Journal articles on the topic 'Toronto (Ont.) – Population'

RÉSUMÉCe livre comporte une série d'articles présentés et écrits par des spécialistes canadiens et européens reconnus pour leur connaissance des services communautaires pour les personnes âgées dans la province de l'Ontario et partout ailleurs au Canada. Ces articles ont été préparés en fonction d'ateliers tenus à Toronto en 1988 qui visaient à élaborer de nouvelles politiques et des programmes pour les personnes âgées. Les articles traitaient plus particulièrement des programmes de l'Ontario et du Manitoba et font quelques comparaisons avec d'autre pays. Ils abordent aussi sommairement d'autres programmes extrêmement bien élaborés comme ceux de la Colombie-Britannique ou de la Saskatchewan. Le livre s'adresse aux decideurs politiques, aux planificateurs, aux étudiants ou aux administrateurs du domaine des soins à domicile.

RÉSUMÉL'ouvrage intitulé Elder Abuse and Neglect in Canada constitue une monographie de référence tant pour les chercheurs, les boursiers, les étudiants, les praticiens et les responsables de politiques que pour les associations de personnes âgées et les intervenants qui s'intéressent à la qualité de vie de la population plus âgée. Les auteurs, qui sont des experts dans leur domaine, ont abordé le sujet du point de vue juridique et social. Ils ont examiné minutieusement l'abondante documentation sur la question et évalué les perspectives théoriques, les services, les programmes et les lois qui existent au Canada. Cette monographic met l'accent sur les droits des adultes plus âgés et conclut que les politiques, les pratiques et les programmes actuels visant à remédier aux abus et à la négligence envers les personnes âgées sont alourdis par les problèmes définitionnels, méthodologiques et théoriques. L'absence de mécanismes de protection «en bonne et due forme» dans les lois canadiennes de protection des adultes est particulièrement évidente, et ces lois doivent être modifiées afin que la liberté individuelle et l'autonomie des adultes plus âgés soient préservées, conformément à la Charte canadienne des droits et libertés.

Résumé Depuis les dernières années, les historiens du Canada anglais se sont beaucoup intéressés au problème de la famille canadienne au XIXe siècle. La majorité de ces études porte sur les populations rurales et urbaines de l'Ontario et elle se préoccupe surtout des réactions diverses de ces communautés aux changements économiques et sociaux. Deux genres de populations ont été ainsi isolées: une première, flottante et migratoire, qui cherche constamment de nouveaux horizons, et une seconde, résidante et persistante, qui réagit différemment aux changements en tentant d'adapter son mode de vie aux conditions qui existent plutôt que de repartir comme la précédente. C'est ce deuxième groupe qui fait l'objet de cette recherche. L'auteur étudie ici le phénomène de la permanence dans l'Ontario rural, et ce, à travers l'exemple d'un canton particulier du comté de Peel, le Toronto Gore. Il traite, entre autre, de la façon dont on accumule la terre; il s'intéresse à la manière dont on l'administre et il s'arrête assez longuement aux divers modes de la transmission des biens dans la famille. Selon lui, cette étude des ménages permanents — et ils constituent près de la moitié de l'ensemble — tend à démontrer que, d'une part, les liens familiaux contribuent grandement à attacher les individus à un coin de pays et que, d'autre part, l'acquisition d'une terre à l'époque s'avère d'importance primordiale. Nul doute, cet élément de stabilité dans la population mérite beaucoup plus d'attention que l'on ne lui en a accordée jusqu'à maintenant.

Dans toute agglomération polyethnique, l'impact de la participation sociale sur l'identité du groupe s'avère être un facteur critique dans la survivance d'une minorité ethnique. Puisque l'identité est formée et maintenue par un processus d'interaction, la participation sociale, qu'elle se situe à l'intérieur ou à l'extérieur des limites ethniques, peut favoriser la conservation ou la dissolution de l'identité ethnique. L'image du Soi est façonnée par ces personnes et ces groupes avec lesquels les membres d'une minorité ethnique « participent fréquemment et partagent d'étroites similitudes de comportement ». D'autres ont déjà appelé ce processus, « l'identification participationnelle ». L'appartenance à un groupe qui s'identifie lui-même comme tel et qui est identifié de la même façon par les autres caractérise le groupe ethnique. Une telle identité ethnique comprend non seulement la conscience de la communauté d'origine, de tradition, de langue et de culture, mais aussi une conception de ce qu'on représente aux yeux de la population environnante. Quoiqu’éprouvée d'une manière subjective, la conscience d'une identité ethnique ne se développe que par l'interaction sociale à l'intérieur des structures institutionnelles et des organisations communautaires de la société d'origine. La conscience d'une identité commence au sein de la famille ; elle est ensuite renforcée par l'interaction sociale à l'intérieur du contexte plus vaste de la communauté et se maintient grâce à une participation soutenue dans les structures sociales communautaires. Les modèles de participation traduisent l'ensemble des croyances, des valeurs et des buts communs aux membres de la communauté ou de la société et se manifestent extérieurement dans les rôles et statuts sociaux qui constituent le genre de vie particulier de la société. Une telle participation est un phénomène social essentiel à la formation et au maintien de l'identité ethnique.

Résumé Pendant les deux dernières décennies du XIXe siècle, le problème du vagabondage devint à ce point crucial que certains le considéraient comme une menace pour l'ordre social existant. Le clochard était perçu comme possédant tous les vices — paresse, intempérance et instabilité — éminemment nuisibles au bon fonctionnement d'une société établie. On s'empressa donc, et ce, dans la plupart des villes nord-américaines où le problème sévissait, de trouver des moyens de diminuer le vagabondage à défaut de pouvoir l'enrayer totalement. L'auteur se penche ici sur les moyens qui ont été utilisés à Toronto pendant les années 1880 et 1890. C'est surtout l'Associated Charities of Toronto, un organisme fondé en 1880, qui se préoccupa de trouver une solution au problème du vagabondage dans la ville. Elle tenta d'abord de fournir du travail aux clochards en ouvrant une carrière et une cour à bois mais ces deux initiatives n'apportèrent pas les succès escomptés. Elle s'appliqua ensuite à faire pression auprès des institutions qui s'occupaient des clochards pour qu'elles imposent une certaine somme de travail à quiconque demandait soupe et asile en guise de compensation pour les services rendus. L'association obtint finalement gain de cause et le système qu'elle préconisait fut mis en vigueur en 1889. Certes, l'application du principe du "labour test" a apporté quelques résultats tangibles à l'époque; cependant, l'événement tire toute son importance du fait qu'il témoigne du climat d'une époque où des gens qui se disaient philanthropes se sont révélés comme étant surtout préoccupés de maintenir tant l'ordre social qu'ils avaient instauré que l'éthique du travail sur lequel ils l'avaient établi. Dans cette perspective, une réalité aussi pénible que celle du chômage et de la population vagabonde qu'il engendre tend à disparaître bien vite derrière l'image d'un clochard paresseux et instable qui ne peut être qu'indigent et sans travail.

Introduction Les campus universitaires et collégiaux sont sans doute les derniers milieux au sein desquels il est possible d’aborder de façon globale la question de la santé d’une grande proportion de la population de jeunes adultes. Il est important que les promoteurs de la santé saisissent en quoi consistent les difficultés collectives auxquelles font face les étudiants et qu’ils comprennent mieux les modèles plus larges de comportements liés au mode de vie qui se manifestent au cours de cette période de la vie. L’objectif de notre étude a été de déterminer des catégories de comportements à risque pour la santé modifiables et d’étudier la relation entre ces catégories et divers paramètres relevant de la santé mentale au sein d’un vaste échantillon d’étudiants universitaires canadiens. Méthodologie Des étudiants de premier cycle (n = 837, âge moyen = 21 ans) de l’Université de Toronto ont répondu à l’enquête National College Health Assessment (NCHA) (évaluation nationale de la santé dans les collèges) qui comprend environ 300 éléments, dont des évaluations de l’état de santé, de la santé mentale et des comportements à risque pour la santé des étudiants. Nous avons réalisé une analyse des classes latentes pour relever des profils en fonction de huit comportements à risque pour la santé connus (consommation de marijuana, consommation d'autres drogues illégales, rapports sexuels à risque, tabagisme, excès occasionnel d’alcool, mauvaise alimentation, inactivité physique, manque de sommeil). Résultats Nous avons obtenu un modèle à trois catégories axé sur les profils de comportement des étudiants : étudiants « typiques », « à risque élevé » et « relativement en bonne santé ». Nos résultats ont par ailleurs montré que les étudiants à risque élevé ont déclaré souffrir d’un niveau de stress considérablement plus élevé que celui des étudiants typiques (χ2 [1671] = 7,26; p < 0,01). Conclusion Les étudiants les plus susceptibles d’adopter de multiples comportements à risque pour la santé ont fait état d’une moins bonne santé mentale, particulièrement en ce qui concerne le stress. Bien que l’on doive interpréter ces conclusions avec prudence en raison du taux de réponse de 28 %, celles-ci suggèrent néanmoins que l’on pourrait envisager des interventions ciblées auprès de groupes d’étudiants ayant des profils similaires de multiples comportements à risque pour la santé.

