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Strasser, Roger, John Hogenbirk, Kristen Jacklin, Marion Maar, Geoff Hudson, Wayne Warry, Hoi Cheu, Tim Dubé, and Dean Carson. "Community engagement: A central feature of NOSM’s socially accountable distributed medical education." Canadian Medical Education Journal 9, no. 1 (March 28, 2018): e33-43. http://dx.doi.org/10.36834/cmej.42151.
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Background: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM’s distinctive model, Distributed Community Engaged Learning (DCEL).Methods: Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies.Results: Community engagement contributes throughout the lifecycle stages of preadmission, admission, and undergraduate medical education. High school students from 70 Northern Ontario communities participate in NOSM’s week-long Health Sciences Summer Camps. The MD admissions process involves approximately 128 volunteers assessing written applications and over 100 volunteer interviewers. Thirty-six Indigenous communities host first year students and third-year students learn their core clinical medicine in 15 communities, throughout Northern Ontario. In general, learners and communities report net benefits from participation in NOSM programs.Conclusion: Community engagement makes a key contribution to the success of NOSM’s socially accountable distributed medical education.
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Evelyn, Encalada Grez. "Evelyn Encalada Grez in Conversation with Marlea Clarke." Migration, Mobility, & Displacement 2, no. 2 (October 3, 2016): 76. http://dx.doi.org/10.18357/mmd22201616156.
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Evelyn is a community organiser and a PhD candidate at OISE of the University of Toronto. Her dissertation focuses on migrant work across rural Ontario and Rural Mexico. Born in Chile, raised in Canada, Evelyn has worked in El Salvador, Nicaragua, Guatemala and Honduras with the Central American Network in Solidarity with Women Maquila Workers and with the Workers Support Centre in Puebla, Mexico. Evelyn is a founding member of Justice for Migrant Workers, a political collective that has fought for the rights of migrant farm workers in Canada since 2001
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Hohenadel, K., E. Pichora, L. Marrett, D. Bukvic, J. Brown, SA Harris, PA Demers, and A. Blair. "Priority issues in occupational cancer research: Ontario stakeholder perspectives." Chronic Diseases and Injuries in Canada 31, no. 4 (September 2011): 147–51. http://dx.doi.org/10.24095/hpcdp.31.4.02.
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Introduction Workers are potentially exposed to known and suspected carcinogens in the workplace, many of which have not been fully evaluated. Despite persistent need, research on occupational cancer appears to have declined in recent decades. The formation of the Occupational Cancer Research Centre (OCRC) is an effort to counter this downward trend in Ontario. The OCRC conducted a survey of the broad stakeholder community to learn about priority issues on occupational cancer research. Methods The OCRC received 177 responses to its survey from academic, health care, policy, industry, and labour-affiliated stakeholders. Responses were analyzed based on workplace exposures, at-risk occupations and cancers by organ system, stratified by respondents’ occupational role. Results Priority issues identified included workplace exposures such as chemicals, respirable dusts and fibres (e.g. asbestos), radiation (e.g. electromagnetic fields), pesticides, and shift work; and occupations such as miners, construction workers, and health care workers. Insufficient funding and a lack of exposure data were identified as the central barriers to conducting occupational cancer research. Discussion The results of this survey underscore the great need for occupational cancer research in Ontario and beyond. They will be very useful as the OCRC develops its research agenda.
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Beavon, Roy V. "The role of gravity and magma in the structural evolution of a deformed Archean volcanic centre, Timmins, Ontario, Canada." Canadian Journal of Earth Sciences 34, no. 5 (May 1, 1997): 655–66. http://dx.doi.org/10.1139/e17-052.
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A deformed bimodal subaqueous volcanic centre in the western Archean Abitibi Subprovince of the Canadian Shield contains structures comparable with those of relatively undisturbed igneous complexes. Similarities include an annular fold pattern initiated by structural doming and downsagging of basaltic flows prior to the terminal felsic volcanism. During this cycle an ancestral dome was ruptured by a northeasterly regional graben defined by fossil fault scarps preserved beneath the terminal volcanic deposits. Fissure vents developed along the northwest boundary of the graben, gradually drained the underlying magma chamber, and transformed the crest of the dome into a central collapse basin surrounded by an annular anticlinal uplift marking the inner periphery of the former dome. Basalts on the basinward side of the fissure vents became detached along interflow argillites and glided into the central collapse, forming secondary gravity folds within the uppermost basalts. Subaqueous deposition of felsic debris occurred in the graben and subsiding collapse basin, succeeded by postvolcanic turbidites. The annular folds were modified by two phases of regional deformation, separated by an episode of Archean molasse sedimentation along the reactivated south boundary of the paleograben.
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Carmichael, Charles M., John S. Mothersill, and William A. Morris. "Paleomagnetic and pollen chronostratigraphic correlations of the late glacial and postglacial sediments in Lake Ontario." Canadian Journal of Earth Sciences 27, no. 1 (January 1, 1990): 131–47. http://dx.doi.org/10.1139/e90-011.
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Lake Ontario is divided by two ridges of glacial till into three basins — Niagara, Mississauga, and Rochester in the western, central, and eastern parts, respectively, of the lake. Piston and benthos cores were taken by the Canada Centre for Inland Waters from each of the three basins from the research ship CSS Lymnos. The lithology, mineralogy, pollen content, and magnetic parameters of the sediment in these cores have been studied as a means of chronostratigraphic correlation. The transition from late glacial to postglacial sediment is inferred to take place where there is a marked increase in the numbers of pollen in the cores. Further chronostratigraphic correlation between cores has been based mainly on simultaneous matching of the magnetic parameters of declination, inclination, intensity, and ratio of natural remanent magnetization (NRM) to anhysteretic remanent magnetization (ARM). Type curves of declination, inclination, and NRM/ARM for Lake Ontario have been produced.
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Villedieu, Yannick, and Kees van Frankenhuyzen. "Epizootic occurrence of Entomophaga maimaiga at the leading edge of an expanding population of the gypsy moth (Lepidoptera: Lymantriidae) in north-central Ontario." Canadian Entomologist 136, no. 6 (December 2004): 875–78. http://dx.doi.org/10.4039/n04-002.
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Ever since its entry from New York State in the late 1960s, the gypsy moth, Lymantria dispar (L.) (Lepidoptera: Lymantriidae), has continued to expand its distribution in Ontario to the north and west (Nealis and Erb 1993). Outbreaks were recorded for the first time in the Sudbury – North Bay region in the early 1990s, by which time there was evidence of resident populations extending along the north shore of Lake Huron as far west as Lake Superior. The population expansion along the north shore is characterized by a patchy occurrence of small outbreaks, which typically last for a few years and then disappear (Annual Forest Health Reports, Great Lakes Forestry Centre, http://www.glfc.cfs.nrcan.gc.ca/foresthealth/index_e.html). Nealis et al. (1999) found that winter weather, parasitoids, and the gypsy-moth-specific fungal pathogen Entomophaga maimaiga Humber, Shimazu et Soper (Zygomycetes: Entomophthorales) were the most prominent sources of mortality in those transient outbreaks.
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Notaro, Michael, Azar Zarrin, Steve Vavrus, and Val Bennington. "Simulation of Heavy Lake-Effect Snowstorms across the Great Lakes Basin by RegCM4: Synoptic Climatology and Variability*,+." Monthly Weather Review 141, no. 6 (June 1, 2013): 1990–2014. http://dx.doi.org/10.1175/mwr-d-11-00369.1.
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Abstract A historical simulation (1976–2002) of the Abdus Salam International Centre for Theoretical Physics Regional Climate Model, version 4 (ICTP RegCM4), coupled to a one-dimensional lake model, is validated against observed lake ice cover and snowfall across the Great Lakes Basin. The model reproduces the broad temporal and spatial features of both variables in terms of spatial distribution, seasonal cycle, and interannual variability, including climatological characteristics of lake-effect snowfall, although the simulated ice cover is overly extensive largely due to the absence of lake circulations. A definition is introduced for identifying heavy lake-effect snowstorms in regional climate model output for all grid cells in the Great Lakes Basin, using criteria based on location, wind direction, lake ice cover, and snowfall. Simulated heavy lake-effect snowstorms occur most frequently downwind of the Great Lakes, particularly to the east of Lake Ontario and to the east and south of Lake Superior, and are most frequent in December–January. The mechanism for these events is attributed to an anticyclone over the central United States and related cold-air outbreak for areas downwind of Lakes Ontario and Erie, in contrast to a nearby cyclone over the Great Lakes Basin and associated cold front for areas downwind of Lakes Superior, Huron, and Michigan.
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Jones, Norman L., and Paul M. O’Byrne. "Respiratory Medicine at McMaster University, Hamilton, Ontario: 1968 to 2013." Canadian Respiratory Journal 21, no. 6 (2014): 325. http://dx.doi.org/10.1155/2014/860834.
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The medical school at McMaster University (Hamilton, Ontario) was conceived in 1965, and admitted the first class in 1969. John Evans became the founding Dean and he invited EJ Moran Campbell to be the first Chairman of the Department of Medicine. Moran Campbell, already a world figure in respiratory medicine and physiology, arrived at McMaster in September 1968, and he invited Norman Jones to be Coordinator of the Respiratory Programme.At that time, Hamilton had a population of 300,000, with two full-time respirologists, Robert Cornett at the Hamilton General Hospital and Michael Newhouse at St Joseph’s Hospital. From the clinical perspective, the aim of the Respiratory Programme was to develop a network approach to clinical problems among the five hospitals in the Hamilton region, with St Joseph’s Hospital serving as a regional referral centre, and each hospital developing its own focus: intensive care and burns units at the Hamilton General Hospital; cancer at the Henderson (later Juravinski) Hospital; tuberculosis and rehabilitation at the Chedoke Hospital; pediatrics and neonatal intensive care at the McMaster University Medical Centre; and community care at the Joseph Brant Hospital in Burlington. The network provided an ideal base for a specialty residency program. There was also the need to establish viable research.These objectives were achieved through collaboration, support of hospital administration, and recruitment of clinicians and faculty, mainly from our own trainees and research fellows. By the mid-1970s, the respiratory group numbered more than 25; outpatient clinic visits and research had grown beyond our initial expectations. The international impact of the group became reflected in the clinical and basic research endeavours.ASTHMA: Freddy Hargreave and Jerry Dolovich established methods to measure airway responsiveness to histamine and methacholine. Allergen inhalation was shown to increase airway responsiveness for several weeks, and the late response was shown to be an immunoglobulin E-mediated phenomenon. Paul O’Byrne and Gail Gauvreau showed that the prolonged allergen-induced responses were due to eosinophilic and basophilic airway inflammation and, with Judah Denburg, revealed upregulation of eosinophil/basophil progenitor production in bone marrow and airways. The Firestone Institute became the centre of studies identifying the inflammatory phenotype of patients with difficult-to-control asthma. Freddy Hargreave and others developed methods for sputum induction to identify persisting eosinophilic airway inflammation and documented its presence in the absence of asthma, and in patients with persistent cough. Parameswaran Nair has applied these techniques to the management of asthma in routine clinical practice. The Asthma Quality of Life Questionnaire and the Asthma Control Tests were developed by Liz Juniper and Gordon Guyatt. The first Canadian evidence-based clinical guidelines for asthma management in 1989 were coordinated by Freddy Hargreave, Jerry Dolovich and Michael Newhouse.DISTRIBUTION OF INHALED PARTICLES: Michael Newhouse and Myrna Dolovich used inhaled radiolabelled aerosols to study the distribution of inhaled particles and their clearance in normal subjects, smokers and patients with chronic obstructive pulmonary disease. They developed the aerochamber, and were the first to radiolabel therapeutic aerosols to distinguish the effects of peripheral versus central deposition. Particle deposition and clearance were shown to be impaired in ciliary dyskinesia and cystic fibrosis.DYSPNEA: Moran Campbell and Kieran Killian measured psychophysical estimates of the sense of effort in breathing in studies of loaded breathing and exercise to show that dyspnea increased as a power function of both duration and intensity of respiratory muscle contraction, and in relation to reductions in respiratory muscle strength. These principles also applied to dyspnea in cardiorespiratory disorders.EXERCISE CAPACITY: Norman Jones and Moran Campbell developed a system for noninvasive cardiopulmonary exercise testing using an incremental exercise test, and more complex studies with measurement of mixed venousPCO2by rebreathing. The 6 min walk test was validated by Gordon Guyatt. Kieran Killian and Norman Jones introduced routine muscle strength measurements in clinical testing and symptom assessment in exercise testing. Muscle strength training improved exercise capacity in older subjects and patients with chronic obstructive pulmonary disease.METABOLISM AND ACID-BASE CONTROL IN EXERCISE: After showing that imposed acidosis reduced, and alkalosis improved performance, Norman Jones, John Sutton and George Heigenhauser investigated the interactions between acid-base status and metabolism in exercise.HIGH-ALTITUDE MEDICINE: John Sutton and Peter Powles participated in high-altitude research on Mount Logan (Yukon), demonstrating sleep hypoxemia in acute mountain sickness and its reversal by acetazolamide, and participated in Operation Everest II.EPIDEMIOLOGY: David Pengelly and Tony Kerrigan followed children living in areas with differing air quality to show that lung development was adversely affected by pollution and maternal smoking. Malcolm Sears and Neil Johnstone showed that the ‘return to school’ asthma exacerbation epidemic was due mainly to rhinoviruses. David Muir investigated the effects of silica exposure in hard-rock miners, and mortality in the nickel industry.SUMMARY: The Respirology Division has grown to more than 50 physicians and PhD scientists, currently provides the busiest outpatient clinic in Hamilton, and has successful training and research programs.
