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1
Maxwell, Deborah. "Preservation of City Directories at Library and Archives Canada." Serials Librarian 49, no. 1-2 (2005): 205–10. http://dx.doi.org/10.1300/j123v49n01_09.
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Pike, Robert M. "Kingston Adopts the Telephone." Articles 18, no. 1 (2013): 32–47. http://dx.doi.org/10.7202/1017822ar.
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The adoption and use of the telephone in urban central Canada between 1876 and 1914 are explored within the context of the wider communications environment and the marketing strategies of the Bell Telephone Company. This context becomes the framework for a case study of the social diffusion of the telephone in Kingston, Ont, between 1883 and 1911. Utilizing telephone directories and early city directories, the case study concentrates on the socioeconomic and organizational characteristics of early phone subscribers and the physical location of their phones. Both business and residential subscribers are shown throughout the period to have been drawn mainly from the commercial and prof essional classes in Kingston and to have used the phone mainly for institutional, work-related purposes.
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Harris, Richard. "Housing in Canadian Cities: An Agenda and Review of Sources." Articles 14, no. 3 (2013): 258–66. http://dx.doi.org/10.7202/1018083ar.
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Historical scholars have not recognized the importance of housing in modern Canada. There is no overall conception of what needs to be known on the subject. In terms of the consumption as opposed to the production of housing, residential segregation, tenure, housing costs and conditions are the four major aspects to be considered. Their full significance can be understood only when viewed as part of the experience of social groups, particularly those defined in terms of class, ethnicity and gender. In describing social variations in housing consumption the most generally useful sources are the Census, City Directories and Assessments. The Censuses for 1871, 1941 and especially 1931 are rich but neglected sources of information on housing, while City Directories are more reliable than many think. These sources could illuminate changes in housing consumption in the first half of the twentieth century, a period of marked scholarly neglect.
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MuftiSau, Aftab A. "Development, availability, and use of engineering computer programs." Canadian Journal of Civil Engineering 12, no. 1 (1985): 43–53. http://dx.doi.org/10.1139/l85-005.
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In the last decade, software engineering has emerged as a discipline very useful for computer application programmers in various engineering fields. In this paper the author considers the programming and management techniques for developing useful and commercially viable engineering software that may be used in the analysis and design of civil engineering projects. The issue of utilizing existing software effectively and efficiently is also discussed. At the conclusion of the presentation, several recommendations are made to encourage engineering software development in Canada. Key words: engineering, software engineering, software, computers, computer service bureaus, software directories.
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de Moissac, Danielle, Jacinthe Savard, Sébastien Savard, Florette Giasson, and Lucy-Ann Kubina. "Management strategies to improve French language service coordination and continuity for official language Francophone seniors in Canada." Healthcare Management Forum 33, no. 6 (2020): 271–76. http://dx.doi.org/10.1177/0840470420931115.
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Evidence suggests that language barriers present obstacles to healthcare access and quality for Francophone seniors in official language minority communities across Canada. Addressing language barriers and providing continuity is challenging, as French language services (FLSs) rely heavily on bilingual providers and the practice of active offer by all staff. This qualitative research used semi-structured group and individual interviews to explore mechanisms supporting FLS coordination and continuity in two Canadian provinces. Identification of the language variable in health records, virtual healthcare, and FLS directories are conducive to FLS continuity, but financial and resource limitations present major obstacles. Management strategies to facilitate continuity of FLS across health organizations are discussed.
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McKnight, Alanna. "Dressmakers and Seamstresses in Toronto, 1834–1861." Costume 52, no. 1 (2018): 48–73. http://dx.doi.org/10.3366/cost.2018.0047.
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The young colonial city of Toronto was a landing place for many newcomers to Canada, and was a city of opportunity. The steady growth in population between 1834 and 1861 afforded women employment outside of the home, notably in the needle-trades (i.e. the roles involved in the manufacture of clothing). This article argues that the needle-trades were a significant source of employment for women in pre-industrial period Toronto and explores the social and professional distinctions between ‘dressmakers’ and ‘seamstresses’, by enumerating and aggregating women from the City Directories and 1861 census. Several biographical case studies are included to demonstrate the variety of women employed in the needle-trades, based on information from the primary source data.
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Chen, Amanda. "Impact of Microplastic Pollution on Freshwater Ecosystems and Effective Mitigation Measures in Canada." European Journal of Physical Sciences 5, no. 2 (2023): 8–18. http://dx.doi.org/10.47672/ejps.1442.
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Purpose: This study investigates the impact of microplastic pollution on freshwater ecosystems and effective mitigation measures in Canada.
 Methodology: The study adopted a desktop methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low-cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: The literature review and research findings demonstrate that microplastic pollution is significantly impacting freshwater ecosystems in Canada. Microplastics can accumulate in water, biota, and sediments, leading to water quality changes, ecological disruptions, and potential risks to human health. The study also highlights the ecological and societal impacts of microplastic pollution, such as changes in habitat structure, alterations in food webs, and potential health risks. Various mitigation measures, including source reduction, wastewater treatment, education and awareness, policy and regulatory measures, and ecosystem-based approaches, are effective in reducing microplastic pollution in freshwater environments.
 Recommendations: This study contributes to the understanding of microplastic pollution's impact on freshwater ecosystems and effective mitigation measures in Canada. The research advances knowledge in environmental science, freshwater ecology, and pollution management, providing insights into sources, pathways, and impacts of microplastic pollution in freshwater ecosystems, and the effectiveness of various mitigation measures. The findings have practical implications for policymakers, environmental managers, and stakeholders involved in freshwater management and pollution control, highlighting the need for interdisciplinary approaches, stakeholder engagement, and evidence-based policy and management strategies to mitigate the negative effects of microplastic pollution on freshwater ecosystems and safeguard their health and sustainability.
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Kurek, Kenneth J., Aaron A. Harthan, and Sandeep Tripathi. "Survey of Pharmacists Regarding the Use of Propofol Infusions in the PICUs in North America." Journal of Pediatric Pharmacology and Therapeutics 24, no. 6 (2019): 473–78. http://dx.doi.org/10.5863/1551-6776-24.6.473.
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OBJECTIVE The objective of this survey was to assess the current use of continuous infusion propofol in PICUs across the United States and Canada. METHODS A list of institutions with PICU beds/units was identified through the residency directories available on the American Society of Health-Systems Pharmacists (ASHP) and Canadian Society of Hospital Pharmacists (CHSP) Web sites. A REDCap questionnaire was sent to each identified institution's program director via email. An initial reminder email was sent out 2 weeks later and a second reminder email was sent 4 weeks after the initial request. The survey was closed at 6 weeks. RESULTS A total of 514 emails were sent to residency program directors, and 50 pharmacists responded to the survey. Of the pharmacists that did respond, 27 (54%) reported using propofol while 23 (46%) did not. Of those that did not, 43.5% reported the FDA boxed warning as the primary reason. Thirty-seven percent of respondents using propofol felt comfortable using a maximum infusion rate of 200 mcg/kg/min. Twenty-nine percent, 25%, and 33% of those who responded as using propofol felt comfortable using this agent for a maximum duration of 24, 48, and 72 hours, respectively. The majority of respondents using propofol did not have a case of propofol-related infusion syndrome. CONCLUSIONS Despite the FDA warning, propofol is used as a continuous infusion (with variable limitations) by a majority of pharmacists in North America. Self-reported incidence of propofol-related infusion syndrome (PRIS) remains low.
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Salinas-Perez, Jose A., Mencia R. Gutierrez-Colosia, Mary Anne Furst, et al. "Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande)." Canadian Journal of Psychiatry 65, no. 10 (2020): 721–30. http://dx.doi.org/10.1177/0706743720944312.
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Objective: Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. Methods: We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. Results: All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. Conclusion: We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
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Ethan, Liam. "Trends and Implications of Emerging Markets and New Destinations for the Hospitality and Tourism Sector in Canada." International Journal of Modern Hospitality and Tourism 4, no. 1 (2024): 15–25. http://dx.doi.org/10.47604/ijmht.2373.
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Purpose: The study sought to analyze the trends and implications of emerging markets and new destinations for the hospitality and tourism sector.
 Methodology: The study adopted a desktop methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: Canada's hospitality and tourism sector is expanding into emerging markets and diversifying beyond traditional destinations. This shift towards sustainability and technology integration is improving the visitor experience and attracting eco-conscious travelers. Enhanced accessibility and economic benefits underscore the need for strategic collaboration to maximize opportunities while ensuring responsible tourism development.
 Unique Contribution to Theory, Practice and Policy: Diffusion of innovation theory, Resource-based theory & Market segmentation theory may be used to anchor future studies in the trends and implications of emerging markets and new destinations for the hospitality and tourism sector. Hospitality businesses should tailor their offerings to cater to the unique needs and preferences of travelers in emerging destinations, while also ensuring sustainability and cultural sensitivity in their operations. Policymakers should prioritize the development of supportive regulatory frameworks and infrastructure to attract investment and foster tourism growth in emerging destinations.
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Beydik, Oleksandr O., Sergii Yu Syrovets, Nataliia S. Koroma, and Mykola A. Molochko. "World mineral deposits in the table of periodic chemical elements." Journal of Geology, Geography and Geoecology 29, no. 4 (2020): 637–46. http://dx.doi.org/10.15421/112057.
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The distribution of mineral deposits and the distribution of chemical elements on the globe are characterized by heterogeneity. A wide range of publications of domestic and foreign specialists - geologists, geographers, geochemists, economists - were dedicated to mineral resources of the world, mineral deposits. During processing the material the comparative-geographical, cartographic (analysis of minerals maps, mineral resources in the context of continents and regions of the world, cartographic interpretation of Mendeleev periodical table), monographic (analysis of fundamental works of leading domestic and foreign geologists and resource scientists, geologists and geologists, and geologists and geologists) directories, multi-volume editions devoted to geology and mineral resources of individual countries and regions of the world) methods, systematic approach, and GIS technologies - all these were used for received data processing and systematization. Explored mineral deposits (current and potential) form on the planet both individual local deposits and geochemical zones – areas where economically valuable chemical elements and their compounds are concentrated, which are diverse in genesis, stocks, and possibilities of exploitation. The largest of the latter is the Appalachians in the US - the Western Hemisphere, the Highveld in South Africa, Khibiny and the Ural Mountains inRussia - the Eastern Hemisphere. The leading countries in which most geochemical resources are extracted from the subsoil are the United States (65% of the total elements of Mendeleev periodical table), Russia (48%), China (38%), Canada (38%), South Africa (30%), Australia, (27%), Kazakhstan (19%), India (14%), Mexico (13%). The ideas about the level of provision of mineral resources and minerals in individual countries and territories of the world were systematized. The Mendeleev periodical table and its mineral and raw content were presented as an objective factor in the international geographical distribution of labor. The illuminated issues are confirmed high density of interdisciplinary links (geology, geography, chemistry, geochemistry, ecology, economics, regional studies, zoning).
