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Ontario health system under increasing strain, report shows

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The latest report card on the quality of health care in Ontario shows a system under increasing strain, with hallway-medicine getting worse and the opioid crisis growing.

The report from Health Quality Ontario — the arms-length agency that monitors the quality of the health system — signals that the province is once again heading into a flu season with overcrowded hospitals.

Craig Lindsay displays a 2007 photograph of his mother Lois and his son Spencer. Lindsay, a retired paramedic, was caregiver to his mother as she was dying of cancer six years ago. Stresses within the health system are resulting in increased pressure on caregivers, according to a new report.
Craig Lindsay displays a 2007 photograph of his mother Lois and his son Spencer. Lindsay, a retired paramedic, was caregiver to his mother as she was dying of cancer six years ago. Stresses within the health system are resulting in increased pressure on caregivers, according to a new report.  (Andrew Francis Wallace / Toronto Star)

As well, it shows that Ontario has experienced its largest annual jump in opioid-related deaths, indicating the epidemic has not yet crested.

Both patients and workers are paying the price for increasing pressures, warns the 76-page report, titled Measuring Up 2018, tabled in the Legislature late Friday afternoon.

“It is not that these are new pressures but we are seeing them get bigger,” remarked HQO interim president Anna Greenberg. “When we see the trends for some of these issues going in the same direction that we don’t want them to, it is concerning.”

“(This) can lead to compromised care for patients and burnout among doctors, nurses and other health-care providers,” it warns.

Demographic changes, including an aging population and more people with complex health needs, are increasing pressures throughout the system, particularly hospitals.

Hospital overcrowding is a “symptom and a source of cascading pressures throughout the health system, which includes longer wait times, insufficient access to mental health and addictions care, wide variation in quality of care among long-term care homes and rising levels of distress among unpaid caregivers,” the report says.

Of every seven days that patients spent in hospital in 2016/17, more than one was taken up by patients awaiting transfer elsewhere, for example, to long-term care homes or rehabilitation facilities. That’s the highest rate in five years and the equivalent of more than 10 large hospitals being occupied every day by patients waiting for care elsewhere.

The overcrowding creates bottlenecks in emergency departments. Wait times for admission to hospital from the ER hit their highest peak in six years. In 2017/18, patients spent an average of nearly 16 hours in the ER before being admitted, more than two hours longer than in 2015/16.

ER visits increased by 11.3 per cent over the past six years, to 5.9 million in 2017/18 from 5.3 million in 2011/12. Visits by high-acuity patients — those with more serious conditions — rose at an even higher rate, up by 26 per cent to 4.1 million from 3.3 million.

Compounding the problem of overcrowded hospitals is the ongoing opioid epidemic.

The report shows that visits to the ER due to opioids more than tripled to 54.6 per 100,000 people in 2017, from 15.2 per 100,000 in 2003.

As well, it reveals that Ontario saw the highest annual jump in opioid-related deaths between 2016 and 2017. Two years ago, the death rate was 6.2 per 100,000 population, while last year it was 8.9 per 100,000 population.

The death rate has nearly tripled since 2003, when there were three deaths per 100,000 population.

Premier Doug Ford campaigned in the run-up to June’s election on a platform that included making headway on hallway medicine and the opioid crisis.

While the time period covered in the report precedes Ford’s victory, it nevertheless reveals an unfavourable trajectory.

Anna Greenberg, interim president of Health Quality Ontario, says pressures are increasing on patients and workers as many Ontario hospitals operate at 100 per cent capacity.
Anna Greenberg, interim president of Health Quality Ontario, says pressures are increasing on patients and workers as many Ontario hospitals operate at 100 per cent capacity.

“Trying to fix the problems in any one single setting is not going to be enough,” Greenberg said, explaining that transitions between various parts of the health system need to be improved.

“What it will take is different parts of the system working together so that patients are able to be cared for in the right place as their needs change,” she added.

The stresses within the health system are resulting in increased caregiver distress, the report shows. Among clients who received home care for six months or longer, in the first half of 2017/18, more than one in four had a primary family or friend caregiver who experienced continued distress, anger or depression in relation to their caregiving role.

That’s up from 20.8 per cent in the first half of 2012/13. The increase represented 13,244 additional caregivers experiencing continued distress, anger or depression.

Toronto resident Craig Lindsay knows this kind of distress all too well. The retired paramedic had a tough time being caregiver to his mother as she was dying of cancer six years ago.

“She wanted to die at home and I tried to manage her at home until it overwhelmed me,” he explained.

It was a difficult juggle, he recounted. He did the overnight shift at his mother’s home in the weeks leading up to her death. The family paid out of pocket for private nursing help during the day.

Their bad experience is reflective of disparities in availability of palliative care services across the province. At the time, service levels were spotty in Scarborough where Lindsay’s mother lived.

Lindsay also had his own health problems to contend with. Suffering from kidney failure, he requires three weekly visits to hospital for dialysis.

On top of all this, he had his immediate family to care for.

“It was very stressful. It compromised my health. I felt depleted,” he said.

In the end, Lindsay was unable to cope. His mother ended up dying at Providence Healthcare where she spent the last three days of her life.

“To be blunt, I think I failed her,” he said of being unable to meet her wishes to die at home. “I think about that often. I don’t think that is how she envisioned her last days.”

HQO’s report contained some good news. For example, longevity is increasing. The life expectancy for someone born in Ontario between 2014 and 2016 is 82.5 years. That compares to 80.8 years for a person born between 2005 and 2007.

Additional bright spots cited include a decreasing rate of hospital-acquired C. difficile infection and a meeting of wait-time targets for most cancer and general surgeries.

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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Anglais

Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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