Journal articles on the topic 'Tamil Canadians – Ontario – Toronto'

This paper examines the experiences of immigrants in Toronto as they pass through, and leave, Ontario Works (OW), a ‘Work First’ approach to social assistance that prioritizes rapid labour force attachment. We examine the Ontario Works activities of immigrants, compared to native born Canadians, and their respective post-OW job characteristics. We find that immigrants experience a significant relative wage disadvantage after participation, and substantially less wage growth when moving to the second post-welfare job. We conclude that Ontario Works, like most ‘work first’ employment programs, is ill-suited to addressing earnings disadvantage among immigrants. We suggest that programs ‘beyond work first’, though not targeted specifically towards immigrants, might nevertheless offer more assistance. The recurring wage disadvantage, however, would remain unaddressed and might require more direct intervention.

Blissymbolics, a comprehensive core communication system through which non-speaking people are able to communicate, has been developed and made available throughout Canada and the world by the Blissymbolics Communication Institute in Toronto, Canada. In addition, Canadian users of the system have become leaders in helping to increase universal awareness of the intellectual, social, emotional and communication needs of communicatively impaired and disadvantaged people.Charles K. Bliss who was born in Australia and now resides in Australia, originally developed Blissymbolics between 1942 and 1965 as an international communication system to promote better understanding among people. The system was first successfully applied during the early 1970’s by a multidisciplinary group of specialists at the Ontario Crippled Children’s Centre in Toronto to cerebral palsied, school-aged, non-speaking children. This graphic and meaning-based system provided them with a means of more grammatically complete communication than picture or word boards.Since its first application, Blissymbolics has been expanded to many other applications and populations. Today it is used as an augmentative communiation system with cognitive and language development programs to support reading and pre-reading activities. Its users include people who are retarded, multiply-handicapped, autistic, aphasic and stroke victims.As experimentation and the use of Blissymbolics increased during the 1970’s, the need for training programs and instructional materials, for information about ongoing programs, for more symbols and for a structure to maintain a standard form of Blissymbols also grew. In order to meet and co-ordinate these requirements the Blissymbolics Communication Foundation was established in Toronto in 1975. The Foundation, through a licensing agreement with Mr. Bliss, obtained the exclusive mandate to co-ordinate the applications of Blissymbolics with non-speaking people around the world. Its mandate was to maintain symbol standards and to provide training and material for the increasing number of people applying the system with non-speaking people. The Foundation was re-named the Blissymbolics Communication Institute in 1978 to better represent its role as a central, co-ordinating educational organization.

Looking at political demonstrations that occurred throughout 2008 and 2009 in Toronto, this article explores popular understandings of diasporic identities within a Canadian multiculturalism framework. It also examines second-generation Sri Lankan Tamils’ (SLT) (re)negotiations of these representations in forming and informing their identities. Drawing on Kathleen Hall’s (2002) framework, identities are understood as constituted through processes of power, discourse, and representation. Through a critical discourse analysis of newspaper editorials and narrative explorations of second-generation Canadian Tamils, this article investigates how diasporic identities are incorporated into the wider Canadian polity. Fifteen semi-structured interviews were conducted with second-generation Tamil Canadians (ages nineteen to twenty-nine). I argue that popular constructions of diasporic identities and Canadian national identity as understood within a multiculturalism framework are not entirely in concurrence with Tamil diasporic minorities’ own identity narratives. The resultant “othering” causes feelings of marginalization and undermines notions of social citizenship. Concurrently, resistive practices by the second generation embodied by the political démonstrations of 2008-2009 contest “Canadian” identity as promoted in hegemonic representations by dominant elements of society, including the state. Divergences that emerge between the resistive discourses of second-generation Tamils and “mainstream” integrationist discourses demonstrate the need for a more sophisticated conceptualization of how Canadian multiculturalism and citizenship might incorporate the transnational political and cultural practices of its citizens.

Calling Power to Account: Law, Reparations, and the Chinese Head Tax Case, David Dyzenhaus and May Moran, eds., Toronto: University of Toronto Press, 2005, pp. 471.This is a collection of fifteen essays that addresses different aspects of the Chinese head tax case. Edited by two law professors and written mostly by lawyers and law professors, the collection has a strong legal flavour. The book begins with the legal case of Mack vs. Attorney General of Canada. However, the book does not provide a succinct summary of the case. In brief, the case involves three Chinese Canadians, Shack Jang Mack, Quen Ying Lee and Yew Lee, filing a statement of claim through their attorney in December, 2000, in a class action on behalf of head tax payers in the Ontario Superior Court. In all, the case went through three courts, and the original ruling dismissing the claim of head tax payers was upheld by the Court of Appeal and the Supreme Court.

Canadian schools introduced community service program in 1999 to engage youth in diverse communities of Canada. Many studies have identified the gap in understanding immigrant youths’ experience on mandatory community service but has yet to study immigrant youth’s experience. Therefore, this paper explores the experiences of young Nepalese Canadians aged 18- 24 who participated in mandatory community involvement for graduating from high schools in Ontario, Canada. The findings are based on qualitative data gathered from ten interviews with young Nepalese Canadians who went to Canadian high schools, and are currently living in the Greater Toronto area (GTA). The study provides a nuanced understanding of visible minority immigrant youth’s experiences of mandatory community service in high school. The findings suggest that participants experience the program as merely an obligatory requirement to graduate from high school rather than a platform for learning civic skills and engaging in diverse Canadian communities. In addition, this case study of Nepalese Canadian youth depicts how young Nepalese Canadians depend on informal sources, mainly peer-to-peer sharing, for engaging in community, and illustrates how they conceptualize what community involvement means to them. Finally, based on this study, we argue that amendment to this mandatory program is an urgent call for engaging visible minority immigrant youth civically and meaningfully in Canadian communities.

