Toronto Region Research Articles

Do new urban and suburban cycling facilities encourage more bicycling?

• Bicycling rates increased across study sites regardless of the presence of a cycling facility. • A new cycling facility increased the odds of bicycling more on the street. • New facilities were associated with increased commute-related bicycling only for regular cyclists. • Mode-substitution was more likely near a new cycle track vs. a painted bicycle lane. • Urban vs. suburban location was associated with more cycling on street, but not with mode substitution. Cycling facilities have become a widely used sustainable transportation policy tool, but their impacts on reduced car dependence are difficult to isolate. This paper presents the findings from a household survey conducted in 17 neighbourhoods in the Toronto region, Canada, some with a recently built cycling facility and some without. Results indicate higher odds of increased commute-related bicycling on streets with a new cycling facility. People who were already commuting by bicycle at least once a week are likely to bicycle more frequently after new facilities are built. Bicycling uptake is more obvious in neighbourhhods with a new cycle track, while changes relating to bicycle lanes were not statistically different from neighbourhoods without a facility. All else being equal, urban cycling facilities were associated with higher odds of increased commute-related bicycling, compared to suburban locations. Findings offer insights into expected outcomes of bicycle network expansion policy/projects.

Housing challenges, mid-sized cities and the COVID-19 pandemic

This article examines key housing challenges in mid-sized cities during the COVID-19 pandemic. Two questions guide our critical reflection: understanding to what extent the pandemic represents new challenges and what planners can do to respond to them? We use the example of the Region of Waterloo, situated 100km west of Toronto and one of Canada’s fastest growing urban areas. Waterloo has many similar characteristics to other mid-sized cities within commuting distance of large urban regions. In this article, we focus on two of the biggest (and inter-related) housing issues: inward migration from the Toronto Region and growing unaffordability. Both these challenges long-predate the COVID-19 pandemic, but there are early indicators that they are accelerating because of it. By rooting the challenges of the pandemic within longer trends and trajectories, our critical reflection suggests that many solutions that have long been understood to address housing inequalities are still important during the pandemic. Rather than devising new solutions, we argue that the pandemic requires implementing ideas called upon for years by researchers and advocates and more proactive planning to address market deficiencies.

Using a web-based multilingual platform to support elementary refugee students in mathematics

ABSTRACT This exploratory study reports on the implementation of a novel web-based multilingual learning platform. This tool allows content to be delivered in different languages simultaneously, including languages of the students. In addition, it creates access to content knowledge aligned to the local curriculum, and in doing so, responds to an emerging need of both teachers and learners, in particular in light of an increasing linguistically and culturally diverse context. Our pilot research aimed to examine implementation elements and the perceived potential impact of the platform in mathematics. We conducted our study in an elementary school in the region of Toronto, Canada, attended by a significant number of students with a refugee background. A language biographical approach allowed us to highlight the role of the multilingual access to content knowledge, particularly on learning autonomy. Our results suggest that the use of this multilingual web-based platform may stimulate the learning autonomy of students and a positive attitude towards maths. In addition, our results suggest that additional strategies may be needed to improve the teachers’ ability to implement digital as well as language friendly strategies in their classrooms.

Design Study of Steel Fibre Reinforced Concrete Shaft Lining for Swelling Ground in Toronto, Canada

Reinforced concrete (RC) is a widely used construction material around the world. RC has many advantages in terms of structural stability. However, the reinforcement of RC requires extensive labour costs. Steel fibre reinforced concrete (SFRC) has been widely studied to replace steel bars in concrete structures over the decades. However, most underground structures, such as tunnel lining, are usually designed using conventional RC for long-term stability due to unexpected geotechnical characteristics, such as directional and depth-dependent varied lateral pressure, earthquakes, groundwater, and time-dependent swelling behaviour. In this paper, an alternative design of shaft structure using SFRC, based on the original RC designed data in the Toronto region, was studied to evaluate the feasibility of SFRC replacing conventional RC. A key geological feature of the site is that the bedrock is comprised of Georgian Bay shale, which exhibits long-term time-dependent deformation (TDD). The capacities of RC and SFRC for the shaft lining were calculated based on the Canadian concrete design codes CSA A23.3 and RILEM TC 162-TDF, to assess the benefit of adding steel fibre, and several analytical solutions were used to calculate the applied load on the lining. A specialised TDD constitutive model in Fast Lagrangian Analysis of Continua (FLAC) 2D was developed to estimate whether the optimum installation time of the shaft lining, based on the geological reports, is appropriate under swelling behaviour, and evaluate the resultant long-term stability. The calculated hoop thrust and bending moment for several loading cases were within the capacity of the SFRC shaft lining. The numerical analysis demonstrated that the proposed lining installation time could be reduced, despite consideration of the long-term TDD behaviour.

