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The philosopher David Hume is renowned in international monetary economics for his 1752 analysis of the specie-flow mechanism of international adjustment. He has been viewed in the literature as an abstract theorist, writing without direct practical experience of public policy or monetary affairs. This paper shows Hume in the unfamiliar role of a British diplomat negotiating the settlement of the outstanding paper money of New France after the British conquest of Canada. [ABSTRACT FROM AUTHOR]

Looks at the turnaround safety performance in the Kenora, Ontario pulp and paper mill of Rainy River Forest Products Inc. which used a questionnaire survey technique. Description on the model developed for safety management; Elements assessed in the questionnaire developed; Survey results; Steps taken by the company to improve its safety rules. INSET: Beliefs & Practices for Excellence in Safety on Which the Model.

Examines whether library reference staff are cognizant of newspapers as a potential source of reference information, and explores what happens when library staff members make referrals--often a sign that they do not know the answer to the question themselves. Discusses results of a recent study of public libraries in Canada which revealed that reference staff are not making good use of this source. (Contains 17 references.) (AEF)

The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Previous position papers have confirmed to varying degrees associations between periodontal microbes and respiratory tract infections such as nosocomial or hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary diseases (COPD). Causal relationships have not been confirmed and have been the source of much confusion for the medical and oral health professions., Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal microbes and respiratory diseases, with a focus on HAP and VAP., Methods: The PICO question was "For patients in hospitals, nursing homes or long-term care facilities who are at high risk for respiratory infections, will an oral care intervention such as toothbrushing, administration of antimicrobial agents, and/or professional care, as compared to no oral care intervention (or usual oral care) reduce the risk for respiratory infections?" Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 47 respiratory studies retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 10 SRs were selected, 9 of which included MAs. Although there was evidence that administration of chlorhexidine gluconate (CHX) reduced the risk for VAP, none existed for HAP. Limitations included inconsistencies among studies in population groups, CHX concentration, frequency of administration, number of applications, and insufficient evidence for use of povidone iodine or toothbrushing in ventilated patients. While some studies reported other patient-centred outcomes (i.e., ICU mortality, length of ICU stay or duration of mechanical ventilation), findings were positive only for cardiac surgery ventilated patients, who did not meet the inclusion criteria., Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal microbes/oral health care and respiratory diseases such as pneumonia., Competing Interests: The authors have declared no conflicts of interest, (Copyright © 2020, CDHA | ACHD.)

Objective: The objective of the study was to compare multimorbidity prevalence using self-reported and administrative data and identify factors associated with agreement between data sources., Study Design and Setting: Self-reported cross-sectional data from four Canadian Community Health Survey waves were linked to administrative data in Ontario, Canada. Multimorbidity prevalence was examined using two definitions, 2+ and 3+ chronic conditions (CCs). Agreement between data sources was assessed using Kappa and Phi statistics. Logistic regression was used to estimate associations between agreement and sociodemographic, health behavior, and health status variables for each multimorbidity definition., Results: Regardless of multimorbidity definition, prevalence was higher using administrative data (2+ CCs: 55.5% vs. 47.1%; 3+ CCs: 30.0% vs. 24.2%). Agreement between data sources was moderate (2+ CCs K = 0.482; 3+ CCs K = 0.442), and while associated with sociodemographic, health behavior, and health status factors, the magnitude and sometimes direction of association differed by multimorbidity definition., Conclusion: A better understanding is needed of what factors influence individuals' reporting of CCs and how they align with what is in administrative data as policy makers need a solid evidence base on which to make decisions for health planning. Our results suggest that data sources may need to be triangulated to provide accurate estimates of multimorbidity for health services planning and policy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to describe agreement between administrative and self-report data on the number and type of chronic conditions (CCs) and determine whether associations between CC count and health service use differ by data source., Study Design and Setting: We linked Canadian Community Health Survey and administrative data for a cohort of adults aged 45+ years in Ontario and identified 12 CCs from both data sources. Agreement was described by count and constituent CCs. We estimated associations between CC count (self-report and administrative data) and health service use (administrative data only) over 1 year., Results: Among 71,317 adults, 26.9% showed agreement on both count and constituent CCs but agreement declined with increasing CCs. Health service use increased with CC count but the association was stronger when CCs were measured with administrative data. For example, when measured with administrative data, the odds of a general practitioner visit for 5+ CCs vs. none was 20.3 (95% CI 20.0-20.5) but when using self-report data, the estimate was 8.0 (95% CI 7.8-8.2)., Conclusion: Agreement on the number of CCs was low and resulted in different estimates on the association with health service use, illustrating the challenges in CC measurement and the ability to interpret the effects on outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion for the profession and public., Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes., Methods: The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes., Conclusion: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2020, CDHA | ACHD.)

