The digital divide: An ongoing state of emergency in adult literacy programs

COVID-19 and closures of in-person interactions with support programs, education providers, government services, and consumer offerings have raised concerns that vulnerable populations may not be able to mitigate the effects of the digital divide. Our chapter discusses the digital divide with a focus on programs for adult learners who have not completed high school. These include literacy, high school completion, and vocational programs. We look specifically at Ontario as a case sample that shares similarities with programs across Canada. These programs are operated by community-based non-profits, school boards, and community colleges. They are usually marginalized within the broader education system and have not been considered as part of comprehensive supports and initiatives when schools and post-secondary institutions were closed. The digital inequalities learners experience have parallels in the very programs they attend to mitigate their own digital learning divide. © Springer Nature Switzerland AG 2021. All rights reserved.

Long-Term Care Staffing Policies Pre-COVID-19 and Pandemic Responses: A Case Comparison of Ontario and British Columbia

À la fin de mai 2020, les cas de COVID-19 chez les résident·es des établissements de soins de longue durée (SLD) en Ontario représentaient 5 157 des 28 499 cas de la province. En Colombie-Britannique (C.-B.), il y avait 339 cas chez les résident·es de ces établissements, comparativement à un total provincial de 2 562 cas. Bien que le secteur des SLD de ces deux provinces présente certaines différences, cet article passe en revue les politiques de dotation en personnel des SLD dans chacune des deux provinces avant la pandémie et compare leurs mesures de prévention de la COVID-19 ayant trait à la dotation pour 2020. Aux politiques de l'Ontario avant 2020 correspondent des ratios personnel-patients inférieurs à ceux de la Colombie-Britannique, ce qui peut avoir eu un effet limitant sur les réactions de l'Ontario à la pandémie. L'établissement de normes ou de lignes directrices ainsi qu'une modification du financement pourraient améliorer la résilience du secteur des SLD en matière de dotation en personnel.Alternate :By late May 2020, COVID-19 cases among long-term care (LTC) residents in Ontario constituted 5,157 of the province's 28,499 cases. In British Columbia (B.C.), there were 339 cases among LTC residents compared with a provincial total of 2,562 cases. While the LTC sectors in these two provinces have some differences, this article reviews their pre-pandemic LTC staffing policies and compares their staffing-related COVID-19 prevention measures in 2020. Ontario's policies before 2020 corresponded with lower staff-to-patient ratios than B.C., which may have constrained Ontario's pandemic responses. Implementation of standards or guidelines and changes to funding could help achieve LTC sector staffing resiliency.

"And Then COVID Hit": (Re)flexibility of Digital Storytelling in Qualitative Health Research

The purpose of our qualitative health research study was to understand the experiences of Ontarians who accompanied someone throughout their dying process using medical assistance in dying (MAiD). The second phase used digital stories as a method to examine and share these experiences at the end of life. And then the COVID-19 pandemic hit, and we faced a pivot to our original plan. This pivot resulted in reinforcing the myriad benefits of using digital storytelling in qualitative health research. And rather than detracting from the initial study, we also learned that digital storytelling is a flexible method that can be creatively, compassionately, and effectively conducted in virtual spaces. We will employ digital storytelling in future qualitative health research as both a component of studies but also as a conduit for explorations of other tools of data collection and dissemination. [ FROM AUTHOR] Copyright of International Journal of Qualitative Methods is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Methodological changes implemented over time to support accurate and timely COVID-19 vaccine coverage estimates: Ontario, Canada.

The COVID-19 vaccination program implementation in Ontario, Canada has spanned multiple years and is ongoing. To meet the challenges of the program, Ontario developed and implemented a new electronic COVID-19 immunization registry, COVaxON, which captures individual-level data on all doses administered in the province enabling comprehensive coverage assessment. However, the need for ongoing COVID-19 vaccine coverage assessments over a multi-year vaccination program posed challenges necessitating methodological changes. This paper describes Ontario's COVID-19 immunization registry, the methods implemented over time to allow for the ongoing assessment of vaccine coverage by age, and the impact of those methodological changes. Throughout the course of the vaccination program, four different methodological approaches were used to calculate age-specific coverage estimates using vaccination data (numerator) obtained from COVaxON. Age-specific numerators were initially calculated using age at time of first dose (method A), but were updated to the age at coverage assessment (method B). Database enhancements allowed for the exclusion of deceased individuals from the numerator (method C). Population data (denominator) was updated to 2022 projections from the 2021 national census following their availability (method D). The impact was most evident in older age groups where vaccine uptake was high. For example, coverage estimates for individuals aged 70-79 years of age for at least one dose decreased from 104.9 % (method B) to 95.0 % (method D). Thus, methodological changes improved estimates such that none exceeded 100 %. Ontario's COVID-19 immunization registry has been transformational for vaccine program surveillance. The implementation of a single registry for COVID-19 vaccines was essential for comprehensive near real-time coverage assessment, and enabled new uses of the data to support additional components of vaccine program surveillance. The province is well positioned to build on what has been achieved as a result of the COVID-19 pandemic and expand the registry to other routine vaccination programs.

