Canadian Initiative Research Articles

Mythmaking in audit regulation: the Canadian initiative on ‘enhancing audit quality’

Although extant literature has provided accounts of regulatory processes that failed to produce new or improved regulation, we know less about how regulators attempt to devise an ‘illusion of regulatory action’ to prevent their initiatives from being labelled failures and deflect public criticism. This study’s focus is on the regulatory initiative in Canada in response to a global post-crisis regulatory trend seeking to address the problem of low audit quality. Despite decisive regulatory responses elsewhere, the Canadian project leaders not only concluded with weak regulation based on problematic assumptions, but they also actively pursued efforts to argue the opposite, thereby creating an illusion of a meaningful regulatory response. By reference to Barthes’s work on mythmaking, we examine the relevant project documents to make sense of such arguments and claims essentially as instances of regulatory actors’ mythmaking designed to diffuse criticism and garner public support. Our findings enable us to offer insights into and consider the role of regulatory myths as important elements in the discursive repertoires by which regulators maintain their legitimacy and authority. We also discuss certain conjectures which increase the likelihood of regulatory mythmaking.

Selecting performance indicators for hospital pharmacy practice: A Canadian initiative

AbstractActivity‐based funding is a method of funding hospitals according to the type and volume of services provided and adjusted to their patient population. Currently, pharmacy practice is mainly evaluated with costs and volumes, which are insufficient to properly measure the contribution of pharmacists. Facing the province of Quebec statewide implementation of activity‐based funding, expert committees were set up to develop a set of indicators using a predefined framework to assess pharmacy performance throughout all hospital activities and patient care. Through consultations, partners and stakeholders showed strong support for the initiative, putting more emphasis on the assessment of appropriateness as well as quality and safety. Among the different roles of pharmacists, respondents favoured the assessment of the pharmaceutical care and education of trainees and colleagues. Of the 150 candidate indicators initially identified, 24 were selected, of which 13 were prioritised for experimentation.

Building knowledge broker capacities during the regional research project: lessons learnt from the West African Health Organisation

The aim of the article was to understand how its project entitled "moving maternal, newborn and child evidence into policy in West Africa" funded under the Canadian initiative has helped the West African Health Organisation to better build its role as a knowledge broker in West Africa. A case study approach was adopted to allow for the validation or otherwise of stated hypotheses using context, actor, process, and outcome data. WAHO as a HPRO has been able through the Moving Maternal Newborn and Child Health Evidence into policy in West Africa project to play the role of KB through strengthening collaboration between policy makers and researchers, generating knowledge for a better understanding of the evidence use environment in the field of maternal and child health, and finally through the implementation of actions to create an enabling environment for the use of evidence to influence health policy and practice. Weaknesses were noted and mostly corrected in the implementation process. The commitment of senior management and other stakeholders, the implementation of the project using the strengths of the institution, the collaboration with regional experts, the provision of additional human resources and the use of evidence in planning project activities facilitate this capacity building. The experience gained enabled the organisation during the COVID-19 pandemic to continue to facilitate the use of evidence for decision making by policy makers in West Africa.

Somos Americanos? The potential of the Inter-american Human Rights System for Indigenous Justice in Canada

This paper explores how Canada’s full commitment to the Inter-American Human Rights System (IAS) could provide a further recourse for monitoring, protecting and promoting Indigenous rights in Canada. Presenting the Americas as a united continent, it emphasizes how reconceptualising what it means to “be American” can help Canadians think about their connection, comprehension and acceptance of this regional system. This paper examines the Canadian government’s historical disinterest in the IAS and establishes this as the primary reason for its current lack of commitment. It argues that Canada’s ratification of the American Convention on Human Rights and recognition of the Inter-American Court of Human Rights jurisdiction would positively impact the rights of Indigenous peoples living within its borders. It concludes by highlighting a Canadian initiative that is working towards making Canada a better player in the IAS and contends that the Canadian government should follow their lead.

3D-Printed Personal Protective Face Shields During the COVID-19 Pandemic: A Survey of Canadian Frontline Workers.

