bluuebunny/crossref_metadata_2025 huggingface dataset:
Inability To Detect Cross-Reactive Memory T Cells Challenges the Frequency of Heterologous Immunity among Common Viruses
Authors: Rowntree Louise C. , Nguyen Thi H. O. , Halim Hanim , Purcell Anthony W. , Rossjohn Jamie , Gras Stephanie , Kotsimbos Tom C. , Mifsud Nicole A.
Published: May 2018

Human memory T cells that cross-react with epitopes from unrelated viruses can potentially modulate immune responses to subsequent infections by a phenomenon termed heterologous immunity. However, it is unclear whether similarities in structure rather than sequence underpin heterologous T cell cross-reactivity. In this study, we aimed to explore the mechanism of heterologous immunity involving immunodominant epitopes derived from common viruses restricted to high-frequency HLA allotypes (HLA-A*02:01, -B*07:02, and -B*08:01). We examined EBV-specific memory T cells for their ability to cross-react with CMV or influenza A virus–derived epitopes. Following T cell immunoassays to determine phenotype and function, complemented with biophysical and structural investigations of peptide/HLA complexes, we did not detect cross-reactivity of EBV-specific memory T cells toward either CMV or influenza A virus epitopes presented by any of the selected HLA allomorphs. Thus, despite the ubiquitous nature of these human viruses and the dominant immune response directed toward the selected epitopes, heterologous virus-specific T cell cross-reactivity was not detected. This suggests that either heterologous immunity is not as common as previously reported, or that it requires a very specific biological context to develop and be clinically relevant.
L'Infrastructure canadienne de données : De meilleures connaissances pour de meilleures décisions
Authors:   GéoConnexions
Published: May 2018

Le présent document est une mise à jour de la Vision de l'Infrastructure canadienne de données géospatiales (ICDG) publiée en 2000. Même si les consultations et les recherches ont démontré que la vision initiale est
toujours valide, de nouvelles (*) idées y ont été intégrées.
Vision

*Faciliter l'accès aux sources de données géospatiales canadiennes exhaustives et qui font autorité pour soutenir la prise de décisions.
Mission

Faciliter la prise de décisions et l'élaboration de politiques correspondant aux priorités du Canada, notamment en matière de santé, de conditions sociales, culturelles, économiques et de ressources naturelles.
Faciliter l'accès aux principales sources de données géospatiales canadiennes.
Assurer une participation et un leadership continus dans l'élaboration de normes et de spécifications géospatiales.
Favoriser les partenariats et le partage de l'information géospatiale dans tous les secteurs, à tous les niveaux de gouvernement ainsi qu'au niveau international.
Soutenir une vaste et dynamique communauté d'utilisateurs.
Assurer la continuité et la viabilité opérationnelle de l'infrastructure.

Principes directeurs

Ouverture : L'ICDG sera basée sur des normes et des spécifications ouvertes et partagées pour les transactions et les échanges d'information.

Transparence : L'ICDG offrira un accès transparent aux données et aux services, malgré la complexité des technologies sous-jacentes.

Coopération : L'ICDG facilitera la coopération et la collaboration des organismes participants de tous les secteurs, des divers niveaux de gouvernement et du milieu universitaire.

Évolution : Les organismes participants à l'ICDG continueront à répondre à de nouveaux besoins, à offrir de nouvelles applications commerciales et prestations de services à leurs clients respectifs.

Ponctualité : L'ICDG sera basée sur des technologies et des services permettant d'assurer un accès en temps réel ou instantané à l'information.

Autonomie : La viabilité de l'ICDG sera assurée par les contributions des organismes participants et de la communauté d'utilisateurs ainsi que par sa pertinence.

Autogestion : L'ICDG permettra à divers niveaux d'organismes participants de contribuer aux informations, métadonnées, services et applications du domaine géospatial.

*Orientée vers l'utilisateur : L'ICDG mettra l'accent sur le soutien et les services offerts à une vaste communauté d'utilisateurs. Les utilisateurs alimenteront le développement futur de l'ICDG.

*Plus près de la source : L'ICDG s'appuiera sur le principe d'autogestion pour encourager les organismes le plus près possible des sources de données à fournir ces données. Ce mode de fonctionnement se traduira par un accroissement d'efficacité et de qualité
tout en réduisant la duplication des efforts et les chevauchements.