The list of vascular plants for the city of Toronto

Abstract1. Urban areas have become epicentres for applied ecological and conservation research and policy. Yet, most urban areas have surprisingly little consolidated information about their biota, including species‐at‐risk and invasive species.2. I used multiple data sources to compile a list of vascular plants for the greater metropolitan Toronto region. This data not only includes taxonomic information but also global and national status ranks, growth from, native status, threatened status, abundance estimates and year of first observation for non‐indigenous species.3. The list includes 1937 taxa from 146 families, of which 822 are non‐indigenous. The majority of native species were ranked as abundant and widespread both globally and provincially. However, non‐indigenous species ranks were bimodal, likely to be either extremely restricted in the province, or very widespread.4. This database provides a robust list of plant taxa in Canada's largest city. It will inform global urban ecology analyses and local and regional management and policy.

295. Is Herd Immunity from Pneumococcal Conjugate Vaccines Changing the Clinical Features of Invasive Pneumococcal Disease in Adults?

BackgroundNumerous factors that affect the presentation and severity of pneumococcal disease. Several studies in the pre-PCV era demonstrated that organism characteristics, including serotype, are associated with variability in disease presentation and severity. We undertook an analysis of population based surveillance for invasive pneumococcal disease (IPD) to assess whether herd immunity from PCVs will change the presentation and severity of IPD in adultsMethodsTIBDN has performed population-based surveillance for IPD in Toronto and Peel region (pop’n 4.5M) since 1995. All sterile site isolates of S. pneumoniae are reported to a central study laboratory, isolates are serotyped, and clinical and vaccination data are collected via patient and physician interview and chart review. Population data are obtained from Statistics Canada. Backwards stepwise logistic regression assessed patient characteristics, illness features, and isolate factors associated with clinical presentation and case fatality.ResultsBetween 1995 and 2018, 8815 episodes of IPD were identified in adults. Patients infected with PCV10not7 serotypes were younger, more likely male and without underlying illness. Patients with infections due to non-vaccine types were more likely to be immunocompromised. Case fatality in IPD declined from 177/754 in 1995/6 to 113/554 in 2017/8; OR 0.67, 95%CI0.51-0.86, P< .0001) and in all serotype groups (Figure). In multivariable models adjusted for host factors, relative to infections caused PCV7 serotypes, those caused by PCV10not7 were less likely to be fatal (OR 0.65, 95%CI 0.46–0.91); those caused by PCV13not10 were more likely to be fatal (OR 1.6, 95%CI 1.3–1.9). Bacteremic pneumonia as a proportion of presentations is highest in IPD due to PCV10not7 and PCV13not10 serotypes (85% and 83%, respectively), and lowest in IPD due to non-vaccine serotypes and PCV20not15 (59% and 68%, P< .0001). Meningitis is least common in IPD due to PCV10not7 serotypes (2.6%), and highest in cases due to non-vaccine types and PCV20not15 (9.0% and 8.0%, respectively, P< .0001).FIgure ConclusionIn our population, herd immunity from PCVs will result in a higher proportion of adult IPD occurring in immunocompromised cases, and a shift from bacteremic pneumonia to bacteremia without focus and meningitis.Disclosures Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)