According to the Canadian Emergencies act, a national emergency is an urgent, critical situation that threatens the health and safety of Canadians (Department of Justice of Canada, 2022). Emergencies can also take on many forms: pandemics, natural disasters, civil unrest, or armed conflict. Currently, the Provincial Emergency Response Plan implemented by the Chief of Emergency Management Ontario is the framework that keeps Ontarians safe, allowing for organizations and municipalities to organize disaster relief, send out emergency alerts, and educate Ontario residents on emergency preparedness (PERP, 2019). This paper explores how serious games can prepare the public for emergencies based on response frameworks currently in use in metropolitan Ontario, Canada (cities such as Toronto, Ottawa, and Hamilton). This example was selected because it represents modern urban settings that require response plans and provides a framework that can be used to elaborate on. This paper will present the positive features of serious game applications concerning public safety and emergency management education. Case studies of serious game applications currently used for public health and safety purposes will be examined. Serious games may be a useful instrument for public safety education to enhance existing emergency preparedness and public safety education frameworks.

Purpose This paper aims to present a panel data econometric model of the main determinants of house prices in the ten largest census metropolitan areas (CMA) in Ontario, Canada, for the years 2001, 2006 and 2011. The impact of immigration on the housing market in Canada is little researched; however, immigration plays an important role into the economy of Canada. According to Statistics Canada, not only is immigration key to Canada’s population growth but also without immigration, in the next 20 years, Canada’s population growth will be zero. The motivation for this study is the bursting of housing bubbles in some developed countries (e.g. USA). The authors analyze variables that are related to the immigration policy in Canada, accounting also for the impact of the interest rate, income, unemployment, household size and housing supply to analyze housing price determinants. The study investigates the magnitude of the impact of the top three leading categories of immigrants to Canada, namely, Chinese, Indian and Filipino, on the housing prices in Ontario’s largest cities. The results show the main factors that explain home prices over time that are interest rate, immigration, unemployment rate, household size and income. Over the 10-year period from 2001 to 2011, immigration grew by 400 per cent in Toronto CMA, the largest receiving area in Ontario, while the nonimmigrant population grew by 14 per cent. For Toronto CMA, immigrants, income, unemployment rate and interest rate explain the CA$158,875 average home price increase over the 2001-2011 time period. Out of this, the three categories of immigrants’ share of total home price increase is 54.57 per cent, with the corresponding interest rate share 58.60 per cent and income share 11.32 per cent of the total price growth. Unemployment rate contributes negatively to the housing price and its share of the total price increase is 24.49 per cent. Design/methodology/approach The framework for the empirical analysis applies the hedonic pricing model theory to housing sales prices for the ten largest CMAs in Ontario over the years 2001-2011. Following Akbari and Aydede (2012) and O’Meara (2015), market clearing in the housing market results in the housing price as a function of several housing attributes. The authors selected the housing attributes based on data availability for the Canadian Census years of 2001, 2006 and 2011 and the variables that have been most used in the literature. The model has the average housing prices as the dependent variable, and the independent variables are: immigrants per dwelling (Chinese, Indian, and Filipino), unemployment rate, average employment income, household size, housing supply and the interest rate. To capture the relative scarcity of dwellings, the independent variable immigrants per dwelling was used. Findings This study seems to suggest that one cause of high prices in Ontario is large inflows of immigrants together with low mortgage interest rate. The authors focused their attention on Toronto CMA, as it is the main destination of immigrants and comprises the largest cities, including Toronto, Mississauga, Brampton and Oakville. Looking over the 10-year period from 2001 to 2011, the authors can see the factors that impact the home prices in Toronto CMA: immigration, unemployment rate, household size, interest rate and income. Over the period of 10 years from 2001 to 2011, immigrants’ group from China, India and the Philippines account for CA$86,701 increase in the home price (54.57 per cent share of the total increase). Income accounts for CA$17,986 increase in the home price (11.32 per cent share); interest rate accounts for CA$93,103 of the average home price increase in Toronto CMA (58.60 per cent share); and unemployment rate accounts for CA$38,916 decrease in the Toronto average home prices (24.49 per cent share). Household size remain stable over time in Toronto (2.8 average household size) and does not have a contribution to home price change. All these four factors, interest rate, immigrants, unemployment rate and income, together explain CA$158,875 increase in home prices in Toronto CMA between 2001 and 2011. Practical implications The housing market price analysis may be more complex, and there may be factors impacting the housing prices extending beyond immigration, interest rate, income and household size. Finally, the results of this paper can be extended to include the most recent census data for the year 2016 to reflect more accurately the price situation in the housing market for Ontario cities. Social implications The fact that currently, in 2017, the young working population cannot afford buying a property in the Toronto CMA area means there is a problem with this market and a corresponding decrease in the quality of life. According to The Globe and Mail (July 2017), a new pool in 2017 suggested that two in five Canadians believe housing in this country is not affordable for them. Further, 38 per cent of respondents who consider themselves middle or upper class believe in no affordability of housing. The Trudeau Government promised Canadians a national housing strategy for affordable housing. Designing a national housing strategy may be challenging because it has to account for the differential income ranges across regions. Municipal leaders are asking the government to prioritize repair and construct new affordable housing. Another reason discussed in the media of the unaffordability of housing in Toronto and Vancouver is foreign buyers. The Canadian Government recently implemented a tax measure on what it may seem the housing bubble problem: foreign buyers. Following Vancouver, in April 2017, Ontario Government imposed a 15 per cent tax on foreign buyers who are not Canadian citizens or permanent residents. This tax is levied on houses purchased in the area stretching from Niagara Region and Greater Toronto to Peterborough. Originality/value Few studies use Canadian data to explain house prices and analyze the effect of immigration on housing prices. There is not much research on the effect of the immigrants and immigrants’ ethnicity (e.g., Chinese, Indian and Filipino immigrants), on the housing prices in Canada cities. This study investigates the impact of the most prevalent immigrant races (e.g., from China, India and the Philippines) on housing prices, using data for Canadian major cities in Ontario within a panel data econometric framework. This paper fills this gap and contributes to the literature, which analyzes the determinants of housing prices based on a panel of cities in the Canadian province of Ontario.