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Jones, Norman L., and Paul M. O’Byrne. "Respiratory Medicine at McMaster University, Hamilton, Ontario: 1968 To 2013." Canadian Respiratory Journal 21, no. 6 (2014): e68-e74. http://dx.doi.org/10.1155/2014/285162.
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The medical school at McMaster University (Hamilton, Ontario) was conceived in 1965 and admitted the first class in 1969. John Evans became the founding Dean and he invited Moran Campbell to be the first Chairman of the Department of Medicine. Moran Campbell, already a world figure in respiratory medicine and physiology, arrived at McMaster in September 1968, and he invited Norman Jones to be Coordinator of the Respiratory Programme.At that time, Hamilton had a population of 300,000, with two full-time respirologists, Robert Cornett at the Hamilton General Hospital and Michael Newhouse at St Joseph’s Hospital. From the clinical perspective, the aim of the Respiratory Programme was to develop a network approach to clinical problems among the five hospitals in the Hamilton region, with St Joseph’s Hospital serving as a regional referral centre, and each hospital developing its own focus: intensive care and burns units at the Hamilton General Hospital; cancer at the Henderson (later Juravinski) Hospital; tuberculosis and rehabilitation at the Chedoke Hospital; pediatrics and neonatal intensive care at the McMaster University Medical Centre; and community care at the Joseph Brant Hospital in Burlington (Ontario). The network provided an ideal base for a specialty residency program. There was also the need to establish viable research.These objectives were achieved through collaboration, support of hospital administration, and recruitment of clinicians and faculty, mainly from our own trainees and research fellows. By the mid-1970s the respiratory group numbered more than 25; outpatient clinic visits and research had grown beyond our initial expectations. The international impact of the group became reflected in the clinical and basic research endeavours.ASTHMA: Freddy Hargreave and Jerry Dolovich established methods to measure airway responsiveness to histamine and methacholine. Allergen inhalation was shown to increase airway responsiveness for several weeks, and the late response was shown to be an immunoglobulin E-mediated phenomenon. Paul O’Byrne and Gail Gauvreau showed that the prolonged allergen-induced responses were due to eosinophilic and basophilic airway inflammation and, with Judah Denburg, revealed upregulation of eosinophil/basophil progenitor production in bone marrow and airways. The Firestone Institute became the centre of studies identifying the inflammatory pheno-type of patients with difficult-to-control asthma. Freddy Hargreave and others developed methods for sputum induction to identify persisting eosinophilic airway inflammation and documented its presence in the absence of asthma and in patients with persistent cough. Parameswaran Nair has applied these techniques to the management of asthma in routine clinical practice. The Asthma Quality of Life Questionnaire and the Asthma Control Tests were developed by Drs Liz Juniper and Gordon Guyatt. The first Canadian evidence-based clinical guidelines for asthma management in 1989 were coordinated by Freddy Hargreave, Jerry Dolovich and Michael Newhouse.DISTRIBUTION OF INHALED PARTICLES: Michael Newhouse and Myrna Dolovich used inhaled radiolabelled aerosols to study the distribution of inhaled particles and their clearance in normal subjects, smokers and patients with chronic obstructive pulmonary disease. They developed the aerochamber, and were the first to radiolabel therapeutic aerosols to distinguish the effects of peripheral versus central deposition. Particle deposition and clearance were shown to be impaired in ciliary dyskinesia and cystic fibrosis.DYSPNEA: Moran Campbell and Kieran Killian measured psychophysical estimates of the sense of effort in breathing in studies of loaded breathing and exercise to show that dyspnea increased as a power function of both duration and intensity of respiratory muscle contraction, and in relation to reductions in respiratory muscle strength. These principles also applied to dyspnea in cardiorespiratory disorders.EXERCISE CAPACITY: Norman Jones and Moran Campbell developed a system for noninvasive cardiopulmonary exercise testing using an incremental exercise test, and more complex studies with measurement of mixed venousPCO2by rebreathing. The 6 min walk test was validated by Gordon Guyatt. Kieran Killian and Norman Jones introduced routine muscle strength measurements in clinical testing and symptom assessment in exercise testing. Muscle strength training improved exercise capacity in older subjects and patients with chronic obstructive pulmonary disease.METABOLISM AND ACID-BASE CONTROL IN EXERCISE: After showing that imposed acidosis reduced, and alkalosis improved performance, Norman Jones, John Sutton and George Heigenhauser investigated the interactions between acid-base status and metabolism in exercise.HIGH-ALTITUDE MEDICINE: John Sutton and Peter Powles participated in high-altitude research on Mount Logan (Yukon), demonstrating sleep hypoxemia in acute mountain sickness and its reversal by acetazol-amide, and participated in Operation Everest II.EPIDEMIOLOGY: David Pengelly and Tony Kerrigan followed children living in areas with differing air quality to show that lung development was adversely affected by pollution and maternal smoking. Malcolm Sears and Neil Johnstone showed that the ‘return to school’ asthma exacerbation epidemic was due mainly to rhinoviruses. David Muir investigated the effects of silica exposure in hard-rock miners, and mortality in the nickel industry.SUMMARY: The Respirology Division has grown to more than 50 physicians and PhD scientists, and currently provides the busiest outpatient clinic in Hamilton, and has successful training and research programs.
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Kourtz, Peter. "Two dynamic programming algorithms for forest fire resource dispatching." Canadian Journal of Forest Research 19, no. 1 (January 1, 1989): 106–12. http://dx.doi.org/10.1139/x89-014.
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The dispatch of water bombers and fire-fighting crews to newly reported fires is an important task carried out by modern regional forest fire management centres. The problem of bomber dispatch involves the use of aircraft of varying speeds, cost, and fire-fighting effectiveness. Candidate aircraft for dispatch can be situated at remote attack bases or at ongoing fires. The problem of crew dispatch also involves candidate crews situated at remote attack bases or at ongoing fires, but unlike bomber dispatch, helicopter transport must be arranged. A transport helicopter must be flown to the specific crew's location and then to the fire. A helicopter is permitted a second trip to pick up an additional crew. The bomber- and crew-dispatch problems have both been formulated as dynamic programming algorithms. The bomber formulation closely resembles the traditional "knapsack" formulation. The crew and helicopter dispatch problem involves a more general formulation. Both algorithms are illustrated by simple examples. FORTRAN programs have been written for both algorithms. These programs are embedded within a large expert system which defines the desired bomber force and number of crews to be dispatched to a specific fire. This system is presently being tested at the North Central Regional Fire Centre of the Ontario Ministry of Natural Resources, located at Thunder Bay. It is expected that this system will undergo several years of testing and modifications before it is considered operational. Recent trials at the Thunder Bay fire centre have demonstrated the potential of the expert system, including the two dynamic programming algorithms, by matching or exceeding the dispatching performance of the dispatchers.
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Mallory, E. C., M. S. Ridgway, A. M. Gordon, and N. K. Kaushik. "Distribution of woody debris in a small headwater lake, central Ontario, Canada." Fundamental and Applied Limnology 148, no. 4 (June 28, 2000): 587–606. http://dx.doi.org/10.1127/archiv-hydrobiol/148/2000/587.
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Ellis, Peter M., Anand Swaminath, and Gregory R. Pond. "Patterns of Relapse in Small Cell Lung Cancer: Competing Risks of Thoracic versus CNS Relapse." Current Oncology 28, no. 4 (July 20, 2021): 2778–88. http://dx.doi.org/10.3390/curroncol28040243.
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Introduction: Treatment algorithms for small cell lung cancer (SCLC) are determined largely by the Veterans Affairs Lung Cancer Staging Group (VALCSG) staging (limited (LS) versus extensive (ES) stage). Relapse occurs frequently; however, patterns of relapse, in particular the competing risk of thoracic and central nervous system relapse, are not well described. This study describes patterns of relapse in SCLC patients treated at a large tertiary institution in Ontario, Canada. Materials and Methods: A retrospective cohort of SCLC patients treated at the Juravinski Cancer Centre was reviewed. Data were abstracted from the medical record on demographic, disease, treatment and outcome variables. The primary outcome was a description of the patterns of relapse stratified by disease stage. Multivariate analysis was performed to identify prognostic variables for thoracic and CNS relapse. Results: Two hundred and twenty nine patients were treated during the study period (LS—83, ES—146). Relapse occurred in the majority of patients (isolated thoracic—28%, isolated CNS—9%, extrathoracic—9%, thoracic/extrathoracic—14%, systemic and CNS—13%). The median OS was consistent with published data (LS—21.8 months, ES—8.9 months). ES disease and elevated LDH were prognostic for increased thoracic relapse, whereas poor PS and older age were prognostic for lower central nervous system (CNS) relapse. Discussion: Thoracic relapse and CNS relapse represent competing risks for patients with SCLC. Decisions about incorporating thoracic or CNS radiation are complex. More research is needed to incorporate performance status and LDH into treatment algorithms.
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Brode, Sarah K., Robert Varadi, Jane McNamee, Nina Malek, Sharon Stewart, Frances B. Jamieson, and Monica Avendano. "Multidrug-Resistant Tuberculosis: Treatment and Outcomes of 93 Patients." Canadian Respiratory Journal 22, no. 2 (2015): 97–102. http://dx.doi.org/10.1155/2015/359301.
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BACKGROUND: Tuberculosis (TB) remains a leading cause of death worldwide and the emergence of multidrug-resistant TB (MDR TB) poses a threat to its control. There is scanty evidence regarding optimal management of MDR TB. The majority of Canadian cases of MDR TB are diagnosed in Ontario; most are managed by the Tuberculosis Service at West Park Healthcare Centre in Toronto. The authors reviewed 93 cases of MDR TB admitted from January 1, 2000 to December 31, 2011.RESULTS: Eighty-nine patients were foreign born. Fifty-six percent had a previous diagnosis of TB and most (70%) had only pulmonary involvement. Symptoms included productive cough, weight loss, fever and malaise. The average length of inpatient stay was 126 days. All patients had a peripherally inserted central catheter for the intensive treatment phase because medications were given intravenously. Treatment lasted for 24 months after bacteriologic conversion, and included a mean (± SD) of 5±1 drugs. A successful outcome at the end of treatment was observed in 84% of patients. Bacteriological conversion was achieved in 98% of patients with initial positive sputum cultures; conversion occurred by four months in 91%.CONCLUSIONS: MDR TB can be controlled with the available anti-TB drugs.
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Darani, Shaheen, Kiran Patel, Laura Hayos, Tanya Connors, Faisal Islam, Anika Saiva, and Sandy Simpson. "Education for corrections officers to better meet the mental health needs of inmates." BJPsych Open 7, S1 (June 2021): S132—S133. http://dx.doi.org/10.1192/bjo.2021.379.
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AimsIn Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Overrepresentation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with mental health struggles of inmates. Nonetheless, the training that officers receive is often considered inadequate. To address this gap, the goal of this study was to design, implement, and evaluate a mental health training for correctional officers at the Toronto South Detention Centre (TSDC) and Vanier Centre for Women (VCW) in Ontario, Canada.MethodA needs assessment was undertaken among officers at the TSDC. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and VCW (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.ResultThe results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviours related to inmate mental health struggles and interest in further training to support officers’ mental health.ConclusionThis study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health.
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Hirama, Takashi, Natasha Sabur, Peter Derkach, Jane McNamee, Howard Song, Theodore Marras, and Sarah Brode. "Facteurs de risque associés à la tuberculose pharmacorésistante dans un centre de référence situé à Toronto (Ontario) au Canada : 2010 à 2016." Relevé des maladies transmissibles au Canada 46, no. 04 (April 2, 2020): 95–103. http://dx.doi.org/10.14745/ccdr.v46i04a05f.
