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Two-year retrospective review of costs associated with COVID-19 case management in Regina, Saskatchewan
No full textAbstract Background The COVID-19 pandemic, declared in March 2020, caused significant morbidity and mortality globally. This study aims to estimate the costs associated with managing COVID-19 infected patients in Regina. Method The study focuses on the direct and indirect healthcare costs of managing a COVID-19 case. Costing elements included are diagnostic, public health, inpatient and outpatient management costs. The costing analysis estimates the total cost of COVID-19 case management in Regina, the average cost per case based on disease severity, and the costs for diagnostics, public health management, and clinical areas. Results Severe cases, representing 1.3% of cases, accounted for a quarter of the total cost of illness, while moderate cases (1.8%) contributed to less than 5% of the overall cost. Mild cases (96.9%) were responsible for three-quarters of the associated illness costs. Over two years, approximately 45 in 2020 to $183 in 2021, reflecting a higher case burden and greater health care utilization. Furthermore, the Omicron variant accounted for 44% of the disease burden and 36% of the illness costs. Patients older than 80 accounted for 10% of illness costs, while children aged less than 18 accounted for about 17%. Conclusion The primary costs were human resources and hospitalizations for older individuals, significantly impacting the Saskatchewan Health Authority's budget due to the pandemic. This analysis does not fully capture the effects in Regina
Derivation and Internal Validation of a Health Administrative Data Algorithm for Identifying Sepsis
No full textObjectives: The primary objective was to externally validate a Canadian ICD-coded sepsis case definition developed by Jolley et al. by examining its sensitivity and specificity in health administrative data among intensive care unit (ICU) patients at The Ottawa Hospital (TOH). We also evaluated whether two modifications (the addition of antimicrobial information and the removal of infection-related ICD codes) to the Jolley algorithm could improve sensitivity while maintaining specificity. The secondary objective was to examine the impact of these modifications on the algorithm's positive and negative predictive values.
Methods: We identified adults (18 years and older) admitted to TOH's Civic and General campus ICUs between April 1, 2014 and March 31, 2019. From this population, a random sample of 870 medical charts was selected for manual chart review, with sepsis positive and negative reference cases classified according to the Sepsis-3 criteria. Chart review data were linked to a health administrative dataset, containing pharmacy records, diagnosis and procedure codes. We then evaluated the sensitivity and specificity of the Jolley algorithm and its modified versions incorporating antimicrobial information and/or excluding infection codes.
Results: Among 10,407 eligible ICU patients, 833 of the 870 charts met the eligibility criteria. Of these, 391 patients met Sepsis-3 criteria through chart review, while 364 patients met Jolley sepsis criteria. The original Jolley algorithm had a sensitivity of 72.6% (95% CI: 69.6% - 75.7%) and specificity of 81.9% (95% CI: 79.3% - 84.5%). Incorporating antimicrobial information increased sensitivity to a range of 80.8% (95% CI: 78.1% - 83.5%) to 99.5% (95% CI: 99.0% -100.0%), but resulted in a marked decline in specificity, ranging from 12.2% (10.0% -14.4%) to 39.6% (95% CI: 36.3% - 42.9%). Removing infection-related ICD codes increased sensitivity to 83.4% (95% CI: 80.8% - 85.9%) but further reduced specificity to 26.9% (95% CI: 23.9% - 29.9%). Combining both modifications raised sensitivity to a range of 88.8% (95% CI: 86.6% - 90.9%) to 99.7% (95% CI: 99.4% -100.0%), while specificity dropped to 4.8% (95% CI: 3.3% - 6.2%) to 13.6% (95%CI: 11.2% -15.9%).
