Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Virus in Seals, St. Lawrence Estuary, Quebec, Canada1.

We describe an unusual mortality event caused by a highly pathogenic avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b involving harbor (Phoca vitulina) and gray (Halichoerus grypus) seals in the St. Lawrence Estuary, Quebec, Canada, in 2022. Fifteen (56%) of the seals submitted for necropsy were considered to be fatally infected by HPAI H5N1 containing fully Eurasian or Eurasian/North American genome constellations. Concurrently, presence of large numbers of bird carcasses infected with HPAI H5N1 at seal haul-out sites most likely contributed to the spillover of infection to the seals. Histologic changes included meningoencephalitis (100%), fibrinosuppurative alveolitis, and multiorgan acute necrotizing inflammation. This report of fatal HPAI H5N1 infection in pinnipeds in Canada raises concerns about the expanding host of this virus, the potential for the establishment of a marine mammal reservoir, and the public health risks associated with spillover to mammals.Nous décrivons un événement de mortalité inhabituelle causé par un virus de l'influenza aviaire hautement pathogène A(H5N1) clade 2.3.4.4b chez des phoques communs (Phoca vitulina) et gris (Halichoerus grypus) dans l'estuaire du Saint-Laurent au Québec, Canada, en 2022. Quinze (56%) des phoques soumis pour nécropsie ont été considérés comme étant fatalement infectés par le virus H5N1 de lignées eurasiennes ou de réassortiment eurasiennes/nord-américaines. Un grand nombre simultané de carcasses d'oiseaux infectés par le H5N1 sur les sites d'échouement a probablement contribué à la contamination de ces phoques. Les changements histologiques associés à cette infection incluaient : méningo-encéphalite (100%), alvéolite fibrinosuppurée et inflammation nécrosante aiguë multi-organique. Cette documentation soulève des préoccupations quant à l'émergence de virus mortels, à la possibilité d'établissement de réservoirs chez les mammifères marins, et aux risques pour la santé publique associés aux propagations du virus chez les mammifères.

Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics.

PURPOSE: This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS: This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS: We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION: Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.

Évaluation de la structure factorielle et des qualités psychométriques de l'Échelle de Fatigue Pandémique parmi la population adulte québécoise: Evaluation of the factorial structure and psychometric qualities of the Pandemic Fatigue Scale among Quebec adult population.

OBJECTIVE: The objective of the study is to evaluate the factorial structure and the psychometric qualities of the Pandemic Fatigue Scale among the Quebec adult population. METHOD: The data analyzed come from a web survey conducted in October 2021 among 10 368 adults residing in Quebec. The scale's factor structure and invariance by gender, age and language used to complete the questionnaire were tested using confirmatory factor analyses. Convergent and divergent validity were also assessed. Finally, the reliability of the scale was estimated from the alpha and omega coefficients. RESULTS: The analyzes suggest the presence of a bidimensional structure in the sample of Quebec adults with informational fatigue and behavioral fatigue. The invariance of the measure is noted for sex, for age subgroups and for the language used for the questionnaire. The results of convergent and divergent validity provide additional evidence for the validity of the scale. Finally, the reliability of the scale scores is excellent. CONCLUSION: The results support the presence of a bidimensional structure as in the initial work of Lilleholt et al. They also confirm that the scale has good psychometric qualities and that it can be used among the adult population of Quebec.

Year-round monitoring of three water sources in Québec, Canada, reveals site-specific differences in conditions for Cryptosporidium and Giardia contamination.

