 Okay. Yeah, I wish we could see everybody, but I'm sure we've met most of you. So welcome. Thanks for joining us tonight. We'll be going live in five more minutes. Okay, everyone, I'm going to turn off my camera. Have a great webinar. Got some nice photos of us there. So welcome. Thanks for joining us as more participants are joining, signing on. So we'll be starting right around six in a few more minutes. So the recording, the webinar will be recorded and available on the website later and it's live stream to the YouTube channel. Okay, so yeah, thank you for everyone who submitted questions before the webinar when you registered. So we will answer as many of them as we can at the end of the tonight, the presentations and if you already submitted a question before. Don't type it into the chat box again just so we'll get through as many as we can at the end answering those questions. Thank you for submitting them. We've had over 100 questions submitted. So there's quite a lot to go through. So thank you for joining us. Yeah, so if you have a question during the presentation, feel free to type them into the Q&A box and we'll try to get to them at the end if we have time. Okay, so more and more people are joining in. Welcome to our event. We'll begin shortly in a few minutes here. We're enjoying the nice summer weather in Calgary. We're coming from Calgary. All right, so welcome. We have close to 300 people, 280 participants. So as you're signing on, if you have any technical problems, just type them into the chat box and surely our technical support will give you help with that. So I guess we will start in a few more moments just so we can get through all the presentations and all the questions tonight. So, okay, we can we will start we'll start our event. Thank you everyone across Alberta for joining our CLSA update for Alberta participants. We're very excited to have Dr. Hogan and Dr. McMillan are two principal investigators joining us from in Calgary here. So we have welcoming all of our comprehensive participants as well as tracking participants in the province. Birchman. Yeah, surely we'll have to sign off so I can start my slide deck. Great. Yeah, there we go. Okay. So Dr. Hogan's graciously agreed to the slide events are visible. So before we begin our event for tonight, I just like to start with a acknowledgement of the land. The Confederacy of Calgary, located in the heart of Southern Alberta, both acknowledges and pays tribute to the traditional territories of the people of treaty seven, which includes the Blackfoot Confederacy comprising the Cisco, the the, sorry, Gaena First Nations, the Stony, Nacoda, including the Chiniki, Bears Paw, and Wesley First Nations, and the Soutena First Nations. So the city of Calgary is also home to region three of the nation of Alberta. By virtue of signing of the treaty seven in 1877, the university recognizes that we're all treaty people. So our presentation for tonight will have a overview, a quick little overview of what we've been doing in the last year and Dr. Hogan will give us an update on the CLSA research. Dr. McMillan will give us a update on the CLSA research related studies in the last year, and we'll answer as many questions as we can at the end that were submitted prior to the event. So in the last year, we adapted really quickly to when the pandemic started in March. We suspended our in-person research to telephone interviews and successfully supported the COVID study which started in April and also the antibody study in the fall. So it was a challenging time for everyone, but we managed to balance the CLSA requirements as well as the university requirements to gather all of the data as much as we can and keep the research going. And most important of all, all our staff has been healthy and well and hope you've all been keeping well as well. And just want to say thank you for our team in Calgary here, our data collection site. We have in-home interviewers, Pam, Glenn, Amy, and Mark, our data collection site staff, Loreline, Jessica, Kim, and Steve, Loan is our lab tech, and Dr. Hogan and Dr. McMillan. And I'm Birchman, the coordinator for the data collection site in Calgary. So for those of you who are our tracking participants all across the province. We are in the Heritage Medical Research Clinic in the TRW building on the Fethills campus. So if you're ever in Calgary, let us know and we can give you a tour. Okay, so now I'll pass it on to Dr. Hogan to give us the update on the CLSA. Thank you very much. Jackman will be talking about the COVID studies in a few moments, but I did want to give you an update about the CLSA study itself. It's been challenging really close to two years because of COVID. We want to acknowledge our national leaders, Dr. Perminarani, who's in McMaster, Dr. Wilson and McGill, and Dr. Kirkland, who's at Dalhousie University on the East Coast. What is a CLSA? Just quickly review the purpose of the Canadian Long-Tool Study in Aging. It really is a study. It's really a research platform and provides the infrastructure needed to do state-of-the-art and interdisciplinary. That means involving people from a variety of disciplines to do population-based research and also inform evidence-based decision-making that hopefully will lead to better health and improve quality of life for Canadians, particularly as we age. The CLSA has a long history. My personal history goes back over 20 years, and it was sort of the descendant of another study called the Canadian Study on Health and Aging, and it's been on the research agenda for about 20 years. There are over 160 researchers and collaborators currently involved with 26 institutions across the country, and I mentioned that a lot of disciplines are involved. That includes biology, genetics, and all the other fields listed here. It's the largest research platform of its kind in Canada for both the breadth of the work we do and also the depth and the detailed information we collect. And overall, we're planning to follow 50,000 plus Canadians aged 45 to 85 when they enter the study for up to 20 years. These are just the logos of various collaborating institutions. I put University Calgary at the top, not