Conclusion: The Jolley algorithm demonstrated reasonable sensitivity and specificity in identifying sepsis patients among TOH ICU patients using administrative data. While adding antimicrobial information or removing infection codes substantially increased sensitivity, these modifications led to a marked decline in specificity. These findings highlight both the promise and limitations of using administrative data for sepsis surveillance and underscore the need for careful algorithm refinement to balance accuracy and utility
A Critical Feminist Assessment of Nigeria's Response to Conflict-Related Sex and Gender-Based Violence in the Light of the United Nations Women Peace and Security Agenda
No full textThis study examines the implementation of the Women, Peace, and Security Agenda (WPS) within national boundaries, focusing on the protection of women and girls' rights against sexual and gender-based violence (SGBV) during conflicts. The WPS Agenda aims to safeguard women in conflict situations and prioritise their rights and participation in peacebuilding and post-conflict reconstruction. A crucial aspect of advancing the WPS Agenda is the role of states, which are expected to fulfil their commitments by developing National Action Plans (NAPs). While the creation of NAPs can be considered an indication of a state's commitment to the WPS Agenda, this study demonstrates that the existence of NAPs alone does not provide sufficient insight into a state's actual implementation efforts or willingness to advance the Agenda's goals. Taking examples from Nigeria, this research illustrates that the mere existence of NAPs only sometimes translates into effective implementation. The study delves into Nigeria's NAPs and subsequent developments to assess how the WPS Agenda has been integrated into the country's legal framework to lay the structures necessary to enhance the protection of women from conflict-related SGBV when enforcement is done. By analysing the gap between policy formulation (NAP), laying of legal structures and enforcement or lack thereof, this study highlights the importance of evaluating the tangible actions states take beyond the creation of NAPs to truly measure their commitment to the WPS Agenda
Characterization of a Model of Laminopathies in Juvenile and Young Adult Zebrafish
No full textWe previously reported the generation of a zebrafish mutant (lmna⁻ᐟ⁻) for the lamin A/C gene that presents with skeletal muscle defects during the first week post fertilization and mild and transient cardiac defects. The phenotype analysis at the early stages of development suggested that this mutant could serve as a model for striated muscle laminopathy. In humans, striated muscle laminopathies often start at a young age, and progress into adulthood. It may be that the defects reported in lmna⁻ᐟ⁻ also progress into adulthood in a similar manner. In this study, we examined cardiac and skeletal muscles in juvenile and young adult zebrafish, to determine if this is the case.
Heart rate analysis shows cardiac defects such as bradycardia and arrhythmia, starting at 2 months post fertilization in homozygous (lmna⁻ᐟ⁻) mutants compared to wild type siblings (lmna⁺ᐟ⁺). Ultrasound analysis reveals a lower E/A ratio and a lower fractional shortening of the lmna⁻ᐟ⁻ juvenile and young adult compared to lmna⁺ᐟ⁺. These juvenile and young adult fish also show swim ability defects but without any apparent defect in trunk muscle. These results further confirm the usefulness of this model in studying striated muscle laminopathies into adulthood, for various purposes such as small molecule testing for phenotype rescue
Understanding patient barriers and enablers to accessing community resources: a qualitative study to inform navigation service delivery
No full textAbstract Background Individuals face multifaceted barriers to accessing community resources, which can significantly impact their ability to obtain necessary support and services. This study examines barriers and enablers to access community resources among primary care patients and explores the interplay between individual- and system-level factors that influence access to resources. Methods In this qualitative study, we conducted 32 semi-structured interviews with primary care patients who participated in a social prescribing trial that compared two navigation services: ARC (patient-centered longitudinal support) vs. Ontario-211 (free 24-hour helpline service) in two regions, Ottawa and Sudbury, in the province of Ontario, Canada. We conducted thematic data analysis with a deductive/inductive hybrid approach, employing Levesque’s theoretical framework for access to health that examines the various system and individual level factors influencing access to healthcare services. Findings At the system level, various systemic barriers encompassing broader organisational, structural, and policy-related elements influenced patients' access to community resources (outreach, availability, location, costs and accommodations for patient needs and preferences). These factors directly interacted with various patient-level factors (awareness of needs, ability to seek support, to reach resources and to pay for those, their physical and mental health, motivation, and confidence to engage in care) to determine access. Conclusions Our findings highlight individual- and system-level barriers and enablers for accessing community resources among socially complex primary care patients with multiple unmet needs. As governments and organizations in Canada are increasingly investing in community-based services to address adverse social determinants of health (SDH), an upstream approach that reduces both systemic and individual-level barriers to access is warranted. Trial registration ClinicalTrials.gov Identifier NCT03451552 registration date 15th Dec 2017
Health and Emergency Department Transfers for Ontario Long-Term Care Home Residents Living with Schizophrenia
No full textObjective. Describe long-term care (LTC) residents living with and without schizophrenia and analyze the association of schizophrenia with emergency department (ED) transfers.
Design. Cross-sectional study and cohort study.
Settings and Participants. Individuals admitted to Ontario LTC between 2012 and 2023.
Methods. Health administrative data were retrieved. Descriptive statistics were calculated for measures of health status and need upon admission. Negative binomial regression was used to analyze ED transfer rate overall and by ambulatory care sensitive conditions in the year following admission.
Results: Residents living with schizophrenia were younger and had fewer comorbidities, more stable health, lower mortality risk, more intact functioning, and similar aggressive behaviour frequency. They received less nursing and personal care. Schizophrenia was not associated with ED transfers.