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Hicks, Alex, and Anne Hicks. "105 Actually, it is easy being green: Ten years of the Canadian PAediatric Society Annual General Meeting viewed through a sustainability lens." Paediatrics & Child Health 25, Supplement_2 (August 2020): e43-e44. http://dx.doi.org/10.1093/pch/pxaa068.104.
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Abstract Introduction/Background The Canadian Paediatric Society (CPS) recently released the “Global climate change and health of Canadian Children” statement. As climate rapidly evolves from “change” to “crisis” there is an increasing pressure toward sustainable conferencing. Knowing the value of attending meetings, the growing body of literature evaluating travel-related carbon cost and convention sustainability can inform environmental harm minimization. Conferences can pressure venues to increase sustainability by choosing sites and venues wisely and communicating their requirements to rejected venues. They can also offer carbon offset purchase through credible companies (e.g. Gold Standard). Over the last 10 years the CPS has conducted its Annual General Meeting (AGM) at host cities that reflect Canada’s large geographic footprint. Venues included both hotel and standalone conference centers. There is no published evaluation of sustainable practices for CPS meetings. Objectives Evaluate the past 10 CPS Annual General Meetings (AGMs) for: Design/Methods Travel-related carbon cost was estimated with a round-trip calculator for economy seating the most direct available flights (https://co2.myclimate.org/en/offset_further_emissions). Cities of origin for attendee were the 11 CaRMS-matched pediatric residency training programs (https://www.carms.ca/match/psm/program-descriptions/). Venues were evaluated based on current publicly available self-reported information using conference sustainability criteria suggested through a literature review and public rating tools (Green Key, Quality Standards of the International Association of Convention Centres). Ground transportation from the airport was scored /3 by: public transport from airport (1), formal shared transport (1), fee deterrence for parking (1). Venue type was split by hotel-associated (H) and standalone convention centre (CC) meeting facilities. Sustainability of meeting facilities was divided into supports /2 (rentable supports, links to local vendors, catering and personnel) for exhibitors (1) and event planners (1), policies /3 by: sustainability, promotion of a green community (1), and waste management (1), and walkability from accommodation /1. Results The last 10 CPS AGMs were held in western (3; Vancouver 2010, Edmonton 2013, Vancouver 2017), eastern (1; Charlottetown 2016) and central (6; Quebec City 2011, London 2012, Montreal 2014, Toronto 2015, Quebec City 2018, Toronto 2019) provinces; in 2020 it is in Vancouver. Central Canada sites had the lowest air travel carbon cost per attendee. Average air travel-related carbon cost per attendee for different host cities ranged from 0.479 (London) to 0.919 (Vancouver) tonnes, with Ontario and Quebec sites averaging 0.518, Charlottetown 0.654 and Edmonton 0.756 tonnes. Ground transportation scores differed by city from Montreal (3/3 with public transit, formal transportation share and parking fees to dissuade driving) to London (0/3), with more favorable public transit options in larger cities. Venues differed when divided by hotel with meeting facilities (H) vs standalone conference center (CC), with CC outranking H for clearly posted sustainability plans (1.6 vs 1.2/2; 2=venue-specific, 1=company chain policy, 0=no plan), green and sustainable community building plans (1.6 vs 1.2/2; 2=greening local communities, 1=company chain policy, 0=no plan) and green waste management policies (1.2 vs 0/2; 2=venue-specific, 1=company chain policy, 0=no plan). Walkable accommodation was equal and present for all venues, with attached accommodation for all but one CC (Montreal), which had immediately adjacent hotels available. Conclusion As expected, the carbon cost of air transportation per attendee was lower in central provinces. Ground transportation from the airport was better in larger host cities. Standalone conference centres had more sustainable event support and locally focused policies regarding sustainability, environmentally friendly community building initiatives and waste management solutions, three major components of “greening” conferences. Based on the available resources across Canada, we recommend that the CPS considers these sustainability criteria in planning future events.
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Stelmack, Carole. "Canadians Generate Blissymbolic Communication Development." Australasian Journal of Special Education 9, no. 2 (November 1985): 33–35. http://dx.doi.org/10.1017/s1030011200021424.
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Blissymbolics, a comprehensive core communication system through which non-speaking people are able to communicate, has been developed and made available throughout Canada and the world by the Blissymbolics Communication Institute in Toronto, Canada. In addition, Canadian users of the system have become leaders in helping to increase universal awareness of the intellectual, social, emotional and communication needs of communicatively impaired and disadvantaged people.Charles K. Bliss who was born in Australia and now resides in Australia, originally developed Blissymbolics between 1942 and 1965 as an international communication system to promote better understanding among people. The system was first successfully applied during the early 1970’s by a multidisciplinary group of specialists at the Ontario Crippled Children’s Centre in Toronto to cerebral palsied, school-aged, non-speaking children. This graphic and meaning-based system provided them with a means of more grammatically complete communication than picture or word boards.Since its first application, Blissymbolics has been expanded to many other applications and populations. Today it is used as an augmentative communiation system with cognitive and language development programs to support reading and pre-reading activities. Its users include people who are retarded, multiply-handicapped, autistic, aphasic and stroke victims.As experimentation and the use of Blissymbolics increased during the 1970’s, the need for training programs and instructional materials, for information about ongoing programs, for more symbols and for a structure to maintain a standard form of Blissymbols also grew. In order to meet and co-ordinate these requirements the Blissymbolics Communication Foundation was established in Toronto in 1975. The Foundation, through a licensing agreement with Mr. Bliss, obtained the exclusive mandate to co-ordinate the applications of Blissymbolics with non-speaking people around the world. Its mandate was to maintain symbol standards and to provide training and material for the increasing number of people applying the system with non-speaking people. The Foundation was re-named the Blissymbolics Communication Institute in 1978 to better represent its role as a central, co-ordinating educational organization.
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Gupta, Sumit, Alex Nachman, Paul Kurdyak, Rinku Sutradhar, Jason D. Pole, and Paul C. Nathan. "Mental healthcare use and severe psychiatric diagnoses in adult survivors of childhood cancer: A population-based study using health services data." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10565. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10565.
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10565 Background: Though physical late effects in childhood cancer survivors are well documented, their risk for adverse mental health outcomes is less clear; existing evidence is contradictory. Health services data offer an objective method for measuring population-based mental health outcomes. Methods: Using a provincial registry with detailed patient, disease, treatment, and outcome data, we assembled a cohort of all five-year survivors of childhood cancer diagnosed before age 18 years and treated in an Ontario pediatric cancer centre between 1987-2008. Patients were linked to population-based healthcare data capturing inpatient, outpatient, and emergency department (ED) visits. The primary outcome was the rate of mental healthcare visits (primary care, psychiatrist, ED or hospital). Secondary outcomes included the time to a severe mental health event (ED visit, hospitalization, or suicide) both overall and by psychiatric diagnostic categories. Outcomes were compared between survivors and matched controls using recurrent event and survival analyses, and predictors of adverse outcomes modeled. Results: When compared to 20,269 controls, 4,117 survivors had a significantly higher rate of mental health visits [47.1 vs. 36.1 visits/100 person years; adjusted relative rate (RR) 1.3, 95% confidence interval (CI) 1.2-1.5]. Higher rates of visits were associated with female gender (RR 1.4, CI 1.1-1.7; p = 0.008) and adolescent age at diagnosis (RR 2.0, CI 1.3-3.0; p = 0.004). Cancer type, treatment intensity or treatments targeting the central nervous system were not significant predictors. The hazard of a severe mental health event did not differ between survivors and controls. Though rare in both groups, survivors were at increased risk of a severe event due to a psychotic disorder (HR 1.8, CI 1.1-2.8; p < 0.05). Conclusions: Childhood cancer survivors experience higher rates of mental health visits than the general population, but are no more likely to experience a severe mental health event. Their risk is not attributable to a specific diagnosis or aspect of treatment. An increased risk of severe psychotic disorders requires confirmation in other cohorts.
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Wasserman, David Warren, Christopher M. Booth, Wilma Hopman, Abdullah Al Sharm, and James Joseph Biagi. "Reasons for delay in time to initiation of adjuvant chemotherapy (AC) for colon cancer (CC)." Journal of Clinical Oncology 31, no. 4_suppl (February 1, 2013): 548. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.548.
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548 Background: AC improves survival among patients with colon cancer. Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). In this study, we examined individual patient charts to determine reasons for delay in AC. Methods: Medical records of patients with CC who initiated AC Aug 2005-Nov 2010 at the Cancer Centre of Southeastern Ontario were reviewed to capture patient, disease, and treatment characteristics including: medical comorbidities, post-operative complications, whether AC was or was not ordered after initial consultation, and the reasons behind the decision. Dates of surgery, referral, consult, central venous catheter (CVC) insertion, and first cycle of AC were recorded. Patients were then categorized into Group 1-medical/surgical reason for delay (MSRD), defined as presence of post-operative complications or intercurrent medical illness, and Group 2–no MSRD. In Group 2, patients were further categorized as having a non-MSRD, defined as patients in whom AC was deferred at time of consultation due to patient preference and/or further investigations required, vs none. A multivariate logistic regression model was used to determine factors associated with TTAC > 8 weeks (w). Results: For 171 patients: Mean age - 67; 52% male; 79% stage 3; IV AC – 80%, Oral AC – 20%. TTAC for all cases was 8.3 ± 2.3w. Mean intervals ± SD between surgery and TTAC in weeks were: surgery to referral 3.1 ± 2.0; referral to consult 2.5 ± 2.3; consult to oral AC 2.0 ± 2.1; for IV AC, consult to CVC 2.2 ± 1.3, and CVC to AC 0.7 ± 0.8. TTAC did not differ between patients with comorbidities (N= 89) and those without (N=82), p= 0.64, but was greater for patients in Group 1 (N=41 with MSRD) vs Group 2 (N = 130), p= 0.002. In Group 2, 43.8% (N=57) had TTAC > 8w while only 20% of cases (n=26) had a non-MSRD. Factors associated with TTAC>8w were MSRD [OR=5.6 (2.3-13.7), p = <0.001] and non-MSRD [OR=6.7 (2.3-19.5), p = <0.001]. Conclusions: Although medical/surgical complications are a strong predictor of delayed TTAC, this only applies to a small proportion of cases. Accordingly, in most patients TTAC>8w is unrelated to their post-operative medical condition and likely reflects health system and logistical issues.
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Niemczycki, Mary Ann Palmer. "The Genesee Connection: The Origins of Iroquois Culture in West-Central New York." North American Archaeologist 7, no. 1 (July 1986): 15–44. http://dx.doi.org/10.2190/gp1m-x2xd-1wf6-ej77.
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The Genesee Valley has long been recognized as a center of Iroquois development, but the connection between Owasco sites in the Genesee and Iroquois sequences in the adjacent regions has never been adequately demonstrated. Attempts to identify transitional Owasco-Iroquois sites in this region have been hampered by the use of diagnostic criteria based on data from eastern New York. This article examines ceramic patterns in the Genesee and establishes a regional cultural sequence based on ceramic criteria which have local diagnostic significance. This sequence reveals the transition from Owasco to Iroquois culture begins in the Genesee with a sudden influx of Ontario Iroquois ceramic traits from the west ca. 1250 A.D. This Owasco-Ontario Iroquois connection in the Genesee negates certain assumptions regarding Iroquois origins and alters our current concept of in situ development.
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Miller, Gord. "Forest and community sustainability – An Ontario perspective." Forestry Chronicle 79, no. 1 (February 1, 2003): 110–12. http://dx.doi.org/10.5558/tfc79110-1.
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Challenges to the sustainability of communities in northern and central Ontario are both ecological and socio-economic in nature. Ecological challenges include persistent impacts such as acid deposition as well as emerging challenges such as the advance of forestry northward and its impact on wildlife populations. Socio-economic challenges of the communities in this region include a declining population level as well as a workforce that is aging. Despite these challenges, northern communities, and forestry planners in particular, have knowledge and experience of value to community planning throughout Ontario. Examples include the fact that foresters and forestry-based communities know how to plan at the landscape ecosystem level, integrate biodiversity conservation and decide on the long-term disposition of land. This knowledge could make a significant contribution to community sustainability in southern Ontario communities, and inadvertently enhance the credibility and influence of forest planning methods and foresters in urban centres. Key words: sustainability, Environmental Commissioner, land use, forest, caribou, ecology, population
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Tian, Chenchen, Catherine Brown, Andrea Perez Cosio, Yvonne Leung, Alisa Lagrotteria, Mindy Liang, Gursharan Gill, et al. "Patient preferences for research access to administrative data in Ontario." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 144. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.144.