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.

As stories of microbiological and infectious disease discoveries are told, one of the most charming of these in Canadian history is the recognition of verotoxigenic Escherichia coli (VTEC) and associated disease. The considerable burden and impact of VTEC-associated infections is currently experienced worldwide. Jack Konowalchuk, Joan Speirs, and their collaborators in Ottawa, Ontario, defined the E. coli verotoxin. Mohamed Karmali, Martin Petric, and colleagues at The Hospital for Sick Children in Toronto, Ontario, established the association of VTEC and hemolytic–uremic syndrome. Nationwide, and with the dissemination of knowledge through the central health directorate in Ottawa, numerous scientists and clinicians were motivated to focus on this theme, and within a relatively brief chronology, much became known about the biology of VTEC and the pathogenesis, epidemiology, and clinical aspects of disease. Many Canadian investigators, but especially those in the veterinary school at Guelph, Ontario, also contributed to the science of VTEC among animals. The interactions between clinical and veterinary researchers led to a then unprecedented exponential growth in the knowledge base of VTEC. Canadians also participated in a better understanding of the origin and potential of the E. coli O157 serogroup. Whereas not exclusively Canadian, the contributions of our national scientists in this field must be seen as a vital part of medical and microbiological Canadiana; this essence is captured in this historical review.

Cancer clinical trials (ccts) are essential for furthering knowledge and developing effective interventions to improve the lives of people living with cancer in Canada. Randomized controlled trials are particularly important for developing evidence-based health care interventions. To produce robust and relevant research conclusions, timely and sufficient accrual to ccts is essential.The present report delivers the key recommendations emerging from a workshop meeting, Improve Accrual to Cancer Clinical Trials, that was hosted by the Canadian Cancer Trials Group and funded by the Canadian Institutes of Health Research. The meeting, which took place in Toronto, Ontario, in April 2012 before the Canadian Cancer Trials Group annual spring meeting, brought together key stakeholders from across Canada to explore creative strategies for improving accrual to ccts. The objectives of the workshop were to provide an opportunity for knowledge exchange with respect to the research evidence and the ethics theory related to cct accrual and to promote discussion of best practices and policies related to enhancing cct access and accrual in Canada.The workshop provided the foundation for establishing new interdisciplinary research collaborations to overcome the identified barriers to cct participation in Canada. Meeting participants also supported the development of evidence-based policies and practices to make trials more accessible to Canadians living with cancer.

Background This proposed study aims to translate the Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (DASHNa-CC), a classroom-based, antihypertensive, dietary educational intervention, to an innovative smartphone app (mDASHNa-CC). This study will enable Chinese Canadian seniors to access antihypertensive dietary interventions anytime, regardless of where they are. It is hypothesized that senior Chinese Canadians will be satisfied with their experiences using the mDASHNa-CC app and that the use of this app could lead to a decrease in their blood pressure and improvement in their health-related quality of life. Objective The goal of this study is to design and test the usability and feasibility of a smartphone-based dietary educational app to support a healthy diet and hypertension control for Chinese Canadian seniors. Methods A mixed-method two-phase design will be used. The study will be conducted in a Chinese immigrant community in Toronto, Ontario, Canada. Chinese Canadian seniors, who are at least 65 years old, self-identified as Chinese, living in Canada, and with elevated blood pressure, will be recruited. In Phase I, we will design and test the usability of the app using a user-centered approach. In Phase II, we will test the feasibility of the app, including implementation (primary outcomes of accrual and attrition rates, technical issues, acceptability of the app, and adherence to the intervention) and preliminary effectiveness (secondary outcomes of systolic and diastolic blood pressure, weight, waist circumference, health-related quality of life, and health service utilization), using a pilot, two-group, randomized controlled trial with a sample size of 60 participants in a Chinese Canadian community. Results The study is supported by the Startup Research Grant from Nipissing University, Canada. The research ethics application is under review by a university research ethics review board. Conclusions The study results will make several contributions to the existing literature, including illustrating the rigorous design and testing of smartphone app technology for hypertension self-management in the community, exploring an approach to incorporating traditional medicine into chronic illness management in minority communities and promoting equal access to current technology among minority immigrant senior groups. Trial Registration Clinicaltrials.gov NCT03988894; https://clinicaltrials.gov/ct2/show/NCT03988894 International Registered Report Identifier (IRRID) PRR1-10.2196/15545

Background: In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. Objective: To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. Methods: A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. Results: We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. Conclusion: Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.