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension., (© 2020 Wiley Periodicals, Inc.)

Objective: To contrast how Brazil's and Canada's different jurisdictional and judicial realities have led to different types of telemedicine and how further scale and improvement can be achieved., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada and Canadian telemedicine experts developed connections with colleagues in Porto Alegre, Brazil, and collaborated to undertake a between-country comparison of their respective telemedicine programs., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of telemedicine in Canada and Brazil., Report: Both Brazil and Canada share expansive geographies, creating substantial barriers to health for rural patients. Telemedicine is an important part of a universal health system. Both countries have achieved telemedicine programs that have scaled up across large regions and are showing important effects on health care costs and outcomes. However, each system is unique in design and implementation and faces unique challenges for further scale and improvement. Addressing regional differences, the normalization of telemedicine, and potential alignment of telemedicine and artificial intelligence technologies for health care are seen as promising approaches to scaling up and improving telemedicine in both countries., (Copyright© the College of Family Physicians of Canada.)

A vast amount of articles centered on brain metastases have been published. To present the 100 most-cited articles dedicated to brain metastasis and to accomplish a broad literature review. In December 2019, we performed a title-focused search using the Thomson Reuters Web of Science database to identify the most cited articles centered on brain metastatic disease. Our search query term was based on using the following algorithm: "brain metastases" OR "brain metastasis" OR "brain metastatic disease" OR "cerebral metastases" OR "cerebral metastasis" OR "cerebral metastatic disease." Afterward, we reviewed the results to certify that they were relevant to the purposes of our research protocol. The 100 most cited papers were chosen and further analyzed. Our search resulted in 11,579 articles, published from 1975 until the completion of our survey. The most cited article, by Patchell et al., was published in 1990, with 1862 citations, and an average of 62.07 citations per year, whereas the last in our list, by Gaspar et al., was published in 2010, with 195 total citations, and an average of 19.50 citations per year. Countries with the highest-cited articles included the United States (75 records), followed by Canada (16 records). We discovered the top 100 most-cited articles centered on brain metastasis, all of which show a potentially increased level of interest, because they are meaningful scientific reports. In addition, we reviewed the historical development and advances in brain metastasis research and relevant points of interest, alongside the relevant contributions of different authors, fields of special interest, and countries. Many of the most cited articles were written by authors whose specialty was not neurosurgery or by neurosurgeons who were supported by colleagues from other medical fields. As a consequence, many of these articles were not published in neurosurgery-dedicated journals. [ABSTRACT FROM AUTHOR]

This document is a comment on a previous article discussing the regulatory design of the Water Sustainability Act (WSA) in British Columbia, Canada. The comment argues that the WSA's regulatory design took a science-forward approach and considered specific regional factors. It addresses criticisms of the WSA and emphasizes the importance of licensing groundwater use for assessing environmental impacts. The WSA allows for nuanced water management through regulation-making authorities, but challenges remain in implementing the regulations, including Indigenous water rights and government resources. Recommendations for improving the WSA's design include defining sustainability goals, regionalizing regulatory action, and long-term planning. Ongoing resourcing and consideration of Indigenous rights are necessary for the effective implementation of the WSA. [Extracted from the article]

Features a study which focused on the methods of auditing occupational health and safety management systems in the paper and pulp industry of Canada. Methodology; Results and discussions.