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144 Background: Clinical trials collect outcome data until the trial ends. Subsequent health data is often available in government or health care administrative databases, yet this information is often not made available to researchers. We assessed patient preferences of long-term linkage of such administrative databases to clinical trials databases. Methods: A self-reported questionnaire was administered to outpatients in clinics of academic and community cancer centres. Cancer patients were presented with a hypothetical scenario of a clinical trial and asked about their willingness to allow confidential research access to their personal health information contained in administrative databases. Results: Of 524 patients, 54% were females, median age was 60 (range 19–93), 81% were Caucasian, and 61% had post-secondary education. Of cancer sites, 20% had breast cancer, 17% GI, 14% GU, 13% hematology, 12% thoracic, 12% head/neck and 11% gynecologic cancers. One-third (33%) had participated in a clinical trial. An overwhelming 93% allowed confidential access to health information in administrative databases (59% always, 34% depending on circumstances) including access to initials and birth dates, to be used to match information across databases (70% always, 23% depending on circumstances). Only 3% were unwilling to release their information under any circumstances. When asked about other identifiable information, such as name and address, more than 74% allowed the secure storage of this information at the central study coordinating center. In a new cohort of 103 patients, 84% preferred long-term data to be continually available to researchers after the clinical trial has ended; only 9% did not want this option. Results were similar across all sociodemographic subgroups studied including patients who had prior participation in clinical trials, although older patients were even more likely to allow access than younger patients (p = 0.02). Conclusions: The vast majority of patients were willing to have their long-term outcome data collected through government and health care administrative databases made available to clinical trial researchers, to improve our understanding of long-term outcomes of trial procedures and drugs.
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Kuo, Kevin H. M., Eiran Warner, Mathew Sermer, and Richard Ward. "The Effect of Comprehensive Care and Degree of Iron Overload on Maternal and Fetal Outcomes in Pregnancies of Transfusion-Dependent Beta-Thalassemia Patients." Blood 118, no. 21 (November 18, 2011): 5297. http://dx.doi.org/10.1182/blood.v118.21.5297.5297.
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Abstract Abstract 5297 Introduction: Iron overload resulting in hypogonadotrophic hypogonadism is the major cause of infertility in patients with beta-Thalassemia Major (bTM). However, in patients who are able to achieve pregnancy, the effects of iron overload and comprehensive care by hematologists specialized in Hemoglobinopathies on maternal-fetal outcomes have not been well-documented. We hypothesize that in patients with transfusion-dependent bTM, lack of comprehensive care prior to conception or elevated ferritin is associated with poor maternal-fetal outcomes and increased rates of antepartum complications. Methods: A retrospective review was conducted on transfusion-dependent bTM patients who delivered at the Mount Sinai Hospital (MSH), a quaternary referral, high risk obstetrics care institution in Central Ontario, Canada, between 2000 and 2010 based on the Antenatal Database, Delivery Database, electronic and paper-based medical records. Patients were jointly managed by a maternal-fetal medicine specialist and hematologist specialized in hemoglobinopathies. All forms of chelation were discontinued during pregnancy. We analyzed the maternal-fetal outcomes and antepartum complications based on the presence or absence of comprehensive care prior to pregnancy by the Red Blood Cell Disorders (RBCD) Clinic at the University Health Network, a hemoglobinopathy comprehensive care centre from the same catchment area as MSH. Components of comprehensive care include regular monitoring of iron burden, screening and treatment of target organ damage from iron overload, genetic counseling from physicians, and psychosocial counseling from a social worker. We also analyzed the relationship between the pre-pregnancy ferritin levels and birth weight, gestational age, and any antepartum complications. Results: We identified 40 singleton deliveries and 3 twin deliveries by 42 patients (40 bTM, 1 Thalassemia Intermedia, 1 Hemoglobin E/beta-Thalassemia). There were no maternal or fetal deaths. The 3 twin pregnancies were excluded from analysis due to being a potential confounder in maternal and fetal outcomes. Mean maternal age at delivery was 33.11 years (95% CI 31.77, 34.45 years). Mean gestational age at delivery was 38.29 weeks (95% CI 37.41, 39.17 weeks) with six (15%) pre-term births (<37 weeks). Fourteen deliveries (35%) were by Caesarian section and 26 were vaginal deliveries. Six (15%) were low birth weight (<2500 g) and 2 (5%) were small for gestational age. Ten of the 39 patients analyzed (11 deliveries) received comprehensive care at RBCD clinic prior to their pregnancies. There was no significant difference in maternal-fetal outcomes or antepartum complications between patients who received comprehensive care prior to conception and those who did not. However, patients who received comprehensive care were significantly younger and had lower parity (P = 0.0072 and 0.0276 respectively). In the 19 deliveries where pre-pregnancy ferritin was available, there was no association between pre-pregnancy ferritin and fetal birth weight, gestational age, or any antepartum complications. Discussion: There was no association between pre-pregnancy ferritin level and maternal-fetal outcomes. Presence of comprehensive care prior to conception did not appear to significantly change the maternal-fetal outcomes in transfusion-dependent beta-Thalassemia patients. We speculate that the lack of difference may be due to a higher proportion of primigravida in the comprehensive care group acting as a potential confounder, given that primigravida in general have higher rates of adverse pregnancy outcome. In addition, patients with higher parity may have less severe complications from iron overload, and consequently are less likely to be referred to a comprehensive care center. Limitations include small sample size and single center study. Further prospective observational studies with larger sample size are required to evaluate whether a) introduction of uniform comprehensive care to all women with bTM in child-bearing age will improve pregnancy outcomes; b) ferritin or liver iron concentration is useful in predicting antepartum complications in bTM patients. Disclosures: Kuo: Novartis Canada: Research Funding.
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Stein, Robert C., Janet A. Dunn, John MS Bartlett, Amy F. Campbell, Andrea Marshall, Peter Hall, Leila Rooshenas, et al. "OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer." Health Technology Assessment 20, no. 10 (February 2016): 1–202. http://dx.doi.org/10.3310/hta20100.
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BackgroundThere is uncertainty about the chemotherapy sensitivity of some oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers. Multiparameter assays that measure the expression of several tumour genes simultaneously have been developed to guide the use of adjuvant chemotherapy for this breast cancer subtype. The assays provide prognostic information and have been claimed to predict chemotherapy sensitivity. There is a dearth of prospective validation studies. The Optimal Personalised Treatment of early breast cancer usIng Multiparameter Analysis preliminary study (OPTIMA prelim) is the feasibility phase of a randomised controlled trial (RCT) designed to validate the use of multiparameter assay directed chemotherapy decisions in the NHS.ObjectivesOPTIMA prelim was designed to establish the acceptability to patients and clinicians of randomisation to test-driven treatment assignment compared with usual care and to select an assay for study in the main RCT.DesignPartially blinded RCT with adaptive design.SettingThirty-five UK hospitals.ParticipantsPatients aged ≥ 40 years with surgically treated ER-positive HER2-negative primary breast cancer and with 1–9 involved axillary nodes, or, if node negative, a tumour at least 30 mm in diameter.InterventionsRandomisation between two treatment options. Option 1 was standard care consisting of chemotherapy followed by endocrine therapy. In option 2, an Oncotype DX®test (Genomic Health Inc., Redwood City, CA, USA) performed on the resected tumour was used to assign patients either to standard care [if ‘recurrence score’ (RS) was > 25] or to endocrine therapy alone (if RS was ≤ 25). Patients allocated chemotherapy were blind to their randomisation.Main outcome measuresThe pre-specified success criteria were recruitment of 300 patients in no longer than 2 years and, for the final 150 patients, (1) an acceptance rate of at least 40%; (2) recruitment taking no longer than 6 months; and (3) chemotherapy starting within 6 weeks of consent in at least 85% of patients.ResultsBetween September 2012 and 3 June 2014, 350 patients consented to join OPTIMA prelim and 313 were randomised; the final 150 patients were recruited in 6 months, of whom 92% assigned chemotherapy started treatment within 6 weeks. The acceptance rate for the 750 patients invited to participate was 47%. Twelve out of the 325 patients with data (3.7%, 95% confidence interval 1.7% to 5.8%) were deemed ineligible on central review of receptor status. Interviews with researchers and recordings of potential participant consultations made as part of the integral qualitative recruitment study provided insights into recruitment barriers and led to interventions designed to improve recruitment. Patient information was changed as the result of feedback from three patient focus groups. Additional multiparameter analysis was performed on 302 tumour samples. Although Oncotype DX, MammaPrint®/BluePrint®(Agendia Inc., Irvine, CA, USA), Prosigna®(NanoString Technologies Inc., Seattle, WA, USA), IHC4, IHC4 automated quantitative immunofluorescence (AQUA®) [NexCourse BreastTM (Genoptix Inc. Carlsbad, CA, USA)] and MammaTyper®(BioNTech Diagnostics GmbH, Mainz, Germany) categorised comparable numbers of tumours into low- or high-risk groups and/or equivalent molecular subtypes, there was only moderate agreement between tests at an individual tumour level (kappa ranges 0.33–0.60 and 0.39–0.55 for tests providing risks and subtypes, respectively). Health economics modelling showed the value of information to the NHS from further research into multiparameter testing is high irrespective of the test evaluated. Prosigna is currently the highest priority for further study.ConclusionsOPTIMA prelim has achieved its aims of demonstrating that a large UK clinical trial of multiparameter assay-based selection of chemotherapy in hormone-sensitive early breast cancer is feasible. The economic analysis shows that a trial would be economically worthwhile for the NHS. Based on the outcome of the OPTIMA prelim, a large-scale RCT to evaluate the clinical effectiveness and cost-effectiveness of multiparameter assay-directed chemotherapy decisions in hormone-sensitive HER2-negative early breast would be appropriate to take place in the NHS.Trial registrationCurrent Controlled Trials ISRCTN42400492.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 10. See the NIHR Journals Library website for further project information. The Government of Ontario funded research at the Ontario Institute for Cancer Research. Robert C Stein received additional support from the NIHR University College London Hospitals Biomedical Research Centre.
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Grinspun, Doris. "Modelo de Enfermería para optimizar sistemas de salud." MedUNAB 20, no. 2 (August 4, 2017): 224–34. http://dx.doi.org/10.29375/01237047.3242.
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Introducción: Los gobiernos de todo el mundo buscan diferentes estrategias para ampliar el acceso a los servicios de salud, abaratar costos y optimizar resultados. Objetivo: Presentar el contexto socio-político de salud en el que se sitúan las guías de buenas prácticas basadas en la evidencia de la Asociación de Enfermeras de Ontario. Temas de reflexión: La discusión se centra en los desafíos claves de salud y atención sanitaria que enfrentan diversos países del mundo, y las amenazas y oportunidades que éstos presentan para Enfermería. Se enfatiza la necesidad del uso de evidencia como una herramienta central pero no la única para optimizar los resultados de salud de los ciudadanos. Conclusiones: Los cuatro componentes principales que facilitan un modelo de atención efectivo corresponde a: Recursos humanos adecuados; trabajo interprofesional positivo; expansión del rol de las enfermeras profesionales; y la práctica basada en la evidencia. Todos estos componentes son necesarios para alcanzar una atención de acceso universal, oportuna y centrada en la persona. [Grinspun D. Modelo de Enfermería para optimizar sistemas de salud. MedUNAB 2017; 20(2): 224-234].
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Wright, Frances Catriona. "Early integration of palliative care in Ontario cancer settings." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18234-e18234. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18234.
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e18234 Background: Introducing palliative care early in the cancer journey results in a better life quality, less aggressive care and possibly longer survival compared to patients receiving standard care. The INTEGRATE project aimed to identify and manage patients who may benefit from palliative care earlier in their cancer treatment. This pilot project assessed whether multidisciplinary forums (Multidisciplinary Cancer Conferences, Clinics and Diagnostic Assessment Programs ) could be used to identify patients using the UK Gold Standards Framework Surprise Question (SQ) “Would you be surprised if this person died within the next year?” Methods: Cancer centres volunteered to pilot test the efficacy of the SQ at multidisciplinary forums and implement a palliative model of care. A survey was completed at 3 different points during the project to measure provider comfort in providing palliative care. All sites received primary level palliative care education. Patient and caregiver experience were assessed using interviews and a validated survey. Identified patients received Advance Care Planning (ACP), symptom management, referrals and standardized reporting to primary care. Patient level data was collected. Results: 3 academic and 1 non-academic cancer centres used the SQ in multidisciplinary forums to identify patients in the Lung, Gastrointestinal and Central Nervous System disease sites between February '15-August '16. A baseline survey showed over 50% of providers had no palliative care training. 157 providers received education and at the end of the project providers had increased comfort & confidence in delivering palliative care. Analyses show that 933 patients were identified using the SQ, from which 78% had ACP initiated and 83% are receiving community palliative care services Conclusions: Multidisciplinary forums appear to be excellent for identifying patients who may benefit from a palliative approach to care. Inter-professional provider education and organized approaches to linking patients to community resources, had a positive impact on provider willingness to address end-of-life and palliative issues. Patients & caregivers report positive experiences of care, but different levels of ‘readiness’ to have the ACP discussions.