To review the characteristics of reported outbreaks of acute rheumatic fever in the United States, and to determine if there is an increase in the incidence of acute rheumatic fever in the population served by the Hospital for Sick Children, Toronto, Ontario, the authors conducted a literature search and a retrospective review of inpatients and outpatients, satisfying the revised Jones criteria for the diagnosis of acute rheumatic fever, from 1972 to 1988. Patients satisfying the revised Jones criteria for the time period 1972–88 were included in the study. There have been eight articles reporting an increase in acute rheumatic fever in the United States. In three, the majority of children were white and from middle class suburban/rural communities in different geographic locations. Mucoid strains of group A streptococci were implicated but not confirmed as being associated with the outbreaks in three. The results of the chart review at the Hospital for Sick Children revealed that 83 cases satisfied the revised Jones criteria. The number of cases per 100,000 children (aged 18 years or less) per year, decreased progressively over the study period. Polyarthritis was the most frequently seen major criterion occurring in 73% of patients (61 of 83). The most frequently affected ethnic groups were Italians 23%, Afro-Canadians 19% and Orientals 8%. The reported outbreaks in the United States are multifocal and predominantly confined to white middle class children residing in suburban/rural communities. There was no evidence of an increase in the number of cases of acute rheumatic fever seen in the population served by the Hospital for Sick Children; there was a progressive decline in number of cases over the study period. The results facilitate the characterization of acute rheumatic fever within North America into three different patterns of occurrence.

The T Eaton company, considered the world's first department store, was named after its founder Timothy Eaton. In 1869, it as a small dry goods business in Toronto. By 1907, at the death of its founder, it was a giant retail store, with a branch in Winnipeg, alongside a country-wide mail-order business. Innovative practices established during his time included sales for cash only and satisfaction guaranteed or money refunded. Eaton's successors extended the Eaton empire across Canada, continuing the tradition of quality goods, prices, customer service and also fair labour practices. It became a Canadian institution. Eaton's filed for protection from its creditors in February 1997 and once again in August 1999 (see Appendix 1 for a chronology of events) under the federal Companies' Creditors Arrangement Act and the Ontario Business Corporations Act (Closings). The restructuring that followed the first bankruptcy was only partially successful. However, it had a significantly positive impact on Eaton's operations, and seemed to turn things around. Were it not for bad economic news and misfortune in mid-to-late 1998 (CNW 3 and CNW 5), the plan might have worked. Store-closings, employee terminations, and a huge liquidation sale followed the second bankruptcy declared in August 1999, as did the suspension of the trading of Eaton's stock (Chron). Sears Canada Inc. agreed to purchase 16 of the Eaton's stores in September 1999 (Sears 1; Material 1). These will open by the fall of 2000 (Material 2; Sears 1). A compromise was made with Eaton's creditors (including the employees) to give them approximately $0.50 on the dollar (Olijnyk 1). A compromise was also arrived at with Eaton's shareholders whereby the latter would be given participation units in exchange for their common shares (on a one-for-one trade) (Amended; Trachuk). These participation units are to be used in a contingent and conditional settlement based upon the possible utilization of tax credits by Sears acquired as a result of Eaton's $390 million in losses since 1996 (Receivership; Amended; Trachuk). These settlement monies might or might not be realized by the former shareholders (Amended; Trachuk). Today, Eaton's is no more. In its place are many great memories by a former generation of Canadians who used to go to the Eaton's stores to buy big things that were always of high quality. "Agnes Lunn, who was visiting [Edmonton, Calgary,] from Dartmouth, N.S., said she will miss the chain because of its trustworthiness. "If you bought something from Eaton's, you knew it was worth having, you knew it would be quality," she said (Auction)." Perhaps having six of the Eaton's stores open up this fall with the Eaton's name on them will rekindle a loyalty in a new generation of Canadians?

The Factory Women is a fictional account of four Italian immigrant women in Toronto, Ontario in the 1960s. Told from the second person point-of-view, the narrative aims to challenge readers to see the story through the main character’s eyes. The women presented in the story sew uniforms in a small workshop that they have dubbed “the factory.” One of the women, Marta, lost her husband to the Hoggs Hollow disaster, an actual historical event in which four Italian workers were killed while building a water main tunnel in Toronto.When a mysterious man begins working at “the factory” alongside the women, he tries to encourage them to join a worker’s union, much to the disapproval of the workroom supervisor.While Toronto Italians have largely assimilated into mainstream Canadian society, The Factory Women strives to remind members of the ethnic community of their conflicted past in an effort to exhort them to speak out against social injustice now. While many young Italian Canadians have led privileged lives, they must remember the experiences of their own ancestors and continue to fight for the equality of all Canadians. While centred on the Italian experience in Canada, The Factory Women aims to remind all people of the importance of group solidarity.

"WHEN A CANADIAN GIRL BECAME AMERICA'S SWEETHEART:" MARY PICKFORD AND QUESTIONS OF NATIONAL IDENTITY DURING THE WWI It is a little known fact that several of the key figures of early American cinema were, in fact, of Canadian extraction. Pioneering writer-director-producer-actor Mack Sennett, for instance, hailed from Richmond, Québec, while May Irwin, famous for providing American cinema with one half of its first onscreen kiss, was originally from Whitby, Ontario. Similarly, each of the first three Academy Award winners for Best Actress also happened to be Canadian-born. (Mary Pickford, born in Toronto, was awarded the first Best Actress Oscar for her performance in Coquette in 1929, to be followed by Montréal native Norma Shearer in 1930 and Cobourg, Ontario's Marie Dressler in 1931). Unlike more obviously foreign, "Other" stars such as Pola Negri and Greta Garbo, these Canadians were, for the most part, physically and linguistically indistinguishable from their...

