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Background Over the past decade, mammography has transitioned from film to digital media with promises of increased productivity and time savings. Between 2007 and 2010 in Nova Scotia, 10 mammography sites transitioned from analog to digital, providing a natural experiment to evaluate the transition (full-field digital mammography) on mammography with respect to changes in throughput volumes in a “real-world” setting. Methods Study data consisted of aggregate, monthly, site-specific counts of screening and diagnostic mammograms for the period 2006 to 2014, which were obtained from an information system that supports central booking, clinical reporting, and patient management for all breast imaging in Nova Scotia. A multigroup interrupted time series design using segmented regression with site-month data assessed pre-to post-transition changes in screening throughput volumes and the proportion of diagnostic mammograms performed. Results The overall mean monthly number of mammograms per machine per full-time equivalent increased by 17% from 192.9 (95% confidence interval: 182.7–203.1) to 225.7 (95% CI 218.3–233.0); however, there was marked heterogeneity across these sites. A pooled analysis for all sites revealed that there was no statistically significantly change in the proportion of diagnostic mammograms performed after transition. Conclusions Increases in throughput volumes were observed only in some sites, suggesting unmeasured site-specific factors may have limited the potential for improvement. Interrupted time series methods are an appropriate and meaningful approach for evaluating technology and procedure changes in diagnostic imaging.

The Diabetes Care Program of Nova Scotia (DCPNS)‘s mission is “to improve, through leadership and partnerships, the health of Nova Scotians living with, affected by, or at risk of developing diabetes.” Working together with local, provincial and national partners, the DCPNS has improved and standardized diabetes care in Nova Scotia over the past 25 years by developing and deploying a resourceful and collaborative program model. This article describes the model and highlights its key achievements. With balanced representation from frontline providers through to senior decision makers in health care, the DCPNS works across the age continuum, supporting the implementation of national clinical practice guidelines and, when necessary, developing provincial guidelines to meet local needs. The development and implementation of standardized documentation and data collection tools in all diabetes centres created a robust opportunity for the development and expansion of the DCPNS registry. This registry provides useful clinical and statistical information to staff, providers within the circle of care, management and senior leadership. Data are used to support individual care, program planning, quality improvement and business planning at both the local and the provincial levels. The DCPNS supports the sharing of new knowledge and advances through continuous education for providers. The DCPNS's ability to engage diabetes educators and key physician champions has ensured balanced perspectives in the creation of tools and resources that can be effective in real-world practice. The DCPNS has evolved to become an illustrative example of the chronic care model in action.

The disclosure of inside information is a core component of EU capital market regulation. It underpins the market abuse regime, providing information to investors, and robbing it of its “inside” quality. Different regimes tackle the issue of inside information disclosure in distinct ways. The EU regime of continuous disclosure stands in sharp contrast to the approach adopted in the US and this paper considers the pros and cons of the EU’s approach. This paper argues that the EU provisions are preferable, and are more likely to promote market efficiency, but the EU regime also creates potential dangers and disadvantages for companies who are the subject of the disclosure obligations. Sufficient flexibility is therefore needed to capture the benefits of continuous disclosure without imposing undue burdens on issuers in the process.

The European Commission published a draft Directive in November 2016, with the aim of ensuring that all Member States have in place an effective mechanism for dealing with viable, but financially distressed, businesses. The draft Directive includes provisions designed to encourage financing for the debtor company, both interim financing to “keep the lights on” for a brief period while the debtor negotiates with its creditors for a resolution to its financial distress, and where possible, to finance implementation of a restructuring plan, called “new financing” in the draft Directive. Creating such a financing regime is a complex and difficult issue, as the law’s intervention in this area often involves constraints on the rights of existing creditors, requiring that a careful balance is maintained between existing creditors’ rights and the rights of the interim financier. This paper examines the underlying policy rationale and benefits of having new and interim financing available to financially distressed debtor companies, and discusses the risks involved. It examines the EU Commission’s proposals in light of the experience of jurisdictions that have already tackled these issues, notably the United States and Canada, or have developed a market-based solution to this problem, such as the UK. While the European Commission’s wish to include such measures in its restructuring proposals is laudable, the measures as drafted raise concerns, particularly regarding risks associated with priority for the grantors of such finance. The authors suggest that there are four fundamental aspects of such financing on which the Directive could give guidance to Member States, namely, effective notice to pre-filing creditors, thresholds for the debtor to qualify, a menu of relevant criteria to balance benefit and prejudice, and a role for the court in resolving disputes, ensuring fairness to stakeholders, and serving as an accountability check on interim financing arrangements, all aimed at maintaining the integrity of the insolvency process.

The importance of regimes containing an effective mechanism to enable the rescue of distressed but viable businesses is increasingly recognised. In the UK the importance of developing a rescue culture has been appreciated for some time and a number of different mechanisms exist which can be used to restructure the debt of distressed companies. The purpose of this paper is to assess the debt restructuring mechanisms currently available to companies in English law and to consider whether reform is needed. There have been a number of calls for the reform of English debt restructuring mechanisms in recent years, most recently by the UK Insolvency Service in 2016, and these reform proposals are analysed and assessed. It is suggested that reform is needed, but that these reforms will need to be introduced with skill and care in order to ensure that the UK’s regime remains fit for purpose for the future.

