“When in Rome…”: structural determinants impacting healthcare access, health outcomes, and well-being of South Asian older adults in Ontario using a multilingual qualitative approach

With the increase in international migration, the need for an equitable healthcare system in Canada is increasing. The current biomedical model of healthcare is constructed largely in the Eurocentric tradition of medicine, which often disregards the diverse health perspectives of Canada’s racialized immigrant older adults. As a result, current healthcare approaches (adopted in the US and Canada) fall short in addressing the health needs of a considerable segment of the population, impeding their ability to access healthcare services. This study aimed to identify and understand the structural and systemic factors that influence healthcare experiences and well-being among South Asian older adults in Ontario, addressing a significant gap in empirical and theoretical knowledge in the Canadian context. We conducted in-depth individual and dyadic interviews (n = 28) utilizing a descriptive multilingual cross-cultural qualitative approach. Through this research, participants expressed that their understanding of well-being does not align with that of their healthcare providers, resulting in unmet health needs. Our study uses an intersectional lens to demonstrate participants’ perceptions of virtual access to care and systemic factors, such as mandatory assimilation and whiteness as a taken-for-granted norm impacting the health and well-being of South Asian older adults. The findings of this research can offer valuable insights to healthcare providers and policymakers in developing culturally competent practices, guidelines, and training policies that effectively address the healthcare needs of the South Asian population in Canada

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Temporal Evolution of Volcanic Eruption, Fluvial Drainage Systems and Faulting on the Northwest Flank of Alba Patera as Revealed by Photogeological Mapping

Although Alba Patera is the largest volcano in aerial extent in the solar system (~6.8 km high and >1000 km in radius), the geologic processes responsible for shaping its exceedingly low-angle flanks remain poorly constrained. These flanks are covered in lava flows, valleys and both radial and annular grabens. Previous attempts, limited by the resolution of the satellite images, assume that the annular grabens formed during the terminal stage of volcanic development whereas surface water flow occurred in the early stage of volcanic construction. In this study, we analyze high-resolution CTX satellite images in conjunction with digital topographic data from MOLA. Our work reveals complex cross cutting relationships between faults, drainage network development and lava flows on the northwestern flank of Alba Patera. We observe a minimum of three generations of lava flows, three generations of drainage channels and three generations of faults. Mutual and successive cross-cutting relationships between drainage channels and faults indicate that the tectonic processes responsible for creating grabens on the volcano flank operated continuously and were coeval with drainage formation. The lava flows are observed to be the oldest geomorphic features and the third generation of faults as the youngest geomorphic features in our mapped region. Crater counting indicates that the surface within the mapped region is Amazonian in age. An analysis of the crater densities reveals a decline in crater densities from the south to the north section of the mapped region. This could be attributed to resurfacing in the north due to sediments deposited by northward flowing drainage channels. Crater counting age estimates for the south section yield a result of ~ 1.74 Ga, +/- 0.12 Ga and ~ 1.35 Ga, +/- 0.26 Ga for the north section. Hence, the younger age estimates of the northern surface could help further constrain the age of the drainage channels and faults on the northwest flank of Alba Patera

Healthcare Experiences of South Asian Older Adults in Canada: Aging well, Engagement, and Access

Background: Racial and ethnic disparities in healthcare have negative consequences for the health and quality of life of immigrants, while the lack of clarity in healthcare systems on how to best provide social and health services for these populations further exacerbates these disparities. With an increase in immigration and in the number of older adults in the Canadian demographic landscape, further research is necessary to understand the diverse ways through which racialized foreign-born older adults experience aging and how structural determinants impact their health and healthcare experience. Objectives: My research aims to (1) describe how foreign-born South Asian older adults define and conceptualize the notion of healthy aging, (2) examine South Asian-born older adults’ experiences and approaches to patient engagement and healthcare decision-making (3) identify and understand the structural determinants and systemic factors influencing the healthcare experiences and well-being of South Asian older adults in Canada. Methods: Employing a descriptive, multilingual, and cross-cultural qualitative approach, 47 South-Asian older adults (60+) were interviewed in a semi-structured format, in Hindi, Tamil, Punjabi, Urdu, Bangla, and English over Zoom. Interviews lasted an average of 84 minutes (min: 32, max: 120). I participated in 167 hours of online community events to support relationship building prior to the interviews. Results: This thesis demonstrates that South Asian older immigrants are a diverse and heterogeneous population and that their conception of healthy aging is strongly influenced by their country of origin. The findings show how racialized foreign-born older adults might provide distinctive perspectives on the aging process and on social theories of aging due to their simultaneous immersion in and belonging to global majority and global minority cultures. The findings also highlight the nuances of language and how miscommunication can arise even when patients and providers are conversing in the same language. Patient engagement and shared decision-making, including the desire for family involvement, are heavily influenced by both culture and gender. Additionally, perceptions of patients regarding the status of physicians can have a notable influence on patient engagement, leading to an increased tendency for patients to agree with healthcare providers’ approach to care. Lastly, this thesis demonstrates participants' perceptions of access to virtual and systemic factors, such as mandatory assimilation and whiteness as a taken-for-granted norm impacting the health and well-being of South Asian older adults