*Sécurité : L'ICDG assurera la sécurité et la protection des données sensibles ou propriétaires.
Quick guide for CGDI service compliance testing and performance optimization
Authors:   GeoConnections
Published: May 2018

The past decade has seen the emergence of spatial data infrastructure programs resulting in what some are calling the mp;lt;'GeoWebmp;gt;'. While Geographic Information Systems (GIS) are well established technologies dating back to the 1960s, accessing and using
geographic information over the Internet is a relatively new development. Recent developments in mass market Geomatics from companies such as Google, Microsoft and Yahoo have raised awareness of the potential application of geospatial information within a wide variety of Web applications.
Additionally, advances in Web development technologies (e.g. AJAX Asynchronous JavaScript And eXtensible Markup Language) are providing a platform for the development of highly integrated, high performance, Web-based applications. Ensuring that these applications can be accessed seamlessly and
reliably with an adequate level of performance requires that users and developers validate and optimize the Web Services used in application development.
Global impact of nitrate photolysis in sea-salt aerosol on NOx, OH, and O3 in the marine boundary layer
Authors: Kasibhatla Prasad , Sherwen Tomás , Evans Mathew J. , Carpenter Lucy J. , Reed Chris , Alexander Becky , Chen Qianjie , Sulprizio Melissa , Lee James D. , Read Katie A. , Bloss William , Crilley Leigh R. , Keene William C. , Pszenny Alex A. P. , Hodzic Alma
Published: May 2018

Abstract. Recent field studies have suggested that sea-salt particulate nitrate (NITs) photolysis may act as a significant local source of nitrogen oxides (NOx) over oceans. We present a study of the global impact of this process on oxidant concentrations in the marine boundary layer using the GEOS-Chem model, after first updating the model to better simulate observed gas/particle phase partitioning of nitrate in the marine boundary layer. Model comparisons with long-term measurements of NOx from the Cape Verde Atmospheric Observatory (CVAO) in the eastern tropical North Atlantic provide support for an in situ source of NOx from NITs photolysis, with NITs photolysis coefficients about 25–50 times larger than corresponding HNO3 photolysis coefficients. Short-term measurement of nitrous acid (HONO) at this location show a clear daytime peak, with average peak mixing ratios ranging from 3 to 6 pptv. The model reproduces the general shape of the diurnal HONO profile only when NITs photolysis is included, but the magnitude of the daytime peak mixing ratio is under-predicted. This under-prediction is somewhat reduced if HONO yields from NITs photolysis are assumed to be close to unity. The combined NOx and HONO analysis suggests that the upper limit of the ratio of NITs : HNO3 photolysis coefficients is about 100. The largest simulated relative impact of NITs photolysis is in the tropical and subtropical marine boundary layer, with peak local enhancements ranging from factors of 5–20 for NOx, 1.2–1.6 for OH, and 1.1–1.3 for ozone. Since the spatial extent of the sea-salt aerosol impact is limited, global impacts on NOx, ozone and OH mass burdens are small (~ 1–3 %). We also present preliminary analysis showing that particulate nitrate photolysis in accumulation-mode aerosols (predominantly over continental regions) could lead to ppbv-level increases in ozone in the continental boundary layer. Our results highlight the need for more comprehensive long-term measurements of NOx, and related species like HONO and sea-salt particulate nitrate, to better constrain the impact of particulate nitrate photolysis on marine boundary layer oxidant chemistry. Further field and laboratory studies on particulate nitrate photolysis in other aerosol types are also needed to better understand the impact of this process on continental boundary layer oxidant chemistry.
Radiative feedbacks of dust-in-snow over East Asia in CAM4-BAM
Authors: Xie Xiaoning , Liu Xiaodong , Che Huizheng , Xie Xiaoxun , Li Xinzhou , Shi Zhengguo , Wang Hongli , Zhao Tianliang , Liu Yangang
Published: May 2018

Abstract. Dust-in-snow on the Tibetan Plateau (TP) could reduce the visible snow albedo by changing surface optical properties and remove the snow cover by increasing snowmelt, which leads to a significant positive radiative forcing and remarkedly alters the regional energy balance and the East Asian climate system. This study extends our previous investigation in dust-radiation interactions to investigate the dust-in-snow radiative forcing (SRF) and its feedbacks on the regional climate and the dust cycle over East Asia by use of the Community Atmosphere Model version 4 with a Bulk Aerosol Model parameterization of the dust size distribution (CAM4-BAM). Our results show that SRF increases the East Asian dust emissions significantly, by 13.7 % in the spring, in contrast to −7.6 % of decreased dust emissions by the dust direct radiative forcing (DRF). SRF also remarkedly enhances the whole dust cycle, including dust transports, dry and wet depositions over East Asia. The simulated results show that the combined effect of DRF and SRF increases the dust emissions by 5.1 %, and enhances the overall dust cycle over this region. Further analysis reveals that these results are mainly due to the regional climatic feedbacks induced by SRF over East Asia. By reducing the snow albedo over the TP, the dust-in-snow mainly warms the TP to enhance its thermal effects by increasing the surface sensible and latent heat flux, and then increases the aridity and westerly winds over Northwest China, in turn enhances the East Asian dust cycle. Additionally, the dust-in-snow also accelerates snow melting, reduces the snow cover, and then expands the East Asian dust source region area, which results in increasing the regional dust emissions. Hence, a significant feature of SRF on the TP can create a positive feedback loop to enhance the dust cycle over East Asia.
How well can global chemistry models calculate the reactivity of short-lived greenhouse gases in the remote troposphere, knowing the chemical composition
Authors: Prather Michael J. , Flynn Clare M. , Zhu Xin , Steenrod Stephen D. , Strode Sarah A. , Fiore Arlene M. , Correa Gustavo , Murray Lee T. , Lamarque Jean-Francois
Published: May 2018

