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Bernhardt, May B., Penelope Bacsfalvi, Marcy Adler‐Bock, Reiko Shimizu, Audrey Cheney, Nathan Giesbrecht, Maureen O'connell, Jason Sirianni, and Bosko Radanov. "Ultrasound as visual feedback in speech habilitation: Exploring consultative use in rural British Columbia, Canada." Clinical Linguistics & Phonetics 22, no. 2 (January 2008): 149–62. http://dx.doi.org/10.1080/02699200701801225.
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Eye, Dana M., Jared R. Maida, Owain M. McKibbin, Karl W. Larsen, and Christine A. Bishop. "Snake mortality and cover board effectiveness along exclusion fencing in British Columbia, Canada." Canadian Field-Naturalist 132, no. 1 (August 28, 2018): 30–35. http://dx.doi.org/10.22621/cfn.v132i1.2031.
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We report on snake mortalities along exclusion fencing in southern British Columbia, showing Western Yellow-bellied Racer (Coluber constrictor mormon) deaths were disproportionately higher than our encounter rates with the species within the snake community. This suggests racers were susceptible to fence mortality more so than Northern Pacific Rattlesnakes (Crotalus o. oreganus) or Great Basin Gophersnakes (Pituouphis catenifer deserticola). Datalogger recordings revealed temperatures under cover boards were well above the tolerable temperatures of the three snake species, although the boards appeared to temper ambient heat more efficiently than natural vegetation. We caution that the effects of fencing and cover boards may vary across ecosystems and snake species.
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Hanlon, Neil, Trish Reay, David Snadden, and Martha MacLeod. "Creating Partnerships to Achieve Health Care Reform: Moving Beyond a Politics of Scale?" International Journal of Health Services 49, no. 1 (October 18, 2018): 51–67. http://dx.doi.org/10.1177/0020731418807094.
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This article critically exams efforts to achieve primary health care reform using a consultative and relationship-building approach. The study is set in a predominantly rural region of British Columbia, Canada, and concerns the efforts of a regional health authority to engage actively with community members to develop more integrated and patient-centered primary health care delivery. We examine points of tension between providers and administrators engaged in the reform process and show how these are often expressed discursively as a binary opposition involving central and local interests. We offer a critical examination of this politics of scale and seek to unpack claims of hierarchy and power as a means to offer insight into health care reform processes more generally.
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Holub, David, Laura Letourneau, Janice Buckingham, and Gord Nettleton. "The New Dawn — Commercial and Regulatory Considerations Affecting Liquified Natural Gas Export from British Columbia." Alberta Law Review 50, no. 2 (December 1, 2012): 301. http://dx.doi.org/10.29173/alr252.
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This article explores a sampling of commercial and regulatory issues, challenges, and risks encountered in the development of the Kitimat Liquified Natural Gas (LNG) project. The authors describe practical and innovative solutions proposed by lawyers to address the issues, resolve the challenges, and mitigate the risks of an LNG export project. The commercial and regulatory arrangements of the Kitimat LNG project are described. Industrial development on Aboriginal lands is overviewed, particularly in regards to the need for consultation with Aboriginal communities and First Nations groups affected by the proposed LNG project. The National Energy Board export authorizations are also overviewed, with a focus on the export licence requirement for an LNG project.
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Hollingworth, Alan S., and David M. Wood. "Recent Regulatory and Legislative Developments of Interest to Oil and Gas Lawyers." Alberta Law Review 37, no. 2 (July 1, 1999): 484. http://dx.doi.org/10.29173/alr530.
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This article reviews numerous recent decisions of the National Energy Board, the Alberta Energy and Utilities Board, the British Columbia Utilities Commission and the Manitoba Public Utilities Board pertaining to oil and gas issues. In addition, changes in the national and provincial statutory frameworks governing the oil and gas industry are explored. While the emphasis throughout the article is placed on developments federally and in Alberta, significant decisions and legislative changes in other jurisdictions within Canada are also highlighted.
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HOLT, CARRIE A., and JAMES R. IRVINE. "Distinguishing benchmarks of biological status from management reference points: A case study on Pacific salmon in Canada." Environmental Conservation 40, no. 4 (June 18, 2013): 345–55. http://dx.doi.org/10.1017/s0376892913000209.
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SUMMARYFor fisheries with multiple, competing objectives, identifying and applying reference points for management can present difficult trade-offs between long-term biological and shorter-term socioeconomic considerations. The term biological benchmarks is proposed to demarcate zones of population status based on conservation and production considerations. These scientifically derived benchmarks contrast with management reference points that generally require additional shorter-term socioeconomic information best obtained through public consultations. This paper illustrates the distinction between biological benchmarks and management reference points with a case study on Pacific salmon (Oncorhynchusspp.). In Canada, the management and assessment of wild Pacific salmon are guided by a major 2005 conservation policy, which calls for the identification of biological benchmarks to categorize status of demographically isolated populations, and decision-support tools, such as management reference points, to integrate biological information with appropriate social and economic information. In the Fraser River (British Columbia, Canada), the selection of management reference points for sockeye salmon (O. nerka) fisheries explicitly considered trade-offs between the probability of meeting long-term biological objectives on component populations and harvest objectives on population aggregates. Decisions about reference points were made in a consultative process that included extensive stakeholder engagement. Other agencies are urged to distinguish biological benchmarks from management reference points to ensure transparency in the relative influence of biological versus socioeconomic information in decision making.
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Koshan, Jennifer. "Intersections and Roads Untravelled: Sex and Family Status in Fraser v Canada." Constitutional Forum / Forum constitutionnel 30, no. 2 (May 12, 2021): 29–42. http://dx.doi.org/10.21991/cf29420.
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It has been a long road to the judicial recognition of women’s inequality under the Cana‑ dian Charter of Rights and Freedoms.1 The Supreme Court of Canada ruling in Fraser v Can‑ ada is significant for being the first decision where a majority of the Court found adverse effects discrimination based on sex under section 15,2 and it was only two years prior that a claim of sex discrimination in favour of women was finally successful at the Court,3 almost 30 years after their first section 15 decision in Andrews v Law Society of British Columbia. 4
1 Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11 [Charter], s 15. 2 Fraser v Canada (Attorney General), 2020 SCC 28 [Fraser]. 3 Quebec (Attorney General) v Alliance du personnel professionnel et technique de la santé et des services sociaux, 2018 SCC 17 [Alliance] (majority found sex discrimination under s 15 and rejected the government’s justification argument under s 1 in the pay equity context). See also Centrale des syndicats du Québec v Quebec (Attorney General), 2018 SCC 18 [Centrale] (majority found violation of s 15 but accepted the government’s s 1 argument, also in the pay equity context). For comments on these decisions see Fay Faraday, “One Step Forward, Two Steps Back? Substantive Equality, Systemic Discrimination and Pay Equity at the Supreme Court of Canada” (2020) 94 SCLR (2d) 301; Jonnette Watson Hamilton & Jennifer Koshan, “Equality Rights and Pay Equity: Déjà Vu in the Supreme Court of Canada” (2019) 15 JL & Equality 1. See also British Columbia Teachers’ Federation v British Columbia Public School Employers’ Association, 2014 SCC 70 (a one-paragraph decision restoring an arbitrator’s award allowing a s 15 employment benefits claim by women); Newfoundland (Treasury Board) v NAPE, 2004 SCC 66 (finding a violation of s 15 but accepting the government’s s 1 argument, again in the pay equity context).4 [1989] 1 SCR 143, 56 DLR (4th) 1.
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Majowicz, Shannon E., Dimitra Panagiotoglou, Marsha Taylor, Mahmood R. Gohari, Gilaad G. Kaplan, Ashok Chaurasia, Scott T. Leatherdale, et al. "Determining the long-term health burden and risk of sequelae for 14 foodborne infections in British Columbia, Canada: protocol for a retrospective population-based cohort study." BMJ Open 10, no. 8 (August 2020): e036560. http://dx.doi.org/10.1136/bmjopen-2019-036560.
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IntroductionOver one in eight Canadians is affected by a foodborne infection annually; however, the long-term consequences, including the risks and costs of sequelae, are unclear. We aim to estimate the health burden and direct costs of 14 infections commonly transmitted by food, considering the acute illness and subsequent sequelae and mortality, for the population of British Columbia, Canada (~4.7 million).Methods and analysisWe will conduct a population-based retrospective cohort study of the British Columbia provincial population, over a 10-year study period (1 January 2005 to 31 December 2014). Exposure is defined as a provincially reported illness caused by Clostridium botulinum, Campylobacter, Cryptosporidium, Cyclospora, Giardia, hepatitis A virus, Listeria, non-typhoidal Salmonella spp, Salmonella Typhi, Salmonella Paratyphi, Shiga toxin-producing Escherichia coli, Shigella, Vibrio parahaemolyticus or Yersinia (excluding pestis). We will link individual-level longitudinal data from eight province-wide administrative health and reportable disease databases that include physician visits, hospitalisations and day surgeries, deaths, stillbirths, prescription medications (except those to treat HIV) and reportable foodborne diseases. Using these linked databases, we will investigate the likelihood of various sequelae and death. Hazard models will be used to estimate the risk of outcomes and their association with the type of foodborne infection. Epidemiological analyses will be conducted to determine the progression of illness and the fraction of sequelae attributable to specific foodborne infections. Economic analyses will assess the consequent direct healthcare costs.Ethics and disseminationThis study has been approved by a University of Waterloo Research Ethics Committee (no 30645), the University of British Columbia Behavioral Research Ethics Board (no H16-00021) and McGill University’s Institutional Review Board (no A03-M12-19A). Results will be disseminated via presentations to academics, public health practitioners and knowledge users, and publication in peer-reviewed journals. Where such publications are not open access, manuscripts will also be available via the University of Waterloo’s Institutional Repository (https://uwspace.uwaterloo.ca).
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Mathews, Maria, Sarah Spencer, Lindsay Hedden, Emily Gard Marshall, Julia Lukewich, Leslie Meredith, Dana Ryan, et al. "Development of a primary care pandemic plan informed by in-depth policy analysis and interviews with family physicians across Canada during COVID-19: a qualitative case study protocol." BMJ Open 11, no. 7 (July 2021): e048209. http://dx.doi.org/10.1136/bmjopen-2020-048209.
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IntroductionGiven the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians’ roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario.Methods and analysisWe will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians’ proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses.Ethics and disseminationApproval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care.
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Pinkerton, Evelyn W. "Local Fisheries Co-management: A Review of International Experiences and Their Implications for Salmon Management in British Columbia." Canadian Journal of Fisheries and Aquatic Sciences 51, no. 10 (October 1, 1994): 2363–78. http://dx.doi.org/10.1139/f94-238.
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The theory and practice of community-based self-management and government–community co-management is examined in terms of the potential of these management systems to address some of the major biological, economic, and political problems of the salmon fishery of British Columbia, Canada. Particular attention is given to government–multiparty arrangements that integrate the concerns of multiple interests, while recognizing the special rights of aboriginal communities. Elements identified as key to the success of various arrangements include: (1) logistical arrangements, such as clear boundaries, membership criteria, interception agreements, and management-unit sizes appropriate to the abundance of natural and human resources; (2) cost-sharing arrangements, such as local cost recovery and local volunteerism; (3) power-sharing arrangements through checks and balances between local multiparty boards, a provincial board, and the Department of Fisheries and Oceans. The processes engendering social learning, through which government and local bodies could move toward such regimes, are discussed through a review of relevant literature on interorganizational conflict resolution, public policy, and organizational learning. Many of the elements of success of both arrangements and processes are likely to apply to a broad range of fisheries co-management situations.
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Chien, Nicole, Diego Villa, Ciara L. Freeman, Graham W. Slack, Kerry J. Savage, David W. Scott, Laurie H. Sehn, Kevin W. Song, and Alina S. Gerrie. "Characteristics and Treatment Outcomes of Plasmablastic Lymphoma in British Columbia (BC)." Blood 136, Supplement 1 (November 5, 2020): 17–18. http://dx.doi.org/10.1182/blood-2020-142351.