This paper forms Part 2 of a two-part discussion paper. Part 1 outlined a short history of adoption in Canada, examined the impact of forced, closed, and external adoptions on Indigenous adoptees and families, and traced the move toward more open statutory adoptions and greater cultural continuity in adoptions. Having zeroed in on the entangled histories of adoption and colonization in Part 1, here we explore traditional and contemporary practices of Indigenous custom adoption and caretaking. We first recount Western understandings and impositions, then feature Indigenous perspectives that centre spiritual and ceremonial protocols, values regarding child well-being and community connectedness, and the importance of kinship and customary forms of caretaking. We consider both the promises and complexities involved in designing and implementing custom adoptions, and the urgent need for adequate, equitable funding and supports to ensure their feasibility and sustainability. Finally, we highlight the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance. [ABSTRACT FROM AUTHOR]

This paper forms Part 1 of a two-part discussion paper on Indigenous custom adoption. Zeroing in on the entangled histories of adoption and colonization, it outlines a short history of adoption in Canada, examines the impact of forced, closed, and external adoptions on Indigenous adoptees, and traces the move toward more open statutory adoptions and greater cultural connection and continuity in adoptions. This historical review sets the stage for Part 2 of our discussion paper, "Honouring Our Caretaking Traditions," where we highlight the connections between customary laws regarding caregiving and the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance. [ABSTRACT FROM AUTHOR]

Applied education, the integration of academic and vocational curricula, cannot supply the trained people needed by a rapidly changing society without sufficient planning and resources. Shortages of skilled workers are a societal issue requiring significant structural adjustment in the way skilled trades are managed. (JOW)

Examines the 19th-century Canadian paper money's iconographies. Discussion on the intersection of culture, society and economy; Indepth look at the consolidation of paper monies in the 18th and 19th centuries; Analysis of the design and production of paper money; Exploration of the national and imperial monetary narratives.

Efforts to prevent work-related injuries have met with tangible success in industrialized countries. In Quebec, workplace accidents and occupational illness have declined sharply since the end of the 1990s. However, there is still considerable room for improvement in small and medium-sized enterprises (SMEs). Expert specialists in accident prevention in SMEs are overloaded. Their interventions are repetitive and not personalised. Few tools are available for accelerating the process of evaluating occupational health and safety (OHS) performance. The aim of this research project was to address this deficiency by proposing a novel OHS performance evaluation tool better adapted to SMEs. For this purpose, research was carried out in two distinct phases. The first phase led to the theoretical model on which the tool is based. The second phase was carried out using an action research approach. The proposed tool was designed and improved during this phase, through field-testing and the involvement of a Quebec industrial partner. In spite of the limitations of this research, we have succeeded in developing a new tool with software support adapted specifically for the evaluation of OHS performance in SMEs. Upon completion of the project, a tested and improved version of the tool was delivered to the industrial partner. Experts in accident prevention have found the tool to be reliable and helpful. It has accelerated the identification of deficiencies in OHS management in several SMEs and has helped specialists to develop personalized and better-focused plans of action. [ABSTRACT FROM AUTHOR]

Since 2017, four provincial legislatures have introduced bills invoking the controversial notwithstanding clause. We present an original dataset of news articles from 10 different outlets that discussed the clause while these bills were being debated in Saskatchewan and Ontario. Empirically, although the clause is typically portrayed accurately, we find over one-fifth of articles about the clause did not indicate that it must be included in legislation. Normatively, the clause was twice as likely to be portrayed negatively as it was positively, and the type of portrayal was strongly associated with the ideological orientation of the news outlet. The rate of negative portrayals was similar across the two provinces, which suggests that attitudes toward the clause may endure beyond the policy issue itself or the level of media visibility. [ABSTRACT FROM AUTHOR]

The article discusses the research in the late 1980s which started a debate about the causes of reproductive impacts of pulp and paper mills on fishes and linkages with the effluents discharged. It mentions that the research affected environmental remediation efforts of the industry related to the aquatic ecosystems. It notes that the study resulted in the development of a standardized, environmental effects monitoring program in Canada.

The article offers information on the Combat Paper Project. This project assists veterans in reconciling and sharing their personal experiences through paper making workshops. The papermaking workshops allow the veterans to create cathartic works by using their uniforms worn in combat. Their old uniforms are being cut up and beaten into a pulp and then they will form it into sheets of paper. This project is being conducted in the U.S., Canada and Great Britain.

The recent introduction of new vaccines into the school-based immunization program in British Columbia (BC) included monitoring of adverse events following immunization (AEFI) for these new vaccines. This commentary discusses different methods used to collect AEFIs in school immunization campaigns and the effects on response rate. The results of a study using an internet-based tool inspired this paper. The study examined adverse events following human papillomavirus (HPV) vaccine given to grades 6 and 9 students. The low response rate of the internet survey resulted in insufficient findings regarding adverse events. Consequent to the analysis of the study's data, a literature review was conducted to examine survey methodologies used to collect adverse event data following school-based immunization of adolescents. A PubMed search used various combinations of the following terms: vaccine, immunization, immunization programs, reactogenicity, adverse reactions, safety, adolescent, schoolchildren, and survey. Potentially relevant papers were identified based upon the titles and abstracts and subsequently reviewed. Only four studies were deemed appropriate for comparison purposes: all were done in Canada.

Examines the impact of performing in `Marks on Paper' on 22 learner/actors from British Columbia, Canada between 1989-1992. Effect of the play on student's literacy; Background on the play; Literacy in British Columbia and Canada; Strategies for addressing illiteracy; Implications of the play on literacy.

Environmental Effects Monitoring (EEM) Programs in Canada have been developed for the pulp and paper and metal mining industries. The EEM Program conducts cyclical evaluations of receiving environments to determine whether effects exist when facilities comply with existing regulations. Investigation of cause (IOC) is a specific stage in the EEM Program that is used after environmental effects in fish and/or benthos have been detected, confirmed and their extent and magnitude have been documented. This paper presents an overview of the processes associated with this phase of monitoring. The objective of an IOC is to obtain sufficient information so that the source of the effect can be identified and removed, or its effects reduced to an acceptable level. The initial direction of an IOC is dependent upon the type of response patterns observed for fish and/or benthos during EEM cycles and extent/magnitude studies. The framework presented in this paper is based on an amalgamation of research projects conducted at Canadian pulp mills over the last decade and selected studies are summarized as examples. It also represents an integration of several research philosophies and scientific disciplines. The framework is based on national response patterns from the second cycle of pulp and paper EEM studies. IOCs are: directed into either an eutrophication-based investigation or a contaminant-based investigation (including metabolic disruption in fish). The framework is constructed with a progression of investigative levels designed to provide mole information on the causative factors. Each of these phases also represents a decision point for stakeholders to determine if sufficient information has been attained about the causal factor(s) and whether the IOC should be concluded. It is expected that the framework will evolve with a growing knowledge base of causal factors, as facilities enter into this phase of the EEM Program. [ABSTRACT FROM AUTHOR]

Objectives : This study evaluated a standardized paper triage process conducted by an advanced practice physiotherapist (APP) at a rheumatology center. The aims were to (1) determine the concordance between paper triage priority assignment and the rheumatologist's diagnosis; (2) determine the sensitivity and specificity of the paper triage process; and (3) assess reasons for incorrect priority ranking. Methods : Referrals were triaged by a formally trained APP into one of the three priorities, guided by a priority referral tool. A retrospective review of 192 charts was performed. Raw proportion of agreement between paper triage and rheumatologist's diagnosis was supplemented by a prevalence-adjusted bias-adjusted kappa (PABAK). Priority categories were collapsed to calculate sensitivity and specificity. For discordant cases, additional information was collected from the referral and chart to identify potential features leading to discrepancy. Results : Overall agreement was 76%. The PABAK was 0.80 [95% confidence interval 0.70-0.90]. Sensitivity ranged 0.64-0.92 and specificity ranged 0.81-0.94, depending on the priority category. Forty-six cases were discordant, with the APP choosing a higher priority in 37 cases. An incorrect diagnosis from the family physician with no supporting information for the paper triage led to discordance in 16 cases. Conclusion : A standardized paper triage process conducted by an APP showed substantial concordance, sensitivity, and specificity.

Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system. [ABSTRACT FROM AUTHOR]

Objective: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades., Methods: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil., Report: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil., (Copyright© the College of Family Physicians of Canada.)