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Boyer, M. Martin. "Directors’ and officers’ insurance in Canada." Corporate Ownership and Control 4, no. 4 (2007): 154–59. http://dx.doi.org/10.22495/cocv4i4p13.
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This paper looks at the insurance demand of a firm’s directors and officers using a sample of Canadian corporations (excluding firms from the financial services and mining sectors) from 1993-1999. More to the point, we study the demand for directors’ and officers’ insurance. Contrary to the financial distress theory of hedging, our results suggest that larger corporations are more likely to purchase D&O insurance. On the other hand, insurance is more likely when the firm is financially weak. Firms are also more likely to purchase D&O insurance when there are few outsiders on the board of directors and when the board members have an important financial stake in the corporation, suggesting that D&O insurance is yet another tool for managerial entrenchment. Surprisingly, being listed on a stock exchange in the United States does not seem to have an impact on the demand for D&O insurance, contrary to previous results
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Matzig, Catherine. "Toronto Playwrights Union of Canada and Playwrights Canada Press: A Profile." Canadian Theatre Review 98 (March 1999): 17–19. http://dx.doi.org/10.3138/ctr.98.005.
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In the late 1960s, Canada’s regional theatres – those established by the federal government to celebrate the 1967 Centennial – had a general reputation for offering few opportunities for Canadian work to appear. Artistic directors of these houses tended to be primarily European-born – Christopher Newton at Theatre Calgary and Heiner Piller at Neptune Theatre, for example – and were inclined to produce remounted Broadway hits and musicals or popular foreign-stage classics. Theatre companies like Edmonton’s Citadel Theatre, Winnipeg’s Manitoba Theatre Centre and Nova Scotia’s Neptune Theatre were ostensibly created to present Canadian theatre, but the repertories broadened and playbills often told a different story, listing productions by Shaw, Miller, Wilde, Chekhov and Shakespeare with the rare Canadian play. As a result, there was virtually no space on our regional stages for new Canadian works and little interest on the part of Artistic Directors to actively search out and develop this genre.
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Knowles, Richard Paul. "Frankie Goes to Hollywood (North); or The Trials of the Oppositional Director." Canadian Theatre Review 76 (September 1993): 4–7. http://dx.doi.org/10.3138/ctr.76.001.
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The politicized director in Canada is faced with many hurdles. This is particularly true of a director who not only wants to change what people think, but to make it possible to think in different ways, to have an impact on the forms and structures through which thought and meaning are produced and by which the possibilities of thought are circumscribed. In spite of the popular impression, itself ideologically coded, that we live in an age of “director’s theatre”, in which directorial concepts serve as the central and determining principles around which all other aspects of theatrical production revolve, it quickly becomes apparent in practice that the ways in which a particular theatrical production communicates meaning, together with the meanings it communicates, are often predetermined or contained by the training, rehearsal processes, traditional wisdoms, and organizational and funding structures within which it operates.
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Sayumwe, Michel, and Boudjemaa Amroune. "Directors characteristics and stock market performance in Canada." Journal of Economic & Financial Studies 5, no. 01 (2017): 01. http://dx.doi.org/10.18533/jefs.v5i01.176.
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Soma, Ashok, Matthew Myatt, Mario McKenna, Soma Ganesan, and Ka Wai Leung. "An examination of entrance criteria for international medical graduates (IMGs) into Canadian psychiatry residency programs." Canadian Medical Education Journal 8, no. 1 (2017): e52-58. http://dx.doi.org/10.36834/cmej.36769.
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Background: Although international medical graduates (IMGs) are essential in health care service delivery, a gap exists in the literature about how IMGs are selected into psychiatry residency programs in Canada. The purpose of this study was to identify the relative weight or importance that Canadian program directors (PDs) of psychiatry place on certain selection criteria when matching IMGs into residency programs.Methods: We electronically distributed a web-based questionnaire to 16 university residency program directors of psychiatry in Canada. Program Directors were asked to rate the importance of 43 selection criteria using 5-point Likert Scales. Criteria were grouped into six domains: academic criteria, extracurricular activities, supporting information, behavioural issues of concern, medical school country, and other education. Mean total values for each set of criteria were calculated and used to create rank orders within each domain.Results: Eight out of 16 program directors responded. Our analysis indicated that academics and behavioral issues of concern were the most important selection criteria.Conclusion: Our findings provide valuable insight about the perspectives of Program Directors toward IMGs who apply for psychiatry residency programs in Canada. Further studies are needed to better understand which criteria contribute to IMGs’ performances as psychiatric residents.
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Hamadziripi, Friedrich, and Patrick C. Osode. "A critical analysis of Zimbabwe's codified business judgment rule and its place in the corporate governance landscape." Law, Democracy and Development 25 (January 28, 2021): 1–29. http://dx.doi.org/10.17159/2077-4907/2021/ldd.v25.20.
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The business judgment rule (BJR or the Rule) is an American legal export which has become a key corporate governance tool in most leading common law jurisdictions, such as, Australia, Canada and South Africa. However, the Rule has not been formally embraced in the United Kingdom. In Zimbabwe, the Rule has traditionally been treated as a common law feature. However, section 54 of Zimbabwe's new Companies and Other Business Entities Act represents one of the significant advances in strengthening the jurisdiction's corporate governance principles by codifying the Rule. The BJR originated together with the directors' duty of care and skill. There are two main formulations of the BJR. The first one is by the Delaware Chancery Court and the second one derives from the American Law Institute's Principles of Corporate Governance. The Rule mostly applies in determining the procedural aspects of the directors' decision or the decision-making process and only in exceptional cases is it invoked to review the merits of their decision. This article seeks to critically analyse the major elements of Zimbabwe's codified BJR and to ascertain its place in the corporate governance framework. As will become clear, it will also be argued that the statutory BJR is intended for the enhancement of directorial accountability.
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Jimenez-Zepeda, Victor, Donna E. Reece, McCurdy R. Arleigh, et al. "Real-World Outcomes with Bortezomib-Containing Regimens and Lenalidomide Plus Dexamethasone for the Treatment of Transplant Ineligible MM Patients: A Multi-Institutional Report from the National Myeloma Canada Research Network (MCRN) Database." Blood 132, Supplement 1 (2018): 2008. http://dx.doi.org/10.1182/blood-2018-99-117363.
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Abstract Introduction: Bortezomib-containing regimens (BCRs) have been the standard frontline approach for the treatment of transplant ineligible multiple myeloma (TIMM) patients in Canada for many years. Based on recent randomized clinical trial results lenalidomide and dexamethasone (Ld) has become another provincially funded option in Canada in the same therapeutic space. We aimed to compare the effect of BCRs and Ld for the treatment of TIMM using the newly-formed Myeloma Canada Research Network Multiple Myeloma Database (MCRN-MM-DB) project. This web-based centralized platform can track and characterize real-world outcomes of patients treated at major Canadian institutions and includes both legacy data dating back to 2007 (from 4 centres) as well as ongoing prospective data collection (from 11 centres) analyzed up to 01/07/18. Patients and Methods: The primary objective was to assess the ORR, PFS and OS for TIMM patients treated with CyBorD/CyBorP, Ld, VMP or VD/VP, each given as reported previously but with dose-adjustments at the discretion of the treating physician to maintain patients on therapy. The two-sided Fisher exact test was used to test for differences between categorical variables. Survival curves were constructed according to the Kaplan-Meier method and compared using the log rank test; a p value of <0.05 was considered significant. Results: 842 TIMM patients were evaluated. Clinical characteristics are shown in Table 1. Median OS and PFS for the entire cohort were 54.1 and 20.4 months, respectively. ORR and ≥VGPR better rates were 83% and 52% for the entire cohort. A ≥VGPR rate of 53%, 46%, 56% and 51% were observed for patients treated with CyBorD/P, VMP, Ld and VD/VP, respectively (p=0.3). The median PFS was longer for Ld patients (25 months) compared to CyBorD/CyBorP, VMP and Vd/VP (19.3, 20.5 and 13.7 months, respectively), (p=0.03, Fig 1a); there was no significant difference in PFS between the 2 different alkylating-agent containing regimens when combined with bortezomib + steroids (CyBorD/P vs VMP, p =0.9). Median OS was 51, 59.5, 29.4 and 66.5 months for those patients treated with CyBorD/CyBorP, VMP, VD/VP and Ld, respectively (p=0.07, Fig 1b). When the OS and PFS for CyBorD/P (typically given for a fixed duration of 9 cycles) were compared with Ld in a subset analysis, the p-values were 0.08 and 0.008, respectively. Conclusions: 1) OS was not significantly different in patients treated with either a bortezomib-containing triplet that includes an alkylator + steroid or continuous Ld. 2) The BCR triplets and Ld were more efficacious than the bortezomib + steroid doublet (VD/VP) for both OS and PFS although, the small sample size and adverse factors, such as frailty and comorbidities, may have influenced the findings. 3) The results in the real-world setting, i.e., a median PFS in the range of 1.5-2 years and median OS of 4.5-5.5 years, confirm triplet-based BCRs and Ld as current valid standards of care for frontline therapy in TIMM. 5) This study confirms the utility of a large comprehensive national database to benchmark current results for comparison with newer regimens as they are introduced into the Canadian therapeutic landscape. Disclosures Arleigh: Celgene: Honoraria; Janssen: Honoraria. Sebag:Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees. Leblanc:Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees. Louzada:Janssen: Honoraria; Celgene: Honoraria; amgen: Honoraria; pfizer: Honoraria. Venner:Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Amgen: Honoraria; Takeda: Honoraria.
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Fleming, J. A. E., and P. G. R. Patterson. "The Teaching of Case Formulation in Canada." Canadian Journal of Psychiatry 38, no. 5 (1993): 345–50. http://dx.doi.org/10.1177/070674379303800512.