Cryptosporidium and Giardia are protozoan parasites responsible for gastrointestinal illnesses in humans and in animal species. The main way these parasites are transmitted is by ingestion of their (oo)cysts in drinking water. Monitoring (oo)cysts in water sources is beneficial to evaluate the quality of raw water supplying treatment plants. Currently, the only standardized protocol to enumerate these parasites from water samples is United States Environmental Protection Agency (USEPA) Method 1623.1. With this method, we monitored three major water sources in Quebec over a year to assess temporal and geographical variations of these parasite (oo)cysts. These three water sources have independent watersheds despite being in the same region. We found a general pattern for Giardia, with high concentrations of cysts during cold and transition periods, and significantly lower concentrations during the warm period. Cryptosporidium's concentration was more variable throughout the year. Statistical correlations (Pearson's correlation coefficients) were established between the concentration of each parasite and various environmental parameters. The three study sites each showed unique factors correlating with the presence of both protozoa, supporting the idea that each water source must be seen as a unique entity with its own particular characteristics and therefore, must be monitored independently. Although some environmental parameters could be interesting proxies to the parasitic load, no parameter was strongly correlated throughout the whole sampling year and none of the parameters could be used as a single proxy for all three studies sources.

How older adults manage misinformation and information overload - A qualitative study.

BACKGROUND: The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19. METHODS: A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis. RESULTS: Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information. CONCLUSIONS: This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.

Production and use of rapid responses during the COVID-19 pandemic in Quebec (Canada): perspectives from evidence synthesis producers and decision makers.

BACKGROUND: The COVID-19 pandemic has required evidence to be made available more rapidly than usual, in order to meet the needs of decision makers in a timely manner. These exceptional circumstances have caused significant challenges for organizations and teams responsible for evidence synthesis. They had to adapt to provide rapid responses to support decision-making. This study aimed to document (1) the challenges and adaptations made to produce rapid responses during the pandemic, (2) their perceived usefulness, reported use and factors influencing their use and (3) the methodological adaptations made to produce rapid responses. METHODS: A qualitative study was conducted in 2021 with eight organizations in the health and social services system in Quebec (Canada), including three institutes with a provincial mandate. Data collection included focus groups (n = 9 groups in 8 organizations with 64 participants), interviews with decision makers (n = 12), and a document analysis of COVID-19 rapid responses (n = 128). A thematic analysis of qualitative data (objectives 1 and 2) and a descriptive analysis of documents (objective 3) were conducted. RESULTS: The results highlight the teams and organizations' agility to deal with the many challenges encountered during the pandemic (e.g., increased their workloads, adoption of new technological tools or work processes, improved collaboration, development of scientific monitoring, adaptation of evidence synthesis methodologies and products). The challenge of balancing rigor and speed was reported by teams and organizations. When available at the right time, rapid responses have been reported as a useful tool for informing or justifying decisions in a context of uncertainty. Several factors that may influence their use were identified (e.g., clearly identify needs, interactions with producers, perceived rigor and credibility, precise and feasible recommendations). Certain trends in the methodological approaches used to speed up the evidence synthesis process were identified. CONCLUSIONS: This study documented rapid responses producers' experiences during the COVID-19 pandemic in Quebec, and decision makers who requested, consulted, or used these products. Potential areas of improvements are identified such as reinforce coordination, improve communication loops, clarify guidelines or methodological benchmarks, and enhance utility of rapid response products for decision makers.

Alouette-R normative data for French-speaking school-aged children living in Quebec.