Introduction Les interventions en santé de la population dans le secteur de l’alimentation de détail, comme celles réalisées dans les dépanneurs, visent à transformer le type de signaux envoyés aux consommateurs afin qu'ils choisissent des aliments plus sains. Peu de recherches abordent les aspects financiers des interventions réalisées dans le milieu de la vente au détail, en particulier les mesures de résultat comme les ventes en magasin, pourtant au centre du processus décisionnel de la vente au détail. Cette étude examine l'évolution des ventes en magasin et les ventes par catégories de produits dans le cadre d’une intervention axée sur un dépanneur santé situé dans un quartier à faible revenu de Toronto (Ontario). Méthodologie Les données sur les ventes effectuées entre août 2014 et avril 2015 ont été regroupées par catégories de produits et par jour. Nous avons utilisé des tableaux croisés dynamiques Excel afin de résumer et de présenter visuellement les données sur ces ventes. Nous avons mené des tests t afin d’étudier les différences au niveau des ventes de chaque catégorie de produits en fonction des jours de vente « de pointe » (jours d’affluence) par rapport aux autres jours de vente. Résultats Les ventes globales du magasin culminaient les derniers jours de chaque mois, soit à la période à laquelle les prestations d’assistance sociale sont versées. La hausse des revenus lors des jours de pointe était principalement imputable aux ventes de laissez-passer de transports en commun. La moyenne des ventes de collations non nutritives et de cigarettes était légèrement plus élevée lors des jours de pointe par rapport aux autres jours. Les stratégies novatrices employées pour augmenter les ventes de fruits et légumes frais ont semblé accroître considérablement les revenus générés par ces catégories de produits. Conclusion Les données sur les ventes en magasin constituent un paramètre important de mesure du succès des interventions en environnement alimentaire. De plus, les prises de décision des détaillants fondé sur ces données peuvent se révéler déterminantes lors de l’adaptation des interventions. Les responsables des recherches et des interventions futures devraient envisager d’établir des partenariats et d’utiliser d'autres indicateurs de rendement lors des interventions ciblant l'environnement de la vente au détail d’aliments dans divers contextes canadiens.

C’est des régions du Centre et du Sud-Ouest, réunies en raison de leur identité commune et fragmentée, et d’une conscience régionale en voie d’éclosion, que traite l’étude d’Yves Frenette. Par la relecture de documents divers (entrevues, témoignages, recensements et études), il brosse un portrait concret de la vie française de ce coin de l’Ontario pour la période 1940-1970. En retraçant les courants migratoires qui ont amené des populations françaises dans ces régions, il sonde leurs motivations, indique les zones d’attraction (Détroit-Windsor, Sarnia, baie Georgienne, Toronto, Hamilton, Welland) et les îlots de peuplement, et parle de leur adaptation au milieu à la faveur du réseau institutionnel chargé de les encadrer. Mais les migrants durent réagir aux préjugés qu’entraînait leur minorisation et qui eurent des effets sur la place de ces nouveaux Franco-Ontariens. Aussi, les problèmes d’anglicisation les confrontèrent-ils très tôt et les divisèrent : sympathie ou trahison des clercs, apathie de plusieurs, incompréhension et rivalités entre groupes francophones (Québécois et Acadiens, Canadiens français et Français) contribuèrent à de nombreux transferts linguistiques. Malgré une assimilation galopante, qui inquiète l’élite, l’école et la progression du réseau institutionnel auraient commencé à freiner l’assimilation.

197 Background: St. Michael’s Hospital (SMH) is an academic, inner-city hospital in Toronto, Canada. In the hematology/oncology (hem/onc) program, a small number of patients appeared to contribute disproportionately to hospital admissions and emergency department (ED) visits. We hypothesized that high needs hem/onc patients could be recognized early in their care and that ED visit and admission rates among these patients could be decreased through targeted interventions. Methods: Members of the hem/onc team were interviewed regarding characteristics, which they felt predicted higher needs and greater liklihood for hospital admission/ED visit. A list of high risk features was generated. ED visit and admission rates for a prospectively identified high needs cohort were compared to rates for the entire hem/onc clinic. An intervention targeting high needs hem/onc patients is on-going. Pre and post-intervention ED visit and admission rates will be compared. Results: Interviews with 3 nurses, 1 social worker, 1 discharge planner, and 4 physicians identified 10 factors that the hem/onc team believed were predictive of higher needs and subsequent higher ED visit and admission rates. Between December 1, 2012, and February 28, 2013, 42 high needs hem/onc out-patients were prospectively identified. The ED visit and admission rates for this cohort were retrospectively compared to those of the entire hem/onc clinic and found to be dramatically higher (Table). Begininng in June 2013, hem/onc patients identified as “high needs” were offered enrollment in a NP-based program offering telephone assessments following ED visits, hospital admissions or discharges. Assessment of the impact of this intervention is ongoing. Conclusions: It is possible to prospectively identify hem/onc patients who are at risk of higher than usual ED visit and admission rates. Identifying this population may provide an opportunity to decrease their ED visit and admission rates. An evaluation of an intervention targeting high needs hem/onc patients is ongoing. Preliminary data will be presented. [Table: see text]

Cumulative susceptibility test data (CSTD) are used to guide empirical antimicrobial therapy and to track trends in antibiotic resistance. The Clinical and Laboratory Standards Institute recommends reporting CSTD at least annually and sets the minimum number of isolates per reported organism at 30. To comply, many hospitals combine data from multiple intensive care units (ICUs); however, this may not be appropriate to guide empirical therapy because of variations in patient populations. In this study, susceptibility data for two different ICUs at a tertiary care hospital in Toronto, Canada, were used to create a traditional CSTD report, which combined data from different ICUs, and a rolling-average CSTD report, which pooled 2 years of data for each ICU separately. For simplicity, data for only the most common Gram-negative organisms (Escherichia coli,Pseudomonas aeruginosa) and the most relevant antibiotics (ciprofloxacin, piperacillin-tazobactam) were examined. With the rolling-average method, significant differences in susceptibility were seen between the ICUs in 50% of the organism-antimicrobial combinations. Furthermore, the 3% median year-over-year difference in susceptibilities seen for the 16 organism-antibiotic combinations by using the traditional method was lower than the 14% median difference seen for the 20 between-ICU within-year comparisons obtained using the rolling-average method. Changes in our selection of empirical antibiotics resulted from this revised approach, and our results suggest that pooling data from ICUs with different patient populations may not be appropriate. A rolling-average method may be an appropriate strategy for the creation of individual-unit CSTD reports.

BACKGROUND: Tuberculosis (TB) is a major infection with nearly eight million cases annually worldwide. Although the majority of these cases are in the developing world, TB is also a problem in Canada.OBJECTIVE: To determine the cost of diagnosis and management of paediatric TB in Canada.DESIGN: Cross-sectional study.SETTING: In-patients and out-patients at The Hospital for Sick Children, Toronto, a tertiary care centre.PATIENTS: Patients were included if they had clinical or radiological evidence of TB infection with a positive tuberculin skin test or a positive culture result, and were treated from July 1, 1995, to June 30, 1996. Twenty-two patients met the criteria for inclusion in the study.OUTCOME MEASURES: Patient characteristics, types of disease, types and numbers of investigations, number of in-patient days and out-patient appointments, course of TB treatment, TB-related complications and antimicrobial resistance were obtained from charts. Costs were derived from allocated hospital costs, Ontario Health Insurance Plan billings and costs provided by the Pharmacy Department at The Hospital for Sick Children.RESULTS: The total cost for one year of management of paediatric TB in a tertiary care centre was $211,576. Pulmonary TB affected one-half of the study patients but accounted for one-quarter of the cost. One case of meningitis resulted in almost the same costs as all cases of pulmonary TB. Hospitalization was the largest contributor to overall cost, accounting for three-quarters of the total. The remaining costs in order of their contribution to overall costs were antimicrobial treatment, out-patient appointments, diagnostic imaging and TB cultures.CONCLUSIONS: From a hospital’s perspective, the costs of managing each of the 22 patients was approximately $10,000. However, there was great variability between patients, with much greater costs for those who required hospitalization or numerous investigations because TB was not suspected. To the authors’ knowledge, this is the first time that such a cost analysis has been performed for a paediatric population. A cost analysis provides a better measure of the burden of illness than is indicated by the absolute number of patients.