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Introduction Plasmablastic lymphoma (PBL) is a rare entity of aggressive large B-cell lymphoma initially described in HIV positive (pos) patients (pts) but subsequently also in immunocompetent pts. Due to its rarity and aggressiveness, there is no standard of care therapy. The published literature suggests CHOP chemotherapy is suboptimal. The role of bortezomib (BTZ) and more intensive therapies including consolidative stem cell transplant (SCT) remain uncertain. We aim to review the clinical characteristics and outcomes of pts with PBL in a population-based cohort from BC, Canada. Methods All pts diagnosed from Jan. 1997 - Oct. 2019 with histologically confirmed PBL using central pathology review were included. Baseline demographic, clinical and outcome data were retrospectively collected from the BC Cancer Lymphoid Cancer Database and medical records. Results 42 pts were diagnosed with PBL during this period, including 15 (36%) HIV pos pts and 9 (21%) receiving chronic immunosuppression (CIS) for autoimmune disorders or renal transplant. Median age at diagnosis was 56 years (y) (range, 23-94 y) with ECOG performance status ≥3 in 26% (10/39 pts), elevated lactate dehydrogenase in 50% (20/40), EBER positive in 84% (32/38), and advanced disease defined by Ann Arbor stage 3-4, B symptoms and/or mass ≥ 10 cm in 69% (29/42). 37 pts (88%) had extranodal involvement; most common sites in order of frequency were oro/nasopharynx, bone, gastrointestinal and lung. 10/15 HIV pos pts were not on highly active antiretroviral therapy (HAART) at diagnosis. All but one were started on HAART after diagnosis. 8/9 pts receiving CIS had a dose reduction at diagnosis. 31 pts (11 HIV pos, 12 HIV negative, 8 CIS) received curative intent chemotherapy: 29 CHOP, 2 CEOP, and 5 had BTZ added/in place of vincristine. 3 pts had a consolidative autologous SCT (autoSCT) upfront. 10 pts, median age 77 y (range 38-94 y), had palliative therapy (single agent chemotherapy or radiation) due to poor performance status and/or comorbidities. An additional pt achieved complete response after HAART, then relapsed 19 months (mos) later, treated with CHOP but had further relapse and died of disease. Median follow-up of living pts was 19 mos (range, 4-170). For pts treated with curative intent (N=31), 13/31 pts (42%) remain alive and in remission. 4 were refractory to first line chemotherapy, of which 3 were HIV pos. Only 2 of the refractory pts were fit for salvage therapy but did not respond and died of disease. 9 pts relapsed at a median of 15 mos (range, 8-50) from diagnosis, including 2/3 pts who received upfront consolidative autoSCT. 6/9 relapsed pts received salvage chemotherapy, generally with GDP. 1 pt died from early treatment toxicity. The other 5 pts were considered for SCT but 2 were ineligible due to progressive disease or comorbidities. Overall, 3 pts underwent consolidative SCT at relapse but 2 pts relapsed again within 6 mos of autoSCT. An additional pt is undergoing allogeneic SCT for relapse, 43 mos post upfront autoSCT. There was no difference in relapse rate according to HIV status (44% HIV negative vs 40% HIV pos, P=.63), however pts receiving CIS appeared to have a lower relapse, although not statistically significant (33%, P=.25). At last follow-up, 18 pts have died: 12 from PBL (4 refractory, 8 relapsed); 4 from treatment complications during/within 3 mos of therapy (infection 2, myocardial infarction 2); 1 had comorbidities and tolerated first line therapy poorly, therefore elected for medical assistance in dying; 1 died in remission of an unrelated cause. For the entire cohort, 1 y PFS and OS were 47% (95% CI, 39-55%) and 51% (95% CI, 43-59%) respectively, Fig. 1. There was no significant difference according to immune status (P=.87 for PFS and P=.72 for OS), Fig 2. Only 1/13 pts who relapsed remains in remission, 1 mo after allogeneic SCT. Conclusion This is one of the largest reviews of PBL pts reported. Our results confirm that PBL is a highly aggressive lymphoma with a low cure rate with current therapies and no difference in outcome according to immune status. We do not have adequate numbers to demonstrate additional benefit of BTZ or SCT. Nearly all pts who relapsed after upfront therapy died of disease. Further research is needed to understand the molecular mechanisms underlying the pathogenesis of PBL and to identify treatment strategies that will improve patient outcomes. Disclosures Villa: Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; AZ: Consultancy, Honoraria, Research Funding; Kite/Gilead: Consultancy, Honoraria; Nano String: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Sandoz Canada: Consultancy, Honoraria; Immunovaccine: Consultancy, Honoraria; Purdue Pharma: Consultancy, Honoraria. Savage:Abbvie: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Servier: Consultancy; Takeda: Honoraria; Verastem: Honoraria. Scott:Abbvie: Consultancy; AstraZeneca: Consultancy; NIH: Consultancy, Other: Co-inventor on a patent related to the MCL35 assay filed at the National Institutes of Health, United States of America.; Roche/Genentech: Research Funding; Janssen: Consultancy, Research Funding; NanoString: Patents & Royalties: Named inventor on a patent licensed to NanoString, Research Funding; Celgene: Consultancy. Sehn:Amgen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Apobiologix: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Genentech, Inc.: Consultancy, Honoraria, Research Funding; Acerta: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Merck: Consultancy, Honoraria; MorphoSys: Consultancy, Honoraria; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Teva: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Chugai: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; Verastem Oncology: Consultancy, Honoraria. Song:Celgene, Janssen, Amgen, Takeda: Honoraria; Celgene: Research Funding. Gerrie:Astrazeneca: Consultancy, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Roche: Research Funding; Sandoz: Consultancy.
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Atak, Idil, Graham Hudson, and Delphine Nakache. "Policing Canada’s Refugee System: A Critical Analysis of the Canada Border Services Agency." International Journal of Refugee Law 31, no. 4 (December 2019): 464–91. http://dx.doi.org/10.1093/ijrl/eez040.
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Abstract The officers of the Canada Border Services Agency (CBSA) play pivotal roles at various stages in Canada’s refugee system, making decisions that are life-changing for asylum seekers. This article examines the evolving institutional setting and processes that define the CBSA’s enforcement policy and its consequences for asylum seekers in Canada. Drawing on the findings of field-research, conducted between October 2015 and May 2018 in three Canadian provinces (Ontario, British Columbia, and Quebec), it argues that the Agency operates in a specific social universe heavily shaped by the post-9/11 geopolitical context of the criminalization of migration. This situation has been exacerbated by the major overhaul of Canada’s refugee system, undertaken by the previous Conservative government in 2012. The article further contends that the way the CBSA has been involved in refugee status determination turns Canada’s refugee system into an adversarial and unfair process for some groups of asylum seekers. To that end, it highlights the CBSA’s policies in three areas: eligibility determination, front-end security screening of refugee claimants, and ministerial interventions at the Immigration and Refugee Board of Canada.
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Rash, Joshua A., Tavis S. Campbell, Lynn Cooper, David Flusk, Aaron MacInnes, Maryam Nasr-Esfahani, Anastasia A. Mekhael, Patricia A. Poulin, Magali Robert, and Yanqing Yi. "Evaluating the efficacy of intranasal oxytocin on pain and function among individuals who experience chronic pain: a protocol for a multisite, placebo-controlled, blinded, sequential, within-subjects crossover trial." BMJ Open 11, no. 9 (September 2021): e055039. http://dx.doi.org/10.1136/bmjopen-2021-055039.
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IntroductionCurrent treatments for chronic pain (eg, opioids) can have adverse side effects and rarely result in resolution of pain. As such, there is a need for adjuvant analgesics that are non-addictive, have few adverse side effects and are effective for pain management across several chronic pain conditions. Oxytocin is a naturally occurring hormone that has gained attention for its potential analgesic properties. The objective of this trial is to evaluate the efficacy of intranasal oxytocin on pain and function among adults with chronic pain.Methods and analysisThis is a placebo-controlled, triple-blind, sequential, within-subject crossover trial. Adults with chronic neuropathic, pelvic and musculoskeletal pain will be recruited from three Canadian provinces (British Columbia, Alberta and Newfoundland and Labrador, respectively). Enrolled patients will provide one saliva sample pretreatment to evaluate basal oxytocin levels and polymorphisms of the oxytocin receptor gene before being randomised to one of two trial arms. Patients will self-administer three different oxytocin nasal sprays twice daily for a period of 2 weeks (ie, 24 IU, 48 IU and placebo). Patients will complete daily diaries, including standardised measures on day 1, day 7 and day 14. Primary outcomes include pain and pain-related interference. Secondary outcomes include emotional function, sleep disturbance and global impression of change. Intention-to-treat analyses will be performed to evaluate whether improvement in pain and physical function will be observed posttreatment.Ethics and disseminationTrial protocols were approved by the Newfoundland and Labrador Health Research Ethics Board (HREB #20227), University of British Columbia Clinical Research Ethics Board (CREB #H20-00729), University of Calgary Conjoint Health Research Ethics Board (REB20 #0359) and Health Canada (Control # 252780). Results will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.Trial registration numberNCT04903002; Pre-results.
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Panagiotoglou, Dimitra, Rita McCracken, M. Ruth Lavergne, Erin C. Strumpf, Tara Gomes, Benedikt Fischer, Austyn Brackett, Cheyenne Johnson, and Perry Kendall. "Evaluating the intended and unintended consequences of opioid-prescribing interventions on primary care in British Columbia, Canada: protocol for a retrospective population-based cohort study." BMJ Open 10, no. 11 (November 2020): e038724. http://dx.doi.org/10.1136/bmjopen-2020-038724.
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IntroductionBetween 2015 and 2018, there were over 40 000 opioid-related overdose events and 4551 deaths among residents in British Columbia (BC). During this time the province mobilised a variety of policy levers to encourage physicians to expand access to opioid agonist treatment and the College of Physicians and Surgeons of British Columbia (CPSBC) released a practice standard establishing legally enforceable minimum thresholds of professional behaviour in the hopes of curtailing overdose events. Our goal is to conduct a comprehensive investigation of the intended and unintended consequences of these policy changes. Specifically, we aim to understand the effects of these measures on physician prescribing behaviours, identify physician characteristics associated with uptake of the new measures, and measure the effects of the policy changes on patients’ access to quality primary care.Methods and analysisThis is a population-level, retrospective cohort study of all BC primary care physicians who prescribed any opioid medication for opioid-use disorder or chronic non-cancer pain during the study period, and their patients. The study period is 1 January 2013–31 December 2018, with a 1-year wash-in period (1 January 2012–31 December 2012) to exclude patients who initiated long-term opioid treatment prior to our study period or whose pain type (ie, ‘chronic non-cancer’, ‘acute’, ‘cancer or palliative’, or ‘other’) cannot be confirmed. The project combines five administrative health datasets under the authority of the BC Ministry of Health, with the CPSBC’s Physician Registry, BC Cancer Agency’s Cancer Registry and Vital Statistics’ Mortality data. We will create measures of prescribing concordance, access, continuity, and comprehensiveness to assess primary care delivery and quality at both the physician and patient level. We will use generalised estimating equations, interrupted time series, mixed effects models, and funnel plots to identify factors related to changes in prescribing and evaluate the impact of the changes to prescribing policies. Results will be reported using appropriate Enhancing the QUAlity and Transparency Of health Research guidelines (eg, STrengthening the Reporting of OBservational studies in Epidemiology).Ethics and disseminationThis study has been approved by McGill University’s Institutional Review Board (#A11-M55-19A), and the University of British Columbia’s Research Ethics Board (#H19-03537). We will disseminate results via a combination of open access peer-reviewed journal publications, conferences, lay summaries and OpEds.
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Semple, Kate E., Marie-Helene Vaillant, Kyu-Young Kang, Seung Won Oh, Gregory D. Smith, and Shawn D. Mansfield. "Evaluating the suitability of hybrid poplar clones for the manufacture of oriented strand boards." Holzforschung 61, no. 4 (June 1, 2007): 430–38. http://dx.doi.org/10.1515/hf.2007.078.
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Abstract Clonal trees from five different plantation-grown, industrially relevant hybrid poplar genotypes of the same age, grown on a common site in British Columbia, Canada, were tested for their performance in strand production and properties of oriented strand board (OSB). The results were compared against a benchmark mill-run OSB furnish derived from native aspen (Populus tremuloides). Variation in solid wood density among the hybrid poplar clones was shown to influence the compaction ratio and densification of the OSB, which in turn led to variation in board strength properties. After accounting for specimen density using co-variate statistical models, it was apparent that there were significant effects of genotype on bonding strength and thickness swell. Lower density wood from the fastest growing P. deltoides×P. trichocarpa (DTAC 7) clone resulted in better mat compaction and higher bond strength, whereas higher density wood from a P. trichocarpa×P. deltoides (TD 50-184) clone resulted in lower compaction and bonding strength. Flexural strength (rupture and elastic moduli) and nail pull through were not as significantly affected by either board density or genotype when adjusted for density. The study clearly demonstrates that fast grown, large diameter wood of lower initial wood density from hybrid poplar is highly suited for OSB production.
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Vassos, Troy D., and Daniel W. Smith. "Environmental engineering registration in Canada The expectations of the professional engineer working in this field." Canadian Journal of Civil Engineering 28, S1 (January 1, 2001): 8–17. http://dx.doi.org/10.1139/l00-076.
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The practice of environmental engineering in Canada is regulated by the 12 individual provincial and territorial associations/ordre, who are also members of the national Canadian Council of Professional Engineers (CCPE). Although CCPE has no regulatory authority over the engineering profession in its own right, it is responsible for establishing national guidelines for registration and for accrediting university engineering programs. The criteria for professional registration in Canada are presented in detail and include both educational and experience components. The educational requirements can be met through graduation from a Canadian Engineering Accreditation Board approved environmental engineering degree program or by passing mandatory examinations assigned by the individual associations/ordre from CCPE's national Environmental Engineering Syllabus. Generally a minimum of four years of satisfactory engineering experience, which has been supervised by a professional engineer who takes direct responsibility for the work carried out, is required. Public interest and public protection go hand in hand with the concept of professional registration for environmental engineers. Problems encountered by the associations/ordre in reviewing environmental engineering registration applications are discussed, and the approach taken by the Association of Professional Engineers and Geoscientists of British Columbia (by example) in addressing these problems is reviewed. Environmental engineering requires a wide range of knowledge in both engineering and science, as well as effective communication skills. Life-long learning is essential to the profession, particularly considering the rapid introduction of new technologies and the advances occurring in scientific and engineering knowledge in the environmental sector.Key words: environmental engineering, registration, professional engineer, education, undergraduate, graduate, certification, professional experience, academic criteria.
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Gardner, Kevin J., Robert D. Mattson, David R. Owings, Don Rodden, and John Sifling. "CANADA-UNITED STATES-DIXON ENTRANCE (CANUSDIX) EXERCISE A MODEL OF INTERNATIONAL COOPERATION FOR PLANNING AND PREPAREDNESS." International Oil Spill Conference Proceedings 2008, no. 1 (May 1, 2008): 57–64. http://dx.doi.org/10.7901/2169-3358-2008-1-57.
