Thousands Of Canadians Research Articles

Cultural Distinction and the University of Toronto: Constructing Symbolic Boundaries of Social Class in Canada, 1894–1950

In the first half of the twentieth century, the University of Toronto was a preeminent cultural institution in Canada. Based on a critical interpretation of archival documents, this article narrates the history of four non-formal educational programs through which the University of Toronto created opportunities for Canadians to develop privileged forms of cultural taste and practice: the administration of local examinations in music across Canada, the development of a museum oriented to public visitation, the organization of public lectures in collaboration with local associations across Ontario, and the delivery of non-credit evening courses in Toronto. These four programs engaged hundreds of thousands of Canadians in forms of activity that supported the development of what Bourdieu conceptualized as constellations of cultural distinction: arrays of tastes and practices that mark symbolic boundaries of social class. Two of the programs resulted in national cultural institutions (Royal Conservatory of Music and Royal Ontario Museum) prominent in fields that have been empirically associated with social class boundaries in Canada. The other two programs declined in significance after 1950 and have not previously been included in analyses of cultural distinction. This article explores the historical role of Canadian universities in constructing symbolic boundaries of social class.

AI Can Improve the Economics of Blindness Prevention in Canada.

Diabetic retinopathy is a leading cause of vision loss in Canada and creates significant economic and social burden on patients. Diabetic retinopathy is largely a preventable complication of diabetes mellitus. Yet, hundreds of thousands of Canadians continue to be at risk and thousands go on to develop vision loss and disability. Blindness has a significant impact on the Canadian economy, on families and the quality of life of affected individuals. This paper provides an economic analysis on two potential interventions for preventing blindness and concludes that use of AI to identify high-risk individuals could significantly decrease the costs of identifying, recalling, and screening patients at risk of vision loss, while achieving similar results as a full-fledged screening and recall program. We propose that minimal data interoperability between optometrists and family physicians combined with artificial intelligence to identify and screen those at highest risk of vision loss can lower the costs and increase the feasibility of screening and treating large numbers of patients at risk of going blind in Canada.

Challenges with new treatments for Alzheimer disease: Accelerated approval of aducanumab in the United States raises questions.

Alzheimer disease (AD) affects hundreds of thousands of Canadians and is a major cause of morbidity and mortality in our country.[1][1] As family physicians are keenly aware, there are no disease-modifying pharmacotherapies for AD available in Canada. Extracellular accumulation of amyloid-β plaques

“Architects’ mistakes should be covered with ivy and doctors’ with sod”: Medical Malpractice, Morton Shulman, and the “Conspiracy of Silence”

Every year thousands of Canadians are killed or injured because of medical mistakes. Plaintiffs, however, face several challenges to suing doctors successfully for malpractice. One challenge is the reluctance of some doctors to criticize other medical professionals, sometimes referred to as the “conspiracy of silence.” This article focuses on the attention given to the conspiracy of silence in Ontario in the 1960s when Dr. Morton Shulman, the pugnacious and flamboyant Chief Coroner of Toronto, alleged that doctors routinely covered up medical errors. Shulman drew media attention to irresponsible doctors, poor practice, and negligent treatment. He demanded more accountability and better care, and deplored efforts to silence him to protect the reputation of doctors. A decline in public trust of experts and of the professions created conditions that lent credence to Shulman’s claims. However, many medical professionals chafed at the questioning of their professionalism, expertise, and ethics. The provincial government’s responses, which included coroner system reforms, expanding the powers of the Ontario College of Physicians and Surgeons, and attempting to silence Shulman, primarily aimed to meet the concerns of the state and medical professionals, rather than those of patients and the public.

#Caremongering: A community-led social movement to address health and social needs during COVID-19.