BACKGROUND: The Alouette-R (2005) by Lefavrais is one of the most widely used tools to assess reading skills in French. However, this instrument does not have normative data specific to the French-speaking population of Quebec, Canada. AIMS: The validity of an assessment being strongly compromised when using inappropriate norms, the first objective of this study was to establish local norms for the Alouette-R. The second objective was to provide sensitivity and specificity data for each Alouette-R measure in the French-speaking Quebec population. The third objective was to compare Quebec and French normative data and their sensitivity to better understand the applicability and effectiveness of the Alouette-R test at the regional level. METHODS & PROCEDURES: A total of 347 fluent readers and 48 children with dyslexia from 3rd to 6th grades were recruited from different regions in Quebec. Participants had to read aloud the 265-word text of the Alouette-R in a maximum of 3 min. OUTCOMES & RESULTS: Norms (means, standard deviations and percentiles) by school grades were created for each test measure: reading time, number of words read, number of errors, number of words correctly read, reading accuracy index and reading fluency index. The sensitivity (i.e., the ability to correctly identify children with dyslexia) and specificity (i.e., the ability to correctly identify children without dyslexia) of these measurements were also documented. The norms and their sensitivity were then compared with those of the original French study by Lefavrais in 2005. CONCLUSIONS & IMPLICATIONS: The presence of differences between European and Quebec norms supports the importance of using local norms when assessing language skills. The reading accuracy and fluency indexes are the measurements that best discriminated children with dyslexia from those without a reading disorder in our study. This study will allow clinicians working in Quebec to have a better interpretation of the Alouette-R measurements and ultimately avoid erroneous conclusions resulting from the use of foreign normative data. WHAT THIS PAPER ADDS: What is already known on this subject The Alouette-R is a reading test validated and standardized in France to screen for dyslexia in children. The validity of existing norms with the Quebec population in Canada is questionable due to socio-linguistic differences with the population of France. What this study adds to existing knowledge This study provides for the first time normative and sensitivity/specificity data of the Alouette-R for French-speaking school-aged children living in Quebec. Differences were noted with the normative data from France, which supports the importance of using local normative data when administering reading tests in Quebec. What are the potential or actual clinical implications of this work? When administering the Alouette-R, clinicians in Quebec will now be able to use normative data adapted to the local population, which will limit erroneous conclusions resulting from the use of foreign normative data. In addition, the sensitivity and specificity values reported in the article will allow these clinicians to better interpret their results when screening for a developmental reading disorder.

Influenza A(H5N1) Virus Infections in 2 Free-Ranging Black Bears (Ursus americanus), Quebec, Canada.

Wholly Eurasian highly pathogenic avian influenza H5N1 clade 2.3.4.4b virus was isolated from 2 free-ranging black bears with meningoencephalitis in Quebec, Canada. We found that isolates from both animals had the D701N mutation in the polymerase basic 2 gene, previously known to promote adaptation of H5N1 viruses to mammal hosts.

Mapping the abundance of endemic mosquito-borne diseases vectors in southern Quebec.

BACKGROUND: Climate change is increasing the dispersion of mosquitoes and the spread of viruses of which some mosquitoes are the main vectors. In Quebec, the surveillance and management of endemic mosquito-borne diseases, such as West Nile virus or Eastern equine encephalitis, could be improved by mapping the areas of risk supporting vector populations. However, there is currently no active tool tailored to Quebec that can predict mosquito population abundances, and we propose, with this work, to help fill this gap. METHODS: Four species of mosquitos were studied in this project for the period from 2003 to 2016 for the southern part of the province of Quebec: Aedes vexans (VEX), Coquillettidia perturbans (CQP), Culex pipiens-restuans group (CPR) and Ochlerotatus stimulans group (SMG) species. We used a negative binomial regression approach, including a spatial component, to model the abundances of each species or species group as a function of meteorological and land-cover variables. We tested several sets of variables combination, regional and local scale variables for landcover and different lag period for the day of capture for weather variables, to finally select one best model for each species. RESULTS: Models selected showed the importance of the spatial component, independently of the environmental variables, at the larger spatial scale. In these models, the most important land-cover predictors that favored CQP and VEX were 'forest', and 'agriculture' (for VEX only). Land-cover 'urban' had negative impact on SMG and CQP. The weather conditions on the trapping day and previous weather conditions summarized over 30 or 90 days were preferred over a shorter period of seven days, suggesting current and long-term previous weather conditions effects on mosquito abundance. CONCLUSIONS: The strength of the spatial component highlights the difficulties in modelling the abundance of mosquito species and the model selection shows the importance of selecting the right environmental predictors, especially when choosing the temporal and spatial scale of these variables. Climate and landscape variables were important for each species or species group, suggesting it is possible to consider their use in predicting long-term spatial variationsin the abundance of mosquitoes potentially harmful to public health in southern Quebec.

