A study on the career advancement and retention of highly qualified women in the Canadian mining industry

The gender imbalance in the Canadian mining industry is considerable and persistent. Despite a substantial forecasted labour shortage, women represent only 14% of the national mining workforce. This research investigates the underutilization and under-representation of a specific labour subset, namely Highly Qualified Women. Highly Qualified Women (HQW) are women who have obtained a Bachelor’s degree or higher. HQW represent a substantial source of technical and leadership capacity for the mining industry. This research study used an online survey as the primary methodology for data collection, and the survey resulted in a sample of 163 HQW respondents. From the responses, HQW career paths were mapped and their perceptions on mining workplace culture and career barriers were analyzed. Results indicated two distinct career pathway trends for HQW in the mining industry. ‘The Specialist,’ a career characterized by multiple professional scientific and technical positions, and ‘The Corporate,’ a career characterized by professional administrative roles and roles in mid-level management. It was found that neither ‘Corporates’ nor ‘Specialists’ systematically progressed into senior management and executive roles. These findings suggest that HQWs careers in mining are stalled, despite a strong indication by respondents of interest in their professional career advancement. With regards to workplace culture, respondents indicated that blatant forms of gender discrimination have been reduced in mining workplaces; however, exclusion from informal networks, implicit bias and subtler forms of workplace discrimination persist. Consistent with previous mining sector research, improving work-life balance, work flexibility and mentorship were found as key drivers for HQW to advance and remain in the industry. From the significant insight of the respondents, strategic recommendations for organizations to improve the advancement and retention of HQW in mining were developed.  Applied Science, Faculty ofMining Engineering, Keevil Institute ofGraduat

Predictors of poor outcomes in non-ischemic cardiogenic shock and the use of hospice in this population

Background Non-ischemic cardiomyopathy is under-appreciated in terms of both research and literature when compared to its ischemic counterpart. Not much is known about this vulnerable population. Therefore, we sought to identify clinical characteristics associated with poor outcomes amongst non-ischemic cardiogenic shock (NICS). Methods A retrospective chart review of NICS patients who were admitted to a tertiary transplant center from 6/2013 to 7/2018. T-test for continuous and chi-square tests for categorical data were used. Univariate analysis and multivariate regression models were used to analyze outcomes. Results Among 192 patients, 71.4% male, mean age of 57 ± 15, 47.9% white. Compared to the non-supported group, left ventricular assist device (62.5% vs 22.8%, p \u3c 0.0001), Veno-arterial extracorporeal membrane oxygenation (62.5% vs 22.8%, p = 0.11), Intra- aortic balloon pump (IABP) (58.8% vs 21.1%, p = 0.0006) had significantly prolonged length of stay (LOS) which were defined as ≥ 20 days. Higher risks of hospital death were associated with age (OR 1.033, CI 1.002-1.064, p = 0.034) and IABP (OR 4.4, CI 1.4-14.5, p = 0.011). When combing all data, older mean age (58 years old vs 51 years old, p = 0.045), prior dialysis (100% vs 86.3%, p = 0.026), and inotrope usage (91% vs 80%, p = 0.011) were associated with the composite poor outcomes. Only 42 patients (22%) received hospice consultation during hospitalization. Hospice were consulted more for black patients (black 32.5% vs white 15.2%, p = 0.009). Conclusion In patients presenting with NICS, older age, prior dialysis, usage of inotropes were predictors of overall poor outcome. Mechanical circulatory support did not shorten inpatient LOS. Surprisingly, we did not identify any factors that increased the risk of readmission. Older age and IABP seemed to have higher inpatient mortality rate. Hospice was significantly underused in practice, especially in Caucasians. Future studies such as directly comparing non-ischemic and ischemic cardiomyopathy are needed to further understand NICS

Utility of ECG-gated computed tomography angiography for the improved diagnosis of bicuspid aortic valve disease prior to transcatheter aortic valve replacement

Background: Diagnosis of a bicuspid aortic valve (BAV) morphology has important prognostic implications due to early valve degeneration and an associated aortopathy. Presence of a BAV also has technical implications for transcatheter aortic valve replacement (TAVR) procedural planning and implantation. BAV is often first identified on transthoracic echocardiography (TTE), but diagnosis may be limited by imaging windows, operator skill, and valve calcification. ECG-gated computed tomography angiography (CTA) may improve identification of BAV. Methods: 335 patients who underwent TAVR between 5/1/18 and 12/20/18 were retrospectively evaluated. Routine pre-procedure planning retrospectively ECG-gated CTA studies were performed with reconstruction phases at 10% increments through the R-R cycle. 50% or greater commissural fusion was categorized as a BAV. Valve morphology from the preprocedural TTE reports was also abstracted. Of 335 patients, 17 patients had prosthetic valves. Of the remaining 318 patients, 267 (52.4% male, age 79 ± 27) had TTE grading of aortic valve morphology. Results: BAV was identified by TTE in 23 patients (8.6% of cohort, age 75 ± 20 years) whereas CTA identified 26 patients (9.7% of cohort, age 74 ± 21 years) with a bicuspid valve. Direct correlation between CTA and TTE was modest (R-value = 0.38). With CTA as the reference standard, TTE had a sensitivity, specificity, positive predictive value and negative predictive value of 88.5%, 100%, 100% and 98.8% respectively. The age of patients with tricuspid vs BAV was 80 ± 28 years vs 74 ± 21 years, respectively. Aortic size in tricuspid vs BAV patients was 34.2 ± 15 vs 37.9 ± 30 mm (p=0.001). In BAV patients, 82% of the patients had no aortic dilation greater than 40mm. Conclusions: In patients referred for TAVR, CTA is valuable tool for diagnosis of BAV and associated aortopathies, particularly when valve morphology cannot be characterized by TTE. In our cohort, BAV patients were older and rarely had significant aortopathy, suggesting an increased prevalence of degenerative valve fusion relative to congenital BAV disease. Further study is required to categorize and distinguish BAV sub-types and their effect on TAVR procedure results

