Academic Integrity Policy and Support Provisions: : Are Ontario Colleges setting International Students up for Success?

International students are critical to the academic, social and economic vitality of post-secondary institutions in Canada, yet, their retention can be challenging. When relations between host and home nations are strained, students are at risk of being required to return home, or of having their scholarships revoked. During the pandemic, international students, forced to study entirely online due to campus closures, were at risk of not having their visas renewed. Another challenge to international student retention is non-compliance with academic integrity policy.  Non-compliance can result in penalties leading to dropouts and expulsion.  Unlike other external challenges, ensuring compliance with academic integrity policy is entirely within institutional jurisdiction, yet Canadian colleges and universities assume varying degrees of responsibility in this regard. Using colleges in Ontario, Canada, as a case study, this paper explores the extent to which each of  Ontario's 22 English-medium colleges provides its international students with ready access to intelligible academic integrity policy and pro-active training therewith. Using a mixed-methods approach, this research consists of content and document analysis, as well as descriptive statistics, to examine the academic integrity policy and support provisions (accessed online through Google searches) of each college.   Colleges were ranked as exemplary, adequate or in need of improvement along a number of dimensions including acknowledging different cultural understandings and availability  of translated material. Findings demonstrate that there is much more that colleges can do to support international students (upon whose tuition fees they are so dependent) in the area of understanding academic integrity compliance

Systematic Reviews of Surgical Comprehensive Geriatric Assessment and Assessment of Drivers of Cost in Elderly Emergency Surgery Patients

Aging populations are increasing the demand for surgical intervention in those over 65 years of age. Older patients experience higher morbidity and mortality. Comprehensive geriatric assessment (CGA) is a multi-faceted approach to in-patient care that addresses medical, functional and psychosocial factors. It is proposed to decrease cost and adverse outcomes in the elderly. I will investigate the effectiveness of CGA in published studies then examine the costs associated with emergency abdominal surgery in a cohort of elderly surgical patients. Two systematic reviews of CGA in surgical patients were conducted. Both examined CGA in surgical patients 65 and older. The primary outcomes for the Cochrane review were mortality and return of pre-morbid function. The primary outcome in the economic review was reported economic outcomes. We also retrospectively examined general surgical inpatient costs over two fiscal years at four hospitals within the Edmonton zone. Costs were compared between surgical risk profile, urgency and age. The Cochrane review found end-of-study mortality trended towards improvement and discharge disposition was significantly improved. Length of stay and readmission were unchanged and complications were decreased. The economic systematic review found lower cost while loss of function, length of stay and mortality were all reduced suggesting CGA may be the economically dominant choice when compared to usual care. All but one study in each review were in orthogeriatric patients; there are insufficient studies to draw conclusions about other surgical populations. Within the Edmonton zone, unscheduled cases were statistically and clinically significantly costlier for 65-79 and 80+ year-old age groups when compared to those under 65. Scheduled surgeries were not clinically significantly different between age groups. Economic evaluation of acute abdominal surgical patients aged 65 and older was conducted. Patients were prospectively enrolled in the Elder-friendly Approaches to the Surgical Environment (EASE) study at two Canadian hospitals in a trial of CGA versus usual surgical care. Baseline clinical, social and demographic characteristics were assessed. Follow-up was conducted at 6 weeks and 6 months following discharge. The Alberta Health Services (AHS) microcosting database along with other AHS and Alberta Health costing databases were used to calculate inpatient, readmission and total healthcare costs from enrolment to 6-months following discharge. Patient-reported resource use within 6 months of discharge was measured using a validated Health Resource Utilization Inventory (HRUI). The primary outcome for database costs analysis was total government healthcare costs; which was assessed using multivariate generalized linear regression. HRUI costs were assessed in a separate analysis with regression. Analysis of the costs accrued by patients enrolled in the EASE study found mean total government costs was $33,752. Multivariate regression found the cost of care increased with higher ASA (Adjusted ratio [AR]=1.24, p=0.002), higher frailty (AR=1.27, p<0.001) and both minor (AR=1.50, p<0.001) and major complications (AR=2.01, p<0.001). After controlling for clinical and demographic data, patients who completed the HRUI had frailty predicted increased cost of healthcare services (AR=1.50, p=0.001) and medical products (AR=1.62, p=0.005) and decreased cost in lost productive hours (AR=0.39, p=0.002). Complications did not predict any change in cost in any category. Overall, CGA is a promising tool to reduce the cost of care while improving outcomes in seniors undergoing unscheduled orthogeriatric procedures. Retrospective analysis identified increased surgical costs with age for unscheduled surgery. Screening elective surgical candidates may decrease admission costs; innovative programs are needed to reduce emergency admission costs. Frailty was also found to predict increased total government costs over 6-months and predicted increased cost of healthcare services and medical products. The EASE study is currently examining the effectiveness of CGA in an unscheduled general surgical population

Review of Risk Assessment Tools to Predict Morbidity and Mortality in Elderly Surgical Patients Brief title: Review of surgical risk assessment tools

Background Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions. Data sources We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies. Conclusions We identified risk assessment tools that can improve surgical risk assessment in elderly surgical patients. The majority of the identified tools are not commonly used for pre-operative risk assessment. NSQIP-PMP, mFI and SURPAS are promising tools. Age is commonly used to predict risk, but frailty may be a more appropriate measure