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Prompted by the Council on Education and Professional Liaison of the Canadian Psychiatric Association, the authors surveyed the program directors and senior residents of departments of psychiatry on the teaching of case formulation skills in Canada. The results showed that case formulation is taught formally in most departments and that students are expected to demonstrate these skills throughout their training. However, less than one-half of the teaching programs provide guidelines for case formulation. The residents, who expected case formulation skills to be assessed in the oral examinations of the Royal College, were unanimous in their view that the process should be standardized and that guidelines be provided. Both the program directors and the residents favoured a biopsychosocial format for recording case formulation, but they did not agree on the content of an ideal formulation.
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Lendsay, Kelly J. "First Nations Bank of Canada: Interview with Mr. Keith Martell Chair Of The Board of Directors." Journal of Aboriginal Economic Development 1, no. 1 (1999): 3–5. http://dx.doi.org/10.29173/jaed86.
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On December 9, 1996, the Federation of Saskatchewan Indian Nations (FSIN) and TD Bank officially launched the First Nations Bank of Canada. The First Nations Bank of Canada is a schedule II chartered bank that serves Aboriginal and non-Aboriginal customers throughout Canada. It is the first such bank of its kind in North America, conceived, packaged and developed by Aboriginal People for Aboriginal People. Former Chief Blaine Favel, FSIN stated at the grand opening “the bank is one of many important steps towards Aboriginal people's economic self sufficiency and political self determination ... the Indian economy alone in Canada represents billions of dollars and we are aggressively seeking customers for the First Nations Bank.” Mr. Keith Martell is the Chair of the Board of Directors of the First Nations Bank of Canada. A member of the Waterhen Lake First Nation, Keith completed his Commerce degree at the University of Saskatchewan, obtained his CA designation and worked with the chartered accounting firm KPMG for 10 years before joining FSIN in 1995.
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Yamga, Eric, Richard Leblanc, and Jean-Samuel Boudreault. "Canadian Retrospective Multicentric Study Comparing the Combination of Bortezomib, Cyclophosphamide and Dexamethasone (Cybord) Versus Bortezomib, Thalidomide and Dexamethasone (VTD) Versus Bortezomib and Dexamethasone (Vd) in Patients with Newly Diagnosed Multiple Myeloma Eligible for Autologous Hematopoietic Stem Cell Transplantation (HCT)." Blood 132, Supplement 1 (2018): 2010. http://dx.doi.org/10.1182/blood-2018-99-117571.
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Abstract Background: Multiple myeloma (MM) is the second most common hematologic cancer. The management of this disease consists of induction therapy followed by autologous hematopoietic stem cell transplantation (HCT). There is no standard of care as for the best induction regime. Recently, the first phase III study (Moreau P and all.) comparing two chemotherapy triplets in transplant-eligible patients, suggested a superiority of VTD over VCD. Although VTD was associated with better treatment response rates, the survival data remains to be seen. We wanted to retrospectively compare 3 Bortezomib-based therapies using response rates (RR), progression-free survival (PFS) and overall survival (OS). Bortezomib-Cyclophosphamide-Dexamethasone (CyBorD) remains the standard in Canada. Method: A total of 75 patients induced between 2010 and 2016 were analyzed. Their charts were reviewed and the data was retrospectively collected. Three distinct treatment groups were included : Vd (19), CyBorD (39) and VTD (17).The main outcome was treatment response rate, 2-year progression-free survival rate (PFS) and 2-year overall survival rate (OS). The secondary outcome was median PFS. Results: Patient characteristics are presented below (table 1). The difference between the treatment response rates were non-statistically significant but demonstrated a favorable trend towards VTD as the VGPR rate was 58.8%, 65% and 88.1% respectively in the Vd, CyBoRD and VTD groups (table 2 and 3). Median progression-free survival was significantly longer in the group that received VTD than in the group that received CyBord (3.58 years vs. 2,80 years; P = 0.03). The 2-year overall survival rate was 88,9%, 96,3% et 93,3% respectively in the 3 groups (table 4). Conclusion: The data from this retrospective study supports the superiority of the VTD induction regimen compared with CyBorD and Vd in terms of response rate and progression-free survival. However, there is no major difference in overall survival over the time period observed. Disclosures Leblanc: Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees. Boudreault:Celgen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees.
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Parmar, Ambica, Heather A. Leitch, Richard A. Wells, et al. "Iron Chelation Is Associated with Improved Survival Adjusting for Disease and Patient Related Characteristics in Low/Int-1 Risk MDS at the Time of First Transfusion Dependence: A MDS-CAN Study." Blood 126, no. 23 (2015): 1701. http://dx.doi.org/10.1182/blood.v126.23.1701.1701.
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Abstract Introduction: Transfusional hemosiderosis is common in myelodysplastic syndromes (MDS). There are multiple retrospective analyses demonstrating a survival benefit associated with iron chelation therapy (ICT) in lower risk, transfusion dependent (TD) MDS patients. However, these studies are limited by their retrospective nature, potential for bias and by the use of risk scores at diagnosis rather than at the onset of TD. Since January 2012 the Canadian MDS Registry has prospectively collected disease and patient-related data on MDS patients including comorbidity (Charlson and MDS-CI), frailty (Rockwood clinical frailty scale) and disability [Lawton Brody Instrumental Activities of Daily Living (sIADL)]. We compared characteristics and clinical outcomes of lower risk TD MDS patients who received ICT to non chelated TD patients, adjusting for MDS and patient-related factors. Methods: Only patients who remained International Prognostic Scoring System (IPSS) low or intermediate (int)-1 risk at the time of first TD were included with MDS and patient-related factors analyzed at first TD rather than at MDS diagnosis or registry enrollment. Univariate and multivariate Cox proportional hazard models were used to determine significant predictive factors for overall survival (OS) and the model with the highest R2 was selected. Results: 219 Low (n=69)/Int-1 (n=149) risk MDS patients at the time of first TD were included. Median age was 73 [interquartile range (IQR 65,80)] with a median time from diagnosis until TD of 7 months (IQR 1,28). 60% were male with a median ECOG of 1 and median blast of 3% (IQR 1,4). By WHO classification, 39% and 37% had unilineage and multilineage dysplasia respectively, 11% CMML and 13% had excess blasts. By IPSS-revised (R), very low, low, intermediate, high and very high risk groups were 12%, 34%, 38%, 15% and 0.5%, respectively. Seventy (32%) patients received ICT with desferrioxamine (n=6), deferasirox (n=56) or both (n=8). At the time of first TD, chelated patients were younger, had higher ferritins and had lower IPSS-R risk scores (Table 1). Importantly, frailty, comorbidity, and disability scores did not differ. At a median follow up of 2.7 (IQR 2.2-3.3) years from diagnosis, OS was 6.1(IQR 4.5-7.5) years. OS was significantly improved among MDS patients treated with ICT as compared to those without (median 8.62 vs. 4.38 years, respectively, p = 0.0005, Figure 1.) By univariate analysis, age, ICT, IPSS, IPSS-R, MDS-CI, frailty, karyotype, time from diagnosis until TD, and disability were associated with improved OS. By multivariate analysis, ICT, age at TD and IPSS-R at TD were independently predictive of OS (Table 2). Conclusions: Adjusting for patient and disease related factors at the time of TD, ICT remains predictive of improved OS in patients with low/int-1 risk MDS who become TD. The adjustment for patient-related factors and analysis from TD rather than MDS diagnosis, diminishes the impact of selection bias that may have favored ICT patients in past analyses and lends additional support to the role for ICT in lower risk MDS. Table 1. Comparing Clinical Factors at the time of First Transfusion Dependency (TD) between Chelated and Non-Chelated Patients Factors at Time of TDMedian (IQR) Without Iron Chelation (n=149) With Iron Chelation (n=70) p-value Age (y) 75 (67,81) 69 (62,75) 0.0008 Ferritin (ug/L) 664 (346,1118) n=92 1201 (883,1691) n=44 <0.0001 RA/RARS, del5q, MDS-U, RCUD [N(%)] RCMD+/-RS CMML/MDS/MPN RAEB1 RAEB2 51 (34) 56(38) 18 (12) 17 (11) 7 (4) 35 (50) 25 (36) 3 (4) 6(9) 1(1) 0.11 IPSS [N(%)] Low Int-1 42 (28) 106 (72) 27 (39) 43 (61) 0.16 IPSS-R [N(%)] Very Low Low Intermediate High Very High 15 (10) 48 (32) 54 (36) 30 (20) 1 (0) 12 (17) 26 (37) 29 (41) 3 (4) 0 (0) 0.01 Frailty N=96 3 (2,4) N=37 3 (2,4) 0.40 Charlson Comorbidity N=95 1 (0,2) N=37 0(0, 1) 0.06 MDS-CI N=95 1 (0,2) N=37 0 (0,2) 0.26 Lawton Brody Disability N=90 1 (0,2) N=36 0 (0,2) 0.68 Time from diagnosis until TD (mo) 6 (1,23) 14 (0,38) 0.19 Table 2. Predictive factors for Overall Survival by Multivariate Analysis Predictive Factors p-value HR 95% CI of HR R2 (%) Iron chelation (no vs. yes) 0.0152 1.821 1.122 2.953 14.76 Age at time of diagnosis (yr) 0.0125 1.025 1.005 1.045 IPSS-R at time of TD 0.0018 High/vHigh vs. Low 0.0004 2.866 1.601 5.132 Int. vs. Low/vLow 0.0775 1.523 0.955 2.429 High/vHigh vs. Low 0.0292 1.882 1.066 3.322 Figure 1. Kaplan-Meier Curve of Overall Survival of Chelated and Non-Chelated Patients Figure 1. Kaplan-Meier Curve of Overall Survival of Chelated and Non-Chelated Patients Disclosures Leitch: Alexion: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Exjade: Speakers Bureau. Wells:Novartis: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Alexion: Honoraria, Research Funding. Nevill:Celgene: Honoraria. Zhu:Novartis Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees. Yee:Oncoethix: Research Funding; Novartis Canada: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene Canada: Membership on an entity's Board of Directors or advisory committees, Research Funding. Leber:Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Sabloff:Celgene: Honoraria. Kumar:Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Geddes:Celgene: Honoraria. Storring:Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Kew:Celgene: Honoraria. Shamy:Novartis Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Elemary:Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees. Buckstein:Celgene: Honoraria, Research Funding.