The Canadian physician Sir William Osler is a key figure in the history of modern medicine. He encouraged lifelong learning for doctors, starting with bedside teaching. Contemporary with Old World figures such as Pasteur in Paris and Virchow in Berlin, he played a major role in raising awareness among clinicians of the importance of the scientific basis for the practice of medicine. He championed a rational approach to treatment and did much to encourage avoidance of 'unnecessary drugging' by prescribers. He is credited with playing a key role in improving education of medical students and postgraduate education of doctors, with important benefits for the care of hospital patients. He also had a major influence on his medical colleagues through founding and leading medical societies. A century on from his death in December 1919, his specific contributions and how he achieved them are not well known. The aim of this article is to consider the evidence that Osler was an influential medical leader and to reflect on the extent to which the achievements which resulted from his leadership are relevant to modern clinical medicine. Questions of interest include his leadership style, what made for his success as a leader, his medical achievements both in North America and in England, his own insight into leadership and how he was viewed by his peers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Full-scale anaerobic digestion processes for organic solid waste are common in Europe but are generally unaffordable in Canada and the United States because of inadequate regulations to restrict cheaper forms of disposal, particularly landfill. We investigated the viability of solid-state anaerobic digestion (SS-AD) as an alternative that reduces the costs of waste pretreatment and subsequent wastewater treatment. A laboratory SS-AD digester, comprising six 10 L leach beds and an upflow anaerobic sludge blanket reactor treating the leachate, was operated continuously for 88 weeks, with a mass balance based on chemical oxygen demand (COD) of 100 ± 2% (COD out /COD in ). The feed was a mixture of fibers (cardboard, boxboard, newsprint, and fine paper) with varying amounts of food waste added. The process remained stable throughout. The addition of food waste caused a synergistic effect, raising methane production from the fiber mixture from a low of 52.7 L kg -1 COD fibers added at no food waste, to 152 L kg -1 COD fibers added at 29% food waste, an increase of 190%. Substrate COD destruction efficiency reached 65%, and the methane yield reached 225 L kg -1 COD added at 29% food waste on a COD basis, with a solids retention time of 42 days. This performance was similar to that of a completely stirred tank reactor digesting similar wastes, but with much lower energy input. Multiple factors likely contributed to the enhanced fiber destruction, including the action of hydrolytic enzymes derived from fresh food waste and continuous leachate recirculation between leach beds of different ages.

Palliative care is an evolving field with extensive studies demonstrating its benefits to patients, families, and the health care system. Many health systems have developed or are developing palliative care programs. The Canadian Society of Palliative Care Physicians (CSPCP) is often asked to recommend how many palliative care specialists are needed to implement and support an integrated palliative care program. This information would allow health service decision makers and educational institutions to plan resources accordingly to manage the needs of their communities. The CSPCP is well positioned to answer this question, as many of its members are Directors of palliative care programs and have been responsible for creating and overseeing the pioneering work of building these programs over the past few decades. In 2017, the CSPCP commissioned a working group to develop a staffing model for specialist palliative care teams based on the interdependence of three key professional roles, an extensive literature search, key stakeholder interviews, and expert opinions. This article is the Canadian Society of Palliative Care's recommended starting point that will be further evaluated as it is utilized across Canada. For more information and to see sample calculations go to the Canadian Society of Palliative Care Physicians Staffing Model for Palliative Care Programs (https://www.cspcp.ca).

Wilder Penfield is justly famous for his contributions to our understanding of epilepsy and of the structure-function relationship of the brain. His theory on the relationship of the brain and mind is less well known. Based on the effects of the electrical stimulation of the cortex in conscious patients, Penfield believed that consciousness and mind are functions of what he referred to as the centrencephalic integrating system. This functional system comprised bidirectional pathways between the upper brainstem, the thalami, and the cerebral cortex of both hemispheres, and was the physical substrate from which memory, perception, initiative, will, and judgment arose. It was the source of the stream of consciousness and the physical basis of mind. This paper reviews how Penfield arrived at this conception of the mind-brain relationship. Although Penfield ultimately felt that he had failed in his attempt to unify brain and mind, his work shed new light on the relationship of memory to the mesial temporal structures and to the temporal cortex; and his association of consciousness and the brainstem preceded the conceptualization of the reticular activating system by a generation. In these, as in so many aspects of neurobiology, Penfield was prescient.

Objective: To develop an ethical framework for collaboration in international academic partnerships in family medicine., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships., Methods: Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017., Report: Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: accountability, cost and efficiencies, excellence, equity, humility, justice, leadership, reciprocity, respect for self-determination, and transparency. Based on these principles, a decision-making framework was created to translate these values into actions and to promote a cohesive and transparent structure for discussions. Fostering fairness, transparency, and consistency in decision making reduces the potential for inequity in a partnership, leading to lasting relationships that endure beyond the scope of a partnership agreement., (Copyright© the College of Family Physicians of Canada.)

Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients' nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.