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McKenney, Daniel W., John H. Pedlar, Jing Yang, Alfons Weersink, and Glenn Lawrence. "An economic analysis of seed source options under a changing climate for black spruce and white pine in Ontario, Canada." Canadian Journal of Forest Research 45, no. 10 (October 2015): 1248–57. http://dx.doi.org/10.1139/cjfr-2015-0051.
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We present a model that maps the net present value (NPV) associated with planting black spruce (Picea mariana (Mill.) Britton, Sterns & Poggenb.) and white pine (Pinus strobus L.) seed sources across a study area centred on Ontario, Canada. The model accounts for climate change through the use of universal response functions, which (in principle) predict the growth of any seed source under any climatic conditions. We demonstrated the use of the model for two locations in northern Ontario; both species exhibited significant variation in NPV across the study area and significant gains associated with climate-smart seed movements. For example, the NPV associated with potential white pine seed sources varied by more than $1500·ha−1 for a planting site at North Bay, Ontario. We also compared the NPV maps with climate similarity maps to examine the degree to which simple climate matching can act as a proxy for the detailed genecology relationships contained in the universal response functions. Overall, the climate similarity maps were well-correlated with the NPV maps; however, there was poor agreement regarding white pine seed deployment from North Bay, for which the two approaches identified opposite seed transfer directions. We propose that this situation can arise when species show strong adaptation to a central climatic optimum.
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Lidtke, Roy H., Carol Muehleman, Mary Kwasny, and Joel A. Block. "Foot Center of Pressure and Medial Knee Osteoarthritis." Journal of the American Podiatric Medical Association 100, no. 3 (May 1, 2010): 178–84. http://dx.doi.org/10.7547/1000178.
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Background: We sought to determine whether symptomatic medial knee osteoarthritis is associated with aberrant loading across the foot during gait. Methods: Twenty-five individuals with medial knee osteoarthritis were compared with 25 controls. Knee radiographs and Western Ontario and McMaster Universities Arthritis Index questionnaires were obtained. Participants walked barefoot over pressure sensors, and the center-of-pressure trace was plotted against the axis of the foot, and a center-of-pressure index was calculated. Results: The center-of-pressure indices in the medial knee osteoarthritis group demonstrated high lateral loading compared with the central center-of-pressure pattern in controls (P < .001). There was a correlation between the severity of pain and the center-of-pressure index in patients with medial knee osteoarthritis but no correlation between center of pressure and radiographic severity. Conclusions: The plantar pressure patterns of patients with medial knee osteoarthritis demonstrated greater loading of the lateral aspect of the foot during the contact and midstance phases of gait but not during propulsion compared with those of controls, suggesting that loading patterns in the feet are related to osteoarthritis in the knee. (J Am Podiatr Med Assoc 100(3): 178–184, 2010)
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Rajora, Om P., Alex Mosseler, and John E. Major. "Mating system and reproductive fitness traits of eastern white pine (Pinus strobus) in large, central versus small, isolated, marginal populations." Canadian Journal of Botany 80, no. 11 (November 1, 2002): 1173–84. http://dx.doi.org/10.1139/b02-105.
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Multilocus (tm) and single-locus (ts) outcrossing and actual inbreeding rates and seed traits were determined for eastern white pine (Pinus strobus L.) in six small, remnant, and marginal populations from two regions (East and West) in Newfoundland and in three large populations from the center of the species' geographic range in Ontario to examine the effects of small population size and fragmentation on mating system parameters and reproductive fitness. The population tm ranged from 0.867 to 0.991, with a mean of 0.924 over all nine populations. The mean ts ranged from 0.672 to 0.908, with a mean of 0.797 over the nine populations. The Ontario populations, on average, showed higher but statistically similar outcrossing rates (tm = 0.947, ts = 0.848) to the Newfoundland populations (tm = 0.912, ts = 0.772). The Newfoundland West populations, on average, showed the lowest outcrossing rates (tm = 0.889, ts = 0.716). Individual family outcrossing rates, although slightly higher, were similar to their respective population outcrossing rates, and no significant differences were observed among families within populations. The mean ts were significantly lower than their corresponding tm, and the differences were significantly and positively correlated with the number of loci showing significant regression of pollen allele frequency on ovule genotype, suggesting possible occurrence of consanguineous mating. The Ontario populations showed the highest and the Newfoundland West populations the lowest reproductive fitness, with Newfoundland East populations ranking higher than Newfoundland West but significantly lower than Ontario populations. Actual inbreeding rates, determined by combining allozyme-based estimates of selfing in the filled seed component with estimates of inbreeding from the proportions of empty seeds, ranged from 7.4 to 31.6%, with an average of 22% for all populations and 11.1% for the Ontario, 24.7% for the Newfoundland East, and 30.1% for the Newfoundland West populations. Multilocus outcrossing rates were significantly correlated (i) negatively with the average distance to the five nearest neighboring trees (a surrogate measure for within-stand densities of reproductively mature trees) and (ii) positively with the proportion of filled seeds per cone. The filial seed progeny fixation index was positively correlated with both (i) average nearest-neighbor distances and (ii) proportion of empty seeds per cone. Thus, we detected strong interrelationships between the within-stand density of reproductively mature trees and both outcrossing rates and filled seed production. Interestingly, there was no relationship between the fixation index of the mature parent stands and their density. The genetic status or integrity of the extant parental populations may have been largely unaffected by the large-scale population decline experienced by eastern white pine early in the 20th century, a decline that showed an adverse effect on reproductive fitness of these populations.Key words: outcrossing and inbreeding, small population size, conservation, genetic and reproductive fitness, actual inbreeding rates, seed traits.
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Saginur, Raphael, Susan F. Dent, Lisa Schwartz, Ronald Heslegrave, Sid Stacey, and Janet Manzo. "Ontario Cancer Research Ethics Board: Lessons Learned From Developing a Multicenter Regional Institutional Review Board." Journal of Clinical Oncology 26, no. 9 (March 20, 2008): 1479–82. http://dx.doi.org/10.1200/jco.2007.12.6441.
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Purpose We describe issues and outcomes in the development of a specialized, central institutional review board (IRB) for multicenter oncology protocols. Numerous authoritative bodies have called for a change to the ethics review system to better manage multicenter trials in terms of quality, timeliness, and efficiency. In 2003, the American Society of Clinical Oncology proposed a network of regional IRBs for cancer. Previous experience with central IRBs has been met with mixed success. Methods We took a bottom-up approach to organizing a province-wide IRB, which was led by an IRB chair and a clinical investigator at one cancer center. Participation on the part of institutions was voluntary. Results Uptake in the first 2 years was modest and increased from 11 clinical trials in year 1 to 21 in year 2. In the third year, there was an apparent upsurge in the number of involved centers (14) and in the number of submitted clinical protocols (54). Conclusion Sponsors and investigators are loath to risk development of a novel IRB until there is a clear demonstration of quality, efficiency, and timeliness of decision. Development of a regional, specialized IRB requires considerable efforts to develop and maintain the trust of sponsors, investigators, and institutions despite prior demands for more efficient and timely ethics review. Voluntary institutional participation, clear delineation of roles and responsibilities, and effective execution promote development of this trust.
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Forsythe, K. Wayne, Michael Dennis, and Chris H. Marvin. "Comparison of Mercury and Lead Sediment Concentrations in Lake Ontario (1968-1998) and Lake Erie (1971–1997/98) using a GIS-Based Kriging Approach." Water Quality Research Journal 39, no. 3 (August 1, 2004): 190–206. http://dx.doi.org/10.2166/wqrj.2004.028.
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Abstract This research analyzed sediment contamination concentrations for mercury and lead in Lakes Ontario and Erie using a GIS-based kriging approach. Environment Canada provided sediment survey data for Lake Ontario (1968 and 1998) and Lake Erie (1971 and 1997/98). Collation and mapping of point measurement data without the application of interpolation methods does not allow for spatial data trends to be fully analyzed. The kriging technique enables the creation of interpolated prediction surfaces, with the advantage that the results can be statistically validated. Although data normality is not required, the kriging results for the historical datasets suggest that it may be desirable, as statistical validity was reduced due to some individual stations having very high contaminant concentrations. Three of the four models developed for the 1997/98 data were statistically valid. For both lakes, the more recent data reveal reduced concentrations of mercury and lead, and there has been an overall reduction in contamination levels. However, sediments in some areas still exceeded Canadian sediment quality guidelines. The areas of greatest sediment contamination in Lake Ontario were within the major depositional basins, presumably as a result of historical industrial activities in watersheds along the southern and western shoreline including the Niagara River. In Lake Erie, areas of greatest sediment contamination continue to be located in the western and south central portions of the lake in proximity to the Detroit River and major urban/industrial centres.
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Chu, Cindy, Charles K. Minns, Nigel P. Lester, and Nicholas E. Mandrak. "An updated assessment of human activities, the environment, and freshwater fish biodiversity in Canada." Canadian Journal of Fisheries and Aquatic Sciences 72, no. 1 (January 2015): 135–48. http://dx.doi.org/10.1139/cjfas-2013-0609.
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Changes in resource development and expansions of urban centres suggest that the intensity and types of anthropogenic stressors affecting Canada’s watersheds are changing. Chu et al. (2003) integrated indices of freshwater fish biodiversity, environmental conditions, and anthropogenic stress to identify priority watersheds for conservation and management. Here, we update those indices using recent climate and census data to assess changes through time. We also applied different conservation and management scenarios to evaluate the robustness of our prioritization approach. Between time periods, the environmental and stress indices expanded northward because of warmer temperatures at higher latitudes and more intense anthropogenic stress in the northern regions of the provinces. Conservation priorities increased in northern British Columbia, Alberta, and Ontario but decreased in southern British Columbia, Saskatchewan, and south-central Quebec. Under multiple scenarios, conservation priorities were consistently highest in British Columbia, the Maritimes, southern Ontario, and southern Quebec. Future research to refine this assessment should focus on developing a nationwide georeferenced assessment of freshwater fisheries stress, quantifying spatial changes in the stressors, and evaluating the sensitivity of each index to the weighting of the individual variables. This work highlights the necessity for conservation and management strategies in Canada to keep pace with changing patterns in climate and human activities.
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Kukreti, Vishal, Emma Mauti, Roxanne Macaskill, Christine Chen, and Matthew D. Seftel. "Quality of Care in Blood and Marrow Transplantation – a Systematic Review in Order to Define a Quality Framework and Develop Quality Indicators." Blood 124, no. 21 (December 6, 2014): 1311. http://dx.doi.org/10.1182/blood.v124.21.1311.1311.