COVID-19–related stressors, family functioning and mental health in Canada: Test of indirect effects

Objective: The purpose of this study was to examine how family relationships relate to stress and mental health during the COVID-19 pandemic response in Ontario, Canada. Background: Generally, families are pillars of strength during times of stress and burden. However, enduring stressors, such as the COVID-19 pandemic, may challenge the cohesion and caregiving functions of families. Researchers are just beginning to explore stressors associated with the COVID-19 pandemic, family functioning, and mental health in the general population. Rooted in stress process theory, the current study disentangles the complex pathways through which COVID-19-pandemic-related stressors and family cohesion and family conflict are associated with the mental health of the general population in Ontario, Canada. Method: Data were collected using an online survey from April 22, 2020, to May 22, 2020. Through convenience sampling, 933 individuals were recruited from the general population in Ontario, Canada. Results: Findings suggest that COVID-19-pandemic- related stressors are associated with anxiety directly and indirectly through eroding family cohesion and exacerbating family conflicts. Conclusion: By looking into family cohesion and family conflicts simultaneously, this investigation has taken a nuanced approach to studying the influence of COVID-19-pandemic-related stressors on family functioning. Implications: These findings suggest that efforts to assist families in bolstering cohesiveness may be helpful. Further, diminishing family conflicts, especially during community or global disasters, such as epidemics, pandemics, or natural disasters, should be a focus in both practice and future research.

Experiential learning and the university's host community: rapid growth, contested mission and policy challenge.

This paper examines the recent growth of experiential learning (EL) and the university-community (or so-called town-gown, TG) connections created as a result of this expansion. The research is framed by critical scholarship on the nature and role of the university and the place of liberal education specifically, as well as policy drivers aimed at social and economic impacts from EL. Two subthemes are also examined: first, the role of the arts, humanities and social sciences disciplines in EL expansion and, second, the extent to which TG connections focus on the university's local host community as opposed to more distant and even international arrangements. Mixed research methods including public document analysis and key informant interviews are used to document and interpret EL developments across nine varied universities in Ontario, Canada. The results underline broad sector commitment to EL that in turn creates new and different TG connections for the university. Rapid expansion has brought a variety of challenges identified both by universities and community EL partners. The paper concludes with discussion of policy implications and consideration of the future of EL in light of the 'digital pivot' of the COVID-19 pandemic.

Managing the curb – Public space and use of curbside cafes during the Coronavirus pandemic

Urban streets, especially curbside spaces, are increasingly complex and often contested. The Coronavirus pandemic created a new demand for street space to enable physical distancing. The urgency of the pandemic and the fear of covid exposure suspended traditional community engagement opportunities, opposition from residents and business owners, and considerations over the privatization of public street space. This exploratory paper uses the case studies of Toronto and Chicago to trace the past and present regulations and programs affecting curbside parking spaces. Through these cases, this paper addresses larger questions that relate the historical conceptions around curbside parking use with those put forward in response to the pandemic. Given the popularity of pandemic-related curbside space programs and their potential to become long-term interventions, this paper also raises several questions around privatization, access and social equity that must be addressed in future iterations of programs affecting curbside space. © 2022 Elsevier Ltd

Using Robotics to Support the Acquisition of STEM and 21st-Century Competencies: Promising (and Practical) Directions