Introduction: Bladder cancer (BC) is the fifth most prevalent cancer in Canada, with 9000 Canadians diagnosed each year.1 While smoking is the most important risk factor, environmental and occupational carcinogens have been found to significantly contribute to BC rates.2 As Canada is highly reliant on natural resource industries, this study seeks to identify geographical and industry-related trends of BC rates in Ontario. Methods: The 1991 and 2001 Canadian Census Health and Environment Cohort (CanCHEC; Statistics Canada) was used, along with individual years of Census data. Maps identifying hot and cold spots for BC within Ontario were generated, and the former were assessed for industry patterns between location and BC rates. Cox proportional hazards models were run for each age cohort to predict the likelihood of developing BC by industry of work. Results: Significant geographical and industrial trends in BC rates were identified. For 1991–2001; hot spots included the Cochrane, Manitoulin, Parry Sound, and Sudbury (90% confidence interval [CI]), and Nipissing and Temiskaming (95% CI) regions. Toronto and York were cold spots. Concurrently, metal (p=0.039), paper and publishing (p=0.0062), and wood and furniture (p<0.0001) industries had increased rates of BC. Notably, these industries had high employment density in our hot spot areas and low density in our cold spots. Conclusions: Significant geographical and industrial BC trends were found in Northern Ontario regions reliant on heavy employment in natural resource-based industries, such as forestry, agriculture, and wood/paper. These findings may inform future screening guidelines and aid in identifying individuals at risk of BC development.

ABSTRACTObjectivesA health services research organization in Toronto, Ontario, Canada conducts population-based research to improve the health of Canadians in seven main areas: (1) cancer, (2) cardiovascular disease, (3) chronic disease and pharmacology, (4) health system planning and evaluation, (5) kidney, dialysis and transplantation, (6) mental health and addictions, and (7) primary care and population health. The Information Management (IM) team within the Data Quality and Information Management (DQIM) department at our non-profit organization is an integral component for upholding privacy and confidentiality policies and procedures while facilitating quality research using different types of data such as health administrative, third-party, primary data collection, and electronic medical records (EMR). MethodsThe IM team is responsible for receiving data, encoding direct personal identifiers, screening for unnecessary identifiers, performing probabilistic data linkage when necessary, importing the data to the Research Analytics Environment (a client/server Linux-based system), and destroying the data according to the terms stipulated in the executed data sharing agreement. The purpose of the presentation is to detail the above steps of processing data to protect individuals’ identities yet preserve the usefulness of carrying out research. The presentation will include aspects from importing data into SAS to storage and encoding of personal identifiers to probabilistic data linkage, which involves maximizing linkage with other datasets at the organization. Linking data at the organization involves the encryption or encoding of health card numbers to “Key Numbers.” ResultsThe processing practices used at the organization comply with Canadian privacy laws such as the Personal Health Information Protection Act (PHIPA) as well as organizational policies and Research Ethics Board approvals. The approaches used to conceal individual identities yet allow linkage to various data sources can be modelled by other health agencies, ministries, and non-health related organizations that work with sensitive data but face challenges in maintaining both privacy and research quality. Our organization strives to make processing as efficient as possible and create maximum linkability to the various data sources in house while upholding privacy and confidentiality.

Introduction: The COVID-19 pandemic has revealed critical gaps in the public’s knowledge of infectious diseases. Experts, including the World Health Organization, acknowledge that an “infodemic” of misinformation is spreading at the same time as the pandemic. Furthermore, 13% of Canadians age 50 and younger reported using social media as their primary source of information about COVID-19. Thus, in January 2020, the Infectious Disease Working Group (IDWG) was formed by a group of students at the Dalla Lana School of Public Health, University of Toronto. The IDWG’s Media Messaging Team (MMT) uses Knowledge Translation (KT) strategies to increase access to evidence-based information related to public health and COVID-19. Specifically, MMT uses virtual platforms, including Twitter and Instagram (@infectious_info), to disseminate information to a wide audience. Objectives: The MMT aims to produce content to dispel pervasive and harmful myths about COVID-19, raise public awareness, and advocate for health equity. Methods: The team creates 2-4 pieces of original content per week on topics such as Ontario Government legislation updates, myth-busting series, and “Wednesday Series” (summaries of novel research findings). The IDWG employs an equity lens to ensure that the content takes into account the experiences and needs of diverse groups, and that graphics are representative of a diverse audience. Health communication strategies are used to promote audience engagement through compelling and bold content design. Results: The Instagram account has over 4,400 followers, with some posts surpassing 50,000 views. Qualitative feedback from social media followers indicates that this project is addressing an emerging gap in knowledge resulting from unclear messaging from official bodies, the spread of mis/disinformation, and disparities in health literacy levels. Conclusions: The findings can inform the development and implementation of KT strategies to reach a wide audience and increase the uptake of public health information.