BackgroundDuring the coronavirus disease 2019 pandemic, three-dimensional (3D) printing was utilized to rapidly produce face shields for frontline workers in response to an acute shortage of personal protective equipment (PPE). In this study, we examine the perceived utility and performance of 3D-printed (3DP) face shields through a survey of frontline workers in Ontario, Canada.MethodologyFrontline workers who received community-produced 3DP face shields from the Canadian initiative “3DPPE GTHA” (March-December 2020) were invited to participate in the study. The survey response rate was 54.3%. Of 63 respondents, 39 were patient-facing and 24 were community-facing frontline workers. Participants were asked to rate performance measures in 10 categories on a five-point Likert scale. Data were categorized by organization and frontline worker type, and a t-test was used to determine statistically significant differences among subgroups.ResultsThe mean preference for 3DP face shields among respondents was 3.2 out of 5 (95% confidence interval [CI]: 2.1-4.3). Community-facing respondents reported significantly greater overall utility scores for 3DP face shields (3.58, 95% CI: 3.38-3.79) compared to respondents working in a patient-facing profession (2.95, 95% CI: 2.77-3.13; p < 0.05). However, no differences were reported in portability and compatibility with other PPE. Respondents from organizations with large service volumes reported significantly lower overall utility scores (2.67, 95% CI: 2.44-2.89) than respondents in organizations with smaller service volumes (3.45, 95% CI: 3.28-3.62; p < 0.05).ConclusionsCommunity-facing frontline workers and those from smaller service volume organizations endorse higher utility for 3DP face shields than patient-facing frontline workers. Despite this, frontline workers generally rate 3DP face shields positively. 3DP face shields are a viable option for personal and community use and can be used to supplement supply in a community setting.

Is Aristotle the Forefather of Informal Logic?

AbstractI argue that Aristotle takes a ‘natural language semantics’ approach to logic, which is consistent with the general attitudes one finds in informal logic today. Although his position is complex, Aristotle emphasizes the intensional rather than the extensional side of argument evaluation. He does not take a truth-functional approach to semantics, but an approach that elucidates the illative mechanism through an understanding of natures. This comes close to what informal logicians insist on. The informal logic movement was, to a very large extent, a Canadian initiative, prominently featuring authors such as Johnson, Blair, Govier, and many others.

A Catalog of Very Large Array Sky Survey Epoch 1 Quick Look Components, Sources, and Host Identifications

Abstract We announce here the public availability of a catalog of ν ∼ 3 GHz Quick Look observations from the first epoch of the Very Large Array Sky Survey. The catalog consists of three distinct and linkable tables, namely (a) the detected radio components, (b) the host identifications with total source properties for single-component, and close double/triple radio sources (angular separations of &lt;10″), and (c) the Quick Look image metadata. Given the Quick Look images are limited in quality, we include data reliability flagging to improve the scientific usability of this catalog. Using our recommended quality flags, this catalog contains 1.7 × 106 unique radio components with S 3 GHz ≳ 1 mJy beam−1, and 6.2 × 105 host IDs (including 20,000 close-double and triple radio sources) reliably detected across the entire sky at δ &gt; −40°. The catalog and an associated User Guide have been produced as part of the Canadian Initiative for Radio Astronomy Data Analysis, and are available at https://cirada.ca/catalogues.

So you want to develop a virtual lecture series? Lessons learned from the Global Inorganic Discussion Weekday (GIDW) — a Canadian initiative

The Global Inorganic Discussion Weekday (GIDW) is a virtual inorganic chemistry symposium series co-organized and co-hosted by Canadian inorganic chemists, Marcus Drover (University of Windsor) and Saurabh Chitnis (Dalhousie University). This perspective describes the mission of the GIDW event, its purpose, lessons learned, and offers an outline for other scientific disciplines that wish to organize similar virtual events at a time when physical conferencing is not safely possible.

Physical activity during COVID-19 quarantine.

The World Health Organization recommends that children and adolescents aged 5-17 should engage in at least 60 minutes of moderate to vigorous intensity physical activity a day. Physical activity is defined as bodily movement performed by skeletal muscles that demand energy expenditure. The physical benefits of this include musculoskeletal and cardiovascular health, a healthy body weight and neuromuscular awareness, for coordination and controlling movement. The psychological benefits include managing anxiety and building self-esteem, which are both important for children's psycho-social development (1).

