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1. An evaluation of the five most used evidence based bedside information tools in Canadian health libraries An evaluation of the five most used evidence based bedside information tools in Canadian health libraries Evidence based medicine; Evaluation; Levels of evidence; Bedside information tools; Point-of-care information resources; Research methods Objective: This project sought to identify the five most used evidence based bedside information tools used in Canadian health libraries, to examine librarians’ attitudes towards these tools, and to test the comprehensiveness of the tools.

2. Effective non-clinical interventions to prevent and treat childhood overweight and obesity in Newfoundland Effective non-clinical interventions to prevent and treat childhood overweight and obesity in Newfoundland and Labrador Interventions; Childhood; Overweight; Obesity; Newfoundland and Labrador; Contextualized health research synthesis The rates of obesity and overweight for Canadians have increased dramatically in the past twenty years. Obesity is now the leading metabolic disorder among adults in Canada and is considered to be a leading cause of avoidable adult mortality. Obesity is closely related to higher rates of physical disease, like osteoarthritis, as well as metabolic diseases like hypertension, diabetes, and non-alcoholic fatty liver disease. Obesity is also associated with a higher incidence of psychological problems, decreased productivity, and lower educational and professional attainment. The shift in the body-weight profile of the Canadian population also applies to children. Rates of obesity and overweight are increasing for youth in Newfoundland & Labrador and are, along with adult rates, the highest among the Canadian provinces. As with adults, overweight and obese children have increased rates of physical and psychological co-morbidities and decreased educational attainment. Since overweight tends to persist into adulthood, these trends forecast significant challenges to the population health and health care resources of Newfoundland & Labrador. Current research is demonstrating that the causes of overweight and obesity are many, complex and inter-related. Obesity is influenced by factors that are genetic, behavioural, nutritional, social, cultural, economic, and environmental. An extensive research literature has developed on population health strategies to prevent and treat childhood overweight. The purpose of this Contextualized Health Research Synthesis is to address the question: What types of effective non-clinical interventions might be helpful for prevention and treatment of childhood overweight and obesity in Newfoundland and Labrador? For the purposes of this report, a non-clinical intervention refers to any intervention that does not include surgical procedures or pharmaceutical prescriptions. The objectives of this report are: 1. to identify high-level research that is related to the research question 2. to synthesize the evidence into a comprehensive set of findings 3. to contextualize the results so that they are attuned to the characteristics and the capacities of Newfoundland & Labrador organizations and populations, and 4. to formulate them in terms that will maximize their uptake into the local decision-making process.

3. Executive Summary: Effective non-clinical interventions to prevent and treat childhood overweight and Executive Summary: Effective non-clinical interventions to prevent and treat childhood overweight and obesity in Newfoundland and Labrador Interventions; Childhood; Overweight; Obesity; Newfoundland and Labrador; Contextualized health research synthesis The rates of obesity and overweight for Canadians have increased dramatically in the past twenty years. Obesity is now the leading metabolic disorder among adults in Canada and is considered to be a leading cause of avoidable adult mortality. Obesity is closely related to higher rates of physical disease, like osteoarthritis, as well as metabolic diseases like hypertension, diabetes, and non-alcoholic fatty liver disease. Obesity is also associated with a higher incidence of psychological problems, decreased productivity, and lower educational and professional attainment. The shift in the body-weight profile of the Canadian population also applies to children. Rates of obesity and overweight are increasing for youth in Newfoundland & Labrador and are, along with adult rates, the highest among the Canadian provinces. As with adults, overweight and obese children have increased rates of physical and psychological co-morbidities and decreased educational attainment. Since overweight tends to persist into adulthood, these trends forecast significant challenges to the population health and health care resources of Newfoundland & Labrador. Current research is demonstrating that the causes of overweight and obesity are many, complex and inter-related. Obesity is influenced by factors that are genetic, behavioural, nutritional, social, cultural, economic, and environmental. An extensive research literature has developed on population health strategies to prevent and treat childhood overweight. The purpose of this Contextualized Health Research Synthesis is to address the question: What types of effective non-clinical interventions might be helpful for prevention and treatment of childhood overweight and obesity in Newfoundland and Labrador? For the purposes of this report, a non-clinical intervention refers to any intervention that does not include surgical procedures or pharmaceutical prescriptions. The objectives of this report are: 1. to identify high-level research that is related to the research question 2. to synthesize the evidence into a comprehensive set of findings 3. to contextualize the results so that they are attuned to the characteristics and the capacities of Newfoundland & Labrador organizations and populations, and 4. to formulate them in terms that will maximize their uptake into the local decision-making process.