Over a 10-year period (January 1993 to October 2002), 101 relapsed or refractory non-Hodgkin lymphoma patients were treated at our center with high-dose chemotherapy and autologous transplantation. The median patient age was 54 years (range, 25-70 years). Thirty-two patients had indolent (low-grade), 42 had aggressive (intermediate-grade), and 27 had very aggressive (high-grade) non-Hodgkin lymphoma. Thirty-six patients had primary refractory disease, 20 had a chemoresistant relapse, 35 patients had a chemosensitive relapse, and 10 patients were "initial high risk" patients. The median number of prior chemotherapy regimens was 2 (range, 1-5). The preparative regimen (BEP) was bischloroethylnitrosourea (BCNU) 600 mg/m 2 , etoposide 2400 mg/m 2 , and Platinol (cisplatin) 200 mg/m 2 given intravenously over 5 days. Within 3 weeks before transplantation, 70 patients received involved-field radiotherapy (IFR) 20 Gy to sites of currently active (2 cm) or prior bulky (5 cm) disease. Most patients (n = 93) received mobilized peripheral blood stem cells (median CD34 + cell dose, 6.7 x 10 6 /kg). Median neutrophil (500/microL) and platelet (20 000/microL, untransfused) recoveries were 11 days (range, 7-19 days) and 14 days (range, 7-36 days), respectively. At a median follow-up of 41 months (range, 4 to 118 months) for survivors, Kaplan-Meier 5-year probabilities of overall survival (OS) and disease-free survival (DFS) were 58.6% and 51.1%, respectively. Four patients (4%) died within 30 days of stem cell infusion (1 pulmonary embolism, 2 septicemias with multiorgan failure, and 1 progressive lymphoma). Two patients (2%) developed interstitial pneumonitis most likely secondary to high-dose BCNU. Three cases (3%) of secondary acute myelogenous leukemia occurred. On multivariate analysis, age (60 oror =60 years), histologic grade (low versus intermediate or high), the use of IFR, and chemotherapy response at baseline did not affect OS or DFS. Of 70 patients given IFR, 27 relapsed: 10 (37%) within and 17 (63%) outside the radiation field. The use of IFR did not affect either OS or DFS, probably because IFR was offered to patients with bulky or chemoresistant disease. BEP with or without IFR is a highly effective and well-tolerated regimen in the relapsed/refractory lymphoma setting. It has low morbidity and transplant-related mortality and a low incidence (3%) of posttransplantation malignancy.

This paper assesses the debt restructuring mechanisms available to companies in English law, compares these mechanisms with the Chapter 11 procedure in the US, and makes some suggestions for reform of the English system in this context. Rehabilitating a company in financial difficulties will almost always be preferable to liquidation for companies and their creditors, at least where the company is merely financially distressed, i.e. it is cash flow insolvent but nevertheless economically viable, so that there is a business worth saving. Five debt restructuring mechanisms are available to companies in English law: workouts, Company Voluntary Arrangements (CVAs), schemes of arrangement, administration and, lastly, a recent innovation of practitioners has been to twin a scheme of arrangement with administration. None of these devices are ideal as debt restructuring tools, as explained in this paper. Lessons can be learned from the US Chapter 11 process, although a simple transplantation of this procedure into English law is not recommended, as there are also disadvantages to the US procedure. Instead it is suggested that the English scheme of arrangement be reformed to allow a cramdown of whole classes to take place, to attach a moratorium to this procedure and to enhance the valuation process where restructuring takes place. Making these changes would provide English law with a stronger and more effective debt restructuring procedure.

Schemes of arrangement originated in England but have since spread to a number of other common law jurisdictions. One of the most common uses of schemes is to effect a change of control transaction, as an alternative to a takeover offer. In some jurisdictions schemes have become the mechanism of choice for recommended bids. Jurisdictions differ in their response to this use of schemes. As regards English schemes, the legislative provisions, the courts and the regulatory authorities are neutral as to whether a change of control is effected by way of a scheme or a takeover offer. By contrast, some jurisdictions, such as Australia, have put in place legislative provisions that potentially constrain this use of schemes, and other jurisdictions make changes to the operation of schemes (such as increasing the approval threshold) which seem designed to respond to concerns regarding the operation of schemes in this context. This paper explores the use of schemes to effect change of control transactions, including their advantages and disadvantages compared to a takeover offer. The concerns raised regarding this use of schemes are discussed and analysed, and the approach regarding English schemes is compared with that of other jurisdictions where a different approach is taken. These include Australia, New Zealand and Hong Kong. The paper questions whether the English approach can be defended, and concludes that it can, as a result of the significant safeguards in place to prevent abuse, in particular the oversight of the court in the process and the fact that the UK Takeover Code covers change of control transactions effected via schemes as well as via takeover offers.

Schemes of arrangement are an extremely valuable tool for manipulating a company's capital. Nothing in the Companies Act 2006 prescribes the subject matter of a scheme. In theory a scheme could be a compromise or arrangement between a company and its creditors or members about anything which they can properly agree amongst themselves. However, one of the most common uses of a scheme is as an alternative to a takeover offer. Indeed, in recent years schemes of arrangement have become the structure of choice for recommended bids. This paper examines the use of schemes of arrangement as an alternative to takeover offers, and in particular compares the level of protection for minority shareholders available under both structures. It might be expected that the level of protection would be equivalent, but this is not the case in practice. Significantly greater protection is put in place for minority shareholders in the target company by takeover regulation than exists in the context of a scheme. However, the purpose of minority protection is quite different within these two structures. This article suggests that the lower level of protection available for minority shareholders in schemes is justified within this context.

s / Can J Diabetes 37 (2013) S6eS11 S11 immigration records for 592376 immigrants to Ontario, Canada. We used Cox-Proportional Hazard models to generate adjusted incidence rates by ethnicity, sex and age and to determine the age cutoffs at which different ethnicities experienced equivalent risk of developing diabetes. Findings: South Asians had the highest overall incidence rate (agesex adjusted rate of 15.7 per 1000 person years), which was 3.3 times higher than in Western Europeans (p