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ABSTRACT Since 1992, the Canadian and U.S. Coast Guard, Province of British Columbia, State of Alaska, OSRO'S, and several other organizations and authorities have joined together in a unique annual exercise program held near Dixon Entrance, a remote waterway marking the U.S./Canadian border at the southern tip of the Alaskan panhandle. Following a continuous improvement philosophy, a growing number of participants from both nations have made great strides in improving preparedness and response at the trans-boundary. Conducted over a 4 day period, CANUSDIX is an innovative combination of spill scenarios, training workshops, equipment deployment, and coordinated multi-year planning. Unlike conventional exercises, CANUSDIX is a year-round program with continuous effort directed toward achieving goals outlined in a formal 2-year workplan. Multi-year efforts include communications and logistics planning and evaluation of web-based information sharing systems. Canadian and U.S. OSRO'S also conduct a periodic review of equipment inventories and jointly plan future capital purchases to ensure equipment compatibility and avoid redundancy. Coordinated planning and exercising by partner agencies is a necessity for Dixon Entrance, an extremely remote, environmentally sensitive, region with severe weather, limited infrastructure, and a sparse road system. Resource trustees on both sides of the border are also key participants, due to crucial subsistence fisheries and numerous historical resources such as culturally important archeological sites. Innovation is a hallmark of CANUSDIX. For example, logistics skills were robustly tested by the “logistics board game,” debuted at CANUSDIX 2003 in Prince Rupert, BC. Resembling sophisticated tabletop war games, the board game employs tokens representing different types of oil spill cleanup equipment and personnel. Tokens are deployed on a board based on a chart of the response area. The logistics game required players to confront realistic equipment mobilization time constraints, while simulating the uncertainties associated with all spill responses. Other significant milestones of CANUSDIX include publication of Geographic and Wildlife Response Guideline Annexes to the Canada-United States Joint Marine Pollution Contingency Plan, a landmark bi-lateral planning, preparedness and response agreement. Embracing innovation while fostering teamwork and continuous improvement, CANUSDIX is a modern, goal driven, exercise regime and a model for international cooperation.
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Ting, Joseph Y., Ashley Roberts, Peter Tilley, Joan L. Robinson, Michael S. Dunn, Vanessa Paquette, Kyong-Soon Lee, et al. "Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study." BMJ Open 10, no. 12 (December 2020): e043403. http://dx.doi.org/10.1136/bmjopen-2020-043403.
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IntroductionEarly empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada.Methods and analysisOur study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology.Ethics and disseminationEthics for the study has been granted by the University of British Columbia Children’s & Women’s Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications.Trial registration numberNCT04388293.
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Mallidou, Anastasia, Dzifa Dordunoo, Elizabeth Borycki, Andre Kushniruk, Kirsten Sadeghi-Yekta, Julie Fraser, and Sirisha Asuri. "Perspectives and Experiences of Policy Makers, Researchers, Health Information Technology Professionals, and the Public on Evidence-Based Health Policies: Protocol for a Qualitative Study." JMIR Research Protocols 9, no. 12 (December 17, 2020): e16268. http://dx.doi.org/10.2196/16268.
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Background Evidence-based health policy (EBHP) development is critical to the judicious use of public funds. EBHPs increase transparency, accountability, effectiveness, and efficiency of policies. Encouraging collaboration between researchers or knowledge producers and policy makers is important because both communities have distinct professional cultures, resulting in them working separately without understanding each other. Knowledge sharing is a complex process that requires understanding of cultural aspects that may reduce cultural differences and increase the use of common language. Health information technology (HIT) is a useful tool to increase knowledge translation, which may result in the transparent use of evidence and networking in developing EBHPs. Our vision is to leverage HIT tools for a better health system that includes digitalized, open source, evidence-based, and transparent ways for collaboration and development of robust mechanisms and for sharing of synthesized evidence with knowledge user–friendly forms. Objective The aim of this study is to develop a conceptual framework on Knowledge translation and health Information Technology for Transparency (KhITT) in policy making and EBHPs (ie, the KhITT framework). The framework will be informed by the views of four key stakeholder groups (ie, policy makers, knowledge producers, HIT professionals, and the public) toward EBHP. The informants may also describe practices that demonstrate the EBHP development process and suggest technology platforms to enable this process. Methods We propose an exploratory, descriptive qualitative study to take place in British Columbia, Canada, using in-depth semistructured interviews. To ensure data saturation and trustworthiness, we will use a nonprobability, purposive snowball sample of up to 15 eligible participants in each of the four stakeholder groups. We will analyze the data using content analysis. Results The KhITT framework focuses on various stakeholders’ perspectives to better understand their perceived needs and priorities in identifying issues with EBHP, in order to make informed recommendations. Ethics approval has been obtained by the harmonized Behavioural Research Ethics Board at the University of British Columbia. We anticipate that we will complete data collection and analysis by December 2020. Preliminary results will be published in summer 2021. Conclusions Our ultimate goal of this study is to develop a conceptual framework and describe the technology platforms that would enable the EBHP process. We anticipate that our rigorous content analysis will be able to produce insights and themes that are able to address our objectives, contribute to an in-depth understanding of the EBHP process within British Columbia, highlight all influential factors, explicitly disseminate and communicate the study results, identify issues with EBHP and provide informed recommendations to address them, and enhance efforts toward transparent EBHPs. International Registered Report Identifier (IRRID) PRR1-10.2196/16268
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Steger, Debra P. "Commentary on the Doha Round: Institutional Issues." Global Economy Journal 5, no. 4 (December 7, 2005): 1850065. http://dx.doi.org/10.2202/1524-5861.1152.
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Commentary on Robert Howse's article "WTO Governance and the Doha Round." Debra Steger is Executive in Residence at the University of Ottawa Faculty of Law where she is working to establish a new institute for international law, economy and security in Canada. Previously, she was Senior Counsel with Thomas & Partners, a law firm specializing in international trade and investment matters. From 1995-2001, she served as the founding Director of the Appellate Body Secretariat of the World Trade Organization in Geneva, Switzerland, during which time she helped to establish the Appellate Body as the first appellate tribunal in international trade. She is Chair of the Trade and Customs Law Committee of the International Bar Association, and has been on the executive of the Trade Committee of the International Law Association for the past 10 years. She is also a member of the Editorial Advisory Board of the Journal for International Economic Law. She participates on the Advisory Council of the UNCTAD Project on Building Capacity through Training in Dispute Settlement in International Trade Investment and Intellectual Property as well as the Governing Council of the World Trade Law Association. During the Uruguay Round of Multilateral Trade Negotiations, she was the Senior Negotiator for Canada on Dispute Settlement and the Establishment of the World Trade Organization as well as the Principal Legal Counsel to the Government of Canada for all of the Uruguay Round agreements. From 1991—1995, she was General Counsel of the Canadian International Trade Tribunal in Ottawa, the agency responsible for administering the antidumping, countervail, safeguards, and government procurement legislation in Canada. Her most recent book is entitled: “Peace Through Trade: Building the WTO” which was published by Cameron May International Legal Publishers in 2004. Steger holds an LL.M. from the University of Michigan Law School, an LL.B. from the University of Victoria Faculty of Law, and a B.A. (Honours) in History from the University of British Columbia.
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Reid, Holly, William Cameron Miller, Elham Esfandiari, Somayyeh Mohammadi, Isabelle Rash, Gordon Tao, Ethan Simpson, et al. "The Impact of COVID-19–Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study." JMIR Research Protocols 10, no. 9 (September 1, 2021): e28337. http://dx.doi.org/10.2196/28337.
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Background The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people’s daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC’s Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants’ sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants’ COVID-19–related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions Findings from our study will inform the development and recommendations of a new resource guide for the post–COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID) DERR1-10.2196/28337
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Marin, Judith G., Laura Beresford, Clifford Lo, Alexander Pai, Gabriela Espino-Hernandez, and Monica Beaulieu. "Prescription Patterns in Dialysis Patients: Differences Between Hemodialysis and Peritoneal Dialysis Patients and Opportunities for Deprescription." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812091265. http://dx.doi.org/10.1177/2054358120912652.
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Background: Patients treated with maintenance dialysis are at high risk of polypharmacy given their many comorbidities as well as complications from their disease state and treatment. The prescribing patterns and burden of polypharmacy in patients treated with maintenance dialysis, and specifically the difference between hemodialysis (HD) and peritoneal dialysis (PD) prescribing, are not well characterized. Objectives: The objectives of this study were to review the prescribing patterns for patients treated with maintenance dialysis, to compare prescribing pattern between HD and PD, and to identify opportunities for deprescription. Design: This is a retrospective cohort study. Setting: This study was conducted in all dialysis centers in British Columbia, Canada. Patients: Patients who were receiving chronic dialysis (>120 days on the same dialysis modality) between June 3 and October 1, 2015, and registered in the British Columbia (BC) Renal Patient Records and Outcomes Management Information System. Measurements: Patient demographics as well as both prescription and non-prescription medications were collected. Comparison of discrete and continuous variables was made by chi-square analysis and independent t test, respectively. All statistical tests were 2-sided, and a P value of <.05 was considered statistically significant. Methods: Medications were classified by indication: (1) management of renal complications, (2) cardiovascular (CV) medications, (3) diabetes medications, or (4) management of symptoms, and then classified as to whether they were a “potentially inappropriate medication” (PIM) or not. Ethics approval was granted from the University of British Columbia Research and Ethics Board. Results: In total, 3017 patients met inclusion criteria (2243 HD, 774 PD). The mean age was 66.2 ± 14.8 years. The HD group had more patients over 80 years old (22.1% vs 12.5%) and more patients with diabetes and CV disease. The mean number (standard deviation [SD]) of discrete prescribed medications was 17.71 (5.72) overall with more medications in the HD group versus the PD group. The mean number of medications increased with dialysis vintage in both groups. HD patients were on more medications for renal complications and management of symptoms than PD patients. Of the total number of medications prescribed, 5.02 (2.78) were classified as a PIM, with the number of PIMs higher in HD vs PD patients: 5.37 (2.83) versus 4.02 (2.37). Limitations: In BC, some of the medications are prescribed through standardized protocols and may not be comparable with other Canadian provinces. We report here prescribing patterns, not utilization patterns, as we are not able to ascertain actual consumption of prescribed medication. Conclusion: This study reviews and characterizes both the prescription and non-prescription medication prescribed to HD patients and PD patients in BC. Pill burden in both groups is high, as is the prescription of PIMs. Patients receiving maintenance HD receive more overall medications and more PIMs. These results highlight areas of opportunities for future systematic and patient-informed deprescription initiatives in both patient groups.
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Norman, Wendy V., Sarah Munro, Melissa Brooks, Courtney Devane, Edith Guilbert, Regina Renner, Tamil Kendall, et al. "Could implementation of mifepristone address Canada’s urban–rural abortion access disparity: a mixed-methods implementation study protocol." BMJ Open 9, no. 4 (April 2019): e028443. http://dx.doi.org/10.1136/bmjopen-2018-028443.
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IntroductionIn January 2017, mifepristone-induced medical abortion was made available in Canada. In this study, we will seek to (1) understand facilitators and barriers to the implementation of mifepristone across Canada, (2) assess the impact of a ‘community of practice’ clinical and health service support platform and (3) engage in and assess the impact of integrated knowledge translation (iKT) activities aimed to improve health policy, systems and service delivery issues to enhance patient access to mifepristone.Methods and analysisThis prospective mixed-methods implementation study will involve a national sample of physicians and pharmacists recruited via an online training programme, professional networks and a purpose-built community of practice website. Surveys that explore constructs related to diffusion of innovation and Godin’s behaviour change frameworks will be conducted at baseline and at 6 months, and qualitative data will be collected from electronic interactions on the website. Survey participants and a purposeful sample of decision-makers will be invited to participate in in-depth interviews. Descriptive analyses will be conducted for quantitative data. Thematic analysis guided by the theoretical frameworks will guide interpretation of qualitative data. We will conduct and assess iKT activities involving Canada’s leading health system and health professional leaders, including evidence briefs, Geographical Information System (GIS)maps, face-to-face meetings and regular electronic exchanges. Findings will contribute to understanding the mechanisms of iKT relationships and activities that have a meaningful effect on uptake of evidence into policy and practice.Ethics and disseminationEthical approval was received from the University of British Columbia Children’s and Women’s Hospital Ethics Review Board (H16-01006). Full publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to research participants through newsletters and media interviews, and to policy-makers through invited evidence briefs and face-to-face presentations.
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Kumar, Jessica, Isabelle Sy, Felix Wei, Jane de Lemos, Gabriel Loh, Megan Harbin, and Karen Dahri. "Evaluation of the Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in Hospitalized Patients." Journal of Pharmacy Technology 36, no. 5 (August 26, 2020): 187–95. http://dx.doi.org/10.1177/8755122520942762.