To combat social distancing and stay-at-home restrictions due to COVID-19, Canadian communities began a Facebook social media movement, #Caremongering, to support vulnerable individuals in their communities. Little research has examined the spread and use of #Caremongering to address community health and social needs. We examined the rate at which #Caremongering grew across Canada, the main ways the groups were used, and differences in use by membership size and activity. We searched Facebook Groups using the term "Caremongering" combined with the names of the largest population centres in every province and territory in Canada. We extracted available Facebook analytics on all the groups found, restricted to public groups that operated in English. We further conducted a content analysis of themes from postings in 30 groups using purposive sampling. Posted content was qualitatively analyzed to determine consistent themes across the groups and between those with smaller and larger member numbers. The search of Facebook groups across 185 cities yielded 130 unique groups, including groups from all 13 provinces and territories in Canada. Total membership across all groups as of May 4, 2020 was 194,879. The vast majority were formed within days of the global pandemic announcement, two months prior. There were four major themes identified: personal protective equipment, offer, need, and information. Few differences were found between how large and small groups were being used. The #Caremongering Facebook groups spread across the entire nation in a matter of days, engaging hundreds of thousands of Canadians. Social media appears to be a useful tool for spreading community-led solutions to address health and social needs.

Conscientious refusal to provide medically assisted dying

Medical assistance in dying (MAiD) became legal in Canada in June 2016. Since that time, many health-care practitioners and health-care institutions have undertaken to provide it, and thousands of Canadians have taken advantage of it. At the same time, a significant number of both practitioners and institutions have refused provision of MAiD for various reasons, including conscience-based objections to it. In this article, I argue that refusal by practitioners could, and should, be tolerated but only where it could be accommodated in practice groups without unduly burdening willing providers or adversely affecting patient access. My conclusion about refusal by institutions is less compromising. In this case, the cost to vulnerable patients of MAiD being delayed or denied is much greater and the burdens of conscience (if we may call them that) to institutions are insignificant. Since it cannot be accommodated without seriously impairing both patient access and patient well-being, refusal by publicly funded health-care institutions to offer MAiD must be completely disallowed.

Conscientious Refusal to Provide Medically-Assisted Dying

Medical assistance in dying (MAiD) became legal in Canada in June 2016. Since that time many health care practitioners and health care institutions have undertaken to provide it, and thousands of Canadians have taken advantage of it. At the same time, a significant number of both practitioners and institutions have refused provision of MAiD for various reasons, including conscience-based objections to it. In this paper I argue that refusal by practitioners could, and should, be tolerated where it could be accommodated without adversely affecting patient access, but not otherwise. My conclusion about refusal by institutions is less compromising. In this case the cost to vulnerable patients of MAiD being delayed or denied is much greater and the burdens of conscience (if we may call them that) to institutions are insignificant. Since it cannot be accommodated without seriously impairing both patient access and patient well-being, refusal by publicly-funded health care institutions to offer MAiD must be completely disallowed.

Guidance for management of cancer surgery during the COVID-19 pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, delaying lifesaving cancer surgeries must be done with extreme caution and thoughtfulness. Modelling indicates that delays in high-risk cancer surgeries beyond 6 weeks could affect long-term outcomes for thousands of Canadians. Consequently, it is possible that postponing cancer surgery without consideration of its implications could cost more lives than can be saved by diverting all surgical resources to COVID-19. This article provides general guidance on supporting curative surgical treatment where appropriate and with available resources.

Suspension, not expungement: Rationalizing misguided policy decisions around cannabis amnesty in Canada

AbstractHundreds of thousands of Canadians continue to carry the burden of convictions for minor possession of cannabis obtained prior to legalization. Despite support for an automatic expungement process to eliminate the collateral consequences of punishment, the Trudeau government opted for a less favourable policy instrument – record suspensions. Drawing from parliamentary debate and committee hearings, the author summarizes the discussion and debate on Bill C‐93 and analyzes this misguided decision using Miljan’s work on policy instrument choice and rationality. The emphasis on bureaucratic rationality specifically resulted in a maintenance of the status quo when it comes to criminal justice policy and an uninspiring approach to cannabis amnesty in Canada.