Suburbanization of Transport Poverty

Many cities have undergone spatial redistributions of low-income populations from central to suburban neighborhoods over the past several decades. A potential negative impact of these trends is that low-income populations are concentrating in more automobile-oriented areas, resulting in increased barriers to daily travel and activity participation, particularly for those who are unable to afford a private vehicle. Accordingly, the objective of this article is to analyze the links between increasing sociospatial inequalities, transport disadvantage, and adverse travel behavior outcomes. This is examined first from a theoretical perspective and second via a spatiotemporal analysis for the Toronto region from 1991 to 2016. Findings show that many suburban areas in Toronto are not only declining in socioeconomic status but are also suffering from increased barriers to daily travel evidenced by longer commute times and decreasing activity participation rates, relative to central neighborhoods. Because of these adverse effects, this evidence further supports the need for progressive planning and policy aimed at curbing continuing trends of suburbanization of poverty while also improving levels of transport accessibility in the suburbs.

Spatial and space-time clustering and demographic characteristics of human nontyphoidal Salmonella infections with major serotypes in Toronto, Canada.

Nontyphoidal Salmonella enterica (NTS) causes a substantial health burden to human populations in Canada and worldwide. Exposure sources and demographic factors vary by location and can therefore have a major impact on salmonellosis clustering. We evaluated major NTS serotypes: S. Enteritidis (n = 620), S. Typhimurium (n = 150), S. Thompson (n = 138), and S. Heidelberg (n = 136) reported in the city of Toronto, Canada, between January 1, 2015, and December 31, 2017. Cases were analyzed at the forward sortation area (FSA)—level (an area indicated by the first three characters of the postal code). Serotype-specific global and local clustering of infections were evaluated using the Moran's I method. Spatial and space-time clusters were investigated using Poisson and multinomial scan statistic models. Case-case analyses using a multinomial logistic regression model was conducted to compare seasonal and demographic factors among the different serotypes. High infection rate FSAs clustered in the central region of Toronto for S. Enteritidis, in the south-central region for S. Typhimurium, in north-west region for S. Thompson, and in the south-east region for S. Heidelberg. The relative risk ratio of S. Enteritidis infections was significantly higher in cases who reported travel outside of Ontario. The relative risk ratio of infections was significantly higher in summer for S. Typhimurium, and in fall for S. Thompson. The relative risk ratio of infection was highest for the 0–9 age group for S. Typhimurium, and the 20–39 age group for S. Heidelberg. Our study will aid public health stakeholders in designing serotype-specific geographically targeted disease prevention programs.

Healthcare costs and resource utilization associated with treatment of out-of-hospital cardiac arrest

BackgroundThe management of out-of-hospital cardiac arrest (OHCA) patients requires the coordination of prehospital, in-hospital and post-discharge teams. Data reporting a comprehensive analysis of all costs associated with treating OHCA are scarce. We aimed to describe the total costs (and their components) related to the management of OHCA patients. Patient and methodsWe performed an analysis on a merged database of the Toronto Regional RescuNet Epistry database (prehospital data) and administrative population-based databases in Ontario. All non-traumatic OHCA patients over 18 years of age treated by the EMS between January 1, 2006, and March 31, 2014, were included in this study. The primary outcome was per patient longitudinal cumulative healthcare costs, from time of collapse to a maximum follow-up until death or 30 days after the event. We included all available cost sectors, from the perspective of the health system payer. We used multivariable generalized linear models with a logarithmic link and a gamma distribution to determine predictors of healthcare costs. Results25,826/44,637 patients were treated by EMS services for an OHCA (mostly male 64.4%, mean age 70.1). 11,727 (45%) were pronounced dead on scene, 8359 (32%) died in the emergency department, 3640 (14%) were admitted to hospital but died before day-30, and 2100 (8.1%) were still alive at day-30.Total cost was $690 [interquartile range (IQR) $308, $1742] per patient; ranging from $290 [IQR $188, $390] for patients who were pronounced on scene to $39,216 [IQR 21,802, 62,093] for patients who were still alive at day-30. In-hospital costs accounted for 93% of total costs. After adjustment for age and gender, rate of patient survival was the main driver of total costs: the rate ratio was 3.88 (95% confidence interval 3.80, 3.95), 49.46 and 148.89 for patients who died in the ED, patients who died after the ED but within 30 days, and patients who were still alive at day-30 compared to patients who were pronounced dead on scene, respectively.Factors independently associated with costs were the number of prehospital teams (rate ratio (RR) 5.50 [5.32, 5.67] for being treated by 4 teams vs. 1), the need for hospital transfer (RR 2.38 [2.01, 2.82]), coronary angiography (RR 1.43 [1.27, 1.62]) and targeted temperature management (RR 1.25 [1.09, 1.44]). ConclusionSurvival is the main driver of total costs of treating OHCA patients in a large Canadian health system. Inpatient costs accounted for the majority of the total costs; potentially modifiable factors include the number of prehospital teams that arrive to the scene of the arrest and the need for between-hospital transfers after successful resuscitation.