Dans le but d'améliorer la façon dont les éducateurs utilisent la robotique pour soutenir le développement des compétences du XXIe siècle et des STIM, nous rapportons ici les résultats de groupes de discussion et d'entretiens individuels avec 133 enseignants et 46 élèves du primaire, de 19 observations de vidéos enregistrées en classe et d'un sondage auprès des enseignants effectué en Ontario, au Canada. Nous constatons que les enseignants utilisent la robotique de diverses manières pour soutenir le développement des compétences cognitives, interpersonnelles et intrapersonnelles. Malgré les avantages potentiels, nos participants ont identifié plusieurs facteurs qui limitent l'adoption de l'enseignement et de l'apprentissage de la robotique à plus grande échelle. Notamment, l'intégration insuffisante dans les curriculums et les évaluations, une pénurie de ressources, et un manque de développement et de soutien professionnel. Nous suggérons des directives politiques pratiques pour soutenir l'intégration plus efficace de la robotique, et considérons la manière dont ces recommandations pourraient éclairer l'enseignement et l'apprentissage dans une salle de classe (post) Covid-19.Alternate :To enhance how educators use robotics to support the development of STEM and 21st century competencies, we report findings from focus groups and interviews with 133 elementary teachers and 46 elementary students, 19 video-recorded classroom observations, and a teacher survey from Ontario, Canada. We find that teachers use robotics in a variety of ways to support the development of cognitive, interpersonal, and intrapersonal skills. Despite the potential benefits, our participants identified several factors that limit the adoption of robotics teaching and learning on a wider scale, including insufficient curriculum and assessment integration, resources, and professional development and support. We provide practical policy guidelines to support the broader integration of robotics and reflect on how these recommendations may inform teaching and learning in a (post-) COVID-19 classroom.

Access to treatment for endometrial cancer patients during the COVID-19 pandemic in Ontario, Canada

ObjectivesDuring the first year of the COVID-19 pandemic in Ontario, biopsies for cancer diagnosis decreased by over 40% and surgical cancer treatment decreased by over 25% during the first pandemic wave1. This study aims to assess the impact of the COVID-19 pandemic on endometrial cancer diagnosis and surgical treatment in Ontario, Canada.MethodsCases were identified from January 1, 2017 to December 31, 2022 from endometrial cancer hysterectomy specimens in Ontario Health – Cancer Care Ontario, ePath system. Endometrial biopsy records were matched to surgical specimens by provincial health card number. System performance was compared before (2017–2019) and during (2020–2021) the COVID-19 pandemic.ResultsThere were 10 446 women treated with hysterectomy for endometrial cancer in Ontario from 2017–2021. The majority were low grade (74%) compared to high grade (18%) with 8% unspecified. In April and May 2020 corresponding with the provincial state of emergency, there was a 56% relative reduction in endometrial biopsies. The median time to surgery was 57 days (IQR 41–73) for low grade and 57 days (IQR 42–76) for high grade endometrial cancer. There was no difference in time to surgery and no change in surgical stage at presentation before (2017–2019) or during the pandemic (2020–2021).ConclusionsDespite significant increase in virtual care and decreased operating room time during the COVID-19 pandemic in Ontario, the healthcare system continued to prioritize service delivery to endometrial cancer patients. Importantly, there were no significant surgical delays or upstaging of endometrial cancer, particularly of high-grade histology. 1Walker et al., JAMA Network Open. 2022;5(4):e228855. doi:10.1001/jamanetworkopen.2022.8855

CONNECTING SENIORS IN MARGINALIZED COMMUNITIES DURING COVID-19

The community of Jane and Finch (also known as Black Creek) is a high-density, multicultural, low-income neighborhood in northwest Toronto, Ontario. Home to people from more than 70 countries, with 100 languages spoken, the area has been described as having more immigrants, more single-parent households, higher rates of unemployment, a higher percentage of the population without a high school diploma, and higher rates of low-income families than the rest of Toronto. The Toronto City Summit Alliance's Strong Neighbourhoods Task Force identified the Jane and Finch neighborhood as one of 13 priority neighborhoods in the city.

Perioperative Nurse Recruitment: An OR Placement Program for Fourth-Year Nursing Students in Ontario: The Official Voice of Perioperative Nursing

Nursing associations have predicted a worldwide shortage of perioperative RNs as more nurses reach retirement age. Additionally, the lack of perioperative exposure during undergraduate nursing programs is contributing to the failure to attract recently graduated nurses to this field. In 2019, multiple hospital sites within the St. Lawrence College network in Ontario, Canada, expressed difficulty recruiting perioperative RNs and expressed an interest in collaborating with the college to increase exposure to the perioperative specialty and recruit students to their ORs after graduation. The college has run a successful preceptor-supported OR placement program for fourthyear baccalaureate nursing students since 2019. Eleven out of thirteen students were hired into the OR after their 2020-2021 placement program. This article outlines the steps taken to initiate this program as well as results of a formal program evaluation conducted in 2021, including detailed feedback from participating students, preceptors, and leaders at the involved hospitals.