P14. Abstract Title: Modulating Fibrinolysis using siRNA against Coagulation Factor XIII

High specificity, easy reversibility, and a half-life on the order of weeks; these are all major advantages that gene therapy has over traditional anticoagulants, add to that a strategy that weakens clots rather than preventing clotting altogether and prophylaxis of thrombosis may become much safer. Currently, anticoagulant drugs are used as a preventative measure for people susceptible to developing disease causing thrombi (which manifest as heart attacks, strokes, and pulmonary embolism), but they require frequent administration and their strict inhibition of clotting increases the risk of uncontrolled bleeding. They are the top drug class to be linked with related adverse events. This project will develop a safer alternative to prevent dangerous blood clots from forming, while avoiding the bleeding risks of current treatment options. siRNA delivered using lipid nanoparticles has been recently approved as a therapeutic; we aim to harness this strategy to target a protein that makes clots resistant to lysis, coagulation factor XIII. The objective being to still allow clots to form at the site of wounds, but enabling the body's clot clearance system to do so much easier in the case of pathological thrombi. In the event of an accident or major surgery, the effect of siRNA may be directly reversed by a simple blood transfusion. By inhibiting clot stabilizing proteins, we aim to maintain a safer hemostatic balance between clot formation, inhibition, and degradation, which we hope could improve the medical options available to the thousands of Canadians that suffer from conditions caused by thromboembolic clots each year.

Primary care management of concussion in Canada.

Concussion has emerged as an important public health issue affecting thousands of Canadians annually. Health care providers including paediatricians, family and emergency medicine physicians, nurses, and nurse practitioners are commonly tasked with the responsibility of providing primary care to patients with acute concussion and those with persistent post-concussion symptoms. In July 2017, Parachute, in collaboration with the Public Health Agency of Canada and Sport Canada released the Canadian Guideline on Concussion in Sport that outlines a standardized and evidence-based approach to the recognition, diagnosis, and management of youth and adults with suspected concussion. In this report, we provide a brief overview of the important roles of primary care providers in the medical assessment, management, and prevention of concussion as outlined in this national best practice guideline.

Association Between Socio-Demographic and Health Functioning Variables Among Patients with Opioid Use Disorder Introduced by Prescription: A Prospective Cohort Study

Background: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada’s opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. Objectives: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes. Study Design: This was an observational, prospective cohort study. Setting: The study took place in 19 Canadian Addiction Treatment Centres across Ontario. Methods: We included a total of 976 participants who were diagnosed with Opioid Use Disorder and currently receiving methadone maintenance treatment. We excluded participants who were on any other type of prescription opioid or who were missing their 6-month follow-up urine screens. We measured the participants’ initial source of introduction to opioids along with other variables using the Maudsley Addiction Profile. We also measured illicit opioid use using urine screens at baseline and at 6-months follow-up. Results: Almost half the sample (n = 469) were initiated to opioids via prescription. Women were more likely to be initiated to opioids via a prescription (OR = 1.385, 95% CI 1.027-1.866, P = .033). Those initiated via prescription were also more likely to have post-secondary education, older age of onset of opioid use, less likely to have hepatitis C and less likely to have use cannabis. Chronic pain was significantly associated with initiation to opioids through prescription (OR = 2.720, 95% CI 1.998-3.722, P < .0001). Analyses by gender revealed that men initiated by prescription were less likely to have liver disease and less likely to use cannabis, while women initiated by prescription had a higher methadone dose. Limitations: This project was limited by its study design being observational in nature; no causal relationships can be inferred. Also, the data did not allow determination of the role that the prescribed opioids played in developing opioid use disorder. Conclusions: Our results have revealed that almost half of this methadone maintenance treatment (MMT) population has been introduced to opioids through a prescription. Given that the increasing prescribing rates of opioids has an impact on this at-risk population, alternative treatments for pain should be considered to help decrease this opioid epidemic in Canada. Key words: Opioid use disorder, chronic pain relief, methadone maintenance treatment, prescriptions, male, female

