Decision-making In Canada Research Articles

Population genetics of caribou in the Alaska-Yukon border region: implications for designation of conservation units and small herd persistence

Better knowledge of genetic relationships between the Fortymile caribou herd and its neighbors is needed for conservation decision-making in Canada. Here, we contribute the first fine-scale analysis of genetic population structure in nine contiguous caribou herds at the geographic boundaries between Barren-ground and Northern Mountain caribou, and at the Alaska-Yukon border. Using pairwise differentiation metrics, STRUCTURE, and discriminant analysis of principal components (DAPC) to analyze 15 microsatellite loci in 379 caribou, we found complex patterns of genetic differentiation. The Fortymile was the only herd assigned to more than one genetic cluster, indicative of its history as a larger herd whose range expansions and gene flow to other herds were likely important to maintaining diversity across a functioning genetic metapopulation. Some small herds (Chisana, Klaza, and White Mountains) were genetically distinct, while others (Hart River, Clear Creek, Mentasta) exhibited little differentiation from herds they occasionally overlap, including herds assigned to different conservation units (DUs). This genetic connectivity does not result from demographic connectivity, as episodic contact during rut, rather than herd switching, is the likely mechanism. Unusually, one small herd (White Mountains) maintained genetic differentiation despite rut overlap with Fortymile. Our data reveal that some herds with different ecological and behavioral attributes are demographically independent but nonetheless genetically connected. Thus, we suggest that managing caribou for an appropriate level of genetic connectivity, while also supporting herd persistence, will be essential to conserve caribou genetic diversity in the region.

Time for a pluralist approach? Judicial review of non-state decision makers in Canada

The doctrinal project of delineating the supervisory jurisdiction of the common law courts and the scholarly project of elucidating the public law–private law divide have had a long and close relationship. The Supreme Court of Canada strengthened this relationship in Highwood Congregation of Jehovah’s Witnesses (Judicial Committee) v Wall, establishing a bright-line test for the availability of judicial review that takes a presumed state/non-state dichotomy as its organizing principle. In this article, I build on existing critiques of the decision, describing how Wall’s categorical paradigm has reduced the judicial oversight of powerful decision makers that have historically been subject to standards of fairness and rationality. However, I also use Wall to raise a more fundamental question, which is whether the public law–private law divide continues to provide the best vocabulary and framework for determining judicial review’s boundaries. I explore legal pluralism, a project that has developed in parallel with the public law–private law scholarship and consider whether it might provide a superior framework for understanding the challenges to practices of normative decision making that lie at the heart of cases like Wall. I argue that legal pluralism is more phenomenologically correspondent than the public law–private law divide with cases involving norm-generating communities and more coherent with the values that the common law supervisory jurisdiction should be seeking to promote.

Hyperbaric Oxygen Therapy: An Emerging Therapy for Post–COVID-19 Condition

What Is the Issue?
 
 Post–COVID-19 condition presents an important challenge to health care decision-makers in Canada and across the world due to the high volume of potential patients, diverse presentations of symptoms, few clinical guidelines and treatments, and unknown pathophysiology.
 
 What Is the Technology?
 
 Hyperbaric oxygen therapy (HBOT) is an established treatment for certain wound injuries, vascular conditions, and in specific medical emergencies. It is now being tested for post–COVID-19 condition, also known as long COVID. The therapy delivers a high concentration of oxygen inside specialized pressure chambers. HBOT has been proposed as a treatment to help resolve prominent symptoms of post–COVID-19 condition, such as fatigue and brain fog. The therapy may induce physiological changes that aid in recovering from the long-term effects and tissue damage due to severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection.
 
 What Is the Potential Impact?
 
 Results from early studies indicate that HBOT could improve a range of post–COVID-19 symptoms and its use is generally safe with few adverse effects. These results are based on 2 randomized control trials and small nonrandomized studies and case reports. However, published results have been based on studies with limited sample sizes and limited long-term follow-up.
 HBOT could offer a therapy option that could support millions of people around the world with post–COVID-19 condition if the ongoing and subsequent studies show efficacy.
 
 What Else Do We Need to Know?
 