because it's the most important, but because we are talking specifically about activities here in Alberta. They can see some of the other universities involved in the program. So the participants of CLSA, and that's the most important component of the whole study, is made up into two groups. We call them the Tracking Cohort or Group and the Comprehensive Cohort or Group. The Tracking Cohort was, the target was to have about 20,000 participants from all 10 provinces who'd be followed through computer assisted telephone interviews that would take about an hour at the first data collection at the baseline. And at the end of the recruitment, 21,241 individuals enrolled into the study. For the Comprehensive Cohort, the target was 30,000 participants who lived within 25 kilometres or 50 kilometres, depending on the particular location of the DCS, that stands for Data Collection Site. We did have some sites that were in more rural areas and had a wider reach out to 50 kilometres. But here in Calgary, we stuck to 25. So their follow-through in-home interviews, I take about an hour at baseline, it's got a bit longer sense, and also further assessments which are done at the data collection sites taking about two to three hours. And at the end of the day, a bit over 30,000, nearly 31,000 individuals across the country were recruited and enrolled. So the CLSA infrastructure includes the Computer Assisted Telephones Interview Centers. They're called CADDI, that stands for Computer Assisted Telephone Interview. And they're based at the University of Sherbrooke, University of Manitoba, Dalhousie University, and Simon Fraser University. Then you have the data collection sites, and I'll show you a map in a few moments, locating them. But the data collection sites, this is where people after the in-home interviews would come in for further interviews and physical assessments that would look at all those areas that I listed here. They also would have a biospecimen collection, if they agree to it, of blood and urine. And part of the assessment includes a detailed cognitive or thinking evaluation. So this tries to summarize everything I mentioned before. So you have the research platform of the beginning longitudinal study in aging, approximately 50,000 individuals, 45, 85 at baseline, 20,000 in the tracking cohort were followed through computer assisted telephone interviews, and 30,000 approximately in the comprehensive, who have computer assisted in-person interviews, plus clinical evaluations, physical tests, and obtaining samples of blood and urine from them, all done at the data collection site. So the baseline evaluation occurred between 2010-2015. We finished the first follow-up in 2015, sorry, the first follow-up in 2018. The first follow-up was done between 2015 and 2018, and we're just finishing up the second follow-up, not quite finished but nearly completed. And the idea is to have active follow-ups having people evaluated every three years. And now we'll go on until 2033. So the data collection sites are the green dots you can see here. There's one in Victoria. There's really two in Vancouver area, but they split between the University of British Columbia and some of Fraser University. And some Fraser is located more in Surrey. Ourselves in Alberta. Then there's one in Manitoba, Winnipeg. Then there's Ottawa and Hamilton in Ontario. And Quebec, there's Sherbrooke in Montreal. And the Maritimes, there's Halifax, and then New Flanders, St. John's. And that's where the data collection sites are based. So there was a question that came up a few times about what has been the withdrawal rate or loss to follow-up rate. At the end of the first follow-up in 2018, 4.3% of participants withdrew from active data collection, though most of them, a bit over 60%, agreed to continue passive data collection that would be done through data linkage. We had received permission to look at administrative databases. In addition to that 4.3%, 2.7% of participants had unfortunately passed away since their baseline assessment. And Calgary are withdrawal rates and mortality rates are really both the same as across the country. At the wrap-up of our follow-up 2, we've again lost an additional 4% or thereabouts. And we've lost about the same number of people, 4%, who have passed away between follow-up 1 and follow-up 2. Now we do make accommodations to keep people in the study. That includes those who might move from one area to another. We just transferred their data collection to a more proximal site. If they move into long-term care, we also remain involved and what permission will visit them in the long-term care facility. We also are open to modifying data collection and for people who can't come into the data collection sites, we have what we call the DCS at home, where we do somewhat a bridged evaluation in the person's own home. Because we don't collect as much data as we would normally collect if they came into DCS, we do restrict that to people who just really can't come. And for those who unfortunately may be developing cognitive or thinking problems, they can appoint a proxy to answer questions for them. Now, the important question I think for you as participants is being reassured that the data is being used. This is not a study that has one research question and then it comes to an end after that question has been addressed or answered. Remember, this is an infrastructure platform and various studies and projects come on or done and then other projects come in and move on to sort of a continuous conveyor belt of studies going on using the data being collected. Now, approved projects, there is over 300 of them. There are 72 approved in 2020 alone. If you're interested in knowing what type of projects are being done, if you visit that web page, you can see the list of all projects, including a summary of the work that is being done. To date, there's about 150 publications arising from the Canadian Languages Study of Aging Data. And if you're interested in looking at what type of publications have come out and also having a link to those papers themselves, visit that website, the WWC LSA Publications link. In addition, the LSA is a subject