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This is a consensus-based Canadian guideline whose primary purpose is to standardize and facilitate the management of chronic graft-versus-host disease (cGvHD) across the country. Creating uniform healthcare guidance in Canada is a challenge for a number of reasons including the differences in healthcare authority structure, funding and access to healthcare resources between provinces and territories, as well as the geographic size. These differences can lead to variable and unequal access to effective therapies for GvHD. This document will provide comprehensive and practical guidance that can be applied across Canada by healthcare professionals caring for patients with cGvHD. Hopefully, this guideline, based on input from GvHD treaters across the country, will aid in standardizing cGvHD care and facilitate access to much-needed novel therapies. This consensus paper aims to discuss the optimal approach to the initial assessment of cGvHD, review the severity scoring and global grading system, discuss systemic and topical treatments, as well as supportive therapies, and propose a therapeutic algorithm for frontline and subsequent lines of cGvHD treatment in adults and pediatric patients. Finally, we will make suggestions about the future direction of cGvHD treatment development such as (1) a mode-of-action-based cGvHD drug selection, according to the pathogenesis of cGvHD, (2) a combination strategy with the introduction of newer targeted drugs, (3) a steroid-free regimen, particularly for front line therapy for cGvHD treatment, and (4) a pre-emptive approach which can prevent the progression of cGvHD in high-risk patients destined to develop severe and highly morbid forms of cGvHD. [ABSTRACT FROM AUTHOR]

For patients with Mantle Cell Lymphoma (MCL), there is no recognized standard of care for relapsed/refractory (R/R) disease after treatment with a Bruton's tyrosine kinase inhibitor (BTKi). Brexucabtagene autoleucel (brexu-cel) represents a promising new treatment modality in MCL. We explored whether brexu-cel was cost-effective for the treatment of R/R MCL. We developed a partitioned survival mixture cure approach to model the costs and outcomes over a lifetime horizon. The clinical data were derived from the ZUMA-2 clinical trial. The costs were estimated from the publicly available Canadian databases, published oncology literature, and pan-Canadian Oncology Drug Review economic guidance reports. The health state utilities were sourced from the ibrutinib submission to the National Institute for Health and Care Excellence for R/R MCL and supplemented with values from the published oncology literature. In the base case over a lifetime horizon, brexu-cel generated an incremental 9.56 life-years and an additional 7.03 quality-adjusted life-years compared to BSC, while associated with CAD 621,933 in additional costs. The resultant incremental cost-utility ratio was CAD 88,503 per QALY gained compared with BSC. Based on this analysis, we found brexu-cel to be a cost-effective use of healthcare resources relative to BSC for treatment of adult patients with R/R MCL previously treated with a BTKi in Canada, though additional research is needed to confirm these results using longer follow-up data. [ABSTRACT FROM AUTHOR]

Parks and other forms of protected areas worldwide face significant threats from rapid climatic and associated ecological change. While the need to adapt to the impacts of climate change on biodiversity is widely acknowledged, and the extant literature has identified numerous adaptation options, much less is known about the institutional preconditions that enable or inhibit adaptation in resource management systems. We address this gap by presenting a framework that assesses the readiness of protected area organizations to adapt to climate change. Specifically, using a mixed methods approach including a literature review, online survey, and workshop, we: (1) adapt a framework to assess organizational adaptation readiness in protected areas organizations; (2) use the framework to assess organizational adaptation readiness in Bruce Peninsula National Park (BPNP) and Fathom Five National Marine Park (FFNMP) in Ontario, Canada, and (3) identify ways to strengthen the readiness of protected area organizations to respond to climate change. Results indicate that BPNP/FFNMP have low to moderate overall organizational adaptation readiness, with higher readiness in terms of understanding social-ecological systems (e.g., mapping and monitoring social and ecological values) and lower readiness in terms of collaboration, knowledge management and exchange. Recommendations to increase the organizational adaptation readiness of protected area organizations include increasing collaboration and knowledge exchange with partners, local residents, and Indigenous communities, and educating staff and visitors about climate change impacts. Overall, framework outcomes can be used to assess organizational strengths, weaknesses, and most importantly identify areas for resource allocation or re-allocation to enhance readiness and ensure that adaptation planning is translated into on-the-ground action. [ABSTRACT FROM AUTHOR]