Abstract Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There is a lack of data on the comprehensive burden of CAP across the life span in Canada. We estimated the incidence of all-cause CAP in all age groups in Ontario and British Columbia (BC), Canada. Methods We identified hospitalized and outpatient CAP episodes from the Discharge Abstract Database (DAD) and physician billing claims databases (Ontario Health Insurance Plan in Ontario and Medical Services Plan in BC) in both provinces. The National Ambulatory Care Reporting System was used to identify CAP episodes from emergency department visits in Ontario. CAP recorded with a primary or secondary diagnosis was identified using International Classification of Diseases 9 (480–486, 510, 513) and 10 (J10.0, J11.0, J12–J18, J86.9, J85.1) codes. We estimated the age and sex adjusted annual incidence of CAP overall, and by age groups (0–4, 5–17, 18–39, 40–64, 65–74, 75–84 and ≥85 years) according to routine childhood pneumococcal conjugate vaccine (PCV) immunization periods from 2005–2018 in Ontario and from 2002–2018 in BC. Poisson regression models were fitted with population denominators from Statistics Canada to estimate the incidence rates. Results Ontario had 3,607,186 CAP episodes from 2005–2015 with a mean annual incidence of 2,801 (95% confidence interval [CI]: 2,748, 2,854) per 100,000 population; incidence declined from 3,077/100,000 in 2005 to 2,604/100,000 in 2010 before increasing to 2,843/100,000 in 2018. BC had 1,146,172 CAP episodes from 2002–2008, with a mean annual incidence of 2,146 (95% CI: 2105, 2189); the incidence increased from 2,005 /100,000 in 2002 to 2,199/100,000 in 2018. A high incidence of CAP was observed in children aged 0–4 years and older adults, particularly in adults aged ≥85 years in both provinces across all PCV program periods (Figure 1). Figure 1: Age group-specific incidence of all-cause community-acquired pneumonia according to childhood pneumococcal conjugate vaccine (PCV) program periods in Ontario (PCV7 [1 Jan 2005–30 Sep 2009]), PCV10 [1 Oct 2009–31 Oct 2010] and PCV13 [1 Nov 2010–31 Dec 2018]) and British Columbia (PCV7 [1 Sep 2003–31 May 2010] and PCV13 [1 Jun 2010–31 Dec 2018]), Canada Conclusion CAP continues to be a public health burden in Canada despite publicly funded pneumococcal vaccination programs. Ontario seems to have higher CAP burden than British Columbia that warrants further investigation. The youngest cohort of children and older adults contribute significantly to the CAP burden. Disclosures Manish Sadarangani, BM BCh, DPhil, GlaxoSmithKline (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)Symvivo (Grant/Research Support)VBI Vaccines (Research Grant or Support) Allison McGeer, MSc,MD,FRCPC,FSHEA, GlaxoSmithKline (Advisor or Review Panel member)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) James D. Kellner, MD, FRCPC, FIDSA, Pfizer, Merck, GSK, Moderna (Grant/Research Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support) Shaza A. Fadel, PhD MPH, Merck (Other Financial or Material Support, Salary is paid by the University of Toronto via a donation by Merck to the Centre for Vaccine Preventable Diseases to support educational and operational activities.) Fawziah Marra, BSc(Pharm), PharmD, Pfizer Canada (Research Grant or Support)

IntroductionWhilst higher rates of alexithymia have previously been reported in FNSD, little is known about the prevalence of autistic traits in adults with FNSD. We aim to:Report on the prevalence of autistic traits in an outpatient group of adults diagnosed with FNSD using the Autism Spectrum Quotient (AQ-10)Report on the prevalence of alexithymia using the Toronto Alexithymia Scale (TAS-20)Report on differences in symptom severity of psychiatric comorbidity between those scoring <6 or ≥6 on the AQ-10, and those with or without alexithymiaMethodOut of 105 consecutive patients reviewed in an outpatient FNSD program, 91 completed self-report assessments for autistic traits, alexithymia, generalised anxiety, depression, social phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) and dyslexia. Patients were grouped by AQ-10 scores of <6 or ≥6 and compared for significant differences in tested variables using a Mann-Whitney U test. Kruskal-Wallis H tested differences in alexithymia status. Simple effects were tested using pairwise comparisons.Results40% screened positive on the AQ-10 (scoring ≥6), and 40% screen positive for alexithymia. When comparing those scoring < or ≥6 on the AQ-10, those with the higher number of autistic traits scored significantly higher on scales of alexithymia, depression, generalised anxiety, social phobia,ADHD, and dyslexia. Positive alexithymia status was significantly associated with a higher number of autistic traits as well symptoms of generalised anxiety, depression, somatic symptoms severity, social phobia and dyslexia.ConclusionWhilst higher rates of neurodevelopmental disorders have previously been reported in FNSD, we report new evidence for a high proportion of autistic traits and further evidence of a high prevalence of alexithymia in a group of adults with FNSD.1–10Mechanistic insights are limited however autistic traits may be associated with FNSD due to altered sensitivity to sensory data, as well as cognitive or affective biases, or increased susceptibility to panic. There may be an additional contribution from psychosocial stressors. Clinically, the AQ-10 and TAS-20 may be important tools in the management of FNSD, and a higher prevalence of autistic traits may highlight a need for specialised communication styles in the MDT.11This builds on research exploring the relationship between autistic traits, alexithymia and FNSD. Previous research suggests that alexithymia and altered interoceptive awareness may be modifying factors in the relationship between autistic traits and FNSD,12and further research is required to clarify the nature of these relationships.ReferencesDemartini B, Nisticò V, Goeta D, Tedesco R, Giordano B, Faggioli R,et al. Clinical overlap between functional neurological disorders and autism spectrum disorders: A preliminary study.Journal of the Neurological Sciences2021 Oct;429:117648.Freedmanet al. Psychogenic nonepileptic events in pediatric patients with autism.Hatta K, Hosozawa M, Tanaka K, Shimizu T. Exploring traits of autism and their impact on functional disability in children with somatic symptom disorder.Journal of Autism and Developmental Disorders2019 Feb 15;49(2):729–37.Jester KA, Londino DL, Hayman J. 2.68 examining the occurrence of conversion disorder diagnoses and asd among adolescents and young adults in the emergency department.Journal of the American Academy of Child & Adolescent Psychiatry [Internet]. 2019 Oct 1 [cited 2022 Feb 7];58(10):S193. Available from: http://www.jaacap.org/article/S089085671931617X/fulltextMcWilliams A, Reilly C, Gupta J, Hadji-Michael M, Srinivasan R, Heyman I. Autism spectrum disorder in children and young people with non-epileptic seizures.Seizure2019 Dec 1;73:51–5.Mierschet al. A retrospective study of 131 patients with psychogenic non-epileptic seizures (PNES)- Comorbid diagnoses and outcome after inpatient treatment.Nimmo-Smith V, Heuvelman H, Dalman C, Lundberg M, Idring S, Carpenter P,et’al. Anxiety disorders in adults with autism spectrum disorder: a population-based study.Journal of Autism and Developmental Disorders. 2020 Jan 1;50(1):308–18.Pun P, Frater J, Broughton M, Dob R, Lehn A. Psychological profiles and clinical clusters of patients diagnosed with functional neurological disorder.Frontiers in Neurology2020 Oct 15;11.Zdankiewicz-Sciga&lstrok;a E, Sciga&lstrok;a D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation.PLoS ONE. 2021 Aug 1;16(8 August).Demartini B, Petrochilos P, Ricciardi L, Price G, Edwards MJ, Joyce E. The role of alexithymia in the development of functional motor symptoms (conversion disorder).Journal of Neurology, Neurosurgery & Psychiatry [Internet]. 2014 Oct 1 [cited 2022 Feb 8];85(10):1132–7. Available from: https://jnnp.bmj.com/content/85/10/1132Cooper M, Gale K, Langley K, Broughton T, Massey TH, Hall NJ,et al. Neurological consultation with an autistic patient.Practical Neurology [Internet]. 2021 Oct 8 [cited 2022 Jan 14];practneurol-2020-002856. Available from: https://pn.bmj.com/content/early/2021/10/07/practneurol-2020-002856Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception.Cortex2016 Aug 1;81:215–20.