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Abstract Introduction: Quality of health care is a major focus for providers, patients, payers and accreditors. Blood and marrow transplantation (BMT) is a complex and specialized process with unique quality needs. Accreditation bodies for BMT programs expect an implemented and coordinated management system. Currently, hospitals performing BMT have many tiers of quality evaluation from hospital accreditation, BMT accreditation, self-evaluation and in Ontario, provincial quality measurement. Hence, a quality framework with a clearly defined process of quality indicator (QI) prioritization, development and measurement is required. Methods: At Princess Margaret Cancer Centre, we conducted a structured review of the literature to identify published QI for BMT. The literature review from 1999 to 2014 focused on BMT with MESH terms including quality improvement/assurance, quality of health care, benchmarking, performance measures/indicators and standards of care. Focus was on the clinical aspects of care and laboratory/cell collection was excluded. We included Medline, Pubmed, Embase and CINAHL databases and a structured “grey zone” literature review. The identified QI were evaluated by a core expert panel and like concepts were merged and quality domains identified. Thereafter, end user engagement of the multidisciplinary team was completed through a modified Delphi Process. QI definitions were evaluated as medidata tables to link to data collection sources. Management/operational related and hospital accreditation QI were evaluated by the expert panel for relevance. A quality framework was then modeled off the Cancer System Quality Index to include the domains of safe, effective, efficient, integrated, equitable, responsive, accessible and innovative. QI were aligned to relevant domains in the framework to give an overall program evaluation and future direction. Results: Structured literature review identified 2211 citations with 111 abstracts meeting the inclusion criteria and only 20 full papers reporting on 114 QI. Grey zone literature review revealed a further 10 sources reporting on 100 QI. Of the 214 QI, 120 were quality domains or quality concepts (“Big Dot”) and not clearly defined QI. With consensus review, 214 QI were merged into 22 clinical and 12 operational/managerial “Big Dot” QI. Of the clinical QI, there were 8 only relevant to allogeneic BMT and 14 were relevant to both autologous and allogeneic BMT (see Table 1). Concurrently, mapping of QI within the framework as well as, alignment of both hospital and provincial BMT QI to the framework and to the 22 clinical QI indicators was done. . Conclusions: An integrated and comprehensive quality management plan is required for BMT which is standards based. We report a framework and strategy to align all quality endeavors occurring at local-regional to national levels as it relates to BMT. We also present a detailed literature review of QI in BMT and the need for more detailed, reproducible indicators in this area. As end-user engagement in quality improvement is necessary, the clinical multidisciplinary team will set QI prioritization for near term and future reporting though a modified Delphi exercise. Table 1: Big Dot Clinical QI in BMT for Prioritization and Development Apheresis Not Performed Due to Insufficient Mobilization Apheresis Not Performed Due to Other Reasons (i.e. progression) Appropriate Donor Screening and Testing Complications During Apheresis Complications During Bone Marrow Harvest Donor Outcomes (i.e. adverse events) Incidence and Measurement of Acute and Chronic Graft vs Host Disease Incidence of ICU Transfers Length of Stay in Hospital Routine Chimerism Analysis Median Time to Engraftment (in days) Number of Patients who enter the program that are not transplanted Nurse Sensitive Outcomes i.e. central venous catheter complications Need for Stem Cell Boost or Second Transplant for Graft Failure Patient Satisfaction at Discharge and at Transitions Rate of Serious Bacterial, Viral and Fungal Infections Readmissions within 30 Days of Discharge Relapse Rate Overall Survival Time to Find an Unrelated Compatible Donor Treatment Related Mortality Whether a Product was Collected From a Donor and Not Infused Disclosures No relevant conflicts of interest to declare.
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Kuo, Kevin H. M., Eiran Warner, Mathew Sermer, and Richard Ward. "The Effect of Comprehensive Care on Maternal and Fetal Outcomes in Sickle Cell Disease Pregnancies." Blood 118, no. 21 (November 18, 2011): 4842. http://dx.doi.org/10.1182/blood.v118.21.4842.4842.
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Abstract Abstract 4842 Introduction: Patients with Sickle Cell Disease (SCD) have increased rates of maternal and fetal complications compared to the general population, including premature rupture of membranes, post-partum infection, low birth weight, small for gestational age (SGA), intrauterine growth retardation (IUGR) and preterm delivery. They also experience higher rates of antepartum complications: painful vasoocclusive crises (VOC), infections, PIH/preeclampsia, abruption, antepartum bleeding, cardiomyopathy, pulmonary hypertension, cerebral vein thrombosis, pneumonia, pyelonephritis, deep vein thrombosis (DVT), transfusion and systemic inflammatory response syndrome. Comprehensive care reduces morbidity and mortality in infancy and early childhood and is the cornerstone of care in SCD. However, the effect of comprehensive care on maternal and fetal outcome in patients with SCD has not been examined. We hypothesize that pre-conception comprehensive care improve maternal and fetal outcomes and reduced rates of antepartum complications in patients with SCD. Methods: We conducted a retrospective review of patients with SCD (SS, SC, S/beta-thalassemia) who delivered at the Mount Sinai Hospital (MSH), a high risk obstetrics care institution in Central Ontario, Canada, between 2000 and 2010 based on the Antenatal Database, Delivery Database, electronic and paper-based medical records. Patients were jointly managed by a maternal-fetal medicine (MFM) specialist and hematologist specialized in hemoglobinopathies. We analyzed the maternal and fetal characteristics and outcomes (age at delivery, genotype, gravida, gestational age, birth weight, number of Caesarian sections and vaginal deliveries), antepartum complications (pregnancy induced hypertension (including pre-eclampsia and eclampsia), gestational diabetes mellitus, preterm premature rupture of membranes, oligohydramnios, abruption/previa, venous thromboembolism, urinary tract infection), and SCD-specific complications (painful vaso-occlusive crises, acute chest syndrome, pneumonia, and transfusion) based on the presence or absence of comprehensive care prior to pregnancy by the Red Blood Cell Disorders (RBCD) Clinic at the University Health Network, a SCD comprehensive care centre from the same catchment area as MSH. t-test was used to compare means of two groups, Fisher's exact test and chi-squared tests were used to compare categorical frequency data, where appropriate. Alpha value of 0.05 was chosen as the level of significance. Results and Discussion: We identified 79 deliveries by 64 patients with SCD who received obstetric care at MSH. Mean gestational age at delivery was 37.69 weeks (95% CI 37.00 to 38.37 weeks) and 21 (27%) were preterm (< 37 weeks). Thirty-one deliveries (39%) were by Caesarian section and 48 were delivered vaginally. Seventeen (22%) were low birth weight (< 2500 g) and 11 (14%) were small for gestational age. Maternal and fetal outcomes and rates of antepartum complications were similar to the existing literature (Powars, 1986; Smith, 1996; Serjeant, 2004; Barfield, 2010). Twenty-eight deliveries by 22 of the 64 patients received comprehensive care at the RBCD clinic prior to their pregnancies for a mean duration of 5 years. There was no significant difference in maternal or fetal outcomes or antepartum complications. The results suggest that the role of comprehensive care prior to conception may not be as crucial in pregnancy outcomes of patients with SCD as previously thought. The lack of difference may also be due to the fact that the patients' care was closely monitored during the pregnancy by both specialists in hemoglobinopathies and high risk obstetrics. Limitations of the study include its single-centered and retrospective nature, exclusion of stillbirths and miscarriages, and small sample size. Also, patients who were enrolled in the comprehensive care program may carry more comorbidities and SCD-specific complications, compared to patients referred from the community, but this was not examined in the present study. Further prospective observational studies of SCD patients in the child-bearing age, with attention to the frequency and type of pre-pregnancy SCD-specific complications, as well as standardized application of comprehensive care, will be helpful in determining whether comprehensive care is useful in reducing antepartum complications in patients with SCD. Disclosures: Kuo: Novartis Canada: Research Funding.
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Pitt, Douglas G., Philip G. Comeau, William C. Parker, Daniel MacIsaac, Scott McPherson, Michael K. Hoepting, Al Stinson, and Milo Mihajlovich. "Early vegetation control for the regeneration of a single-cohort, intimate mixture of white spruce and trembling aspen on upland boreal sites." Canadian Journal of Forest Research 40, no. 3 (March 2010): 549–64. http://dx.doi.org/10.1139/x10-012.
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In Canada’s boreal forest region, there is increasing demand for practical regeneration strategies that will recreate mixed stands of white spruce ( Picea glauca (Moench) Voss) and trembling aspen ( Populus tremuloides Michx.). In 2002, we implemented an experiment in both west-central Alberta and northeastern Ontario to better understand the effects of herbaceous and woody vegetation control on crop tree survival and growth, within the context of prescription development for the regeneration of a single-cohort, intimate mixture of spruce and aspen. After five growing seasons, good spruce growth, health, and survival were observed with 2 m radial treatments consisting of herbaceous and woody (i.e., complete) vegetation control centred on trees planted at 5 m spacing. These spruce were 4%–64% taller and 68%–178% larger in stem diameter than untended trees, leading to 167%–1166% gains in stem volume, and were at least equivalent to the same stock grown at 2.5 m spacing and provided with complete, continuous relief from competition. Removing only the woody vegetation within treated radii stimulated herbaceous competition, resulting in reduced survival and growth of spruce and reduced height of surrounding aspen. Early results suggest that spot treatments that provide 2–4 years of relief from herbaceous and woody competition may offer a practical strategy for growing spruce with aspen.
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Lockhart, Elizabeth, Eric Gutierrez, Padraig Richard Warde, Davin Dubeau, Sophie Huang, Harry Johnson, Saul Melamed, et al. "eOutcomes-H&N: Development of an electronic point-of-care outcomes collection system for head and neck cancer." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 247. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.247.
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247 Background: Outcomes data increases the ability to understand the impact of cancer treatment and helps ensure that we direct appropriate investments to achieve improvements in quality of care. Cancer Care Ontario (CCO) has developed an outcomes data collection system for patients with head and neck cancer treated with radiotherapy. Methods: Clinicians involved in the care of these patients agreed on 5 key clinical outcomes to collect as a part of this initiative: local failure, regional failure, distant metastasis, second primaries, and treatment toxicity. Based on the Princess Margaret Hospital Head and Neck Cancer Anthology of Outcomes process, CCO has developed a similar system to collect outcomes data at the point-of-care on a provincial scale. The population-based provincial system aims to provide practice efficiencies and allow for evolution of the system in response to user feedback and expansion to other clinical areas. Results: The system includes a secure web application and iPad mobile application to facilitate the collection and management of outcomes data for head and neck cancer patients treated with radiotherapy in Ontario. Cancer centres upload patient clinic schedule details (including patient identifiers and appointment dates) prior to clinics. A list of patient summaries, including corresponding diagnosis, radiotherapy information and previously recorded outcomes is then generated. In clinic, physicians use these lists to capture outcomes noted at the point-of-care. Data captured are then transferred in real time to a secure central database. Following initial testing, the application was piloted to assess usability, system reliability, and overall satisfaction. Initial results show high physician satisfaction and no documented issues with system availability. Feedback has identified potential improvements and will inform future modifications. Conclusions: The identification of potential variation in recurrence, toxicity and survival data will inform the areas in which quality improvement initiatives or additional investments may be needed. The intent is to leverage project learnings for future outcomes initiatives in other diseases and treatment modalities.
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Reddeman, Lindsay, Sophie Foxcroft, Eric Gutierrez, Margaret Hart, Elizabeth Lockhart, Marissa Mendelsohn, Michelle Ang, et al. "ReCAP: Improving the Quality of Radiation Treatment for Patients in Ontario: Increasing Peer Review Activities on a Jurisdictional Level Using a Change Management Approach." Journal of Oncology Practice 12, no. 1 (January 2016): 81–82. http://dx.doi.org/10.1200/jop.2015.006882.
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QUESTION ASKED: What is the impact of the Cancer Care Ontario (CCO) strategy (designed with guidance from a change management framework) to accelerate the use of peer-review processes in radiation oncology (ie, review of a radiation oncologist’s proposed treatment plan by a second radiation oncologist with or without additional multidisciplinary input) across all of its 14 cancer treatment centers? SUMMARY ANSWER: By following a number of key change management principles for organizational transformation, the proportion of radical-intent radiation therapy courses peer reviewed province-wide increased from 43.5% (April 2013) to 68.0% (March 2015), with some centers reaching over 95%. METHODS: The initiative design was guided by the Kotter eight-step process for organizational transformation, including the creation of a multidisciplinary leadership team, site visits to individual centers, the development of education and implementation processes (done in collaboration with each center), and the creation of new performance metrics for central reporting. Monitoring of these metrics enabled the leadership team to track the percentage of radiation therapy courses peer reviewed and the timing of peer review (before 25% treatment visits complete, after 25% treatment visits complete). Performance targets for the quality measures were arrived at by consensus that included engagement of all center radiation treatment program leaders. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Peer review has been shown to increase quality of care. However, it requires that resources be invested, including the time and effort of radiation oncologists, and the programmatic work required to organize, execute, and document peer-review activities. There is currently no way of confirming the quality of peer-review activities. REAL-LIFE IMPLICATIONS: A change management framework can be useful for planning and achieving substantial increases in peer-review activities on a jurisdictional basis. Ongoing work will capitalize on facilitators of peer review and on addressing barriers to its application that were identified as part of the initiative. Guidance for peer-review activities specific to common clinical cases is required and is under development. The principles of peer review could be extended to other oncological disciplines with the goal of improving individual patient care and overall program quality. [Figure: see text]
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Amayiri, Nisreen, Maisa Swaidan, Najiyah Abuirmeileh, Maysa Al-Hussaini, Tarik Tihan, James Drake, Awni Musharbash, et al. "Video-Teleconferencing in Pediatric Neuro-Oncology: Ten Years of Experience." Journal of Global Oncology, no. 4 (December 2018): 1–7. http://dx.doi.org/10.1200/jgo.2016.008276.
