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• Allogeneic stem cell transplantation (SCT) did not offer a significant survival advantage over autologous SCT. • Relapse with progressive disease was the main cause of death. • Patients with PCL should be included in clinical trials of novel immunotherapies. Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P =.09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P =.41). The median OS from diagnosis was 27 months and 49 months, respectively (P =.50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients. [ABSTRACT FROM AUTHOR]

• Quality of life is well preserved after autologous hematopoietic stem cell transplantation (AHSCT) in older patients. • Relapse remains one of the main challenges affecting quality of life. • Self-care is the least affected area after undergoing AHSCT. • Older patients should not be excluded from AHSCT based solely on their age. High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) improves survival in patients with chemosensitive non-Hodgkin lymphoma (NHL). Determination of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) has contributed to improve patient selection while allowing for prediction of nonrelapse mortality. We previously demonstrated the efficacy and safety of AHSCT in a cohort of older patients with chemosensitive NHL. Quality of life following AHSCT still has not been widely evaluated. The goal of this study was to assess the long-term quality of life of elderly patients surviving AHSCT. This single-center, Research and Ethics Committee-approved study investigated QoL in survivors of AHSCT for the treatment of NHL in a cohort of older patients. Inclusion criteria were defined as patients age ≥60 years who underwent AHSCT for NHL between January 1, 2008, and January 1, 2015, at our center. Fifty-nine patients from the original cohort of 90 survived at a median of 50 months post-AHSCT. Forty-seven (79.7%) of those patients agreed to complete the QoL assessment questionnaires after the transplantation and are included in this report. All patients provided signed informed consent. We used the EQ-5D instrument to assess mobility, self-care, usual activities, pain/discomfort, and anxiety/depression and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) questionnaire to assess physical, social/family, emotional, and functional well-being and BMT-specific concerns. With both tools, a higher score indicates better QoL. Fifteen percent of patients were in relapse at the time of the QoL assessment. In the EQ-5D, few patients (9%) reported severe impairment, which requires significant negative effects in 4 or 5 domains. Lower Karnofsky Performance Status (KPS) score at the time of transplantation was negatively correlated with mobility (P =.001), self-care (P =.001), and usual activities (P =.007) dysfunction. Anxiety was significant for patients in relapsed after transplantation (P =.002). FACT-BMT questionnaire results demonstrated that physical, social, and emotional well-being were all well preserved after the transplantation, whereas functional well-being was more variable among patients. Relapse was associated with impaired functional well-being (P =.007) and lower total FACT-BMT score (P =.014). Other comparators, including the conditioning regimen, sex, age subgroups (<65 or ≥65 years), HCT-CI score, and disease status at transplantation, did not impact any of these outcomes. This study demonstrates that physical, social, and functional well-being are preserved in older patients following AHSCT. Low KPS score before AHSCT is a predictor of disability at distance from AHSCT. Relapse following AHSCT remains the most significant impediment to maintaining a good QoL. Innovative interventions to improve performance status before transplantation and measures to prevent relapse thereafter should be investigated to improve survival and QoL. [ABSTRACT FROM AUTHOR]

Highlights • One of the largest older patients cohort undergoing autologous transplant for NHL. • Toxicity and resource use are not different for patients ≥65 years old. • Stable and chemo resistant disease at transplant are associated with poor outcomes. • Treatment related mortality is only 1% at one year in this older patient cohort. Abstract Background Autologous hematopoietic stem cell transplantation (AHSCT) in the older population is associated with an increased risk of morbidity and mortality. Determination of the hematopoietic cell transplant comorbidity index (HCT-CI) has contributed to improve patient selection while allowing prediction of their non-relapse mortality (NRM). The goal of this study was to identify factors influencing both safety and efficacy of AHSCT in an older non-Hodgkin lymphoma (NHL) population to better select those who will benefit from this intervention in the Canadian context of a single-payer government healthcare program. Methods This single center, retrospective study, examined clinical outcomes in 90 consecutive older patients (≥60 years old) with B-cell NHL treated with AHSCT between 2008 and 2014. Findings Median age was 63 (60–69) at time of transplantation. The HCT-CI risk score was low, intermediate and high in 34%, 40% and 26% of patients, respectively. NRM was 1% at 100 days and one-year post transplant and not influenced by age. At a median follow-up of 52 months, median progression-free survival (PFS) was 56 months while median overall survival (OS) was still not reached. Stable and progressive disease status at time of transplantation were associated with a lower PFS (HR 2.94) and OS (HR 3.91). BEAC conditioning and a graft cell dose 5 × 106 CD34+/kg led to faster recovery, decreased toxicity and resource consumption. Interpretation In the older population, AHSCT is safe and optimal when restricted to fit chemosensitive patients. [ABSTRACT FROM AUTHOR]