e18618 Background: The coronavirus disease (COVID-19) pandemic has created unprecedented strain on healthcare systems across the world. COVID-19 has thought to have significant impacts on the oncology patient population and has affected their care. Additional research is needed to ascertain the impact of the COVID-19 pandemic at the patient level. We sought to evaluate whether the delivery of cancer care, quality of life (QoL) and treatment outcomes of oncology patients at Mount Sinai Hospital (MSH), Toronto, Canada was impacted by the COVID-19 pandemic. Methods: A 3-part longitudinal questionnaire study including 138 oncology patients receiving active treatment or in active follow-up at MSH was conducted between June 15, 2020 and August 25, 2021. The questionnaire consisted of the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer QoL Questionnaire Version 3) and satisfaction with virtual healthcare questionnaire. The questionnaire was completed at baseline (Jun 15-Sep 8, 2020), 1 month follow-up (Jul 15-Oct 8, 2020), and 12 months follow-up (Aug 4-Aug 25, 2021). Repeated measures analysis of variance tests were performed to evaluate EORTC QLQ-C30 subscale score changes and satisfaction with virtual care question scores over time. Results: Overall, the mean EORTC QLQ-C30 QoL scores were seen to improve in oncology patients from 65.1 (SD±22.3) at baseline to 69.1 (SD±16.9) at 12 months follow-up (p = 0.2). Within the EORTC QLQ-C30 functional scales, mean role functioning and mean social functioning scores were observed to increase over 12 months of follow-up, 66.4 to 79.2 (p < 0.05) and 67.7 to 76.4 (p = 0.17), respectively. Little change was observed within other EORTC QLQ-C30 functional scales and individual symptom scales during follow-up. Over 12 months of follow-up, mean agreement (0 = strongly disagree to 6 = strongly agree) to the questionnaire statement regarding avoiding going to the hospital during COVID-19 pandemic had declined, from 4.6 (SD±2.0) at baseline to 3.9 (SD±2.2) at 12 months follow-up (p = 0.09). Although not significant, virtual care satisfaction generally decreased over the follow-up time period. 97% of 48 patients who completed the survey at 12 months of follow-up reported feeling more safe coming into the hospital when considering the current increased vaccination rates in Ontario. Conclusions: As the COVID-19 pandemic has evolved, there has been increased knowledge of disease transmission, along with the introduction of health care measures such as vaccination and treatment. During this time, cancer outpatients at MSH became more comfortable as demonstrated by improvements in both QoL and virtual care scores. Prospective studies should still be considered to assess the efficacy of different methods of improving oncology patient care and QoL during the COVID-19 pandemic.

Abstract Abstract 5295 In 2006, deferasirox was licensed in Canada for use in children over the age of 6 years. Deferasirox (Exjade â, ICL 670) is an orally active iron chelators which represents the new class of tridentate iron chelator. Deferasirox has been formulated as a dispersible tablet based on technical feasibility, stability, and adequate bioavailability. Deferasirox has been shown to be as effective as deferral (DFO) and has a clinically manageable safety profile (the most common side effects are gastrointestinal disturbances and rashes). Few studies have been conducted to compare the satisfaction, convenience, activity limitations, and patient preferences of deferasirox in comparison with DFO in sickle cell and thalassemia patients. The purpose of the present study was to evaluate the long-term response of deferosirox in iron-overloaded children aged 6 years or older treated with transfusion dependent anemia and secondary objective was to collect and analyze the following parameters such as serum ferrtin, SLT, AST, creatinine, audiology and ophthalmology, liver iron concentrations (LIC) and patient reported outcomes measures over a period of 2 years from the start of deferasirox. The study population comprised of male and female patients aged 6 years or <17.99 with chronic iron overload related to blood transfusions in patients with Thalassemia and Sickle cell disease. Fifty-one patients were enrolled into this study at the Hematology Clinic, Hospital for Sick Children, Toronto, ON Canada. This study was observational and does not impose a therapy protocol, diagnostic/therapeutic interventions or a strict visit schedule. Patients were treated with deferasirox according to the local physician's judgment and in accordance with the local (country-specific) deferasirox prescribing information. Data were collected at study entry (baseline), and at 12 months. Patients were approached for the study after the ethics approval was obtained. All variables were explored and summarized using descriptive statistics such as means, standard deviation, median and ranges, counts and proportions, graphs as appropriate. Patients reported outcomes measures questionnaires were given after the written consent/assent was obtained. Statistical analysis was done by descriptive statistics and paired t-test. Of the 51 subjects, 30 were females, 21 were males, and median age for the patients was 14 ± 5.3. Out of 51 patients, 49 patients had thalassemia and two had sickle cell disease. All of the subjects were on desferal chelation therapy before the start of the deferasirox, Analysis of patient reported outcomes measures showed that majority of the patients (73%) were very satisfied with deferasirox, when they started and after 12 months on the study, however 1 patient who reported dissatisfaction in 2009, reported satisfaction in year 2010. The main reason for the deferasirox, treatment preference were relief of pain associated with injections (30%) and more convenient (35%) in administration. Other reasons given were improved sleep patterns (2%) and less disruption to the family (6%). At baseline and 12 months laboratory evaluations were as follows: Mean Creatinine values (88% of the patients) (baseline- 34.41±11.49, 12 months – 52.41 ± 19.82), Mean ALT (65% of the patients) (baseline- 41.73 ± 7.32, 12 months – 30.94 ± 5.30) and serum ferritin (baseline- 1995± 276, 12 month, 1833 ± 203). Mean LIC (baseline-11.08 ± 1.29, 12 months- 7.87 ± 1.12) evaluations showed the incremental decrease over time with 14/51 showed the values of <3 over a 12 months period. Chelation therapy was held for some patients for a short period to prevent toxicity related to the chelator. Mild (4/51) and moderate (1/51) hearing loss were observed in subjects over period from 2009–2010. Data will be collected after 24 months to evaluate their long-term responses and for comparative analysis. Further, we can conclude that given the high levels of satisfaction, it is likely that the quality of life and adherence to chelation treatment have improved for patients who are receiving the deferasirox treatment compared with previous subcutaneous chelation treatment. Disclosures: No relevant conflicts of interest to declare.

For nearly 150 years the University of Toronto has integrated public health into its teaching and research. From early lectures in sanitation (1871) to the discovery of insulin (1921), the University of Toronto’s rich history is reflected in its prominence as a global leader in public health research and education. Therefore, it is fitting for the University of Toronto to host an academic journal of public health that showcases both high-impact scholarship and public health practice. Founded in 2020, the University of Toronto Journal of Public Health has an ambitious, yet essential, vision: to foster the next generation of public health researchers and practitioners in order to improve population health nationally and globally. In this editorial, we honour the diverse and complementary nature of the fields of biostatistics, epidemiology, health policy and practice, and social and behavioural health sciences by highlighting an important historical date from each. We reflect on these milestones within a historical and contemporary context, and conclude by considering the importance of each discipline for the future of public health in Canada and abroad.