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Toyota, Brian D. "Spinal Subspecialization in Post Graduate Neurosurgical Education." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 31, no. 2 (2004): 204–7. http://dx.doi.org/10.1017/s0317167100120566.
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AbstractBackground:The growing science and technology of various neurosurgical areas fosters subspecialization. The transmission of this expanding knowledge base to the neurosurgical resident becomes an increasing challenge. A survey of neurosurgical residency program directors was undertaken to evaluate their response to the budding subspecialization of spine surgery within general neurosurgery.Methods:A survey requesting background data, educational infrastructure and prevailing opinion was distributed to all 13 neurosurgical program directors in Canada. The responses were tabulated and results recorded. It is upon these results that conclusions and proposed directions are based.Results/Conclusions:The current practice of the overwhelming majority of Canadian academic neurosurgical centers is to have neurosurgical spinal subspecialists working under the umbrella of the general neurosurgical division. A large percentage of neurosurgical program directors in Canada believe that the management of spinal disease, including both intradural procedures and instrumentation, is and should remain an integral part of general neurosurgical training. A consensus statement regarding the requirements of neurosurgical training in spinal disorders is the expressed desire of almost all program directors. A proposed direction and resolution is discussed.
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Gillman, L. M., A. Vergis, J. Park, and M. Taylor. "53. Resident training and the dictated operative report - A national perspectives." Clinical & Investigative Medicine 30, no. 4 (2007): 56. http://dx.doi.org/10.25011/cim.v30i4.2814.
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Operative dictation training is a poorly studied area of surgical resident education and there is currently no literature on the national experience with operative dictation training in Canada. We therefore undertook a web-based survey of residents and program directors in general surgery training programs in Canada to determine if there is an ongoing desire for formal operative dictation training. 
 Every resident and program director in English speaking General Surgery programs in Canada was contacted by email and asked to participate in the study. A secure, web based survey program was developed to conduct the survey and collect the data. The survey contained questions regarding comfort level with dictation, feedback on dictations and methods of dictation training employed by the individual residents and the resident training programs. 
 Two hundred and seventy-four residents and 11 program directors responded to the survey (70.4% and 78.5% response rate, respectively). Among residents, 201 residents (73.3%) reported that their dictations were in need of improvement while 191 residents (69.7%) requested further training in dictation. Two-hundred and six residents (75.2%) reported that their training program did not employ any formal methods to help improve their dictations. Furthermore, 153 residents (55.8%) had never received feedback on their dictations.
 Ten program directors (90.9%) felt that residency programs should include formal training in operative dictation. Unfortunately, half of these program directors could not identify any formal methods currently being employed in their training programs, this despite the fact that 45.5% of program directors could identify specific instances where direct patient care was negatively affected by a poor operative report.
 Both program directors and residents identified operative dictation templates and formal feedback on dictations as the two interventions they would like to see instituted to improve operative dictations in their residency training programs.
 Residents and program director recognize a need for the development of formal operative dictation training in Canada.
 Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6.
 Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2.
 Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.
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Smith, Yaakov “Jacob.” "My Little Pony: A New Generation (2021)." Film Matters 14, no. 2 (2023): 97–105. http://dx.doi.org/10.1386/fm_00294_5.
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Rudakoff, Judith. "Aleksandar Lukac: Theatre Offensives from Belgrade to Toronto." TDR/The Drama Review 43, no. 4 (1999): 95–112. http://dx.doi.org/10.1162/105420499760263561.
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Gasparetto, Cristina J., Suzanne Lentzsch, Gary J. Schiller, et al. "Deep and Durable Responses with Selinexor, Daratumumab, and Dexamethasome (SDd) in Patients with Multiple Myeloma (MM) Previously Exposed to Proteasome Inhibitors and Immunomodulatory Drugs: Results of Phase 1b Study of SDd." Blood 132, Supplement 1 (2018): 599. http://dx.doi.org/10.1182/blood-2018-99-117201.
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Abstract Introduction - Selinexor is a first-in-class Selective Inhibitor of Nuclear Export (SINE) compound that binds and inactivates Exportin 1 (XPO1). Selinexor with low dose dexamethasone (Sd) or in with protesome inhibitors (PIs) or immunomodulatory drugs (IMiDs), has shown anti-MM activity in patients (pts) with relapsed or refractory MM. Daratumumab (Dara), an anti-CD38 mAb, is approved for the treatment of heavily pretreated MM is limited by short PFS and an ORR of ~21% in quad-refractory MM. Selinexor in combiniation with dara have shown preclinical synergistic killing of MM cells. Methods - Pts were eligible if they had received ≥ 3 prior lines of anti-myeloma therapy, including a PI and an IMiD. Selinexor was dose-escalated in 2 concurrent cohorts: once-weekly (QW, at 100 mg) or twice-weekly (BIW, at 60 mg). Dara was 16 mg/kg IV (recommended schedule) and dexamethasone (dex) was 40 mg QW or 20 mg BIW. The objectives were to determine the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), safety, tolerability and preliminary efficacy of the combination of this SDd combination in pts with PI/IMiD refractory MM Results - As of Jul 20th2018, 25 pts (11 males / 14 females) have been enrolled. Three pts have been enrolled into the 60 mg BIW and 22 pts in the 100 mg QW cohorts. Pts have a median age of 68 years and a median of 3 (range, 2 - 10) prior treatment regimens. Common SDd treatment related adverse events included (all grades, grades 3/4): thrombocytopenia (58%, 42%), leukopenia (54%, 38%), anemia (46%, 29%), nausea (50%, 0%) and fatigue (46%, 8%). Two dose limiting toxicities (DLTs) were reported in the 60 mg BIW cohort: G3 thrombocytopenia and G2 fatigue requiring dose reduction in selinexor to 100 mg QW. In the 100 mg QW escalation cohort, 6 pts enrolled, 5 evaluable, with no DLTs. This cohort was expanded and enrollment is ongoing. A total of 21 pts were evaluable for response. In 19 dara-naïve pts, the ORR was 74% (5 VGPR, 9 PR, 2 MR, 2 SD, 1 PD), including 3 unconfirmed PRs, 1 unconfirmed MR. In the 2 pts with dara refractory MM, there was one PD and one SD. The longest duration of therapy is 13 months. Based on tolerability and efficacy, the RP2D of SDd is selinexor 100 mg, daratumumab 16 mg/kg and dex 40 mg, administered QW. Conclusions - Selinexor 100 mg QW can be combined safely with dara (per approved dosing) and dex. The preliminary ORR of 74% with SDd in patients with PI/IMiD refractory MM who are dara naïve is promising and compares favorably to 21% ORR of Dara and Sd in quad refractory myeloma. This once weekly regimen is well tolerated with no major organ toxicities to date. Data from the full phase 1 dose expansion will be presented. Disclosures Gasparetto: Takeda: Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel; Janssen: Consultancy, Honoraria, Other: Travel; Celgene: Consultancy, Honoraria, Other: Travel, Research Funding. Schiller:Celator/Jazz Pharmaceuticals: Research Funding; Pharmacyclics: Research Funding. Bensinger:Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; amgen: Speakers Bureau; Takeda: Speakers Bureau. Bahlis:Celgene: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria. White:Amgen, Celgene, Janssen, Takeda: Honoraria. Sebag:Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees. Venner:Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Amgen: Honoraria; Takeda: Honoraria. Leblanc:Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees. Chen:Amgen: Honoraria. Shah:Karyopharm Therapeutics: Employment. Jeha:Karyopharm Therapeutics: Employment. Saint-Martin:Karyopharm Therapeutics: Employment. Kauffman:Karyopharm Therapeutics: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Shacham:Karyopharm Therapeutics: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Lipe:Celgene: Consultancy.
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Chen, Christine I., Heather J. Sutherland, Rami Kotb, et al. "Selinexor Plus Pomalidomide and Low Dose Dexamethasone (SPd) in Patients with Relapsed or Refractory Multiple Myeloma." Blood 132, Supplement 1 (2018): 1993. http://dx.doi.org/10.1182/blood-2018-99-117349.
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Abstract Introduction - The nuclear export protein exportin 1 (XPO1) is overexpressed in a wide variety of cancers including multiple myeloma (MM). Selinexor is a first-in-class Selective Inhibitor of Nuclear Export (SINE) compound that binds and inactivates XPO1. Selinexor forces nuclear retention and reactivation of cell cycle regulators such as p53, IkB, and Rb. Pomalidomide/dexamethasone (Pd) is approved in relapsed/refractory MM (RRMM)with an overall response rate (ORR) of 30% and progression-free survival (PFS) rate of <4 months in patients (pts) having received a prior proteasome inhibitor (PI) and IMiD. Strategies to improve the ORR and PFS are needed. In murine MM models, the combination of selinexor with IMiDs shows synergistic anti-MM activity and good tolerability. Methods- Pts with RRMM who received ≥ 2 prior therapies including lenalidomide (len) and a PI were enrolled. Selinexor was evaluated in 2 different dosing schedules of once-weekly (QW, 60 or 80 mg) or twice-weekly (BIW, 60 or 80 mg), with pomalidomide (pom)3 or 4 mg PO daily, and dexamethasone (dex) 20 mg BIW or 40 mg QW. The primary objectives were to determine the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), safety, and preliminary efficacy of the combination of selinexor, pomalidomide, and low dose dex (SPd) in pts with RRMM. Results- As of July 20th2018, 34 pts (16 male / 18 female) have been enrolled. The median age is 61 years and patients received a median of 4 (range, 2 - 9) prior treatment regimens. Thirty-two patients were IMiD refractory (21 len, 11 pom/len). Six dose limiting toxicities (DLTs) were observed: G3 fatigue (60 mg BIW, pom 4 mg), G3 febrile neutropenia (FN) (60 mg BIW, pom 3 mg), G3 FN and G4 neutropenia (80 mg QW, pom 4), G3 thrombocytopenia (80 mg QW, pom 3 mg) and 4 missed doses in Cycle 1 due to symptomatic hyponatremia (80 mg BIW, pom 4 mg). Enrollment on selinexor 80 mg QW, pom 3 mg is ongoing. Common SPd treatment related adverse events included (all grades, grades 3/4): neutropenia (62%, 56%), thrombocytopenia (59%, 32%), anemia (53%, 29%), anorexia (56%, 0%), fatigue (50%, 9%), nausea (47%, 0% ). Thirty pts were evaluable for response, which is outlined in Table 1. Median PFS is 10.3 months with a median follow up of 9.4 months. Conclusions- Enrollment is ongoing to evaluate once weekly selinexor in combination with Pd , (SPd). This all-oral SPd combination has clinical activity with an ORR 55% in pom-naive pts with heavily pretreated MM compared to previously published data of 30% ORR for Pd alone. Similarly, the PFS on SPd is 10.3 months vs. <4 months for Pd alone. No unexpected adverse events were noted. Phase 1 dose escalation of the combination of SPd is ongoing to define the optimal RP2D. Disclosures Chen: Amgen: Honoraria. Sebag:Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees. White:Amgen, Celgene, Janssen, Takeda: Honoraria. Bensinger:Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Speakers Bureau; celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; amgen: Speakers Bureau. Gasparetto:Bristol-Myers Squibb: Consultancy, Honoraria, Other: Travel; Janssen: Consultancy, Honoraria, Other: Travel; Takeda: Honoraria; Celgene: Consultancy, Honoraria, Other: Travel, Research Funding. Leblanc:Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees. Venner:Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Amgen: Honoraria; Takeda: Honoraria. Schiller:Pharmacyclics: Research Funding; Celator/Jazz Pharmaceuticals: Research Funding. Lipe:Celgene: Consultancy. Shah:Karyopharm Therapeutics: Employment. Jeha:Karyopharm Therapeutics: Employment. Saint-Martin:Karyopharm Therapeutics: Employment. Kauffman:Karyopharm Therapeutics: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Shacham:Karyopharm Therapeutics: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Bahlis:Amgen: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding.