4. Executive Summary: The development of a PET/CT program in Newfoundland and Labrador Executive Summary: The development of a PET/CT program in Newfoundland and Labrador Positron emission; Computed tomography; PET/CT; Contextualized health research synthesis This report was initially designed to examine research-based evidence about whether the province of NL should acquire a Positron Emission Tomography (PET) scanner. At various stages throughout the project we were informed of developments that required us to reformulate our research question. First, we learned that the Government of NL had actually made a commitment to purchase a PET scanner. Next, it rapidly became clear that current trends in technology development have moved towards hybrid models of diagnostic imaging technologies; hence, virtually all new PET scanners come bundled with a Computed Tomography (CT) scanner in a device commonly referred to as a PET/CT scanner. Since hybrid models are the acceptable standard for clinical use and fit the North American vendor market, they became the focus for this project. Later in the course of our work, we were informed that the Government had determined that it would also need to purchase a cyclotron rather than depending on radioactive isotopes flown in from elsewhere. In addition, we were told that a decision had been reached to locate these two pieces of equipment in St. John’s. Accordingly, rather than focus on our original question (PET or not?) or on the obvious related questions (should we also acquire a cyclotron? where should the new equipment be located?), we have focused on a set of ancillary, but still very important, issues: • where, within the St. John’s area, should the new equipment be located? • for what clinical indications is PET currently the best choice in terms of clinical effectiveness and cost-effectiveness?• what other indications are emerging for which it makes sense to plan for PET use? • what is the optimal method for organizing and managing access to PET scans? • what are the advantages of early development of a cyclotron program and the challenges of operating without one? • what are the requirements of a PET/CT scanning program in terms of professional competencies for physicians and technologists, training, financing and space? and, • what is the optimal sequencing of the activities required for effective acquisition, installation, licensing and start-up of a PET/CT scanning program? All of these questions have been considered by means of a systematic reading and synthesis of the literature plus input concerning the recent experience of two other Canadian jurisdictions (Manitoba and Nova Scotia), all with a careful eye to the specific context of Newfoundland and Labrador. There are currently three broad categories of accepted clinical application for PET/CT technology: (a) in oncology imaging, to help determine how extensive a cancer is, whether it has responded to therapy, and whether it has recurred; (b) in brain imaging, for select patients with seizure disorders and for the early detection of dementia; and (c) in cardiac imaging, to assess the viability of heart muscle. At present, patients in Newfoundland and Labrador who require a PET scan must travel out of the province to either Alberta or Quebec at a substantial cost to the provincial health system as well as to the patient and his/her family. On average, on the basis of a bilateral agreement between the Department of Health and Community Services and the out-of-province provider facility, the province pays $1,250 per scan. There is no reciprocal billing for PET scanning. Patients and families pay out-of-pocket travel and accommodation expenses, a portion of which may be reimbursed through the Medical Transportation Assistance Program, depending on eligibility. While the recorded number of NL residents who received PET scans in the past has been relatively small (fewer than 35 patients per year since 2004), these numbers may not represent the true size of the population that might have benefited from PET, nor provide a reliable guide to future demand. This report’s lead author, who was involved in establishing the Winnipeg PET/CT program, believes that the number of patients currently being sent out of province greatly underestimates the number of scans that are likely to be performed when a PET/CT program is established in NL. The details of this analysis are explained in the report. The purpose of this Contextualized Health Research Synthesis is to answer the following core research question: Given the geographic, demographic, fiscal and political context of Newfoundland and Labrador, what is the most appropriate, effective, and efficient way to operate a PET/CT program so that the population derives the maximum benefit at the best possible cost?