of literature, and I want to bring to your attention, a very interesting chapter in a book written by a Calgary participant, Laura Werschler, I hope I pronounced your last name correctly, who wrote a chapter in a book called Aging in Three Year Increments. I can think of a better title for a CLSA chapter. And it's found in a book, You Look Good for Your Age, it's an anthology looking at ageism and its impact on women as a age. It was published by the University of Alberta Press this year. And you might be interested in getting a copy of Ro and I know I've ordered one myself. There are some questions about where can they learn more about the data what's been found. And I'd like to refer you to a report on the baseline data that can be downloaded from the website at the bottom of the slide. It looks at the baseline data as broken into a number of chapters. And their number of highlights that I'm just going to talk a bit about. I do want to point out here that in Alberta, if you look at the tracking and comprehensive court, we have just shy of 5,000 individuals who initially enrolled in this study. So if you look at the baseline report, you'll see that 90% rated or housed as good, very good, or excellent of the CLSA participants. 95% rated their mental health is good and very good, or excellent. And what's interesting is if you look at more issues or concerns about mental health, it was higher in the youngest portion of the CLSA enrollees. So people 45 to 54 tended to have more mental health concerns than people who were, you know, 55 to 64, 65 to 74 and 75 and up. You can also see that more women than men reported loneliness. We had one in 20 and suffered a fall in the last year. And while in general there were healthy, only a quarter were as physically active as has been recommended for us to stay healthy. Another somewhat surprising finding for me was that about 40% of participants were caregivers to someone else, and only about 10 to 15% were care recipients, which go very much against sort of the view of us as we age. And I'm 67 myself is that we are just care recipients. We also are very active in giving care to members of our family to people in our community. But I really encourage you to take a look at that, that report if you have an interest. And, and sort of baseline data. So I want to give you some highlights for 2020 and 2021. The major activity was responding to the COVID-19 pandemic. You know, we stopped seeing people in person in March of 2020. And it's been a long time since people have visited our data collection sites, or we visited them in their own homes. And everything had to be moved to working remotely, which was quite a challenge for the study quite a challenge for our staff. And we did our best in collecting data over the phone but clearly there are some things we couldn't do. Another highlight was that this year, the Canadian Foundation for Innovation has decided to make a further investment in CLSA to renew our infrastructure because our current infrastructure is 10 plus years old. And also add new tools that help us to identify the causes in early stages with certain chronic health conditions, such as mobility impairment, disability and cognitive decline. Additional funding is also provided to the study by the Public Health Agency of Canada to address cognitive issues in a particular dementia as we age. The CLSA hosted a summer program in aging for graduate students and postdoctoral researchers. That was just held about a month ago. Great success. And funding has been provided by the CIHR. That's the main federal source of funding for healthcare research to use CLSA data to help support researchers who wanted to use the data that's been collected to address important research questions. I encourage you to visit the CLSA website, search it, look at it. A lot of information. If you have some general inquiries, you can contact the CLSA through that web, sorry, that email address. And I do want to point out that we are very grateful the funding that we received from the government of Canada through CIHR, CFI, and also from participating in provincial governments and universities, which here in Alberta would include our provincial government and also the University of Calgary and other partners. Now, I'll turn this over to Jacqueline. Thank you, Dr. Hogan. Thank you to everyone for participating this evening and also a thank you for your involvement in the study and I think as you'll see as we go along here that there's a lot of knowledge gaps that are being addressed by your participation in the study so it's with a lot of gratitude that will share some of these findings. So, as many of you know, with the response to the COVID-19 pandemic. As Dr. Hogan mentioned, we moved to in person pardon me in March 2020 in person data collection was suspended with migration to telephone interviews and around that time there was development of the COVID-19 and questionnaires, which some of you may be familiar with. Next slide. Great. So the CLSA COVID-19 questionnaire study was launched in April of 2020 and included both web and telephone questionnaires. This involved weekly, bi-weekly monthly and monthly data collection and approximately 28,000 of the baseline participants across Canada participated in this questionnaire based study. For those of you who participated, you'll know that there was baseline questionnaire. And then there was also an exit questionnaire in addition to the weekly, bi-weekly and monthly questionnaires. And the exit questionnaire was in the fall of 2020. This study was funded through the McMaster Institute for Research on Aging, McMaster University, the Jerevinsky Research Institute, the Nova Scotia COVID-19 Health Research Coalition and the Public Health Agency of Canada. The questionnaire study did include a lot of different domains and questions and this was related to COVID symptoms, COVID status, risk factors, health care use, health behaviors, public health measures, social factors, depression and anxiety, economic consequences of COVID as well as consequences on function and mobility. And so we'll discuss and I'll share with you later some of the early findings from the