, immigration records and cause of death. The negative reference cohort included all children residing in Ontario cities who had never been seen at a hemoglobinopathy centre, and therefore assumed not to have disease. Various combinations of administrative data codes were tested for their ability to identify children &lt;18 years of age with hemoglobinopathies from within the databases, and we selected the algorithms with the highest positive predictive value, while maintaining sensitivity &gt;80%. Using two validated algorithms, we identified all children with hemoglobinopathies born between April 1, 1991 and March 31, 2013. We described the crude incidence and prevalence per 100,000 patient-years (PYs). Results: Two algorithms functioned best to identify incident and prevalent hemoglobinopathy cases (see Table). Among children born between April 1, 1991 to March 31, 2013, 1526 incident hemoglobinopathy patients were identified using Algorithm 1 (crude incidence of 4.85 per 100,000 PYs) and 1660 new hemoglobinopathy patients were identified using Algorithm 2 (crude incidence 5.28 per 100,000 PYs, 95% CI 3.51 to 3.92). In 2013, the overall prevalence of children &lt;18 years living with hemoglobinopathies was 1215-1325 cases. Conclusion: Through an innovative approach using provincial health administrative, immigration and demographic data, this study identified a rising incidence and prevalence of hemoglobinopathies among Ontario children &lt;18 years of age between April 1, 1991 and March 31, 2013, potentially due to increased immigration rates. These findings could be used to inform health services distribution. This surveillance cohort will be used to understand the impact of immigration status on health care inequality for hemoglobinopathy-related health services delivery, as well as to assess outcomes in this important group of chronic diseases. Disclosures Klaassen: Amgen Inc.: Membership on an entity's Board of Directors or advisory committees; Octapharma AG: Consultancy, Honoraria; Agios Pharmaceuticals Inc.: Consultancy; Novartis: Research Funding; Hoffman-La Roche: Consultancy; Shire: Consultancy; Cangene: Research Funding. Jardine:Pfizer: Other: Advisory board; Bayer: Other: Advisory board; Baxalta: Other: Advisory board.