Laboratory Features of Trichinellosis and Eosinophilia Threshold for Testing, Nunavik, Quebec, Canada, 2009-2019.

Prolonged eosinophilia is characteristic of trichinellosis. To determine the optimal eosinophil threshold for reflex Trichinella testing, we examined all 43 cases in Nunavik, Quebec, Canada, during 2009-2019. Using receiver operating characteristic analysis, we determined that eosinophil counts >0.8 × 109 cells/L should prompt consideration of trichinellosis and testing to rapidly identify potential outbreaks.

Network-building by community actors to develop capacities for coproduction of health services following reforms: A case study.

INTRODUCTION: Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider-led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alternate view, exploring how, in a period following reforms, community actors forge network alliances to (re)gain legitimacy and capacities to coproduce health services with system providers. METHODS: A longitudinal case study traced the network-building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group's meetings and activities, documents circulated within and by the group, and semi-directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor-network theory. RESULTS: Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes. CONCLUSION: Network-building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of 'organizational infrastructure'. PATIENT OR PUBLIC CONTRIBUTION: The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.

First Report of Powdery Mildew Caused by Golovinomyces ambrosiae on Cannabis sativa L. (marijuana) in Quebec, Canada.

Marijuana (Cannabis sativa L.) is legal in Canada for medical and recreational purposes and is currently a multi-million-dollar industry. The province of Quebec follows British Columbia and Ontario in production acreage (Government of Canada 2018). During the growing season 2020-2021, five greenhouse growers throughout Quebec reported the presence of signs and symptoms reminiscent of powdery mildew including the presence of white powdery patches on the adaxial sides of leaves of several C. sativa cultivars. From one commercial facility, infected leaves of three cannabis cultivars (Sour Diesel, Orange Krush, and Lemon Sour) were photographed and the fungal mycelium was collected for identification in the laboratory. Fungal mycelium on leaf tissue was white and amphigenous and displayed unbranched hyaline conidiophores ranging from 130 to 275 µm in height (n = 50). Conidiophores arose from the upper surface of hyphal mother cells ranging from 35-70 × 8-13 µm in diameter (n = 25) and formed catenescent conidia. Conidia were broad ellipsoid-ovoid and measured, 24 to 35 × 12 to 19 µm (n = 50), and hyphae ranged from 3-8 µm in diameter (n = 30). Based on previous description (Qiu et al. 2020), the fungus was placed within the Golovinomyces genus. The species identification was confirmed through multi-locus phylogenetic using internal transcribed spacer (ITS), 28S large ribosomal subunit, and chitin synthase I (CHS1) genes amplified as recommended (Qiu et al. 2020), and directly sequenced with amplification primers (Centre Hospitalier de l'Université Laval de Quebec, CA). The three marker sequences shared 100% similarity for all the samples analyzed and were deposited in Genbank under accession numbers: OM131434 (28S), OM131448 (ITS), and OM141118 (CHS1). The phylogenetic analysis of the multi-locus sequences amplified grouped all three Quebec marijuana isolates in the G. ambrosiae accessions, confirming their identification. Pathogenicity was confirmed by transferring conidia onto detached healthy leaves of hop plants (Humulus lupulus) cultivar Northern Brewer kept under greenhouse conditions (28C, 50-60% relative humidity, and 14 h light) via paint brush inoculation. Hop leaves were used as surrogate due to the restricted availability of marijuana leaves. Inoculated leaves were placed in the growth chamber set at 20C, 50-60% relative humidity, and long days conditions as previously suggested (Weldon et al. 2020). The leaves developed powdery mildew colonies after 21 days, and the fungus was confirmed to be G. ambrosiae following morphological characterization and amplification of CHS1. Powdery mildew caused by G. ambrosiae (previous Golovinomyces cichoracearum) has been reported affecting hemp (Cannabis sativa) in New York and Oregon, United Sates (Weldon et al. 2020; Wiseman et al. 2021), and in British Columbia, Canada (Pépin et al. 2018; Punja et al. 2021), and this is the first report of G. ambrosiae causing powdery mildew on marijuana in Quebec. REFERENCES Government of Canada 2018. Online, retrieved January 7, 2021 https://www150.statcan.gc.ca/n1/daily-quotidien/180430/dq180430b-eng.htm Pépin N, Punja ZK, Joly DL. 2018. First report of powdery mildew caused by Golovinomyces cichoracearum sensu lato on Cannabis satia in Canada. Plant Disease. 102(12):2644. Doi: https://doi.org/10.1094/PDIS-04-18-0586-PDN Punja, Z. P. (2021). First report of the powdery mildew pathogen of hops, Podosphaeria macularis, naturally infecting cannabis (Cannabis sativa L., marijuana) plants under field conditions, Canadian Journal of Plant Pathology, Doi: https://doi.org/10.1080/07060661.2021.1960424. Qiu, P.-L., Liu, S.-Y., Bradshaw, M., Rooney-Latham, S., Takamatsu, S., Bulgakov, T. S., Tang, S.-R., Feng, J., Jin, D.-N., Aroge, T., Li, Y., Wang, L.-L., and Braun, U. 2020. Multi-locus phylogeny and taxonomy of an unresolved, heterogeneous species complex within the genus Golovinomyces (Ascomycota, Erysiphales), including G. ambrosiae, G. circumfusus and G. spadiceus. BMC Microbiology. 20:51. Doi : https://doi.org/10.1186/s12866-020-01731-9. Weldon WA, Ullrich MR, Smart LB, Smart CD, Gadoury DM. 2020. Cross-infectivity of powdery mildew isolates originating from hemp (Cannabis sativa) and Japanese hop (Humulus japonicus) in New York. Plant Health Progress. 21(1):47-53. Doi: https://doi.org/10.1094/PHP-09-19-0067-RS Wiseman, M. S., Bates, T. A., Garfinkel, A. R., Ocamb, C. M., and Gent, D. H. 2021. First Report of Powdery Mildew Caused by Golovinomyces ambrosiae on Cannabis sativa in Oregon. Plant Disease 105(9):2733. Doi: https://doi.org/10.1094/PDIS-11-20-2455-PDN.