questionnaire study. So our study recruitment for the questionnaire study, you'll see in the top left corner, our entire CLSA sample is approximately, well it's 51,338 participants and prior to this study for COVID beginning, 8,638 participants were excluded for a variety of reasons. That left us with 42,700 participants who were invited to participate and once they were invited, a further 189 were excluded for a couple of different reasons. Some being related to having passed away in the interval or requiring a proxy. And that left us with 42,511 which was the eligible sample and 67% of people agreed to participate. So the CLSA COVID study for the questionnaire study involved 28,559 participants. So this is the time that was spent on the study and the, and as the weeks went by how the study unfolded so the baseline questionnaire was launched April 15 of 2020, and was performed either through a phone based interview or through web based interviews Depending on which pathway participants entered into. They either had bi-weekly questionnaires if they were phone based, or they had four weekly questionnaires performed over the web based questionnaire so there was the two pathways. Following that there were three monthly questionnaires, and then the exit questionnaire as I mentioned that occurred in the fall of 2020. So those of you who may be interested, you can visit the CLSA website, and the address is just at the bottom there and you'll find some high level data about the CLSA COVID questionnaire study so as you can see, you can navigate this page. And it will give you some information on the types of very high level data that was available is available. You'll see that there were just over 28,000 participants, 52% of whom were female, and you can navigate the website to select what age group had different percentage of participants, how many were from each province and you can find different high level data if you're interested in that you can visit the website. As far as this questionnaire study that I was referring to there are some learnings to date that I'll share with you just briefly. The first one was on vaccination willingness and if you're interested further in this I will highlight that one of the investigators, Dr. Nicole Basta will be presenting a week from tomorrow on this and you can register for this webinar on the CLSA website. We looked at factors associated with willingness to receive a COVID vaccine, and from the data that was provided by the participants responses what was found is that people who are less likely to be willing to receive a COVID vaccine tended overall to be younger female and the vast overall by and large to have a lower education and income household income. They were people who tended not to have received the influenza vaccine in the year prior. And they were individuals who had had COVID had had the infection. The respondents 83% were willing to receive a COVID vaccine, and there was a strong association between willingness to receive the COVID vaccine and having received an influenza vaccine in the 2020 to 2021 flu season. So, Dr. Basta will be presenting at length that on this next week if you're interested and it should be a really interesting presentation and you can register online. This is mental health. One of the findings that this study, the questionnaire study has revealed is it looked at a comparison of depression symptoms during COVID compared to pre pandemic levels, and overall there was a two fold higher odds of depressive symptoms. There was an initial lockdown that occurred in the approximately the first eight to 10 months of the pandemic in Canada, and these depressive symptoms remained elevated at the time of the exit survey, which was in the fall of 2020. And there were some associations with these higher depressives. I was muted myself there. It's a cliffhanger you have to guess what those were. Those were included individuals who were female of lower income, residing in urban areas, and living alone those were predictive of the higher depressive symptoms. As far as mobility and function those individuals who were confirmed to have had COVID-19. Approximately a two fold higher odds of worsening mobility and physical function compared to those who did not have COVID. And again older age female sex, lower annual household income, living alone and living with greater than three chronic conditions were more likely to report worsening mobility. And then lastly, there are some early findings about long haul COVID or some of the persistent symptoms of COVID. And it was found that at one sit people who some of the symptoms that were persistent greater than one month in 15% of people who had had COVID. They reported moderate to severe fatigue dry cough and a decrease sense of smell for greater than one month, and greater than 10% of those who had had COVID reported moderate to severe shortness of breath, muscle or joint pain pain for greater than one month. There will be more information and studies released about more of this but, as you can see, there's some knowledge being gained from your participation in these studies and, and it may influence sort of how we look at the impacts that COVID has had on middle aged and older Canadians. Thank you, please. Thanks. So I'm going to shift gears a little bit to the antibody study that you may have heard of this was this rolled out in the fall as well and the goal of the study was to understand the prevalence and impact of SARS COVID to or the virus that causes COVID 19 infection on middle aged and older adults in Canada. Next slide please. Thank you. It was launched in November 2020 and enrolled approximately 19,000 CLSA participants across Canada, and it involved a blood sample to determine if a person participant has been previously infected with SARS COVID to or had been vaccinated with SARS COVID to so one of the challenges with this study has been the rapidity of the development of the vaccines because when this study was being developed in early fall of 2020. We didn't know where on the horizon vaccines would be and we knew that these antibody studies would be able to detect antibodies to natural infection but we didn't