BRIEF REPORT: Factors Associated with COVID-19 Infections Among a High-Risk Sample of Adults with Intellectual and Developmental Disabilities in Ontario

This brief report describes the demographic and clinical profiles of 190 adult home care users with intellectual and developmental disabilities tested for COVID-19 from March 2020 to May 2021. A crosssectional study design (n=190) was conducted. ChiSquare tests, Fisher’s Exact tests, and odds ratios with 95% confidence intervals are reported. Older age and congregate living increased the odds of having a positive COVID-19 test, while dependence in personal dressing was associated with decreased odds. These findings provide useful data from the first 15 months of the pandemic;trends over time should be investigated.  Alternate :Ce rapport bref décrit les profils démographiques et cliniques de 190 résidents adultes recevant des soins à domicile et ayant un trouble développemental ou une déficience intellectuelle qui ont été testés pour la COVID-19 entre mars 2020 et mai 2021. Un devis d’étude transversale (n = 190) a été mené. Des tests du Chi carré, des tests selon la méthode exacte de Fischer, et des rapports des cotes ayant un intervalle de confiance à 95% sont présentés. Un âge avancé et la vie en habitation collective a augmenté la probabilité d’obtenir un résultat positif au test de la COVID19, tandis que la dépendance pour l’habillage était associée à une probabilité moins élevée. Ces  résultats offrent des données utiles issues des 15 premiers mois de la pandémie;les tendances au fil du temps devraient être étudiées. Mots-clés : COVID-19, trouble du développement, déficience intellectuelle, soins à domiciles, interRAI, adultes.

Health governance of COVID-19 in Milan and Toronto: long-term trends and short-term failures

In this paper, we examine a crisis in the governance of health and care that characterized the regions of Milan and Toronto, which the COVID-19 pandemic impacted substantially—both in early 2020 when SARS-CoV-2 first hit and later in the fall and winter when the disease entered its second and third waves. We analyze restructuring in health and care in both regions, and, where necessary, in national contexts. We make the case that restructuring and implementing welfare and health policy, including long-term care, in Toronto and Milan in the context of long-standing tendencies of health governance restructuring that were part of a more general rescaling of the regional welfare state be held responsible for the toll COVID-19 levied. This paper is part of the SPE Theme on the Political Economy of COVID-19.

The Health Impacts of Social Distancing Among Indigenous People in Ontario During the First Wave of COVID-19

Among Indigenous Peoples in Canada and around the world, the health impacts of COVID-19 have been measured largely through biological, social, and psychological impacts. Our study draws from a relational concept of health to examine two objectives: (1) how social distancing protocols have shaped Indigenous connections with self, family, wider community, and nature;and (2) what these changing relationships mean for perceptions of Indigenous health. Carried out by an Indigenous team of scholars, community activists, and students, this research draws from a decolonizing methodology and qualitative interviews (n = 16) with Indigenous health and social care providers in urban and reserve settings. Our results illustrate a considerable decline in interpersonal connections-such as with family, community organizations, and larger social networks-as a result of social distancing. Among those already vulnerable, underlying health, social, and economic inequities have been exacerbated. While the health impacts of COVID-19 have been overwhelmingly negative, participants noted the importance of this time for self-reflection and reconnection of human-kind with Mother Earth. This paper offers an alternative perspective to popularized views of Indigenous experiences of COVID-19 as they relate to vulnerability and resilience.

Cross-Sectional Study of the Impact of the COVID-Pandemic on Diabetes Management in Primary Care in Ontario, Canada

Background: This study describes the impact of the pandemic on the management of people with type 2 diabetes (PwT2D) in a primary care network with existing virtual care capabilities in Ontario, Canada. Methods: Using de-identified primary care electronic medical records, PwT2D who had at least one healthcare touchpoint between March 1, 2018 and February 28, 2021 were analyzed by time period (baseline: 2018-19, pre-COVID-19: 2019-20, COVID-19: 2020-21) . The primary outcome measures include the number of people with at least one visit, number of people with vital measurements or lab tests, and the vital or lab results. Results: The three time periods had a similar average age and gender distribution (Table 1) . Compared to the pre-COVID-period, fewer people had any healthcare touchpoint (17% reduction) . In-person visits were reduced while more people had virtual visits. Fewer people had test results recorded during the COVID-vs. two pre-COVID-time periods, however, average results were similar across all three time periods. Conclusion: Our study described the immediate impact of the COVID-pandemic on patterns of primary care for PwT2D. While the total number people getting tests remains below pre-pandemic levels, of those who sought care, the mean A1c, LDL-c and eGFR were comparable across the three time periods.