Abstract. We develop a new protocol for merging in situ measurements with 3-D model
simulations of atmospheric chemistry with the goal of integrating these
data to identify the most reactive air parcels in terms of tropospheric
production and loss of the greenhouse gases ozone and methane. Presupposing
that we can accurately measure atmospheric composition, we examine whether
models constrained by such measurements agree on the chemical budgets for
ozone and methane. In applying our technique to a synthetic data stream of
14 880 parcels along 180∘ W, we are able to isolate the performance of the
photochemical modules operating within their global chemistry-climate and
chemistry-transport models, removing the effects of modules controlling
tracer transport, emissions, and scavenging. Differences in reactivity across
models are driven only by the chemical mechanism and the diurnal cycle of
photolysis rates, which are driven in turn by temperature, water vapor, solar
zenith angle, clouds, and possibly aerosols and overhead ozone, which are
calculated in each model. We evaluate six global models and identify their
differences and similarities in simulating the chemistry through a range of
innovative diagnostics. All models agree that the more highly reactive
parcels dominate the chemistry (e.g., the hottest 10 % of parcels control
25–30 % of the total reactivities), but do not fully agree on which parcels
comprise the top 10 %. Distinct differences in specific features occur,
including the spatial regions of maximum ozone production and methane loss,
as well as in the relationship between photolysis and these reactivities.
Unique, possibly aberrant, features are identified for each model, providing
a benchmark for photochemical module development. Among the six models tested
here, three are almost indistinguishable based on the inherent variability caused
by clouds, and thus we identify four, effectively distinct, chemical models.
Based on this work, we suggest that water vapor differences in model
simulations of past and future atmospheres may be a cause of the different
evolution of tropospheric O3 and CH4, and lead to different
chemistry-climate feedbacks across the models.
Remote sensing of canopy nitrogen at regional scale in Mediterranean forests using the spaceborne MERIS Terrestrial Chlorophyll Index
Authors: Loozen Yasmina , Rebel Karin T. , Karssenberg Derek , Wassen Martin J. , Sardans Jordi , Peñuelas Josep , De Jong Steven M.
Published: May 2018

Abstract. Canopy nitrogen (N) concentration and content are linked to several
vegetation processes. Therefore, canopy N concentration is a state variable
in global vegetation models with coupled carbon (C) and N cycles. While there
are ample C data available to constrain the models, widespread N data are
lacking. Remotely sensed vegetation indices have been used to detect canopy N
concentration and canopy N content at the local scale in grasslands and
forests. Vegetation indices could be a valuable tool to detect canopy N
concentration and canopy N content at larger scale. In this paper, we
conducted a regional case-study analysis to investigate the relationship
between the Medium Resolution Imaging Spectrometer (MERIS) Terrestrial
Chlorophyll Index (MTCI) time series from European Space Agency (ESA) Envisat satellite at 1 km spatial
resolution and both canopy N concentration (%N) and canopy N content
(N g m−2, of ground area) from a Mediterranean forest inventory in the
region of Catalonia, in the northeast of Spain. The relationships between the datasets were
studied after resampling both datasets to lower spatial resolutions (20, 15,
10 and 5 km) and at the original spatial resolution of 1 km. The results at
higher spatial resolution (1 km) yielded significant log–linear
relationships between MTCI and both canopy N concentration and content:
r2 = 0.32 and r2 = 0.17, respectively. We also investigated
these relationships per plant functional type. While the relationship between
MTCI and canopy N concentration was strongest for deciduous broadleaf and
mixed plots (r2 = 0.24 and r2 = 0.44, respectively), the
relationship between MTCI and canopy N content was strongest for evergreen
needleleaf trees (r2 = 0.19). At the species level, canopy N
concentration was strongly related to MTCI for European beech plots
(r2 = 0.69). These results present a new perspective on the
application of MTCI time series for canopy N detection.
Massive carbon addition to an organic-rich Andosol increased the subsoil but not the topsoil carbon stock
Authors: Zieger Antonia , Kaiser Klaus , Ríos Guayasamín Pedro , Kaupenjohann Martin
Published: May 2018