We Break Up, I Publish: Theorising and Emotional Processing like Taylor Swift In 2007 after the rather painful end of my first long-term same-sex relationship I asked myself two questions (and like a good graduate student wrote a paper about it that was subsequently published): (1) what is love; (2) and if love exists, are queer and straight love somehow different. I asked myself the second question because, unlike my previous “straight” breakups (back when I honestly thought I was straight), this one was different, was far more messy, and seemed to have a lot to do with the fact that my then fresh ex-boyfriend and I had dramatically different ideas about how the relationship should look, work, be codified, or if it should or could be codified. It was an eye-opening experience since the truth that these different ideas existed—basically his point of view—really only “came out” in my mind through the act and learning involved in that breakup. Until then, from a Queer Theory perspective, you could have described me as a “man who had sex with men,” called himself homosexual, but was so homonormative that if you’d approached me with even a light version of Michel Foucault’s thoughts on “Friendship as a Way of Life” I’d have looked at you as queerly, and cluelessly, as possible. Mainstream Queer Theory would have put the end of the relationship down to the difference and conflict between what is pejoratively called the “marriage-chasing-Gay-normaliser,” represented by me, and the “radical-Queer(ness)-of-difference” represented by my ex-boyfriend, although like a lot of theory, that misses the personal (which I recall being political...), and a whole host of non-theoretical problems that plagued that relationship. Basically I thought Queer/Homosexual/Lesbian/Transgendered and the rest of the alphabet soup was exactly the same as Straight folks both with respect to a subjective understanding of the self, social relations and formations, and how you acted or enacted yourself in public and private except in the bedroom.. I thought, since Canada had legalised same-sex marriage, all was well and equal (other than the occasional hate-crime which would then be justly punished). Of course I understood that at that point Canada was the exception and not the rule with respect to same-sex rights and same-sex marriage, so it followed in my mind that most of our time collectively should be spent supporting those south of the border or overseas who still faced restrictions on these basic rights, or out-and-out violence, persecution and even state-sanctioned death for just being who they are and/or trying to express it. And now, five years on, stating that Canada is the exception as opposed to the rule with respect to the legalisation of same-sex marriage and the codification of same-sex rights in law has the potential to be outdated as the recent successes of social movements, court rulings and the tenor of political debate and voting has shifted internationally with rapid speed. But it was only because of that breakup that these theoretical and practical issues had come out of my queer closet and for the first time I started to question some necessary link between love and codification (marriage), and how the queer in Queer relationships does or potentially can disrupt this link. And not just for Queers, but for Straight folk too, which is the primary point that should be underlined now and is addressed at the end of this paper. Because, embittered as I was at the time, I still basically agree with the theoretical position that I came to in that paper on love—based on a queering of the terms of Alain Badiou—where I affirmed that love resisted codification, especially in its queer form, because it is fidelity to an act and truth between two or more partners which resists the rigid walls of State-based codification (Potts, Love Hurts; Badiou, Ethics and Saint Paul). But as one of the peer reviewers for this paper rightly pointed out, the above distinctions between my ex and myself implicitly rely upon a State-centric model of rights and freedoms, which I attacked in the first paper, but which I freely admit I am guilty of utilising and arguing in favour of here. But that is because I am interested, here, not in talking about love as an abstract concept towards which we should work in our personal relationships, but as the state of things, and specifically the state of same-sex marriage and the discourse and images which surrounds it, which means that the State does matter. This is specifically so given the lack of meaningful challenges to the State System in Canada and the US. I maintain, following Butler, that it is through power, and our response to the representatives of power “hailing us,” that we become bodies that matter and subjects (Bodies That Matter; The Psychic Life of Power; and Giving An Account of Oneself). While her re-reading of Althusser in these texts argues that we should come to a philosophical and political position which challenges this State-based form of subject creation and power, she also notes that politically and philosophically we have yet to articulate such a position clearly, and I’d say that this is especially the case for what is covered and argued in the mainstream (media) debate on same-sex marriage. So apropos what is arguably Foucault’s most mature analysis of “power,” and while agreeing that my State-based argument for inclusion and rights does indeed strengthen the “biopolitical” (The History of Sexuality 140 and 145) control over, in this case, Queer populations, I argue that this is nonetheless the political reality with which we are working in and analyzing, and that is my concern here. Despite a personal desire that this not be the case, the State or state sanctioned institutions do continue to hold a monopoly of power in conferring subjecthood and rights. To take a page from Jeremy Bentham, I would say that arguing from a position which does not start from or seriously consider the State as the current basis for rights and subjecthood, though potentially less ethically problematic and more in line with my personal politics, is tantamount to talking and arguing about “nonsense on stilts.” “Caught in a Bad Romance?” Comparing Homonationalist Trajectories and the Appeal of Militarist Discourse to LGBT Grassroots Organisations In comparing the discourses and enframings of the debate over same-sex marriage between Canada in the mid 1990s and early 2000s and in the US today, one might presume that how it came to say “I do” in Canada and how it might or might not get “left at the altar” in the US, is the result of very different national cultures. But this would just subscribe to one of a number of “cultural explanations” for perceived differences between Canada and the US that are usually built upon straw-man comparisons which then pillorise the US for something or other. And in doing so it would continue an obscuration that Canada, unlike the US, is unproblematically open and accepting when it comes to multicultural, multiracial and multisexual diversity and inclusion. Which Canada isn’t nor has it ever been. When you look at the current discourse in both countries—by their key political representatives on the international stage—you find the opposite. In the US, you have President Barack Obama, the first sitting President to come out in favour of same-sex marriage, and the Secretary of State, Hillary Clinton, setting same-sex rights at home and abroad as key policy planks (Gay Rights are Human Rights). Meanwhile, in Canada, you have Prime Minister Stephen Harper, in office since 2006, openly support his Conservative Party’s “traditional marriage” policy which is thankfully made difficult to implement because of the courts, and John Baird, the badly closeted Minister of Foreign Affairs, who doesn’t mention same-sex rights at home or with respect to foreign relations—unless it is used as supplementary evidence to further other foreign policy goals (c.f. Seguin)—only showing off his sexuality outside of the press-gallery to drum up gay-conservative votes or gay-conservative fundraising at LGBTQ community events which his government is then apt to pull funding for (c.f. Bradshaw). Of course my point is not to just reverse the stereotypes, painting an idyllic picture of the US and a grim one of Canada. What I want to problematise is the supposed national cultural distinctions which are naturalised when arguments are made through them as to why same-sex marriage was legalised in Canada, while the Defense of Marriage Act still stands in the US. To follow and extend Jasbir Puar’s argument from Terrorist Assemblages, what we see in both same-sex marriage debates and discourses is really the same phenomenon, but, so far, with different outcomes and having different manifestations. Puar contends that same-sex rights, like most equalising rights for minority groups, are only granted when all three of the following conditions prevail: (1) in a state or narrative of exception, where the nation grants a minority group equal rights because “the nation” feels threatened from without; (2) only on the condition that normalisation (or homonormalisation in the case of the Queer community) occurs, with those who don’t conform pushed further from a place in the national-subject; (3) and that the price of admission into being the “allowed Queer” is an ultra-patriotic identification with the Nation. In Canada, the state or narrative of exception was an “attack” from within which resulted in the third criterion being downplayed (although it is still present). Court challenges in a number of provinces led in each case to a successful ruling in favour of legalising same-sex marriage. Appeals to these rulings made their way to the Supreme Court, who likewise ruled in favour of the legalisation of same-sex marriage. This ruling came with an order to the Canadian Parliament that it had to change the existing marriage laws and definition of marriage to make it inclusive of same-sex marriage. This “attack” was performed by the judiciary who have traditionally (c.f. Makin) been much less partisan in appointment or ruling than their counterparts in the US. When new marriage laws were proposed to take account of the direction made by the courts, the governing Liberal Party and then Prime Minister Paul Martin made it a “free vote” so members of his own party could vote against it if they chose. Although granted with only lacklustre support by the governing party, the Canadian LGBTQ community rejoiced and became less politically active, because we’d won, right? International Queers flocked to Canada—one in four same-sex weddings since legalisation in Canada have been to out of country residents (Postmedia News)—as long as they had the proper socioeconomic profile (which is also a racialised profile) to afford the trip and wedding. This caused a budding same-sex marriage tourism and queer love normalisation industry to be built around the Canada Queer experience because especially at the time of legalisation Canada was still one of the few countries to allow for same-sex marriages. What this all means is that homonationalism in Canada is much less charged. It manifests itself as fitting in and not just keeping up with the Joneses when it comes to things like community engagement and Parent Teacher Association (PTA) meetings, but trying to do them one better (although only by a bit so as not to offend). In essence, the comparatively bland process in the 1990s by which Canada slowly underwent a state of exception by a non-politically charged and non-radical professional judiciary simply interpreting the Canadian Charter of Rights and Freedoms at the provincial and then the federal level is mirrored