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Doja, Asif, Chantalle Clarkin, Sharon Whiting, and Mahendranath Moharir. "What is the Future of Pediatric Neurology in Canada? Resident and Faculty Perceptions of Training and Workforce Issues." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, no. 4 (2016): 549–53. http://dx.doi.org/10.1017/cjn.2016.6.
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AbstractBackground: Pediatric neurology trainee numbers have grown considerably in Canada; recent research, however, has shown that the number of pediatric neurology graduates is outpacing the need for future pediatric neurologists. The purpose of this study was to seek the opinion of pediatric neurology program directors and trainees regarding possible solutions for this issue. Methods: Two focus groups were convened during the Canadian Neurological Sciences Federation annual congress in June 2012; one consisted of current and former program directors, and the other of current pediatric neurology trainees. Groups were asked for their perceptions regarding child neurology manpower issues in Canada as well as possible solutions. Focus groups were audio-recorded and transcribed for analysis. Theme-based qualitative analysis was used to analyze the transcripts. Results: Major themes emerging from both focus groups included the emphasis on community pediatric neurology as a viable option for trainees, including the need for community mentors; recognizing the needs of underserviced areas; and establishing academic positions for community preceptors. The need for career mentoring and support structures during residency training was another major theme which arose. Program directors and trainees also gave examples of ways to reduce the current oversupply of trainees in Canada, including limiting the number of trainees entering programs, as well as creating a long-term vision of child neurology in Canada. Conclusions: A nationwide dialogue to discuss the supply and demand of manpower in academic and community pediatric neurology is essential. Career guidance options for pediatric neurology trainees across the country merit further strengthening.
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Sheridan, Alison. "Accessing Directorships: Comparison of Views of Canadian and Australian Women Directors." Psychological Reports 90, no. 1 (2002): 150–56. http://dx.doi.org/10.2466/pr0.2002.90.1.150.
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Compared are views of Canadian and Australian women directors concerning the difficulties women face in accessing the most privileged level of management—directorships of companies. The Canadian data are from a study of 278 women directors of corporate boards in Canada while the Australian results are from a study of 47 women directors of publicly listed companies in Australia. Despite the different time periods and geographical locations in which the studies were carried out, the profiles and responses of the two groups are quite similar. Both groups believe the current mix of directors is not adequate and that barriers still exist in nominating women to boards.
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Girgis, H., V. LeBlanc, A. Chaput, and F. Alkherayf. "P.177 The Effect of the COVID 19 Pandemic on theTraining of Surgical Residents in Canada. A Survey of Residents and Program Directors." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (2021): S70—S71. http://dx.doi.org/10.1017/cjn.2021.453.
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Background: The coronavirus 2019 pandemic has led to restructuring of health care systems and has subsequently had secondary effects on medical education. This study examines the impact on training of surgical residents in Canada. Methods: The study consisted of a 25-question survey for residents and a 22-question survey for program directors, which were distributed electronically through program administrators on July 3rd- July 11th, 2020. Questions sought to elicit residents’ current experiences and gain insight into methods by which to enhance future training. Results: 108 residents and 21 program directors, from various surgical specialties across Canada, completed the survey. Operative exposures were reported to be reduced by 25-100% and 39% of residents were redeployed. However, 89% of residents reported accessing academic half days virtually and 57% had additional online modules. Despite lost time, 100% of program directors confirmed that residents did not require training extensions. Concerns regarding training, personal health, employability and fellowships were raised. 55-70% of residents and program directors advocated for alternative educational courses, increasing elective time, utilizing simulation for assessment and flexibility in crediting different training experiences. Conclusions: Canadian surgical residents had a significant reduction in operative experiences during the pandemic. Moving forward, it will be important to find alternative educational experiences.
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Priya Kumari and Rishi Kumar. "Business Judgment Rule: Defense for the Directors in Cases of Alleged Breach of Duties." Legal Research Development: An International Refereed e-Journal 4, no. III (2020): 34–43. http://dx.doi.org/10.53724/lrd/v4n3.04.
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In this article researchers will explain about Business Judgment Rule and how it can be used as a defence by the directors’ of the corporation. In simple language it can be said that the “Business judgment rule” is nothing but a judicially evolved doctrine derived out of case laws in the field of corporate laws. This doctrine has its origin in USA followed by U.K. The rule is in use in some form or the other in the common law countries e.g. whales, Australia, Canada, India &c. Australia has codified this rule under sec.1180(2) Corporations Act 2001, in South Africa Companies Act 71 of 200 section 76(4) provides for director’s duty to work towards best interest of the business with due care, skill and diligence, in India section 166(2) of Companies Act, 2013 requires that for the benefit of different constituencies of a company a director must act bona fide to promote the object of the company. The Business Judgment Rule tries to protect the directors of the company by creating a safe harbour for those who works for the betterment and interest of the corporations in an honest manner and in good faith. The scope of the paper is restricted to mainly US decisions, which has seen the greatest development in interpreting cases, though certain important landmarks in the Indian and UK context have also been referred to. The paper is limited by secondary sources such as books, articles and reports available on the subject.
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Leblanc, Richard, Imran Ahmad, Rafik Terra, et al. "Minimal Residual Disease Evaluation Using 8-Color Flow Cytometry Predicts Risk of Relapse in High-Risk and/or Young Myeloma Patients Who Receive Bortezomib Consolidation after Frontline Tandem Transplantation." Blood 132, Supplement 1 (2018): 4666. http://dx.doi.org/10.1182/blood-2018-99-112313.
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Abstract Introduction: Multiple myeloma (MM) remains incurable with standard therapies. Allogeneic stem cell transplantation (alloSCT) is the only curative treatment for these patients. We hypothesized that bortezomib (BTZ) consolidation after tandem autologous stem cell transplantation (ASCT) and nonmyeloablative (NMA) alloSCT could improve quality of response while decreasing relapse and cGVHD. We also sought to determine prospectively the predictive value of bone marrow minimal residual disease (MRD) evaluation using a highly sensitive flow cytometry assay. Methods: Newly diagnosed myeloma (NDMM) patients ≤65 years with high-risk (HR) features (based on cytogenetics, ISS 3 or plasma cell leukemia) or ≤50 year regardless of risk status with an 8/8 HLA matched donor are eligible to participate in this prospective trial. After a BTZ-based induction and ASCT, outpatient NMA alloSCT is performed with either fludarabine and cyclophosphamide (sibling donor) or fludarabine and TBI 2 Gy (unrelated donor) followed by peripheral blood stem cells. GVHD prophylaxis consists of tacrolimus and MMF. BTZ is initiated on day +120 post-alloSCT at 1.3 mg/m2 every 2 weeks for 1 year. Response evaluation is based on IMWG criteria. Bone marrow MRD evaluation is performed on 10x106 nucleated cells with highly sensitive (≥10-5) next-generation flow cytometry using the 8-color EuroFlow protocol (CD45, CD38, CD138, CD56, CD19, CD27, CD81, CD117, CyIgκ and CyIgλ) before alloSCT, before BTZ and every 3 months for 2 years. Immunophenotypic complete response (iCR) is defined as stringent CR in addition to 2 consecutive negative MRD results. aGVHD and cGVHD are evaluated prospectively. Results: As of June 29th 2018, 37 patients have been enrolled with a median age of 53 (range: 35-64) years. ISS 3 is found in 43% and HR cytogenetics in 54% (5% del17p, 14% t(4;14), 22% gain 1q21 and 14% >1 HR cytogenetics). Induction consisted of CyBorD (81%) or VTD (19%) for a median of 4 (range: 4-7) cycles. Median times from induction to ASCT and from ASCT to alloSCT were 5.8 and 4.4 months, respectively. Sibling and unrelated donor transplants were performed in 43% and 57%, respectively. KPS and HCT-CI were 90 (range 80-100) and 1 (range 0-3), respectively. Median follow-up is 21 (range 0-39) months after alloSCT. Of enrolled patients, 34 have started BTZ and received 92.5% of planned doses, with no dose reduction needed for toxicity. Observed grade ≥3 non-hematologic toxicities possibly/related to BTZ included diarrhea (n=1), viral hemorrhagic cystitis (2 adenovirus, 1 BK) and nocardial brain abscesses (n=1). Cumulative incidences of grade II-IV and III-IV aGVHD were 26% and 11%. Incidences of all grade, moderate/severe and severe cGVHD at 24 months were 61%, 47% and 10%, respectively, with mostly mouth, skin and liver involvement. Compared to 27 historical controls who did not receive BTZ after tandem transplant, the incidence of moderate/severe cGVHD was much lower in BTZ recipients (47 vs 78%; p=0.002). After reviewing each target organ involvement, mouth and eye cGVHD were significantly less severe with BTZ. Three patients died, one from myeloma progression and 2 from grade III aGVHD, with a 24-month non-relapse mortality of only 8%. BTZ consolidation improved depth of response, increasing ≥CR rate from 64% to 85% and iCR rate from 25% to 59%, regardless of cytogenetic abnormalities (Table 1). Probability of progression-free survival (PFS) at 24 months was 65% (CI 95%: 42-81) while overall survival (OS) was 90% (CI 95%: 70-97; Fig. 1A). The cumulative incidence of progression at 24 months was 28%. Importantly, the presence of ≤50 myeloma cells in the bone marrow 10 months post-alloSCT (after 6 months of BTZ) was associated with a significantly lower probability of progression (15% versus 80%; p=0.03; Fig. 1B). Conclusion: Tandem ASCT-NMA alloSCT followed by BTZ consolidation results in a remarkably high rate of ≥CR, including iCR. For the first time in allogeneic transplant recipients, MRD evaluation using the EuroFlow protocol demonstrates that identification of ≤50 myeloma cells in the bone marrow 10 months after alloSCT/6 months after BTZ seems predictive of a better outcome. If confirmed, this landmark could be used to design future therapeutic interventions in order to decrease the risk of relapse after tandem transplant. Finally, BTZ following alloSCT is safe and may contribute to decrease both incidence and severity of cGVHD. Disclosures Leblanc: Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees. Sebag:Amgen Canada: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees. Cohen:ExCellThera: Patents & Royalties: Royalities from sales of UM171. Kiss:Alexion: Membership on an entity's Board of Directors or advisory committees, Research Funding; Otsuka: Membership on an entity's Board of Directors or advisory committees, Research Funding. Lachance:ExCellThera: Patents & Royalties: Royalities from sales of UM171. Roy:Kiadis Pharma: Other: Travel support; University of Montreal: Patents & Royalties: Author on patent; Hopital Maisonneuve Rosemont: Patents & Royalties: Author on patent. Sauvageau:ExCellThera: Employment, Equity Ownership. Roy:Janssen Inc.: Membership on an entity's Board of Directors or advisory committees; Takeda Canada: Membership on an entity's Board of Directors or advisory committees; Celgene Canada: Membership on an entity's Board of Directors or advisory committees; Celgene: Research Funding.
