Exploring Preferences for Urban Greening in Association with Learning About Sustainability in a Museum-based Urban Ecology Exhibit

Sustainable urban design and planning is grounded in understanding complex interconnecting relationships between human and ecological processes (Alberti & Marzluff, 2004). While compulsory education may provide an introduction to this subject, supplementary means are necessary in order to support citizen knowledge, interest and understanding of these complex relationships. Informal learning settings, such as museums, create opportunities for lifelong learning (Falk and Dierking, 2010) and can introduce, incorporate and link urban sustainability issues to provide an accessible and engaging introduction to the subject. Sustainable responses to urban development point to the need for higher density neighbourhoods coupled with extensive urban tree canopy (Alberti & Marzluff, 2004). However, more research is needed to ascertain if these urban forms match the preferred settings of urban residents. A family science museum provides a unique setting to explore urban greening in residential settings and provides museum visitors with the opportunity to participate in social-science research

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis.

BACKGROUND:Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain. METHODS AND FINDINGS:This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3-54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration. CONCLUSIONS:We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain

Exploring Preferences for Urban Greening

Sustainable responses to urban development point to the need for higher density neighborhoods coupled with extensive urban tree canopy and greening. However, little research has been conducted with urban residents to ascertain if these urban forms match their preferred setting. This study sought to understand whether higher levels of greening could moderate preference for lower density residential settings when 212 participants rated images for preference. Each of the independent variables, greening and density, made a difference in preference: greener settings were more preferred than less green settings overall, and perceived density was marginally significant in relation to preference. A factor analysis resulted in the grouping of five neighborhood types distinguished by certain characteristics (e.g., greening, buffer, building form) which, together with the qualitative responses suggested insights for making higher density residential environments more preferred. We did not find a significant interaction between greening and perceived density in relation to preference, suggesting that greening does not moderate the density-preference relation

Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia

<p>Abstract</p> <p>Background</p> <p>Five cases of severe neutropenia (neutrophil counts < 0.5 per 10⁹cells/L) associated with exposure to cocaine and levamisole, an antihelimithic agent no longer available in Canada, were identified in Alberta in 2008. Alberta and British Columbia (BC) public health officials issued an advisory and urged health care professionals to report cases to public health. This paper presents the findings of the public health investigations.</p> <p>Methods</p> <p>Cases were identified prospectively through reporting by clinicians and a retrospective review of laboratory and medical examiners data from January 1, 2006 to March 31, 2009. Cases were categorized as confirmed, probable or suspect. Only the confirmed and probable cases are included in this paper.</p> <p>Results</p> <p>We compare cases of severe neutropenia associated with tainted cocaine (NATC) identified in Alberta and BC between January 1, 2008 to March 31, 2009. Of the 42 NATC cases: 23(55%) were from Alberta; 19(45%) were from British Columbia; 57% of these cases reported crack cocaine use (93% of those who identified type of cocaine used); 7% reported using cocaine powder; and the main route of cocaine administration was from smoking (72%). Fifty percent of the NATC cases had multiple episodes of neutropenia associated with cocaine use. Cases typically presented with bacterial/fungal infections and fever. One Alberta NATC case produced anti-neutrophil antibodies, and four were positive for anti-neutrophil cytoplasmic antibody (ANCA). Analysis of two crack pipes and one drug sample obtained from NATC cases confirmed the presence of both cocaine and levamisole. A further 18 cases were identified through the retrospective review of laboratory and medical examiner data in Alberta</p> <p>Interpretation</p> <p>Our findings support a link between neutropenia and levamisole tainted cocaine; particularly from smoking the crack form of cocaine. Some patients may be genetically predisposed to develop levamisole-related neutropenia. Awareness of the differential diagnosis will assist clinicians with case timely detection and appropriate management.</p

Comparing different methods of learning in the development of social accountability and CanMEDS roles in medical students

