A mixed-method study evaluating an innovative care model for rural patients undergoing outpatient breast surgery.

BACKGROUND: The Delta Oasis program was launched in New Brunswick in 2006 to offer patients from rural areas who were undergoing breast cancer surgery and their families 1 night of free accommodations and a postoperative consultation with an extramural nurse. We sought to investigate patient experiences with this program. METHODS: This mixed-method retrospective study took place from 2020 to 2022 and compared the preoperative anxiety and quality of recovery of program participants and control patients who were discharged home over 100 km from hospital. We conducted 2 × 2 analysis of variance to evaluate the effects of intervention group and surgery type. We conducted semistructured interviews with intervention participants, which we then thematically analyzed. Two patient partners were engaged during data synthesis to support the interpretation of results. RESULTS: We included 34 patients who participated in the program and 18 control patients. No statistically significant differences were found between treatment groups in preoperative anxiety and quality of recovery, regardless of surgery type. Thematic analysis of interviews with 17 intervention participants revealed that they were highly satisfied with the program and that the experience helped reduce stress and discomfort related to their surgery. INTERPRETATION: The Delta Oasis program is a cost-effective alternative to inpatient care after breast cancer surgery and is highly regarded by rural patients; expansion to other regions with the inclusion of additional low-risk surgeries could help address hospital capacity issues. This study contributes to our understanding of the patient experience with the Delta Oasis program and informs the development of similar programs elsewhere.

Enigmatic fossil plants with three-dimensional, arborescent-growth architecture from the earliest Carboniferous of New Brunswick, Canada.

The evolution of arborescence in Devonian plants, followed by their architectural radiation in the Carboniferous, is a transition fundamental to Earth-system processes and ecological development. However, this evolutionary transition in trees is based on preserved trunks, of which only a few known specimens possess crowns. We describe Mississippian-aged (Tournaisian) trees with a unique three-dimensional crown morphology from New Brunswick, Canada. The trees were preserved by earthquake-induced, catastrophic burial of lake-margin vegetation. The tree architecture consists of an unbranched, 16-cm-diameter trunk with compound leaves arranged in spirals of ∼13 and compressed into ∼14 cm of vertical trunk length. Compound leaves in the upper ∼0.75 m of the trunk measure >1.75 m in length and preserve alternately arranged secondary laterals beginning at 0.5 m from the trunk; the area below the trunk bears only persistent leaf bases. The principal specimen lacks either apical or basal sections, although an apex is preserved in another. Apically, the leaves become less relaxed toward horizontal and are borne straight at an acute angle at the crown. The compact leaf organization and leaf length created a crown volume of >20-30 m3. This growth strategy likely maximized light interception and reduced resource competition from groundcover. From their growth morphology, canopy size, and volume, we propose that these fossils represent the earliest evidence of arborescent subcanopy-tiering. Moreover, although systematically unresolved, this specimen shows that Early Carboniferous vegetation was more complex than realized, signaling that it was a time of experimental, possibly transitional and varied, growth architectures.

FIRST REPORTS OF LIGULA INTESTINALIS AND A SCHISTOCEPHALUS SP. INFECTING SMALL-BODIED FISH IN NEW BRUNSWICK, CANADA.

Morphological characteristics and DNA sequencing were used to identify plerocercoids of a Schistocephalus sp. infecting slimy sculpin (Cottus cognatus) from northern New Brunswick and plerocercoids of Ligula intestinalis infecting blacknose dace (Rhinichthys atratulus) in Fundy National Park (FNP, New Brunswick). To our knowledge, no previous publications documented either cestode from New Brunswick, Canada. Blacknose dace represent a new host record for L. intestinalis. Identifications were made based on the presence or absence of segmentation and sequencing partial nicotinamide adenine dinucleotide dehydrogenase subunit 1 (ND1; mitochondrial DNA) and/or partial cytochrome c oxidase subunit 1 (COI; mitochondrial DNA). Plerocercoids from blacknose dace in FNP were identified as Ligula intestinalis based on >99% nucleotide identity with COI for this species in the NCBI GenBank database. Plerocercoids in slimy sculpin from northern New Brunswick were identified as a Schistocephalus sp. based on high nucleotide identity with congenerics in the NCBI GenBank database. The absence of GenBank entries with sufficient high percent identity to our specimens, and potential species hybrids in this genus, prevents species-level identification of Schistocephalus sp. plerocercoids currently. The absence of previous documentation of these cestodes might reflect recent environmental change promoting the transmission of these parasites that can modulate host fish behavior, induce sterility of host fishes, and contribute to epizootics.

How energy benchmarking in healthcare facilities supports greenhouse gas emission reduction.

Energy benchmarking of Horizon Health Network's facilities has been the foundation of an energy management system for the health authority that has led to greenhouse gas emission reductions. Benchmarking energy consumption and appropriately understanding the true impact of energy consumption is the first step in setting target greenhouse gas emission reduction. ENERGY STAR® Portfolio Manager® is the benchmarking tool used by Service New Brunswick for all Government of New Brunswick owned buildings, including all 41 owned Horizon healthcare facilities. This web-based tracking tool then produces benchmarks which supports identification of energy conservation opportunities and efficiencies. Progress for energy conservation and efficiency measures can then be monitored and reported. Since 2013, this approach has supported 52,400 metric tonnes reduction in greenhouse gas emission from Horizon facilities.

Genomic characterization of coexisting anatoxin-producing and non-toxigenic Microcoleus subspecies in benthic mats from the Wolastoq, New Brunswick, Canada.

The presence of toxigenic benthic cyanobacteria in riverine ecosystems is an increasing concern around the world. In 2018, the death of three dogs along the Wolastoq (also known as the Saint John River) in New Brunswick, Canada, was attributed to anatoxin exposure after they ingested benthic microbial mats found along the shore. Here, we shotgun sequenced the DNA of 15 non-axenic cyanobacterial isolates derived from four anatoxin-containing benthic mat samples associated with the dog deaths. Anatoxins were produced by some of the isolates, but not all. We retrieved near-complete Microcoleus metagenome-assembled genomes (MAGs) from the isolates that are closely related to anatoxin-producing Microcoleus from the Cardrona River (New Zealand), although the Microcoleus MAGs from the Wolastoq varied in the presence/absence of the anatoxin-a biosynthesis cluster. Sequence similarity at the genomic level suggests that toxigenic and non-toxigenic Microcoleus MAGs from the Wolastoq belong to the same species but are separate subspecies. The toxigenic and nontoxic Wolastoq Microcoleus subspecies coexisted in the mat samples in similar relative abundance. Overall genomic comparisons revealed that toxigenic Microcoleus MAGs are longer and code for more accessory genes than their non-toxigenic relatives, suggesting a differential responsiveness to changing environments, stress conditions and nutrient availability.

Historical pesticide applications for the treatment of eastern spruce budworm infestations in New Brunswick.

Pesticides have been used in Canada since 1945 as part of large-scale aerial spray applications to control insect pests on forested lands. Some of the pesticides used historically were efficacious, nonselective, persistent, and have led to serious impacts on the environment. A well known, and extensively documented example is the large-scale aerial spray programs in New Brunswick, Canada. From 1952 to 1993, 97% of the 6.2 million ha of the forested lands of New Brunswick were treated with at least one application of one insecticide, the majority of which were applied to control outbreaks of eastern spruce budworm (Choristoneura fumiferana). The most well known insecticide was dichlorodiphenyltrichloroethane (DDT), applied from 1952 to 1968, which still persists in treated soils and adjacent water bodies, and caused the individual and cumulative ecosystem effects that can still be measured today. The insecticides that replaced DDT were nonpersistent and unlikely to be found today. However, during the years of application some of the insecticides were likely to have impacted local ecosystems to some degree. To aid future studies on the efficacy and environmental impact of these insecticides we created a digital spatial data set of known pesticide application in New Brunswick forestry from 1952 to 1993. The data set includes active ingredient, formulation, application rate, tank mix, aircraft type, and other ancillary information. The current version of the data is available on the New Brunswick Department of Natural Resources and Energy Development, GIS Open Data Page and in the supplemental material. Use of the data set for academic and educational purposes is encouraged, provided that both this data paper and the data source are properly cited; the Government of New Brunswick should be acknowledged as the data source (Open Government License http://www.snb.ca/e/2000/data-E.html).

Effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada.

OBJECTIVE: To assess the effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada. METHODS: All paediatric bilateral myringotomy and tube insertion cases from 1 July 2015 through 30 June 2021 were provided by New Brunswick Medicare. The numbers of otolaryngologists, cataract surgical procedures, total hip arthroplasties and thyroidectomies were collected to assess the availability of operating theatres and otolaryngologists. Negative binomial logarithmic regressions were used for analyses. RESULTS: Of the 5175 paediatric bilateral myringotomy and tube insertion cases that were included, the bilateral myringotomy and tube insertion rate significantly decreased by 2.9 times (p < 0.001) during the pandemic. Thyroidectomies, cataract surgical procedures and total hip arthroplasties did not significantly decrease. The number of otolaryngologists increased (20 vs 16-17). CONCLUSION: Paediatric bilateral myringotomy and tube insertion rates significantly decreased during the pandemic. This cannot be accounted for by reduced otolaryngologists or operating theatre availability. The paediatric bilateral myringotomy and tube insertion rate decrease is likely due to public health measures reducing the transmission of upper respiratory tract infections, resulting in fewer indications for paediatric bilateral myringotomy and tube insertion.

Timely access to primary care in New Brunswick: Variability across health regions.

OBJECTIVE: To examine the factors that influence variation in timely access to primary care across the different health regions in New Brunswick. DESIGN: Descriptive and comparative study of organizational practices in primary care practices based on speed of access. Data were collected from December 2019 to March 2020 using semistructured interviews conducted by telephone, in person, or online, according to participants' preferences. SETTING: New Brunswick. PARTICIPANTS: Participants were primary care providers. Two types of regions were targeted: those with a higher proportion of citizens with timely access to primary care (regions with faster access) and those with less timely access (regions with slower access). A sample of 27 participants was used. MAIN OUTCOME MEASURES: Organizational practices (ie, new technologies, team-based health services, performance measurement, method of appointment booking, and physician remuneration model) according to prevalence of timely access. RESULTS: Participants in regions with faster access measured their performance more often (45.5% vs 12.5%, P=.046), did not use mixed compensation models (0.0% vs 31.3%, P<.001), and managed more patients (average of 2157 patients vs 950, P=.025), compared with participants from regions with slower access. CONCLUSION: This study found that performance measurements and other organizational practices are favourably linked to timely access to primary care.

Nursing Home Residents' Use of Radiography in New Brunswick: A Case for Mobile Radiography?

Introduction: Identifying ways to eliminate unnecessary transfer of nursing home (NH) residents to hospitals provides an opportunity to improve outcomes and use scarce healthcare resources more efficiently. This study's goal was to better understand where NH residents access X-ray (XR) and computed tomography (CT) scans and to determine if there was a case for mobile radiography policies in New Brunswick. Methods: A retrospective analysis of all the visits to the emergency department (ED) and outpatient imaging departments in two hospitals in Saint John, New Brunswick, in 2020, that involved XR or CT investigations was conducted. Results: There were 521 visits by 311 unique NH residents and 920 investigations (688 XR and 232 CT scans). Most investigations were ordered in the ED (696 of 920; 75.6%; confidence interval: 72.8-78.3%). Of the NH residents who visited the ED and received either an XR or a CT scan, 33.2% received only XR imaging and were discharged back to the NH after a mean ED stay of 5.15 hours. Discussion: The pattern of NH residents' use of the ED for their imaging needs supports the creation of mobile XR policies to deliver more safe and efficient care in a Canadian medium population urban centre.

Anatoxins from benthic cyanobacteria responsible for dog mortalities in New Brunswick, Canada.

In July 2018 three dogs died after visiting the Wolastoq (Saint John River) near Fredericton, New Brunswick, in Atlantic Canada. All showed signs of toxicosis, and necropsies revealed non-specific pulmonary edema and multiple microscopic brain hemorrhages. Liquid chromatography-high-resolution mass spectrometry (LC-HRMS) analysis of vomitus and stomach contents as well as water and biota from the mortality sites confirmed the presence of anatoxins (ATXs), a class of potent neurotoxic alkaloids. The highest levels were measured in a dried benthic cyanobacterial mat that two of the dogs had been eating before falling ill and in a vomitus sample collected from one of the dogs. Concentrations of 357 and 785 mg/kg for anatoxin-a and dihydroanatoxin-a, respectively, were measured in the vomitus. Known anatoxin-producing species of Microcoleus were tentatively identified using microscopy and confirmed by 16S rRNA gene sequencing. The ATX synthetase gene, anaC, was detected in the samples and isolates. The pathology and experimental results confirmed the role of ATXs in these dog mortalities. Further research is required to understand drivers for toxic cyanobacteria in the Wolastoq and to develop methodology for assessing occurrence.