Abstract In 2010 Parties to the United Nations (UN) Convention on Biological Diversity (CBD) agreed to reduce the rate of biodiversity loss within a decade by achieving 20 objectives that are commonly known as the Aichi Targets. This article explores aspects of Canada's work on one of the few quantified targets (Target 11), which is intended to improve the status of biodiversity through protected areas (PAs) and a new type of designation, "other effective area-based conservation measures" (OECMs). In a faltering attempt to reach its Aichi Target 11 commitments by 2020, some Canadian jurisdictions have elected to focus more on coverage (quantity) and less on ecological integrity (quality), which has significant ramifications for long-term success of biodiversity conservation. For example, a jurisdiction responsible for marine conservation has re-designated regulated fishery closures as 'marine refuges' under the auspices of an OECM designation, which brings into question the real intent of Canada's commitment to the CBD and its own Biodiversity Strategy. Ambiguous language used to define and prescribe application of OECMs is being used as the basis for a revisionist paradigm that promises to undermine national and international conservation standards, fracture partnerships, and jeopardize the integrity of Canada's PA network. Canada must reject half measures that will result in ineffective or unintended perverse conservation outcomes, and focus on a post-2020 agenda that prioritizes conservation outcomes, management effectiveness, and the implementation of accountability measures within and between jurisdictions and by the Secretariat of the CBD. Highlights • Practitioners/scholars warned about the potential risks to effective biodiversity conservation associated with Aichi Target 11. • In Canada, recently established, 'marine refuges' do little to mitigate the increasing risks to ocean ecosystems. • Focusing on quantity over quality of protection jeopardizes biodiversity conservation. • Canada should focus on biodiversity outcomes under its post-2020 conservation agenda outcomes. • Enhanced accountability in Canada and also by the Secretariat of the CBD is required. [ABSTRACT FROM AUTHOR]

Other Effective Area-based Conservation Measures (OECMs) were introduced in the language of the United Nations Convention on Biological Diversity (CBD) 2011–2020 Strategic Plan for Biodiversity as a mechanism to formally recognize the contributions that areas beyond traditional protected areas can make to the effective, long-term, in-situ conservation of biodiversity. Since the international conservation community agreed to a definition of OECMs in 2018, various Parties to the CBD have begun designating these areas and they are now being reported in global and national protected and conserved area databases. Using examples from Canada, this perspective details how the designation of some OECMs is circumventing the use of established and well-known decision support tools that work to uphold conservation standards, and why these designations may result in negligible gains for biodiversity. The perspective also details how labeling OECMs as "marine refuges" and "conserved areas" is misleading and can misinform the public on conservation success. To avoid the loss of biodiversity in 'paper parks' and eroding public trust in the institutions charged with effectively conserving biodiversity, the paper concludes by underscoring the need for new tools to evaluate the effectiveness of OECMs and new measures to hold countries accountable to protected and conserved area targets in the CBD so that their original intent is not further compromised in the post-2020 era of conservation. [ABSTRACT FROM AUTHOR]

Despite increased commitment to manage for climate change by various levels of government around the world, empirical knowledge of how adaptation processes are convened and policies developed remains scarce. In this paper, we describe the approach, methods, and results of a multi-partner pilot project that was used to assess vulnerabilities of natural and built systems to climate change and develop adaptation options for inclusion in a climate change adaptation strategy for the Lake Simcoe Watershed in Ontario, Canada. The multi-method approach, which included workshops, face-to-face meetings, and an iterative Policy Delphi survey, proved to be efficient and effective in helping identify and understand multi-sector climate change vulnerabilities in the watershed, and in bringing climate change experts and decision-makers together to work on a proactive, science-based policy outcome. Challenges experienced during the adaptation planning process included short project timelines, limited financial resources, and a lack of expertise to address regional vulnerabilities in some sectors. However, the non-linear, iterative nature of the approach provided the capacity required to respond to some of these capacity issues during the pilot project. Overall, the process demonstrated the importance of engaging appropriate expertise and adopting a flexible and stakeholder-enabling adaptation framework. Perspectives for strengthening links among the scientific and policy-making communities are highlighted, and practical lessons learned are provided to help other decision-makers begin and amplify the process of integrating climate change into public policy and planning initiatives. [ABSTRACT FROM AUTHOR]

Abstract: A growing range of studies have begun to document the health and well-being benefits associated with contact with nature. Most studies rely on generalized self-reports following engagement in the natural environment. The actual in-situ experience during contact with nature, and the environmental features and factors that evoke health benefits have remained relatively unexplored. Smartphones offer a new opportunity to monitor and interact with human subjects during everyday life using techniques such as Experience Sampling Methods (ESM) that involve repeated self-reports of experiences as they occur in-situ. Additionally, embedded sensors in smartphones such as Global Positioning Systems (GPS) and accelerometers can accurately trace human activities. This paper explores how these techniques can be combined to comprehensively explore the perceived health and well-being impacts of contact with nature. Custom software was developed to passively track GPS and accelerometer data, and actively prompt subjects to complete an ESM survey at regular intervals throughout their visit to a provincial park in Ontario, Canada. The ESM survey includes nine scale questions concerning moods and emotions, followed by a series of open-ended experiential questions that subjects provide recorded audio responses to. Pilot test results are used to illustrate the nature, quantity and quality of data obtained. Participant activities were clearly evident from GPS maps, including especially walking, cycling and sedate activities. From the ESM surveys, participants reported an average of 25 words per question, taking an average of 15 s to record them. Further qualitative analysis revealed that participants were willing to provide considerable insights into their experiences and perceived health impacts. The combination of passive and interactive techniques is sure to make larger studies of this type more affordable and less burdensome in the future, further enhancing the ability to understand how contact with nature enhances health and well-being. [Copyright &y& Elsevier]

Abstract: Given the known and potential impacts of climate change on ecosystem composition, structure, and function, some recent studies question the efficacy and relevancy of current protected area policies and management objectives. For example, in a rapidly changing climate is it practical to continue to identify and protect ‘representative’ samples of the natural heritage estate? This paper examines a number of climate-related issues that now confront agencies and organizations responsible for the protection of natural heritage areas, including the roles of protected areas, representation targets, ecological integrity, protected area design, management techniques, research and monitoring needs, and agency capacity to respond. Potential avenues for adaptation are proposed in light of these issues. The development and implementation of a cross-jurisdictional landscape-scale strategic conservation framework focused on protecting, connecting, and restoring ecosystems will be fundamental to enhancing ecological resilience to climate change. We conclude that even though climate change presents unprecedented and significant challenges, the protected area contribution to ecosystem function and human health and well-being will remain an essential and worthwhile investment in the 21st century. [Copyright &y& Elsevier]

Identification and protection of important areas to improve connectivity in support of biodiversity conservation, climate change adaptation, and Indigenous Rights has been a key aspect in the Convention on Biological Diversity 's policymaking for over two decades. Target 3 of the recently adopted Kunming-Montreal Global Biodiversity Framework reiterated this need, calling on nations to conserve 30 % of terrestrial and marine areas by 2030 through "well-connected" and equitably governed systems of protected and conserved areas, among other considerations. In response to this call, Canada has initiated and amplified a new National Program for Ecological Corridors to enable collaborative efforts to protect and restore ecological connectivity across the country. Using multiple methods, including a literature review and a combination of interviews and workshops with conservation stakeholders, seven enabling conditions to support the effective and equitable implementation of the program were identified. These enabling conditions encompass respectful and meaningful engagement of and inclusion of Indigenous Peoples; establishing high-level commitment and vision, consistent with international and national biodiversity conservation and climate change commitments, supported by predictable, sustained funding and enabling legislation; and developing an appropriately scaled national corridor vision and supporting criteria and indicators to effectively monitor and communicate outcomes for biodiversity and people. Supporting mechanisms and strategies are detailed that can be used to effectively enable a national corridor program in Canada, providing early lessons learned and next steps for consideration by the wider global conservation community who are also striving to meet their own biodiversity and climate change adaptation goals. [Display omitted] • Ecological corridors support biodiversity and climate change mitigation and adaptation. • Corridor programs must engage, respect, and advance Indigenous rights and leadership. • Successful implementation requires sustained financial and institutional supports. • Strong leadership, partnerships, co-governance, and co-management are essential. • Place-based biodiversity and social benefits of corridors should be communicated. [ABSTRACT FROM AUTHOR]

Sorafenib and pazopanib, two tyrosine kinase inhibitors (TKI), are widely used in patients with progressive symptomatic desmoid tumors (DT). Limited real-word data is available on long-term outcomes of patients who progressed on, stopped, or continued TKIs. Patients diagnosed with DTs and treated with sorafenib or pazopanib between 2011 and 2022 at 11 institutions were reviewed. Patient history, response to therapy and toxicity were recorded. Statistical analyses utilized Kaplan-Meier and log-rank tests. 142 patients with DT treated with sorafenib (n = 126, 88.7 %) or pazopanib (n = 16, 11.3 %) were analyzed. The median treatment duration was 10.8 months (range: 0.07- 73.9). The overall response rate and the disease control rate were 26.0 % and 95.1 %, respectively. The median tumor shrinkage was − 8.5 % (range −100.0 %- +72.5 %). Among responders, the median time to an objective response was 15.2 months (range: 1.1 to 33.1). The 1-year and 2-year progression-free survival rates were 82 % and 80 %. Dose reductions were necessary in 34 (23.9 %) patients. Grade 3 or higher adverse events were reported in 36 (25.4 %) patients. On the last follow-up, 55 (38.7 %) patients continued treatment. Treatment discontinuation (n = 85, 59.9 %) was mainly for toxicity (n = 35, 45.9 %) or radiological or clinical progression (n = 30, 35.3 %). For the entire cohort, 36 (25.4 %) patients required subsequent treatment. In the 32 responders, only 1 (3.1 %) patient required a subsequent treatment. In patients who discontinued TKI, 25 (44.6 %) with stable disease received subsequent treatment compared to 0 (0.0 %) of responders. This retrospective study represents the largest cohort of DT patients treated with sorafenib or pazopanib to date. Discontinuation of treatment in responders is safe. The optimal treatment duration in patients with stable disease remains to be defined. • Sorafenib and pazopanib are effective treatments for desmoid tumor patients. • Treatment discontinuation should be discussed in radiologically responding patients. • Optimal treatment duration for patients with stable disease remains unknown. [ABSTRACT FROM AUTHOR]

The direct and indirect impacts of resource extraction activities are an increasingly important planning and management challenge for organizations responsible for protected areas and other effective area-based conservation measures (OECMs). The development of subsurface resources in protected areas or OECMs can have significant implications for the ways in which such areas are established and their overall effectiveness in conserving biodiversity. In this article, we introduce a decision-support tool, developed through expert consensus and real-world application, that can be used to assist organizations to evaluate the effectiveness of conservation mechanisms (laws, regulations, and associated policies) and other management tools from potential subsurface resource extraction activities. The tool provides a novel and comprehensive method to determine whether a potential protected area or OECM is effective in managing all subsurface activities that may have an impact on biodiversity. While developed in Canada, the tool has universal applicability for conservation managers globally working to achieve standards of protection for biodiversity. We conclude by discussing the ways in which Parties to the Convention on Biological Diversity (CBD) can consider resource extraction rights and impacts in national efforts to effectively achieve the goals and targets of the recently adopted Kunming-Montreal Global Biodiversity Framework (GBF). [ABSTRACT FROM AUTHOR]