An Exploratory Study of Graduate Student Unions in Canada

Graduate student unions are beginning to attract attention in Canada and the United States. In Canada, unionization on campuses is especially important for organized labour, as union density has dropped below 30 percent for the first time in five decades. Graduate student unionization is also important in the wider context of precarious employment in North America. Despite the decline in overall union density, graduate student unions have continued to grow in the past decade. However, there is a paucity of scholarly research in this area. In this article, we trace the historical origins of graduate student unions in Canada, discuss relevant legal concerns, analyze pertinent collective bargaining and strike issues, and suggest avenues for future research.Les syndicats d’étudiants diplômés commencent à capter considérablement l’attention des universitaires et des praticiens en Amérique du Nord. Au Canada, la syndicalisation sur les campus universitaires prend de l’importance dans le monde du travail syndiqué, au moment où la densité syndicale a plongé en bas de 30 % pour la première fois depuis cinq décennies. Entre 1992 et 1997, le membership syndical a perdu 255 000 personnes, une baisse moyenne de 51 000 par année, ce qui représente une perte de 7 % de l’effectif. Malgré le déclin de la densité globale, les syndicats étudiants ont continué à croître au cours de la dernière décennie. Cette propension à se syndiquer peut être reliée à la situation financière critique dans le monde universitaire canadien, qui a à son tour exercée un impact sur les salaires, la charge de travail, les frais de scolarité et possiblement dans l’avenir sur l’endettement des étudiants. Le syndicalisme apparaît alors comme le véhicule permettant graduellement aux étudiants diplômés de faire connaître leurs intérêts.Par ailleurs, on constate l’inexistence des publications scientifiques sur le syndicalisme chez les étudiants aux études supérieures. En tenant compte de la nature éphémère de ces syndicats, où les étudiants maintiennent leur membership seulement au cours des périodes limitées aux études supérieures, il est alors intéressant de constater qu’ils peuvent créer une préoccupation additionnelle au système de gestion des universités par le recours éventuel à la grève ou au ralentissement des activités. La section locale 3 903 du SCFP (Syndicat canadien de la fonction publique), qui représente le syndicat des étudiants diplômés de l’Université York, fournit un exemple frappant de l’influence d’un tel syndicat à ce niveau. Comme tel, il devient important que des recherches soient réalisées sur la syndicalisation des étudiants diplômés, car leur intérêt à se syndiquer semble se maintenir avec autant d’intensité.Pour obtenir de l’information et des données sur la syndicalisation des étudiants diplômés, nous avons effectué une revue de la documentation pertinente, une revue de l’information fournie sur les sites Internet des syndicats étudiants, et nous avons interviewé plusieurs représentants des syndicats et des administrations.Au premier chef, nous avons observé que l’organisation des étudiants diplômés au Canada s’est produite en deux mouvements : les premières sections locales sont apparues dans les universités au milieu des années 1970 en Ontario et en Colombie-Britannique. La deuxième vague s’est produite au cours de la dernière décennie, avec quelques additions dans la période intermédiaire. Les raisons communes aux deux vagues sont de l’ordre des taux de rémunération et de la charge de travail. Des efforts plus récents ont été motivés par des perspectives réduites d’emploi et par des frais de scolarité accrus.Au Canada, comme elle le prévoit pour d’autres groupes de salariés, la loi permet aux diplômés de s’organiser et de négocier collectivement, une fois qu’ils rencontrent les seuils de support et de communauté d’intérêts au sein des unités d’accréditation. Ces droits ont été reconnus par une décision importante de la Commission des relations de travail de l’Ontario en 1975 dans le cas des assistants diplômés de l’Université de York. Ce cas a pavé la voie à la syndicalisation des assistants d’enseignement en Ontario et dans le reste du Canada.Avant