Gender and Peacekeeping

A major challenge for contemporary military policy makers has been the integration of gender into policy. Since 2000, Canada has opened all military roles (including combat and naval ones) to women. This includes Canadian participation in peacekeeping operations (PKO), an essential part of the national identity. From Lester B. Pearson’s work with the United Nations during the Suez crisis to missions in Haiti, Cyprus and Bosnia, Canada has been a part of multilateral operations to support peaceful resolution of conflicts throughout the 20th and 21st centuries. Tens of thousands of Canadians have served in over 40 peacekeeping and peace support operations since the 1960s (Veterans Affairs Canada, 2011, 2012). Despite the freedom to participate, women still constitute a significant minority of Canadian and UN peacekeeping forces. Yet, the nature of PKO and the roles Canadians play today has changed significantly since the end of the Cold War. The impact of armed conflict on women has dramatically increased and the violation of women’s rights has become a focal point in most modern conflicts. Due to the changes in conflicts and the role of a peacekeeper, the integration of gender into all aspects of peacekeeping operations would significantly increase their operational effectiveness. I will begin by explaining the types of modern peacekeeping operations, defining the concept of gender and discussing how operational effectiveness of peacekeeping is measured. Utilizing this definition of operational effectiveness, this presentation will explore how the inclusion of gender will increase operational effectiveness from two perspectives – that of the peacekeeper and that of the victim.

Finding Your Way – A Breakout Session and Discussion about Wayfinding, Design and Learning from Those with Vision Loss ( breakout presentation )

Background Our presentation will raise awareness of what life is like for the thousands of Canadians who live with vision loss. We will discuss the basic concepts of wayfinding and universal accessibility, and how these notions relate to partially sighted individuals. Urban Systems has partnered with the Canadian National Institute for the Blind (CNIB) for this presentation to promote awareness and share the experience of the blind and partially sighted as they find their way through public and private infrastructure. Description of Program Urban Systems will discuss how ideas of wayfinding and accessibility influence our work as Landscape Architects, Environmental Designers and Urban Planners, and share local examples from environments that we design and encounter on a daily basis. We see the potential to explore concepts of wayfinding as a tool to navigate our pedestrian environment and how it can be adapted and designed to serve a broader community regardless of adversity. CNIB will discuss different levels of visual impairment and how the built environment affects the blind and partially sighted. To those with vision loss, walking can be equated with freedom. An Orientation and Mobility instructor from CNIB will discuss some of the issues and concerns that visually impaired people experience as they navigate through the built environment, as well as models to increase access. Outcomes Urban Systems and CNIB will share specific examples of everyday design elements that pose challenges and opportunities for those with vision loss. We will discuss how simple design changes or products can improve these challenges. Our team will also share examples where designers and CNIB have collaborated on inclusive projects, such as the CNIB Scent Garden, and the CNIB Sensory Playground. Our breakout session will conclude with a discussion to explore successful elements, lessons learned and potential considerations for the future to make the public realm and wayfinding elements accessible, diverse and useful to the communities they serve. Implications Through a shared discussion of experiences, participants will learn and converse. The intent is that all will leave with an awareness of how design decisions related to wayfinding and accessibility within the pedestrian environment affect people of all abilities and mobilities.

Legal Mechanisms to Improve Quality of Care in Canadian Hospitals

Tens of thousands of Canadians die each year as a result of preventable injuries sustained in hospitals. The patient safety literature suggests that we must implement systems and processes designed to prevent errors, rather than focusing on the mistakes of individual health professionals. Although the law tends to reinforce the provider-centric approach to errors, several law reforms have the potential to catalyze a systems-centric approach that finds support in the patient safety literature: shifting some liability from physicians to hospitals, reforming hospital governance practices, and reconsidering the legal relationship between physicians and hospitals.

A descriptive analysis of the spatio-temporal distribution of enteric diseases in New Brunswick, Canada.