New Year. In this edition of the news I am highlighting several online resources as well as conferences, tours, and exhibits of possible interest.First of all, I highly suggest you sign up at the Alberta School Library Council's new LitPicks site (aslclitpicks.ca). It is free, filled with promise, and includes only books recommended by the reviewers. The reviews are searchable by grade level and genre (e.g., animal, biographical fable, fantasy, humour, historical, horror, verse, realistic, mystery, myth) and include all formats. The reviews include curriculum connections and links to relevant resources. Library staff review titles based on engagement of story, readability, descriptive language, illustration excellence and integrity of data, and source for non-fiction titles. The target users are teachers, teacher-librarians, library techs, and others working in libraries. School library cataloguers can provide a link to the review from within the catalogue record.Another recommended resource is CanLit for Little Canadians, a blog that focuses on promoting children's and YA books by Canadian authors and illustrators. The blog postings can also be found on Facebook. (http://canlitforlittlecanadians.blogspot.ca/)First Nation Communities READ is another resource for your tool box. It is an annual reading program launched in 2003 by the First Nations public library community in Ontario and includes titles that are written and/or illustrated by (or otherwise involve the participation of) a First Nation, Métis, or Inuit creator and contain First Nation, Métis, or Inuit content produced with the support of First Nation, Métis, or Inuit advisers/consultants or First Nation, Métis, or Inuit endorsement. Julie Flett's Wild Berries - Pakwa Che Menisu, available in both English and Cree, was the First Nation Communities Read Selection for 2014-2015 and the inaugural recipient of the Periodical Marketers of Canada Aboriginal Literature Award. (http://www.sols.org/index.php/develop-your-library-staff/advice-consulting/first-nations/fn-communities-read)This resource should also be of great value for those schools and libraries participating in TD Canadian Children’s Book Week in 2015. Each May, authors, illustrators and storytellers visit communities throughout the country to share the delights of Canadian children’s books. Book Week reaches over 25,000 children and teens in schools and libraries across Canada every year. The theme for this year is Hear Our Stories: Celebrating First Nations, Métis and Inuit Literature, celebrating the remarkable variety of topics, genres and voices being published by and about members of our First Nations, Métis and Inuit (FNMI) communities in Canada. On a personal note, I will be touring as a storyteller in Quebec as part of this year’s Book Week tour.Freedom to Read Week: February 22-28, 2015. This annual event encourages Canadians to think about and reaffirm their commitment to intellectual freedom, which is guaranteed them under the Charter of Rights and Freedoms. This year’s Freedom to Read review marks the thirtieth anniversary of its publication and of Freedom to Read Week in Canada. It was first published in 1984 to explore the freedom to read in Canada and elsewhere and to inform and assist booksellers, publishers, librarians, students, educators, writers and the public. To commemorate Freedom to Read’s thirtieth anniversary, some of our writers have cast a look back over the past three decades. As usual, the review provides exercises and resources for teachers, librarians and students. This and previous issues of Freedom to Read, as well as appendices and other resources, are available at www.freedomtoread.ca.Half for you and Half for Me: Nursery Rhymes and Poems we Love. An exhibit on best-loved rhymes and poems and a celebration of the 40th anniversary of Alligator Pie held at the Osborne Collection in the Lillian H. Smith Library in Toronto until March 7, 2015.Serendipity 2015 (March 7, 2015). An exciting day exploring the fabulous world of young adult literature with Holly Black, Andrew Smith, Mariko Tamaki, Molly Idle, and Kelli Chipponeri. Costumes recommended! Swing Space Building, 2175 West Mall on the UBC campus. (http://vclr.ca/serendipity-2015/)For educators: Call for entries for the Martyn Godfrey Young Writers Award (YABS). An annual, juried contest open to all students in Alberta in grades 4 through 9. Students are invited to submit their short stories (500-1500 words) or comic book by March 31, 2015 to the YABS office, 11759 Groat Road, Edmonton, AB, T5M 3K6. Entries may also be emailed to info@yabs.ab.ca.Breaking News: The Canada Council for the Arts has revised the Governor General’s Literary Awards Children’s Literature categories (in consultation with the literary community) in the wake of controversy regarding graphic novels. The revised category titles and definitions:The new Children’s Literature – Illustrated Books category will recognize the best illustrated book for children or young adults, honouring the text and the illustrations as forming one creative work. It includes picture books and graphic novels, as well as works of fiction, literary non-fiction, and poetry where original illustrations occupy at least 30% of the book’s space.The Children’s Literature – Text category will recognize the best book for children or young adults with few (less than 30%) or no illustrations. http://www.bookcentre.ca/news/governor_general%E2%80%99s_literary_awards_revisions_children%E2%80%99s_literature_categoriesGail de Vos, an adjunct instructor, teaches courses on Canadian children's literature, Young Adult Literature and Comic Books and Graphic Novels at the School of Library and Information Studies for the University of Alberta and is the author of nine books on storytelling and folklore. She is a professional storyteller and has taught the storytelling course at SLIS for over two decades.