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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are estimated to cost $1.5 billion annually in Canada. Previous studies have shown that barely half of all patients receive ideal care in hospitals. Deviations from guideline-defined optimal care lead to longer hospital stays, readmissions, and increased mortality. Objective: To determine the proportion of patients admitted to hospital for AECOPD who received treatment adherent to guidelines. Methods: A retrospective cohort study was conducted with ethics approval from the University of British Columbia Clinical Research Ethics Board. Patients hospitalized for ≥24 hours with an AECOPD at a tertiary care center and a community hospital were assessed. Guideline-adherent treatment was defined as appropriate use of supplemental oxygen, inhaled bronchodilators, systemic corticosteroids, antibiotics, venous thromboembolism prophylaxis, initiation/continuation of nicotine replacement therapy for current smokers, and vaccination optimization, reflecting international standards of care. Outcomes were assessed using descriptive statistics. Results: A random sample of 210 patients were selected of which 99 met inclusion criteria. Only 4% received therapy that met all recommendations. Differences in management were found between sites, specifically the appropriate use of bronchodilators, corticosteroids, antibiotics, and supplemental oxygen. Venous thromboembolism prophylaxis and smoking cessation rates were 97% and 94%, respectively, at the tertiary care center, compared with 73% and 100% at the community hospital. Additionally, less than half of all patients had their immunization history verified. Conclusion: Gaps in the inpatient management of AECOPD continue to exist. Initiatives must be targeted to optimize management and reduce the burden of the disease.
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Rott, M., A. M. Schmidt, V. Joshi, C. Masters, S. Godkin, and R. Johnson. "First Report of Colombian datura virus in Brugmansia in Canada." Plant Disease 93, no. 2 (February 2009): 196. http://dx.doi.org/10.1094/pdis-93-2-0196b.
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Colombian datura virus (CDV) was first described in 1968 (3) and has since been reported in Europe (4), Japan (see 4 for additional references), and the United States (1,2). CDV is a member of the family Potyviridae with flexuous, filamentous nucleocapsids that can be transmitted by mechanical inoculation and grafting and is known to be vectored by the common aphid Myzus persicae. In the fall of 2007, five Brugmansia plants of unknown species from a Parks Board Collection in a Lower Mainland nursery, British Columbia, Canada, were found to be displaying symptoms typical of a viral infection: chlorotic flecking and mottling on leaves, leaf shrivel, and vein banding. Symptomatic leaves from these five plants were tested by ELISA (Immuno Strip Test, Agdia, Elkhart, IN) for several common viruses including Impatiens necrotic spot, Tobacco mosaic, Cucumber mosaic, and Tomato spotted wilt viruses and found to be negative for all. However, rub inoculations onto the herbaceous indicators Nicotiana occidentalis and N. benthamiana resulted in severe symptom formation including necrosis, wilting, shriveling, stunted growth, petiole and stem tip collapse, as well as collapse from the base of the plants, and plant death within 2 weeks after inoculation. A leaf dip assay of the original infected Brugmansia sample and infected N. benthamiana tissue revealed flexuous, potyvirus-like particles with the electron microscope (EM). On the basis of the Brugmansia leaf symptoms and the EM results, a possible infection with CDV was suspected. Primers CDV-3 and CDV-NIb5, specific to CDV (4), were used in a reverse transcription (RT)-PCR assay that amplified an approximate 1,600-bp fragment from the original Brugmansia sample and inoculated N. bentamiana and N. occidentalis plants. The amplified portion of the genome is the extreme 3′ terminus and includes the 3′ noncoding sequence, the viral coat protein gene, and part of the viral replicase gene. Fragments were cloned into pCR2.1-TOPO (Invitrogen, San Diego, CA) and two clones from each plant (total of six clones) were sequenced in both directions. Sequences of all clones were essentially identical, with only three nucleotide differences among the clones (GenBank Accession No. EU571230). BLASTn analysis revealed the highest match to several CDV isolates ranging from 98.7 to 99.5% nucleotide sequence identity. BLASTp analysis of the 451 amino acid viral polyprotein translation product gave a similarly high match with CDV isolates, with the highest match to a Hungarian isolate of CDV (GenBank Accession No. CAD26690) of 99.8% identity, or only one mismatch out of 451 amino acids. An additional group of 15 large symptomless Brugmansia plants, located approximately 6 m from the five symptomatic plants, were also tested by RT-PCR and found to be positive. These 15 plants were of a different but also unknown species of Brugmansia. In conclusion, analysis of symptomatic Brugmansia from a Canadian collection by transfer of disease to herbaceous indicators, EM, RT-PCR, and genomic sequence comparisons, are consistent with the detection and identification of the potyvirus Colombian datura virus. To our knowledge, this is the first report of this viral pathogen in Canada. References: (1) S. Adkins et al. Phytopathology (Abstr.) 95(suppl.):S2, 2005. (2) C. R. Fry et al. J. Phytopathol. 152:200, 2004. (3) R. P. Kahn and R. Bartels. Phytopathology 58:58, 1968. (4) J. Schubert et al. J. Phytopathol. 154:343, 2006.
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Yu, Irene S., Shiru L. Liu, Valeriya Zaborska, Tyler Raycraft, Sharlene Gill, Howard Lim, and Janine M. Davies. "The Impact of Geography in Hepatocellular Carcinoma: A Retrospective Population Based Study." Current Oncology 28, no. 1 (January 12, 2021): 396–404. http://dx.doi.org/10.3390/curroncol28010042.
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Background: The treatment of hepatocellular carcinoma (HCC) includes different therapeutic modalities and multidisciplinary tumor board reviews. The impact of geography and treatment center type (quaternary vs. non-quaternary) on access to care is unclear. Methods: A retrospective chart review was performed on HCC patients who received sorafenib in British Columbia from 2008 to 2016. Patients were grouped by Statistics Canada population center (PC) size criteria: large PC (LPC), medium PC (MPC), and small PC (SPC). Access to specialists, receipt of liver-directed therapies, and survival outcomes were compared between the groups. Results: Of 286 patients, the geographical distribution was: LPC: 75%; MPC: 16%; and SPC: 9%. A higher proportion of Asians (51% vs. 9% vs. 4%; p < 0.001), Child–Pugh A (94% vs. 83% vs. 80%; p = 0.022), and hepatitis B (37% vs. 15% vs. 4%; p < 0.001) was observed in LPC vs. MPC vs. SPC, respectively. LPC patients were more likely referred to a hepatologist (62% vs. 48% vs. 40%; p = 0.031) and undergo transarterial chemoembolization (TACE) (43% vs. 24% vs. 24%; p = 0.018). Sixty percent were treated at a quaternary center, and the median overall survival (OS) was higher for patients treated at a quaternary vs. non-quaternary center (28.0 vs. 14.6 months, respectively; p < 0.001) but similar when compared by PC size. Treatment at a quaternary center predicted an improved survival on multivariate analysis (hazard ratio (HR): 0.652; 95% confidence interval (CI): 0.503–0.844; p = 0.001). Conclusions: Geography did not appear to impact OS but patients from LPC were more likely to be referred to hepatology and undergo TACE. Treatment at a quaternary center was associated with an improved survival.
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Khelifi, Rania S., Steven J. T. Huang, Kerry J. Savage, Diego Villa, David W. Scott, Khaled Ramadan, Joseph M. Connors, Laurie H. Sehn, Cynthia L. Toze, and Alina S. Gerrie. "Real-World Characterization of Ibrutinib Therapy for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) Patients in British Columbia (BC)." Blood 136, Supplement 1 (November 5, 2020): 33–34. http://dx.doi.org/10.1182/blood-2020-138887.
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Background: Ibrutinib has dramatically changed the treatment landscape for relapsed/refractory (R/R) and newly diagnosed CLL/SLL patients (pts), leading to durable remissions in the majority of pts; however, this comes at a high cost to the healthcare system particularly since treatment is continued until progression. Ibrutinib has been available in BC on compassionate access basis since 2014, publicly funded for R/R CLL/SLL or upfront for pts with deletion 17p (del17p) since 2016, and as upfront therapy in fludarabine-ineligible pts since 2018. In view of Ibrutinib's widespread use and rapid uptake among BC physicians, we sought to investigate discontinuation rates, dose modifications, and overall survival (OS) with introduction of ibrutinib within the publicly funded BC healthcare system. Methods: CLL/SLL pts ≥ 18 years (y) who initiated single-agent ibrutinib in routine practice in BC from Nov. 2014-Jun. 2018, with minimum of 6 months follow-up (f/u), were included. Pts were identified retrospectively using provincial databases. Patient level information on dates of ibrutinib and dose modifications were obtained from the BC Cancer Pharmacy Database. Results: 350 CLL/SLL pts were identified who received ibrutinib for first line (1L, n=31) or R/R disease (2L, n=175; 3L+, n=144) at a median 7.3 y (range, 0.17 - 30) from CLL diagnosis. Most pts were male (69%) with Rai stage 0-II (287/319, 90%) at CLL diagnosis. FISH abnormalities prior to any therapy, among 205 pts tested, were: 16% del17p, 22% del11q, 23% trisomy 12, 51% del13q and 19% no abnormalities. Median age at ibrutinib treatment was 71 y (range, 42-92) and pts with R/R disease had a median of 2 prior treatment lines (range, 1-13). At ibrutinib initiation, most pts had low-intermediate Rai stage (209/332, 63%). Median f/u from ibrutinib initiation for living pts was 27.2 months (mos) (range, 6.1-49.4). Median starting dose was 420 mg daily (range, 140-560) and median duration of ibrutinib was 22.3 mos (range, 0-49.4), with 261 pts (75%) alive and remaining on ibrutinib at last f/u. Dose reductions occurred in 32% (104/322) of pts, most commonly for toxicity (86/104, 83%). Other reasons for dose reductions included new comorbidities, n=2; medication interactions, n=3; incorrect starting dose, n=1; other causes, n=10; and unknown, n=2. Temporary dose interruptions recorded by physicians were observed in 114/305 pts (37%). A total of 89 pts (25%) discontinued ibrutinib for reasons other than death: toxicity, including infections and/or cardiac events, n=45 (51%); progression, n=28 (31%); and other reasons, n=16 (18%) (6 patient/physician choice, 4 SCT, 4 new comorbidity/drug interaction, 2 change in goals of care). Pts who discontinued treatment for toxicity and progression had median exposure times of 10.4 mos (range, 0.8-31.4) and 11.9 mos (range, 1.0-32.8), respectively. An additional 21 pts (6%) died while on ibrutinib: 9 from CLL progression; 5 cardiac causes (2 ischemic heart disease; 1 myocardial infarction; 1 cardiac arrest; 1 ventricular tachycardia); 4 infection; and secondary malignancy, COPD and unknown in 1 pt each. From time of ibrutinib initiation, 2 y OS for the whole cohort was 87.4% (95% CI: 83-91%) with median not reached (Fig. 1A). By line of therapy, 2 y OS from ibrutinib was 95.7% for 1L, 88.0% 2L, and 84.9% 3L+, with no significant difference between groups (P=.4) (Fig. 1B). Pts who discontinued ibrutinib, excluding those who died on ibrutinib, had a median OS from time of discontinuation of 32.5 mos (95% CI: 23.4-41.6) (Fig. 2A), with no significant difference based on reason for discontinuation (2 y OS from discontinuation for toxicity, progression or other was 72.4 %, 56.1%, and 78%, respectively, P=.14; P=.06 for toxicity vs progression) (Fig. 2B). Conclusion: This real-world analysis of CLL/SLL pts on ibrutinib confirms excellent survival in both the front-line and R/R settings; however, after 2 years on ibrutinib therapy, 25% of pts discontinued treatment and had poor outcomes regardless of the reason for discontinuation. This data serves as a benchmark to assess healthcare utilization with the introduction of ibrutinib at a population-level, in order to assess its cost-effectiveness and sustainability. Disclosures Savage: Merck, BMS, Seattle Genetics, Gilead, AstraZeneca, AbbVie: Honoraria; Roche (institutional): Research Funding; BeiGene: Other: Steering Committee; Merck, BMS, Seattle Genetics, Gilead, AstraZeneca, AbbVie, Servier: Consultancy. Villa:Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; AZ: Consultancy, Honoraria, Research Funding; Kite/Gilead: Consultancy, Honoraria; Nano String: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Sandoz Canada: Consultancy, Honoraria; Immunovaccine: Consultancy, Honoraria; Purdue Pharma: Consultancy, Honoraria. Scott:NanoString: Patents & Royalties: Named inventor on a patent licensed to NanoString, Research Funding; Celgene: Consultancy; Abbvie: Consultancy; AstraZeneca: Consultancy; Janssen: Consultancy, Research Funding; NIH: Consultancy, Other: Co-inventor on a patent related to the MCL35 assay filed at the National Institutes of Health, United States of America.; Roche/Genentech: Research Funding. Sehn:Chugai: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Teva: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding; MorphoSys: Consultancy, Honoraria; Merck: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Acerta: Consultancy, Honoraria; Genentech, Inc.: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria; Apobiologix: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Verastem Oncology: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria. Toze:Janssen: Consultancy, Other: advisory board. Gerrie:Astrazeneca: Consultancy, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Roche: Research Funding; Sandoz: Consultancy.
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Hussain, Amir. "Me and the Mosque." American Journal of Islam and Society 23, no. 2 (April 1, 2006): 124–25. http://dx.doi.org/10.35632/ajis.v23i2.1634.
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Zarqa Nawaz is a Canadian Muslim filmmaker who lives with her family inRegina, Saskatchewan. There are any number of comments that could beinserted at this point. Having spent time on both the Saskatchewan andManitoba prairies, I note only that Zarqa is developing a television series forthe Canadian Broadcasting Corporation entitled “Little Mosque on thePrairie.” She has made two earlier short films, BBQ Muslims and DeathThreat. Information about those films, as well as about Zarqa, can be foundon her website, Fundamentalist Films, available at www.fundamentalistfilms.com.Me and the Mosque, her first documentary, is distributed by the NationalFilm Board of Canada. The film is directly related to her own concerns as aMuslim woman, namely, as to space available to her in the mosque. The filmbegins on a light-hearted note (as does her web site, with the tag line of “puttingthe fun back into fundamentalism”) with Muslim comic Azhar Usmanjoking about the lack of appropriate space available in mosques for Muslimwomen.The documentary traverses mosques in Canada and the United States,such including places as Aurora, Illinois; Mississauga, Ontario; Winnipeg,Manitoba; Regina, Saskatchewan; Surrey, British Columbia; and Morgantown,West Virginia. It includes the voices of established scholars, amongthem Asma Barlas, Umar Abd-Allah, and Aminah McCloud, alongside thenewer scholarly voices of Aisha Geissinger, Jasmine Zine, and Itrath Syed.In addition, there is a wide range of interviews with people from the Muslimcommunity, from such activists as Asra Nomani and Aminah Assilmi to suchscholars as Abdullah Adhami and Tareq Suwaidan.As mentioned above, the film begins on a humorous note with the comedyof Azhar Usman (of “Allah Made Me Funny” fame). However, what hejokes about, the nice “dungeons” that many people mention when they talkabout the basements where some mosques give space to women, is no laughingmatter. The film then moves to the mosque in Aurora to begin its discussionof these issues. I would like to think that this is Zarqa’s subtle homageto another Canadian filmmaker, Mike Myers, who bases his fictional character,Wayne Campbell, in Aurora. Zarqa then mentions her upbringing inToronto and contrasts the mosque that she attended (the Jami’ Mosque) while ...
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Lavergne, M. Ruth, Laurie J. Goldsmith, Agnes Grudniewicz, David Rudoler, Emily Gard Marshall, Megan Ahuja, Doug Blackie, et al. "Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study." BMJ Open 9, no. 9 (September 2019): e030477. http://dx.doi.org/10.1136/bmjopen-2019-030477.
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IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.Methods and analysisWe plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.Ethics and disseminationThis study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.
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Aktary, Michelle L., Stephanie Caron-Roy, Tolulope Sajobi, Heather O'Hara, Peter Leblanc, Sharlette Dunn, Gavin R. McCormack, et al. "Impact of a farmers’ market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation." BMJ Open 10, no. 5 (May 2020): e035143. http://dx.doi.org/10.1136/bmjopen-2019-035143.
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IntroductionLow-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers’ market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers’ Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers’ markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.Methods and analysisIn a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10–15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers’ markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25–30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants’ experiences with and perceived outcomes from the programme.Ethics and disseminationEthical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.Trial registration numberNCT03952338.
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Venner, Christopher P., Joseph M. Connors, Heather J. Sutherland, John D. Shepherd, Linda Hamata, Yasser Abou Mourad, Michael J. Barnett, et al. "Exposure to Novel Agents Increases Post Relapse Survival in Patients with High Risk Myeloma Defined by Early Relapse (<12 months)." Blood 114, no. 22 (November 20, 2009): 2872. http://dx.doi.org/10.1182/blood.v114.22.2872.2872.
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Abstract Abstract 2872 Poster Board II-848 Intro: Relapse within 12 months of stem cell transplant is an important clinically relevant prognostic factor predicting poor outcome for patients with multiple myeloma (MM). Little is known about the use of novel agents (NA) in this setting and their impact on survival. In British Columbia autologous stem cell transplantation (ASCT) as a part of initial treatment is the standard of care for patients who are eligible. The use of NA is largely restricted to the relapsed setting thus providing a large cohort of patients to assess the impact of these drugs. Patients: We reviewed our experience with 418 patients with MM treated with ASCT diagnosed between 1985 and 2008. 307 have relapsed. Although thalidomide was available starting in 1999, the other novel agents, bortezomib and lenalidomide, were not available until after 2004, permitting division into two groups before and after Dec 2004. Methods: The cohort was separated into four groups based upon year of relapse (pre and post 2004) and remission duration post ASCT. Early relapse was defined as recurrence within 12 months (m) of ASCT. Four groups were defined: Group A, late relapse after 2004 (n=138); B, early relapse after 2004 (n=70); C, late relapse before 2004 (n=58); D, early relapse before 2004 (n=41). We examined the impact of NA exposure on post relapse survival (PRS). Results: Median overall survival from diagnosis of myeloma of the whole cohort was 79.9 months (95% CI; 70, 89). Median PRS was 31.0m (95% CI; 25, 36). Exposure to novel agents conferred a better PRS (35.7m, 95% CI; 30, 42 vs. 9.1m, 95% CI; 4, 13; p < 0.001). Results comparing the various groups are summarized in table 1. Kaplan-Meier curves of the four groups are shown in figure 1. Conclusion: Post relapse survival for patients with MM treated with ASCT has improved with the introduction of novel agents. Although relapse within 12m of ASCT remains an important clinical prognostic factor predicting worse outcome, the introduction of bortezomib and lenalidomide after 2004 correlates with a 24 month improvement in post relapse survival in these patients. Disclosures: Connors: Roche Canada: Research Funding.
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Gerhart, W., M. T. Duruöz, J. Lowe, D. Webb, L. Wermskog, J. Davies, R. Howard, M. Mallinson, and C. L. Koehn. "OP0275-PARE THE UNACCEPTABLE DELAY TO DIAGNOSIS IN AXIAL SPONDYLOARTHRITIS; DEVELOPING A CALL TO ACTION FOR A GLOBAL HEALTHCARE CHALLENGE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 167.1–167. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2368.
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Background:The current delay to diagnosis from symptom onset represents one of the greatest challenges in axial spondyloarthritis (axSpA). Research shows an average global delay of almost 7 years1 – and as long as 15 years in some cases2 – during which time the condition can progress considerably and lead to irreversible damage. Data indicates that women wait longer than men for a diagnosis3, and there has been very limited progress in reducing the time to axSpA diagnosis. The axSpA diagnosis delay has a hugely detrimental impact on an individual’s quality of life. Because the disease frequently has early onset1, individuals are left with untreated or incorrectly-treated symptoms at a formative period in their life course, whilst they await their diagnosis.Objectives:The Axial Spondyloarthritis International Federation (ASIF) set out to coordinate a comprehensive evidence-based global review of the factors influencing the current axSpA diagnosis delay and to produce a definitive report that shines a light on these barriers, as well as providing a resource that can ultimately empower a range of international stakeholders to reduce this delay.Methods:A full literature review was carried out to identify relevant available global evidence exploring the axSpA diagnosis delay. In autumn 2020 ASIF held two virtual global forum events, involving patients and patient group representatives, researchers, rheumatologists and other healthcare professionals, to methodically explore key diagnosis challenges across different healthcare systems and the opportunities for addressing these. Break-out discussions were held and participants were asked to identify the personal and societal effects of the diagnostic delay; the reasons it occurs; and initiatives to tackle the challenge. Alongside key stakeholder testimonies, best practices from around the world were also identified. 92 stakeholders participated in the events; they represented patients and healthcare professionals from 23 countries across five continents.Results:The findings from these activities were incorporated within a new ‘Delay to Diagnosis’ report, which for the first time definitively sets out the lived realities from a global perspective of the axSpA diagnosis delay. The report identified important commonalities across different countries and healthcare systems contributing to the current average global 7-year diagnosis delay, including: •Poor awareness of axSpA, particularly in primary care services •Complexities in diagnosing the disease •Poorly defined referral pathways •Insufficient patient access to rheumatologists and appropriate diagnosticsThe report also highlights the significant impact this delay has on individuals and wider society, providing a foundation for future advocacy work. A series of recommendations have also been identified, the implementation of which will help to instigate tangible progress in reducing the current delay.Conclusion:Despite longstanding challenges, there are now clear opportunities for transforming how axSpA is diagnosed around the world. This message needs to be heard and acted upon urgently by all those involved in the management and delivery of axSpA care. The future programme of work for ASIF’s Delay to Diagnosis project will respond to these findings and be centred around supporting axSpA patient associations globally to take this call to action forward throughout 2021 and beyond.References:[1]Zhao et al; Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis; Rheumatology, 2021[2]Garrido-Cumbrera, M., Poddubnyy, D., Gossec, L. et al. The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective—an Analysis of 2846 Patients Across 13 Countries. Curr Rheumatol Rep 21, 19 (2019)[3]Jovani et al; Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis; The Journal of Rheumatology December 2016Disclosure of Interests:Wendy Gerhart Employee of: I was employed by Janssen Canada from 1992 - 2017, Mehmet Tuncay Duruöz: None declared, Jo Lowe Grant/research support from: No financial grants received individually. However, my role as Project Manager at ASIF is currently funded partially by UCB Global and partially by Novartis Global, Dale Webb Speakers bureau: Janssen and Novartis, Grant/research support from: Individually, no. But NASS receives grants from AbbVie, Biogen, Eli Lilly, Janssen, Novartis and UCB, Lillann Wermskog Grant/research support from: Individually, no. But Spafo Norge receives a small amount of funding for ongoing projects from Novartis., Jo Davies Grant/research support from: Individually, no. However, ASIF are currently funded by UCB, Lilly, Boehringer Ingelheim, Janssen and Novartis; this funding partially covers staff salaries as well as a range of projects, the content and outputs of which are not influenced by the funders., Richard Howard Shareholder of: AbbVie, Amgen, Bristol-Myers Squibb, GSK, Johnson & Johnson, Eli Lilly, Merck, Novartis, Pfizer, and Teva. I own <20 shares of any one stock and these stocks represent <4% of personal investments, Consultant of: Yes, GSK, Novartis - but then donated to Spondylitis Association of America, Grant/research support from: I have not personally received financial grants. SAA has received financial support from AbbVie, Amgen, BI, J&J, Lilly, Novartis, Pfizer, UCB., Michael Mallinson Consultant of: No. But, for full disclosure: I have received honoraria in the past, for participating in patient advisory board activities, from Abbvie, Novartis, Pfizer and UCB., Cheryl L Koehn Grant/research support from: OUR ORGANIZATION, ARTHRITIS CONSUMER EXPERTS, HAS. I HAVE NOT AS AN INDIVIDUAL. HERE IS OUR PUBLICLY AVAILABLE DISCLOSURE ON ALL ONLINE AND PRINT MATERIALS, PRESENTATIONS, MEETINGS, GOVERNMENT CONSULTATIONS:https://jointhealth.org/about-principles.cfm?locale=en-CAOver the past 12 months, ACE received grants-in-aid from: Arthritis Research Canada, Amgen Canada, Canadian Institutes of Health Research, Canadian Rheumatology Association, Eli Lilly Canada, Hoffman-La Roche Canada Ltd., Knowledge Translation Canada, Merck Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi Canada, St. Paul’s Hospital (Vancouver), UCB Canada, and the University of British Columbia.
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Wali, Mohan K. "Introduction." Canadian Journal of Botany 66, no. 12 (December 1, 1988): 2603–4. http://dx.doi.org/10.1139/b88-355.
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The year 1985 was a landmark in Canadian biology, for it witnessed both the first Canadian Congress of Biology and the 80th birthday of Professor Vladimir Joseph Krajina. Because Krajina's work has had an impact on more than one biological discipline, we believed that the congress would be an appropriate forum to pay tribute to one of Canada's premier ecologists and botanists. Krajina has done much to awaken Canada's environmental consciousness and shape its ecological thinking and, in the process, has made major contributions to the international discipline of ecology.Professor Krajina was born in 1905 in Slavice, a small Moravian village in Czechoslovakia. Historians of science have characterized 1905 as “the miraculous year.” That was the year Albeit Einstein published the theory of relativity and George Santayana began his book The Life of Reason with the following first line printed in boldface, “Man affects his environment, sometimes to good purpose.” E. M. Forster published his Where Angels Fear to Tread, Vladimir Lenin his Two Tactics of Social Democracy in the Democratic Revolution, and Sigmund Freud his Three Contributions to the Theory of Sex. That year, the English novelist and science educator C. P. Snow was born, and the Canadian provinces of Alberta and Saskatchewan were formed.It was a very significant year for ecology as well. The first American textbook, Research Methods in Ecology, was published by a then little-known ecologist named Frederick E. Clements. Carl Raunkiaer in Denmark published his Types biologiques pour la géographie botanique, later to be cited in ecological literature as Raunkiaer's system of life forms and biological spectra. In addition, Karel Domin, who would become Krajina's mentor, published Das böhmische Mittelgebirge in Czechoslovakia.Krajina received his doctorate at the age of 22 from Charles University in Prague. There, he rose to become Professor of Botany and Head of the Department of Plant Sociology and Ecology. Krajina was a major force in the Second World War. A champion of democracy and possessing immense foresight and fortitude, he provided strategic information to the Allies, not without great personal hardship. This aspect of his life is beyond the scope of this review, but many volumes are available that document his indomitable courage and his contributions (see, for example, J. Korbel, The Communist Subversion of Czechoslovakia, Princeton University Press, Princeton, NJ, 1959). After the war, he received both military and civilian medals and was elected to the Czechoslovakian parliament.He arrived in Vancouver in 1949. Not in possession of his transcripts or even a reprint of his own work, he joined the University of British Columbia as Lady Davis Foundation Fellow and Special Lecturer, and later attained the rank of full professor. It was here that he developed the ecological schema that bear his imprint and guided 33 students through their doctoral and master's programs. Highly respected as a teacher and researcher, he has left an indelible mark on Canadian ecology. His contributions have been recognized by honorary degrees from major universities, by medals of honor from many societies, and in several feature films on environment from the National Film Board of Canada. Even today, he remains active in finalizing his massive treatise on the ecology of British Columbia vegetation.In presenting this series of papers as a tribute to Professor Krajina, it was the intention of the organizers to reflect on two contemporary topics of ecology, rather than present a comprehensive overview or a complete documentation of Krajina's contributions. What is presented here, therefore, is a series of ecological vignettes on community organization and ecosystem conservation, areas of science in which Professor Krajina has played a major role.The organizers extend their warm thanks to Professor Jennifer Shay of the University of Manitoba for her help and assistance, to Professor Jack Major for writing the epilogue, to Professor Taylor A. Steeves, who encouraged the publication of this symposium, and to Professor Paul F. Maycock, Associate Editor of the Canadian Journal of Botany, who edited this series of articles.
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Bruce, Aisha Aiko, Lauren Bolster, Catherine Corriveau-Bourque, Michelle Dang, Ghazi S. Alotaibi, Maria McGrath, Mary Anne Venner, and Hatoon M. Ezzat. "National Emergency Cards for Sickle Cell Disease: A Survey on Usefulness from the Patient Perspective." Blood 134, Supplement_1 (November 13, 2019): 2171. http://dx.doi.org/10.1182/blood-2019-124467.
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Patients with Sickle Cell Disease (SCD) frequently present for emergency care with pain or fever. The rate of emergency visits/year is between 2-4 per patient every year with 12% of patients visiting the emergency 4 or more times/year1. National medical organizations in Canada and the United States recommend pain therapy within 30 minutes of arriving to the emergency department2,3. Feedback from patients in Canada reflected a lack of awareness of the medical community regarding the disease and optimal management. As a response Canadian Haemoglobinopathy Association2 (CanHaem), created the "Sickle Cell Disease Emergency Wallet Cards" which were inspired from the successful Hemophilia "Factor First Card4". The goal of the cards was to provide simple care instructions to an emergency responder and facilitate timely care for patients in crisis. These wallet cards have recommendations for treatment of pain and fever within 30 minutes, patient's diagnosis, program contact details, and patient's individual pain plan. The cards have been in circulation for 4 years. The purpose of this study was to determine if the cards are used by parents and patients as intended. Research Questions: 1.Are the CanHaem Cards used by patients and families? 2. Do patients find the card helpful in facilitating their care delivery? Methods: The surveys were administered to patients and/or proxies. Prior to survey distribution three parents/patients have verified the utility of the questions, the content and the readability of the survey. The survey was translated into French/Arabic by two independent translators per language. It was distributed in Alberta and British Columbia, Canada in specialty clinics known to use the cards. The University of Alberta Ethics Board deemed the project a quality improvement initiative and the ARECCI tool: A pRoject Ethics Community Consensus Initiative was completed prior to quality improvement project start. Results: 140/184 participants completed the survey. The response rate: 76%. Demographics: 91% province of Alberta. Proxy: 49%; Patients: 51%. The majority of respondents were female: 54%, median age: 37 years (range 16-84 years). See graphs 1-4 below: 72.3% felt the card was helpful in their care. 78.6% carry the physical card (purse, wallet, and diaper bag), while 10.7% have a picture on their phone, 9.3% don't carry the card, 7.1% state they never received a card. The majority (63.6%) show the card at first contact in emergency, 48.9% felt staff read the card. Total of 68 comments. 67.6% of comments were positive: "Sense of security"; "Get us in to see the doctor faster..." Neutral comments (22%) ranged from requests for lamination to provider response to the card being variable "sometimes it is faster and sometime(s) doesn't really change anything". Finally, 10% were negative reflecting long wait times "Good concept, the idea itself is great. Execution... could be improved greatly", and requests for more information on the card. Conclusion: In Canada, SCD is an uncommon disease and many healthcare providers may not be aware of national and international guidelines regarding acute presentations. To help facilitate knowledge transfer and to aid communication with emergency services, CanHaem created wallet cards as a Canada-wide initiative. This survey demonstrates the patient/parent perspective of the emergency cards. Eighty-nine percent of patients/proxies carried the card (either digitally or physically) and 63% showed the card in the acute care setting. The discrepancy between those who carry the card and those who show it may reflect that numerous respondents stated they had not required emergency care since receiving the card as well some respondents were "carried away by the pain and forget to use the card". Comments revealed a sense of security and patient's appreciation for having the card available to them indicating the value of card to patients. The card demonstrates a simple and low cost intervention to facilitate emergency care for hemoglobinopathy patients. References: 1. Paulukonis ST et al. Emergency department utilization by Californians with sickle cell disease. Ped Blood and Ca 2017. doi: 1002/pbc.26390 2. CanHaem https://www.canhaem.org/healthcare-professionals/ 3. Evidence-Based Management of Sickle Cell Disease: Expert Panel, 2014. 4. Canadian Hemophilia Society. Stop the Bleeding. https://www.hemophilia.ca/files/ER%20CARD%20E_%20Jan%2009.pdf Figure Disclosures Ezzat: Novartis: Honoraria, Speakers Bureau; ApoPharma: Research Funding.
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El-Galaly, Tarec Christoffer, Chan Yoon Cheah, Mette Dahl Bendtsen, Gita Thanarasjasingam, Roopesh Kansara, Kerry J. Savage, Joseph M. Connors, et al. "An International Collaborative Study of Outcome and Prognostic Factors in Patients with Secondary CNS Involvement By Diffuse Large B-Cell Lymphoma." Blood 128, no. 22 (December 2, 2016): 1874. http://dx.doi.org/10.1182/blood.v128.22.1874.1874.
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Abstract Background: Secondary CNS involvement (SCNS) is a detrimental complication seen in ~5% of patients with diffuse large B-cell lymphoma (DLBCL) treated with modern immunochemotherapy. Data from older series report short survival following SCNS, typically <6 months. However, data in patients that develop SCNS following primary therapy that contains a rituximab-based-regimen as well as the impact of more intensified treatment for SCNS are limited. Aims: The aims of this study were to i) describe the natural history of SCNS in a large cohort of patients treated with immunochemotherapy, and ii) determine prognostic factors after SCNS. Patients and methods: We performed a retrospective study of patients diagnosed with SCNS during or after frontline immunochemotherapy (R-CHOP or equivalently effective regimens). SCNS was defined as new involvement of the CNS (parenchymal, leptomeningeal, and/or eye) in patients without known CNS involvement at the time of first pathologic diagnosis of DLBCL. Patients were identified from local databases and/or regional/national registries in Denmark, Canada (British Columbia), Australia, Israel, US (University of Iowa/Mayo Clinic SPORE), and England (Guy's and St. Thomas' Hospital, London). Clinico-pathologic and treatment characteristics at the time of SCNS were collected from medical records. Results: In total, 281 patients with SCNS diagnosed between 2001 and 2016 were included. Median age at SCNS was 64 (range 20-93) years and male:female ratio was 1.3. SCNS occurred as part of first relapse in 244 (87%) patients and 112 (40%) had documented concurrent systemic disease at the time of SCNS. The median time from initial DLBCL diagnosis to SCNS was 9 months, which was similar for patients treated with (N=76, 27%) or without upfront CNS prophylaxis (N=205, 73%) (10 vs 9 Mo; P=0.3). The median post-SCNS OS was 4 months (interquartile range 2-13) and the 2yr survival rate was 20% (95% CI 15-25) for the entire cohort. Associations between clinicopathologic features, management strategy, and post-SCNS survival are shown in Table 1, which excludes patients who did not receive any treatment against SCNS, patients treated with steroids alone, and a patient with unavailable treatment information (n=43, 15%). In multivariable analysis, performance status >1, concurrent leptomeningeal and parenchymal involvement, SCNS developing before completion of 1st line treatment, and combined systemic and CNS involvement by DLBCL were associated with inferior outcomes. Upfront CNS prophylaxis did not influence post-SCNS OS. High-dose methotrexate (HDMTX) and/or platinum based treatment regimens (i.e. ICE, DHAP, or GDP [+/- IT treatment and/or radiotherapy], N=163) for SCNS were associated with reduced risk of death (HR 0.45 [0.32-0.62, P<0.01]). The 2yr post-SCNS survival for patients treated with HDMTX and/or platinum-based regimens (N=163) was 29% (95% CI 22-37). For patients with isolated parenchymal SCNS, single modality treatment with radiotherapy resulted in 2-yr OS of 19% (95% CI 8-35). For the subgroup of 49 patients treated with HDMTX- and/or platinum-based regimens for isolated SCNS after 1st line DLBCL treatment and with performance status 0 or 1, the 2yr post-SCNS survival was 46% (95% CI 31-59). Overall, 9% of the patients received HDT with ASCT as part of salvage therapy at the time of SCNS. Amongst 36 SCNS patients without systemic involvement and in CR following intensive treatment (HDMTX and/or platinum-based treatments), 11 patients consolidated with HDT had similar outcomes to 25 patients treated without consolidating HDT (P=0.9, Fig 1) Conclusions: Outcomes for patients with SCNS remain poor in this large international cohort of patients from the immunochemotherapy era. Combined parenchymal and leptomeningeal disease, presence of systemic disease concurrent with SCNS, performance status >1, and SCNS developing during first line treatment were independently associated with inferior OS. However, a significant fraction of patients with isolated SCNS after first line DLBCL treatment and with good performance status may achieve long-term remissions after intensive regimens for SCNS. Disclosures El-Galaly: Roche: Consultancy, Other: travel funding. Cheah:Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees, Other: Speaker's Bureau. Kansara:Celgene: Honoraria. Connors:Bristol Myers Squib: Research Funding; NanoString Technologies: Research Funding; F Hoffmann-La Roche: Research Funding; Millennium Takeda: Research Funding; Seattle Genetics: Research Funding. Sehn:roche/genentech: Consultancy, Honoraria; amgen: Consultancy, Honoraria; seattle genetics: Consultancy, Honoraria; abbvie: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; celgene: Consultancy, Honoraria; lundbeck: Consultancy, Honoraria; janssen: Consultancy, Honoraria. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding. Seymour:Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Villa:Celgene: Honoraria; Lundbeck: Honoraria; Roche: Honoraria, Research Funding.
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Alzahrani, Musa, Maryse M. Power, Emilie Nevill, Yasser Abou Mourad, Michael J. Barnett, Raewyn Broady, Donna L. Forrest, et al. "Improving Revised International Prognostic Scoring System (IPSS-R) Pre-Allogeneic Stem Cell Transplant Does Not Translate into Better Post-Transplant Outcomes for Patients with Myelodysplastic Syndromes." Blood 128, no. 22 (December 2, 2016): 4662. http://dx.doi.org/10.1182/blood.v128.22.4662.4662.
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Abstract Background: The myelodysplastic syndromes (MDS) encompass a heterogeneous group of hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production leading to cytopenia and a variable risk of transformation to acute myeloid leukemia. The natural history of patients (pts) with MDS is variable and several prognostic scoring systems have been developed to guide treatment decisions. The revised IPSS (IPSS-R) score is commonly used in practice to predict outcome in newly diagnosed pts as well as in predicting their transplant outcomes. It remains unclear however whether improving IPSS-R pre allogeneic transplant (allo-SCT), using different therapeutic strategies, is associated with better clinical outcomes post-transplant. Methods: The Leukemia/BMT Program of British Columbia database was queried to identify all pts with MDS who had undergone an allo-SCT between Feb 1997 and April 2013. Pertinent information on clinical features and outcomes were then retrospectively reviewed. IPSS-R was calculated at MDS diagnosis (dx) and then re calculated prior to transplant. Outcomes of pts who had improvement in IPSS-R were then compared to those with no improvement or worsened IPSS-R score. Overall survival (OS) and Event free survival (EFS) were estimated using the Kaplan-Meier method and a competing risk analysis was used to calculate relapse and non-relapse mortality (NRM). Univariate and multivariate analyses were conducted. Log-Rank test was used to determine the p value. Results: We identified 138 pts who have undergone allo-SCT with the following characteristics: median age at transplant was 49 years (yrs) (range 17-66); 76 (55%) were male; 121 pts (88%) underwent myeloablative (MA) conditioning, 68 (49%) related donor and 70 (51%) unrelated donors out of which 43 (61%) were matched and 27 (39%) were mismatched. The source of stem cells were: peripheral blood n=101 (73%), bone marrow n=35 (25%) and cord blood n=2 (1%). The median interval from dx to transplant was 128 days. The median follow up (FU) of live pts was 7.3 yrs (range 1.5-17.4). Acute graft vs. host disease (aGVHD) grade 2 or higher was present in 74 (54%), chronic graft vs. host disease (cGVHD) was present in 94 (68%). During the time of FU 83 (60%) of pts had died. Relapse occurred in 41 (30%). Causes of death were: relapse n=39; GVHD n=20; regimen related n=11; infection n=5 and other causes, n=9. Baseline characteristics of all pts are shown in table 1. In 12 (9%) pts, the IPSS-R could not be calculated either because cytogenetics failed or bone marrow biopsy pre transplant was not done. At the time of transplant 85 (62%) pts had blasts <5%, 38 (28%) had 5-20% and 10 (7%) had blasts >20% and blasts count was unknown in 5 pts. IPSS-R improved in 62 (45%), worsened in 23 (17%), no change 41 (30%) and unknown in 12 (9%). Type of treatment was chemotherapy in 55 (40%), best supportive care in 80 (58%) and immunosuppressive therapy (IST) in 3 (2%). The OS and EFS for all pts were 34% and 33%, respectively. There was no difference in outcome between pts who have undergone MA vs non-MA, OS 34% and 39% (p=0.63) and EFS 34% and 32% (p=0.86), respectively. OS was not statistically different between pts with improved IPSS-R vs worsened vs unchanged, 30% vs 22% vs 40%, p= 0.63 (see figure 1). EFS was 30% vs 21% vs 40%, p=0.53, respectively. Relapse was 36% vs 53% vs 31%, p=0.35 and non-relapse mortality was 54% vs 57% vs 42%, p=0.75, respectively. There was no difference in OS and EFS between pts treated with chemotherapy vs supportive care with OS of 40% vs 41%, p=0.63 and EFS of 33% vs 32%, p=0.46, respectively. OS and EFS for grade 2 or higher aGVHD were 34% vs 32%, p=0.13 and 32% vs 32%, p=0.22, respectively. Figure 2 shows OS for Pts with blast <5% vs 5-20% vs >20% at transplant. Relapse of pts with blasts <5 vs 5-20 vs >20 at the time of transplant was 23% vs 69% vs 66%, p=0.0004, respectively. On multivariate analysis, only three factors were associated with worse OS and EFS which were: cytogenetics at dx, blast count at transplant and absence of cGVHD. Conclusion: Improving IPSS-R before allogeneic transplant does not translate into better clinical outcome. The IPSS-R cytogenetic risk group at the time of diagnosis and blast count at transplant are highly predictive of post-transplant outcomes. Patient characteristics Patient characteristics Disclosures Gerrie: Roche Canada: Research Funding. Toze:Roche Canada: Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding. Nevill:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Gerrie, Alina S., Cynthia L. Toze, Khaled M. Ramadan, Charles H. Li, Adrian Yee, and Joseph M. Connors. "Fludarabine (F) and Rituximab (R) (FR) as Initial Therapy for Symptomatic Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL): Population-Based Experience Matches Clinical Trials." Blood 114, no. 22 (November 20, 2009): 2363. http://dx.doi.org/10.1182/blood.v114.22.2363.2363.
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Abstract Abstract 2363 Poster Board II-340 Background: Clinical trials report that FR as initial therapy in symptomatic CLL produces an overall response rate of 90% and significantly improves progression-free survival (PFS) and overall survival (OS) compared retrospectively to F alone [Byrd Blood 2003, 2005] and that FCR (F, cyclophosphamide and R) improves response rates and PFS compared to FC alone [Hallek ASH 2008]. FR has been the standard initial therapy for CLL/SLL in British Columbia (BC) (population = 4.2 × 106) since 2004. We wished to determine if, in an unselected community based population, the same results could be achieved with FR therapy as those seen in highly selected clinical trial populations. Patients and Methods: The BC Cancer Agency (BCCA) Lymphoid Cancer Database was searched to identify pts who received FR as initial therapy for CLL/SLL as per BCCA guidelines (F 40mg/m2/day orally D1-5 or 25mg/m2/day IV D1-5 [adjusted for renal function] and R 375mg/m2 IV D1, q 28 days for 4-8 cycles). Pts were excluded if they had more than one hematologic malignancy (n=2). OS was calculated from date of FR to date of death or last follow-up. Treatment-free survival (TFS) was calculated from date of FR to date of next treatment or death from toxicity. Factors present at initiation of treatment were analyzed for impact on outcomes. Results: 98 pts were identified who received FR from 2004-2009 as initial therapy for CLL (83%) or SLL (17%). Median age at FR was 62 y (range, 42 – 86 y). 36% had Rai stage 3 or 4 and 13% had ECOG performance status 2-3. Median lymphocyte count was 30 × 109/L (range 0.6-282 × 109/L) and LDH was elevated in 34% (29/86 with available levels). Nearly half of all pts tested were positive for CD38 (34 of 69 pts, 49%) and ZAP 70 expression (10 of 22 pts, 45%). FISH was performed in 35 pts: 13q deletion, 21 (60%); 11q deletion, 5 (14%); 17p deletion, 10 (29%); trisomy 12, 11 (31%). Most pts (65%) were observed prior to FR for a median of 28 months (range, 3 – 172 mos). Common indications for treatment included symptomatic lymphadenopathy (n=36), cytopenias (n=28), fatigue (n=23), and constitutional symptoms (n=19). Pts underwent a median of 6 cycles of FR (range, 1-8). Treatment was discontinued due to toxicity in 13 pts (13%) (cytopenias, 5; febrile neutropenia, 3; infection, 2; pulmonary disease, 1; ITP, 1; AIHA, 1) and due to progression in 4 pts (4%). Hospitalization during therapy was required in 13 pts (13%) (febrile neutropenia, 5; documented infection, 2; elective splenectomy, 2; pulmonary disease, 2; ITP, 1; rituximab administration, 1). At a median follow up of living pts of 2.4 y, 31 pts (32%) have received additional therapy after FR including CVP in 11 pts (+R, 8); chlorambucil, 7 (+ R, 1; +prednisone, 1); FR, 5; cyclophosphamide, 5 (+prednisone, 3; +vincristine, 1); CHOP, 3 (+R, 2). At time of analysis (June 2009), 86 pts were alive; 14 died, 12 from progressive CLL and 2 from toxicity of FR (severe infection, 1; interstitial lung disease, 1). For the entire 98 pts, the 2 and 4 y OS were 90% and 72%, respectively (median not reached); 2 and 4 y TFS were 69% and 54%, respectively (median 4.0 y). Factors at treatment contributing to OS in univariate analysis included elevated LDH (P=0.004), Hb <110 g/L (P=0.03), and the presence of deletion 17p by FISH (P=0.04) or CD38 expression (>15% of CD19+ cells) by immunophenotyping (P=0.04). TFS was significantly worse in those with Hb <110 g/L (P=0.003), Rai stage 3-4 (P=0.008) or lymphocyte count >150 × 109/L (P=0.0013) while cytogenetic abnormalities and immunophenotyping had no effect on TFS. Age ≥ 60 y (n=60) or age ≥ 70 y (n=26) had no effect on either OS or TFS. Conclusions: In this non-selected community based population of pts with CLL/SLL, including many over 60 y (61%) and 70 y (27%) of age, our results show that initial treatment with FR leads to excellent OS and TFS, consistent with clinical trial results: 2 y OS, this study 90%; FR Byrd [Blood 2005] 93%; FCR Hallek [ASH 2008] 91%; 2 y TFS, this study 69%; FR Byrd, 2 y PFS 67%; FCR Hallek 2 y PFS 77%. FR can be safely and successfully given to community based pts, irrespective of age, for first-line therapy for CLL/SLL with OS and TFS similar to that achieved in clinical trial settings. Disclosures: Connors: Roche Canada: Research Funding.
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Perry, Sarah E., Derrick G. Lee, Ciara L. Freeman, Diego Villa, Alina S. Gerrie, Pedro Farinha, Jeffrey W. Craig, et al. "Rituximab Monotherapy Compared to Observation in Patients with Newly Diagnosed Asymptomatic Advanced Stage Follicular Lymphoma: A Retrospective Population-Based Analysis." Blood 136, Supplement 1 (November 5, 2020): 23–24. http://dx.doi.org/10.1182/blood-2020-136457.
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Introduction Many pts with advanced (adv) stage follicular lymphoma (FL) present with low burden asymptomatic disease and are suitable for observation. Previous studies have shown that rituximab can delay the need for definitive therapy in these pts (Ardeshna et al, Lancet Oncol 2014), and that rituximab maintenance does not offer a long-term advantage (Kahl et al, JCO 2014). Based on early results of these trials, BC Cancer endorsed the use of rituximab monotherapy (R-mono), administered as 4 weekly doses for pts with newly diagnosed asymptomatic adv stage FL in British Columbia in 2011. The aim of this study was to assess the benefit of R-mono and to compare outcomes to pts undergoing observation (OBSE) prior to the introduction of R-mono (OBSE-1) or since the availability of R-mono (OBSE-2). Methods The BC Cancer Lymphoid Cancer and Provincial Pharmacy Databases were used to identify all pts >16 y of age with newly diagnosed, adv stage (extensive stage 2-4), asymptomatic (low tumour burden), grades 1-3a FL betw Jan 2011-Aug 2019, who were treated with R-mono. Results were compared with two OBSE cohorts with similar clinical inclusion criteria; a historical cohort (OBSE-1) diagnosed Jan 2004-Dec 2010 and a current-era cohort (OBSE-2) diagnosed Jan 2011-Aug 2019. Use of R-mono was at the discretion of the treating physician and reflected patient preference. The primary endpoint was time-to-new treatment (TTNT), measured from date of diagnosis to start of any therapy following R-mono or OBSE (systemic, radiotherapy or splenectomy); pts who did not need new treatment were censored at last follow-up. Clinical factors were compared using chi-square tests, ANOVA, and Kruskal-Wallis tests. Kaplan-Meier curves were used to generate survival estimates and differences between cohorts were examined using a log-rank test. Multivariable cox proportional hazard models were used to estimate hazard ratios for each cohort adjusting for relevant clinical factors, including the FLIPI group. Results In total, 843 pts were identified; R-mono (n=301), OBSE-1 (n=302), OBSE-2 (n=240). Median f/up was longer for OBSE-1 (12.1y, range 0.2-16.2), compared with R-mono (4.5y, 0.1-8.8) and OBSE-2 (4.3y, 0.4-9.3). Median time from diagnosis to R-mono was 0.21y (range, 0.05-1.06). Clinical characteristics were largely comparable betw the historical (OBSE-1) and current-era cohorts (R-mono + OBSE-2). However, in the current era, pts receiving R-mono were slightly younger and more likely to have stage 3/4 disease than OBSE-2 pts, indicating a possible selection bias in the use of R-mono (Table). Of the 301 pts receiving R-mono, 298 were evaluable for response, with 210 (70%) achieving CR(u), 70 (23%) PR, and 18 with non-response (2 stable disease, 16 progression, 6%). 10/18 R-mono non-responders developed transformed disease, with significantly poorer OS than responders (p<0.001) (Fig. 1). However, time-to-transformation was not significantly different betw the R-mono, OBSE-1 and OBSE-2 cohorts (p=0.40). Overall, TTNT was significantly improved in the R-mono cohort (p<0.001), with 3y and 5y TTNT estimates as follows: 3y TTNT R-mono 73% (95% CI 67-79), OBSE-1 52% (47-58), OBSE-2 57% (51-65); 5y TTNT R-mono 61% (54-68), OBSE-1 40% (35-46), OBSE-2 44% (37-52) (Fig. 2a). Median TTNT was 6.4y, 3.3y and 3.6y in R-mono, OBSE-1 and OBSE-2, respectively. Hemoglobin <120 (p=0.037), number of nodal sites >4 (p<0.0001), and high-risk FLIPI (p< 0.001) were associated with a shorter TTNT. On multivariate analysis controlling for relevant clinical factors and FLIPI, R-mono remained an independent predictor for TTNT (HR 0.53, 95% CI 0.41-0.69, p<0.001). With available f/up, OS was not statistically different (p=0.32). 5y OS was 86% (95% CI 81-91), 81% (76-85) and 80% (74-86) in R-mono, OBSE-1 and OBSE-2, respectively (Fig. 2b). Conclusions This is the largest study to date evaluating the benefit of R-mono in pts with newly diagnosed adv stage asymptomatic FL. The use of R-mono administered over 1 month delayed the median time to start of new treatment by approximately 3 years. Non-responders to R-mono had a high rate of transformation and poor OS, and may represent pts with high-risk biology. While the overall rate of transformation and OS were not altered, pts receiving R-mono were approximately 50% less likely to require definitive therapy at 5-years, enabling some pts to avoid treatment toxicity and providing time for novel therapies to emerge. Disclosures Perry: Seattle Genetics: Honoraria. Villa:Seattle Genetics: Consultancy, Honoraria; Purdue Pharma: Consultancy, Honoraria; Nano String: Consultancy, Honoraria; Kite/Gilead: Consultancy, Honoraria; AZ: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Sandoz Canada: Consultancy, Honoraria; Immunovaccine: Consultancy, Honoraria. Gerrie:Sandoz: Consultancy; Roche: Research Funding; Janssen: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Astrazeneca: Consultancy, Research Funding. Scott:Abbvie: Consultancy; AstraZeneca: Consultancy; Celgene: Consultancy; Janssen: Consultancy, Research Funding; NanoString: Patents & Royalties: Named inventor on a patent licensed to NanoString, Research Funding; NIH: Consultancy, Other: Co-inventor on a patent related to the MCL35 assay filed at the National Institutes of Health, United States of America.; Roche/Genentech: Research Funding. Savage:Abbvie: Consultancy, Honoraria; Verastem: Honoraria; Takeda: Honoraria; Servier: Consultancy; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Sehn:AbbVie: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Genentech, Inc.: Consultancy, Honoraria, Research Funding; Acerta: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Karyopharm: Consultancy, Honoraria; Lundbeck: Consultancy, Honoraria; Merck: Consultancy, Honoraria; MorphoSys: Consultancy, Honoraria; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Teva: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Chugai: Consultancy, Honoraria; Verastem Oncology: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; Apobiologix: Consultancy, Honoraria.
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Jones, Kerina, Kim McGrail, Rainer Schnell, Claudia Coeli, and Stephanie Lee. "International Journal Population Data Science: development and future directions." International Journal of Population Data Science 3, no. 4 (August 24, 2018). http://dx.doi.org/10.23889/ijpds.v3i4.692.