know what the impact of vaccines would be and we also didn't know that the vaccines would necessarily be available as the study was being rolled out so I will present these results just with the knowledge that things have changed as as the study has rolled out itself. So there's been three waves of data collection. There was a $4 million investment to support this study from the government of Canada, COVID-19 immunity task force so if you see CITF on any of the later slides, that is the COVID-19 immunity task force. Thank you. So the COVID-19 antibody study, there was venus but blood collection so participants attended a data collection site. This DCS site, the data collection sites did use enhanced health and safety measures and COVID-19 screening just for the safety of participants and staff. And 50 milliliters of blood or about three tablespoons were drawn with the venus blood collection. This was along with a telephone questionnaire and the partners for this study were Alberta precision laboratories FedEx and the COVID immunity task force. Great. And then we have the dried blood spots. So this involved self collection of blood samples at home. So if you you could almost liken this to an individual who has diabetes who does blood collections at home to monitor glucose levels it's in some way similar. And so the participant would have self collected four to five drops of blood from their fingertip using a blood collection kit. And then this questionnaire was either telephone or online. And again the partners included Boston micro fluids, Alberta precision laboratories, FedEx and the COVID-19 immunity task force. So think about the goal of this study so it's an antibody study, and it's meant to look at seroprevalence so I think that if we just pause there and think about what seroprevalence what information we can gain from a seroprevalence study. We're at the level of pathogen in a population as measured in the blood so in our case the pathogen is SARS-CoV-2 so the virus that causes COVID-19 and our population is a subset of CLSA participants. So any comments that we make about this study must be made in the context of these factors that we're just looking at a subset of CLSA participants we are not, we can't comment about people of younger ages we can't comment about people who are not CLSA participants. And so there are some things that we must consider when we when we look at the results of this study. And then the serum is the component of the blood that we get so that would be from the dried blood spotter from the venus blood collection. So when we think about the pathogen so the SARS-CoV-2 or the virus that causes COVID-19 we used tests to detect antibodies to SARS-CoV-2 so antibodies are protective proteins produced by the immune system. They indicated an immune response to a foreign body so the SARS virus is that foreign body. And in this study we tested for two common antibodies to SARS-CoV-2. So next slide please. For those of you who participated in the study, I will chat a little bit about what results you'll receive and the timeframe of receiving those results. So just as far as the first line there participants will receive a letter this may be by email depending on when you consent how you consented. Your results will be delivered to you based on how you consented so this may be a letter or an email or a telephone call but your results will be sent to you and will indicate your results of each of these two antibody tests. So if you have ever seen pictures of the SARS virus it has spikes on the outside and then on the inside there's a nucleocapsid so the antibodies can be to either of those two components that we were testing for. So the nucleocapsid antibody can be reported as positive or negative for each individual and then the spike protein antibody will be reported as positive or negative for each individual. And so antibodies can be produced to either the nucleocapsid or the spike protein if you have experienced natural infection from COVID-19 because your body has seen the entire virus as it is in nature. It's seen the nucleocapsid and it's seen the spike protein and so your immune system may have developed antibodies to one or both. The duration that they remain in your body is not certain but they if both of those are present that would be from immune infection or natural infection. When we look at the vaccines available in Canada. We have Moderna, Pfizer and AstraZeneca and those vaccines were developed using the spike protein and so your body only sees the spike protein. And so the antibodies that are produced based on vaccination would be to the spike protein and so what will be provided to participants will be an interpretation of the results. So in an individual were they positive or negative to nucleocapsid and where was their blood positive or negative to spike protein. And so you will be provided with an interpretation based on the results and then you'll also be provided with a list of frequently asked questions if you are curious about further interpretation. So, as far as the timeframe, when you may expect your results, there were three windows of data collection so if you were in the first window, you can expect your results in approximately late July. If you were in the second window of result of data collection for the venous blood draw that may be into August. If you were in the third window of the venous blood draw that will be into late August. And then the dry blood spot results will be slightly later. And so we're looking at into late August, late September late October respectively. And those timeframes are barring any external factors that may influence the release of the results. But those are the goal timeframes at this point. So as I mentioned earlier, there has been a few things along the way, developing a study and creating a way to communicate the results while things are evolving in the science. We expect those are the timeframes and that's our those are our goals right now. Okay, so next slide, perfect. So if we go back to what does a serial prevalence study provide us what type of information it provides us about the level of pathogen in the population, as measured