BackgroundEnteric diseases affect thousands of Canadians annually and several large outbreaks have occurred due to infection with enteric pathogens. The objectives of this study were to describe the spatial and temporal distributions of reportable Campylobacter, Escherichia coli, Giardia, Salmonella and Shigella from 1994 to 2002 in New Brunswick, Canada. By examining the spatial and temporal distributions of disease incidence, hypotheses as to potential disease risk factors were formulated.MethodsTime series plots of monthly disease incidence were examined for seasonal and secular trends. Seasonality of disease incidence was evaluated using the temporal scan statistic and seasonal–trend loess (STL) decomposition methods. Secular trends were evaluated using negative binomial regression modeling. The spatial distribution of disease incidence was examined using maps of empirical Bayes smoothed estimates of disease incidence. Spatial clustering was examined by multiple methods, which included Moran’s I and the spatial scan statistic.ResultsThe peak incidence of Giardia infections occurred in the spring months. Salmonella incidence exhibited two peaks, one small peak in the spring and a main peak in the summer. Campylobacter and Escherichia coli O157 disease incidence peaked in the summer months. Moran’s I indicated that there was significant positive spatial autocorrelation for the incidence of Campylobacter, Giardia and Salmonella. The spatial scan statistic identified clusters of high disease incidence in the northern areas of the province for Campylobacter, Giardia and Salmonella infections. The incidence of Escherichia coli infections clustered in the south-east and north-east areas of the province, based on the spatial scan statistic results. Shigella infections had the lowest incidence rate and no discernable spatial or temporal patterns were observed.ConclusionsBy using several different spatial and temporal methods a robust picture of the spatial and temporal distributions of enteric disease in New Brunswick was produced. Disease incidence for several reportable enteric pathogens displayed significant geographic clustering indicating that a spatially distributed risk factor may be contributing to disease incidence. Temporal analysis indicated peaks in disease incidence, including previously un-reported peaks.

The Paradoxical Situation of Blood Donation in the Haitian-Quebec Community

Blood donation involves precise regulations aiming to protect donors and recipients. At the beginning of the 1980’s, thousands of Canadians were infected with HIV and Hepatitis C. To prevent the contamination of blood products, health authorities asked Haitians, among other groups, to voluntarily refrain from giving blood. Witness testimonies at the Royal Commission of Inquiry on the Blood System in Canada (Krever Commission) show how profoundly affected Haitians were by these events. Today, we know that it is preferable to use phenotyped blood from the same community as the donor in the case of certain diseases. Increasing blood donation from the Black community is believed to be the best way to find donors who will be compatible with patients suffering from sickle-cell disease. Blood supply agencies such as Héma-Québec are seeking to convince Haitians to give blood in greater numbers. However, this task represents a great challenge, since, less than one generation ago, authorities asked that Haitians voluntarily abstain from donating blood. This paradoxical situation inspired the present analysis. Through the conceptual lens of a constructivist approach to ethnicity, this case study draws on a number of sources. By retracing the history of this community and the major events that have affected it over the decades, we are brought to a better understanding of the perceptions and realities of the Haitian community in Montreal with regard to blood donation. Our analyses show that even if Haitian-Quebec leaders are positively disposed towards blood donation, our results also expose that past events of the 1980’s have not been forgotten. Even if many are now willing to give blood to meet specific medical needs, for some, this could also contradict the usual universalist and altruistic message of blood donation. This case study highlights the importance of examining what happens at the relational boundary between minority and majority groups: after all, these events also contribute to redefining them. Le don de sang au Québec est encadré par des règles définies pour protéger les donneurs et ceux qui doivent subir une transfusion sanguine. Au début des années 1980, des milliers de Canadiens seront infectés par le VIH et l’Hépatite C. Pour prévenir la contamination des produits sanguins, les autorités sanitaires ont invité certains groupes, dont les Haïtiens, à s’abstenir volontairement de donner du sang. Les témoignages à la Commission d’enquête sur l’approvisionnement en sang au Canada (Commission Krever) ont montré à quel point les Haïtiens-Québécois en ont été affectés. Aujourd’hui, on sait qu’il est préférable d’utiliser le sang phénotypé qui provient de la même communauté que le donneur dans le cas de certaines maladies. Par exemple, l’augmentation de dons de sang de la communauté noire serait la meilleure façon de trouver des donneurs compatibles avec les patients atteints d’anémie falciforme. Convaincre les Haïtiens de donner du sang en plus grand nombre semble pourtant un véritable défi du fait qu’il y a à peine une génération, les autorités responsables ne voulaient pas de leur sang. C’est cette situation paradoxale qui a inspiré la présente analyse. À partir d’une approche constructiviste de l’ethnicité, cette étude de cas fait appel à de nombreuses sources afin de faire le point sur le rapport de la communauté haïtienne du Québec au don de sang, en reprenant le fil de l’histoire de cette communauté. Même si les leaders de la communauté haïtienne québécoise sont maintenant plutôt favorables au don de sang et qu’Héma-Québec a fait de nombreux efforts pour recruter des donneurs au sein de cette communauté, nos analyses montrent que la mémoire des événements difficiles vécus dans les années 1980 n’a pas complètement été effacée. De plus, même si plusieurs peuvent être motivés à donner du sang pour répondre aux besoins médicaux de la communauté, pour certains, ceci peut aussi aller à l’encontre du message universaliste du don de sang. Cette étude de cas montre l’importance de s’intéresser aux événements qui affectent ce qui se passe à la frontière des relations entre minorités et majorité et contribuent ainsi à les redéfinir.