Abstract. Andosols are among the most carbon-rich soils, with an average of
254 Mg ha−1 organic carbon (OC) in the upper 100 cm. A current
theory proposes an upper limit for OC stocks independent of increasing carbon
input, because of finite binding capacities of the soil mineral phase. We
tested the possible limits in OC stocks for Andosols with already large OC
concentrations and stocks (212 g kg−1 in the first horizon,
301 Mg ha−1 in the upper 100 cm). The soils received large inputs
of 1800 Mg OC ha−1 as sawdust within a time period of 20 years.
Adjacent soils without sawdust application served as controls. We determined
total OC stocks as well as the storage forms of organic matter (OM) of five
horizons down to 100 cm depth. Storage forms considered were pyrogenic
carbon, OM of < 1.6 g cm−3 density and with little to no
interaction with the mineral phase, and strongly mineral-bonded OM forming
particles of densities between 1.6 and 2.0 g cm−3 or
> 2.0 g cm−3. The two fractions
> 1.6 g cm−3 were also analysed for aluminium-organic matter
complexes (Al–OM complexes) and imogolite-type phases using ammonium-oxalate–oxalic-acid extraction and X-ray diffraction (XRD). Pyrogenic organic carbon represented only up to 5 wt % of OC, and thus
contributed little to soil OM. In the two topsoil horizons, the fraction
between 1.6 and 2.0 g cm−3 had 65–86 wt % of
bulk soil OC and was dominated by Al–OM complexes.
In deeper horizons, the
fraction > 2.0 g cm−3 contained 80–97 wt % of the
bulk soil's total OC and was characterized by a mixture of Al–OM complexes
and imogolite-type phases, with proportions of imogolite-type phases
increasing with depth. In response to the sawdust application, only the OC
stock at 25–50 cm depth increased significantly (α=0.05, 1-β=0.8). The increase was entirely due to increased OC in the two fractions
> 1.6 g cm−3. However, there was no significant increase
in the total OC stocks within the upper 100 cm. The results suggest that long-term large OC inputs cannot be taken up by the
obviously OC-saturated topsoil but induce downward migration and gradually
increasing storage of OC in subsurface soil layers. The small additional OC
accumulation despite the extremely large OC input over 20 years, however,
shows that long time periods of high input are needed to promote the downward
movement and deep soil storage of OC.
A simple temperature-based method to estimate heterogeneous frozen ground within a distributed watershed model
Authors: Follum Michael L. , Niemann Jeffrey D. , Parno Julie T. , Downer Charles W.
Published: May 2018

Abstract. Frozen ground can be important to flood production and is often
heterogeneous within a watershed due to spatial variations in the available
energy, insulation by snowpack and ground cover, and the thermal and moisture
properties of the soil. The widely used continuous frozen ground index (CFGI)
model is a degree-day approach and identifies frozen ground using a simple
frost index, which varies mainly with elevation through an elevation–temperature relationship. Similarly, snow depth and its insulating
effect are also estimated based on elevation. The objective of this paper is
to develop a model for frozen ground that (1) captures the spatial
variations of frozen ground within a watershed, (2) allows the frozen
ground model to be incorporated into a variety of watershed models, and
(3) allows application in data sparse environments. To do this, we
modify the existing CFGI method within the gridded surface subsurface
hydrologic analysis watershed model. Among the modifications, the snowpack
and frost indices are simulated by replacing air temperature (a surrogate for
the available energy) with a radiation-derived temperature that aims to
better represent spatial variations in available energy. Ground cover is also
included as an additional insulator of the soil. Furthermore, the modified
Berggren equation, which accounts for soil thermal conductivity and soil
moisture, is used to convert the frost index into frost depth. The modified
CFGI model is tested by application at six test sites within the Sleepers
River experimental watershed in Vermont. Compared to the CFGI model, the
modified CFGI model more accurately captures the variations in frozen ground
between the sites, inter-annual variations in frozen ground depths at a given
site, and the occurrence of frozen ground.
Long-term temporal trajectories to enhance restoration efficiency and sustainability on large rivers: an interdisciplinary study
Authors: Eschbach David , Schmitt Laurent , Imfeld Gwenaël , May Jan-Hendrik , Payraudeau Sylvain , Preusser Frank , Trauerstein Mareike , Skupinski Grzegorz
Published: May 2018

Abstract. While the history of a fluvial hydrosystem can provide essential
knowledge on present functioning, historical context remains rarely
considered in river restoration. Here we show the relevance of an
interdisciplinary study for improving restoration within the framework of a
European LIFE+ project on the French side of the Upper Rhine (Rohrschollen
Island). Investigating the planimetric evolution combined with historical
high-flow data enabled us to reconstruct pre-disturbance hydromorphological
functioning and major changes that occurred on the reach. A deposition
frequency assessment combining vertical evolution of the Rhine thalweg,
chronology of deposits in the floodplain, and a hydrological model revealed
that the period of incision in the main channel corresponded to high rates of
narrowing and lateral channel filling. Analysis of filling processes using
Passega diagrams and IRSL dating highlights that periods of engineering works
were closely related to fine sediment deposition, which also presents
concomitant heavy metal accumulation. In fact, current fluvial forms,
processes and sediment chemistry around Rohrschollen Island directly reflect
the disturbances that occurred during past correction works, and up to today.
Our results underscore the advantage of combining functional restoration with
detailed knowledge of the past trajectory to (i) understand the functioning
of the hydrosystem prior to anthropogenic disturbances, (ii) characterize the
human-driven morphodynamic adjustments during the last 2 centuries,
(iii) characterize physico-chemical sediment properties to trace
anthropogenic activities and evaluate the potential impact of the restoration
on pollutant remobilization, (iv) deduce the post-restoration evolution
tendency and (v) evaluate the efficiency and sustainability of the
restoration effects. We anticipate our approach will expand the toolbox of
decision-makers and help orientate functional restoration actions in the
future.
From screams to dreams
Authors: Ali Asma Amir , Puvanenthirajah Nirushan
Published: May 2018