in the blood. So the reason I repeat kind of what we way looked at a few slides ago is just to remind us of the limitations that can exist on interpreting study results and so the results that we get from the antibody study are meant to be used on a population level. By that I mean, at a group level and that group is CLSA participants so it tells us about in this group of CLSA participants what do we know what can we say. And the flip side of that is that population level data should not influence individual level behaviors. So as you receive your results. It's important that your results shouldn't change your behavior during the pandemic and so we have results that are population level, but individually we should continue and continue to adhere to public health measures and those may vary by region or potentially but those are the measures that are designed to prevent infection and transmission. And so even though we have population level results we need to adhere to individual level restrictions and mechanisms in place. Okay, next slide please. In the antibody study negative results results may occur so if you get a results that you think that you may be surprised by. They can occur. If the blood was collected soon too soon after infection or vaccination in persons who are immunosuppressed in persons with mild or asymptomatic infection. If the concentration of antibody is below the detection limit of the test. Lastly results should not be used to diagnose recent infection. Okay, next slide please. If you are interested in these serology tests and you are curious and would like a bit more reading. These are three websites you can visit so we have the Canada dot ca website for medical devices. It will be found under the medical devices section. Next slide please. This is the most recent study that you may or may not have heard of but you over the coming months. This is the next and next stage of the COVID studies within the CLSA, and it's called the brain health study. It was funded by the Canadian Institutes of Health Research in the Western Brain Institute and it's being led by Dr. Teresa Lou and Rose of the University of British Columbia, Dr. Eric Smith, who's with us at the University of Calgary, and Dr. Perminder Reina from McMaster University. So the goal of this study is to explore the impact of the COVID pandemic on human cognition and brain health. Our current understanding is limited to acute and overt manifestations. So those are the ones that occur in a hospitalized population or during the acute infection. And the goal of the brain health study is to focus on understanding possible covert neurological consequences of COVID-19 and their impact on human brain and cognition. Next slide please. Thank you. So we have the baseline CLSA research on the left side with our baseline follow up one and follow up two and three. And then on the right are CLSA COVID studies that are at various stages, including the questionnaire study, the antibody study and the brain health study. So a big thank you to all of you who have participated in all the different parts of this slide. And I think that I will wrap up there and we can move on to any questions that may arise. Right. Thank you very much, Jacqueline Birchman. So we were going to alternate, you know, between myself and Jacqueline and answer any questions. And then at the end, Birchman, if something comes up from the box, please let us know. But we're going to go through the submitted questions first. And I'll start to give you a bit of a break Jacqueline. As Jacqueline mentioned, we had well over 100 questions submitted. And a very common question about the CLSA study itself is, what was the most interesting finding? You know, as I tried to point out the CLSA is really a platform and infrastructure. And there's a whole host of studies going on. So what's the most interesting often is driven by your own personal interests. I've been involved with others as a research team looking at CLSA data to look at the link between thinking cognition and how we walk and how our balance is. There's an interesting link in that if you start developing cognitive or thinking issues, often there are some changes in the way you walk. And that's sort of an interesting and important emerging area of research. So I've been involved in that. I love Alberta and I love Calgary, and I was very interested in how CLSA data could be used to reflect on what's going on in my city, Calgary, and also how it could be used to make Calgary a more age friendly community. So I've been involved in looking at how representative the CLSA participants from Calgary were to the overall population in Calgary. And I can tell you that as with many volunteer studies, the volunteers tend to be more highly educated, economically better off. And in Calgary, we're also much more likely to be from Calgary and not internal migrants, you know, people from other parts of the country, or also immigrants into our country. And so it can tell us a lot about Calgary and people living in Calgary and how we can inform public policy, but we have to understand that can answer all questions, because there are certain populations underrepresented. Another study I was involved was was looking at the impact of the 2013 flood, because it was right in the middle of our baseline data collection so we can compare people before and after. And it was obvious when you thought of it, but the biggest impact was that if you're from neighborhoods which flooded, after the flood, you're much more like less likely to be enrolled into the study, because you had more important things to do. And also your phone may have been out of order, because we were using landlines at that time to contact people. There also was some hint that there was increase in sort of general level anxiety. But it didn't show as big an impact as we thought we would see, but it's mainly because I think people who were from the affected neighborhoods weren't being enrolled and we couldn't see that impact of the flood was sort of an interesting. But when you think of it kind of an obvious finding. I'm also very interested in, and dementia and cognitive changes and I'm going to be involved in future studies, and Jacqueline and ourselves are doing a COVID study we're looking at the questionnaire data. And not not, this is not reflective of our own personal habits, but we looked at alcohol intake and the impact of COVID and a number of studies have shown increasing levels of alcohol consumption. With the COVID pandemic. At first glance at the data, the other thing we're finding interesting is that there is some would increase levels, but about an equal number had decreasing levels of alcohol consumption, which no one else had has commented on yet that we want to plum and look at in more detail which was quite surprising to me. The surprising finding is all through the study and I really would encourage you to look at the publications look scan the titles take a look at some of the studies. And I'll just give you some examples, and then I'll stop talking sweep apnea, where you have trouble breathing at nighttime while you're asleep. And you can see I see data has been shown to be associated with a higher likelihood of developing glaucoma and age related macular generation, which was suggested people who had sleep apnea should be seen by my professional and have that monitored. I think that modifiable health variables walking more, having higher intake of fruit and vegetables associated with better cognitive performance. These are kind of things your mother told you, but it's nice to see confirmed. One is that participants who were from rural and mixed rural urban areas were less likely to be seen by founding physicians or specialist physicians, but more likely to go to emergency rooms. When you look at the data across the country. One finding that I found shocking to me was that there was a study looking at the adverse childhood experiences among CLSA participants. They asked about issues like physical abuse intimate partner violence, emotional abuse, when people were children, and this data was collected during the first follow up and an astounding 61.6% said they experienced an adverse childhood experience. It was shocking to me about a quarter said they were a victim of physical abuse, about 20 to 25% reported intimate partner violence, and about a fifth had instances of emotional abuse that they felt were was distressing to them, and that they would well be having long term health impacts but I was just floored by the high percentages, but I'll stop here and turn over to Jacqueline Andrews and questions dealing with COVID. I'm just going to scroll through the Q&As here and see if there's any I many of the questions related to COVID where that people surprisingly wanted to know their results I can't imagine why there would be such curiosity but I think that it speaks to the year we've had and reflecting on could I have had COVID when I had those symptoms back in March or the spring could that have been COVID and so it's very understandable that that there's some individual curiosity about that. I know I was posed a couple of questions around vaccines, and those ones are a little tricky to answer because a lot of it does come down to your individual, your individual health so I would encourage anyone who is contemplating vaccination or who has not been vaccinated and those ones I would encourage you to speak with your primary care provider because certainly your personal medical history will influence that. And then we also have some guidance from NACI that you can also refer to so individual vaccine questions are a little bit trickier. There will be some results, some early results from the questionnaire study that you'll see if you check back on the CLSA website. In the coming weeks and months and as I mentioned before Dr. Basta's presentation, I think is the last of the CLSA webinar series for the year but I think we've saved at least one of the best for last because I think it's going to be some really interesting results that she's going to be sharing about vaccination willingness. And I would imagine that in the new in the next months and perhaps into the new year there's going to be some more information on the other studies beyond the questionnaire study. There is a question I'm seeing here about antibody testing done post vaccine and there, there will be and there has been antibody testing done post vaccine so the first wave, the first phase of Venus blood draws and and dry blood spots did occur in November to December of 2020 and so most people who are being vaccinated at that time frame were residents of aggregated living facilities and so many of our participants would not have been vaccinated but certainly by wave two and presently wave three of the Venus blood draws people have been vaccinated and so that's part of the need for very cautious and clear communication that you'll receive in your letters about what the interpretation may be because some of you may have received one or both vaccines by the time your blood draws were completed. I believe that for those of you who are looking to get the links to some of the links that Dr Hogan and I posted earlier. I think that you may be able to have access to the slides but I will defer that question and just see if there's any others popping up there I think we can share the slides afterwards but we'll check with our communications team. And Dr McMillan there were a couple of ones about how the participants could participate in the brain study or antibody study. I believe they were all random sample selection. Yes, and I think the brain study may be slightly different but as far as the other ones it was it was random. And the brain one may be slightly more selective, because there are much fewer participants and and so fewer of you will be contacted for the brain study certainly in Alberta. So, and just a little plug. We are still continuing the antibody study until the first week of July for the blood draw the penis part of the study. So, if you have been contacted or received an email and still interested there's still time to do that part of the study. And that's also true for the dry blood spot I believe to. Birchman, if I may, there was also some questions asking about participants getting results from their evaluation and the CLSA and also some questions about could this be sent to their family physician. I just want to address that. So, you know, when you come to the DCS, you are given a sheet about measurements taken at the time of your visit. And that, you know, includes things like your body mass index, your weight circumference, a waste circumference and hip circumference, your blood pressure, lung capacity, hearing vision, and your fracture risk. And really, that's the data that we provide to you. And if there's an abnormality in the data provided, we encourage you to discuss that with your health care provider. But we don't send out other test results, and we don't send results to anyone else because of issues of confidentiality. The study takes very seriously privacy and confidentiality. And we don't have the data on people who come to the Calgary data collection site in Calgary. The data is sent in a secure way to Hamilton, and then we don't keep that. It's destroyed, it's eliminated. And in Hamilton, there is industrial strength layers to protect the data. There is a separate file that has your name, address, and phone number, also with your study ID number. And that's only used to really contact you. And a separate data set, a database, as all your CLSA data, but you're not identified by name in that. It's only by your study ID. And that's only linked to you by name in this separate database. And the access to the data is minimized. The researchers apply for access to data and they justify their request. It would be provided, but it's in an anonymous fashion. And we don't provide the data on small groups where it would be possible to identify where you're from. For example, that was one of the challenges when we did the Calgary flood study, because we couldn't go in specific ways. We had a group of neighborhoods to keep the numbers large enough that we could mask people. And study information is not released other than what we provide to yourself by the CLSA to any third party unless we're ordered to buy a court order or by the law. So it's not shared with family physicians. Now, there's an exception if in the course of your visit, something is found that would be of concern. Then the staff would inform Birchman who would then inform myself or Jacqueline as the lead investigators. We would review it. We would contact the participants and seek permission from them to inform their healthcare practitioner about what was found that was of concern. So there is a ways to ensure that if something of concern was found that we'd be able to contact the person's attending physician or other healthcare practitioner, but it's only done with the participants knowledge and agreement. That's great. I know that comes up a lot with results especially you've been during the regular follow ups. We get a lot of questions about that. So thank you, Dr. So shall we do one more question one time for one more. There was I think, do we know the, the infected rate of COVID from the COVID questionnaire compared to nationally or participants get having confirmed cases of COVID. Good question. There was a prevalence of just under 1% and it is going to vary across the different time periods of when people were asked. And it does vary regionally because we know that different provinces experienced peaks at different times and there were different methods of determining whether someone had had COVID. So one of the questions asked, did you have a test that was subsequently positive? Were you told by a healthcare practitioner that you had COVID without a test? Or are you very likely to have had COVID based on this constellation of symptoms and having been a close contact of someone with known COVID. And so that kind of gave us different categories of confirmed probable or suspected COVID within the questionnaire part respondents. And so we are seeing prevalence estimates that are similar to what is estimated across Canada but there's a little there's very likely some regional variation and then variation across time points and then those three different definitions. And Jack, just to add to that because I was looking at the data recently, there's a, you know, 1, 2, 3% who have confirmed, but there's about 15% who think personally they may have. Yes, yeah. And so that's an interesting question and I'm sure that is driving a lot of participants personal interest about their own antibody results. Exactly. Yeah. And early on the testing wasn't available to to many people it was you really had to have a travel history or have been in contact. So, so I think that's certainly one of the curiosities to as early on did I have it when when I had those symptoms. And this also is important emphasize that the blood test is very different than the COVID testing where they do the nasal swab which looks for an active infection. And so when you get the results it doesn't mean if it's if it's positive you have to go in isolation or informal sort of people, you might well have been infected in the past but remember we're talking about blood samples which are months ago, and you're really a risk to yourself or others other than the level we all are risked to ourselves and others. And that's why you would still follow the public recommendations but there's no need for you to act on the results of your serological test. That's great. Thank you so much Dr. Hogan Dr. McMillan for our wonderful presentations hopefully we've answered most of the questions that were posed and thank you for all the participants across Alberta for being part of the study. And we will be in touch with you all very soon. And just also a special thank you to our communications and technical team in Hamilton at McMaster. Thank you so much for your early key orcas. Laura Lawson and Jerry. I hope I'm saying your last thing right. So thank you so much. I couldn't have done it without you. Yeah. I forgot to mention. Yeah, sir. When you log off. Yeah, you'll be given a link to a questionnaire that we'd ask you to please complete. And in the follow up email if you don't do it now, we'll badge you again and ask you please fill out the questionnaire. Okay, great. Thank you. Thank you. Thank you so much everyone. Enjoy.