501. Risk of Infection in Persons Colonized with Carbapenemase-Producing Enterobacteriales (CPE) in Ontario, Canada

BackgroundWe aimed to assess the risk of subsequent infection among patients colonized by CPE.MethodsThe Toronto Invasive Bacterial Diseases Network (TIBDN) has conducted population-based surveillance for CPE colonization/infection in Toronto and Peel region, Ontario, Canada, since CPE were first identified (2007). All laboratories report all CPE isolates to TIBDN. Clinical data are collected via patient interview and hospital chart review. Initially colonized patients are followed for 5y; subsequent CPE infection is defined as an episode with onset >3 days after initial detection of CPE colonization that meets National Healthcare Safety Network criteria for infection with a clinical isolate of CPE.ResultsFrom 2007 to 2018, 790 persons with CPE colonization/infection were identified. Among 364 cases colonized at identification, 42 (12%) subsequently had at least one clinical isolate, and 23 (6%) had an infection: 8 with bacteremia (primary or secondary), 7 UTI, 5 pneumonia, and 3 other. The median time from identification of colonization to infection was 21 days (IQR 7–38), with a probability of developing an infection of 7% at 3 months, and 18% by 3 years (figure). In 305 cases with data available to date, older persons, those admitted to the ICU, and those with current/recent invasive medical devices were more likely to develop infection (table). Gender, underlying conditions and other procedures were not associated with risk of infection. There was a trend to infections being more likely in patients colonized with K. pneumoniae (52% vs. 35%, P = 0.13).ConclusionThe risk of subsequent infection in our cohort was 18%, with highest risk in the first 3 months; most infections occurred in patients requiring intensive care unit admission and invasive medical devices. Disclosures All authors: No reported disclosures.

An Integrated Kidney Care eConsult Practice Model: Results from the iKinect Project

Background: Collaborative management of kidney disease relies on coordinated and effective partnerships between multiple provider teams. Siloed care contributes to limited access between physicians, resulting in delays in the diagnosis and treatment of kidney disease and inappropriate use of healthcare resources. These gaps contribute to dissatisfied and disempowered providers and patients. Digital systems such as eConsult can support collaborative management and address these gaps, thereby streamlining the consultation and referral process between primary care physicians (PCPs) and nephrologists. In this study, we evaluated an established eConsult platform integrated with a central triage process for a network of PCPs and nephrologists. The study aimed to assess the acceptability, feasibility, and impact on access to nephrology when using eConsult integrated into the management of kidney disease between PCPs and nephrologists. Methods: We conducted a 1-year pilot study and used mixed methods to measure the acceptability and feasibility of using eConsult for the management of kidney disease. We compared eConsult and traditional referrals with respect to types of consultation, referrals, and times to response to determine impact on access to kidney care. We conducted semi-structured interviews of PCPs and nephrologists to assess physician experience. Results: From January 8, 2018, to January 11, 2019, 52 PCPs and 23 nephrologists participated in the study, with 250 traditional referrals and 106 eConsults submitted during that period. The median response time for eConsult was 15 (3–64) h, with 25% originating outside the central Toronto region. The median time to first clinic appointment from a traditional referral was 4 months (111 [61–163] days). PCP and nephrologist interviews revealed high user satisfaction, citing efficiency and timely response as key facilitators. Conclusion: The eConsult platform was acceptable, feasible, and facilitated access to nephrology care compared to traditional referrals. Physicians report improvements in physician care delivery, nephrology care gaps, patient experience, and healthcare utilization.