Historically, surgery was risky and, more often than not, unsuccessful for patients. To improve surgical outcomes, medical practitioners needed to control three things: pain, bleeding, and infection. This paper will focus on how improvements with pain control contributed to changing ideas about disease and allowed for an increase in the type and quantity of surgeries performed.
Mental health promotion in the wake of natural disaster
Authors: Robinson Lilian J , Su Hong Yu (Andrew)
Published: May 2018

Significant psychological trauma to victims is an unavoidable by-product of severe natural disasters, and Hurricane Matthew is no exception. Making landfall on the 4th of October 2016, it swept across Haiti and eastern Cuba before reaching coastal regions of Florida, Georgia, and South Carolina. Despite Matthew’s far-reaching impact, it was in Haiti where the Category Four hurricane made its greatest mark. Infrastructure damage led to water contamination and cholera outbreaks, sparking major concern amongst the World Health Organization and Haitian Ministry of Health. Consequently, physical health impact related to cholera control through clean water access was prioritized over psychological repercussions. In this article, we aim to provide recommendations for local organizations to deliver effectively psychological intervention to Haitian victims of Matthew. We focused on Global Trauma Research, one of few humanitarian agencies with an established framework for implementing psychological trauma relief efforts, and wish to use it as the basis of our suggestions. In order to do so, we chose to review mental health promotion in the context of a relevant historical precedent, Hurricane Katrina. We uncovered a two-pronged approach taken by Hurricane Katrina responders: identification of at-risk groups followed by provision of targeted-relief efforts, and widespread delivery of care to all affected populations, with an emphasis on community reintegration. Based on these general principles, we recommend that Global Trauma Research identify groups at risk of long-term emotional disturbance, provide relief in a targeted fashion on the basis of relative need, and place emphasis on Haitian citizen support through relocation and community integration.
Point of care ultrasound in disaster triage
Authors: Chau Brandon , Sivakumar Gayathri
Published: May 2018

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.
Life behind the knife
Authors: D'Andrea Dino , Yi Alice
Published: May 2018

Dr. Rob Leeper is an Assistant Professor of Surgery at Western University. After completing his training in surgery, critical care, and trauma in Baltimore, Maryland, he returned to London to join the staff at London Health Sciences Centre (LHSC) and the Department of Surgery in 2015. We sat down with him to discuss his work as a trauma surgeon, as well as what it is like for him to live life behind the knife.
Indigenous access barriers to health care services in London, Ontario
Authors: McConkey Stephanie
Published: May 2018

Introduction: Indigenous peoples in Canada suffer higher rates of health inequalities and encounter a number of health services access barriers when compared to their non-Indigenous counterparts. Indigenous peoples experience social and economic challenges, cultural barriers, and discrimination when accessing mainstream health services.

Methods: In London, Ontario, 21 interviews and 2 focus groups (n = 25) with service providers were completed, each session spanning approximately 1 to 1.5 hours. Interviews were voice recorded and transcribed verbatim. Themes were identified using NVIVO 10 software.

Findings: Approximately 2 to 5% of clients are Indigenous in hospital-based services. There are a number of social factors that influence whether Indigenous peoples access health services. Indigenous peoples do not have access to adequate pain medications because physicians are reluctant to provide Indigenous patients with pain medications due to common perceptions of addiction. Indigenous peoples also have barriers accessing a family physician because physicians are reluctant to take on new patients with complex health needs.

Conclusion: Systemic discrimination is still alive in the health care system; therefore, there is a need for cultural safety training among physicians to increase awareness of access barriersand challenges that many Indigenous patients face when seeking health care.
Collegiality and career success
Authors: Schneiderman Gerald
Published: May 2018

Success in one’s career and life are subjectively determined. However, the presence or absence of regrets are good indicia of one’s sense of fulfillment. In the context of professional education, “learning environment” is a key predictor of one’s future sense of fulfillment. Collegiality, mutual support, and decency towards one’s classmates were considered by the author in this small-scale study to be important predictors of one’s later success in life and medical practice.
Collaborative care models for integrating mental health and primary care
Authors: Maskell Rachelle , Rudkovska Anna , Kfrerer Marisa , Sibbald Shannon
Published: May 2018

Background: Mental health service demands in Ontario often result in long wait times and a lack of access to specialized services. As a result, primary care providers are frequently required to provide mental health care for patients with complex diagnoses despite a lack of support or sufficient training. To address these issues, a shift toward collaborative models of mental health care delivery is occurring.

Objective: This paper aims to assess whether evidence-based policy recommendations to improve collaborative mental health care are addressed in the recent Patients First documents.

Methods: To achieve this, a qualitative analysis was conducted using NVivo10©.

Results: While many of the evidence-based policy recommendations were mirrored in the Patients First documents, very few addressed collaborative mental health care directly.