State of polycyclic aromatic hydrocarbon (PAH) contamination in the Saint John Harbour, New Brunswick, Canada.

This study examined the concentrations and compositions of polycyclic aromatic hydrocarbon (PAH) contaminants in the surficial sediments of the Saint John Harbour (SJH) and assessed PAH exposure to local aquatic biota. Our findings suggest that sedimentary PAH contamination is heterogeneous and widespread in the SJH, with several sites exceeding the Canadian and NOAA recommended guidelines for the protection of aquatic life. Despite high concentrations of PAHs at some sites, there was no indication that local nekton was affected. Lack of a biological response may be due in part to a low bioavailability of sedimentary PAHs, presence of confounding factors (e.g., trace metals), and/or adaptation of local wildlife to the historic PAH contamination in this region. Overall, although no indication of effects to wildlife was observed with the data collected in the present study, continued efforts should be made to remediate highly contaminated areas and reduce the prevalence of these compounds.

Exploration of how primary care models influence job satisfaction among primary care providers during the COVID-19 pandemic in New Brunswick: a descriptive and comparative study.

BACKGROUND: The COVID-19 pandemic has highlighted human resource gaps and physician shortages in healthcare systems in New Brunswick (NB), as evidenced by multiple healthcare service interruptions. In addition, the New Brunswick Health Council gathered data from citizens on the type of primary care models (i.e. physicians in solo practice, physicians in collaborative practice, and collaborative practice with physicians and nurse practitioners) they use as their usual place of care. To add to their survey's findings, our study aims to see how these different primary care models were associated with job satisfaction as reported by primary care providers. METHODS: In total, 120 primary care providers responded to an online survey about their primary care models and job satisfaction levels. We used IBM's "SPSS Statistics" software to run Chi-square and Fisher's exact tests to compare job satisfaction levels between variable groups to determine if there were statistically significant variations. RESULTS: Overall, 77% of participants declared being satisfied at work. The reported job satisfaction levels did not appear to be influenced by the primary care model. Participants reported similar job satisfaction levels regardless of if they practiced alone or in collaboration. Although 50% of primary care providers reported having symptoms of burnout and experienced a decline in job satisfaction during the COVID-19 pandemic, the primary care model was not associated with these experiences. Therefore, participants who reported burnout or a decline in job satisfaction were similar in all primary care models. Our study's results suggest that the autonomy to choose a preferred model was important, since 45.8% of participants reported choosing their primary care models, based on preference. Proximity to family and friends and balancing work and family emerged as critical factors that influence choosing a job and staying in that job. CONCLUSION: Primary care providers' staffing recruitment and retention strategies should include the factors reported as determinants in our study. Primary care models do not appear to influence job satisfaction levels, although having the autonomy to choose a preferred model was reported as highly important. Consequently, it may be counterproductive to impose specific primary care models if one aims to prioritize primary care providers' job satisfaction and wellness.

Reproductive ecology of muskellunge (Esox masquinongy), an introduced predator, in the lower Wolastoq/Saint John River, New Brunswick, Canada.

Introduced predators can have harmful top-down effects on their newly colonized system through competition with and direct predation on native species. Following an initial introduction of muskellunge in Lac Frontière, Québec in the 1970s at the headwaters of the Wolastoq/Saint John River, the species rapidly migrated downstream, expanding its range by ~500 km over ~20 years. Despite this expansive colonization and concern over possible threats to native species, little is known about the basic ecology of muskellunge in this system. The last downstream barrier is the hydroelectric facility, Mactaquac Generating Station (MGS), 150 km upstream of the sea. While there are no downstream fish passage facilities at MGS, adult muskellunge have been recorded downstream. In this study, muskellunge (n = 23) were surgically tagged with very-high-frequency (VHF) radio or combined acoustic radio telemetry (CART) tags and tracked over two spawning seasons. We sought to determine if there was a reproducing population downstream of MGS and tracked Tagged muskellunge over two spawning seasons. We tracked fish to locate and confirm spawning sites, and followed up with egg and/or juvenile sampling surveys. Tagged muskellunge (90%) moved upstream towards the MGS during the spawning period in each year (2016 and 2017), where they remained throughout the entire spawning period. No spawning or nursery sites were confirmed near MGS, but in 2016 three distinct spawning locations and six distinct nursery sites were confirmed 10-12 km downstream amongst a chain of flooded islands. In 2016, eggs, sac-fry and juveniles were collected and confirmed as muskellunge by genetic sequencing, providing the first empirical observation of successful spawning downstream of MGS.