Mapping civil society: the ecology of actors in the Toronto region greenbelt

ABSTRACTCivil society’s potential as a force for solving complex societal problems – particularly those that require a challenge to the status quo – has provoked practical and theoretical interest, with its potential largely reliant on the perception that it is a ready if variable source of social capital resources. However, there are no guarantees that civil society will use its social capital for the greater good. Civil society encompasses a range of groups, some more inward-looking and oriented to private interests, and others more outward-looking and oriented to public interests. This divergent character of civil society was evident in the three campaigns for greenspace protection that eventually led to the creation of the Toronto region greenbelt, where civil society organisations (CSOs) from both growth and conservation camps contended for influence, each succeeding at different times. But over time (a time when state actors were increasingly in need of non-state partners to help solve complex governance problems), coalitions of environmental CSOs in the three campaigns – to protect the Niagara Escarpment, Oak Ridges Moraine and surrounding countryside – became more effective at influencing government to protect greenspace. A comparison of the coalitions using a framework based on key attributes of CSOs – missions and memberships – suggests that the environmental coalitions were more effective when they recruited more members with a diverse set of resources arising from both bonding and bridging social capital. In general, the more inclusive and public-interested the CSOs, the more effective the challenge to the status quo.

Land developers as institutional and postpolitical actors: Sites of power in land use policy and planning

Land developers play an active role as institutional actors that shape the development and governance of urban regions. In this paper, we find that developers not only influence state institutions governing land use, they are place-based actors whose influence is normalized as invited strategic stakeholders in planning exercises. Our analysis highlights the complementarity of institutional and postpolitical theories in offering a nuanced understanding of the multi-faceted and multi-scalar relationships among powerful actors engaged in land development processes. Postpolitical theories highlight the participatory processes of inclusion and exclusion in collaborative-based planning exercises that privilege certain stakeholders and exclude others. Through the lens of institutionalist theory, we move beyond specific land conflicts to focus on the day-to-day interactions and institutionalized roles of key actors, ideas and political influences in shaping contested land policy and outcomes. The analysis is based on multi-year research projects that drew upon interviews, observation and document analysis of key actors’ engagement in initiatives to formulate and implement growth management policies in the Toronto region.

Biking the First Mile: Exploring a Cyclist Typology and Potential for Cycling to Transit Stations by Suburban Commuters

Regional commuter rail has become an important means of traveling to urban employment centers across North America, but planners are faced with the challenge of connecting commuters from their origin or destination locations to a train station. Cycling may be an efficient and low-cost way of taking these transit-access trips. However, cycling behavior of rail commuters, particularly in a suburban context, remains understudied. This research examined perceptions of cycling and current cycling behavior of 257 transit users from three suburban commuter rail stations in the Toronto region, Canada. Using a cluster analysis approach, four distinct cyclist types were identified, namely: recreational cyclists (29%), all-purpose cyclists (10%), safety-conscious occasional cyclists (33%), and facility-demanding occasional cyclists (28%). Differences between these groups included different mode-choice motivations, tolerance for adverse weather conditions, comfort bicycling in various hypothetical traffic/infrastructure conditions, and current frequency of cycling for transportation and recreational purposes. The safety-conscious group included a higher percentage of women compared to other groups. Overall, 32.5% of regional transit users would be interested in cycling more often to rail stations. A higher proportion of recreational cyclists (compared to other groups) were “interested first-mile cyclists”, whereas the safety-conscious group had a significantly greater proportion of “uninterested” respondents. With careful planning of bicycle infrastructure and awareness campaigns targeting perceptions of cycling, there is much potential for cycling to accommodate a greater proportion of transit-access trips in suburban communities, reducing demand for automobile parking at transit stations.