The prevalence of advanced dementia (AD) is expected to increase dramatically over the next few decades. Patients with AD suffer from recurrent episodic illnesses that frequently result in transfers to acute care hospitals. The default pathway followed by some emergency physicians, internists and intensivists who see those patients is to prioritize disease-directed therapies over attention to the larger picture of AD. While this strategy is desired by many families, some families prefer a different approach. This essay examines the reason why there can be a failure to focus on the over-arching issue of AD and offers suggestions for improvement. Gaps in information and physician workload are important factors, but we argue that until physicians who see patients in emergency departments learn to pause first and ask “Why are we doing this?” they will revert to their comfort zone of ordering tests and therapies that may be unwanted. A separate emergency palliative care pathway may be one solution. Shifting the focus back to the larger picture of AD and away from the physiologic disturbance of the moment may alter the trajectory of care in ways that truly respect the wishes of some patients and their families. On s’attend à ce que la prévalence de la démence avancée (DA) augmente de façon extrêmement importante au cours des prochaines décennies. Or, il arrive que des patients atteints de DA soient aux prises avec des maladies épisodiques récurrentes qui entraînent fréquemment un transfert dans un hôpital de soins actifs. La voie suivie par défaut par certains urgentologues, internistes et intensivistes qui reçoivent ces patients consiste à donner la priorité à l’application de traitements axés sur la maladie plutôt qu’à aborder le problème plus large de la DA. Cette stratégie satisfait bien des familles, mais certaines préfèrent une autre approche. Cet article examine pourquoi on semble vouloir éviter de s’attarder au problème récurrent de la DA et offre des suggestions d’amélioration. Des lacunes en matière d’information ainsi que la charge de travail des médecins sont sûrement des facteurs importants qui mènent à cette situation. Toutefois, nous soutenons que tant que les médecins qui voient ces patients au service des urgences ne prendront pas le temps de s’arrêter et de se questionner sur leur choix d’actions, ils se limiteront à se retirer dans leur zone de confort qui consiste à prescrire des tests et des traitements qui risquent d’être inopportuns. Une voie distincte en matière de soins palliatifs d’urgence peut s’avérer être une solution. En déplaçant l’accent mis sur les troubles physiologiques du moment pour le mettre sur le problème plus large de la DA, la trajectoire des soins pourrait être modifiée de façon à mieux respecter les désirs de certains patients et de leur famille.An 84-year-old bed-bound man with severe Alzheimer’s dementia presents to the emergency department with pneumonia, accompanied by his 3 daughters. He has been hospitalized 4 times in the past 2 years for antibiotic-associated Clostridium difficile diarrhea. Antibiotics and intravenous fluids were started by the first physicians who saw him. An internist was consulted to take over his care.In 2016, 564,000 Canadians were living with dementia. Each year 25,000 new cases of dementia are diagnosed, and it is expected that by 2030 there will be close to 1 million Canadians who have dementia.1 People with advanced dementia (AD) suffer with cognitive deficits and are unable to communicate, ambulate and have incontinence. They are at high risk for imminent death,2,3 an under-recognized fact even among health care professionals.4 In contrast to patients with terminal cancer and end stage heart disease, most patients with AD do not die from devastating acute events (like bowel obstruction, or heart failure) that result from the progression of their primary disease. Instead, they die from recurrent episodic illnesses that can be treated with relatively simple therapeutic responses (like intravenous fluids or antibiotics). 3 These include pneumonias, urinary tract and skin infections, influenza, problems with eating (including aspiration) and dehydration. It is not surprising that in the United States that 19% of nursing home residents with cognitive impairment experience at least one transfer to a hospital in the last 120 days of life.5When these patients arrive in the emergency department (ED), the default pathway is to prioritize disease-directed therapies (e.g., intravenous fluid and antibiotics) over attention to the larger picture of AD. The physiologic disturbances receive intense focus and the AD is seemingly forgotten. These patients often suffer from treatable symptoms, including pain and shortness of breath.3 In some (but not all) cases, patients may receive care they don’t really want, families may be afraid to express their true wishes, and health care professionals may deliver care they suspect is unnecessary, or even harmful. This essay examines the reasons why this phenomenon occurs and offers suggestions for improvement by encouraging acute care clinicians to pause and ask themselves, “Why are we doing this?” and by engage family members in focused goals of care discussions that include outcomes of aggressive disease-directed treatments and palliative approaches.There are many reasons why the physicians who treat these patients in acute care hospitals (primarily emergency physicians, internists/hospitalists and intensivists) prioritize life-sustaining therapies over relief of burdensome symptoms as the default strategy. Information gaps affect the process of care. These physicians likely assume that a transfer to an acute care facility indicates the (sometimes mistaken) desire for life-sustaining interventions by the patient’s relatives. Transfer decisions are a human endeavour, and thus are subject to error6 especially when personnel worry about blame. While nearly half of all transfers from nursing homes to the ED are for cardiovascular and respiratory problems, 7 key factors influencing decisions to transfer as reported by family physicians include medico-legal concerns, family pressure, the capability of nursing home staff and the physician’s workload.8Even in Ontario, where nursing home residents are legally required to have annually updated instructions about whether transfer to acute care hospitals is indicated, the process only works as well as the nature of the counselling and discussion (which is often perfunctory) that takes place before the patients or their legal substitutes sign that document. In the United States, it is unclear how and whether the rapid uptake of Physician Orders for Life-Sustaining Treatment in nursing homes has affected end-of-life care in AD.9 From an economic and medico-legal perspective, there is no incentive for nursing homes or their staff to manage the acutely ill nursing home patient themselves, and every incentive to transfer care to an ED even when “no transfer” instructions are clearly recorded. The physician who meets the patient for the first time in the ED often lacks familiarity with the patient’s clinical course and his or