EFFECT OF NICORANDIL IN PATIENTS WITH REFRACTORY ANGINA AND ADVANCED CORONARY ARTERY DISEASE

Refractory angina (RFA) is a chronic morbid condition hampering the quality of life of thousands of Canadians and effective therapies are desperately needed. Nicorandil is a nicotinamide vasodilator with cardioprotective effects that has been shown to improve cardiac outcomes in patients with stable coronary artery disease (CAD). Nicorandil has never been studied in patients with refractory angina. We investigated the safety and efficacy of nicorandil in patients with advanced coronary artery disease unsuitable for revascularization and persistent angina (CCS Class II to IV) despite maximal tolerable doses of two anti-angina agents, and compared it with similar control patients not exposed to nicorandil. Consecutive patients were selected from our RFA clinic from August 2009 to August 2013 and followed-up for at least 6 months. Nicorandil was available via the Health Canada’s special access program, and a pharmacist dedicated to the program monitored observance to nicorandil and the occurrence of drug-related adverse effects. We assessed the association between nicorandil and cardiovascular outcomes (1st endpoint) and CCS angina class (2nd endpoint) in patients with RFA. Forty patients treated with maximum orally tolerated dose of Nicorandil (up to 30 mg three times daily) were compared to 38 control patients (total n = 78). Baseline characteristics and cardiovascular status were similar in both groups as shown in Table 1. Over a median follow-up of 15 months, fewer patients treated with nicorandil experienced the combined occurrence of death or heart transplant + acute coronary syndrome + coronary revascularization + hospitalization rates at 1-year for angina compared to control patients (37.5% vs. 71.1%, p < 0.05). Nicorandil was associated with a significant improvement in the functional status, as shown in the figure.View Large Image Figure ViewerDownload (PPT) In patients with advanced coronary artery disease and RFA, Nicorandil is associated with both a reduction on cardiovascular events and improvement in functional class.

Reducing the public health risk of Escherichia coli O157 exposure by immunization of cattle.

The One Health approach investigates the complexities surrounding the interplay between the animal, human and environmental domains. Zoonotic pathogens, such as Escherichia coli (E. coli) O157, which have animal reservoirs, also have direct impact on public health. Cattle are the primary reservoir of E. coli O157, however infection with this bacterium is asymptomatic. Infected cattle appear healthy and have normal growth rates and milk production abilities. Each year, thousands of Canadians become ill following exposure to E. coli O157. To reduce this public health risk, immunization of cattle would be an effective intervention. Several models have shown that on-farm pathogen reduction programs would significantly reduce the risk of human illness.

Palliative care training substandard

Most of the hundreds of thousands of Canadians who die each year from natural causes spend their final days under the care of family doctors and nurses. Many experts in end-of-life care question whether these caregivers have the skills necessary to ensure dying patients meet peaceful ends, and are