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.

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.
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.
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.
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.

In many developed countries, reforms of public healthcare systems are ongoing but do not always achieve desired results. In this article, we present the history of the healthcare system reform in the Canadian province of New Brunswick with the objective of analyzing its difficult steering by the state, in light of the dynamics between the actors involved.
Qualitative methods were chosen. Data collection includes semi-structured interviews (N = 39) with representatives of the State, such as health ministers, and other relevant stakeholders, such as managers, citizens or health professionals.
The stakeholders were compelled by various aspects of the reform, for example francophone health care services, that had consequences on the trajectory of change. To stay on target, the State must adapt to the dynamic interactions of the actors involved.
Reforms take place over a long period of time and their programming by the State can be very difficult, as it requires the mobilization of different types of instruments at its disposal. In order to influence the behaviour of the actors concerned, the State must define a goal whose general orientations are agreed upon, succeed in forging bonds of trust and managing resistance, and finally, use standardized data in order to provide a normative framework and evaluate the progress of the reform project.

In many developed countries, reforms of public healthcare systems are ongoing but do not always achieve desired results. In this article, we present the history of the healthcare system reform in the Canadian province of New Brunswick with the objective of analyzing its difficult steering by the state, in light of the dynamics between the actors involved.
Qualitative methods were chosen. Data collection includes semi-structured interviews (N = 39) with representatives of the State, such as health ministers, and other relevant stakeholders, such as managers, citizens or health professionals.
The stakeholders were compelled by various aspects of the reform, for example francophone health care services, that had consequences on the trajectory of change. To stay on target, the State must adapt to the dynamic interactions of the actors involved.
Reforms take place over a long period of time and their programming by the State can be very difficult, as it requires the mobilization of different types of instruments at its disposal. In order to influence the behaviour of the actors concerned, the State must define a goal whose general orientations are agreed upon, succeed in forging bonds of trust and managing resistance, and finally, use standardized data in order to provide a normative framework and evaluate the progress of the reform project.

Presently only about 9% of seniors over the age of 75 live in residential care facilities but the anticipated exponential growth of the senior population will put increasing pressure on the need for supportive, continuing care services in the years ahead (CIHI 2017a). They are on average 86 years of age with a diagnosis of dementia (67%) and some cognitive and/or functional impairment (98%) (CIHI 2017b). These compromised seniors are also more likely to use hospital services than others, and in many jurisdictions occupy acute care beds for extended periods because ongoing management of their complex conditions is often not possible within long-term care (LTC) homes. In addition, unnecessary and futile care at the end of life often leads to suffering for individuals and their families (Dobbins 2016), which might otherwise be avoided with the presence of institutionally based providers such as nurse practitioners (NPs). Christian and Barker (2009) identified NPs as a valuable resource to prevent unnecessary hospitalizations which often lead to complications and devastating results for seniors. Although evidence of the positive impact of NPs working in LTC facilities dates back to the 1970s, very few organizations have created and obtained funding support for these positions in LTC settings. This case study illustrates the impact of the NP role in a New Brunswick LTC facility; demonstrating the value of a model that includes an NP collaborating with physicians, nurses and allied health professionals. As shown in this case, the presence of an NP clearly impacted a reduction in emergency room visits and hospitalizations, events that more often than not accelerate further physical, mental and functional decline particularly among the frail elderly. Christian and Barker (2009) described the significant consequences of hospitalization for the elderly patient including irreversible decline in function, delirium and exposure to iatrogenic disease. Having an NP available within LTC affords the residents ongoing monitoring that allows for preemptive and proactive care. NPs providing oversight to the collaborative management of the care of LTC residents has the potential to not only realize cost-avoidance for the healthcare system but also enhance the quality of care for residents and their families.