Perceptions of Freshwater Algal Blooms, Causes and Health among New Brunswick Lakefront Property Owners.

Changes to water conditions due to eutrophication and climate change have resulted in the proliferation of algae blooms in freshwater and marine environments globally, including in Canadian lakes. We developed and administered an online survey to evaluate the awareness of these blooms and the perceptions of health risks in a sample of New Brunswick waterfront cottage and homeowners. The survey was distributed to lake and cottage associations in New Brunswick and was completed by 186 eligible respondents (18 years of age or older). Participants were asked about the water quality of their lake, awareness about algae blooms, sociodemographic and cottage characteristics, and to complete a self-rated measure of physical and mental health. While approximately 73% of participants reported that the quality of their lake water was good or very good, 41% indicated a concern about algae blooms. We found no differences in self-reported physical or mental health between those who were aware of algae blooms at their cottage and those who were not (p > 0.05). Participants expressed concerns about the impacts of algae blooms on the health of their pets, and wildlife. While climate change was the most frequently identified cause of algae blooms, there was substantial heterogeneity in the responses. In addition, the reporting of the presence and frequency of algae bloom varied between respondents who lived on the same lake. Taken together, the findings from our survey suggest that cottage owners in New Brunswick are aware and concerned about the impacts of algae blooms, however, there is a need to provide additional information to them about the occurrence and causes of these blooms.

NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada.

BACKGROUND: Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

Analyzing Communication Strategies Used in Long Term Care Facilities during the COVID-19 pandemic in New Brunswick, Canada.

PURPOSE: Effective communication is a key component to managing an event such as a global pandemic. In Canada, federal/provincial reports indicated that effective communication was a challenge in the early days of the COVID-19 pandemic. The purpose of this study was to examine the communication strategies used within long term care facilities in the Canadian province of New Brunswick. METHODS: Online surveys were used to collect data from administrators, staff, and individuals with family members living in long-term care facilities. RESULTS: The findings show an overall satisfaction with the information received by staff and families, however the frequency and format in which information was communicated were inconsistent. All participants indicated that too much information and poor quality information was a challenge. The importance of digital platforms to provide COVID-19 information was consistently identified as a successful communication strategy. CONCLUSION: The findings of this study reveal that the quantity and quality of information provided during the pandemic created challenges for administrators, staff, and families. This is in line with reports from Canadian provincial/federal reports on COVID-19 and long-term care. Recommendations have been made that would benefit the long-term care sector, not only for pandemics, but for communication in general.

Optimizing tuberculosis screening for immigrants in southern New Brunswick: A pilot study protocol.

INTRODUCTION: Immigrants from high tuberculosis-burdened countries have been shown to have an increased risk of latent tuberculosis infection (LTBI). To reduce the risk of increased tuberculosis cases in Canada, the country has a comprehensive immigration medical examination process that identifies individuals with active tuberculosis using chest X-ray; however, it fails to identify LTBI. The lack of LTBI identification is concerning because immigrants with LTBI are at an increased risk of developing active tuberculosis within their first few years of migration due to stressful experiences common to many immigrants. OBJECTIVES: The goal of this pilot study is to improve the current LTBI screening protocols among immigrants from high tuberculosis incidence countries and to better prevent and manage tuberculosis cases, by introducing an LTBI screening pilot program. The objectives are threefold: 1) to screen LTBI in immigrants from high tuberculosis incidence countries, including immigrants identified as being at risk of LTBI by the NB health care system, using the QuantiFERON-TB Gold Plus interferon-gamma release assay (IGRA); 2) to offer LTBI treatment and supports to those identified as having LTBI; and 3) to assess immigrant and health care providers (HCPs) satisfaction of the LTBI screening pilot program. METHODS: This cross-sectional study seeks to recruit 288 participants. Participants will be recruited via posters, social media platforms, invitations at immigrant wellness check-ups, presentations to local ethnocultural groups, and by snowball sampling. Consenting participants will be asked to submit a blood sample for LTBI screening; if positive, participants will be assessed and offered treatment for LTBI based on clinical assessment. Participants and HCPs' feedback will be gathered via short questionnaires. For the quantitative portion of the study, descriptive statistics will be used to summarize participant characteristics and feedback. Simultaneous logistic regression will be performed to identify variables associated with the IGRA test outcome and evidence of increased CD8 T-cell immune response among those found to be LTBI-positive. Qualitative results will be analyzed using inductive thematic analysis. DISCUSSION: The findings from this study will allow us to understand the role of the IGRA LTBI screening assay and its feasibility and acceptability by immigrants and HCPs in New Brunswick. The findings will additionally provide information on the enhancers and barriers of LTBI screening and management useful in determining how best to expand the LTBI screening program if deemed appropriate.