Cartoforum – A Map-Based Discussion Forum with Applications in the Planning of Cycle Lanes, Community Food Gardens and Campus Sustainability

Map-based discussion forums can be used for crowdsourcing people’s ideas and opinions with respect to public planning processes. Their volunteered geographic information consists of text and other media that are linked to geographic features. Building on the concept of argumentation mapping, Cartoforum was developed using the Boundless geostack, an open-source geospatial software package. We present the software architecture and functionality along with three pilot studies covering cycle lane planning in Toronto, Canada; community garden site-selection in the Toronto region; and campus sustainability at the University of Kerala, India. Together, the pilot studies demonstrate the utility of argumentation mapping and illustrate the range of its potential applications in citizen participation.

1205. Emergence of Carbapenemase Producing Enterobacteriaceae in South Central Ontario, Canada

BackgroundThe spread of CPE is an increasing global threat to patient safety. We describe the introduction and evolution of CPE in south-central Ontario, Canada.MethodsThe Toronto Invasive Bacterial Diseases Network has performed population based surveillance for CPE in metropolitan Toronto and Peel region from first identified isolates in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for PCR testing for carbapenemases. Demographic and medical data and travel history are collected from chart review and patient/physician interview.ResultsSince 2007, 659 patients have been identified as colonized/infected with CPE; 362, 57%) have at least one clinical isolate. Annual incidence has increased from 0 in 2006 to 1.3 per 100,000 in 2016/17 (Figure 1). First bacteremia occurred in 2010, the incidence in 2017 was 0.14 per 100,000 population. 388 (59%) patients were male, median age was 70 years (range 3 months–100 years). Most common genes among first isolates were NDM (306, 46%), OX48 (149, 23%), KPC (122, 19%). Most common species were K. pneumoniae (268, 41%) and E. coli (259, 39%). Over time, second species/same gene were identified in 113 (16%) patients. In addition, 34/xxx patients with isolates with NDM and/or OXA-48 subsequently had a second isolate with a different gene/gene combination. Of 518 patients whose travel and hospitalization history are available, patients with VIM were less likely than other patients to have a foreign hospitalization or travel history (9/28 vs. 341/490, P < 0.0001). Patients with KPC were more likely to have a hospitalization history outside Canada and the Indian subcontinent (25/70, 36%), in Canada (47/164,29%) than to have no hospitalization in the last year (13/93, 14%), or a history of hospitalization in the Indian subcontinent (2/191, 1%) (P < 0.001). The number of incident patients with different hospitalization and travel history over time is shown in Figure 2.ConclusionCPE is increasingly recognized in southern Ontario, both in patients with a history of exposure in healthcare in other countries, and to healthcare in Canada. Intensification of control programs is urgently needed.Figure 1.Incidence of clinical isolates of CPE over time.Figure 2.Number of incident CPE cases with different hospitalization (H) and travel (T) history over time.Disclosures S. Poutanen, MERCK: Scientific Advisor, Speaker honorarium. COPAN: Speaker(but not part of a bureau), Travel reimbursement. Accelerate Diagnostics: Investigator, Research support. Bio-Rad: Investigator, Research support. bioMérieux: Investigator, Research support.

After Suburbia: research and action in the suburban century

ABSTRACT Reviled by most professionals and academics due to their ecological impact and problematic societal effects, suburbs are largely invisible in theoretical debates on the future of urbanism. Still, suburbanization continues unabated. Around the world, the spatial peripheries of cities are expanding fast and are buzzing with activities. Suburbanization is diversifiying in morphology, socioeconomic and demographic profile, and boundaries between cities and their peripheries are increasingly breaking down. Yet, as pervasive the suburban has become, it is under-researched and perhaps misunderstood. In this intervention, Iput forward lineaments of astrategy for research and action on suburbanization and suburban ways of life that may guide some of our work in future years. Using the suburban municipality of Brampton in the Toronto region, this paper looks ahead to identify ways in which research on suburbanization could be best placed in the mainstream of theoretical and conceptual debates in urban studies more generally.