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Purpose The management of central nervous system tumors is challenging in low- and middle-income countries. Little is known about applicability of twinning initiatives with high-income countries in neuro-oncology. In 2004, a monthly neuro-oncology video-teleconference program was started between King Hussein Cancer Center (Amman, Jordan) and the Hospital for Sick Children (Toronto, Ontario, Canada). More than 100 conferences were held and > 400 cases were discussed. The aim of this work was to assess the sustainability of such an initiative and the evolution of the impact over time. Methods We divided the duration in to three eras according to the initial 2 to 3 years of work of three consecutive oncologists in charge of the neuro-oncology program at King Hussein Cancer Center. We retrospectively reviewed the written minutes and compared the preconference suggested plans with the postconference recommendations. Impact of changes on the patient care was recorded. Results Thirty-three sets of written minutes (covering 161 cases) in the middle era and 32 sets of written minutes (covering 122 cases) in the last era were compared with the initial experience (20 meetings, 72 cases). Running costs of these conferences has dropped from $360/h to < $40/h. Important concepts were introduced, such as multidisciplinary teamwork, second-look surgery, and early referral. Suggestions for plan changes have decreased from 44% to 30% and 24% in the respective consecutive eras. Most recommendations involved alternative intervention modalities or pathology review. Most of these recommendations were followed. Conclusion Video-teleconferencing in neuro-oncology is feasible and sustainable. With time, team experience is built while the percentage and the type of treatment modifications change. Commitment and motivation helped maintain this initiative rather than availability of financial resources. Improvement in patients’ care was achieved, in particular, with the implementation of a multidisciplinary team and the continuous effort to implement recommendations.
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Khanna, O. Shervan, Aftab A. Mufti, and Baidar Bakht. "Experimental investigation of the role of reinforcement in the strength of concrete deck slabs." Canadian Journal of Civil Engineering 27, no. 3 (June 1, 2000): 475–80. http://dx.doi.org/10.1139/l99-094.
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To study systematically the role of each layer of steel reinforcement in conventionally reinforced deck slabs of girder bridges, a full-scale model was built of a 175 mm thick concrete deck slab on two steel girders with a center-to-center spacing of 2.0 m. The 12 m long deck slab was conceptually divided into four 3 m long segments, identified as segments A, B, C, and D. Segment A contained isotropic steel reinforcement in two layers, conforming to the requirements of the Ontario Highway Bridge Design Code (OHBDC). Segment B contained only the bottom layer of steel reinforcement. Segment C contained only the bottom transverse steel bars. Segment D contained only bottom transverse glass fibre reinforced polymer (GFRP) bars having the same axial stiffness, but 8.6 times the axial tensile strength, as those of the steel bars in segment C. Each segment of the deck slab was tested to failure under a central concentrated load, simulating the dual tire footprint of 250 × 500 mm dimension of a typical commercial vehicle. All segments failed in the punching shear mode. The failure loads for the four segments were found to be 808, 792, 882, and 756 kN, respectively; these failure loads are similar in magnitude to that of a 175 mm thick steel-free deck slab with steel straps having nearly the same cross-sectional area per metre length of the slab as those of the bottom transverse steel bars in the first three segments. The tests on the four segments of the full-scale model have confirmed that (i) only the bottom transverse reinforcement influences the load carrying capacity of a reinforced concrete deck slab and (ii) the stiffness of the bottom transverse reinforcement, rather than its strength, is of paramount importance.Key words: arching, deck slab, FRP, shake down, slab-on-girder bridge.
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Haji, Farzana, Lisa Catherine Barbera, Colleen Bedford, Brett Nichols, and Michael Donald Brundage. "Standardized symptom screening: Cancer Care Ontario's expanded prostate cancer index composite for clinical practice (EPIC-CP) provincial implementation approach." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 100. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.100.
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100 Background: Cancer Care Ontario endorses patient reported outcome measures to improve outcomes and experience for nearly 14 million Ontarians. The EPIC-CP tool, validated to screen/monitor symptoms and side-effects in men with localized prostate cancer, was selected to improve patient and provider experience, and facilitate symptom management. Two pilots tested EPIC-CPs feasibility and acceptability. Subsequent recommendations include: province-wide implementation, improving technological privacy, patient and provider education and communication processes. This abstract will describe the provincial strategy for implementation of EPIC-CP. Methods: The implementation approach involved stakeholder-driven practices based on Kotter’s organizational process framework. Clinical, technical, administrative and patient stakeholder representatives from 14 cancer centres formed working groups to create a climate for change, to engage centres to strategize locally, to implement and sustain change and to address the challenges identified by the EPIC-CP pilot. Results: The final pilot ended in June 2015, and executive endorsement for EPIC-CP provincial implementation in March 2016. A schedule for multi-site phased implementation was informed by stakeholder consultations and began in Oct 2016. Technological privacy improvements were informed by 95 representatives creating a multidisciplinary team tasked with provincial oversight, development of EMR guidelines and IT solutions. Five patient and five clinical educational guides were designed to assist in symptom management, each focusing on one domain of EPIC-CP. Creation of the guides drew on the clinical and scientific expertise among 12 clinicians of varying disciplines in collaboration with four patients. This team assisted in enhancing communication processes by designing 21 training materials, including FAQs and narrated guides, accessible on a central communications hub. Conclusions: Results indicate that this framework-based, stakeholder-driven approach was successful and could be applied to other wide-scale implementations of symptom management tools.
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Collins, Nicholas C. "Daytime Exposure to Fish Predation for Littoral Benthic Organisms in Unproductive Lakes." Canadian Journal of Fisheries and Aquatic Sciences 46, no. 1 (January 1, 1989): 11–15. http://dx.doi.org/10.1139/f89-002.
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Fish activity near the bottom was monitored in two central Ontario lakes using time-lapse video equipment. Predation risk for benthic invertebrates was measured as the frequency of fish entries into a hypothetical cylinder with dimensions such that an imaginary 2–3 mm invertebrate at the bottom-center of the cylinder would be within the detection radius of any fish entering the space. By this criterion, risk of predation is high, even in lakes with low fish densities. For 7 d of data spread over different lakes, sites, and months, the median rate of exposure of the hypothetical invertebrate to passing fish was 14.2 times/h; the median rate of exposure to fish that stopped or turned as if foraging was 3 times/h. Exposure to benthivorous fish varied markedly between two lakes in June and within a lake between June and August. Changes in the fish species, sizes, and level of activity all contributed to the variance. Exposure to fish also varied markedly among days, within a day, and among sites within a lake. Differences in predation risk between two neighboring sites were consistent for several days, suggesting that some of the patchiness in benthic invertebrate composition might be generated by patchy fish exploitation. The high median levels of exposure to fish suggest that benthic organisms should spend a high proportion of their time in risk-reducing positions or behaviors, so that competition among fish caused by resource depression will be important.
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Clowes, Ron M. "Logan Medallist 5. Geophysics and Geology: An Essential Combination Illustrated by LITHOPROBE Interpretations–Part 2, Exploration Examples." Geoscience Canada 44, no. 4 (December 19, 2017): 135–80. http://dx.doi.org/10.12789/geocanj.2017.44.125.
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Lithoprobe (1984–2005), Canada’s national, collaborative, multidisciplinary, Earth Science research project, investigated the structure and evolution of the Canadian landmass and its margins. It was a highly successful project that redefined the nature of Earth science research in Canada. One of many contributions deriving from the project was the demonstration by example that Earth scientists from geophysics and geology, including all applicable sub-disciplines within these general study areas, must work together to achieve thorough and comprehensive interpretations of all available data sets. In Part 1, this statement was exemplified through studies involving lithospheric structures. In Part 2, it is exemplified by summarizing interpretations from six exploration-related studies derived from journal publications. In the first example, subsurface structures associated with the Guichon Creek batholith in south-central British Columbia, which hosts porphyry copper and molybdenum deposits, are better defined and related to different geological phases of the batholith. Reprocessed seismic reflection data and 2.5-D and 3-D inversions of magnetic and gravity data are combined with detailed geological mapping and drillhole information to generate the revised and improved subsurface interpretation. Research around the Bell Allard volcanogenic massive sulphide deposit in the Matagami region of northern Quebec provides the second example. A seismic reflection line over the deposit shortly after it was discovered by drilling, aided by core and geophysical logs, was acquired to test whether the deposit could be imaged. Direct detection of the ore body from the seismic section would be difficult if its location were not already known; however, structural characteristics that can be tied to lithologies from boreholes and logs were well identified. Nickel deposits and associated structures in the Thompson belt at the western limit of the Superior Province in northern Manitoba were the focus of seismic and electromagnetic (EM) studies combined with geology and physical property measurements. The combined seismic/EM image indicates that the rocks of the prospective Ospwagan Group, which have low resistivity, extend southeastward beneath the Archean gneiss and that structural culminations control the subsurface geometry of the Ospwagan Group. The Sudbury structure in Ontario is famous for its nickel deposits, the largest in the world, which formed as the result of a catastrophic meteorite impact. To help reconcile some of the enigmas and apparent contradictions surrounding studies of the structure and to develop more effective geophysical techniques to locate new deposits, Lithoprobe partnered with industry to carry out geophysical surveys combined with the extensive geological information available. A revised structural model for the Sudbury structure was generated and a 3-D seismic reflection survey identified a nickel deposit, known from drilling results, prior to any mine development. The Athabasca Basin of northwestern Saskatchewan and northeastern Alberta is one of the world’s most prolific producers of uranium from its characteristically high-grade unconformity-type deposits and is the only current uranium producer in Canada. An extensive database of geology, drillhole data and physical properties exists. Working with industry collaborators, Lithoprobe demonstrated the value of high-resolution seismic for imaging the unconformity and faults associated with the deposits. The final example involves a unique seismic reflection experiment to image the diamondiferous Snap Lake kimberlite dyke in the Slave Province of the Northwest Territories. The opportunity to study geological samples of the kimberlite dyke and surrounding rocks and to ground-truth the seismic results with drillhole data made available by the two industry collaborators enabled a case history study that was highly successful.RÉSUMÉLithoprobe (1984-2005), ce projet de recherche pancanadien, multidisciplinaire et concerté en sciences de la Terre, a étudié la structure et l'évolution de la croûte continentale canadienne et de ses marges. Ça a été un projet très réussi et qui a redéfini la nature de la recherche en sciences de la Terre au Canada. L'une des nombreuses retombées de ce projet a démontré par l'exemple que les spécialistes des sciences de la Terre en géophysique et en géologie, y compris toutes les sous-disciplines applicables dans ces domaines d'étude généraux, doivent travailler de concert afin de parvenir à une interprétation exhaustive de tous les ensembles de données disponibles. Dans la partie 1, cette approche s'est concrétisée par des études portant sur les structures lithosphériques. Dans la partie 2, elle a produit un résumé des interprétations tirées de six études liées à l'exploration à partir de publications dans des revues scientifiques. Dans le premier exemple, les structures souterraines associées au batholite du ruisseau Guichon, dans le centre-sud de la Colombie-Britannique, et qui renferme des gisements porphyriques de cuivre et de molybdène, sont maintenant mieux définies et mieux reliées aux différentes phases géologiques du batholite. Un retraitement des données de sismique réflexion, et d’inversion magnétique et gravimétrique 2,5-D et 3-D combiné à une cartographie géologique détaillée et à des données de forage ont permis une interprétation révisée et améliorée du de subsurface. La recherche autour du gisement de sulfures massifs volcanogéniques de Bell Allard de la région de Matagami, dans le nord du Québec, est un deuxième exemple. Un levé de sismique réflexion réalisé au-dessus du gisement, peu après sa découverte par forage, couplé avec des diagraphies géophysiques et de carottes, a été réalisé pour vérifier si l'ensemble pouvait donner une image du gisement. La détection directe du gisement de minerai à partir de la coupe sismique serait difficile si son emplacement n'était pas déjà connu; cependant, les caractéristiques structurales qui peuvent être liées aux lithologies déduites des forages et des diagraphies ont été bien définies. Les gisements de nickel et les structures qui y sont reliées dans la bande de Thompson, à la limite ouest de la province du Supérieur, dans le nord du Manitoba, ont fait l'objet d'études sismiques et électromagnétiques (EM), combinés à des mesures de caractéristiques géologiques et physiques. L'image sismique/EM combinée indique que les roches du groupe d’intérêt d’Ospwagan, lesquelles ont une résistivité faible, s'étendent vers le sud-est sous le gneiss archéen et, les culminations structurales contrôlent la géométrie souterraine du groupe d’Ospwagan. La structure de Sudbury, en Ontario, est réputée pour ses gisements de nickel, les plus importants au monde, lesquels se sont formés à la suite d'un impact météoritique catastrophique. Pour aider à comprendre certaines des énigmes et résoudre d’apparentes contradictions entourant les études de la structure, et pour développer des techniques géophysiques plus efficaces afin de localiser de nouveaux gisements, Lithoprobe s'est associé à l'entreprise privée pour réaliser des levés géophysiques, et les comparer aux très nombreuses informations géologiques disponibles. Une révision du modèle structural du gisement de Sudbury, ajouté à un levé sismique réflexion tridimensionnelle, ont permis de circonscrire un gisement de nickel, avant tout autre travail de développement minier. Le bassin de l'Athabasca, dans le nord-ouest de la Saskatchewan et le nord-est de l'Alberta, est l'un des producteurs d'uranium les plus prolifiques au monde provenant de gisements à haute teneur de type discordant, et est le seul producteur d'uranium au Canada. Une volumineuse base de données sur la géologie, les forages et les propriétés physiques est disponible. En collaboration avec des entreprises privées, Lithoprobe a démontré la valeur de la sismique à haute résolution pour l'imagerie de la discordance et des failles associées aux gisements. Le dernier exemple est celui d'une expérience de sismique réflexion unique visant à représenter le dyke de kimberlite diamantifère du lac Snap dans la province des Esclaves, dans les Territoires du Nord-Ouest. L'occasion d'étudier des échantillons géologiques du dyke de kimberlite, et des roches environnantes, et de valider les résultats sismiques à l'aide des données de forage mises à disposition par les deux partenaires privés, a permis une étude de cas très fructueuse.