Human health and well-being benefits have increasingly been associated with contact with nature. However, limited research has focused on the influence of ecosystem type and quality on these outcomes. This paper reports on the results of an in-situ survey of 467 visitors to an Ontario protected area. Results revealed high overall restorative outcomes across all ecosystem types, with greater benefits reported for women than men. Perceived ecosystem quality, including species richness, naturalness, and ecological integrity, had the greatest impact on restorative outcomes, while the type of ecosystem and time spent had surprisingly little influence. Greater restorative outcomes for women were also associated with specific ecosystem types. The study advances our limited understanding of the nuanced relationship between human health and well-being outcomes and exposure to diverse ecosystems, and by extenstion the unique aspects of biodiversity and ecosystem condition that Canada's protected areas exhibit. [ABSTRACT FROM AUTHOR]

The health and well-being benefits of nature contact in parks and other forms of protected areas are now well established, but remain beyond the grasp of many due to century-old design legacies and inadequate investment in inclusive visitor services. This paper reports on lessons learned from an interdisciplinary workshop that brought together park agency staff, academics, and individuals representing accessibility organisations. The purpose of this workshop was to develop a shared vision and explore planning and management pathways for advancing accessibility in parks and protected areas. Four interrelated priority action areas were identified: (1) inclusivity through employment; (2) inclusive programming; (3) information sharing; and, (4) partnering in next steps. This paper contributes to an underdeveloped literature on accessibility and nature by identifying parameters around which park agencies can collaborate to empower diverse populations to enhance their health and well-being through nature contact. Findings strongly suggest the need for parks and protected areas planning and management to evolve at all levels of service delivery in order to keep in step with new federal and provincial legislation focused on building a more inclusive Canada. [ABSTRACT FROM AUTHOR]

National parks in Canada operate under the dual mandate of conservation and visitor use, which involves balancing ecological integrity and nature-based tourism activities. Climate-induced environmental change may increase the existing tension between conservation and visitor use as major tourism resources located in protected areas (PAs) are projected to undergo large-scale changes. This study draws upon the behavioural approach, scenario planning, and landscape visualizations to examine the relationship between climate change impacts, visitor perceptions, and visitor experience management at the Athabasca Glacier in Jasper National Park, Canada. Four tourism development scenarios defined by two management drivers (ecological integrity and visitor demand) with corresponding storylines and visualizations were developed for 2050. The visualized scenarios were presented to visitors (n = 304) in a survey to understand potential implications on visitor satisfaction. The results suggest that park managers need to find a balance between ecological integrity and visitor use in a way that ensures commercialized tourism development is limited, educational material is prioritized, and ecological integrity is maintained. While understanding the behaviour of future tourists is complex, it is a critical component of climate change adaptation planning and decision-making processes that needs to be prioritized by policymakers and PAs managers. [ABSTRACT FROM AUTHOR]

Parks and protected areas are a global ecological, social and health resource visited by over 8 billion people annually. Their use can yield substantial benefits, but only if a balance between ecological integrity and sustainable visitation is struck. This research explores the potential influence of climate-driven environmental change on visitation to North America's most popular glacier, the Athabasca Glacier in Jasper National Park, Canada. Photorealistic environmental visualizations were used to gauge visitors’ perceptions of environmental change and potential impacts on consumer behaviour. Results suggest that impacts could substantially diminish the site's pull as a tourism destination. Rather than improving visitation prospects, expert-proposed adaptations underestimated the importance of perceived naturalness and contributed to further potential decline. Findings are relevant to protected areas planning and management. They suggest that a natural path to climate change adaptation is the best way to support both ecological integrity and the long-term tourism pull of protected areas. [ABSTRACT FROM PUBLISHER]

The threat that climate change impacts pose to rare and vulnerable destinations has given rise to a phenomenon known as last chance tourism. This travel behaviour involves tourists increasingly travelling to destinations they perceive to be critically threatened, while contributing to greenhouse gas emissions and climate change impacts in these very places. For last chance destinations to be managed effectively in the face of climate change, a clearer understanding of what drives this travel behaviour is needed. Drawing on the importance of place and nature to identity construction, this research uses a structural equation modelling approach to examine last chance tourism motivations in Churchill, Canada. Results provide evidence of a motivation to engage in a last chance experience. They also indicate that this motivation is related to a desire to share a connection to nature with similar individuals, and to become part of the local story. Beyond this, results show that visitors' sense of place identity and nature relatedness contribute significantly to their motivation to engage in last chance tourism. Findings from this research are important to the management of last chance destinations, including protected areas that are legislated to preserve significant natural and cultural features. [ABSTRACT FROM PUBLISHER]

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]

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]

L'adaptation aux changements climatiques dans les réseaux d'aires protégées du Canada : état des lieux La Commission mondiale des aires protégées a récemment laissé entendre que les actions en faveur de la conservation sont vouées à l'échec, à moins que ces dernières tiennent compte des changements climatiques. Pour ce faire, les organismes chargés des aires protégées doivent dès maintenant s'assurer de l'intégration des changements climatiques dans les politiques, les cadres de planification et les modes de gestion. Le présent article rend compte des résultats d'une enquête réalisée conjointement par l'Université de Waterloo et le Conseil canadien des aires écologiques. Celle-ci vise à dresser un état des lieux sur l'adaptation aux changements climatiques dans tout le réseau d'aires protégées du Canada qui relève du palier fédéral, provincial ou territorial. Il se dégage de l'analyse plusieurs constats importants. Tout d'abord, sur l'ensemble des organismes chargés des aires protégées que nous avons interrogés, les trois quarts ont déclaré que les changements climatiques ont déjà des effets visibles sur leur réseau d'aires protégées. Ensuite, 94 pour cent des participants à l'enquête estiment qu'au cours des vingt-cinq prochaines années, l'enjeu des changements climatiques sera au cœur de la politique et de la planification des aires protégées. Finalement, malgré la perception voulant que les changements climatiques exercent une pression croissante, la portée des mesures politiques, de planification, de gestion ou de recherche mises de l'avant par la plupart des organismes jusqu'à maintenant demeure limitée. Si 91 pour cent des organismes indiquent ne pas disposer des capacités nécessaires en ce moment pour réagir de façon optimale aux changements climatiques, l'enquête a permis de mettre en évidence un écart significatif entre la perception de la gravité des changements climatiques et la capacité des organismes chargés des aires protégées de s'adapter. La faiblesse du financement, une capacité d'action limitée, et un manque de compréhension des changements climatiques et de leurs répercussions réelles ou potentielles comptent parmi les difficultés auxquelles sont confrontés les organismes canadiens chargés des aires protégées. Il est impératif de les surmonter afin que ces organismes puissent exercer leurs mandats et être en mesure d'assumer leurs responsabilités concernant la protection et la biodiversité des aires, par exemple, la protection de l'intégrité du patrimoine naturel au Canada dans un contexte de changements climatiques accélérés. [ABSTRACT FROM AUTHOR]

Copyright of Forestry Chronicle is the property of Canadian Institute of Forestry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

For more than a decade, climate change has been identified as an important emerging issue for protected areas. Utilising outputs from two equilibrium global vegetation models (GVMs) forced with six climate-change scenarios, this study assessed potential terrestrial biome-type change in Canada's protected area network (2,979 national parks, national wildlife areas, migratory bird sanctuaries, Ramsar sites, ecological reserves, wilderness wildlife areas and provincial parks). Vegetation-modelling results project that 37-48 percent of Canada's protected areas could experience a change in terrestrial biome type under doubled atmospheric carbon-dioxide conditions. Park and protected area planning in Canada have traditionally been founded upon enduring-feature analysis and ecoregion representation frameworks. These conservation-planning frameworks are based on climatic and biogeographic stability; assumptions that what these modelling results for Canada's protected areas and other vegetation-modelling studies indicate are untenable in an era of global climate change. Implications for protected area policy and planning in Canada are also discussed. [ABSTRACT FROM AUTHOR]

Copyright of Forestry Chronicle is the property of Canadian Institute of Forestry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim The study examined the potential for change in biome representation within Canada's national park system under multiple climate change scenarios and subsequent potential vulnerabilities in Parks Canada policy and planning frameworks. Location The study was conducted for Canada's 39 national parks. Methods The vegetation change scenarios were based on modelling results from the BIOME3 and MAPSS equilibrium process-based global vegetation models (GVM), run with multiple doubled-CO[sub 2] climate change scenarios. The six vegetation distribution scenarios were calculated at 0.5° latitude-longitude resolution and the boundaries of 39 national parks superimposed in a geographic information system (GIS). Park management plans and other planning documents were also reviewed as part of the analysis. Results The proportional distribution of biomes in Canada's national park system was very similar (within 3% of area for each biome) using BIOME3 and MAPSS under the current climate. Regardless of the GVM and climate change scenario used, the modelling results suggest the potential for substantial change in the biome representation in Canada's national park system. In five of six vegetation scenarios, a novel biome type appeared in more than half of the national parks and greater than 50% of all vegetation grid boxes changed biome type. The proportional representation of tundra and taiga/tundra in the national park system declined in each of the vegetation scenarios, while more southerly biomes (temperate forests and savanna/woodland) increased (in some scenarios doubling to quadrupling). Results for boreal forest varied among the climate change scenarios. A range of potential vulnerabilities in existing policy and planning frameworks were identified, including the national park system plan, individual park objectives, and fire and exotic species management plans. Conclusions Climate change represents an unprecedented challenge to Parks Canada and its ability... [ABSTRACT FROM AUTHOR]

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]

Background: Chimeric antigen receptor (CAR) T-cells are an important new third-line treatment option for large B-cell lymphoma (LBCL). The objective response rates in pivotal early phase clinical trials with CAR T-cells were very promising. The objective of this study was to describe the efficacy results obtained with CAR T-cells infusions in our institution and to compare the toxicities of our cohort with those of pivotal trials and studies conducted in a real-life setting., Patients and Methods: Efficacy and safety data were retrospectively collected from 25 patients with LBCL treated with CAR T-cells therapy at CHU de Québec-Université Laval. A literature search was then performed to identify other efficacy or safety data from a real-life setting., Results: At 3 months post infusion, the objective response rate (ORR) in our population with tisagenlecleucel and axicabtagene-ciloleucel were 20% and 47%, respectively. Bulky disease was the only negative predictor of poor response at 3 months (0% vs. 53%, P = .03). Bulky disease was associated with a median PFS of 2 months compared to 5 months for non-bulky disease (P = .0009). Grade ≥ 3 hematological toxicities were greater in patients treated with axi-cel (60% vs. 20%, P = .048), without bone marrow involvement (55% vs. 0%, P =.046), without stage IV disease (72% vs. 21%, P =.02), with refractory disease (67% vs. 10%, P =.01) or having been affected by cytokine release syndrome (58% vs. 0%, P =.02)., Conclusion: The poor response rate at 3 months after infusion in our cohort was influenced mainly by bulky disease. Further studies are needed to better characterize the loss of efficacy of CAR T-cells because the majority of patients will relapse over time., (Copyright © 2022 Elsevier Inc. All rights reserved.)

There is a rapidly closing window of opportunity to stop biodiversity loss and secure the resilience of all life on Earth. In December 2022, Parties to the United Nations (UN) Convention on Biological Diversity (CBD) will meet in Montreal, Canada, to finalize the language and terms of the Post-2020 Global Biodiversity Framework ( Post-2020 GBF ). The Post-2020 GBF aims to address the shortcomings of the previous Strategic Plan on Biodiversity 2011-2020 , by introducing a Theory of Change, that states that biodiversity protection will only be successful if unprecedented, transformative changes are implemented effectively by Parties to the CBD. In this policy perspective, we explore the implications of the Theory of Change chosen to underpin the Post-2020 GBF , specifically that broad social transformation is an outcome that requires actors to be specified. We detail how the health sector is uniquely positioned to be an effective actor and ally in support of the implementation of the Post-2020 GBF . Specifically, we highlight how the core competencies and financial and human resources available in the health sector (including unique knowledge, skill sets, experiences, and established trust) provide a compelling, yet mostly untapped opportunity to help create and sustain the enabling conditions necessary to achieve the goals and targets of the framework. While by no means a panacea for the world's biodiversity problems, we posit that explicitly omitting the health sector from the Post-2020 GBF substantially weakens the global, collective effort to catalyze the transformative changes required to safeguard biodiversity.