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Cockcroft, Donald W., and David Wensley. "Respirology Manpower in Canada -- A Report for the Canadian Thoracic Society Education Committee." Canadian Respiratory Journal 7, no. 6 (2000): 451–55. http://dx.doi.org/10.1155/2000/704369.
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A report on adult and pediatric respirology manpower in Canada was prepared from data supplied by the Royal College of Physicians and Surgeons of Canada (RCPSC), and from program directors (and other colleagues) at universities across Canada. The data support a significant deficiency of adult respirologists in Canada, which is estimated to be from 10%, based on a 10-year-old outdated RCPSC recommendation, to 20%, based on equalization with the 'best' province, to as high as 50%, based on long waiting lists, particularly for respiratory sleep problems, and estimates obtained from academic centres across Canada. Although there are less data available for pediatric respirology, a similar approach suggests a 50% to 100% shortfall in pediatric respirologists. Output from Canadian training programs in adult and pediatric respirology is not likely to meet this need. We recommend that steps be taken urgently to provide sufficient resources for training adult and pediatric respirologists, and to ensure that funding is provided for subspecialist positions in the community.
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Hoeffe, Julia, Marie Pier Desjardins, Jason Fischer, Benoit Carriere, and Jocelyn Gravel. "Emergency point-of-care ultrasound in Canadian pediatric emergency fellowship programs: current integration and future directions." CJEM 18, no. 6 (2016): 469–74. http://dx.doi.org/10.1017/cem.2016.20.
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AbstractBackgroundAdult and pediatric emergency physicians have been using point-of-care ultrasound (POCUS) for many years. It is a fast, usually painless, noninvasive diagnostic tool that does not expose the patient to radiation. Information about its current implementation in pediatric emergency medicine (PEM) fellowship programs in Canada is lacking.ObjectiveThe main goal of our study was to investigate current integration and future direction of POCUS training in Canadian PEM programs.MethodsThe study consisted of two surveys designed for fellows and program directors of all Canadian PEM fellowship programs. The major aspects of the survey were 1) to describe current training in POCUS in fellowship programs, 2) to compare the kind of training that programs offer with what fellows actually receive, and 3) a needs assessment by fellows and program directors for future POCUS training programs. Surveys were sent to program directors and passed on to their fellows.ResultsNinety percent of fellowship program directors as well as 70% (42/60) of fellows responded to the survey. A formal POCUS curriculum exists in five of the nine PEM programs included in this study. Three programs offer specific pediatric POCUS training. The main application is the FAST (focused assessment with sonography for trauma) exam.ConclusionThere is a wide variation in POCUS content and delivery across PEM fellowship programs, as well as differences in perceptions of current training and of needs by fellows and program directors. However, given that both groups feel POCUS is very important and essential for PEM training, the opportunity exists to develop a standardized curriculum across Canada.
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Phuong, Melissa S. Phuong, Valera Castanov, Claudia Turco, et al. "Fall 2022: Clinician Investigator Trainee Association of Canada (CITAC)." Clinical and Investigative Medicine 45, no. 3 (2022): E1–2. http://dx.doi.org/10.25011/cim.v45i3.39272.
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On behalf of the Clinical Investigator Trainee Association of Canada (CITAC) Board of Directors, I would like to extend an enthusiastic welcome to our new MD+ trainee members! I hope you soaked up all that summer had to offer and are in good back-to-school spirits. A new academic year is upon us, and opportunities abound for the Canadian physician scientist trainee community.
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Khan, Khurram J., and Mark A. Levstik. "Ranking in Canadian Gastroenterology Residency Match: What Do Residents and Program Directors Want?" Canadian Journal of Gastroenterology 24, no. 6 (2010): 369–72. http://dx.doi.org/10.1155/2010/537435.
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BACKGROUND: Matching to a gastroenterology (GI) fellowship position in Canada is increasingly competitive.OBJECTIVE: To identify factors that determine how residents rank programs across the country, and how program directors rank their applicants.METHODS: Using input from several current GI trainees and former program directors, two separate surveys were developed. An online survey was sent one month after the match to every resident matched to an adult GI program in the 2007 match. A separate online survey was simultaneously sent to all program directors of 14 accredited GI programs in Canada. Two subsequent cohorts (2008 and 2009) of matched residents were surveyed during the annual GI fellow endoscopy course at McMaster University (Hamilton, Ontario).RESULTS: The overall response rate was 64 of 91 (70%) for residents and 11 of 15 (73%) for program directors (one program had codirectors). Using a five-point Likert scale for rating the importance of various factors influencing their decision, residents from three years ranked the following factor as most important: suitable location for spouse/partner/family (median score = 5). The overall least important factor was an opportunity for pediatric elective (median score = 2). Using the same scale, program directors ranked the following factors as most important (median score = 5) in ranking residents to their program: the ability to get along with others, outstanding reference letters, exceptional curriculum vitae and applying to only one specialty.CONCLUSIONS: Several factors important for GI applicants and program directors were identified, as well as a few less-important factors. Based on these results, GI training programs can more effectively market their programs to applicants in the future, and residents applying to GI programs can strengthen their applications in the ever competitive match process.
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Nath, Avik, Krishan Yadav, and Jeffrey J. Perry. "Describing CCFP(EM) programs in Canada: A national survey of program directors." CJEM 21, no. 2 (2018): 274–82. http://dx.doi.org/10.1017/cem.2018.374.
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AbstractObjectivesEnhanced skills training in emergency medicine through the Canadian College of Family Physicians, CCFP(EM), has existed since the 1980s. Accreditation standards define what every program “must” and “should” have, yet little is known on what is currently done across Canada. Our objectives were to 1) describe major components of CCFP(EM) programs and 2) determine how curricular components are taught.MethodsAfter a rigorous development process (expert content development, cognitive reviews, and pilot testing), a survey questionnaire was administered to all 17 CCFP(EM) program directors using a modified Dillman technique.ResultsAll (17/17) program directors responded. Programs are similar in core clinical rotations conducted and provide ultrasound courses for basic skills (trauma, abdominal aortic aneurysm, intrauterine pregnancy). Variation exists for offering independent ultrasound certification (77%), advanced scanning (18%), and protected time for scanning (53%). All programs utilize high fidelity simulation. Some programs use in situ simulation (18%) and carry out a simulation boot camp (41%). Most centres require an academic project, which is a quality assurance project (53%) and/or a critical appraisal of the literature (59%). Publication or national conference presentations are required by 12% of programs. Competency-based curricula include simulation for rare procedures (88%), direct observations (65%), and a “transition to practice” curriculum (24%). All programs maintain strong connections to family medicine.ConclusionThis study demonstrates the diverse structures of CCFP(EM) programs across Canada. Programs have similar clinical rotations, ultrasound, and simulation requirements. Variation exists in administrative structure and financial resources of programs, academic project requirements, and programs’ competency-based curricula.
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Ahmed, Rami A., Jennifer Frey, Aimee K. Gardner, James A. Gordon, Rachel Yudkowsky, and Ara Tekian. "Characteristics and Core Curricular Elements of Medical Simulation Fellowships in North America." Journal of Graduate Medical Education 8, no. 2 (2016): 252–55. http://dx.doi.org/10.4300/jgme-d-15-00276.1.
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ABSTRACT In the past few years, there has been rapid growth in the number of simulation fellowships for physicians in the United States and Canada, with the objective of producing faculty with expertise and leadership training in medical simulation. Relatively little is known about the collective content and structure of these new fellowship opportunities.Background We sought to identify a common set of core curricular elements among existing simulation fellowships and to obtain demographic background information on participants and leadership.Objective We designed a web-based survey and circulated it to simulation fellowship directors in the United States and Canada. The questions explored aspects of the fellowship curriculum. A grounded theory approach was used to qualitatively analyze fellowship goals and objectives.Methods Of the 29 program directors surveyed, 23 responded (79%). The most commonly listed goals and objectives were to increase skills in simulation curriculum development, simulation operations and training environment setup, research, educational theory, administration, and debriefing. The majority of the responding fellowship directors (17 of 22, 77%) indicated that a set of consensus national guidelines would benefit their fellowship program.Results Simulation fellowships are experiencing a period of rapid growth. Development of a common set of program guidelines is a widely shared objective among fellowship directors.Conclusions
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Jones, Andrea A., Enoch Ng, Marc-Olivier Deguise, et al. "MD/PhD Training in Canada: Results from a national trainee and program director review." Clinical & Investigative Medicine 39, no. 4 (2016): 132. http://dx.doi.org/10.25011/cim.v39i4.27092.