Targeted exclusion of proximal obstructive coronary disease on coronary computed tomography angiography for deferral of routine invasive coronary angiography prior to transcatheter aortic valve replacement

Background: Aortic stenosis is associated with coronary artery disease (CAD) and routine invasive coronary angiography (ICA) is performed prior to transcatheter aortic valve replacement (TAVR). Evaluation of CAD on computed tomography angiography (CTA) is limited due to coronary calcification, cardiac motion and absence of sublingual nitroglycerin but may be feasible for the exclusion of only proximal CAD. Methods: 339 patients (52% male, age 79 ± 27) who underwent TAVR between 5/1/18 and 12/20/18 were retrospectively studied. Routine pre-procedure ECG-gated CTA was performed with reconstruction phases in 10% increments. CTA evaluation of proximal CAD performed clinically on request from multidisciplinary heart team. CAD analysis performed on 3D workstations by experienced cardiologists and radiologists. Stenosis grades: 0=normal, 1=1-25%, 2=26-50%, 3=51-70%, 4=71-99%, 5=occluded, 8=absent, 9=uninterpretable. Results: Of 339 patients, 62 (18%) patients had CTA coronary analysis of which 49 (14%) also had ICA before or at time of TAVR. Of these patients, 21 (43%) patients had no stenosis more than 50% on CTA, and of those 21 patients, 19 (91%) also had no stenosis more than 50% on ICA. 28 patients who had both ICA and CTA had ≥50% stenosis in at least one coronary artery on CTA. Of these, 22 (79%) also had ≥50% stenosis on ICA. When excluding those with coronary artery bypass grafts (12 patients), 63% of patients had ≥50% stenosis on both CTA and ICA.13 patients had CTA without follow up ICA. Overall including all patients with no CAD on ICA and those who were deferred ICA based on CTA results, 32 (52%) patients avoided or could have avoided ICA, leading to a total theoretical cost saving of $155,000-310,000. No patients had acute coronary syndrome (ACS) at the time of discharge post TAVR. Conclusions: Exclusion of proximal obstructive CAD on routine pre- TAVR CTA is feasible and can decrease utilization of ICA with no increase in ACS at the time discharge post TAVR implantation. This strategy can decrease invasive procedures and potentially reduce cost. Further study is needed on longitudinal outcomes with this strategy

Utility Of Standardized Pre-CTA Hydration Protocol On Patients Referred For Transcatheter Aortic Valve Replacement

Introduction: ECG-gate computed tomography angiography (CTA) is the standard technique for pre-procedural planning prior to transcatheter aortic valve replacement (TAVR). CTA requires use of potentially nephrotoxic iodinated contrast, limiting use in patients with renal dysfunction. We evaluated the utility of a tiered hydration protocol in patients with renal dysfunction referred for TAVR. Methods: 258 patients (52.7% male, age 79 ± 8 years) who underwent TAVR between 1/1/18 and 12/30/18 were retrospectively evaluated. Pre-procedural CTA was performed per institutional protocols with weight based contrast dosing. Patients requiring hemodialysis prior to CTA were excluded. Patients with GFR \u3c22ml/min did not receive CTA. Patients with GFR 22 - 40 ml/min underwent hydration protocol guidelines: Outpatients received normal saline (NS) at ≤3 mL/kg over one hour pre-procedure/test and 1 to 1.5 mL/kg/hour during and up to six hours post-procedure/test. Inpatients received normal saline for 1 mL/kg/hour for 6 to 12 hours pre-procedure/test, intra-procedure, and up to 12 hours post-procedure. Results: Total baseline creatinine was 1.08 ± 0.41 ng/dL. Hydration protocol patient creatinine levels were 1.67 ± 0.41 ng/dL. Upper quartile of creatinine was 1.91 ng/dL (range 0.79 - 2.65 ng/dL). Average CTA contrast dose was 100 ± 23 mL. 43 (17%) of patients received pre-CTA hydration protocol. Hydration protocol NS total infusion volumes were 490 ± 119 mL (range 40-100ml). Duration between CT and TAVR was 86 ± 155 days. Pre-TAVR creatinine was 1.09 ± 0.39, creatinine at discharge was 1.06 ± 0.73. 3 patients (1%) had ≥1 increase in CKD grade at discharge. No patients required dialysis prior to discharge or within 1 month of TAVR. No complications from hydration protocol were identified. Conclusions: Utilization of a routine pre-TAVR CT hydration protocol in patients at risk for contrast induced nephropathy is feasible and associated with no new renal dysfunction prior to TAVR, and low rates of new renal dysfunction post TAVR. In TAVR patients hydration carries risks and further study is needed to identify whether a more conservative hydration protocol can be utilized