ORCID Profile
0000-0001-8115-7437
Current Organisations
Centre for Addiction and Mental Health
,
University of Toronto
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Publisher: SAGE Publications
Date: 11-2008
DOI: 10.1177/070674370805301110
Abstract: Smoking cessation policies are increasingly imposed in mental health facilities because of the high prevalence of tobacco smoking and its related adverse health consequences. The objective of this study was to measure the impact of 2 smoking cessation policies—one imposed in a specific psychiatric hospital and the other across the entire province of Ontario—on weekly visit rates to a psychiatric emergency department. Administrative data records from consecutive patient visits to a psychiatric emergency department were grouped by week from March 1, 2002, to December 31, 2005. The patients were grouped into 3 broad diagnostic categories: substance-related disorders, psychotic disorders, and other disorders. The impact of 2 smoking cessation policies—one imposed on September 21, 2005 at the Centre for Addiction and Mental Health (CAMH) and one imposed on May 31, 2006 across the province of Ontario—on psychiatric emergency department visit rates was measured using time series analysis. The CAMH-specific smoking cessation policy had no impact on psychiatric emergency department visit rates in any diagnostic category. The province-wide smoking cessation policy resulted in a 15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder. The benefits of a smoking cessation policy need to be balanced by the impact of the policy on the likelihood of patients to seek treatment.
Publisher: Elsevier BV
Date: 03-2018
Publisher: SAGE Publications
Date: 26-01-2016
Abstract: Little is known about mental health service use among Canadian children and youth. Our objective was to examine temporal trends in mental health service use across different sectors of the health care system among children and youth living in Ontario. We conducted a population-based, repeated annual cross-sectional study of mental health service use, including mental health- and addictions-related emergency department (ED) visits, psychiatric hospitalizations, and mental health-related outpatient physician visits using linked health administrative databases. Subjects included Ontario residents between 10 and 24 years of age. We tested temporal trends between 2006 and 2011 using linear regression models. Between 2006 and 2011, the relative increase in rates of mental health-related ED visits and hospitalizations were 32.5% and 53.7%, respectively. The absolute increase in anxiety disorders, the most common reason for ED visits, was 2.2 per 1000 population ( P 0.001) while mood and affective disorders, the most common reason for hospitalizations, showed an increase of 0.6 per 1000 population ( P 0.01). The overall relative increase in rates of outpatient visits was 15.8%, with the largest absolute increase found among family physician visits (28.7 per 1000 population, P = 0.01). Mental health care use for children and youth is increasing over time in all sectors, but appears to be increasing at a greater rate in the acute care sector. Further research is required to understand whether the observed differences reflect difficulty with access to outpatient care.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.JAD.2010.02.120
Abstract: Over the past decade, the clinical recognition and treatment of bipolar disorder (BD) in youth have increased significantly however, little is known about prevalence of and service use for this disorder at a population level. The objective of this study was to measure the lifetime prevalence of BD, and to describe the socio-demographics, comorbidities, and use of mental health services among 15-24-year-olds with BD. Data were extracted from the Canadian Community Health Survey: Mental Health and Well-being (CCHS 1.2), a representative population-based survey of 36,984 people age 15 and older. Among subjects age 15-18 and 19-24 (N=5673), we calculated lifetime prevalence rates of BD and report the demographic and clinical characteristics and rates of service use of this s le. The weighted lifetime prevalence of BD was 3.0% among 15-24-year-olds (N=191): 2.1% among 15-18-year-olds, and 3.8% among 19-24-year-olds. Rates of psychiatric comorbidity were high, with anxiety disorders, problematic substance use, and suicidality present among nearly half of the s le. Mental health services were accessed in the previous 12 months by 56.1% of youth with BD. The questionnaire used in CCHS 1.2 relied on self-report, limiting its applicability to this younger s le. BD is particularly common among young adults and there are specific factors associated with BD in youth. Nearly half of all youth with BD have never used mental health services, suggesting that clinicians should be more vigilant about the signs and symptoms of BD in young people.
Publisher: SAGE Publications
Date: 02-2008
DOI: 10.1177/070674370805300205
Abstract: To examine the association between markers of social position and psychiatric disorder among older adults, and test whether social support mediates the association between social position and psychiatric disorder in this population. We used data from the Canadian Community Health Survey: Mental Health and Well-Being to examine the social patterning of disorder. Using a series of logistic regression analyses, we regressed indicators of mood, anxiety, and any disorder on markers of social position and social support. A negative association between age and disorder was evident across all models, and the likelihood of reporting disorder was elevated among separated– orced and widowed respondents relative to their married counterparts. Social support was statistically significant in all models, and mediated a considerable amount of the effect of marital status on disorder. Many of the markers of social position associated with disorder among younger adults continue to be important predictors among older adults, and these variables are mediated to varying degrees by social support. The results support the general notion that social circumstances are important to psychological well-being. We discuss potential explanations for findings related to sex, age, marital status, and education as predictors of disorder in later life.
Publisher: BMJ
Date: 22-03-2007
Publisher: SAGE Publications
Date: 11-2009
DOI: 10.1177/070674370905401103
Abstract: To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants. Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey—Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects ( n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use. Lifetime prevalence rate of CCHS 1.2–defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%) however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05). Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-03-2021
DOI: 10.1200/JCO.20.02019
Abstract: Risk and predictors of long-term mental health outcomes in survivors of adolescent and young adult (AYA) cancers are poorly characterized. Mental health is consequently neglected in long-term follow-up. We identified all AYA in Ontario, Canada age 15-21 years when diagnosed with one of six common cancers between 1992-2012 using a population-based database, and compared them with matched controls. Linkage to provincial healthcare data allowed analysis of rates of outpatient (family physician and psychiatrist) visits for psychiatric indications and time to severe psychiatric events (emergency room visit, hospitalization, and suicide). Demographic-, disease-, and treatment-related predictors of adverse outcomes, including treatment setting (adult v pediatric), were examined. Among 2,208 survivors and 10,457 matched controls, 5-year survivors experienced higher rates of outpatient mental health visits than controls (671 visits per 1,000 person-years v 506 adjusted rate ratio [RR] 1.3 95% CI, 1.1 to 1.5 P = .006). Risk of a severe psychiatric episode was also increased among survivors (adjusted hazard ratio [HR], 1.2 95% CI, 1.1 to 1.4, P = .008). Risk of a psychotic disorder–associated severe event was doubled in survivors (HR, 2.0, 95% CI, 1.3 to 2.4 P = .007) although absolute risk remained low (15-year cumulative incidence 1.7% 95% CI, 1.0 to 2.7). In multivariable analysis, survivors treated in adult centers experienced substantially higher outpatient visit rates compared with those treated in pediatric settings (RR 1.8 95% CI, 1.0 to 3.1 P = .04). Survivors of AYA cancer are at substantially increased risk of adverse mental health outcomes, with those treated in adult centers at particular risk. Although absolute incidence was low, survivors were at increased risk of psychotic disorder–associated severe events. Long-term mental health surveillance is warranted, as is research into effective interventions during or after cancer treatment.
Publisher: SAGE Publications
Date: 09-2013
DOI: 10.1177/070674371305800908
Abstract: Public Health Ontario and the Institute for Clinical Evaluative Sciences have collaborated to estimate the burden of illness attributable to mental disorder and addictions in Ontario. Health-adjusted life years were used to estimate burden. It is conceptually similar to disability-adjusted life years that were used in the global burden of disease studies. Data sources for the mental illnesses and addictions used in our study included health administrative data for the province of Ontario, survey data from Statistics Canada and the Centre for Addiction and Mental Health, vital statistics data from the Ontario Office of the Registrar General, and US epidemiologic survey data. The 5 conditions with the highest burden are: major depression, bipolar affective disorder, alcohol use disorders (AUDs), social phobia, and schizophrenia. The burden of depression is double the next highest mental health condition (that is, bipolar affective disorder) and is more than the combined burden of the 4 most common cancers in Ontario. AUDs were the only disease group that had a substantial proportion of burden attributable to early death. The burden estimates for the other conditions were primarily due to disability. The burden of these conditions in Ontario is as large or larger than other conditions, such as cancer and infectious diseases, owing in large part to the high prevalence, chronicity, and age of onset for most mental disorders and addiction problems. The findings serve as an important baseline for future evaluation of interventions intended to address the burden of mental health and addictions.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.JAD.2010.02.118
Abstract: Many people with bipolar disorder (BD) in the community are misdiagnosed with major depressive disorder (MDD). A probabilistic model has been proposed to assist in the identification of BD among patients with depressive symptoms, however there are limited population-based data on the key distinguishers of BD from MDD. The objective of this study was to identify distinguishers of BD from MDD in a population-based s le. Population-based data were extracted from the Canadian Community Health Survey: Mental Health and Well-Being. Sociodemographic variables, clinical variables, and depressive symptomatology were compared between subjects with BD (N=467) and MDD (N=4145). Logistic regression analysis was used to identify significant correlates of BD, and areas under the receiver operating characteristic curves (AUCs) were determined for each model. BD and MDD subjects differed across a number of characteristics. Clinical variables significantly associated with BD included greater number of lifetime depressive episodes, earlier age of first depressive episode, lifetime anxiety disorder, problematic substance use, and lifetime suicide attempt. Symptoms significantly more common during a major depressive episode among BD subjects included agitation, suicidal ideation, anxious symptoms, and irritability. AUCs for these models ranged from 0.72 to 0.81. Data were not available for all potential distinguishers subgroups of BD could not be determined cross-sectional data. These population-based results reinforce the effort to establish a generalizable probabilistic model that incorporates clinical and symptom variables in order to assist clinicians in the diagnostic assessment of BD.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 2020
DOI: 10.1200/JCO.19.01382
Abstract: Although a diagnosis of childhood cancer can have a profound effect on the entire family unit, its impact on the long-term mental health of family members is not well characterized. A provincial childhood cancer registry in Ontario, Canada, was linked to birth records to identify separate population-based cohorts of mothers and siblings of children diagnosed with cancer between 1998 and 2014. The mother and sibling cohorts were matched to corresponding population controls and linked to health services data. The rate of mental health–related outpatient visits (family physician, psychiatrist) and the incidence of severe psychiatric events (psychiatric emergency department visit, psychiatric hospitalization, suicide) were compared between mothers and siblings and their controls. Possible predictors of mental health outcomes were examined, including demographics, characteristics of the cancer-affected child, and cancer treatment. We identified 4,773 mothers and 7,897 siblings of children diagnosed with cancer during the study period. Compared with controls, both groups experienced elevated rates of outpatient visits (mothers: rate ratio [RR], 1.4 P .0001 siblings: RR, 1.1 P .0001). The risk of severe psychiatric events was not increased in either cohort. Mother and sibling demographic factors associated with increased risk of adverse mental health included younger maternal age at cancer diagnosis, low socioeconomic status, and rural residence among mothers and older sibling age among siblings. Treatment-related variables pertaining to the cancer-affected child were not associated with mental health outcomes. Mental health outcomes clustered within families. Both mothers and siblings experience elevated and prolonged need for mental health–related health care as compared with the general population. Demographic risk factors predict subpopulations at highest risk. Increased psychosocial support for family members during and after cancer therapy is warranted.
Publisher: CMA Joule Inc.
Date: 24-10-2011
DOI: 10.1503/CMAJ.111664
Publisher: SAGE Publications
Date: 18-11-2022
DOI: 10.1177/07067437211055414
Abstract: In iduals with mental illness and addiction are overrepresented in prisons. Few studies have assessed mental health and addiction (MHA)-related service use among in iduals experiencing incarceration using health administrative data and most focus on service use after prison release. The objective of this study was to determine the prevalence of MHA-related service use in the 5 years prior to and during incarceration. We used linked correctional and administrative health data for people released from Ontario provincial jails in 2010. MHA-related service use in the 5 years prior to the index incarceration was categorized hierarchically into four mutually exclusive categories based on the type of service use: psychiatric hospitalization, MHA-related emergency department (ED) visit, MHA-related outpatient visit (from psychiatrist or primary care physician), and no MHA-related service use. Demographic, diagnostic, and incarceration characteristics were compared across the four service use categories. MHA-related service use during the index incarceration was assessed by category and length of incarceration. A total of 48,917 in iduals were included. Prior to incarceration, 6,116 (12.5%) had a psychiatric hospitalization, 8,837 (18.1%) had an MHA-related ED visit, and 15,866 (32.4%) had an MHA-related outpatient visit. Of the in iduals with any MHA-related service prior to incarceration, 60.4% did not receive outpatient care from a psychiatrist prior to incarceration and 65.6% did not receive MHA-related care during incarceration. Despite a high prevalence of mental illness and addiction among people experiencing incarceration, access to and use of MHA-related care prior to and during incarceration is poor. Increasing the accessibility and use of MHA-related services throughout the criminal justice pathway is warranted.
Publisher: BMJ
Date: 04-10-2013
Abstract: Fewer than half of in iduals with a mental disorder seek formal care in a given year. Much research has been conducted on the factors that influence service use in this population, but the methods generally used cannot easily identify the complex interactions that are thought to exist. In this paper, we examine predictors of subsequent service use among respondents to a population health survey who met criteria for a past-year mood, anxiety or substance-related disorder. To determine service use, we use an administrative database including all physician consultations in the period of interest. To identify predictors, we use classification tree (CART) analysis, a data mining technique with the ability to identify unsuspected interactions. We compare results to those from logistic regression models. We identify 1213 in iduals with past-year disorder. In the year after the survey, 24% (n=312) of these had a mental health-related physician consultation. Logistic regression revealed that age, sex and marital status predicted service use. CART analysis yielded a set of rules based on age, sex, marital status and income adequacy, with marital status playing a role among men and by income adequacy important among women. CART analysis proved moderately effective overall, with agreement of 60%, sensitivity of 82% and specificity of 53%. Results highlight the potential of data-mining techniques to uncover complex interactions, and offer support to the view that the intersection of multiple statuses influence health and behaviour in ways that are difficult to identify with conventional statistics. The disadvantages of these methods are also discussed.
Publisher: Wiley
Date: 22-02-2018
DOI: 10.1002/CNCR.31279
Abstract: The elevated risk for physical late effects in childhood cancer survivors (CCS) is well documented, but their risk for mental health problems is less well described. The authors assembled a cohort of all 5-year CCS who were diagnosed before age 18 years and treated in an Ontario pediatric cancer center between 1987 and 2008. Patients were matched to population controls and linked to health administration databases. The authors calculated rates of mental health care visits (family physician, psychiatrist, emergency department, hospitalization) and the risk for a severe mental health event (emergency department, hospitalization, suicide). Outcomes were compared using recurrent event and survival analyses. Compared with 20,269 controls, 4117 CCS had a higher rate of mental health visits (adjusted relative rate [RR], 1.34 95% confidence interval [CI], 1.12-1.52). Higher rates were associated with female gender (RR, 1.39 CI, 1.10-1.75 P = .006) and being diagnosed at ages 15 to 17.9 years (compared with ages 0-4 years: RR, 1.81 95% CI, 1.17-2.80 P = .008). Cancer type, treatment intensity, and treatments targeting the central nervous system were not significant predictors. Survivors were at increased risk for a severe event compared with controls (adjusted hazard ratio, 1.13 95% CI, 1.00-1.28 P = .045). CCS who were diagnosed with cancer at age 4 years or younger were at greatest risk: 16.3% (95% CI, 13.2%-19.8%) had experienced a severe event by age 28 years. CCS experienced higher rates of mental health visits and a greater risk for a severe event than the general population. Survivors of adolescent cancer have a higher rate of mental health visits overall, whereas survivors of cancer before age 4 years have a markedly elevated risk of severe events. Cancer 2018 :2045-57. © 2018 American Cancer Society.
Publisher: American Academy of Pediatrics (AAP)
Date: 03-2014
Abstract: Fertility rates among adolescents have decreased substantially in recent years, yet fertility rates among adolescent girls with mental illness have not been studied. We examined temporal trends in fertility rates among adolescent girls with major mental illness. We conducted a repeated annual cross-sectional study of fertility rates among girls aged 15 to 19 years in Ontario, Canada (1999–2009). Girls with major mental illness were identified through administrative health data indicating the presence of a psychotic, bipolar, or major depressive disorder within 5 years preceding pregnancy (60 228 person-years). The remaining girls were classified into the comparison group (4 496 317 person-years). The age-specific fertility rate (number of live births per 1000 girls) was calculated annually and by using 3-year moving averages for both groups. The incidence of births to girls with major mental illness was 1 in 25. The age-specific fertility rate for girls with major mental illness was 44.9 per 1000 (95% confidence interval [CI]: 43.3–46.7) compared with 15.2 per 1000 (95% CI: 15.1–15.3) in unaffected girls (rate ratio: 2.95 95% CI: 2.84–3.07). Over time, girls with major mental illness had a smaller reduction in fertility rate (relative rate: 0.86 95% CI: 0.78–0.96) than did unaffected girls (relative rate: 0.78 95% CI: 0.76–0.79). These results have key clinical and public policy implications. Our findings highlight the importance of considering major mental illness in the design and implementation of pregnancy prevention programs as well as in targeted antenatal and postnatal programs to ensure maternal and child well-being.
Publisher: SAGE Publications
Date: 04-2007
DOI: 10.1177/070674370705200408
Abstract: Short screening instruments, which exclude respondents unlikely to have psychiatric disorders, can make epidemiologic surveys shorter and more cost-effective. The Kessler 6-Item Psychological Distress Scale (K6), a measure of generalized distress, has been proposed for this role and has shown good agreement with the Composite International Diagnostic Interview (CIDI). However, performance of the K6 may vary for in idual disorders or combinations of disorders. In this report, we examine the ability of the K6 to detect disorders among respondents in different diagnostic categories. We used data from Cycle 1.2 of the Canadian Community Health Survey to assemble 5 groups of respondents with different 12-month psychiatric disorders ( n = 4481). A sixth group comprised those with 2 or more disorders. We examined the sensitivity of the K6 among respondents with an in idual disorder as well as those with multiple disorders. The sensitivity of the K6 varies significantly by disorder it is highest among respondents with multiple disorders and lowest among those with agoraphobia only. Use of the K6 as a screen for the CIDI is likely to result in biased prevalence estimates. However, both instruments should be compared with a third standard to fully assess the benefits and drawbacks of their combination.
Publisher: BMJ
Date: 06-12-2016
Abstract: Lone parenthood is associated with poorer health however, the vast majority of previous studies have examined lone mothers and only a few have focused on lone fathers. We aimed to examine the self-rated health and mental health status among a large population-based cross-sectional s le of Canadian lone fathers compared with both partnered fathers and lone mothers. We investigated differences in self-rated health and mental health among 1058 lone fathers compared with 20 692 partnered fathers and 5725 lone mothers using the Ontario component of the Canadian Community Health Survey (2001-2013). Multivariable logistic regression was used to compare the odds of poor/fair self-rated health and mental health between the study groups while adjusting for a comprehensive list of sociodemographic factors, stressors and lifestyle factors. Lone fathers and lone mothers showed similar prevalence of poor/fair self-rated health (11.6% and 12.5%, respectively) and mental health (6.2% and 8.4%, respectively) the odds were similar even after multivariable adjustment. Lone fathers showed higher odds of poor/fair self-rated health (OR 1.53, 95% CI 1.07 to 2.17) and mental health (OR 2.09, 95% CI 1.26 to 3.46) than partnered fathers after adjustment for sociodemographic factors however, these differences were no longer significant after accounting for stressors, including low income and unemployment. In this large population-based study, lone fathers had worse self-rated health and mental health than partnered fathers and similarly poor self-rated health and mental health as lone mothers. Interventions, supports and social policies designed for single parents should also recognise the needs of lone fathers.
Publisher: SAGE Publications
Date: 02-2007
DOI: 10.1177/070674370705200209
Abstract: Structured diagnostic interviews are very time-consuming and therefore increase both the expense and the respondent burden in epidemiologic surveys. A 2-staged interview that screens potential cases before the full diagnostic instrument is administered has the potential to greatly reduce the average interview length. In this paper, we evaluate 2 measures of psychological distress (the Kessler 6- and 10-Item Psychological Distress Scales [K6 and K10]) as potential screening instruments for depression. We use data from Cycle 1.2 of the Canadian Community Health Survey and receiver operator characteristic analysis to examine the agreement between the K6 and K10 and the World Mental Health Composite International Diagnostic Interview module for major depression (1-month and 12-month estimates). Of the respondents, 823 were positive for 1-month depression (2.0% 95% confidence interval [CI], 1.8% to 2.2%), and 1930 were positive for 12-month depression (4.8% 95%CI, 4.5% to 5.1%). Both the K6 and K10 performed very well as predictors of 1-month depression, with areas under the curve (AUC) of 0.929 (95%CI, 0.908 to 0.949) for the K10 and 0.926 (95%CI, 0.905 to 0.947) for the K6. For 12-month depression, the AUCs remained good at 0.866 (95%CI, 0.848 to 0.883) for the K10 and 0.858 (95%CI, 0.840 to 0.876) for the K6. Both the K6 and the K10 appear to be excellent screening instruments, especially for current depression. Although performance of the 2 instruments is similar, the K6 is more attractive for use as a screening instrument because of the lower response burden.
Publisher: Wiley
Date: 06-2016
DOI: 10.1002/WPS.20321
Publisher: Oxford University Press (OUP)
Date: 06-07-2023
DOI: 10.1093/NTR/NTAC166
Abstract: There has been little investigation of whether the clinical effectiveness of smoking cessation treatments translates into differences in healthcare costs, using real-world cost data, to determine whether anticipated benefits of smoking cessation treatment are being realized. We sought to determine the association between smoking cessation treatment and healthcare costs using linked administrative healthcare data. In total, 4752 patients who accessed a smoking cessation program in Ontario, Canada between July 2011 and December 2012 (treatment cohort) were each matched to a smoker who did not access these services (control cohort). The primary outcome was total healthcare costs in Canadian dollars, and secondary outcomes were sector-specific costs, from one year prior to the index date until December 31, 2017, or death. Costs were partitioned into four phases: pretreatment, treatment, posttreatment, and end-of-life for those who died. Among females, total healthcare costs were similar between cohorts in pretreatment and posttreatment phases, but higher for the treatment cohort during the treatment phase ($4,554 vs. $3,237, p < .001). Among males, total healthcare costs were higher in the treatment cohort during pretreatment ($3,911 vs. $2,784, p < .001), treatment ($4,533 vs. $3,105, p < .001) and posttreatment ($5,065 vs. $3,922, p = .001) phases. End-of-life costs did not differ. Healthcare sector-specific costs followed a similar pattern. Five-year healthcare costs were similar between females who participated in a treatment program versus those that did not, with a transient increase during the treatment phase only. Among males, treatment was associated with persistently higher healthcare costs. Further study is needed to address the implications with respect to long-term costs. The clinical effectiveness of pharmacological and behavioral smoking cessation treatments is well established, but whether such treatments are associated with healthcare costs, using real-world data, has received limited attention. Our findings suggest that the use of a smoking cessation treatment offered by their health system is associated with persistent higher healthcare costs among males but a transient increase among females. Given increasing access to evidence-based smoking cessation treatments is an important component in national tobacco control strategies, these data highlight the need for further exploration of the relations between smoking cessation treatment engagement and healthcare costs.
No related grants have been discovered for Paul Kurdyak.