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Purpose: There has been limited examination of clinician scientist training in Canada, particularly regarding training integration and funding. This study assessed program structure, funding, tuition and mentorship structures available at Canadian MD/PhD programs. 
 
 Methods: Clinician Investigator Trainee Association of Canada administered an anonymous survey to current trainees and program directors that captured program structure, trainee funding, tuition and mentorship opportunities and needs across institutions. 
 
 Results: In June 2015, 101/228 (44%) trainees and 9/13 (69%) program directors completed the online survey. In all programs, students completed the PhD degree prior to clerkship training. Seven programs offered research training upon completion of pre-clerkship, four offered concurrent clinical and research training, and three offered alternative structures. Nine held seminars exposing students to clinical and research integration and two offered clinician scientist skills courses. Stipend funding and tuition varied, especially during clinical training years. Regarding mentorship, all programs held regular meetings, though eight programs do not have formal mentorship opportunities. Both trainees and program directors identified the need for further career planning and development support as a student priority.
 
 Conclusion: MD/PhD programs varied by program structure, funding, tuition and mentorship opportunities. Mechanisms to share and spread program innovations should be instated. Students may benefit from concurrent research and clinical training as well as courses specific to clinician scientist skill development. Decreasing debt burden may attract and retain trainees in this demanding path. To ensure mentorship programs align with trainee priorities, program directors should directly collaborate with students in their development and evaluation.
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Reidel, Kristen, Shelagh Abriel, Rachel Tavares, Mollie Roark, Ruth McLellan, and Eva Kehayia. "Transitional Employment Programs within Clubhouses as a Means of Promoting Recovery for Individuals Living with Mental Illness: Reviewing the Case for Québec." Canadian Journal of Community Mental Health 40, no. 1 (2021): 1–34. http://dx.doi.org/10.7870/cjcmh-2021-001.
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Transitional employment (TE) within the Clubhouse model has been adopted across Canada and the world for its effectiveness in promoting work and recovery for persons living with mental illness. However, attempts to establish a TE program in the province of Québec have been met with numerous roadblocks. Using a qualitative phenomenological approach, this study aimed to synthesize knowledge that could inform local implementation of TE. Experiences of Montréal Clubhouse members and Canadian Clubhouse directors were examined. Member narratives identified employment-program and systemic shortcomings, while directors provided key strategies for overcoming barriers to TE implementation.
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Demers, Robert. "Achat et rachat d'actions en vertu de la Loi régissant les sociétés commerciales canadiennes." Articles 22, no. 1 (2005): 55–79. http://dx.doi.org/10.7202/042423ar.
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The power to purchase its own shares by a corporation constitutes the most remarkable innovation in recent company legislations throughout Canada. This article deals primarily with the power to acquire shares under the Canada Business Corporations Act and the exercise of this power, subject to various conditions relating to the corporation's solvency and directors' duties. In a wider perspective, the rights of creditors of the corporation are analysed and the clear transition from a concept of the corporate capital as a trust fund for creditors to a concept of capital as a practical planning device emerges from the analysis.
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MacDonald, Shannon L., and Lawrence R. Robinson. "Academic Physical Medicine and Rehabilitation Acute Care Consultations." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, no. 4 (2018): 470–73. http://dx.doi.org/10.1017/cjn.2018.18.
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AbstractThe objective of this study was to describe the provision of Physical Medicine and Rehabilitation acute care consultations in the United States and Canada. Physical Medicine and Rehabilitation department chairs/division directors at academic centers in Canada and the United States were mailed an 18-item questionnaire. Seven of 13 (54%) Canadian and 26/78 (33%) American surveys were returned. A majority of Canadian and American academic institutions provide acute care consultations; however, there were some national differences. American institutions see larger volumes of patients, and more American respondents indicated using a dedicated acute care consultation service model compared with Canadians.
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Levesque, Mario. "Characteristics of Disability Leaders: An Atlantic Canada Profile." Canadian Journal of Disability Studies 9, no. 1 (2020): 143–80. http://dx.doi.org/10.15353/cjds.v9i1.599.
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 Leadership in the nonprofit sector including the disability sector has changed with the growth of the neoliberal state with governments downloading their social policy implementation role to civil society actors. The competitive climate disability nonprofits now find themselves in calls into question the leadership and skills required of their leaders. Based on 58 semi-structured interviews, this article develops a profile of Atlantic Canadian disability organization leaders— executive directors and government disability program managers. It argues that existing leadership models insufficiently capture their operating logic and finds disability leaders increasingly transformed into a new entrepreneurial role, which challenges service provision for persons with disabilities.
 
 
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Buckstein, Rena, Richard A. Wells, Nancy Y. Zhu, et al. "Quality of Life Scores Improve with Increasing Hemoglobin but Optimal Thresholds Vary According to Transfusion Dependence and Clinical Risk Scores: A Canadian Cross Sectional Study of 689 Patients with 2969 Measurements." Blood 128, no. 22 (2016): 3192. http://dx.doi.org/10.1182/blood.v128.22.3192.3192.
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Abstract Background : We previously presented that selected quality of life (QOL) domains in MDS patients are impaired compared with age-matched controls and most impacted by hemoglobin (Hgb) level, transfusion dependence, frailty and comorbidity in an initial cohort of 236 patients from a Canadian MDS registry (Buckstein R. et al, Abstract 699, ASH 2012 and Abstract 2500, ASH 2009). The optimal Hgb threshold associated with improved QOL may vary according to health states that may fluctuate for any given patient. With longer follow up and greater sample size, we now examine the impact of Hgb levels on QOL in transfusion dependent (TD) versus independent (TI) patients and according to IPSS-R risk scores. Methods:Since 2008, we have prospectively assessed QOL in all patients registered in the Canadian national MDS registry using the instruments EORTC QLQ-C30, FACT-F, global fatigue scale (GFS) and EQ-5D, at enrollment and every 4-6 months. These QOL data are paired with disease specific and laboratory information at the same time intervals. Each patient could provide multiple QOL measurements at different time points. Clinically significant score differences were considered 10 points for the EORTC, 0.08 for the EQ-5D and 4 for the FACT F. General linear regression analysis was applied to search for a significant relationship between physical and social functioning, dyspnea, fatigue and QOL with Hgb, according to transfusion dependence, IPSS and IPSS-R measured categorically. To account for multiple comparisons among 5 Hgb categories, Bonferroni adjusted p-value < .01 was considered statistically significant. Results: 689 patients from 15 Canadian sites completed their first QOL assessment at a median time of 7.8 (IQR 2.7-23) months from MDS diagnosis. The median time from MDS diagnosis to death or last follow-up was 2.5 years (IQR 1.2-4.9). The median Hgb at enrollment was 100 g/L (IQR 86-113) and the distribution of risk scores included: very low (13%); low (35%); intermediate (28%); high (15%); and very high (10%). 27% of patients were TD at enrollment and 54% were TD at any time. The median number of QOL assessments per patient completed was 3 (IQR 2-6) with 547 patients completing at least 2, 424 at least 3 and 335 at least 4 serial QOL measurements at a median time interval of 17 weeks (IQR 13-25). When examined by Hgb thresholds, mean physical functioning, dyspnea, fatigue (QLQ-C30 and GFS) and global QOL improved with increasing Hgb. QOL symptom and function scores were clinically and statistically significantly superior in TI versus TD patients (table 1). The optimal discriminating Hgb threshold for improved symptom and function scores was 100 g/L for patients that were TI or with IPSS-R very low, low and intermediate risk MDS; and 90 g/L for high and very high risk disease (table 2). No discriminating threshold was found in TD patients. Conclusions: In the largest reported serial cross sectional population based assessment of QOL in MDS patients, we confirm that higher Hgb and transfusion independence have significant impact on QOL, symptoms and self-reported function and should be considered important surrogate endpoints for clinical improvement. Disclosures Buckstein: Novartis: Honoraria; Celgene: Honoraria, Research Funding. Wells:Janssen: Honoraria, Other: Advisory Board; Celgene: Honoraria, Other: advisory board; Novartis: Honoraria, Other: advisory board; Alexion: Honoraria, Other: Advisory board. Zhu:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Geddes:Celgene: Other: Advisory Board, Research Funding. Sabloff:Gilead: Research Funding; Novartis Canada: Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Lundbeck: Research Funding. Leber:BMS Canada: Honoraria, Research Funding, Speakers Bureau; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Keating:Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees. Storring:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Yee:Novartis Canada: Membership on an entity's Board of Directors or advisory committees, Research Funding. Leitch: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; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. St-Hilaire:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Canada: Membership on an entity's Board of Directors or advisory committees. Nevill:Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Shamy:Celgene: Honoraria, Other: Advisory board; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Kumar:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees. Delage:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Morzycki, Alexander, Martin LeBlanc, and Jason Williams. "Undergraduate Plastic Surgery Education: A National Survey of Clerkship Directors." Plastic Surgery 26, no. 2 (2017): 104–9. http://dx.doi.org/10.1177/2292550317740687.
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Background: The delivery of medical education has received increased attention in recent years due to ongoing time and financial constraints faced by medical educators. Given the recent calls to action by the Carnegie Foundation and Health Canada, an evaluation of the specialty education sector is warranted. To our knowledge, this is the first assessment of the Canadian plastic surgery undergraduate clerkship curriculum. Method: An anonymous electronic survey was distributed to the plastic surgery clerkship directors of all Canadian medical schools (N = 17). The survey consisted of Likert scales and open-ended short answer questions. Themes included general clerkship information, exposure characteristics, teaching characteristics, resource characteristics, and challenges and barriers faced by clerkship directors. Results: Survey response rate was 88%. All responding schools offered a clerkship rotation of varying length in time (1-4 weeks). Students had the most exposure to breast surgery (100%) and general plastic surgery (100%) and the least exposure to aesthetic surgery (40%). Sixty percent of schools indicated the use of modern educational methods. Resources available for teaching students varied. Rotations received excellent feedback from medical students (67%). More than half of respondents would like to see a universal, nationally formulated plastic surgery clerkship curriculum. Conclusion: There is significant heterogeneity in the delivery of plastic surgery clerkship in Canada. A number of areas for improvement have been identified. We hope to establish a national plastic surgery clerkship task force to address the concerns raised here and improve the delivery of undergraduate medical education. Assessment of students based on a national curriculum may help in decision-making regarding plastic surgery program admissions by introducing an element of standardization to clerkship exposure.
