Championing the Joint Force: A Job for the Public and our Political Leaders – Not Just Military Professionals Alone

Canada’s security interests and the mission of our Armed Forces – that is to defend Canada, defend North America and to promote peace and security abroad – may largely remain unchanged and timeless. The nature of the security environment, however, has not – nor will it be in the years to come. An effective and relevant Canadian Armed Forces will continue to require capable, wellequipped and operationally-ready maritime, air and land forces who are largely raised and trained within our Army, Navy and Air Force. But in order for Defence to remain relevant and effective in an era of increased instability, volatility and unpredictability, our Armed Forces need the ability and capacity to match these with an increased understanding of what is going on, and preparedness for what is to come. This is the business of our military’s Joint Forces – those beyond the tactical units that the services provide. It is the joint organizations and networks within the institution that generate intelligence, provide understanding and lead the partnering, planning, force posturing and practicing so essential to the anticipation of, preparation for, and conduct of, operations – in particular in a world of unrelenting complexity. A decade after General Rick Hillier’s extraordinary initiatives to transform our Armed Forces from a service-centric machine-age force to one focused on the business of operations, one that thinks and acts Canadian Forces (joint) first, we do see evidence of real progress in the approach to joint operations and improved appreciation of our military’s joint functions and capabilities. Unlike the political and public calls for strong services and the modernization of their major platforms, however, this progress has been realized largely through efforts internal to the Armed Forces themselves. The initiative has been without political leadership and external policy topcover, rendering this progress and its future vulnerable and reversible. This paper describes the functions of the Joint Force; advocates for the capabilities they require to enable partnerships, enhance understanding and advance mission preparedness; and calls for unified leadership of the joint domain and over our military’s joint culture. Our traditional international partners have travelled this road. They too see that clarity on joint functions, joint capability, joint domain leadership, and stewardship over joint culture are vital to their military’s relevance and operational effectiveness – and to their agility and flexibility in the years to come. Their progress is the result of internal professional transformation, as well as the understanding of, and requirement by political leaders and modern defence policy to make this so. Here in Canada, the forming of new government this fall calls for a relook at Defence policy, providing new opportunity to invite that same political leadership and influence. Joint functions, joint capabilities and clear joint leadership are vital to our military’s relevance to, and effectiveness in, our national defence and operations. Joint Forces and the joint domain, like strong and capable Army, Navy and Air Forces, need to be led, resourced and fully engaged before planes fly, ships sail, and troops deploy. Joint-ness requires external understanding and proponents, and, within the Forces, a clearly identifiable champion. In Canada, these range from ambiguous to absent

Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies.

BACKGROUND: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN: The design was a prospective multicentre cohort study. SETTING: The setting was 16 NHS hospitals. PARTICIPANTS: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD: Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS: Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS: Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS: In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information

Influenza Pandemic Periodicity, Virus Recycling, and the Art of Risk Assessment

Conditions that lead to influenza pandemics are not fully understood

Modelo para redução do risco à segurança do consumidor no desenvolvimento de produtos de consumo /

Dissertação (Mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico

What's in a Name? Shifting Identities of Traditional Organized Crime in Canada in the Transnational Fight against the Calabrian ‘Ndrangheta

The Italian antimafia authorities have warned Canadian law enforcement about the risks and the growing concerns for the infiltration of clans of the Calabrian mafia, known as ‘ndrangheta, in Eastern Canada. The alarm linked to the rise of the ‘ndrangheta challenges the paradigms of traditional organized crime in Canada, because the ‘ndrangheta is presented as traditional but also innovative and more pervasive than other mafia-type groups. Through access to confidential investigations and interviews to key specialist law enforcement teams in Toronto and Montreal, this article investigates today's institutional perception of mafia – the ‘ndrangheta in particular – in Canada when compared to Italian conceptualizations. I will argue that the changes in narratives in Canada can be read in relation to changes in the Italian identity in the country, moving towards regionalization and specialist knowledge of ethnic differences

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Championing the Joint Force: A Job for the Public and our Political Leaders – Not Just Military Professionals Alone

Canada’s security interests and the mission of our Armed Forces – that is to defend Canada, defend North America and to promote peace and security abroad – may largely remain unchanged and timeless. The nature of the security environment, however, has not – nor will it be in the years to come. An effective and relevant Canadian Armed Forces will continue to require capable, wellequipped and operationally-ready maritime, air and land forces who are largely raised and trained within our Army, Navy and Air Force. But in order for Defence to remain relevant and effective in an era of increased instability, volatility and unpredictability, our Armed Forces need the ability and capacity to match these with an increased understanding of what is going on, and preparedness for what is to come. This is the business of our military’s Joint Forces – those beyond the tactical units that the services provide. It is the joint organizations and networks within the institution that generate intelligence, provide understanding and lead the partnering, planning, force posturing and practicing so essential to the anticipation of, preparation for, and conduct of, operations – in particular in a world of unrelenting complexity. A decade after General Rick Hillier’s extraordinary initiatives to transform our Armed Forces from a service-centric machine-age force to one focused on the business of operations, one that thinks and acts Canadian Forces (joint) first, we do see evidence of real progress in the approach to joint operations and improved appreciation of our military’s joint functions and capabilities. Unlike the political and public calls for strong services and the modernization of their major platforms, however, this progress has been realized largely through efforts internal to the Armed Forces themselves. The initiative has been without political leadership and external policy topcover, rendering this progress and its future vulnerable and reversible. This paper describes the functions of the Joint Force; advocates for the capabilities they require to enable partnerships, enhance understanding and advance mission preparedness; and calls for unified leadership of the joint domain and over our military’s joint culture. Our traditional international partners have travelled this road. They too see that clarity on joint functions, joint capability, joint domain leadership, and stewardship over joint culture are vital to their military’s relevance and operational effectiveness – and to their agility and flexibility in the years to come. Their progress is the result of internal professional transformation, as well as the understanding of, and requirement by political leaders and modern defence policy to make this so. Here in Canada, the forming of new government this fall calls for a relook at Defence policy, providing new opportunity to invite that same political leadership and influence. Joint functions, joint capabilities and clear joint leadership are vital to our military’s relevance to, and effectiveness in, our national defence and operations. Joint Forces and the joint domain, like strong and capable Army, Navy and Air Forces, need to be led, resourced and fully engaged before planes fly, ships sail, and troops deploy. Joint-ness requires external understanding and proponents, and, within the Forces, a clearly identifiable champion. In Canada, these range from ambiguous to absent