Infection with Renibacterium salmoninarum, the cause of Bacterial Kidney Disease (BKD) occurs in salmon populations in many locations, including the east coast of Canada. However, information about risk factors for BKD and their effects in the saltwater phase of the salmon aquaculture industry in the region is inadequate. We conducted a retrospective observational cohort study using industry health records in which BKD was recorded in New Brunswick, Canada, between 2006 and 2012. Several risk factors for BKD, such as stocking season, mortality percentage in the first four weeks, food conversion ratio (FCR), lice treatment, Bay Management Area (BMA), and production year were analyzed in a survival analysis using Cox proportional hazards models with cross-classified random effects to account for the structure of the data. The models incorporated effects on two different time scales, time since stocking and calendar time. The risk period was from stocking in salt water to first occurrence of clinical BKD in a pen. Results were time varying. Stocking season had a pronounced effect on time to clinical BKD after middle October of the first year after stocking, with clinical cases occurring less frequently in fall/winter-stocked fish compared to summer and spring-stocked fish; for example, in middle October, the Hazard Ratio of spring- compared to fall/winter-stocked fish was 15.8 (95% CI; 1.05, 354). Differences lasted until June and July of the second year after stocking. Effects of final hatchery before transfer to seawater, and egg source were not detected, but a limitation of this study was that this information was not available for 44.3% of the fish groups in our dataset. BKD status of a site/pen before fallow period and distance to nearest site with BKD were also not detected. Feed conversion ratio and mortality during the first four weeks affected BKD, indicating that better performing fish have a reduced hazard for BKD or vice versa, and implying that good general husbandry practices and BKD are correlated.

Androgen deprivation therapy (ADT) has been the backbone of treatment for metastatic prostate cancer since the 1940s. We assessed whether concomitant treatment with ADT plus docetaxel would result in longer overall survival than that with ADT alone.
We assigned men with metastatic, hormone-sensitive prostate cancer to receive either ADT plus docetaxel (at a dose of 75mg per square meter of body-surface area every 3wk for 6 cycles) or ADT alone. The primary objective was to test the hypothesis that the median overall survival would be 33.3% longer among patients receiving docetaxel added to ADT early during therapy than among patients receiving ADT alone.
A total of 790 patients (median age, 63y) underwent randomization. After a median follow-up of 28.9 months, the median overall survival was 13.6 months longer with ADT plus docetaxel (combination therapy) than with ADT alone (57.6 vs. 44.0mo; hazard ratio for death in the combination group, 0.61; 95% confidence interval [CI]: 0.47-0.80; P<0.001). The median time to biochemical, symptomatic, or radiographic progression was 20.2 months in the combination group, as compared with 11.7 months in the ADT-alone group (hazard ratio, 0.61; 95% CI: 0.51-0.72; P<0.001). The rate of a prostate-specific antigen level of less than 0.2ng/ml at 12 months was 27.7% in the combination group vs. 16.8% in the ADT-alone group (P<0.001). In the combination group, the rate of grade 3 or 4 febrile neutropenia was 6.2%, the rate of grade 3 or 4 infection with neutropenia was 2.3%, and the rate of grade 3 sensory neuropathy and of grade 3 motor neuropathy was 0.5%.
Six cycles of docetaxel at the beginning of ADT for metastatic prostate cancer resulted in significantly longer overall survival than that with ADT alone. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00309985.).

Bacterial kidney disease (BKD) is considered an important cause of loss in salmon aquaculture in Atlantic Canada. Causative agent of BKD is the Gram-positive bacteria Renibacterium salmoninarum. Infected salmon are often asymptomatic (subclinical infection), and the disease is considered chronic. One of the challenges in quantifying information from farm production and health records is the application of a standardized case definition. Case definitions for farm-level and cage-level clinical and subclinical BKD were developed using retrospective longitudinal data from aquaculture practices in New Brunswick, Canada, combining (i) industry records of weekly production data including mortalities, (ii) field observations for BKD using reports of veterinarians and/or fish health technicians, (iii) diagnostic submissions and test results and (iv) treatments used to control BKD. Case definitions were evaluated using veterinarians\' expert judgements as reference standard. Eighty-nine and 66% of sites and fish groups, respectively, were associated with BKD at least once. For BKD present (subclinical or clinical), sensitivity and specificity of the case definition were 75-100% varying between event, fish group, site cycle and level (site pen). For clinical BKD, sensitivities were 29-64% and specificities 91-100%. Industry data can be used to develop sensitive case definitions.

The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients\' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions.

New Brunswick is one of the provinces most affected by the aging of the population. Moreover, aging at home in Francophone minority communities is a major challenge in rural areas. The goal of this paper is to identify the main advantages and disadvantages of aging at home and to expose organizational strategies deployed by seniors and their families in order to promote aging in place. The case study is the method of analysis that we have recommended. Our methodology is based on content analysis of 13 semi-structured interviews with seniors and their children. The results show that family and community support, resourcefulness and resiliency, the practice of leisure activities as well as the living environment are among the principal means used by older adults to promote aging at home.