Implications: More research is required to fully understand the effects of the implementation of Patients First on mental health systems and services.
Applying health promotion theories to improve depressive symptoms through exercise
Authors: Abelman Dor David , Hanna Andrew Daniel
Published: May 2018

Considering both the high monetary and emotional costs associated with caring for patients afflicted with depression, it is apparent that health professionals should find effective treatments to ensure that interventions are both cost effective and risk-reducing. While exercise is generally known to be important in maintaining general health and wellbeing, numerous studies have also indicated that it can play a critical role in moderating symptoms of mild to moderate depression. Globally, research continues to show a powerful reduction in depressive symptoms due to the benefits of exercise. This review article will highlight the growing perspective regarding the influence of exercise as a first-line treatment for depression over pharmacotherapy for patients with mild to moderate depression. Health promotion theories including the Theory of Planned Behaviour, Theory of Reasoned Action, and Motivational Interviewing will be applied.
The detrimental effects of obstetric evacuation on Aboriginal women’s health
Authors: Corrado Ann Marie
Published: May 2018

In Western society, many colonial practices, such as the removal of Aboriginal women from their communities prior to birth, still detrimentally affects Aboriginal peoples’ lives. Health Canada’s evacuation policy for pregnant Aboriginal women living in rural and remote areas involves nurses, who are employed by the federal government, coordinating the transfer of all pregnant women to urban cities at 36-38 weeks gestational age to await the birth of their baby.1 The policy states that it is founded on concerns for the wellbeing of Aboriginal women, in an attempt to “curb First Nations’ child and maternal mortality rates”.1 However, there is a need to problematize the practice of obstetric evacuation given its colonial roots and its impact on Aboriginal women. The objective of this review paper is to explore and bring awareness to some of the consequences of Canada’s evacuation policy for pregnant Aboriginal women who live in rural and remote regions. Morespecifically, this paper, drawing on ethnographic research previously conducted with Canadian Aboriginal women on their lived experiences of prenatal care and birth, will examine the lack of social support, loss of control, and lack of culturally competent care that Aboriginal women face. The findings demonstrate an urgent need for policy makers to also consider the lived experience of Aboriginal women when making decisions that impact their health.
The ethical concerns of physician recruitment from Africa to the global North
Authors: Corrado Ann Marie
Published: May 2018

For decades, medical recruitment agencies have tried to deal with physician shortages in rural and remote areas of developed countries by recruiting physicians from areas of scarce health human resources in the global South. In South Africa alone, one-third to one-half of medical school graduates migrate to the global North every year, with the majority settling down in Canada, the United States, and the United Kingdom.1 This review paper aims to bring attention to the unethical practice of physician recruitment from Africa to the global North. In particular, it will explore how physician recruitment negatively impacts the donor countries’ economies, compromises the quality of care they can give their citizens, and provides only a short term solution to the recipient country. It is critical that this practice is prohibited and that countries in the global North look for sustainable solutions within their own borders to solve workforce shortages.
Evaluation of supervised injection facilities as an ethically sound approach to treatment of injection drug abuse
Authors: Fleshner Katherine , Greenacre Matthew
Published: May 2018

Novel approaches are needed to address the issue of injection drug use in Canada, which can have negative consequences for drug users and society. Supervised injection facilities (SIFs) are legally sanctioned facilities in Canada where drug users can receive sterile drug paraphernalia, referral to cessation programs and timely medical care if necessary. SIFs operate under the principle of harm reduction, which aims to reduce rates of infection and death due to overdose among drug users. SIFs are largely driven by the utilitarian ideal of maximizing benefit for the greatest number of people, through supervision of active drug users and appropriate referral for those wishing to quit. Deontological theory may support SIFs depending on how one applies the categorical imperative. Studies of the first SIF in North America, Insite, have shown demonstrable reductions in adverse health and societal consequences of injection drug use, rationalizing their implementation under consequentialism. SIFs are, therefore, suitable for greater adoption by the healthcare system.
Cover art
Authors: Yu Richard Ying
Published: May 2018

Cover art by Richard Ying Yu.

Description: The Canadian Healthcare system is an efficient system that provides care for its patients. However, there are still many aspects of it that need to be addressed and improved, including Indigenous health, mental health, long wait times, and the current ongoing opioid crisis. I wanted to draw a cartoon that could encapsulate these broad aspects that need to be improved in a simple picture with minimal clutter. I decided that a sick Canada could represent that and the Schulich stethoscope represents our important role in addressing these heath care disparities.
The legacy of Dr Earl Russell
Authors: Botros Sandra
Published: May 2018

Dr Earl Russell (1920-2008) was a Canadian anesthetist and pain specialist who spent the majority of his career as a Western University faculty member and a pain physician in Southwestern Ontario. Dr Russell obtained his medical degree at Western, graduating in the class of 1950, and went on to serve in the Korean War as a medical officer. It was in Korea that he began developing a keen interest in pain medicine, using self-taught anesthesia skills to help soldiers suffering from frostbite. He returned to Canada and focused the rest of his career on the practice and advancement of pain medicine, and endowed the Earl Russell Chair in Pain Management in order to fund future research and education in the field. This article highlights the importance of his contributions to the field, in particular through his creation of the Earl Russell Chair, and how this led to the first Pain Medicine residency program in Canada at Western University.
The case for a student run clinic in London
Authors: Abou-Hamde Yara , Hopfgartner Adam
Published: May 2018

Student Run Clinics (SRCs) are an emerging form of primary healthcare involving the collaboration of students and licensed health care professionals. SRCs aim to identify healthcare needs in the community and to meet those needs with supervised clinical and non-clinical services, education, and outreach. The SRC model provides students with direct patient interaction to complement classroom learning and develop extracurricular clinical skills.