Abstract P1-17-17: Real-word implementation of patient report outcomes: Sustainability constraints and impact on patients health outcomes

Abstract Background: St Mary’s Hospital is an affiliated McGill Teaching University Hospital in Montreal, receiving ~700 new cancer patients yearly. In 2008, the oncology department implemented Patient Reported Outcomes (PROs) on paper. In 2014-17, electronic PROs were implemented through the Improving Patient Experience and Health in Outcomes Collaborative (iPEHOC) Implementation Project, as part of a PRO Canadian Initiative to improve the Patient Experience across the cancer journey through standardized measurement that accelerates optimal care and measures impact (health-related outcomes for patients) across Canada. Methodology: The PROs measures included the Edmonton Symptom Assessment Scale (ESASr), four additional secondary PROMs for Fatigue, Anxiety, Depression, and Pain, the Social Difficulties Inventory-21 and a single item Quality of Life. PRO data was scored in real-time; nurses and patients received a printed summary report. Nurses were provided with an algorithm (Global Response to Distress) and follow-up instructions. Monthly Distress Screening Dashboard ware generated with number of screenings, number of patients screened, symptom prevalence, secondary PROMs trigger rates, Social Difficulties triggered and clinically significant symptoms changes on the four secondary PROMs. In 2016, all patients receiving chemotherapy were assessed at each cycle of treatment (screening). After project completion, due to nursing staff shortage, the frequency of screenings was reduced and offered at pre-established time-points (assessment). Yearly Dashboard results were used to promote a discussion with clinicians and address sustainability constraints of PROs in real-word oncology practice. Results: In 2016, a total of 366 patients were screened, resulting in 1366 annual screens. In 2018, 325 patients were screened resulting in 753 annual screens. This change in practice, that culminated organically, allows for an observation analysis between screening versus assessment. Noteworthy comparison between 2018 and 2016 showed that the decrease in frequency of screenings resulted in significant increase in symptom severity in all health-related outcomes. Breast cancer represented 35% of all screens completed. We propose to present a three year retrospectively cross analyzed patient data to examine symptom change over time, frequencies of screening, the impact on patients’ health outcomes, the overlapping sustainability constraints encountered and mitigation plans. Discussion: Embedding the use of PRO into existing hospital structures requires constant review involving administrative, clinician and patient engagement. PRO data can be used to better identify the needs of a specific cancer type population and create tailored care paths. Citation Format: Ashley Kushneryk, Rosana Faria. Real-word implementation of patient report outcomes: Sustainability constraints and impact on patients health outcomes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-17-17.

Real world implementation of patient report outcomes: Sustainability constraints and impact on patients health outcomes.

291 Background: St Mary’s Hospital, an affiliated McGill Teaching University Hospital, receives ~700 new cancer patients yearly. In 2014-17, electronic PROs were implemented through the Improving Patient Experience and Health in Outcomes Collaborative in partnership with Cancer Care Ontario, granted by Canadian Partnership against Cancer and Rossy Cancer Network, as part of a PRO Canadian Initiative to improve the Patient Experience across Canada through standardized measurement of health-related outcomes for patients. Methods: The PROs measures included the Edmonton Symptom Assessment Scale (ESAS), additional measures for Fatigue, Anxiety, Depression, and Pain, the Social Difficulties Inventory-21 and Quality of Life. PRO-data was scored in real-time; nurses and patients received a printed summary report. Nurses were provided with an algorithm and instructions. Monthly Distress Screening Dashboard were generated with key indicators. In 2016, all patients receiving chemotherapy were assessed at each cycle of treatment. After project completion, due to nursing staff shortage, the frequency of screenings was reduced. Yearly Dashboard results were used to promote discussion with clinicians and address sustainability constraints of PROs in real-word oncology practice. Results: In 2016 1366 total screens completed ( 376 patients) and in 2018, 753 total screens (325 patients). This comparison indicates that a decrease in frequency of screenings resulted in an increase in symptom severity in all health-related outcomes. Physicians’ participation was proposed as mitigation plan to increase screening frequency. We propose to present a three year retrospectively cross analyzed patient data to examine symptom change over time, frequencies of screening, impact on patients’ health outcomes, overlapping sustainability constraints encountered and mitigation plans. Conclusions: Embedding the use of PRO into existing hospital structures requires constant review involving administrative, clinician and patient engagement.