 As of now, there are uncertainties about how to effectively deliver and dose the therapy and the potential safety implications for people with post–COVID-19 condition. Implementation considerations, such as the number and location of hyperbaric oxygen chambers, will be important if HBOT is appropriate for a large number of people. As the evidence base develops, the potential role of HBOT in therapy for people with post–COVID-19 condition will become clearer and will provide an indication of what kind of health system planning may be needed to provide HBOT for those who can benefit.

Objective Assessment System for Cognitive Function

Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; these technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. Identifying cognitive conditions allows health professionals to develop tailored rehabilitation strategies and track treatment effects for people with functional impairment. This Horizon Scan summarizes the available information regarding an emerging technology, VoxNeuro CORE, and its software for the objective evaluation of cognitive performance, the cognitive health assessment management platform (CHAMP).

Less Talk, More Action: Strategies to Mitigate Inequities Experienced by Indigenous Peoples in the Healthcare System.

Healthcare policy and decision makers in Canada have the power to address the persistent inequities experienced by Indigenous Peoples. Bold, immediate actions are necessary to address the varying manifestations of systemic racism, the ongoing denial of racism and the negative impacts on access to care and health outcomes. The perspectives presented in this issue of HealthcarePapers highlight a clear imperative: much more must be done at multiple levels to make healthcare systems safer for Indigenous Peoples. The actions discussed in this introductory paper reflect key, evidence-informed strategies to guide healthcare policy and decision makers in Canada and, potentially, other jurisdictions.

Low-Level Laser Treatment for Lower Back Pain


 The CADTH Horizon Scanning Service identifies emerging health technologies that may be of potential interest to health care decision-makers in Canada.
 Chronic pain, including chronic low back pain, challenges many aspects of people's lives, including social, physical, mental, and professional. Approximately 80% of adults will be affected by chronic lower back pain at least once in their lifetime and seek out multiple treatment options, including drug treatments, psychological treatments, and physical therapies.
 This Horizon Scan summarizes available information regarding an emerging technology, the Erchonia FX 635 low-level laser system, for the treatment of chronic low back pain.

Point-of-Care Tests for Pancreatitis


 Horizon scan reports provide brief summaries of information regarding new and emerging health technologies, which are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 The Actim Pancreatitis test is a rapid point-of-care test that detects acute pancreatitis (including endoscopic retrograde cholangiopancreatography–related pancreatitis). It has the potential to provide a diagnosis of pancreatitis more quickly and with fewer financial and human resources. It may be particularly useful in settings that do not have quick access to laboratory services.

Vagus Nerve Stimulation for the Treatment of Post–COVID-19 Condition


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Health Technology Update articles typically focus on a single device or intervention. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding vagus nerve stimulation for the treatment of post–COVID-19 condition, also known as long COVID. In particular, the Horizon Scan discusses the Dolphin Neurostim, the first medical device to receive a Health Canada emergency authorization for expanded use in post–COVID-19 conditions.
 The emerging evidence from early findings of small pilot studies suggests that vagus nerve dysfunction may be implicated in some post–COVID-19 conditions and neurostimulation of the vagus nerve could help improve some symptoms. However, the evidence is limited because the studies were not powered to detect statistically significant differences in outcomes, and it is unclear if the reported findings were clinically meaningful.
 Due to the heterogeneity of post–COVID-19 condition and limited understanding of its pathophysiology, the extent of vagus nerve dysfunction’s involvement in the condition is unclear. Where that dysfunction is implicated, electrical stimulation of the vagus nerve may be a potentially useful therapeutic option, likely complementary to other treatment options. Emerging evidence from ongoing and future research could help define the clinical effectiveness of the technology and guide its appropriate use.

Shared decision-making in Canada: Update on integration of evidence in health decisions and patient-centred care government mandates

In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare.Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities.In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute’s decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM.