The Alliance of Students Providing Interprofessional Resources and Education (ASPIRE) is a new interdisciplinary student group from the University of Western Ontario, Fanshawe College, and the University of Waterloo. Using established Canadian SRCs as a framework, ASPIRE is working to start a London-based SRC. A recent review of healthcare needs and social determinants of health completed by ASPIRE for the City of London identified a high incidence of mental health conditions and HIV in the community. Furthermore, the adequate provision of primary healthcare in London is complicated by transportation issues, financial constraints, and language barriers among underserved and minority populations. These concerns may be addressed by care provided by professional students from various disciplines organized by ASPIRE.

The future of ASPIRE includes health promotion in the London community with presentations on topics such as opioid addiction and overdose prevention, diabetic foot care, and smoking cessation. ASPIRE will continue to work towards a transition into a larger role in health promotion and health advocacy, with the ultimate goal of establishing an SRC in the City of London.
Analgesia for the critically ill patient
Authors: Riggs Jamie , Wang Dominic
Published: May 2018

You are the ICU fellow on call overnight at a tertiary care hospital. At approximately 2 AM, you receive a call from the emergency department (ED) with a consult. The ED resident gives you the following details: Mrs P is a 67 year old woman who presented recently with acute dyspnea and severe pain focused around an area of extensive erythema on her left arm. She has apulse rate of 115, respiratory rate 45 breaths per minute, temperature 39°C, blood pressure 95/65 mm Hg, and O2 saturation 68% on room air. The resident also notes areas of dark and yellowish tissue surrounding her left elbow, which are suspected to be necrotic. She is currently receiving 100% O2 via a high flow mask and fluid resuscitation via two peripheral IVs. She is experiencing severe pain, which she rates as 10/10, but is otherwise stable. You agree to have this patient transferred to your care. While she is on the way up you remind yourself of the key components of pain management in the critically ill patient.
The role of medical cannabis in the opioid crisis
Authors: Samoilov Lucy , Browne Claire P
Published: May 2018

Opioid use increased dramatically in the 1990s upon introduction of newer, more relaxed regulations. As opioid prescriptions for pain increased, a parallel increase in opioid abuse and addiction occurred; this phenomenon is widely known as the opioid crisis. Cannabis had long been considered a recreational drug until legislation in 2001 allowed highly limited access to the drug for medicinal purposes. Although small-scale clinical trials show promising results for the use of cannabis in pain management, it is not currently indicated for chronic or severe-to-moderate acute pain, for which opioids are typically considered the standard of care. The impending legalization of recreational cannabis may mark a turning point in pain medicine as the general public becomes able to selfmedicate with cannabis. This increased availability may lead individuals prescribed opioids to combine or replace them with cannabis, with potential positive impacts. There is growing evidence that cannabinoid compounds present in cannabis are able to augment opioid-induced pain relief. Increased availability of cannabis is linked to decreased opioid-related mortality and hospitalizations; furthermore, cannabis might act as a tool to treat opioid addiction. Cannabis does possess adverse effects and addiction risk, and expanded research into its properties is needed. However, its relatively decreased risk profile and potential positive effects indicate that it may serve an important role in addressing the opioid crisis.
Ethical examination of sham surgeries for relief of chronic pain in clinical practice
Authors: Fleshner Katherine , Orzylowski Jacek
Published: May 2018

Treatment of chronic pain is challenging for both patients and physicians alike. Interventional management of pain is often indicated for patients who are not helped by pharmacotherapy, and can include procedures such as neurectomy and vertebroplasty. However, randomized controlled trials of these procedures often demonstrate a significant improvement in symptomology among patients in the control arm who have instead undergone a sham surgery, which eliminates the perceived surgical steps required for benefit but mimics the surgery in every other way. We examine whether an ethical framework might exist for sham surgeries to hypothetically be performed for clinical benefit of chronic pain. Once all evidence-based options are exhausted, performing sham surgeries may be justified under beneficence and non-maleficence since sham procedures are often equally efficacious but considerably safer than their true intervention counterparts. Physicians must only recommend such procedures with the intent of ameliorating patient suffering. Some degree of disclosure of a possible placebo effect prior to a sham surgery may satisfy the principle of autonomy while still maintaining the placebo response.
Moving towards a molecular understanding of pain management
Authors: Van Nynatten Logan , Veettil Shafaz
Published: May 2018