in the rather bland and non-radical homonationalism which resulted. So unlike the US, the rhetoric of the LGBT community stays subdued unless there’s a hint that the right to same-sex divorce might get hit by Conservative Party guns, in which case all hell breaks loose (c.f. Ha). While the US is subject to the same set of logics for the currently in-progress enactment of legalising same-sex marriage, the state of exception is dramatically different. Puar argues it is the never-ending War on Terror. This also means that the enframings and debate in the US are exceptionally charged and political, leading to a very different type of homonationalism and homonationalist subject than is found in Canada. American homonationalism has not radically changed from Puar’s description, but due to leadership from the top (Obama, Clinton and Lady Gaga) the intensity and thereby structured confinement of what is an acceptable Queer-American subject has become increasingly rigid. What is included and given rights is the hyper-patriotic queer-soldier, the defender of the nation. And what reinforces the rigidity of what amounts to a new “glass closet” for queers is that grassroots organisations have bought into the same rhetoric, logic, and direction as to how to achieve equality as the Homecoming advertisement from the Equal Love Campaign in Britain shows. For the other long-leading nation engaged in the War on Terror narrative, Homecoming provides the imagery of a gay member of the armed services draped in the flag proposing to his partner at the end of duty overseas that ends with the following text: “All men can be heroes. All men can be husbands. End discrimination.” Can’t get more patriotic—and heteronormative with the use of the term “husbands”—than that. Well, unless you’re Lady Gaga. Now Lady Gaga stands out as a public figure whom has taken an explicitly pro-queer and pro-LGBT stance from the outset of her career. And I do not want to diminish the fact that she has been admirably effective in her campaigning and consistent pro-queer and pro-LGBT stance. While above I characterised her input above as leadership from the top, she also, in effect, by standing outside of State Power unlike Obama and Clinton, and being able to be critical of it, is able to push the State in a more progressive direction. This was most obviously evidenced in her very public criticism of the Democratic Party and President Obama for not moving quickly enough to adopt a more pro-queer and pro-LGBT stance after the 2008 election where such promises were made. So Lady Gaga plays a doubled role whereby she also acts as a spokesperson for the grassroots—some would call this co-opting, but that is not the charge made here as she has more accurately given her pre-existing spotlight and Twitter and Facebook presence over to progressive campaigns—and, given her large mainstream media appeal and willingness to use this space to argue for queer and LGBT rights, performs the function of a grassroots organisation by herself as far as the general public is concerned. And in her recent queer activism we see the same sort of discourse and images utilised as in Homecoming. Her work over the first term of Obama’s Presidency—what I’m going to call “The Lady Gaga Offensive”—is indicative: she literally and metaphorically wrapped herself in the American flag, screaming “Obama, ARE YOU LISTENING!!! Repeal ‘Don’t Ask, Don’t Tell’ and [have the homophobic soldiers] go home, go home, go home!” (Lady Gaga Rallies for Repeal of Don’t Ask, Don’t Tell). And presumably to the same home of otherness that is occupied by the terrorist or anything that falls under the blanket of “anti-American” in Puar’s critique of this approach to political activism. This speech was modelled on her highly successful one at the National Equality March in 2009, which she ended with “Bless God and Bless the Gays.” When the highly watched speeches are taken together you literally can’t top them for Americanness, unless it is by a piece of old-fashioned American apple-pie bought at a National Rifle Association (NRA) bake-sale. And is likely why, after Obama’s same-sex “evolution,” the pre-election ads put out by the Democratic Party this year focused so heavily on the repeal of “Don’t Ask, Don’t Tell” and the queer patriotic soldier or veteran’s obligation to or previous service in bearing arms for the country. Now if the goal is to get formal and legal equality quickly, then as a political strategy, to get people onside with same-sex marriage, and from that place to same-sex rights and equal social recognition and respect, this might be a good idea. Before, that is, moving on to a strategy that actually gets to the roots of social inequality and doesn’t rely on “hate of ‘the other’” which Puar’s analysis points out is both a byproduct of and rooted in the base of any nationalist based appeal for minoritarian rights. And I want to underline that I am here talking about what strategy seems to be appealing to people, as opposed to arguing an ethically unproblematic and PC position on equality that is completely inclusive of all forms of love. Because Lady Gaga’s flag-covered and pro-military scream was answered by Obama with the repeal of “Don’t Ask, Don’t Tell” and the extension of some benefits to same-sex couples, and has Obama referring to Gaga as “your leader” in the pre-election ads and elsewhere. So it isn’t really surprising to find mainstream LGBT organisations adopting the same discourse and images to get same-sex rights including marriage. One can also take recent poll numbers from Canada as indicative as well. While only 10 percent of Canadians have trust in political parties, and 17 and 16 percent have trust in Parliament and Prime Minister Harper respectively, a whopping 53 percent have trust in the Canadian Forces (Leblanc). One aspect that undergirds Puar’s argument is that especially at a "time of war," more than average levels of affection or trust is shown for those institutions that defend “us,” so that if the face of that institution is reinscribed to the look of the hyper-patriotic queer-soldier (by advertising of the Homecoming sort which is produced not by the State but by grassroots LGBT organisations), then it looks like these groups seem to be banking that support for Gays and Lesbians in general, and same-sex marriage in specific, will further rise if LGBT and Queer become substantively linked in the imagination of the general public with the armed forces. But as 1980s Rockers Heart Asked: “But There’s Something That You Forgot. What about Love?” What these two homonationalist trajectories and rhetorics on same-sex marriage entirely skip over is how exactly you can codify “love.” Because isn’t that the purpose of marriage? Saying you can codify it is like grasping at a perfectly measured and exact cubic foot of air and telling it to stay put in the middle of a hurricane. So to return to how I ended my earlier exploration of love and if it could or should be codified: it means that as I affirm love, and as I remain in fidelity to it, I subject myself in my fundamental weakness constantly to the "not-known;" to constant heartbreak; to affirmations which I cannot betray as it would be a betrayal of the truth process itself. It's as if at the very moment the Beatles say the words 'All you need is love' they were subjected to wrenching heartbreak and still went on: 'All you need is love...' (Love Hurts) Which is really depressing when I look back at it now. But it was a bad breakup, and I can tend to the morose in word choice and cultural references when depressed. But it also remains essentially my position. If you impose “till death or divorce do us part” on to love you’re really only just participating in the chimera of static love and giving second wind to a patriarchal institution which has had a crappy record when it comes to equality. It also has the potential to preserve asymmetrical roles “traditional marriage” contains from when the institution was only extended to straight couples. And isn’t equality the underlying philosophical principle and political position that we’re supposedly fighting for if we’re arguing for an equal right to get married? Again, it’s important to try and codify the same rights for everyone through the State at the present time because I honestly don’t see major changes confronting the nation state system in Canada or the US in the near future. We remain the play-children of a digitally entrenched form of Foucaultian biopower that is State and Capital directed. Because while the Occupy Wall Street movements got a lot of hay in the press, I’ve yet to see any substantive or mainstreamed political change come out of them—if someone can direct me to their substantive contribution to the recent US election I’d be happy to revise my position—which is likely to our long term detriment. So this is a pragmatic analysis, one of locating one node in the matrices of power relations, of seeing how mainstream LGBT political organisations and Lady Gaga are applying the “theoretical tool kits” given to us by Foucault and Puar, and seeing how these organisations and Gaga are applying them, but in this case in a way that is likely counter to authorial intention(s) and personal politics (Power/Knowledge 145, 193; Terrorist Assemblages). So what this means is that we’re likely to continue to see, in mainstream images of same-sex couples put out by grassroots LGBT organisations, a homonationalism and ideological construction that grows more and more out of touch with Queer realities—the “upper-class house-holding PTA Gay”; although on a positive note I should point out that the Democratic Party in the US seems to be at least including both white and non-white faces in their pre-election same-sex marriage ads—and one that most Queers don’t or can’t fit themselves into especially when it comes down to the economic aspect of that picture, which is contradictory and problematic (c.f. Christopher). It also means that in the US the homonationalism on the horizon looks the same as in Canada except with a healthy dose of paranoia of outsiders and “the other” and a flag draped membership in the NRA, that is, for when the queer super-soldier is not in uniform. It’s a straightjacket for a closet that is becoming smaller because it seeks, through the images projected, inclusion for only a smaller and smaller social sub-set of the Lesbian and Gay community and leaves out more and more of the Queer community than it was five years ago when Puar described it. So instead of trying to dunk the queer into the institution of patriarchy, why not, by showing how so many Queers, their relationships, and their loving styles don’t fit into these archetypes help give everyone, including my “marriage-chasing-Gay-normaliser” former self a little “queer eye, for all eyes.” To look at and see modern straight marriage through the lenses and reasons LGBT and Queer communities (by-and-large) fought for years for access to it: as the codification and breakdown of some rights and responsibilities (i.e. taking care of children); as an act which gives you straightforward access to health benefits and hospital visitation rights; as an easy social signifier for others of a commitment to another person that doesn’t use diluted language like “special friend;” and because when it comes down to it that “in sickness and in health” part of the vow—in the language of a queered Badiou, a vow can be read as the affirmation of a universal and disinterested truth (love) and a moment which can’t be erased retrospectively, say, by divorce—seems like a sincere way to value at least one of those you really care for in the world. And hopefully it, as a side-benefit, it acts as a reminder