Blowing the whistle during the first wave of COVID-19: A case study of Quebec nurses.

The experiences of nurses who blew the whistle during the COVID-19 pandemic have exposed gaps and revealed an urgent need to revisit our understanding of whistleblowing. AIM: The aim was to develop a better understanding of whistleblowing during a pandemic by using the experiences and lessons learned of Quebec nurses who blew the whistle during the first wave of COVID-19 as a case study. More specifically, to explore why and how nurses blew the whistle, what types of wrongdoing triggered their decision to do so and how context shaped the whistleblowing process as well as its consequences (including perceived consequences). DESIGN: The study followed a single-case study design with three embedded units of analysis. METHODS: We used content analysis to analyse 83 news stories and 597 forms posted on a whistleblowing online platform. We also conducted 15 semi-structured interviews with nurses and analysed this data using a thematic analysis approach. Finally, we triangulated the findings. RESULTS: We identified five themes across the case study. (1) During the first wave of COVID-19, Quebec nurses experienced a shifting sense of loyalty and relationship to workplace culture. (2) They witnessed exceedingly high numbers of intersecting wrongdoings amplified by mismanagement and long-standing issues. (3) They reported a lack of trust and transparency; thus, a need for external whistleblowing. (4) They used whistleblowing to reclaim their rights (notably, the right to speak) and build collective solidarity. (5) Finally, they saw whistleblowing as an act of moral courage in the face of a system in crisis. Together, these themes elucidate why and how nurse whistleblowing is different in pandemic times. CONCLUSION: Our findings offer a more nuanced understanding of nurse whistleblowing and address important gaps in knowledge. They also highlight the need to rethink external whistleblowing, develop whistleblowing tools and advocate for whistleblowing protection. IMPACT: In many ways, the COVID-19 pandemic has challenged our foundational understanding of whistleblowing and, as a result, it has limited the usefulness of existing literature on the topic for reasons that will be brought to light in this paper. We believe that studying the uniqueness of whistleblowing during a pandemic can address this gap by describing why and how health care workers blow the whistle during a pandemic and situating this experience within a broader social, political, organizational context.

