Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments.

Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.

Bombus (Pyrobombus) johanseni Sladen, 1919, a valid North American bumble bee species, with a new synonymy and comparisons to other "red-banded" bumble bee species in North America (Hymenoptera, Apidae, Bombini).

The bumble bee (Hymenoptera, Apidae, Bombini, Bombus Latreille) fauna of the Nearctic and Palearctic regions are considered well known, with a few species occurring in both regions (i.e., with a Holarctic distribution), but much of the Arctic, especially in North America, remains undersampled or unsurveyed. Several bumble bee taxa have been described from northern North America, these considered either valid species or placed into synonymy with other taxa. However, some of these synonymies were made under the assumption of variable hair colour only, without detailed examination of other morphological characters (e.g., male genitalia, hidden sterna), and without the aid of molecular data. Recently, Bombus interacti Martinet, Brasero & Rasmont, 2019 was described from Alaska where it is considered endemic; based on both morphological and molecular data, it was considered a taxon distinct from B. lapponicus (Fabricius, 1793). Bombus interacti was also considered distinct from B. gelidus Cresson, 1878, a taxon from Alaska surmised to be a melanistic form of B. lapponicus sylvicola Kirby, 1837, the North American subspecies (Martinet et al. 2019). Unfortunately, Martinet et al. (2019) did not have DNA barcode sequences (COI) for females of B. interacti, but molecular data for a melanistic female specimen matching the DNA barcode sequence of the holotype of B. interacti have been available in the Barcodes of Life Data System (BOLD) since 2011. Since then, additional specimens have been obtained from across northern North America. Also unfortunate was that B. sylvicola var. johanseni Sladen, 1919, another melanistic taxon described from far northern Canada, was not considered. Bombus johanseni is here recognized as a distinct taxon from B. lapponicus sylvicola Kirby, 1837 (sensuMartinet et al. 2019) in the Nearctic region, showing the closest affinity to B. glacialis Friese, 1902 of the Old World. As the holotype male of B. interacti is genetically identical to material identified here as B. johanseni, it is placed into synonymy. Thus, we consider B. johanseni a widespread species occurring across arctic and subarctic North America in which most females are dark, with rarer pale forms (i.e., "interacti") occurring in and seemingly restricted to Alaska. In addition to B. johanseni showing molecular affinities to B. glacialis of the Old World, both taxa also inhabit similar habitats in the arctic areas of both Nearctic and Palearctic, respectively. It is also likely that many of the specimens identified as B. lapponicus sylvicola from far northern Canada and Alaska might actually be B. johanseni, so that should be considered for future studies of taxonomy, distribution, and conservation assessment of North American bumble bees.

Xylocopa sonorina Smith, 1874 from Vancouver, British Columbia, Canada (Hymenoptera: Apidae, Xylocopinae) with comments on its taxonomy.

BACKGROUND: Only one species of large carpenter bee, Xylocopa virginica (Linnaeus, 1771), has been recorded from Canada, albeit restricted to southern Ontario and Quebec. However, a single female specimen identified by Hurd in 1954 as X. varipuncta Patton, 1879 from British Columbia is in the C.A. Triplehorn Insect Collection at The Ohio State University (OSUC), suggesting that this species was accidentally introduced into coastal western Canada. As wood-nesters, many large carpenter bees are likely capable of expanding their range great distances by natural and unnatural transport methods while nesting inside suitable substrates, the presumed mode of transport into western Canada, and likely elsewhere. The ease at which the nests are transported has likely contributed to the nomenclatural and distributional ambiguity surrounding this species due to morphological similarities of specimens from North America, Hawaii, and several South Pacific islands. NEW INFORMATION: By comparing DNA barcodes of specimens from the western United States to specimens from Hawaii, we confirm the early opinion of P.H. Timberlake (Timberlake 1922) that specimens long established on the Hawaiian Islands are the same X. varipuncta from continental North America. Furthermore, these DNA barcode sequences also match those of specimens identified as X. sonorina Smith, 1874 from the French Polynesian and Samoan Islands, thus fully supporting the opinion of Groom et al. (2017) that all are likely conspecific. As X. sonorina, a species described from and likely introduced to Hawaii is the oldest name available, X. varipuncta is here placed into synonymy. Additional research will be needed to trace the timing and pathway of introduction and establishment of X. sonorina; it is presumed that the species is native to the southwestern United States but has been established in Hawaii since the mid-1800s. It is also established in French Polynesia, the Samoan Islands, and likely other south Pacific islands, with additional records of occurrence from Java, New Zealand, and now Canada.

A new western Canadian record of Epeoloides pilosulus (Cresson), with discussion of ecological associations, distribution and conservation status in Canada.

BACKGROUND: Epeoloides pilosulus, one of the rarest bees in North America, is a cleptoparasite of Macropis bees which themselves are uncommon oligoleges of oil-producing Lysimachia flowers. Only two specimens of the cleptoparasite have been reported from Canada since the 1960s, both from Nova Scotia. NEW INFORMATION: A recently collected specimen of Epeoloides pilosulus from Alberta, Canada confirms this species from that province and greatly increases its known range in western North America. This record and additional specimens from southern Ontario (one collected in 1978) have implications for the conservation status of this COSEWIC assessed species in Canada, which are discussed.

First Canadian record of the water mite Thermacarus nevadensis Marshall, 1928 (Arachnida: Acariformes: Hydrachnidiae: Thermacaridae) from hot springs in British Columbia.

BACKGROUND: Thermacarus nevadensis Marshall, 1928 is an uncommonly collected mite associated with hot spring environments in the western United States. Information on its distribution and ecology are incomplete. NEW INFORMATION: In this paper, we report Thermacarus nevadensis from northern British Columbia. These records represent the first of Thermacaridae from Canada, the most northern records of this species in North America, and the most northern records for the family globally. We also provide short notes and images of the habitats in which specimens have been collected in Canada.