Temporal Evolution of Volcanic Eruption, Fluvial Drainage Systems and Faulting on the Northwest Flank of Alba Patera as Revealed by Photogeological Mapping

Although Alba Patera is the largest volcano in aerial extent in the solar system (~6.8 km high and >1000 km in radius), the geologic processes responsible for shaping its exceedingly low-angle flanks remain poorly constrained. These flanks are covered in lava flows, valleys and both radial and annular grabens. Previous attempts, limited by the resolution of the satellite images, assume that the annular grabens formed during the terminal stage of volcanic development whereas surface water flow occurred in the early stage of volcanic construction. In this study, we analyze high-resolution CTX satellite images in conjunction with digital topographic data from MOLA. Our work reveals complex cross cutting relationships between faults, drainage network development and lava flows on the northwestern flank of Alba Patera. We observe a minimum of three generations of lava flows, three generations of drainage channels and three generations of faults. Mutual and successive cross-cutting relationships between drainage channels and faults indicate that the tectonic processes responsible for creating grabens on the volcano flank operated continuously and were coeval with drainage formation. The lava flows are observed to be the oldest geomorphic features and the third generation of faults as the youngest geomorphic features in our mapped region. Crater counting indicates that the surface within the mapped region is Amazonian in age. An analysis of the crater densities reveals a decline in crater densities from the south to the north section of the mapped region. This could be attributed to resurfacing in the north due to sediments deposited by northward flowing drainage channels. Crater counting age estimates for the south section yield a result of ~ 1.74 Ga, +/- 0.12 Ga and ~ 1.35 Ga, +/- 0.26 Ga for the north section. Hence, the younger age estimates of the northern surface could help further constrain the age of the drainage channels and faults on the northwest flank of Alba Patera

Monitoring Rice Agriculture across Myanmar Using Time Series Sentinel-1 Assisted by Landsat-8 and PALSAR-2

Assessment and monitoring of rice agriculture over large areas has been limited by cloud cover, optical sensor spatial and temporal resolutions, and lack of systematic or open access radar. Dense time series of open access Sentinel-1 C-band data at moderate spatial resolution offers new opportunities for monitoring agriculture. This is especially pertinent in South and Southeast Asia where rice is critical to food security and mostly grown during the rainy seasons when high cloud cover is present. In this research application, time series Sentinel-1A Interferometric Wide images (632) were utilized to map rice extent, crop calendar, inundation, and cropping intensity across Myanmar. An updated (2015) land use land cover map fusing Sentinel-1, Landsat-8 OLI, and PALSAR-2 were integrated and classified using a randomforest algorithm. Time series phenological analyses of the dense Sentinel-1 data were then executed to assess rice information across all of Myanmar. The broad land use land cover map identified 186,701 km2 of cropland across Myanmar with mean out-of-sample kappa of over 90%. A phenological time series analysis refined the cropland class to create a rice mask by extrapolating unique indicators tied to the rice life cycle (dynamic range, inundation, growth stages) from the dense time series Sentinel-1 to map rice paddy characteristics in an automated approach. Analyses show that the harvested rice area was 6,652,111 ha with general (R2 = 0.78) agreement with government census statistics. The outcomes show strong ability to assess and monitor rice production at moderate scales over a large cloud-prone region. In countries such as Myanmar with large populations and governments dependent upon rice production, more robust and transparent monitoring and assessment tools can help support better decision making. These results indicate that systematic and open access Synthetic Aperture Radar (SAR) can help scale information required by food security initiatives and Monitoring, Reporting, and Verification programs

“Think positive and don’t die alone” - Foreign-born, South Asian older adults’ perceptions on healthy aging

South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults’ ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens

Mapping rice greenhouse gas emissions in the Red River Delta, Vietnam

Rice greenhouse gas (GHG) emissions in the Red River Delta, Vietnam, were mapped using multiscale satellite imagery and a processed-based biogeochemical model. Multiscale synthetic aperture radar (SAR) and optical imagery were fed into a random forest classifier using field observations and surveys as training data to map rice extent. Time series analysis then generated geospatial information on crop calendar, hydroperiod and cropping intensity to use as parameters for the denitrification–decomposition (DNDC) model to estimate emissions. Results show a 2015 rice extent of 583,470 ha with total harvested area of 1,078,783 ha and total methane emissions for the delta at 345.4 million kg CH4-C equivalent to 11.5 million tonnes CO2e (carbon dioxide equivalent). Satellite remote sensing was able to accurately map water management and improve model parameterization to understand the impacts of decisions such as irrigation practices, changes in GHG emissions, and mitigation initiatives. The approach described in this research provides a framework for using open-access SAR to derive maps of rice and landscape characteristics to drive process models like DNDC. These types of tools and approaches will support the next generation of monitoring, reporting, and verification (MRV) efforts to combat climate change and support robust and transparent policy decisions