Abstract Objective: Medical students at the University of British Columbia undertake a population health course that aims to cultivate social accountability and CanMEDS roles. Students choose between Discussion Group Option (DGO), Community Service Learning Option (CSLO), or Self-Directed Project Option (SDPO). The objective of this study was to evaluate the effectiveness of these three different learning options in developing social accountability and CanMEDS roles in medical students. Methods: Expert consultation and literature review were undertaken to develop a self-report survey. Students who had completed the course from 2009 to 2013 were surveyed. The results were analyzed to evaluate differences between groups. Results: We recruited 168 participants with equal representation from each option. CSLO and SDPO students reported greater development of social accountability and CanMEDS roles from the course compared to DGO students. In addition, CSLO and SDPO students reported greater academic output and satisfaction from their experience. Conclusion: Students who participated in community-based or project-based learning reported significantly better acquisition of social accountability and CanMEDS roles compared to students who engaged in group discussion.  Résumé Objectif: Les étudiants en médecine de l’Université de la Colombie-Britannique suivent un cours sur la santé de la population qui vise à cultiver la responsabilité sociale et les rôles CanMEDS. Les étudiants choisissent entre l’option de discussion de groupe (DGO, de l’anglais), l’option d’apprentissage par l’engagement communautaire (CSLO, de l’anglais) ou l’option de projet autonome (SDPO, de l’anglais). L’objectif de cette étude était d’évaluer l’efficacité de ces trois options d’apprentissage différentes pour le développement de la responsabilité sociale et des rôles CanMEDS chez les étudiants en médecine. Méthodes: Des consultations d’experts et une revue de la littérature ont été entreprises afin de concevoir un sondage d’autodéclaration. Les étudiants ayant complété le cours de 2009 à 2013 ont été interrogés. Les résultats ont été analysés afin d’évaluer les différences entre les groupes. Résultats: Nous avons recruté 168 participants, avec une représentation égale pour chaque option. Les étudiants des groupes CSLO et SDPO ont déclaré plus de développement de leur sens de responsabilité sociale et des rôles CanMEDS à la suite du cours, en comparaison aux étudiants du groupe DGO. De plus, les étudiants des groupes CSLO et SDPO ont rapporté un plus grand nombre de réalisations scolaires et une meilleure satisfaction par rapport à leur expérience. Conclusion: Les étudiants qui ont participé à l’apprentissage par l’engagement communautaire ou par l’entremise d’un projet autonome ont rapporté une acquisition nettement meilleure de la responsabilité sociale et des rôles CanMEDS, en comparaison aux étudiants qui ont participé à une discussion de groupe.

Teaching across disciplines: a case study of a project-based short course to teach holistic coastal adaptation design

Climate change has led to the need for innovation in resilient infrastructure and the social policies which will support those. This requires greater interdisciplinary interactions and knowledge building among emerging professionals. This paper presents a case study of a pilot short course intended to immerse graduate students in the design of resilient infrastructure using place-based and interdisciplinary active team learning. This course helps graduate students bridge the gap between research and practice on the social science and engineering of resilient infrastructure for coastal adaptation. The intellectual framework for the course (the Adaptive Gradients Framework) provides a holistic evaluation of adaptation design proposals and was used to recognize the complexity of social, ecological and engineering aspects and varied social benefits. The course provides a model to move outside rigid boundaries of institutions and disciplines to begin to build, in both students and instructors, the ability to work more effectively on complex social-ecological-engineering problems. Finally, this paper presents a summary of lessons learned from this pilot short course

Awareness of Fentanyl Exposure and the Associated Overdose Risks Among People Who Inject Drugs in a Canadian Setting