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Background and rationaleThe International Journal of Population Data Science (IJPDS) was launched in April 2017. It is an electronic, open-access, peer reviewed journal, publishing articles on all aspects of research, development and evaluation connected with about people and populations. It represents an internationally unique vehicle for publishing a broader range of articles than most journals in related fields by including in scope: working papers, methodological developments, informative reports, and other pieces of interest, in addition to more traditional manuscripts. As such, it provides a focal point (and a home) for all areas of Population Data Science. The creation of the IJPDS was inspired by the IPDLN, and places great importance on the viewpoints and activities of Network members to guide the development of the journal.
ObjectiveInformation dissemination – stakeholder consultation – informing future directionsThe main objective of this collaborative session is to present the audience with an up-to-date summary of journal strategy and progress to date, and to use this forum to gain further viewpoints to better target future directions of the journal to meet the needs of those working in Population Data Science.
PlanThe session will comprise 5 sections:
A short presentation overviewing the journal, its historical origins, its remit and relationship to the IPDLN and Network members. Primary objectives of the journal and performance metrics from the first 18 months of operation will be presented.
Gauging audience opinion on:
What they like/dislike about the journal
What is working well/not so well
Feedback and discussion on the survey results
Discussions with audience in groups, each focusing on some/all of the following questions, and a question of their own choice if something arises:
How can we make IJPDS articles more accessible to the general reader/non-specialist researcher?Example options: short video/audio; general reader summaries; infographics; other
How can we increase the reach of, and interest in, the journal?
Open answers
What would you suggest as a special issue?These topics for group discussion will be posed to the session audience with the aim of using the feedback in defining our priorities for the coming year.
Feedback and summing up
The groups will be asked to give their feedback.
Feedback from the discussions and voting will be used to inform the next steps for IJPDS.
Facilitators
Kerina Jones, Founding Editor-in-Chief, Swansea University, Wales
Kim McGrail, Deputy Editor, University of British Columbia, Canada
Claudia Medina Coeli, Editorial Board member, Rio de Janeiro Federal University, Brazil
Rainer Schnell, Editorial Board member, University of Duisburg-Essen, Germany
Stephanie Lee, Journal Director of Operations, Swansea University, Wales
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"Minutes meeting of the governing board international neuropsychological society February 11, 1989 Vancouver, British Columbia, Canada." Journal of Clinical and Experimental Neuropsychology 12, no. 1 (January 1990): 122–23. http://dx.doi.org/10.1080/01688639008400957.
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"Minutes meeting of the governing board international neuropsychological society February 11, 1989 Vancouver, British Columbia, Canada." Journal of Clinical and Experimental Neuropsychology 12, no. 1 (January 1990): 127–28. http://dx.doi.org/10.1080/01688639008400959.
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Jock, Richard, and Colleen Erickson. "Introduction." International Journal of Indigenous Health 16, no. 2 (February 12, 2021). http://dx.doi.org/10.32799/ijih.v16i2.36040.
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On behalf of the First Nations Health Authority (FNHA) in British Columbia (BC), and FNHA’s Board of Directors, we welcome you to this two-part guest edition of the International Journal of Indigenous Health (IJIH): “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.” This guest edition encompasses two issues, “Honouring the Sacred Fire: Ending SystemicRacism toward Indigenous Peoples” and “Wisdom of the Elders: Honouring Spiritual Laws in Indigenous Knowledge,” which address significant determinants of Indigenous Peoples’ health, and issues in health systems here in Canada and globally.
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Haycock, Ken. "Strategic Directions and Newer Dilemmas for Teacher-Librarians and School Library Resource Centres." IASL Annual Conference Proceedings, March 20, 2021, 141–52. http://dx.doi.org/10.29173/iasl8074.
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Once a leader in the provision of effective school library services, the Vancouver (British Columbia, Canada) School Board has seen its intellectual and material assets diminish with growing confusion about the role of the teacher-librarian, particularly with regard to information technologies. The investigator reviewed the current status of school library resource centres, including staffing, resources and use, to identify "revenue-neutral" improvements based on research evidence and best practice. In the course of the review several dilemmas emerged that challenged conventional wisdom regarding the delivery of school library services; these dilemmas are the focus of this paper.
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Harvie, Alan, and Terrance M. Hughes. "Recent Regulatory and Legislative Developments of Interest to Oil and Gas Lawyers." Alberta Law Review, July 1, 2005. http://dx.doi.org/10.29173/alr481.
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This article identifies and outlines significant regulatory decisions, legislative changes and regulatory policy developments occurring from April 2003 through March 2004 that primarily affect the midstream and upstream oil and gas industry in Canada. It begins by reviewing major National Energy Board (NEB) decisions, including pipeline and powerline applications and recent toll and tariff rulings. The NEB portion of the article outlines important procedural issues, such as Appropriate Dispute Resolution, a new Filing Manual and pre-application meetings with staff members. The article emphasizes the significant impact that NEB decisions have on the Canadian energy industry. The authors also highlight applications in environmentally sensitive or urban areas, special well spacing requests and joint review panel decisions concerning oil sands projects. Directives and guidelines from Alberta Energy and Utilities Board concerning the gas over bitumen issue are mentioned. In addition, the authors examine a series of legislative developments that will impact the industry, including amendments to various statutes and regulations by the Canadian. Alberta and British Columbia governments.
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Kosny, Agnieszka, Marni Lifshen, Basak Yanar, Sabrina Tonima, Ellen MacEachen, Andrea Furlan, Mieke Koehoorn, Dorcas Beaton, Juliette Cooper, and Barbara Neis. "The Role of Healthcare Providers in Return to Work." International Journal of Disability Management 13 (2018). http://dx.doi.org/10.1017/idm.2018.4.
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International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.
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"Dietetic Research Event: June 7 and 8, 2018." Canadian Journal of Dietetic Practice and Research 79, no. 3 (September 2018): 139–54. http://dx.doi.org/10.3148/cjdpr-2018-022.
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Vancouver, British Columbia was the host city of the 2018 Dietitians of Canada Annual Conference. Through the support of Dietitians of Canada (DC) and Canadian Foundation for Dietetic Research (CFDR), the 2018 Research Showcase was an informative exchange of research and experience-sharing efforts. The submissions for this year’s CFDR event represented the diversity of dietetic research conducted within Canada. The 2018 Research Showcase highlighted the Early Bird abstracts in 2 formats; some as 10 minutes oral sessions and others as ePosters with a short oral component. The Late Breaking abstracts were displayed as ePosters. This research event would not be possible without the commitment and dedication of many people. On behalf of DC and CFDR, we would like to extend a special thank you to members of our Early Bird abstract review committee: Susan Campisi (University of Toronto); Elaine Cawadias (Retired); Andrea Glenn (St. Francis Xavier University); Mahsa Jessri (University of Ottawa); Jessica Lieffers (University of Saskatchewan). Members of the Late Breaking abstract review committee included: Laurie Drozdowski (University of Alberta); Laura Forbes (Co-chair)(University of Guelph); Joann Herridge (Hospital for Sick Children); Grace Lee (Toronto General Hospital); Lee Rysdale (Northern Ontario School of Medicine); Jessica Wegener (Ryerson University); Sarah Woodruff Atkinson (University of Windsor). We would also like to thank all of our moderators, Pierrette Buklis (CFDR Board), Marcia Cooper (Health Canada), Jenny Gusba (CFDR Board), Brenda Hartman (Brescia College), Paula Brauer (University of Guelph), Dawna Royall (DC), and MaryAnne Smith (DC), who kept our research presentation sessions on time during the conference. Finally, a special thank you to France Bertrand and Michelle Naraine at CFDR for their assistance and support throughout the review process. We enjoyed interacting with many of you at the oral research presentations as we highlighted the research findings from our dietetic colleagues across our country! Christina Lengyel, PhD, RD Chair, 2018 Early Bird Abstracts Review Committee Associate Professor Director of the Dietetics Program Food and Human Nutritional Sciences University of Manitoba Janis Randall Simpson, PhD, RD, FDC Chair, 2018 Late Breaking Abstracts Review Committee Professor Emerita University of Guelph Executive Director, CFDR
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Beaton, M. Denise, Gabrielle Hadly, and Shelina Babul. "Stakeholder Recommendations to Increase the Accessibility of Online Health Information for Adults Experiencing Concussion Symptoms." Frontiers in Public Health 8 (January 11, 2021). http://dx.doi.org/10.3389/fpubh.2020.557814.
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Background: Concussion is a global public health problem. In Canada, concussion is among the top five reasons for workplace time-loss. Concussion results in physical, cognitive, and/or emotional symptoms that temporarily worsen with physical and mental exertion, such as viewing electronic screens. The Internet is the primary source of consumer health information. Studies on the end-user needs of adults with brain injuries in regards to digital health technologies largely focus on informational content. There is little to no research on the accessibility of screen-based informational websites and smartphone applications among this population.Objective: The aim of this research was to involve stakeholders in the design of a comprehensive educational resource to guide concussion recognition, recovery, and return-to-work, called the Concussion Awareness Training Tool for Workers and Workplaces (CATT WW). In order to ensure both relevant content and appropriate delivery of the information to the target groups, participants were asked whether adaptations could increase the accessibility of online health information for the general adult population experiencing concussion symptoms.Methods: Data have been generated through semi-structured in-depth interviews and focus groups with participants from across British Columbia (BC): workers from various industries who were in the concussion recovery process or had returned to work (n = 31); and healthcare or workplace professionals who support concussion diagnosis, recovery, and return-to-work (n = 16). Data were analyzed using NVivo 12. Before commencing data collection, ethical permission was granted by the University of British Columbia Research Ethics Board (H18-00604), and approval was received from WorkSafeBC Research Services.Results: Participants (n = 47) recommended twenty adaptations or supplements to electronic screen-based digital health technologies.Conclusion: Given the high prevalence of concussion among the working adult population, the symptom exacerbation commonly caused by prolonged use of electronic screens, and the demand for online educational resources, these findings can guide clinicians, researchers, technology developers, employers, and occupational health and safety committees to further support adults in concussion recovery and return-to-work.
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Mehdi Ebadi, Mohammad, Michele Richards, Carol Brown, and Samer Adeeb. "COMPARISON OF THE CIVIL ENGINEERING CURRICULUM AMONG SEVERAL CANADIAN UNIVERSITIES." Proceedings of the Canadian Engineering Education Association (CEEA), June 12, 2020. http://dx.doi.org/10.24908/pceea.vi0.14143.
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Growing attention to environmental sustainability, modular construction, and application of new generation of materials, accompanied with advanced data collection techniques and computer modeling, has revolutionized the area of Civil Engineering within the past few years. This demonstrates the necessity of continually reviewing the curriculum to assure that graduating engineers are knowledgeable enough to deal with complex problems in their area of specialty. This is also essential to satisfy the continual improvement process (CIP) requirements mandated by the Canadian Engineering Accreditation Board (CEAB). As a first step to design a rigorous CIP, a comprehensive comparison was made between the Civil Engineering curricula of the University of Alberta (UofA) and eight other major universities across Canada, including the University of Calgary, University of Toronto, McGill University, University of Windsor, University of Regina, University of British Columbia (UBC), University of Waterloo, and Polytechnic of Montreal. After categorizing the courses into twelve different streams, it was observed that some universities paid less attention to a specific stream in comparison with the average, which could be identified as a gap in the curriculum. A capstone design or group design project that is multidisciplinary and covers multiple areas of specialty is the predominant approach followed by most of the universities.
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Salim, K. M. Emtiaz, Hadia Awad, Mustafa Gül, Robert Knudson, and Mohamed Al-Hussein. "An Experimental Framework for Investigating the Hygrothermal Properties of Multi-Functional Wood Fibre and XPS Panels for Residential Buildings." Modular and Offsite Construction (MOC) Summit Proceedings, September 29, 2016. http://dx.doi.org/10.29173/mocs33.
Full textAbstract:
In this paper, an experimental setup developed for an ongoing project to investigate the hygrothermal performance of wall systems under different climate conditions is presented. As a step toward establishing the hygrothermal performance of various wood-frame wall assemblies, this research focuses on field experimentation of two types of multi-functional panels (MFPs), along with a conventional wall assembly, in two different locations in Canada: Vancouver, British Columbia, and Edmonton, Alberta. The three wall assembly types are adjacent to one another along the north- and south-facing walls of the test huts in the two cities. This experiment focuses on the effect of the various ambient weather conditions on the two innovative MFPs and on the conventional wall assembly, and on determining the long-term hygrothermal performance of the tested assemblies; it also establishes the passive solar effect on the south-facing assemblies compared to the corresponding north-oriented assemblies. Both MFPs are fixed on the exterior side of a conventional wood-frame wall assembly. The components of the first MFP are 6.4 mm Oriented Strand Board (OSB), 40 mm wood-fiber insulationäóîan environmentally-friendly and fully recyclable materialäóîand 6.4 mm OSB, while those of the second MFP are 6.4 mm OSB, 25 mm Extruded Polystyrene (XPS) core, and 6.4 mm OSB. Along with the details of the experimental setups, some sample data is presented.
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Joolaee, Soodabeh, Anita Ho, Kristie Serota, Matthieu Hubert, and Daniel Z. Buchman. "Medical assistance in dying legislation: Hospice palliative care providers’ perspectives." Nursing Ethics, September 19, 2021, 096973302110120. http://dx.doi.org/10.1177/09697330211012049.
Full textAbstract:
Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying.