“Waiting for a Wife”: Transnational Marriages and the Social Dimensions of Refugee “Integration”

This paper addresses the gap in research on the social dimensions of refugee resettlement. This is accomplished by examining refugee belonging and definitions of “integration”through a case study of Acehnese refugees resettled in Vancouver, British Columbia, between 2004 and 2006. We analyze findings based on a survey and in-depth interviews conducted five years after resettlement. Our findings suggest that recently resettled groups like the Acehnese, who are “new and few,” face specif c integration challenges. Importantly,the lengthy timelines to enact sponsorship of a spouse and/or family reunification from Aceh unwittingly inhibit the social integration of the sponsors waiting in Canada.Cet article traite de lacunes en matière de recherche sur les dimensions sociales de la réinstallation des réfugiés en examinant l’appartenance de réfugiés et les définitions de «l’intégration» à travers une étude de cas de réfugiés acehnais réinstallés à Vancouver en Colombie-Britannique, entre 2004 et 2006. Nous analysons les résultats sur la base d’un sondage et d’entrevues en profondeur menés cinq ans après la réinstallation. Nos résultats suggèrent que des groupes récemment réinstallés comme les habitants d’Aceh, qui sont «nouveaux et rares», sont confrontés à des difficultés d’intégration particulières. Notamment, les longs délais pour établir le parrainage d’un conjoint et/ou le regroupement des familles à Aceh empêchent sans le vouloir l’intégration sociale des parrains qui attendent au Canada

Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research

Objectives This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. Methods A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. Results A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Conclusions Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases

Alcohol consumption and prostate cancer incidence and progression: A Mendelian randomisation study.

Prostate cancer is the most common cancer in men in developed countries, and is a target for risk reduction strategies. The effects of alcohol consumption on prostate cancer incidence and survival remain unclear, potentially due to methodological limitations of observational studies. In this study, we investigated the associations of genetic variants in alcohol-metabolising genes with prostate cancer incidence and survival. We analysed data from 23,868 men with prostate cancer and 23,051 controls from 25 studies within the international PRACTICAL Consortium. Study-specific associations of 68 single nucleotide polymorphisms (SNPs) in 8 alcohol-metabolising genes (Alcohol Dehydrogenases (ADHs) and Aldehyde Dehydrogenases (ALDHs)) with prostate cancer diagnosis and prostate cancer-specific mortality, by grade, were assessed using logistic and Cox regression models, respectively. The data across the 25 studies were meta-analysed using fixed-effect and random-effects models. We found little evidence that variants in alcohol metabolising genes were associated with prostate cancer diagnosis. Four variants in two genes exceeded the multiple testing threshold for associations with prostate cancer mortality in fixed-effect meta-analyses. SNPs within ALDH1A2 associated with prostate cancer mortality were rs1441817 (fixed effects hazard ratio, HRfixed  = 0.78; 95% confidence interval (95%CI):0.66,0.91; p values = 0.002); rs12910509, HRfixed  = 0.76; 95%CI:0.64,0.91; p values = 0.003); and rs8041922 (HRfixed  = 0.76; 95%CI:0.64,0.91; p values = 0.002). These SNPs were in linkage disequilibrium with each other. In ALDH1B1, rs10973794 (HRfixed  = 1.43; 95%CI:1.14,1.79; p values = 0.002) was associated with prostate cancer mortality in men with low-grade prostate cancer. These results suggest that alcohol consumption is unlikely to affect prostate cancer incidence, but it may influence disease progression.This work was supported by a Cancer Research UK (C18281/A19169) programme grant to RMM and Caroline Relton (Integrative Cancer Epidemiology Programme). LZ was funded by a UK MRC Special Training Fellowship (G0501864/76656) and a UK MRC Population Health Scientist fellowship [grant number G0902144]. LZ and NMD work in a unit that receives funding from the UK MRC [G0600705] and the University of Bristol (MC_UU _12013/1,9). The CRUK study and the PRACTICAL consortium were supported by the Canadian Institutes of Health Research; the European Commission's Seventh Framework Programme grant agreement number 223175 (HEALTH-F2-2009-223175); Cancer Research UK Grants C5047/A7357, C1287/A10118, C5047/A3354, C5047/A1069 2, C16913/A6135; and the National Institute of Health (NIH) Cancer Post-Cancer GWAS initiative grant: No. 1 U19 CA 148537-01 (the GAME-ON initiative). Funding for the iCOGS infrastructure came from: the European Community's Seventh Framework Programme under grant agreement n° 223175 (HEALTH-F2-2009- 223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A 10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15 007, C5047/A10692), the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065 and 1U19 CA148112 - the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The ProtecT study is funded by the U.K. Health Technology Assessment (HTA) Programme of the NIH Research (HTA 96/20/99; ISRCTN 20141297). The authors thank the provision of the additional epidemiological data by the NHS R&D Directorate supported Prodigal study and the ProMPT (Prostate Mechanisms of Progression and Treatment) collaboration which is supported by the National Cancer Research Institute (NCRI) formed by the Department of Health, the Medical Research Council and Cancer Research UK (G0500966/75466). RAE and ZKJ are supported by Cancer Research UK Grant C5047/A7357 and the NIHR Biomedical Research Centre at The Institute of Cancer Research and Royal Marsden NHS Foundation Trust. RMM was supported by the National Institute for Health Research Bristol Nutrition Biomedical Research Unit based at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. FCH, DEN and JLD are NIHR Senior Investigators.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/ijc.3043