5. Executive Summary: The provision of dialysis services in rural and remote populations in Newfoundland Executive Summary: The provision of dialysis services in rural and remote populations in Newfoundland and Labrador Dialysis services; Newfoundland and Labrador; Contextualized health research synthesis The incidence of end-stage renal disease (ESRD) is increasing worldwide, especially among the elderly. In Newfoundland and Labrador, in particular, the number of patients aged 65 years and older with ESRD on renal replacement therapy is the highest in the country. Limited human and financial resources coupled with demographic predictions of an aging population who have underlying chronic diseases strongly associated with ESRD, all point to the need for evidence-based decision making on the provision of dialysis services in this province. Decisions about the provision of dialysis services are further challenged by the geographic dispersion of small clusters of patients with ESRD living in rural and remote locations. Currently, the primary modality of renal replacement therapy in Newfoundland and Labrador is in-centre hemodialysis. Approximately 65 % of patients are being treated in main hospital-based dialysis units, centralized in St. John's and Corner Brook, and in Grand Falls-Windsor, a satellite of St. John's that operates much like a main unit. There has been a push from the interested public to develop satellite units throughout the province, in both hospital and non-hospital settings, despite the challenges associated with these service modalities. These challenges include changes in the medical stability of patients, unpredictable demands on the main dialysis units, and human resource requirements and maintenance of competencies, to name a few. Home-based therapies, including both hemodialysis and peritoneal dialysis, reduce the burden of travel and relocation, but the number of patients choosing these modalities is low at present, possibly because of issues of informed patient choice and the acceptability and feasibility of these modalities particularly for older patients with high co-morbidity living in isolated communities. The purpose of this contextualized HTA synthesis is to answer the question: in meeting the needs for dialysis services in rural and remote populations, what are the differences among the available treatment options with regards to efficacy/effectiveness, cost, acceptability, and feasibility in Newfoundland and Labrador.

6. Interprofessional education for collaborative patient-centred practice : research synthesis paper Interprofessional education for collaborative patient-centred practice : research synthesis paper Interprofessional relations; patient-centred care; patient-focused care; education, professional; collaborative patient-centred care; Health Care The purpose of this paper is to summarize the main themes emerging from the research report and discussion papers which have been commissioned to date as part of the IECPCP initiative. The 2004 literature review and environmental scan report prepared by Oandasan et al., as well as the discussion papers prepared by Brown, Cook, Curran, D’Eon, Gilbert, Hall, Lahey and Currie, and Steinert (2004) were reviewed in preparing this synthesis paper. The organization of the paper is based upon D’Amour and Oandasan’s Conceptual Model of Interdisciplinary Education for Collaborative Patient-Centred Care. The key factors, determinants and elements which emerged from the review of the research report and discussion papers were presented and discussed in relation to this framework.