Quality indicator framework for primary care of patients with dementia.

OBJECTIVE: To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators. DESIGN: Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was carried out through a stakeholder survey. SETTING: Ontario, Quebec, New Brunswick, and Saskatchewan. PARTICIPANTS: Stakeholders in community dementia care (N=109) including clinicians, patients, caregivers, decision makers, and managers. MAIN OUTCOME MEASURES: Primary care quality indicators. RESULTS: The framework comprised 34 indicators across 8 domains of quality (access, integration, effective care, efficient care, equity, safety, population health, and patient-centred care). Access to a regular primary care provider, continuity of care, early-stage diagnosis, and access to home care were consistently rated as priorities. Equitable care was a specific priority among patients and caregivers; clinicians reported avoidable hospitalizations as among their priorities. CONCLUSION: A framework of indicators was established for persons with dementia that adds an important dimension to existing primary care and dementia quality indicators by providing primary care and population-based perspectives. This framework could set a foundation for the ongoing monitoring of primary care practices and policies for persons with dementia at a population level.

Regional impact of large-scale climate oscillations on ice out variability in New Brunswick and Maine.

The available ice out (the date of disappearance of ice from a water body) records were analyzed from four relatively closely spaced lakes in southwestern New Brunswick (Harvey, Oromocto, Skiff) and eastern Maine (West Grand Lake), with the longest set of available observations being for Oromocto Lake starting in 1876. Results of a coherence analysis carried out on the ice out data from the four lakes indicates that there is regional coherence and correspondingly, that regional drivers influence ice out. These results also indicate that ice out dates for lakes from the region where records have not been kept can also be interpolated from these results. As the ice out record was coherent, further analysis was done for only Oromocto Lake on the basis of it having the longest ice out record. Cross-wavelet analysis was carried out between the ice out record and a variety of cyclic climate teleconnections and the sunspot record to identify which phenomena best explain the observed ice out trends. The most important observed contributors to ice out were the North Atlantic Oscillation (NAO) and the El Niño Southern Oscillation (ENSO), with observed periodicities at the interannual scale. At the decadal scale the Pacific Decadal Oscillation (PDO) and the 11-year solar cycle were the only patterns observed to significantly contribute to ice out.

The Impact of Rural Hospital Closures and Health Service Restructuring on Provincial- and Community-Level Patterns of Hospital Admissions in New Brunswick.

In the early 2000s, the Province of New Brunswick, Canada, undertook health system restructuring, including closing some rural hospitals. We examined whether changes in geographic access to hospitals and primary care were associated with changes in patterns of hospital use. We described three measures of hospital use for ambulatory care sensitive conditions (ACSCs) among adults 75 years and younger annually during the period 2004-2013 overall, and at the community scale. We described spatial and temporal patterns in: age-standardized hospitalization rates, age-standardized incidence of hospital admissions, and rates of admissions via ambulance. Overall, rates and incidence of hospitalizations for ACSCs declined while admissions via ambulance remained largely unchanged. We observed considerable regional variation in rates between communities in 2004. This regional variation decreased over time, with rural areas demonstrating the sharpest declines. Changes in hospital service provision within individual communities had little impact on rates of ACSC admissions. Results were consistent across urban and rural communities and were robust to analyses that included older patients and those admitted for reasons other than ACSCs. Our results suggest that the restructuring and hospital closures did not result in substantial changes to regional patterns or rates of service use.