cette décision, la position du Conseil des gouverneurs de l’Université York était à l’effet que les étudiants diplômés et les assistants d’enseignement ne se qualifiaient pas comme des salariés au sens du Code du travail de l’Ontario. L’université soutenait que les étudiants diplômés qui agissaient comme assistants dans l’enseignement et dans la recherche se retrouvaient dans la même catégorie que les étudiants bénéficiaires de bourses ou de prêts venant de l’université. L’Association des étudiants diplômés soutenait pour sa part que les diplômés qui travaillaient comme assistants d’enseignement ou de recherche constituaient une catégorie distincte parce que le travail qu’ils accomplissaient n’était pas relié à leurs études; par conséquent, les fonds obtenus devaient être considérés comme un salaire. La Commission des relations de travail de l’Ontario déclara que les étudiants diplômés engagés comme assistants d’enseignement et les autres engagés comme tuteurs ou directeurs de cours au Collège Atkinson (le programme du soir de l’université) se qualifiaient comme salariés au sens du Code du travail de l’Ontario, alors que les étudiants diplômés en étaient exclus. Un membre dissident de la Commission se rangea du côté de la décision majoritaire tout en étant d’avis que les assistants diplômés pouvaient aussi se qualifier. Ceci devenait la première décision de ce type au Canada, ouvrant ainsi la voie à la syndicalisation chez les étudiants diplômés à titre de salariés tels que prévu par le Code du travail.Nous avons également constaté que le taux de syndicalisation varie d’une province à l’autre. Effectivement, les taux sont plus élevés en Nouvelle-Écosse, en Ontario, en Colombie-Britannique et en Saskatchewan; ils le sont moins en Alberta, au Québec et au Nouveau-Brunswick. Dans la dernière partie de cet essai, nous avons élaboré un modèle sous forme de diagramme des antécédents de la syndicalisation des étudiants diplômés et nous avons suggéré des avenues de recherche pour le futur.Dans le monde syndical, l’organisation de ceux qui ne sont pas syndiqués demeure un enjeu significatif. Par exemple, au SCFP, le travail de syndicalisation est perçu comme vital. En effet, le taux d’attrition est de l’ordre de 5 % par année, par conséquent, il faut recruter autour de 9 000 nouveaux membres chaque année seulement pour maintenir le niveau de l’effectif syndical. Les universités offrent donc un bon potentiel de syndicalisation.Il faut poursuivre les recherches sur le sujet. Les étudiants diplômés occupent une place importante dans la société. Non seulement fournissent-ils le leadership dans le monde universitaire et celui des affaires une fois leurs études complétées, mais encore ils fournissent également un leadership dans des milieux syndiqués longtemps après leur diplômation. Ils peuvent être lourdement endettés lorsqu’ils quittent l’université, et cela peut continuer même par la suite pour de longues périodes. Sans l’aide de la syndicalisation pour leur procurer une rémunération acceptable, cet endettement serait sans aucun doute accru. Par conséquent, la syndicalisation de ces groupes demeure importante pour s’assurer de la qualité de vie des étudiants diplômés, qui dépendent de ce type de travail pour maintenir une aide financière pendant leurs études.Los sindicatos de estudiantes graduados han comenzado a llamar la atención en Canadá y en Estados Unidos. En Canadá, la sindicalización en las universidades es particularmente importante para el movimiento laboral, puesto que la densidad ha descendido por debajo del 30 por ciento por la primera vez en cinco décadas. Sindicalizar los estudiantes graduados es también importante en el amplio contexto del empleo precario en America del Norte. A pesar del deterioro de la densidad sindical global, los sindicatos de estudiantes graduados han seguido creciendo durante la ultima década. Existe sin embargo una restricción respecto a la investigación académica. En este documento, nosotros examinamos los orígenes históricos de los sindicatos de estudiantes graduados en Canada, discutimos las cuestiones legales mas importantes, analizamos las cuestiones pertinentes a la negociación colectiva y la huelga, y sugerimos pistas por futuras investigaciones