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

BACKGROUND: To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS: In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS: Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION: We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Towards a More Just Canadian Education-migration System: International Student Mobility in Crisis

Education-migration, or the multi-step recruitment and retention of international students as immigrants, is an increasingly important component of both higher education and so-called highly-skilled migration. This is particularly true in Canada, a country portrayed as a model for highly-skilled migration and supportive of international student mobility. However, education-migration remains under-analyzed from a social justice perspective. Using a mobility justice framework, this paper considers COVID-19’s impact on Canada’s education-migration system at four scales: individuals, education institutions, state immigration regimes, and planetary geoecologies. It identifies ethical tensions inherent to Canada’s education-migration from a systems-level and suggests that a multi-scalar approach to social justice can both usefully complexify discussions and introduce unsettling paradoxes. It also stresses that the COVID-19 pandemic offers an opportunity to reimagine rather than return

From protracted situations to protracted separations: Acehnese-Canadian refugee settlement in Vancouver, BC

Between 2004 and 2006, the Canadian government resettled 154 refugees originally from Aceh, Indonesia in Metro Vancouver, British Columbia. Their resettlement was unique for three reasons: (1) they were the first group of refugees resettled entirely in one Canadian metropolitan area; (2) they were the first Acehnese refugees ever resettled in Canada; and (3) among adults, the gender ratio was disproportionately skewed towards (young, single) men. This thesis probes the meanings of refugee ‘integration’ by examining their settlement five years after arrival. Through an analysis of surveys and interviews, I document structural barriers to settlement. I then relate these barriers to the ‘integration’ of single men in particular, who, after years in a protracted refugee situation involving detention, face long wait times in pursuit of transnational marriages. Rather than place the onus on resettled refugees to ‘integrate’ better, I argue that Canadian policy can better accommodate their desires to settle

The ethics of edugration : Canada’s higher education-migration nexus

This dissertation focuses on higher education-migration (edugration), arguing that the growing recruitment of international post-secondary students as (im)migrants is (1) a distinct form of economic (im)migration, and (2) has shifted the role of higher education in society. Presenting the Canadian context as an example, it uses a critically-informed, decolonial complexity approach to frame edugration as a wicked problem and explore its ethical complexities and paradoxes, particularly in relation to settler colonialism, surveillance, and border imperialism. Through critical policy analysis, it first demonstrates the role higher education institutions play as actors in Canada’s (im)migration regime, specifically in (1) immigrant selection, and (2) migrant surveillance and bordering. It then employs critical discourse analysis to demonstrate how higher education institutions explicitly positioned themselves as (im)migration actors by instrumentalizing their nation-building function in response to COVID-19 budget concerns. Finally, using the COVID-19 pandemic as a ‘stress test,’ the dissertation uses a mobility justice framework to illustrate how horizons of justice – e.g. how justice is defined, and for whom/what – are often constrained by limited conceptualizations of scale. This limits our ability to recognize complicity and imagine alternative, and potentially more just, possibilities for both education and migration within a modern colonial system.Education, Faculty ofEducational Studies (EDST), Department ofGraduat

Higher educational institutions as emerging immigrant selection actors : a history of British Columbia’s retention of international graduates, 2001–2016

In an effort to more efficiently utilize immigration to mitigate the negative economic impacts of falling population rates, some governments are shifting from human-capital to demand-driven immigrant selection approaches. While employers are typically seen as the resulting non-governmental selection actors, recent niche but growing immigration programs are repositioning higher educational institutions as additional yet inadvertent selection actors, typically unaware of their role. To illustrate the complexities inherent in this policy evolution, I historically trace the past 15 years of immigration selection design targeting international students in the Canadian province of British Columbia and highlight potential implications in light of increasing internationalization. I argue that educational policy researchers need to further understand and engage with the development of increasingly intertwined yet previously neglected policy areas – in this instance, immigration – as higher education assumes new roles in public life.Education, Faculty ofEducational Studies (EDST), Department ofReviewedGraduat