Impact of the COVID-Pandemic on Diabetes Screening from 20to 2021 in Ontario, Canada

Diabetes incidence is expected to increase following the COVID-pandemic due to widespread changes in physical activity, diet, and access to health care services. We used administrative health care databases from Ontario, Canada to examine monthly changes in diabetes screening during the pandemic (Mar 2020-Feb 2021) compared to the pre-pandemic period (Mar 2019-Feb 2020) among adults aged 20-85 without prior diabetes. The eligible population was 9,599,079 in Mar 20 and 9,941,336 in Feb 2021. Overall, the number of people screened for diabetes was 25.3% lower in the pandemic (N=4,060,348) versus pre-pandemic (N=5,437,284) period. However, the number of people screened each month declined by 65.6% between February and April 2020 (Figure 1;1.53 vs. 4.44 per 100, -2.91 per 100) . Screening rates recovered by July 2020 (3.88 per 100) but remained 15.6% lower than in the pre-pandemic period. Similar patterns were observed in all age groups but declines in screening rates between February and April 2020 were greatest in adults aged 35-49 (-69.4%) and 50-64 (-69.5%) . Findings were also consistent across income groups. In summary, we observed a sudden decline in diabetes screening in Ontario, Canada, where laboratory tests and other health care services are universally insured. This may lead to delays in prediabetes and diabetes diagnosis, resulting in missed opportunities for diabetes prevention and early management.

‘Excellence in adversity: abortion care in the coronavirus pandemic’

BSACP serves its members by providing a forum for professional development and networking, as well as by raising the profile of the specialty and improving understanding amongst those responsible for abortion-related policy, guidance, commissioning, regulation and training. 2 Utility of a routine ultrasound for detection of ectopic pregnancies amongst women requesting abortion: a retrospective review Clara I Duncan1* John J Reynolds-Wright2 Sharon T Cameron2,3 1The Medical School, University of Edinburgh, Edinburgh, UK 2MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK 3Chalmers Centre for Sexual and Reproductive Health, Edinburgh, UK Background Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may give false reassurance that a pregnancy is intrauterine. 3 Acceptability of early medical abortion delivered by telemedicine – preliminary data from an NHS community abortion service John Reynolds-Wright1* Anne Johnstone2 Karen McCabe3 Claire Nicol4 Sharon Cameron5 1Clinical Research Fellow, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK 2Clinical Research Nurse, University of Edinburgh, Edinburgh, UK 3Clinical Research Midwife, University of Edinburgh, Edinburgh, UK 4Advanced Sexual and Reproductive Health Practitioner, NHS Lothian, Edinburgh, UK 5Consultant Gynaecologist, NHS Lothian and Honorary Professor of Sexual and Reproductive Health, University of Edinburgh, Edinburgh, UK Introduction In response to the COVID-19 outbreak, the NHS Lothian abortion service (based at the Chalmers Centre for Sexual and Reproductive Health, Edinburgh) transferred wholly to telemedicine delivery of abortion care. Continuing to provide the majority of EMA care via telemedicine would appear to be an effective approach, appreciated by patients. 4 Do medication abortion complications increase when mifepristone is available without regulations restricting practice? A population-based study using linked health administrative data from Canada Laura Schummers1,2* Elizabeth K Darling2,3 Anastasia Gayowsky2 Sheila Dunn4 Kimberlyn McGrai5 Michael Law5 Tracey-Lea Laba6 Wendy V Norman1,7 1Department of Family Practice, University of British Columbia, Vancouver, Canada 2ICES McMaster, Hamilton, Ontario, Canada 3Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada 4Department of Family and Community Medicine, University of Toronto, Toronto, Canada 5School of Population and Public Health, University of British Columbia, Vancouver, Canada 6Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia 7Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK Objective In January 2017, mifepristone became available in Canada, where abortion has been fully decriminalised since 1988.