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Background: Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. Aim: To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. Design: Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. Setting: UK. Participants: The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. Methods: (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. Results: Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical ‘ladder’ towards smoking cessation and breastfeeding. Incentive interventions provide opportunity ‘rungs’ to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women’s capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave ‘healthily’ risk them feeling pressurised and failing. To avoid ‘losing face’, women may disengage. Limitations: Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. Conclusions: Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is importan

Relationship between Antibody Susceptibility and Lipopolysaccharide O-Antigen Characteristics of Invasive and Gastrointestinal Nontyphoidal Salmonellae Isolates from Kenya

Background: Nontyphoidal Salmonellae (NTS) cause a large burden of invasive and gastrointestinal disease among young children in sub-Saharan Africa. No vaccine is currently available. Previous reports indicate the importance of the O-antigen of Salmonella lipopolysaccharide for virulence and resistance to antibody-mediated killing. We hypothesised that isolates with more O-antigen have increased resistance to antibody-mediated killing and are more likely to be invasive than gastrointestinal. Methodology/Principal findings: We studied 192 NTS isolates (114 Typhimurium, 78 Enteritidis) from blood and stools, mostly from paediatric admissions in Kenya 2000-2011. Isolates were tested for susceptibility to antibody-mediated killing, using whole adult serum. O-antigen structural characteristics, including O-acetylation and glucosylation, were investigated. Overall, isolates were susceptible to antibody-mediated killing, but S. Enteritidis were less susceptible and expressed more O-antigen than Typhimurium (p\u3c0.0001 for both comparisons). For S. Typhimurium, but not Enteritidis, O-antigen expression correlated with reduced sensitivity to killing (r = 0.29, 95% CI = 0.10-0.45, p = 0.002). Both serovars expressed O-antigen populations ranging 21-33 kDa average molecular weight. O-antigen from most Typhimurium were O-acetylated on rhamnose and abequose residues, while Enteritidis O-antigen had low or no O-acetylation. Both Typhimurium and Enteritidis O-antigen were approximately 20%-50% glucosylated. Amount of S. Typhimurium O-antigen and O-antigen glucosylation level were inversely related. There was no clear association between clinical presentation and antibody susceptibility, O-antigen level or other O-antigen features. Conclusion/Significance: Kenyan S. Typhimurium and Enteritidis clinical isolates are susceptible to antibody-mediated killing, with degree of susceptibility varying with level of O-antigen for S. Typhimurium. This supports the development of an antibody-inducing vaccine against NTS for Africa. No clear differences were found in the phenotype of isolates from blood and stool, suggesting that the same isolates can cause invasive disease and gastroenteritis. Genome studies are required to understand whether invasive and gastrointestinal isolates differ at the genotypic level

The OMERACT-OARSI Core Domain Set for Measurement in Clinical Trials of Hip and/or Knee Osteoarthritis

Objective: To update the 1997 OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) core domain set for clinical trials in hip and/or knee osteoarthritis (OA). Methods: An initial review of the COMET database of core outcome sets (COS) was undertaken to identify all domains reported in previous COS including individuals with hip and/or knee OA. These were presented during 5 patient and health professionals/researcher meetings in 3 continents (Europe, Australasia, North America). A 3-round international Delphi survey was then undertaken among patients, healthcare professionals, researchers, and industry representatives to gain consensus on key domains to be included in a core domain set for hip and/or knee OA. Findings were presented and discussed in small groups at OMERACT 2018, where consensus was obtained in the final plenary. Results: Four previous COS were identified. Using these, and the patient and health professionals/researcher meetings, 50 potential domains formed the Delphi survey. There were 426 individuals from 25 different countries who contributed to the Delphi exercise. OMERACT 2018 delegates (n = 129) voted on candidate domains. Six domains gained agreement as mandatory to be measured and reported in all hip and/or knee OA clinical trials: pain, physical function, quality of life, and patient’s global assessment of the target joint, in addition to the mandated core domain of adverse events including mortality. Joint structure was agreed as mandatory in specific circumstances, i.e., depending on the intervention. Conclusion: The updated core domain set for hip and/or knee OA has been agreed upon. Work will commence to determine which outcome measurement instrument should be recommended to cover each core domain

Antigen-Engaged B Cells Undergo Chemotaxis toward the T Zone and Form Motile Conjugates with Helper T Cells