but is not the actuality of that first fuzzy feeling which (hopefully) doesn’t go away. But I learned my lesson the first time and know that the fuzzy feeling might disappear as it often does. It doesn’t matter how far we try and cram it into any variety of homonationalist closets, since it’ll always find a way to not be there, no matter how tight you thought you’d locked the door to keep it in for good if it wants out. Because you can’t keep emotions by contract: so at the end of the day the logical, ethical and theoretically sound position is to argue for the abolition of marriage as an institution. However, Plato and others have been making that argument for thousands of years, and it still doesn’t seem to have gained popular traction. And we also need to realise, contrary to the opinion of my former self and The Beatles, that you really do need more than love as fidelity to an event of you and your partner’s making when you are being denied your partners health benefits just because you are a same-sex couple, especially when those health benefits could be saving your life. And if same-sex marriage codification is a quick fix for that and similar issues for those who can fit into the State sanctioned same-sex marriage walls, which admittedly leaves some members of the Queer community who don’t overlap out, as part of an overall and more inclusive strategy that does include them then I’m in favour of it. That is, till the time comes that Straight and Queer can, over time and with a lot of mutual social learning, explore how to recognise and give equal rights with or without State based codification to the multiple queer and sometimes polyamorous relationship models that already populate the Gay and Straight worlds right now. So in the meantime continue to count me down as a “marriage-chasing-Gay.” But just pragmatically, not to normalise, as one of a diversity of political strategies for equality and just for now. References Badiou, Alain. Ethics: An Essay on the Understanding of Evil. New York: Verso, 2001. ———. Saint Paul: The Foundation of Universalism, Stanford: Stanford UP, 2003. Bradshaw, James. “Pride Toronto Denied Federal Funding.” The Globe and Mail. 7 May. 2012 ‹http://www.theglobeandmail.com/news/toronto/pride-toronto-denied-federal-funding/article1211065/›. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge,1990. ———. 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Collectives bring people and their concerns together. In the twenty-first century, this assembly happens across different material and virtual spaces that, together, establish connective layers of society. A kind of politics has emerged that seeks new forms of communication and expression and proposes new modes of (co)existence. Riots in the suburbs of metropolitan areas, the repair of a public village centre, railway workers’ strikes, green activists’ protests, songs in support of tsunami victims… These are some examples of collective actions that unite people and places. But very often these kinds of events and social practices take place and fade away too quickly without visible traces of becoming collectives. This article focuses on the contingent spaces that enable collective action and provide possibilities for “peripheral” concerns and communities to become public. The concept of “diasporas” is widened to permit discussion of how emerging (international) communities make their voices heard through political events. Some theoretical concepts will be illustrated, using two examples of collective action on 1 May 2009 that demonstrate different initiatives concerning the global (economic) crisis. Assembling Collectives and Affective Events Building a house/centre and singing for something: these are examples of practices that bring people and their ideals together in a collective action or event. This article discusses the different communities that evolve within spaces that enable collective action. These communities are formed not only on the basis of nationality, occupation, or race; elements of (temporal) membership are created out of a wide spectrum of affiliations and a sense of solidarity. Hinchliffe (13) argues that collective action can be seen as a collection of affects that link together disparate places and times, and thus the collective is a matter of considerable political interest. The emergent spaces of collective action publicise particular concerns that may connect already existing but (spatially) dispersed communities and diasporas. However, there is a need to discuss the affects, places, and temporalities that make the assemblage of new collectivities possible. The political potential of collective spaces needs careful elaboration in order that such initiatives may continue to grow without extending the influence of existing (capitalist) powers. Various communities connected “glocally” (locally and globally) can call new publics into existence, posing questions to politics which are not yet “of politics” (Thrift 3). Thus collective action can invent new connecting concerns and practices that catalyse (political) change in society. To understand the complex spatiality of collective action and community formations, it is crucial to look at processes of “affect”. Affects occur in society as “in-becoming” atmospheres and “imitation-suggestions” (Brennan 1-10) that stimulate concerns and motivate practices. The “imitation” can also be an invention that creatively binds existing know-how and experiences into a local-social context. Thinking about affects within the spaces of collective action provides a challenge to rethink what is referred to simply as the “social”. Massumi (228) argues that such affects are virtual expressions of the actually existing things that embody them; however, affects such as emotions and feelings are also autonomous to the degree that they exceed the particular body within which they are presently confined. The emerging bodies, or spaces, of collective action thus carry the potential to transform coexistence across both intellectual and physical boundaries, and communication technology has been instrumental in linking the affective spaces of collective action across both time and space. According to Thrift, the collision of different space-times very often provokes a “stutter” in social relations: the jolt which arises from new encounters, new connections, new ways of proceeding. But how can these turbulent spheres and trajectories of collective action be described and discussed? Here the mechanisms of “events” themselves need to be addressed. The “event” represents, abstractly, a spatio-temporal locus where different concerns and practices are encountered and negotiated. “Event” refers to an incoming, or emerging, object (agent) triggering, through various affective responses, new ideas and initiatives (Clark 33). In addition to revolutions or tsunamis, there are also smaller-scale events that change how people live and come together. In this sense, events can be understood to combine individual and social “bodies” within collective action and imaginations. As Appadurai has argued, the imagination is central to all forms of agency, is itself a social practice, and is the key component of our new global order (Appadurai 29-30). Flusty (7) argues that the production of the global is as present in our day-to-day thoughts and actions as it is in the mass movement of capital, information, and populations which means that there should be the potential to include more people in the democratic process (Whatmore). This process can be seen to be a defining characteristic of the term cosmopolitics which Thrift describes as: “one of the best hopes for changing our engagement with the political by simply acknowledging that there is more there” (Thrift 189). For many, these hopes are based on a new kind of telematic connectedness, in which tele- and digital communications represent the beginning of a global networked consciousness based on the continuous exchange of ideas, both cognitive and affective. Examples of Events and Collectives Taking Place on 1 May 2009 The first day in May is traditionally dedicated to working people, and there are many public gatherings to express solidarity with workers and left-wing (“red”) policy. Issues concerning work and various productions are complex, and recently the global economic crisis exposed some weaknesses in neoliberal capitalism. Different participatory/collective actions and spaces are formed to make some common concerns public at the same time in various locations. The two following examples are part of wider “ideoscapes” (official state ideologies and counter-ideologies) (see Appadurai) in action that help to illustrate both the workings of twenty-first century global capitalism and the translocal character of the public concern. EuroMayDay One alternative form of collective action is EuroMayDay, which has taken place on May 1 every year since 2001 in several cities across (mainly Western) Europe. For example, in 2006 a total of about 300,000 young demonstrators took part in EuroMayDay parades in 20 EU cities (Wikipedia). The purpose of this political action is “to fight against the widespread precarisation of youth and the discrimination of migrants in Europe and beyond: no borders, no workfare, no precarity!” (EuroMayDay). This manifesto indicates that the aim of the collective action is to direct public attention to the insecure conditions of immigrants and young people across Europe. These groups may be seen to constitute a kind of European “diasporic collective” in which the whole of Europe is figured as a “problem area” in which unemployment, displacement, and (possibly) destitution threaten millions of lives. In this emerging “glocality”, there is a common, and urgent, need to overcome the boundaries of exclusion. Here, the proposed collective body (EuroMayDay) is described as a process for action, thus inviting translocal public participation. The body has active nodes in (Western) Europe (Bremen, Dortmund, Geneva, Hamburg, Hanau, Lisbon, Lausanne, Malaga, Milan, Palermo, Tübingen, Zürich) and beyond (Tokyo, Toronto, Tsukuba). The collective process marks these cities on the map through a webpage offering contacts with each of the “nodes” in the network. On 1 May 2009, May Day events, or parades, took place in all the cities listed above. The “nodes” of the EuroMayDay process prepared posters and activities following some common lines, although collective action had to be performed locally in every city. By way of example, let’s look at how this collective action realised its potential in Berlin, Germany. The posters (EuroMayDay Berlin, "Call") articulate the oppressive and competitive power of capitalism which affects everyone, everyday, like a machine: it constitutes “the permanent crisis”. One’s actual or potential unemployment and/or immigrant status may cause insecurity about the future. There is also a focus on liminal or transitional time, and a call for a new collectivity to overcome oppressive forces from above that protect the interests of the State and the banks. EuroMayDay thus calls for the weaving together of different forms of resistance against a deeply embedded capitalist system and the bringing together of common concerns for the attention of the general public through the May Day parade. Another poster (EuroMayDay Berlin, "May"), depicting the May Day parade, centres around the word “KRISE?” (“crisis”). The poster ends with an optimistic call to action, expressing a desire to free capitalism from institutional oppression and recreate it in a more humanistic way. Together, these two posters represent fragments of the “ideoscope” informing the wider, collective process. In Berlin in 