Revisiting the Acquisition of Onset Complexity: Affrication in Québec French.

I investigate the acquisition of affrication in Québec French (QF), where affricates are in complementary distribution with coronal stops, being realized before high front vowels and glides. Previous research on other languages shows that affricates are acquired before branching onsets, which supports the idea that complexity at the level of the segment is acquired before complexity at the level of the syllable (Lleó & Prinz, 1997). In contrast, I hypothesize that affricates are acquired after branching onsets in QF, as learners are required to understand the constraints on their distribution. I examine longitudinal data from two QF-speaking children for whom the acquisition of branching onsets has been previously analyzed (Rose, 2000). Results show that affricates are indeed acquired after branching onsets, consistent with the hypothesis. Overapplication errors indicate that children make generalizations about the phonological constraints on affrication from an early age, which is expected for the acquisition of rules.

An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists.

OBJECTIVES: Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada. METHODS: The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data. RESULTS: Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities. CONCLUSIONS: A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.

Word structure and consonant interaction in a French-speaking child with protracted phonological development.

This paper presents data from a Québec French-speaking child with protracted phonological development (PPD) who received phonological intervention based on a nonlinear phonological framework. At 5;3, he showed relative strengths in word structure compared with consonants (e.g., /s, f, v, k, É¡/). Addressing segmental constraints in intervention led to higher overall accuracy and more consistent production of singleton consonants and word-medial consonant sequences and further gains in word structure. As part of a special cross-linguistic issue on individual profiles in PPD, the current paper provides an in-depth pre/post-treatment phonological analysis and contributes to emerging normative French-Canadian data on assessment and treatment.

Voyager pour apprendre : les Canadiens reçus docteurs en médecine à Paris au XIXe siècle.

Thirteen Canadians obtained a doctoral degree from the Faculty of Medicine of Paris between 1822 and 1905. Their studies in France played a decisive role in some of the major trends of 19th-century Canadian history: the formation of a French-Canadian professional bourgeoisie, the formalization of diplomatic ties between Canada and France, the development of bacteriology in America, and the rise of French-Canadian nationalism at the turn of the 20th century. This article traces the careers of these medical doctors by using unpublished sources, mainly their student files and doctoral theses, located through the Pierre Moulinier database and made available by the Bibliothèque Interuniversitaire de Santé of the Université Paris-Descartes. By examining these doctors' travels to Paris, it shows the impact on the Canadian medical profession of the relationship between a former North American colony and its former imperial capital.

Treize Canadiens sont reçus docteurs à la Faculté de médecine de Paris entre 1822 et 1905. Leurs séjours en France jouent un rôle déterminant dans certaines tendances majeures de l'histoire canadienne du XIXe siècle, notamment la formation d'une bourgeoisie professionnelle canadienne-française, l'officialisation des liens diplomatiques entre le Canada et la France, l'essor de la bactériologie en Amérique et la montée du nationalisme canadien-français au tournant du XXe siècle. Grâce à des sources inédites, principalement les dossiers étudiants et les thèses doctorales recueillis dans le fichier Pierre Moulinier de la Bibliothèque Interuniversitaire de Santé de l'Université Paris-Descartes, cet article retrace les parcours de ces docteurs canadiens. En s'attardant à leurs séjours à Paris, il examine les effets sur la profession médicale des rapports entre une ancienne colonie d'Amérique du Nord et sa première capitale impériale.

Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada.

This retrospective multicenter cohort study assessed temporal changes in the severity and mortality rate of blastomycosis in Quebec, Canada, and identified risk factors for death in patients with blastomycosis in 1988-2016. The primary outcome was 90-day all-cause deaths. Among 185 patients, 122 (66%) needed hospitalization and 30 (16%) died. We noted increases in the proportion of severe cases, in age at diagnosis and in the proportion of diabetic and immunocompromised patients over time. Independent risk factors for death were age (adjusted odds ratio [aOR] 1.04, 95% CI 1.00-1.07), immunosuppression (aOR 4.2, 95% CI 1.5-11.6), and involvement of >2 lung lobes (aOR 5.3, 95% CI 1.9-14.3). There was no association between the Blastomyces genotype group and all-cause mortality. The proportion of severe cases of blastomycosis has increased in Quebec over the past 30 years, partially explained by the higher number of immunosuppressed patients.

Population genomics of a reindeer lichen species from North American lichen woodlands.

PREMISE: Lichens are one of the main structural components of plant communities in the North American boreal biome. They play a pivotal role in lichen woodlands, a large ecosystem situated north of the closed-crown forest zone, and south of the forest-tundra zone. In Eastern Canada (Quebec), there is a remnant LW found 500 km south of its usual distribution range, in the Parc National des Grands-Jardins, originated mainly because of wildfires. We inferred the origin of the lichen Cladonia stellaris from this LW and assessed its genetic diversity in a postfire succession. METHODS: We genotyped 122 individuals collected across a latitudinal gradient in Quebec. Using the software Stacks, we compared four different approaches of locus selection and single-nucleotide polymorphism calling. We identified the best fitting approach to investigate population structure and estimate genetic diversity of C. stellaris. RESULTS: Populations in southern Quebec are not genetically different from those of northern LWs. The species consists of at least four phylogenetic lineages with elevated levels of genetic diversity and low co-ancestry. In Parc National des Grands-Jardins, we reported high values of genetic diversity not related with time since fire disturbance and low genetic differentiation among populations with different fire histories. CONCLUSIONS: This first population genomic study of C. stellaris is an important step forward to understand the origin and biogeographic patterns of lichen woodlands in North America. Our findings also contribute to the understanding of the effect of postfire succession on the genetic structure of the species.

A qualitative study of women and partners from Lebanon and Quebec regarding an expanded scope of noninvasive prenatal testing.

BACKGROUND: In the near future, developments in non-invasive prenatal testing (NIPT) may offer couples the opportunity to expand the range of genetic conditions tested with this technology. This possibility raises a host of ethical and social concerns, such as the type of information (medical vs. non-medical information) that couples might be exposed to and how this might complicate their informed decision-making. Currently, only limited research, mainly carried out in western countries, was conducted on women's and partners' views regarding the potential expansion of NIPT. METHODS: This study used semi-structured interviews with pregnant women and their partners to explore their views on future potential NIPT applications such as non-medical sex selection and non-medical traits, paternity testing, and NIPT use for fetal whole genome sequencing (FWGS). It was conducted in Lebanon and Quebec, as case studies to explore the impact of cultural differences on these views. RESULTS: We found no differences and many similarities when comparing the perceptions of participants in both contexts. While couples in both settings disapproved of the use of NIPT for non-medical sex selection and non-medical traits such as physical characteristics, they were near-unanimous about their support for its use for paternity testing in specific cases, such as legal doubts or conflicts related to the identity of the father. Participants were more ambivalent about NIPT for Fetal Whole Genome Sequencing. They supported this use to detect conditions that would express at birth or early childhood, while objecting to testing for adult-onset conditions. CONCLUSIONS: These results can further inform the debate on the future uses of NIPT and future policy related its implementation.