Tirzepatide for Type 2 Diabetes Mellitus


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding an emerging technology, tirzepatide, for the treatment of hyperglycemia in adults with type 2 diabetes.
 Type 2 diabetes (T2D) is a metabolic disease where blood glucose concentrations cannot be maintained at a normal level (hyperglycemia). Several antihyperglycemia drugs are currently available for the treatment of T2D including metformin, insulin secretagogues (meglitinides, sulfonylureas), dipeptidyl peptidase-4 (DPP4) inhibitors, sodium glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like polypeptide-1 (GLP-1) receptor agonists, thiazolidinediones, alpha-glucosidase inhibitors, and slow/fast-acting insulin analogues. Despite the number of drugs currently available to mitigate hyperglycemia, a significant unmet need for new therapeutics still exists.
 Tirzepatide (LY3298176; Eli Lilly Inc.) is a first in class dual glucagon-like polypeptide-1 (GLP-1) receptor and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist currently under development to treat hyperglycemia and obesity in individuals with T2D.
 To date, phase III clinical trials have been completed and several other trials are in progress to determine the efficacy of tirzepatide to reduce hyperglycemia (SURPASS studies) and obesity (SURMOUNT-2 study) in adults with T2D.
 This Horizon Scan bulletin focuses on the glycemic effect of tirzepatide in T2D. In summary, tirzepatide demonstrates efficacy in reducing mean glycated hemoglobin (A1C) compared to placebo, semaglutide, insulin degludec, and insulin glargine. Studies investigating the possible effect of tirzepatide on cardiovascular outcomes are currently ongoing.

Emerging Multi-Cancer Early Detection Technologies


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; these technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This report is not an endorsement or assessment of any test or technology.
 This Horizon Scan summarizes the available information regarding the emerging technology of liquid biopsy–based, multi-cancer early detection tests for cancer screening. This Horizon Scan focuses specifically on the Galleri (GRAIL Inc.) and CancerSEEK (Exact Sciences) tests, which are further along in the development cycle and are being assessed in different international clinical studies.
 Multi-cancer early detection technologies aim to provide a new approach to complement traditional cancer screening programs. These tests examine genetic signals within blood samples with next-generation sequencing and computational algorithms to assess the presence and type of different cancers. Research to date has focused on describing results from training and validation studies that have provided initial estimates of test performance and modelling studies estimating the potential impact on cancer incidence.
 This Horizon Scan also highlights some issues for health care decision-makers to consider about the technology relating to real-world test performance, the potential benefits and harms of screening with multi-cancer early detection tests, and the disruptiveness to health systems they could pose. Ongoing review of clinical trials and the emerging evidence base can help inform health systems in Canada about their potential role within cancer-control initiatives.

Electrospun Healing Fibres for the Management of Burns and Wounds


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention.
 These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding an emerging technology, Spincare Wound Healing System, for the management of burns.

Artificial Intelligence for the Prediction of Sepsis in Adults


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention.
 These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding an emerging technology, artificial intelligence algorithms, for the prediction of sepsis in adults.

Vacuum-Induced Uterine Tamponade for Postpartum Hemorrhage


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention.
 These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding an emerging technology, the Jada System, for the management of postpartum hemorrhage.

Emerging Drugs for Amyotrophic Lateral Sclerosis


 Horizon scan reports provide brief summaries of information regarding new and emerging health technologies. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding emerging drug therapies for the treatment of patients with amyotrophic lateral sclerosis.
 Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurodegenerative disorder characterized by muscle weakness and wasting. ALS can be classified as sporadic (sALS), which accounts for 85% to 90% of the cases, or familial (fALS), which includes 10% to 15% of the cases.
 At present, 2 drugs are available in Canada for the treatment of patients with ALS, riluzole and edaravone. These 2 drugs provide modest benefits in terms of survival and function.
 Many treatments are currently in various stages of clinical development. Fasudil, ibudilast, inosine, and masitinib are drugs of interest as they have completed phase II, and some have initiated phase III, of their respective clinical development. Several other drugs are in clinical development and are briefly described in this report: AT-1501, CNM-Au8, Engensis, Pridopidine, Verdiperstat, and Zilucoplan.
 Emerging drugs for ALS pertain to different drug classes. Despite different mechanisms of action, these drugs all aim at providing a neuroprotective effect that will result in slowing of disease progression, maintenance of patient functional status, and improvement in patient survival.
 Of the 4 ALS drugs of interest in late-stage development, Fasudil, Ibudilast, and Inosine have completed phase II of clinical development.
 The estimated completion date for phase III of clinical development for Masitinib is December 2022.

Emerging Drugs for Generalized Myasthenia Gravis


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding emerging targeted therapies for the treatment of generalized myasthenia gravis (MG).
 MG is a rare and chronic autoimmune disease in which autoantibodies attack specific proteins in the neuromuscular junction, resulting in muscle weakness. Many patients develop generalized MG resulting in severe fatigable muscle weakness with difficulties in facial expression, speech, swallowing, and mobility.
 Current treatments for MG include anticholinesterase inhibitors, systemic corticosteroids, and nonsteroidal immunosuppressive drugs. IV immunoglobulins or therapeutic plasma exchange are the current treatment options for patients with severe or acutely worsening generalized MG. Thymectomy is also considered a treatment option for patients with generalized MG who fail to respond to immunotherapy or have intolerable side effects.
 In this scan, we have reviewed 6 new treatment strategies that target specific areas of the immune system involved in the pathogenesis of MG: efgartigimod, rozanolixizumab, zilucoplan, ravulizumab, batoclimab, and nipocalimab. Phase II and III clinical trials have shown that these drugs may potentially benefit patients with generalized MG based on improvements in measures of disease severity and functional disability.
 The information presented is limited in that most of the available evidence comes from phase II trials that were designed to primarily investigate safety and tolerability based on small sample sizes, short trial duration, and narrow inclusion criteria. Therefore, findings do not reflect current standard of practice for maintenance therapy for generalized MG in the real-world setting.
 Considerations for future use include identifying the population that will most likely benefit from therapy and evaluating these drugs for rare and serious adverse events. Factors such as ease of administration, dosing schedule, and cost are all important factors that will help determine uptake and place in therapy for these emerging targeted therapies.

Renal Denervation for People With Hypertension

Horizon scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding an emerging technology — Symplicity Spyral — a renal denervation system for the treatment of uncontrolled hypertension.

Increasing the accountability of automated decision-making systems: An assessment of the automated decision-making system introduced in Canada's temporary resident visa immigration stream

States are increasingly turning to automated decision-making systems to increase efficiency in program and service delivery. While automation offers several desirable benefits, great care must be given to establishing and increasing the accountability of automated decision-making systems in the public sector. This paper focuses on accountability in automated decision-making systems in migration management. A key issue is what the impact of automated decision-making is on accountability in migration management? This paper seeks to explore this question by evaluating the accountability mechanisms established by the Canadian government in the use of automated decision-making systems to triage Temporary Resident Visa immigration applications. This paper begins with an explanation of the interaction between public administration and digital governance, with a particular focus on the human decision-making component of public administration and a review of accountability in the public sector. What follows is an explanation of how decision-making in Canada's Temporary Resident Visa Application stream traditionally occurs. A brief review of the Canadian Algorithmic Impact Assessment Tool introduces a thorough explanation of the Canadian government's Temporary Resident Visa (TRV) eApps Advanced Analytics Pilot to showcase changes between the traditional human decision-making process and the more recent experiment engaging automated decision-making in this particular immigration stream. The paper concludes by posing a question on what accountability amounts to for the Canadian government and whether the accountability measures introduced in Canada's TRV Pilot are sufficient.

Ministerial Education Councils’ Capacity for Policy Decision-Making in Canada, Germany, and Switzerland: Finding a Balanced Perspective

Scholars have become increasingly vigilant about leaders, the role of government and wider governance bodies, and their influence on education policy. Councils in Europe and North America, generally, and education councils, specifically, are good examples of influential bodies whose decision-making processes have rightfully come under scrutiny; however, many scholarly assessments have been characterized by rhetorical claims that focus on these bodies’ limited ability to make decisions and address social challenges. This article details a qualitative, comparative case study conducted in 2018 that investigated how Councils of Ministers of Education in Canada, Germany, and Switzerland address national educational issues of collective interest. The resulting dataset is comprehensive, and this research invites colleagues to refine or rethink some of their limiting rhetorical tools and underlying assumptions.

Adaptive Deep Brain Stimulation for the Treatment of Parkinson Disease and Essential Tremor


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention.
 These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding an emerging technology, Percept PC Deep Brain Stimulation (DBS) system with BrainSense technology, for the treatment of Parkinson disease and essential tremors.