Abstract 249: The Effect of Response Time on Out-Of-Hospital Cardiac Arrest Survival Varies by Patient Subpopulation

Itroduction: Previous research has quantified the impact of EMS response time on the probability of survival from OHCA, but the impact on different subpopulations is currently unknown. Aim: To investigate how response time affects OHCA survival for different patient subpopulations. Methods: We conducted a logistic regression analysis on non-EMS witnessed OHCAs of presumed cardiac etiology from the Toronto Regional RescuNet between January 1, 2007 and December 31, 2016. We predicted survival using age, sex, public location, presenting rhythm, bystander witnessed, bystander resuscitation, and response time, defined as the time interval from 911 call to EMS arrival at the patient. We conducted subgroup analyses to quantify the effect of response time on survival for eight different subpopulations: public, private, bystander resuscitation, no bystander resuscitation, patients ≥65, patients &lt;65, witnessed, and unwitnessed OHCA. We also quantified the effect of response time on survival for pairwise intersections of the subpopulations. We compared our results to Valenzuela et al. (1997), which suggests survival odds decrease by 10% for each minute delay in response time. Results: We identified 22,988 OHCAs. Overall, a one-minute delay in EMS response time was associated with a 13.2% reduction in the odds of survival. The reduction varied by subpopulation, ranging from a 7.2% reduction in survival odds for unwitnessed arrests to a 16.4% reduction in survival odds for arrests with bystander resuscitation. Response time had the largest impact on survival for the subpopulation of OHCAs that were both witnessed and received bystander resuscitation (17.4% reduction in survival odds). Conclusion: The effect of a one-minute delay in EMS response on the odds of survival from OHCA can be as low as a 7.2% reduction and as high as a 17.4% reduction. This variability contrasts with the currently accepted 10% rule that is assumed across the entire population.

Enduring Features of the North American Suburb: Built Form, Automobile Orientation, Suburban Culture and Political Mobilization

As any social phenomenon, the evolution of suburbs can be seen as at the confluence of two contradictory sets of forces. There are first forces of change, which propel suburbs in new directions. Much of the present literature on suburbs highlights suburban transitions in the form of social and economic diversification, and of new forms of development. The article attempts to rebalance the discourse on suburbs by emphasizing forces of durability. It does not deny the importance of observed suburban transitions, but argues that there is, at the heart of North American suburbs, an enduring automobility-induced transportation dynamic, which reverberates on most aspects of suburbs. The article explores the mechanisms undergirding suburban durability by linking the suburban transportation dynamic to the self-reproductive effects of a suburban lifestyle and culture and their political manifestations. These forces impede planning attempts to transform suburbs in ways that make them more environmentally sustainable. To empirically ground its argument, the article draws on two Toronto region case studies illustrating processes assuring the persistence of the durable features of North American suburbs: the layout of large suburban multifunctional centres and the themes raised by Rob Ford during his successful 2010 mayoralty electoral campaign.

Assessment of the degradation of aesthetics Beneficial Use Impairment in the Toronto and region Area of Concern

Toronto and Region was designated a Great Lakes Area of Concern in 1987 due to significant degradation of environmental quality and impaired beneficial uses, including Degradation of Aesthetics. Historically overflows of combined sewers, direct discharge of poorly treated industrial wastewater, contaminated storm water, and litter contributed to excessive floating debris, odour and unnatural turbidity along parts of the waterfront and in some sections of Area of Concern watersheds. Despite the perception of poor aesthetic quality of these waters, little to no monitoring was carried out to assess the Degradation of Aesthetics Beneficial Use Impairment due to the challenge of reporting aesthetics in a quantifiable, unbiased manner. Here we describe the qualitative monitoring program implemented in the Toronto region to assess the aesthetic condition of local watersheds. An Aesthetic Quality Index developed for use by Areas of Concern was adapted by taking advantage of existing monitoring programs and local expertise. Results of the assessment indicate that no persistent objectionable deposit, unnatural colour or turbidity, or unnatural odour was present in the Toronto region during the period of study.