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Hummer, Kim E. "History of the Origin and Dispersal of White Pine Blister Rust." HortTechnology 10, no. 3 (January 2000): 515–17. http://dx.doi.org/10.21273/horttech.10.3.515.
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The center of diversity for white pine blister rust (WPBR) (Cronartium ribicola J.C. Fischer) most likely stretches from central Siberia east of the Ural Mountains to Asia, possibly bounded by the Himalayas to the south. The alternate hosts for WPBR, Asian five-needled pines (Pinus L.) and Ribes L. native to that region have developed WPBR resistance. Because the dispersal of C. ribicola to Europe and North America occurred within the last several hundred years, the North American five-needled white pines, Pinus subsections, Strobus and Parya, had no previous selection pressure to develop resistance. Establishment of WPBR in North American resulted when plants were transported both ways across the Atlantic Ocean. In 1705, Lord Weymouth had white pine (P. strobis L.), also called weymouth pine in Europe, seed and seedlings brought to England. These trees were planted throughout eastern Europe. In the mid-1800s, WPBR outbreaks were reported in Ribes and then in white pines in eastern Europe. The pathogen may have been brought to Europe on an infected pine from Russia. In the late 1800s American nurserymen, unaware of the European rust incidence, imported many infected white pine seedlings from France and Germany for reforestation efforts. By 1914, rust-infected white pine nursery stock was imported into Connecticut, Indiana, Massachusetts, Minnesota, New Hampshire, Ohio, Pennsylvania, Vermont, and Wisconsin, and in the Canadian provinces of Ontario, Quebec, and British Columbia. The range of WPBR is established in eastern North America and the Pacific Northwest. New infection sites in Nevada, South Dakota, New Mexico and Colorado have been observed during the 1990s.
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Willison, Donald J., Kathryn A. Gaebel, E. Keith Borden, Mitchell Ah Levine, Jeffrey W. Poston, Charles H. Goldsmith, and Bruce Wong. "Experience in The Development of a Postmarketing Surveillance Network: The Pharmacy Medication Monitoring Program." Annals of Pharmacotherapy 29, no. 12 (December 1995): 1208–13. http://dx.doi.org/10.1177/106002809502901203.
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Objective: To describe the pilot and early implementation phase of a system for assembling and recruiting cohorts of patients taking selected prescription medications and prospectively monitoring them for new health events. Design: Prospective observational study, based on telephone interviews, of 1475 patients filling prescriptions for a nonsteroidal antiinflammatory drug (NSAID). Patients were interviewed by telephone using trained interviewers at a central site. Hospitalizations and deaths were followed up and reviewed by an independent physician. Setting: Community setting in a region of Hamilton, Ontario, Canada. Participants: All consenting patients filling new or repeat prescriptions for NSAIDs at participating pharmacies. Main Outcome Measures: The authors report on the development and assessment of systems for: (1) ongoing recruitment of patients through community pharmacies; (2) data transfer from pharmacies to the coordinating center; (3) surveying patients; (4) classifying, coding, and evaluating new health events; and (5) following up on new serious adverse events. Results: Fifty-one percent of patients approached were recruited, and 83% of these provided completed interviews. For patients picking up their own medications, pharmacy workload varied from 4 to 10 minutes per patient approached. Nineteen percent of patients reported having a new health problem or unusual symptom at the initial telephone interview. Reported health-related events were similar to those described in other studies of NSAIDs. Conclusions: Most aspects of the monitoring system performed well. One limitation was the low recruitment rate for patients who did not directly drop off or pick up their own prescriptions. Even so, this method of patient accrual may complement alternative monitoring programs.
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Gibson, Paul James, Uma H. Athale, Vicky Rowena Breakey, Nicole Mittmann, Mylene Bassal, Mariana Silva, Serina Patel, et al. "Predictors of clinical trial enrollment and impact on outcome in children and adolescents with acute lymphoblastic leukemia: A population based study." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 7031. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.7031.
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7031 Background: Outcomes in pediatric acute lymphoblastic leukemia (ALL) have shown remarkable improvements in large part due to sequential clinical trials. Concerns however persist around whether access to clinical trials is equitable. It is also unclear whether patient outcomes are improved simply by enrolling on a clinical trial. Our objective was to therefore determine which patient and disease-related factors are associated with enrollment, and whether enrollment was associated with clinical outcomes among children and adolescents with ALL in a single-payer health system in Ontario, Canada. Methods: We included all Ontario patients diagnosed with ALL between 0-18 years of age from 2002-2012 treated at a pediatric center, identified through a provincial pediatric cancer registry. Clinical trial availability was determined by whether each patient’s primary institution had an open frontline trial for which the patient was eligible at the time of their diagnosis, considering individual disease characteristics such as lineage, central nervous system (CNS) status and risk group. Demographic, disease, trial enrolment, and outcome data were obtained through chart abstraction. Logistic regression models determined factors associated with trial enrolment, while Cox proportional hazard models determined factors associated with event-free and overall survival (EFS, OS). Results: Of 858 patients, 693 (81%) were eligible for an open clinical trial at their time of diagnosis. 476 (69%) enrolled on a trial. In adjusted analyses, age > 15 years (odds ratio 0.4 vs. age 5-9, 95th confidence interval (95CI) 0.2-0.8; p = 0.01) and CNS3 disease (OR 0.38 vs. CNS1, 95CI 0.17-0.83; p = 0.01) were significantly associated with decreased likelihood of enrolment, while sex and neighborhood income quintile were not associated with enrolment. Adjusted for disease and demographic factors, clinical trial enrolment was not significantly associated with either EFS (hazard ratio (HR) 1.1, 95CI 0.7-1.7; p = 0.83) or OS (HR 1.3, 95CI 0.7-2.5; p = 0.44). Conclusions: The majority of patients with ALL eligible for available clinical trials at their time of diagnosis were enrolled. While no disparities in enrolment by income status were noted, adolescents were substantially less likely to participate in trials even within pediatric centers. Studies of mechanisms underlying this disparity are warranted in order to design and implement effective interventions targeting increased enrolment rates in this patient population. Our results however also suggest that clinical trial enrolment on its own is not associated with improved outcomes in the context of a single payer health system.
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LeDrew, Robyn, Erika Bariciak, Richard Webster, Nick Barrowman, and Alexandra Ahmet. "Evaluating the Low-Dose ACTH Stimulation Test in Neonates: Ideal Times for Cortisol Measurement." Journal of Clinical Endocrinology & Metabolism 105, no. 12 (September 8, 2020): e4543-e4550. http://dx.doi.org/10.1210/clinem/dgaa635.
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Abstract Context Low-dose adrenocorticotropic hormone stimulation testing (LDST) can be used to diagnose central adrenal insufficiency. However, uncertainty remains over optimal times to draw serum cortisol levels. Objective To determine optimal times to draw serum cortisol levels for the LDST in neonates. Design A retrospective chart review of LDSTs performed on neonates from January 1, 2009 to September 30, 2017. Setting Children’s Hospital of Eastern Ontario (CHEO), a tertiary-care outborn pediatric center. Patients Forty-nine patients were included: 23 (46.9%) born at term, 12 (24.5%) born very preterm to late preterm, and 14 (28.6%) born extremely preterm. Intervention Cortisol levels were drawn at baseline and 15, 30, and 60 minutes following administration of Cortrosyn 1 mcg/kg (maximum dose 1 mcg). Main Outcome Measure Timing of peak cortisol level and marginal value of drawing a second and third cortisol sample at 15, 30, or 60 minutes was determined. Results Cortisol peaked at 15-, 30-, and 60-minute sampling times for 4%, 27%, and 69% of patients, respectively. The probability that a failed LDST changes to a pass by adding a 15- or 30-minute sample to the superior 60 minute sample is 5.6% (1% to 25.8%) and 11% (3.1% to 32.6%), respectively, for a cortisol pass threshold of 18.1mcg/dL (500 nmol/L). Conclusions In contrast to studies of older children, we found that the majority of neonatal LDST cortisol peaks occurred at the 60-minute sampling time with the addition of a 30-minute sample providing substantial benefit. It is questionable if a 15-minute sample provides any benefit, making a case to revise LDST protocols to sample cortisol later for neonates.
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Fisher, Kathryn, Maureen Markle-Reid, Jenny Ploeg, Amy Bartholomew, Lauren E. Griffith, Amiram Gafni, Lehana Thabane, and Marie-Lee Yous. "Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada." Journal of Comorbidity 10 (January 1, 2020): 2235042X2096339. http://dx.doi.org/10.1177/2235042x20963390.
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Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.
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Lang, Daniel W. "Self-regulation with rules." Quality Assurance in Education 23, no. 3 (July 6, 2015): 216–32. http://dx.doi.org/10.1108/qae-09-2014-0046.
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Purpose – The purpose of this paper is to discuss how the province over time has addressed problems that are generic to many jurisdictions in assuring quality: level of aggregation, pooling, definition of new and continuing programs, scope of jurisdiction, role of governors, performance indicators, relationship to accreditation, programs versus credentials, benchmarking and isomorphism. The paper will pay particular attention to the balance between institutional autonomy in promoting quality and innovation in contrast to system-wide standards for assuring quality. The Province of Ontario has had some form of quality assurance since 1969. For most of the period since then, there were separate forms for undergraduate and graduate programs. Eligibility for public funding is based on the assurance of quality by a buffer body. In 2010, after two years of work, a province-wide task force devised a new framework. Design/methodology/approach – The structure of the paper is a series of “problem/solution” discussions, for example, aggregation, pooling, isomorphism and jurisdiction. Findings – Some problems are generic, for example, how to define a “new” program. Assuring quality and enhancing quality are fundamentally different in terms of process. Research limitations/implications – Although many of the problems discussed are generic, the paper is based on the experience of one jurisdiction. Practical implications – The article will be useful in post-secondary systems seeking to balance autonomy and innovation with central accountability and standardization. It is particularly applicable to undifferentiated systems. Social implications – Implications for public policy are mainly about locating the most effective center of gravity between assuring quality and enhancing quality, and between promoting quality and ensuring accountability. Originality/value – The approach of the discussion and analysis is novel, and the results portable.
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King, Lauren K., Esther J. Waugh, C. Allyson Jones, Eric Bohm, Michael Dunbar, Linda Woodhouse, Thomas Noseworthy, Deborah A. Marshall, and Gillian A. Hawker. "Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study." BMJ Open 11, no. 6 (June 2021): e047061. http://dx.doi.org/10.1136/bmjopen-2020-047061.
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ObjectiveTo assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA).DesignProspective cohort study.SettingTwo provincial central intake hip and knee centres in Alberta, Canada.Participants1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA.Primary and secondary outcome measuresPre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA.ResultsMean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least one comorbidity. Individuals with a higher number of comorbidities had worse pre-TKA and post-TKA scores for pain, physical function and 6MWT distance. At 12-month follow-up, mean changes in pain, function and 6MWT distance, and proportion reporting a PASS, were similar for those with and without comorbidities. In multivariable regression analysis, adjusted for potential confounders and clustering by surgeon, no specific comorbidities nor total number of comorbidities were associated with less improvement in pain, physical function or 6MWT distance at 12 months after TKA. Patients with diabetes (OR 0.64, 95% CI 0.44 to 0.94) and a higher number of lower extremity troublesome joints (OR 0.85, 95% CI 0.76 to 0.96) had lower odds of reporting a PASS.ConclusionFor individuals with knee OA, comorbid conditions do not limit improvement in pain, physical function or walking ability after TKA, and most conditions do not impact achieving an acceptable symptom state.
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Mohammed, Shan Darrel, Pamela Savage, and Camilla Zimmermann. "Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 98. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.98.
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98 Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.