Conclusion and Implications. Residents living with schizophrenia require less support for general health. LTC is supporting residents living with schizophrenia but access to mental health care may be improved
Ontario Medical Schools' Contribution to a Socially Accountable Primary Care Workforce: Associations with Pursuit of Extended Training and Practice in Rural or Remote Areas
No full textBackground: This thesis examines how Ontario's medical schools contribute to the primary care workforce.
Methods: We used data from the College of Physicians and Surgeons of Ontario to conduct two cross-sectional cohort studies of the association between family medicine graduates' characteristics and our two outcomes: pursuit of extended training and practice in rural/remote settings.
Results: Between 1995 and 2021, 25.3% family medicine graduates pursued extended training. After adjustment, Queen's University graduates had significantly higher odds of pursuing extended training compared to NOSMU (males: OR=2.03; 95% CI: 1.31-3.16; females: OR=5.32; 95% CI: 3.48-8.14). Among 2263 recent graduates, 10.4% were practicing in rural/remote areas. Graduates from the University of Toronto (OR=0.12; 95% CI: 0.07-0.21) and McMaster University (OR=0.23; 95% CI: 0.14-0.38) had the lowest odds of practicing in rural/remote areas compared to NOSMU.
Conclusion: Findings underscore the need for policy and training reforms to support a socially accountable workforce
Banishment of Sexual Offenders: Socio-Spatial Control in the National Capital of Canada
No full textThere has been an upward trend of advocacy for harsher restrictions akin the United States for individuals who have sexually offended when they are released in the community after incarceration in Canada. While the consequences of these restrictions have been vastly documented in an American context, the "cautious" approach taken by Canada has not provided many answers about the socio-spatial exclusion of individuals convicted of sexual offences. While banishment has rarely been used by the Canadian jurisprudence, this research attempts to uncover how banishment is covered under restrictive mechanisms of control for sexual offenders in the community. Based on previous research findings, the concept of space and carceral expansion is at the basis of this framework to study banishment. These concepts build onto one another to create a foundation of banishment that encompasses both social and spatial processes. Using a mixed qualitative methodology involving the analysis of ATIP documents, cartography, and semi-structured interviews, the findings and analytical observations dismiss the previous claim of Canada's relatively less punitive approach to sexual offender management in the community. Rather, the thesis concludes that the socio-spatial restrictions imposed on individuals who have committed sexual offences do lead to banishment, which has considerable implications for the re-entry of these individuals into the community
Calibration of Geotechnical Resistance Factor for Axially Loaded Steel Piles Driven in Alberta and Related Cost-Benefit Analysis
No full textDriven steel open-ended piles are used as foundations to support structures by transferring loads to the surrounding soil and/or deeper, more competent strata. These foundations are commonly employed in oil & gas, and infrastructure projects across Alberta. During the design phase, their capacity is typically estimated using semi-empirical equations based on static analysis methods and soil mechanics principles. However, uncertainties in pile capacity prediction persist, primarily due to site characterization, soil behavior, and construction quality. To address these uncertainties and ensure adequate safety under working loads, a Geotechnical Resistance Factor (GRF), as recommended by part of LRFD design approach, is applied to the calculated pile capacity. In Canada, based on the updated Canadian Foundation Engineering Manual (CEFM) for sites with a typical level of geotechnical understanding and where neither Pile Dynamic Analysis (PDA) nor static load testing is performed, a GRF with a value of 0.4 is recommended. However, several studies have indicated that using a uniform GRF without accounting for regional soil and bedrock variability often results in overly conservative designs. Similarly, applying a single GRF value to both shaft and toe capacities, while neglecting pile setup effects, further compounds this conservatism. Recalibration of GRFs is therefore necessary to better reflect these variables. This study aims to recalibrate GRF values regionally within Alberta for open-ended driven steel piles that have been axially loaded with the use of advanced statistical methods, PDA test data collected across the province and related geotechnical investigation data. The regional calibrated GRFs have been obtained initially for five (5) regions of Alberta (NE, NW, SE, SW, C). These values have been further recalibrated considering pile setup effects and differentiate value for shaft and toe capacities. Additionally, a cost-benefit analysis has been used to evaluate how much optimized GRFs can significantly reduce pile length requirements in design and cost in construction. Results show that locally calibrated GRFs yield the greatest savings about 20% compared to 10% for regionally calibrated values and 15% for soil-type-based calibrations. Incorporating pile setup effects into locally calibrated GRFs further enhances cost efficiency, with potential savings ranging from 23% to 35%, depending on soil conditions and calibration methodology