Auditing and the Development of the Modern State

ABSTRACTPrevious research has highlighted the crucial roles that accounting plays in both the construction and development of the state. However, only limited attention has been paid to how accounting is both conceived and implemented as a technology of government. Taking a historical perspective, and through extensive archival analysis of the Canadian experience, we explore here the ways in which accounting practices were significantly expanded and elaborated over time. Progressively, accounting was successful in increasingly infiltrating the machinery of the state, resulting in greater power and influence being accorded to state accounting professionals. We contribute to existing governmentality research on accounting in two principal ways. First, we demonstrate how the territorializing power of accounting has transnational dimensions. The Canadian initiative was galvanized by simultaneous initiatives taking place in the United Kingdom, the United States, and a range of other Commonwealth nations. The similar trajectories of these various initiatives leads to a view of accounting as something that is co‐constructed across borders, a process we refer to here as transnational territorialization. Second, we demonstrate the crucial role played by key individuals in this transnational territorialization. Auditors general worked both individually and in concert to skillfully sell the evaluative potential of accounting to key power brokers in the state apparatus, thereby creating advantageous positions for themselves. This highlights the crucial role required by skillful and reflexive social agents in the elaboration of accounting technologies, something that hitherto has been underappreciated in extant literature on both auditing and governmentality.

Patient-Oriented Research Competencies in Health (PORCH) for patients, healthcare providers, decision-makers and researchers: protocol of a scoping review

BackgroundPatient-Oriented Research (POR) is a Canadian initiative for health research that refers to research processes informed by full and active patient involvement in all aspects of the research. Ideally, POR results in a wide dissemination of the research findings and the uptake of such findings in both clinical practice and health policy. The Canadian Institute for Health Research (CIHR) identifies four stakeholder groups that are involved in POR who are envisioned to take on a collaborative role in enacting this approach to research. Those stakeholder groups are patients, researchers, health care providers and healthcare decision-makers. To achieve collaboration among stakeholders in POR, tools, resources, education/training and capacity building are required for each stakeholder group engaged in this work. Therefore, this review focuses on understanding and articulating competencies needed by participants to engage in POR. The aim is to summarize existing knowledge on discrete POR competencies for the four stakeholder groups; to support collaboration among them for uptake and strengthening of POR; and to inform policy, education and future research. Accordingly, our research question is ‘What are the POR core competencies needed by patients, researchers, healthcare providers, and decision-makers?’ The main objectives are to (1) systematically explore the academic and grey literature on competencies needed for these stakeholder groups to engage in POR; (2) map the eligible publications and research gaps in this area; (3) gain knowledge to support collaboration among stakeholders; and (4) provide recommendations for further research to use competencies that emerge in developing stakeholder groups’ readiness to conduct POR.Methods/designWe will use a methodologically rigorous scoping review approach including formulation of the research question and development of the protocol; screening and identification of the literature; selection of relevant studies; data extraction; and collation, summary and report of the results. Our eligibility criteria include elements of population (patients, researchers, healthcare providers and decision-makers); concept (competencies: knowledge, skills, attitudes; and POR); context (level of involvement in research, settings, funding sources); study design (sample, stakeholder group, methodology, grey literature, theoretical framework); outcomes (primary: relevant to decision-making/policy and practice; and secondary: relevant to education and research); language (English, French); and timing (1990–2017). Registration with PROSPERO is not eligible for scoping reviews; so, it has not been registered.DiscussionResearch on core competencies required to enact POR is in its infancy. In this review, we can articulate what is known and thought about competencies (knowledge, skills and attitudes) needed by individuals on POR research teams and ultimately provide knowledge that could impact research, practice, education and policy. Identification of competencies can contribute to design of healthcare professionals’ basic and ongoing educational programmes, patient training in research, and professional development activities for health care providers and decision-makers. In addition, knowledge of core competencies can permit individuals to evaluate their own readiness to enter POR research teams.