7. Mcl-1 is a key regulator of apoptosis during CNS development and after DNA damage Mcl-1 is a key regulator of apoptosis during CNS development and after DNA damage Neurogenesis; Cell death; Neuronal progenitors; Neuron; Apoptosis; Development; Despite the importance of Mcl-1, an anti-apoptotic Bcl-2 family member, in the regulation of apoptosis, little is known regarding its role in nervous system development and injury-induced neuronal cell death. Because germline deletion of Mcl-1 results in peri-implantation lethality, we address the function of Mcl-1 in the nervous system using two different conditional Mcl-1 mouse mutants in the developing nervous system. Here, we show for the first time that Mcl-1 is required for neuronal development. Neural precursors within the ventricular zone and newly committed neurons in the cortical plate express high levels of Mcl-1 throughout cortical neurogenesis. Loss of Mcl-1 in neuronal progenitors results in widespread apoptosis. Double labeling with active caspase 3 and Tuj1 reveals that newly committed Mcl1 deficient neurons undergo apoptosis as they commence migration away from the ventricular zone. Examination of neural progenitor differentiation in vitro demonstrated that cell death in the absence of Mcl-1 is cell autonomous. Although conditional deletion of Mcl-1 in cultured neurons does not trigger apoptosis, loss of Mcl-1 sensitizes neurons to an acute DNA damaging insult. Indeed, the rapid reduction of Mcl-1mRNA and protein levels are early events after DNA damage in neurons, and maintaining high Mcl-1 levels can protect neurons against death. Together, our results are the first to demonstrate the requirement of Mcl-1, an anti-apoptotic Bcl-2 family protein, for cortical neurogenesis and the survival of neurons after DNA damage.

8. Mediated computer search services relative to instruction services: a survey of one health sciences library Mediated computer search services relative to instruction services: a survey of one health sciences library Mediated search services; Computer search services; Instructional services To assess the quality and usefulness of one health sciences library's mediated computer search service, a survey was undertaken to determine satisfaction rates, why users do or do not use the service, and how useful the service is perceived to be in comparison to instructional service. Satisfaction rates were high, with users indicating librarian expertise and time/cost savings as the main reasons for using the service. Non-users indicated that they preferred to do their own searching, and many were unaware of the service. Though a majority of respondents do not currently use the service, surprisingly a majority of respondents placed significant value on the mediated search service in relation to instruction.


9. p107 regulates neural precursor cells in the mammalian brain p107 regulates neural precursor cells in the mammalian brain Neural stem cells; Self-renewing division; Regeneration Here we show a novel function for Retinoblastoma family member, p107 in controlling stem cell expansion in the mammalian brain. Adult p107-null mice had elevated numbers of proliferating progenitor cells in their lateral ventricles. In vitro neurosphere assays revealed striking increases in the number of neurosphere forming cells from p107-/- brains that exhibited enhanced capacity for self-renewal. An expanded stem cell population in p107-deficient mice was shown in vivo by (a) increased numbers of slowly cycling cells in the lateral ventricles; and (b) accelerated rates of neural precursor repopulation after progenitor ablation. Notch1 was up-regulated in p107-/- neurospheres in vitro and brains in vivo. Chromatin immunoprecipitation and p107 overexpression suggest that p107 may modulate the Notch1 pathway. These results demonstrate a novel function for p107 that is distinct from Rb, which is to negatively regulate the number of neural stem cells in the developing and adult brain.

10. Rehabilitation gaps and needs assessment Eastern Health Rehabilitation gaps and needs assessment Eastern Health Rehabilitation; Medical care; Needs assessment; Newfoundland and Labrador; Eastern Health (N.L.) Rehabilitation is aimed at enabling people disabled by injury or disease to obtain their optimal physical, intellectual, psychological and social functioning. It requires an integrated team of health professionals using a bio-psycho-social model of health across the continuum of care. An aging population, emphasis on chronic disease management, and the move towards community living for people with disabilities requires the re-evaluation of rehabilitation services. The purpose of the Rehabilitation Gaps and Needs Assessment was to outline existing rehabilitation services, identify areas to improve care, and to provide the foundation for a strategic plan for rehabilitation within Eastern Health. Due to the tertiary role of Eastern Health, provincial input was sought and some recommendations made for other health authorities that would help improve services throughout the province. -- Primary data was gathered from patients, families, managers, administrators, and rehabilitation providers using surveys, focus groups and key informant interviews. Secondary data was analyzed from provincial and regional health indicators and databases, previously completed human resources and rehabilitation reports, and rehabilitation reports from other provinces. The research process and results were directed by community stakeholders, managers and other experts in the field. -- The results showed that, other than the physical facilities, existing inpatient and outpatient services at the L.A. Miller Centre were adequate overall. The greatest need identified was community-based rehabilitation; rehabilitation in homes, long term care facilities and personal care homes. Findings suggested that there is a need for inpatient restorative care for the elderly, for community-based management programs for people with chronic disease (cardiac, pulmonary, arthritis, obesity, etc.) and for vocational and cognitive rehabilitation for people with brain injury. Access to rehabilitation is polarized along rural and urban lines with rural areas having very limited access to inpatient, outpatient and community rehabilitation. We found that for people with rehabilitation needs, over half were readmitted to hospital within a year. There were 19,418 alternate level of care days for rehabilitation patients in 2005-2006. Gaps in rehabilitative care cause impairment in patient flow through the system and ultimately limit the person’s ability to live independently at home. These substantial improvements in rehabilitation services would require an action plan over a period of 5-6 years. -- There are ways to improve recruitment and retention of rehabilitation providers, including therapists, nurses and physical medicine and rehabilitation specialists across the province. There are also methods such as reducing clerical duties and improving health record and patient information technology that have the potential to improve efficiency. -- We found that gaps in the system can be improved through enhanced communication, patient navigation and development of a coordinated provincial rehabilitation network. Admission criteria designed to identify the most appropriate patients for a service, especially at the L.A. Miller Centre, causes confusion for health providers, patients and families and ultimately creates gaps. It is essential that we avoid a silo approach to care and ensure that patients and their families find the most appropriate rehabilitation service for them.

11. The Availability of MeSH in vendor-supplied cataloguing records, as seen through the catalogue of a Canadian The Availability of MeSH in vendor-supplied cataloguing records, as seen through the catalogue of a Canadian academic health library Subject headings; Full-text databases; MARC records; Outsourcing; Electronic journals This study examines the prevalence of medical subject headings in vendor-supplied cataloguing records for publications contained within aggregated databases or publisher collections. In the first phase, the catalogue of one Canadian academic medical library was examined to determine the extent to which medical subject headings (MeSH) are available in the vendor-supplied records. In the second phase, these results were compared to the catalogues of other Canadian academic medical libraries in order to reach a generalization regarding the availability of MeSH headings for electronic resources. MeSH was more widespread in records for electronic journals but was noticeably lacking in records for electronic monographs, and for Canadian publications. There is no standard for ensuring MeSH are assigned to monograph records for health titles and there is no library in Canada with responsibility for ensuring that Canadian health publications receive Medical Subject Headings. It is incumbent upon libraries using MeSH to ensure that vendors are aware of this need when purchasing record sets.

12. The development of a PET/CT program in Newfoundland and Labrador The development of a PET/CT program in Newfoundland and Labrador Positron emission; Computed tomography; PET/CT; Contextualized health research synthesis This report was initially designed to examine research-based evidence about whether the province of NL should acquire a Positron Emission Tomography (PET) scanner. At various stages throughout the project we were informed of developments that required us to reformulate our research question. First, we learned that the Government of NL had actually made a commitment to purchase a PET scanner. Next, it rapidly became clear that current trends in technology development have moved towards hybrid models of diagnostic imaging technologies; hence, virtually all new PET scanners come bundled with a Computed Tomography (CT) scanner in a device commonly referred to as a PET/CT scanner. Since hybrid models are the acceptable standard for clinical use and fit the North American vendor market, they became the focus for this project. Later in the course of our work, we were informed that the Government had determined that it would also need to purchase a cyclotron rather than depending on radioactive isotopes flown in from elsewhere. In addition, we were told that a decision had been reached to locate these two pieces of equipment in St. John’s. Accordingly, rather than focus on our original question (PET or not?) or on the obvious related questions (should we also acquire a cyclotron? where should the new equipment be located?), we have focused on a set of ancillary, but still very important, issues: • where, within the St. John’s area, should the new equipment be located? • for what clinical indications is PET currently the best choice in terms of clinical effectiveness and cost-effectiveness?• what other indications are emerging for which it makes sense to plan for PET use? • what is the optimal method for organizing and managing access to PET scans? • what are the advantages of early development of a cyclotron program and the challenges of operating without one? • what are the requirements of a PET/CT scanning program in terms of professional competencies for physicians and technologists, training, financing and space? and, • what is the optimal sequencing of the activities required for effective acquisition, installation, licensing and start-up of a PET/CT scanning program? All of these questions have been considered by means of a systematic reading and synthesis of the literature plus input concerning the recent experience of two other Canadian jurisdictions (Manitoba and Nova Scotia), all with a careful eye to the specific context of Newfoundland and Labrador. There are currently three broad categories of accepted clinical application for PET/CT technology: (a) in oncology imaging, to help determine how extensive a cancer is, whether it has responded to therapy, and whether it has recurred; (b) in brain imaging, for select patients with seizure disorders and for the early detection of dementia; and (c) in cardiac imaging, to assess the viability of heart muscle. At present, patients in Newfoundland and Labrador who require a PET scan must travel out of the province to either Alberta or Quebec at a substantial cost to the provincial health system as well as to the patient and his/her family. On average, on the basis of a bilateral agreement between the Department of Health and Community Services and the out-of-province provider facility, the province pays $1,250 per scan. There is no reciprocal billing for PET scanning. Patients and families pay out-of-pocket travel and accommodation expenses, a portion of which may be reimbursed through the Medical Transportation Assistance Program, depending on eligibility. While the recorded number of NL residents who received PET scans in the past has been relatively small (fewer than 35 patients per year since 2004), these numbers may not represent the true size of the population that might have benefited from PET, nor provide a reliable guide to future demand. This report’s lead author, who was involved in establishing the Winnipeg PET/CT program, believes that the number of patients currently being sent out of province greatly underestimates the number of scans that are likely to be performed when a PET/CT program is established in NL. The details of this analysis are explained in the report. The purpose of this Contextualized Health Research Synthesis is to answer the following core research question: Given the geographic, demographic, fiscal and political context of Newfoundland and Labrador, what is the most appropriate, effective, and efficient way to operate a PET/CT program so that the population derives the maximum benefit at the best possible cost?

13. The Ontario New Graduate Nursing Initiative - an exploratory process evaluation The Ontario New Graduate Nursing Initiative - an exploratory process evaluation Nursing; New Graduate Initiative; Home care; Recruitment; Retention Objective: To conduct an exploratory process evaluation of the Onatrio Ministry of Health and Long-Term Care's (MOHLTC) New Graduate Nursing Initiative implemented by one home care agency. Methods: Qualitative data were gathered online, stored electronically and then analyzed using an Affinity Diagram. Results: Seven groupings of participants' comments were created: advertising and external information dissemination; orientation; internal dissemination; impact of the program; transition to the workforce; pay/benefits; and retention. Participants viewed many aspects of the program favourably but identified the following areas for improvement: comprehensibility of the Health Force Ontario website (advertising and external information); orientation of new graduates (orientation); and communication of information about the initiative to existing staff (internal dissemination). Conclusions: This exploratory study points to both strengths and weakness of the New Graduate Nursing Initiative. Further study of the implementation of this policy is recommended.

14. The provision of dialysis services in rural and remote populations in Newfoundland and Labrador The provision of dialysis services in rural and remote populations in Newfoundland and Labrador Dialysis services; Newfoundland and Labrador; Contextualized health research synthesis The incidence of end-stage renal disease (ESRD) is increasing worldwide, especially among the elderly. In Newfoundland and Labrador, in particular, the number of patients aged 65 years and older with ESRD on renal replacement therapy is the highest in the country. Limited human and financial resources coupled with demographic predictions of an aging population who have underlying chronic diseases strongly associated with ESRD, all point to the need for evidence-based decision making on the provision of dialysis services in this province. Decisions about the provision of dialysis services are further challenged by the geographic dispersion of small clusters of patients with ESRD living in rural and remote locations. Currently, the primary modality of renal replacement therapy in Newfoundland and Labrador is in-centre hemodialysis. Approximately 65 % of patients are being treated in main hospital-based dialysis units, centralized in St. John's and Corner Brook, and in Grand Falls-Windsor, a satellite of St. John's that operates much like a main unit. There has been a push from the interested public to develop satellite units throughout the province, in both hospital and non-hospital settings, despite the challenges associated with these service modalities. These challenges include changes in the medical stability of patients, unpredictable demands on the main dialysis units, and human resource requirements and maintenance of competencies, to name a few. Home-based therapies, including both hemodialysis and peritoneal dialysis, reduce the burden of travel and relocation, but the number of patients choosing these modalities is low at present, possibly because of issues of informed patient choice and the acceptability and feasibility of these modalities particularly for older patients with high co-morbidity living in isolated communities. The purpose of this contextualized HTA synthesis is to answer the question: in meeting the needs for dialysis services in rural and remote populations, what are the differences among the available treatment options with regards to efficacy/effectiveness, cost, acceptability, and feasibility in Newfoundland and Labrador.

15. The reprocessing and reuse of single-use medical devices in Newfoundland and Labrador The reprocessing and reuse of single-use medical devices in Newfoundland and Labrador medical devices; equipment; patient safety; infection prevention & control Across Canada, the practice of reusing medical devices intended for single use is evolving. Health institutions that once routinely reprocessed single-use devices (SUDs) in-house have now moved away from this practice because of concerns about patient safety and legal liability. This report by the Newfoundland and Labrador Centre for Applied Health Research (NLCAHR) reviews the evidence on the effectiveness, safety, and potential economic benefits of SUD reuse. As such, it should be of interest to any researchers or knowledge-users who work in the areas of patient safety and/or infection control. This report was based primarily on a French-language review by AETMIS, and subsequently contextualized by NLCAHR for the province of NL with input from local stakeholders with expertise in infection prevention and control. AETMIS found that there was insufficient evidence to support, in clinical practice, the reprocessing and reuse of all but one of the devices it reviewed. Moreover, the economic evidence on cost-effectiveness was insufficient to support reuse. In NL, while current policies prohibit this practice, local factors identified in the report appear to contribute to the continued potential risk of SUD reuse in both public and private health care settings. The analysis in the report points to the following implications for provincial decision makers: NL's health department should develop a province-wide policy on SUD reuse in all health care settings; Regular audits should be performed to confirm compliance with said policy; NL should work with Health Canada to establish a Canada-wide regulatory mechanism.

16. The Retinoblastoma family member p107 regulates the rate of progenitor commitment to a neuronal fate The Retinoblastoma family member p107 regulates the rate of progenitor commitment to a neuronal fate Neural stem cells; Regeneration The Retinoblastoma protein p107 regulates the neural precursor pool in both the developing and adult brain. As p107-deficient mice exhibit enhanced levels of Hes1, we questioned whether p107 regulates neural precursor self-renewal through the repression of Hes1. p107 represses transcription at the Hes1 promoter. Despite an expanded neural precursor population, p107-null mice exhibit a striking reduction in the number of cortical neurons. Hes1 deficiency rescues neurosphere numbers in p107-null embryos. We find that the loss of a single Hes1 allele in vivo restores the number of neural precursor cells at the ventricular zone. Neuronal birthdating analysis reveals a dramatic reduction in the rate of neurogenesis, demonstrating impairment in p107–/– progenitors to commit to a neuronal fate. The loss of a single Hes1 allele restores the number of newly generated neurons in p107-deficient brains. Together, we identify a novel function for p107 in promoting neural progenitor commitment to a neuronal fate.
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