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Gray, Wayne D. "Personal Tax Planning: Due Diligence Defence to Liability for Unpaid Statutory Remittances." Canadian Tax Journal/Revue fiscale canadienne 68, no. 1 (2020): 281–312. http://dx.doi.org/10.32721/ctj.2020.68.1.ptp.
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Several potentially onerous liabilities may be imposed on directors outside the provisions of the statute under which their corporation is incorporated or continued. In particular, some of the most common sources of personal liability for directors arise under statutes requiring the corporation to pay employee payroll source deductions (income tax, Canada Pension Plan contributions, and employment insurance premiums), withholding taxes owing by non-residents of Canada, and net goods and services tax and harmonized sales tax remittances. These statutory regimes all have certain features in common, including a statutory due diligence defence. This article examines the state of the law under the objective standard of care first adopted in the tax context by the Federal Court of Appeal in <i>Buckingham</i>. In particular, it examines the principles that guide jurisprudence on the due diligence defence, the factual circumstances that have met with success or failure for appellants, and how the defences apply differently depending on whether a director is an inside or outside director.
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Daneman, Nick, Damon C. Scales, Bernard Lawless, John Muscedere, Vanessa Blount, and Robert A. Fowler. "Infection Prevention and Control in the Intensive Care Unit: Open versus Closed Models of Care." Infection Control & Hospital Epidemiology 34, no. 8 (2013): 867–71. http://dx.doi.org/10.1086/671275.
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In the intensive care unit (ICU), our sickest patients receive our most invasive treatments and are therefore highly vulnerable to hospital-acquired infection. Up to one-third of ICU patients develop infectious complications of care, with associated increases in morbidity, mortality, and healthcare costs. Earlier research has indicated substantial heterogeneity in uptake of infection prevention best practices in North American hospitals, and this variability may also exist in ICUs. We hypothesized that ICU system-level characteristics, including closed model of care, academic affiliation, and availability of a dedicated infection control practitioner (ICP), may be associated with improved infection prevention practices.During July 2011, we conducted a province-wide survey of nurse directors in ICUs across Ontario, Canada (population, 12 million). We developed a 77-item questionnaire to broadly capture ICU structures and processes relevant to infection prevention. The questionnaire was developed (item generation and reduction) by the authors and was further improved through pilot and sensibility testing by 3 ICU nurse directors and 2 ICPs. It was then distributed via e-mail by the Ontario Ministry of Health and Long-Term Care Critical Care Secretariat to nurse directors of all ICUs. A second email was sent to nonrespondents 2 weeks later. Approval was granted by the research ethics board at Sunnybrook Health Sciences Centre in Toronto, Canada.
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Fulcher, Jill, Zahra Abdrabalamir Alshammasi, Nathan Cantor, et al. "Acute Myeloid Leukemia (AML) Treated with Azacitidine: Survival Outcomes for Patients Who Complete More Than Six Cycles Are Similar to High-Risk Myelodysplastic Syndrome/Low Blast Count AML." Blood 134, Supplement_1 (2019): 5156. http://dx.doi.org/10.1182/blood-2019-122122.
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INTRODUCTION: Despite accumulating evidence supporting the efficacy of hypomethylating agents in patients with AML and > 30% bone marrow blasts as well as in relapsed/refractory AML, this therapy is not yet funded by National Health Plans / Healthcare Funding Agencies in a number of countries including Canada. The assistance of an industry-sponsored compassionate program has enabled provision of azacitidine for this group of patients at The Ottawa Hospital. We report here our local "real-world" experience of azacitidine efficacy in this diverse group of AML patients and identify a sub-group whose outcomes are equivalent to that of patients with higher-risk Myelodysplastic Syndrome (MDS) and AML with 20-30% blasts for whom azacitidine therapy has funding approval in Canada. METHODS: All patients who received azacitidine at The Ottawa Hospital between 2009 and 2016 were included in this single-center, retrospective analysis. Azacitidine was administered at a dose of 75mg/m2 subcutaneously daily for 7 consecutive days every 28 days. Response was evaluated with a repeat bone marrow aspirate and trephine biopsy after the 6th cycle. In those patients confirmed to have stable or responsive disease, azacitidine was continued until progression of disease, intolerable side-effects of the drug or the patient chose to discontinue therapy. Overall survival curves were generated using the Kaplan-Meier method and log-rank tests were used to compare subgroups of patients. Actuarial median survival months were calculated with 95% confidence intervals (CI). P-values less than 0.05 were considered statistically significant. RESULTS: During the study period, 109 patients received azacitidine: 54 had MDS /AML with 20-30% blasts (the 'funded' group) and 55 had either AML with > 30 % blasts (n=23), AML relapsed post-intensive chemotherapy (n=14), AML relapsed post-allogeneic stem cell transplant (n=10) or primary refractory AML (n=8) (the 'unfunded' group). Median survival of the 'funded' group was 12.2 months while median survival of the 'unfunded' group was 5.6 months (95% CI 3.3-7.7; p=0.0058). Of the AML patients in the 'unfunded' group, 24% completed more than 6 cycles of azacitidine compared to 52% of patients in the 'funded' group. In both the 'funded' and 'unfunded' groups, patients who completed more than 6 cycles of azacitidine had similar survival outcomes (p=0.7277): the 'funded' group had a median survival of 19 months (95% CI 14.4-25.3) while the median survival of this sub-population of the 'unfunded' AML group was 22 months (95% CI 11.7-24.9). Patients in both groups who failed to complete more than 6 cycles of azacitidine also had a similar outcome (p=0.39), with a median survival of 5.7 months (95% CI 4.0-6.3) for patients with MDS/AML 20-30% blasts and 3.6 months (95% CI 2.2-5.1) for AML patients with > 30% blasts or relapsed/refractory disease. Reasons for patients not completing at least 6 cycles of azacitidine included progression of disease (25%), bacterial infections most commonly pneumonia (53%) and patient preference (7%). CONCLUSION: A significant sub-population of AML patients with > 30% blasts or refractory/relapsed AML can achieve a meaningful survival benefit with the hypomethylating agent, azacitidine. A higher proportion of this AML patient population discontinued azacitidine as a result of infective complications. The provision of routine prophylactic antibiotics may enable more patients with AML to receive an adequate amount of azacitidine to achieve therapeutic benefit and warrants further investigation. Our results add to the growing body of 'real-world' evidence that supports healthcare funding agencies to provide coverage of azacitidine for patients with AML who in some countries at present do not fulfill government funding criteria. Disclosures Bredeson: Otsuka: Research Funding. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Sabloff:Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; ASTX: Membership on an entity's Board of Directors or advisory committees, Research Funding; Actinium Pharmaceuticals, Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas Pharma Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi Canada: Research Funding.
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Pike, Meghan, Ashley Chopek, Nancy Young, et al. "Validation Study of the Heavy Menstrual Bleeding Questionnaire in Adolescents." Blood 136, Supplement 1 (2020): 45. http://dx.doi.org/10.1182/blood-2020-134545.
Full textAbstract:
Introduction Heavy menstrual bleeding (HMB) is a common problem among adolescent girls that affects many aspects of their lives. Estimating the effect of HMB on health-related quality of life (HRQoL) is important but challenging, as there is no instrument that measures menstrual bleeding-specific HRQoL for girls ages &lt; 18 years. Aim To develop and assess the psychometric properties of a menstrual bleeding-specific HRQoL tool adapted for use by girls with HMB aged &lt; 18 years. Methods HMB was defined using a pictorial bleeding assessment chart (PBAC) score &gt;100 and/or hemoglobin &gt;2 SD below age appropriate means. Phase 1 utilized a focus group of girls with HMB to review items of the Menstrual Bleeding Questionnaire (MBQ), validated for use in women ages ≥ 18 years, to generate new items and develop the Adolescent MBQ (aMBQ). In phase 2, participants were divided in two groups: those with and those without HMB. Each participant completed 3 questionnaires (aMBQ, Pediatric Quality of Life core module [PedsQL] and PBAC) at 2 time points. Validity of the aMBQ was measured by Spearman's correlation with the PedsQL. Reliability was calculated using an intra-class correlation (ICC) random effect model in those without HMB who repeated the 3 questionnaires within 30-60 days from baseline. Receiver Operating Characteristic (ROC) curve analysis assessed the ability of the aMBQ to distinguish between participants with and without HMB. Ethics approval and informed consent were obtained prior to participation. Results Phase 1 included 5 girls with previously diagnosed HMB. The MBQ was revised to be appropriate for adolescents by substituting 4 words/phrases that altered 8 of 20 questions (Table 1). With the addition of one new question, a 21-item aMBQ was developed with a score range of 0-77, with 77 representing the worst HRQoL. Phase 2 included 73 participants: 19 with HMB and 56 without HMB. Mean age of participants was 14.7 years (range 11-17 years). The validity of the aMBQ was confirmed by a moderate correlation with PedsQL (rho=-0.61). Test-retest reliability was substantial (ICC=0.71, p=0.03). An aMBQ score of &gt;30 identified those with HMB with excellent discrimination (AUC=0.826, sensitivity 71.4%, specificity 88.0%). Conclusion The aMBQ is a valid and reliable measurement tool to assess HRQoL in adolescents with HMB that is easily implemented in the office setting. Furthermore, it may assist clinicians in identifying those with HMB and aid in the evaluation of treatment effectiveness both in clinical practice and research. Disclosures Belletrutti: Takeda Canada: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk Canada: Membership on an entity's Board of Directors or advisory committees; Bayer Canada: Membership on an entity's Board of Directors or advisory committees; Roche Canada: Consultancy, Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees. Matteson:ABOG: Honoraria, Other: Received stipend for being an oral boards examiner.; Myovant: Membership on an entity's Board of Directors or advisory committees; Bayer Ensure: Other: Co-Investigator for longitudinal research study and clinical trial. All funds go to site of research, Research Funding.