Canada's Progressive Trade Agenda: NAFTA and Beyond

Canada is developing a progressive trade agenda (PTA) in response to the global rise of anti-globalization populism. This Commentary reviews the PTA concept, its motivation, the specific elements that comprise it, the likely efficacy of these measures in addressing the factors thought to be driving populism, and the extent to which the PTA can shape Canada’s trade agreements in general and the renegotiated NAFTA in particular. It concludes the following: • The PTA closely parallels the concept of “inclusive trade,” which has received much attention internationally, including in the World Trade Organization (WTO), the G20, and the World Economic Forum. It also closely parallels the concept of “trade sustainability” that has been developed by the European Union. It is, accordingly, part of a mainstream, progressive vision, rather than an idiosyncratic Canadian initiative. • The PTA responds to a widely accepted view that the gains from globalization have not been fairly shared, that there have been losers as well as winners, and that this reality has been a factor fuelling the populist reaction against globalization. In particular, it responds, along with similar agendas elsewhere, to the declining middle class share of income in industrialized societies. • While the policy is coherently framed and it goes without saying that trade policy should, indeed, help redress the distributional inequities to which it contributes, the role that trade policy has played in generating the current backlash against globalization was arguably relatively small. • At the same time, the measures that have been developed to advance the PTA have limited traction in affecting economic structure and income distribution. Expectations concerning the PTA’s potential efficacy should be calibrated accordingly. • The PTA faces modality issues: the norm-setting aspect is most effectively pursued at the multilateral level; in bilateral negotiations, policy coherence issues arise with both new and existing FTA partners, depending on the progressive credentials of partner governments (and changing administrations); and limiting the PTA’s substantive content in negotiations with less progressive trade partners may result in Canada facing competitive disadvantages and cause difficulties in mobilizing support for any trade agreement. • A failure to achieve strong PTA outcomes as part of the NAFTA renegotiation would signal that the move to deeper integration on the North American continent in the sense of harmonization of policy is both unlikely and ill-advised.

Unhelpful Fixer? Canada, the Euromissile Crisis, and Pierre Trudeau's Peace Initiative, 1983–1984

ABSTRACTThis article provides the most rigorous international history to date of Prime Minister Pierre Trudeau's 1983 peace initiative, one of Canada's major foreign policy ventures of the Cold War, examining both Trudeau's motives and the reception of his initiative among Canada's allies. Drawing on newly declassified sources in Canada, it uncovers the two-track strategy behind this initiative, aiming to mobilise Western European leaders to exert pressure on the Reagan Administration on the one hand, while quietly urging European allies to call for a review of NATO strategy on the other. Based on previously unavailable archival materials from seven different countries, this article also reveals how the Canadian initiative was received by the world leaders Trudeau sought to win over. It reassesses the Canadian initiative, revealing that it borrowed heavily from existing proposals from other countries, and that NATO leaders viewed the initiative as a mere electoral ploy to help Trudeau win re-election rather than a serious project to ease East–West tensions. This article concludes that with this initiative Canada was not in fact playing the role of a ‘helpful fixer’ and that the initiative constituted part of a wider and understudied trend in government responses to the ‘Second Cold War’.

Remote Rural Broadband Systems in Canada

The Rural Remote Broadband Systems (RRBS) program is a unique Canadian initiative to provide broadband access to unserved and underserved regions via fixed wireless service operating on unassigned television frequencies in the 512-608 MHz and 614-698 MHz bands. RRBS operators pay a nominal annual fee to access spectrum and receive a secondary license that offers no guarantee of protection from interference from broadcasting services.In 2011, the year the program was launched, Industry Canada issued 555 licenses for RRBS operations across the country. By 2014, there were 84 RRBS stations in Canada, the majority of which were concentrated in the province of Alberta. In December 2014, Industry Canada placed a moratorium on granting more spectrum licenses for RRBS operations while it examined the potentials of repurposing the 600 MHz band. As of August 2015, there were 52 RRBS stations operating in Canada.This study’s objective is to evaluate the RRBS policy as a method to bring efficient and affordable wireless internet service to remote and rural regions of Canada. This research looks at service providers at the margins of the Canadian wireless industry. Most RRBS providers in Canada are small enterprises that are often run by a few individuals and can have customer bases of less than one hundred. Despite the limited economic potential, early results show RRBS providers remain positive about its possibilities, if given the necessary policy support. This project explores the development of these small enterprises, RRBS business practices, as well as the continued role of the Canadian federal government in developing broadband infrastructures in remote and rural areas. The results of the study include quantitative data collected via surveys of RRBS service providers across Canada, and qualitative information obtained via structured interviews.Among the key questions: What precipitated the enormous drop in interested RRBS providers between 2011 and 2014? Can a secondary licence offer reliable service? Why are so many RRBS providers concentrated in the province of Alberta? What is the role of the federal government in supporting the development of small wireless providers? Is there a viable economic model to provide wireless broadband service in remote regions?This research is the only known study of this unique Canadian wireless broadband initiative. This study contributes to international telecommunication research involving Television White Space and unlicensed spectrum. It will prove valuable for any country with a large hinterland where wired access is a challenge.