The management of chronic pain remains a challenging area in the practise of medicine. As our population ages, the incidence and prevalence of those living with chronic pain continues to increase. Hence, there is need for methods that promote optimal pain management. One promising avenue is that of “personalized and molecular pain management”. Indeed, a variety of genetic and molecular factors have been shown to impact metabolism of narcotics, limiting drug effectiveness. Furthermore, the prominence of polypharmacy can complicate the action of pain medications. Additional laboratory and diagnostic tests may be of benefit for risk stratifying patients at high risk of abusing pain medications from those at lower risk. Combining this with physician worry of worsening the opioid addiction crisis in North America via prescribing narcotics, there remains great pressure on physicians to limit their use of narcotics. Unfortunately, this may result in patients who are suitable candidates for prescription opioids receiving inadequate pharmaceutical treatment to complement non-pharmacological interventions. Moving forward, the implementation of molecular medicine approaches to pain management may provide unique solutions to these challenges.
Cannabis for pain management: Pariah or panacea?
Authors: Hudson Roger , Puvanenthirarajah Nirushan
Published: May 2018

Cannabis has been used in a medicinal context throughout recorded history and across diverse cultures to aid in the treatment of a wide array of ailments. Remarkably, clinical and preclinical investigations are only recently beginning to reveal the neurobiological mechanisms responsible for the clinically-relevant actions of cannabis that have been acknowledged by medical pharmacopeia for millennia. The therapeutic potential of cannabis-derived phytochemicals such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are currently being explored in several contexts. Experimental evidence suggests that modulation of signal transduction pathways underlying cellular excitability, as well as interactions with the endocannabinoid and serotonin systems, which modulate emotion and pain sensitivity under physiological conditions, are among the mechanisms responsible for its clinical efficacy. Interestingly, the diverse pharmacodynamic profile of CBD suggests a synergistic interaction with current first- and second-line medications used in the treatment of neuropathic pain to produce clinically meaningful therapeutic benefits. To advance understanding of the neurobiological mechanisms underlying therapeutic cannabis use in pain management and to integrate its use into modern clinical practices, it is important to understand medicinal cannabis use in historic and medical contexts. This review highlights the copious history of medical practices incorporating the use of cannabis, and discusses the potential pharmacological mechanisms responsible for its therapeutic efficacy in the management of neuropathic pain.
“¿Por qué no ser agentes de salud nosotras/os mismas/os?”: Mujeres y políticas de salud en un movimiento campesino argentino
Authors: Pena Mariela
Published: May 2018

A través de un estudio etnográfico de las acciones políticas en torno a la salud construidas por el Movimiento Campesino de Santiago del Estero-Vía Campesina (MOCASE-VC) de Argentina, analizamos su relación en tanto actor colectivo con el sistema público de atención a la salud, y dentro de este marco exploramos las estrategias emprendidas por las mujeres campesinas en torno a su salud sexual y (no) reproductiva. Argumentamos que la organización ha creado una perspectiva propia que hemos denominado como apropiación crítica-contestación estratégica respecto del modelo médico y sanitario, englobada a su vez en su postura política más general. Esta trayectoria provoca un giro subjetivo en las mujeres que las re-posiciona en las relaciones médico-paciente y frente a las violencias institucionales de las que son víctima, si bien sobre sus cuerpos se entrecruzan presiones múltiples que el Movimiento no siempre consigue acompañar.
La ciudad, línea abismal. Identidades de clase en Bangkok
Authors: Barrera Blanco José
Published: May 2018

Vorng, Sophorntavy. 2017. A Meeting of Masks: Status, Power and Hierarchy in Bangkok. Copenhague: NIAS Press.
The Effect of Smaller Prisoner Numbers at a Prison on The Prisoners’ Access to Food: a Case of Malawi’s Prisons
Authors: Moloko Hastings B. , Ng’ong’ola Davis H. , Kamkwamba Henry
Published: May 2018

While Malawi’s per capita cereal production may be higher than her per capita cereal consumption, Malawi is a net cereal importer and thus food insecure. The food situation is much worse in Malawi’s prisons because inmates generally eat one meal per day.The general objective of this study was to determine the effect of smaller prisoner numbers at a prison on the inmates’ access to food. This was done by comparing food insecurity in small prisons with that in big institutions. An institution housing less than 400 inmates was considered a small prison while one housing more than 400 prisoners was considered a big institution. Using structured questionnaires in face to face interviews, the study collected data from 1000 inmates and 30 officers-in-charge from all prisons in the country. The data was analysed using Stata 12 and employed the probit and the Foster-Greer-Thorbecke (FGT) models as analytical tools.Results from the analysis showed that practically all inmates in Malawi’s prisons were food insecure. There was, however, a higher perception of food insecurity in big prisons than there was in small ones. Conditions of severe food insecurity were experienced more in big institutions than in small ones, and more inmates in big prisons depended on food brought to them from their homes. Food insecurity was more prevalent in big prisons than in small ones.