2009, thousands of people (mostly young) participated in the May Day parade (which started from the public square Bebelplatz), backed by a musical soundtrack (see Rudi). Some people also had posters in their hands, displaying slogans like: “For Human Rights”; “Class Struggle”; “Social Change Not Climate Change”; and “Make Capitalism a Thing of the Past”. Simultaneously, dozens of other similar parades were taking place across the cities of Europe, all bearing “accelerated affective hope” (Rosa) for political change and demanding justice in society. Unfortunately, the May Day parade in Berlin took a violent turn at night, when some demonstrators attacked police and set cars on fire. There were also clashes during demonstrations in Hamburg (Kirschbaum). The media blamed the clashes also on the economic recession and recently dashed hopes for change. The Berlin May Day parade event was covered on the EuroMayDay webpage and on television news. This collective action connected many people; some participated in the parade, and many more saw the clashes and burning cars on their screens. The destructive and critical force of the collective action brought attention to some of the problems associated with youth employment and immigration though, sadly, without offering any concrete proposals for a solution to the problem. The emotional character of the street marches, and later the street fighting, were arguably an important aspect of the collective action inasmuch as they demonstrated the potential for citizens to unite, translocally, around affective as well as material grief (a process that has been given dramatic expression in more recent times with events in Egypt, Libya, and Syria). Further, although the recent May Day events have achieved very little in terms of material results, the network remains active, and further initiatives are likely in the future. “Let’s Do It! My Estonia” On 1 May 2009, about 11,000 people participated in a public “thought-bee” in Estonia (located in north-eastern Europe in the region of the Baltic Sea) and (through the Estonian diaspora) abroad. The “thought-bee” can be understood as a civil society initiative designed to bring people together for discussion and problem-solving with regards to everyday social issues. The concept of the “bee” combines work with pleasure. The bee tradition was practised in old Estonian farming communities, when families in adjacent villages helped one another. Bees were often organised for autumn harvesting, and the intense, communal work was celebrated by offering participants food and drink. Similarly, during the Soviet era, on certain Saturdays there were organised days (obligatory) for collective working (e.g. to reconstruct sites or to pick up litter). Now the “bee” concept has become associated with brainstorming in small groups across the country as well as abroad. The number of participants in the May 1st thought-bee was relatively large, given that Estonia’s total population is only 1.4 million. The funding of the initiative combined public and private sources, e.g. Estonian Civil Society Foundation, the European Commission, and some companies. The information sheet, presented to participants of the May 1st thought-bee, explains the event’s purpose in this way: The main purpose of today’s thought-bee is to initiate as many actions as possible that can change life in Estonia for the better. My Estonia, our more enjoyable and more efficient society, will appear through smaller and bigger thoughts. In the thought-bee we think how to make life better for our own home-place... Let’s think together and do it! (Teeme Ära, "Teeme", translated from Estonian) The civil society event grew out of a collective action on 3 May 2008 to pick up and dispose of litter throughout Estonia. The thought-bee initiative was coordinated by volunteers. The emotional appeal to participate in the thought-bee event on May 1st was presented and circulated in newspapers, radio, television, Internet portals, and e-mails. Famous people called on residents to take part in the public discussion events. Some examples of arguments for the collective activity included the economic crisis, the need for new jobs, self-responsibility, environmental pressures, and the general need to learn and find communal solutions. The thought-bee initiative took place simultaneously in about 500 “thought-halls” all over Estonia and abroad. Small groups of people registered, chose main discussion topics (with many suggestions from organisers of the bee) and made their groups visible as nodes on the “initiative” webpage. Other people had the opportunity of reading several proposals from the various thought-halls and of joining as members of the public brainstorming event on 1 May. The virtual and living map of the halls presented them as (green) nodes with location, topics, members, and discussion leaders. Various sites such as schools, clubs, cultural centres, municipality buildings, and theatres became part of the multiple and synchronous “space-times” within the half-day thought-bee event. Participants in the thought-bee were asked to bring their own food to share and, in some municipalities, open concerts were held to celebrate the day. These practices indicate some continuity with the national tradition of bees, where work has always been combined with pleasure. Most “thought-halls” were located in towns and smaller local centres as well as on several Estonian islands. Moreover, these thought-halls provided for both as face-to-face and online encounters. Further, one English-speaking discussion group was organised in Tallinn so that non-Estonian speakers could also participate. However, the involvement of Russian-speaking people in the initiative remained rather limited. It is important to note that these embodied spaces of participation were also to be found outside of Estonia—in Brussels, Amsterdam, Toronto, Oslo, Stockholm, Helsinki, Copenhagen, Prague, Baltimore, New York, and San Diego—and, in this way, the Estonian diaspora was also given the opportunity to become involved in the collective action. Following the theories of Thrift and Clark cited at the beginning of this article, it is interesting to see an event in which simultaneously connected places, embodying multiple voices, becomes part of the communal present with a shared vision of the future. The conclusions of each thought-hall discussion group were recorded on video shortly after the event. These videos were made available on the “Let’s Do It! My Estonia” webpage. The most frequently addressed topics of the thought-bee (in order of importance) were: community activities and collaboration; entrepreneurship and new jobs; education, values; free time and sport; regional development; rural life; and the environment and nature conservation (PRAXIS). The participants of the collective action were aware of the importance of local as well as national initiatives as a catalyst for change. The initiative “Let’s Do It! My Estonia” continued after the events of May Day 2009; people discussed issues and suggested proposals through the “initiative” webpage and supported the continuation of the collective action (Teeme Ära, "Description"). Environmental concerns (e.g. planting trees, reducing noise, and packaging waste) appear as important elements in these imaginings along with associated other practices for the improvement of daily life. It is important to understand the thought-bee event as a part of an emerging collective action that started with a simple litter clean-up and grew, through various other successful local community initiatives, into shared visions for a better future predicated upon the principles of glocality and coexistence. The example indicates that (international) NGOs can apply, and also invent, radical information politics to change the terms of debate in a national context by providing a voice for groups and issues that would otherwise remain unheard and unseen (see also Atkinson and Scurrah 236-44). Conclusions The collective actions discussed above have created new publics and contingent spaces to bring additional questions and concerns into politics. In both cases, the potential of “the event” (as theorised in the introduction of this article) came to the foreground, creating an additional international layer of temporal connectivity between many existing social groups such as unemployed young people or members of a village union. These events were both an “outcome” of, and an attempt to change, the involuntary exclusion of certain “peripheral” groups within the melting pot that the European Union has become. As such, they may be thought of as extending the concept of “diasporas” to include emerging platforms of collective action that aim to make problematic issues visible and multiple voices heard across the wider public. This, in turn, illustrates the need to rethink diasporas in the context of the intensive de-territorialisation of human concerns, “space-times and movement-trajectories yet to (be)come” (Braziel and Mannur 18). Both the examples of collective action discussed here campaigned for “changing the world” through a one-day event and may thus be understood in terms of Rosa’s theory of “social acceleration” (Rosa). This theory shows how both to the “contraction of the present” and the general instability of contemporary life have given rise to a newly affective desire to improve life through an expression of the collective will. Such a tendency can clearly take on far more radical forms as has been recently demonstrated by the mass protests and revolts against autocratic ruling powers in Egypt, Libya, and Syria. In this article, however, cosmopolitics is better understood in terms of the particular skills (most evident in the Estonian case) and affective spheres that mobilised in suggestions to bring about local action and global change. Together, these examples of collective action are part of a wider “ideoscape” (Appadurai) trying to reduce the power of capitalism and of the state by encouraging alternative forms of collective action that are not bound up solely with earning money or serving the state as a “salient” citizen. However, it could be argued that “EuroMayDay” is ultimately a reactionary movement used to highlight the oppressive aspects of capitalism without offering clear alternatives. By contrast, “Let’s Do It! My Estonia” has facilitated interactive public discussion and the practice of local skills that have the power to improve everyday life and the environment in a material and quantifiable way. Such changes in collective action also illustrate the speed and “imitative capacity stimulating expressive interactions” that now characterise everyday life (Thrift). Crucially, both these collective events were achieved through rapid advances in communication technologies in recent times; this technology made it possible to spread know-how as well as feelings of solidarity and social contact across the world. Further research on these fascinating developments in g/local politics is clearly urgently needed to help us better understand the changes in collective action currently taking place. Acknowledgements This research was supported by Estonian Science Foundation grant SF0130008s07 and by the European Union through the European Regional Development Fund (Center of Excellence CECT). References Appadurai, Arjun. “Disjuncture and Difference in the Global Cultural Economy.” Theorizing Diaspora: A Reader. Ed. Jana Evans Braziel and Anita Mannur. Oxford: Blackwell, 2003. 25-48. Atkinson, Jeffrey, and Martin Scurrah. Globalizing Social Justice: The Role of Non-Governmental Organizations in Bringing about Social Change. 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