Interlinkages: Governance for Sustainability Chapter 8

The Earth functions as a system: atmosphere, land, water, biodiversity and human society are all linked in a complex web of interactions and feedbacks. Environment and development challenges are interlinked across thematic, institutional and geographic boundaries through social and environmental processes. The state of knowledge on these interlinkages and implications for human well-being are highlighted in the following messages: Environmental change and development challenges are caused by the same sets of drivers. They include population change, economic processes, scientific and technological innovations, distribution patterns, and cultural, social, political and institutional processes

Post-glacial sea-level change along the Pacific coast of North America

Sea-level history since the Last Glacial Maximum on the Pacific margin of North America is complex and heterogeneous owing to regional differences in crustal deformation (neotectonics), changes in global ocean volumes (eustasy) and the depression and rebound of the Earth\u27s crust in response to ice sheets on land (isostasy). At the Last Glacial Maximum, the Cordilleran Ice Sheet depressed the crust over which it formed and created a raised forebulge along peripheral areas offshore. This, combined with different tectonic settings along the coast, resulted in divergent relative sea-level responses during the Holocene. For example, sea level was up to 200 m higher than present in the lower Fraser Valley region of southwest British Columbia, due largely to isostatic depression. At the same time, sea level was 150 m lower than present in Haida Gwaii, on the northern coast of British Columbia, due to the combined effects of the forebulge raising the land and lower eustatic sea level. A forebulge also developed in parts of southeast Alaska resulting in post-glacial sea levels at least 122 m lower than present and possibly as low as 165 m. On the coasts of Washington and Oregon, as well as south-central Alaska, neotectonics and eustasy seem to have played larger roles than isostatic adjustments in controlling relative sea-level changes

Is current preoperative frailty assessment adequate?

Preoperative frailty predicts adverse postoperative outcomes. Recommendations for preoperative assessment of elderly patients include performing a frailty assessment. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical health care professionals’ perception and use of frailty assessment for perioperative care. We surveyed local health care employees to assess their attitudes toward and practices for frail patients. Nurses and allied health professionals were more likely than surgeons to agree frailty should play a role in planning a patient’s care. Lack of knowledge about frailty issues was a prominent barrier to the use of frailty assessments in practice, despite clinicians understanding that frailty affects their patients’ outcomes. Results of this survey suggest further training in frailty issues and the use of frailty assessment instruments is necessary and could improve the uptake of such tools for perioperative care planning

Is current preoperative frailty assessment adequate?

Preoperative frailty predicts adverse postoperative outcomes. Recommendations for preoperative assessment of elderly patients include performing a frailty assessment. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical health care professionals’ perception and use of frailty assessment for perioperative care. We surveyed local health care employees to assess their attitudes toward and practices for frail patients. Nurses and allied health professionals were more likely than surgeons to agree frailty should play a role in planning a patient’s care. Lack of knowledge about frailty issues was a prominent barrier to the use of frailty assessments in practice, despite clinicians understanding that frailty affects their patients’ outcomes. Results of this survey suggest further training in frailty issues and the use of frailty assessment instruments is necessary and could improve the uptake of such tools for perioperative care planning

The association of peri-operative scores, including frailty, with outcomes after unscheduled surgery

Summary Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long‐term survival. We recorded in‐hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre‐operative frailty with the 7‐point Clinical Frailty Scale: 81 patients were ‘not vulnerable’ (frailty score 1–3) and 83 were ‘vulnerable or frail’ (frailty score urn:x-wiley:00032409:media:anae14269:anae14269-math-0001 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. Within 30 postoperative days 8/164 (5%) patients died, all with frailty scores urn:x-wiley:00032409:media:anae14269:anae14269-math-0002 4, p = 0.007. Postoperative morbidity was less frequent in patients categorised as ‘not vulnerable’ on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6–18 [2–221]) days for patients with frailty scores 1–3, and 22 (12–33 [2–270]) days for patients with score urn:x-wiley:00032409:media:anae14269:anae14269-math-0003 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E‐POSSUM, 0.74 (0.60–0.92), p = 0.007; ASA 2, 0.35 (0.13–0.98), p = 0.046, ASA 3, 0.17 (0.06–0.47), p = 0.001 and ASA 4/5, 0.08 (0.02–0.28), p < 0.001; operative severity ‘major +’, 0.69 (0.41–1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81–74.40), p = 0.08

Local Response in Health Emergencies: Key Considerations for Addressing the COVID-19 Pandemic in Informal Urban Settlements

This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There are further challenges to do with the lack of reliable data and the social, political and economic contexts in each setting that will influence vulnerability and possibilities for action. The potential health impacts of COVID-19 are immense in informal settlements, but if control measures are poorly executed these could also have severe negative impacts. Public health interventions must be balanced with social and economic interventions, especially in relation to the informal economy upon which many poor urban residents depend. Local residents, leaders and communitybased groups must be engaged and resourced to develop locally appropriate control strategies, in partnership with local governments and authorities. Historically, informal settlements and their residents have been stigmatized, blamed, and subjected to rules and regulations that are unaffordable or unfeasible to adhere to. Responses to COVID-19 should not repeat these mistakes. Priorities for enabling effective control measures include: collaborating with local residents who have unsurpassed knowledge of relevant spatial and social infrastructures, strengthening coordination with local governments, and investing in improved data for monitoring the response in informal settlements