her family, which coupled with a lack of communication training for these circumstances, inhibits addressing goals of care directly.10Physician workload is also an important factor. In a busy ED, an empathetic conversation that elucidates patients’ goals of care, educates families about the outcomes of care11 and offers the option of prioritizing attention to symptoms takes time and requires a higher cognitive load than ordering tests, intravenous fluids and antibiotics. In addition, the process of acute care, once initiated, may be a contributing factor. Family members see that life-prolonging therapies can be given, making it more difficult for them to decide to forgo disease-directed therapies once started without being overwhelmed by a sense of guilt. Finally, precise prognostication in a patient with AD is fraught with hazards.12 All of these factors play a role, but overall, until the physicians who see patients in the ED acquire the expertise to routinely address goals of care, and experience the rewards and sense of professional fulfillment that can be derived from sparing patients unwanted invasive care, the opportunity to prioritize comfort may not be offered. Those physicians will revert to their comfort zone of checking the electrolytes, obtaining a chest x-ray and urine culture which then results in a discussion that starts by asking families questions like, “Do you want us to treat the hypernatremia?” When phrased that way, few family members (even those who are physicians) are prepared to say “No.”While assessing goals of care for patients with AD may currently be viewed as impractical in the busy ED, perhaps the right models have not been proposed. Complexity has not deterred the rapid response in EDs for patients with acute strokes and ST-elevation myocardial infarctions. One solution may be to develop a separate “emergency palliative care pathway” where the primary task is prioritizing relief of burdensome symptoms and eliciting true preferences.13 thus avoiding stressful lengthy stays in the chaotic ED where patients with AD are often of low priority. Interventions aimed upstream from the ED may include increasing resources for training of nursing home staff along with the provision of decision aids to assist caregivers in the clarification of goals of care prior to transfer to the ED.14Some patients with AD and their families may prefer prioritizing comfort above all else but may not be offered the chance to make that choice. In a survey of elderly hospitalized Canadians, 70% reported wanting to focus on providing comfort rather than life-prolonging treatment, yet 54% of these patients are admitted to intensive care units at the end of life. 15 Even if this circumstance occurs in a minority of the dementia patients who are sent to EDs, the substantial rise in the number of people with dementia means that it will occur much more commonly in the future. In these cases, emergency physicians and the consultants that they approach for help can play a critical role if they push the pause button before beginning empiric disease-directed therapies, and simply ask patients’ families, “What is your understanding of your loved one’s prognosis?” and, “ What are you hoping for?” On the one hand, these conversations take time. On the other, they can be efficient, focus on these simple questions, and describe outcomes of care including potential discomforts associated with treatments. By shifting the focus back to the larger picture of AD and away from the physiologic disturbance of the moment, they may alter the trajectory of care, ultimately reducing the burden to patients and their families. We can facilitate patients’ wishes and honour the truly vital role that family members play as members of the health care team.Returning to the case, after a 7-minute discussion of the goals and options for care, led by the internist, the patient’s daughters were unable to decide upon the best course of treatment. A phone call to his wife was made, and she indicated that comfort measures were “what he would want.” After initiating oxygen and subcutaneous morphine for relief of pain and dyspnea in the ED, the patient was transferred to the ward with palliative care physicians. He received comfort-directed care and died peacefully 4 days later surrounded by his family. Competing InterestsNone declared AcknowledgementsWe thank S. Ryan Greysen MD, Gurpreet Dhaliwal (both of University of California San Francisco), Lewis A. Lipsitz MD (Harvard), Howard Ovens MD and Barry J. Goldlist MD (both of University of Toronto) for comments on an earlier draft.References1. Alzheimer Society of Canada. Report summary Prevalence and monetary costs of dementia in Canada (2016): a report by the Alzheimer Society of Canada. Health promotion and chronic disease prevention in Canada: research, policy and practice. October 2016:231–32.2. Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA 2000;284(1):47–52.3. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of AD. N Engl J Med 2009;361(16):1529–38. doi:10.1056/NEJMoa0902234.4. Chang A, Walter LC. Recognizing dementia as a terminal illness in nursing home residents: Comment on "Survival and comfort after treatment of pneumonia in AD." Arch Intern Med 2010;170(13):1107–1109. doi:10.1001/archinternmed.2010.166.5. Gozalo P, Teno JM, Mitchell SL, et al. End-of-life transitions among nursing home residents with cognitive issues. N Engl J Med 2011;365(13):1212–21. doi:10.1056/NEJMsa1100347.6. Stephens CE, Newcomer R, Blegen M, Miller B, Harrington C. Emergency department use by nursing home residents: effect of severity of cognitive impairment. Gerontologist 2012;52(3):383–93. doi:10.1093/geront/gnr109.7. Jensen PM, Fraser F, Shankardass K, Epstein R, Khera J. Are long-term care residents referred appropriately to hospital emergency departments? Can Fam Physician 2009;55(5):500–505.8. McDermott C, Coppin R, Little P, Leydon G. Hospital admissions from nursing homes: a qualitative study of GP decision making. Br J Gen Pract 2012;62(601):e538–e545. doi:10.3399/bjgp12X653589.9. Halpern SD. Toward evidence-based end-of-life care. N Engl J Med 2015;373(21):2001-2003. doi:10.1056/NEJMp1509664.10. Lamba S, Nagurka R, Zielinski A, Scott SR. Palliative care provision in the emergency department: barriers reported by emergency physicians. J Palliat Med 2013;16(2):143–47. doi:10.1089/jpm.2012.0402.11. Givens JL, Jones RN, Shaffer ML, et al. Survival and comfort after treatment of pneumonia in AD. Arch Intern Med 2010;170(13):1102–107. doi:10.1001/archinternmed.2010.181.12. Mitchell SL, Miller SC, Teno JM, et al. Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. JAMA 2010;304(17):1929–35. doi:10.1001/jama.2010.1572.13. Grudzen CR, Stone SC, Morrison RS. The palliative care model for emergency department patients with advanced illness. J Palliat Med 2011;14(8):945–50. doi:10.1089/jpm.2011.0011.14. Hanson LC, Zimmerman S, Song M-K, et al. Effect of the goals of care intervention for AD. JAMA Intern Med 2017;177(1):24–28. doi:10.1001/jamainternmed.2016.7031.15. Fowler R, Hammer M. End-of-life care in Canada. Clin Invest Med 2013;36(3):E127–E132.