Introduction and Aims: Illicitly-manufactured fentanyl continues to fuel the opioidoverdose crisis throughout the United States and Canada. However, little is known about factors associated with knowingly or unknowingly using fentanyl. Therefore, we sought to identify the prevalence and correlates of suspected/known and unknown exposure to fentanyl (excluding the prescribed one) among people who inject drugs (PWID), including associated overdose risks. &nbsp; Design and Methods: Data were derived from three prospective cohort studies of community-recruited people who use drugs in Vancouver, Canada in 2016–2017. Multivariable logistic regression was used to identify correlates of suspected/known exposure (i.e., urine drug screen positive [UDS+] and self-reporting past three-day exposure) and unknown exposure to fentanyl (i.e., UDS+ and self-reporting no past three day exposure), respectively. &nbsp; Results: Among 590 PWID, 296 (50.2%) tested positive for fentanyl. Of those, 143 (48.3%) had suspected/known and 153 (51.7%) had unknown exposure to fentanyl. In multivariable analyses, using supervised injection sites and possessing naloxone were associated with both suspected/known and unknown exposure (all p&lt;0.05). Injecting drugs alone (Adjusted Odds Ratio [AOR]: 3.26; 95% Confidence Interval [CI]: 1.72–6.16) was associated with known exposure, but not with unknown exposure. &nbsp; Discussion and Conclusions: We found a high prevalence of fentanyl exposure in our sample of PWID, with one half of those exposed consuming fentanyl unknowingly. While those exposed to fentanyl appeared more likely to utilize some overdose prevention services, PWID with suspected/known fentanyl exposure were more likely to inject alone, indicating a need for additional overdose prevention efforts for this group

Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort.

BACKGROUND & AIMS: Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID. METHODS: We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs. RESULTS: Of 4,114 individuals who met the inclusion criteria, most were male (n = 2,692, 65%), born before 1965 (n = 3,411, 83%) and were either recent (n = 875, 21%) or former PWID (n = 1,793, 44%). Opioid-agonist therapy (OAT) was received by 19% of PWID. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR 6.7; 95% CI 1.9-23.5) and former PWID (1.4/100 PYs; IRR 3.7; 95% CI 1.1-12.9) than non-PWID (0.3/100 PYs). Among recent PWID, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection. CONCLUSIONS: Population-level reinfection rates remain elevated after DAA therapy among PWID because of ongoing exposure risk. Engagement of PWID in harm-reduction and support services is needed to prevent reinfections. LAY SUMMARY: Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection

Pathways to Coastal Resiliency: The Adaptive Gradients Framework

Current and future climate-related coastal impacts such as catastrophic and repetitive flooding, hurricane intensity, and sea level rise necessitate a new approach to developing and managing coastal infrastructure. Traditional “hard” or “grey” engineering solutions are proving both expensive and inflexible in the face of a rapidly changing coastal environment. Hybrid solutions that incorporate natural, nature-based, structural, and non-structural features may better achieve a broad set of goals such as ecological enhancement, long-term adaptation, and social benefits, but broad consideration and uptake of these approaches has been slow. One barrier to the widespread implementation of hybrid solutions is the lack of a relatively quick but holistic evaluation framework that places these broader environmental and societal goals on equal footing with the more traditional goal of exposure reduction. To respond to this need, the Adaptive Gradients Framework was developed and pilot-tested as a qualitative, flexible, and collaborative process guide for organizations to understand, evaluate, and potentially select more diverse kinds of infrastructural responses. These responses would ideally include natural, nature-based, and regulatory/cultural approaches, as well as hybrid designs combining multiple approaches. It enables rapid expert review of project designs based on eight metrics called “gradients”, which include exposure reduction, cost efficiency, institutional capacity, ecological enhancement, adaptation over time, greenhouse gas reduction, participatory process, and social benefits. The framework was conceptualized and developed in three phases: relevant factors and barriers were collected from practitioners and experts by survey; these factors were ranked by importance and used to develop the initial framework; several case studies were iteratively evaluated using this technique; and the framework was finalized for implementation. The article presents the framework and a pilot test of its application, along with resources that would enable wider application of the framework by practitioners and theorists

Considerations for preparing a randomized population health intervention trial: lessons from a South African–Canadian partnership to improve the health of health workers

Background: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. Objective: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships. Design: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. Results: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. Conclusion: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge