The acrolect, in territories like Jamaica, is described in the literature in a number of ways -as "the local standard English" or as the theoretical upper end of the construct referred to as "the continuum". Data was collected from a sample of Jamaican speakers whose work prospects require use of Standard Jamaican English. The analysis reveals that phonological variation in Jamaican English is structured in such a way as to reflect the coexistence of Creole and English, in a speech community that values the speaker who can use both varieties. In a linguistic context that is characterized by continuous variation, use of some variables is crucial in defining the boundaries between Creole and English, thus establishing the variety the speaker is using. These I call "load-bearing phonological variables". I show that it is not the use of English variants per se that defines someone as speaking the acrolect; rather it is use of variants of these load-bearing variables.

Climate change impacts are being felt across sectors in all regions of the world, and adaptation projects are being implemented to reduce climate risks and existing vulnerabilities. Climate adaptation actions also have significant synergies and tradeoffs with the Sustainable Development Goals (SDGs), including SDG 5 on gender equality. Questions are increasingly being raised about the gendered and climate justice implications of different adaptation options. This paper investigates if reported climate change adaptation actions are contributing to advancing the goal of gender equality (SDG 5) or not. It focuses on linkages between individual targets of SDG 5 and climate change adaptation actions for nine major sectors where transformative climate actions are envisaged. The assessment is based on evidence of adaptation actions documented in 319 relevant research publications published during 2014–2020. Positive links to nine targets under SDG 5 are found in adaptation actions that are consciously designed to advance gender equality. However, in four sectors—ocean and coastal ecosystems; mountain ecosystems; poverty, livelihood, sustainable development; and industrial system transitions, we find more negative links than positive links. For adaptation actions to have positive impacts on gender equality, gender-focused targets must be intentionally brought in at the prioritisation, designing, planning, and implementation stages. An SDG 5+ approach, which takes into consideration intersectionality and gender aspects beyond women alone, can help adaptation actions move towards meeting gender equality and other climate justice goals. This reflexive approach is especially critical now, as we approach the mid-point in the timeline for achieving the SDGs.

Background Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. Objective The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. Methods In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. Results Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. Conclusions This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. International Registered Report Identifier (IRRID) DERR1-10.2196/42484

There are analogous challenges when it comes to the management and provision of health services and drinking water in First Nations reserves in Canada; both represent human rights and both involve complex and multijurisdictional management. The purpose of this study is to translate the tenets of Jordan’s Principle, a child-first principle regarding health service provision, within the broader context of First Nation drinking water governance in order to identify avenues for positive change. This project involved secondary analysis of data from 53 semi-structured, key informant (KI) interviews across eight First Nation communities in western Canada. Data were coded according to the three principles of: provision of culturally inclusive management, safeguarding health, and substantive equity. Failure to incorporate Traditional Knowledge, water worldviews, and holistic health as well as challenges to technical management were identified as areas currently restricting successful drinking water management. Recommendations include improved infrastructure, increased resources (both financial and non-financial), in-community capacity building, and relationship building. To redress the inequities currently experienced by First Nations when it comes to management of and access to safe drinking water, equitable governance structures developed from the ground up and embedded in genuine relationships between First Nations and Canadian federal government agencies are required.

Using this approach, we estimate the unmet need, in women, for DEXA scans to be 180 per 10000 total practice population. Allowing for scan uptake, this would define approximately 60 women per 10000 total practice population with low BMD. The application of this screening strategy has identified a group of women who might benefit from treatment or prophylaxis for osteoporosis.