Interactions between B and T cells are essential for most antibody responses, but the dynamics of these interactions are poorly understood. By two-photon microscopy of intact lymph nodes, we show that upon exposure to antigen, B cells migrate with directional preference toward the B-zone–T-zone boundary in a CCR7-dependent manner, through a region that exhibits a CCR7-ligand gradient. Initially the B cells show reduced motility, but after 1 d, motility is increased to approximately 9 μm/min. Antigen-engaged B cells pair with antigen-specific helper T cells for 10 to more than 60 min, whereas non-antigen-specific interactions last less than 10 min. B cell–T cell conjugates are highly dynamic and migrate extensively, being led by B cells. B cells occasionally contact more than one T cell, whereas T cells are strictly monogamous in their interactions. These findings provide evidence of lymphocyte chemotaxis in vivo, and they begin to define the spatiotemporal cellular dynamics associated with T cell–dependent antibody responses

Randomized placebo-controlled trial on azithromycin to reduce the morbidity of bronchiolitis in Indigenous Australian infants: rationale and protocol

Background: Acute lower respiratory infections are the commonest cause of morbidity and potentially preventable mortality in Indigenous infants. Infancy is also a critical time for post-natal lung growth and development. Severe or repeated lower airway injury in very young children likely increases the likelihood of chronic pulmonary disorders later in life. Globally, bronchiolitis is the most common form of acute lower respiratory infections during infancy. Compared with non-Indigenous Australian infants, Indigenous infants have greater bacterial density in their upper airways and more severe bronchiolitis episodes. Our study tests the hypothesis that the anti-microbial and anti-inflammatory properties of azithromycin, improve the clinical outcomes of Indigenous Australian infants hospitalised with bronchiolitis.Methods: We are conducting a dual centre, randomised, double-blind, placebo-controlled, parallel group trial in northern Australia. Indigenous infants (aged ≤ 24-months, expected number = 200) admitted to one of two regional hospitals (Darwin, Northern Territory and Townsville, Queensland) with a clinical diagnosis of bronchiolitis and fulfilling inclusion criteria are randomised (allocation concealed) to either azithromycin (30 mg/kg/dose) or placebo administered once weekly for three doses. Clinical data are recorded twice daily and nasopharyngeal swab are collected at enrolment and at the time of discharge from hospital. Primary outcomes are 'length of oxygen requirement' and 'duration of stay,' the latter based upon being judged as 'ready for respiratory discharge'. The main secondary outcome is readmission for a respiratory illness within 6-months of leaving hospital. Descriptive virological and bacteriological (including development of antibiotic resistance) data from nasopharyngeal samples will also be reported.Discussion: Two published studies, both involving different patient populations and settings, as well as different macrolide antibiotics and treatment duration, have produced conflicting results. Our randomised, placebo-controlled trial of azithromycin in Indigenous infants hospitalised with bronchiolitis is designed to determine whether it can reduce short-term (and potentially long-term) morbidity from respiratory illness in Australian Indigenous infants who are at high risk of developing chronic respiratory illness. If azithromycin is efficacious in reducing the morbidly of Indigenous infants hospitalised with bronchiolitis, the intervention would lead to improved short term (and possibly long term) health benefits. Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000326099

Identifying the quality of life effects of urinary incontinence with depression in an Australian population

Background: To explore the additive effect of urinary incontinence, in people with comorbid depression, on health related quality of life. Methods: Males and females, 15 to 95 years (n = 3010, response rate 70.2%) were interviewed face to face in the 1998 Autumn South Australian Health Omnibus Survey. Results: Self-reported urinary incontinence was found in 20.3% (n=610), and depression as defined by the PRIME-MD in 15.2% (n=459) of the survey population. Urinary incontinence with comorbid depression was found in 4.3% of the overall population. Univariate analysis showed that respondents with urinary incontinence and comorbid depression were more likely to be aged between 15 and 34 years and never married when compared to those with incontinence only. Multivariate analysis demonstrated that in people with incontinence, the risk of having comorbid depression was increased by an overall health status of Fair or Poor, or the perception that their incontinence was moderately or very serious. Respondents reporting that they experienced incontinence with comorbid depression scored significantly lower than those experiencing incontinence without depression on all dimensions of the SF-36. The interaction of the presence of incontinence and the presence of depression was significantly associated with the dimensions of physical functioning. Conclusions: Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health, perhaps by increasing a person’s negative perceptions of their illness. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall QOL.Jodie C Avery, Nigel P Stocks, Paul Duggan, Annette J Braunack-Mayer, Anne W Taylor, Robert D Goldney and Alastair H MacLenna

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707