Expanding the foundation of occupational therapy educational research – A Canadian initiative

ABSTRACTIn the health professions, it is important to recognise and embrace research that focuses on both the art and the science of education. The occupational therapy literature contains a small and largely descriptive pool of research regarding educational practices. The unsystematic use (or non-use) of research to inform educational practices compromises the quality and effectiveness of professional education. This paper describes a national strategy undertaken in Canada to profile the state of research activity in occupational therapy education, initiate an action plan to address underlying barriers, and build a community of educational researchers. Recommendations are provided for an international response targeted at mobilising broad-based collaboration and knowledge exchange.

LO42: Ice Cream Rounds: the adaptation and implementation of a peer-support wellness rounds in an emergency medicine residency training program

Introduction/Innovation Concept: Emergency Medicine (EM) is a specialty that requires physicians to deal with acutely ill patients in a fast-paced environment, which can create stress, mental exhaustion and burnout. Continually changing working teams in the Emergency Department does not always allow appropriate debriefing for difficult patient encounters and outcomes on shift. To address these challenges, we sought to adapt and implement a peer-support rounds called ‘Ice Cream Rounds’ used in some Pediatric training programs for an EM training program. Methods: CCFP and Royal College EM residents were surveyed to determine interest and need for Ice Cream Rounds. Of the 31/50 respondents, 87% (26/31) identified their co-residents as their main source of support after difficult patient encounters and 71% (22/31) felt that current opportunities to debrief after difficult experiences were only “sometimes” or “rarely” adequate. Overall, 84% (26/31) were interested in attending Ice Cream Rounds. Residents expressed that they did not want staff present for Ice Cream Rounds so two residents (SCS and TK) obtained training to lead peer-support sessions from The Faculty of Medicine Wellness Program. Attendance at rounds was voluntary and the EM program provided funding for refreshments. Two Ice Cream Rounds were piloted. Attendance and feedback was recorded from pilot sessions. Curriculum, Tool, or Material: Resident-only, peer-run confidential debriefing sessions. Sessions were voluntary and lasted one hour. Approximately 20-30/50 residents attended each Ice Cream Rounds. Discussions were confidential but include topics such as difficult patient encounters, poor patient outcomes, challenges in residency, and ethical issues. In response to positive attendance and feedback, the EM program provided 3-4 one-hour protected time slots with a stipend for refreshments for future academic years. Comments from residents consistently reaffirmed that Ice Cream Rounds was a helpful forum to discuss important issues with colleagues and provided a safe and confidential resource to help cope with residency challenges. Conclusion: We adapted, implemented, and evaluated a novel Peer-Support Wellness Rounds for debriefing resident issues and difficult patient encounters in a EM training program. To our knowledge this is the first Canadian initiative to implement such rounds in an EM training program. We believe that this template can be easily adopted by any EM training program and will effectively address wellness challenges faced by residents during their training.

PEARL-Pain in Early Life: A New Network for Research and Education.

Andersen, Randi Dovland MSc, RN; Axelin, Anna PhD, RN; Kristjánsdóttir, Guðrún PhD, RN; Eriksson, Mats PhD, RN Author Information

PEARL – Pain in early life. A new network for research and education

Abstract Aims To establish a network for research and education and to provide expert knowledge to parents and health care professionals about pain in early life. Methods In November 2014 a group of Nordic researchers and research students, committed to the field of pain in early life, gathered for an open lecture day and workshop in Örebro, Sweden. Inspired by the work of the Canadian initiative PICH – Pain In Child Health, the network formulated it’s vision: To be a stabile and competent research and training network within the area of pain in early life. A first collaborate project was designed: “Translation, cultural adaptation and validation of the revised version of the Premature Infant Pain Profile (PIPP-R): An effort to improve pain assessment in infants in the Nordic countries”. Results Fourteen months later, in January 2016, the second PEARL-meeting was held, in Oslo, Norway. The lecture day provided clinically active nurses and physicians from several countries with the latest findings on how to best manage pain in neonatal settings. The network which now consist of 18 researchers from different professions and academic levels presents itself on a five-language website: www.pearl.direct. The PIPP-R project has progressed according to the plan. The PIPP-R is translated into Finnish, Icelandic, Norwegian and Swedish. The cultural adaptation and validation should be finished in fall 2016. The members work on and plan for further collaborate projects. The next two steps are to translate and distribute educational material for parents via Internet and social media, and to establish a research and mas-ters course about pain in early life. The work has been secured by funding from Örebro University and Örebro University Hospital Research Foundation. Conclusions PEARL fulfils the need for a collaborative network for pain in early life researchers in the Nordic countries.