Providing care in divided space : nursing in Northern Saskatchewan, 1944-1957 and beyond

In 1944, the Government of Saskatchewan created the Northern Administrative District (NAD), which established Northern Saskatchewan as a spatial entity within the provincial milieu. Attention was focused on modernizing the region, and public health nursing became one of the first state-sponsored institutions to be introduced by the provincial government. By examining the day-to-day activities of nurses who worked at remote nursing outposts in Northern Saskatchewan between 1944 and 1957 and beyond, this research examines the complex internal factors involved in region-making. Nurses lived and worked amongst their patients in small remote communities, thus making them effective vehicles for promoting modernization principles through preventative and educations programs. Despite the government’s intention to modernize Northern Saskatchewan, a colonial relationship emerged between the region and the rest of the province. This situation left nurses in a confusing and often difficult position, because the institution behind initiatives to modernize the region was also their employer to whom they had certain obligations. Furthermore, the colonial attitude towards the region also extended to the nursing stations and the nurses, which often frustrated their attempts to provide medical care. As such, the small cadre of nurses played an ambiguous role, both as agents of modernization, but also opponents of its egregious effects. The research examines the role of nursing in region-making through two types of geography: A geography of region-making where the literature focuses on the formal process of institutionalization, and a geography of social life, where the emerging literature on the geography of nursing provides an entry point. This two-part approach provides an opportunity to use different lenses to view the processes involved in shaping Northern Saskatchewan as it emerged as a distinct northern place within Canada

From Soldier to Student II: Assessing Campus Programs for Veterans and Service Members

The United States is in the process of bringing more than 2 million service members home from Iraq and Afghanistan and reducing the size of America's military. Today's veterans are the beneficiaries of the Post-9/11 GI Bill, which has provided unprecedented financial support for attending college. More than 500,000 veterans and their families have utilized Post-9/11 GI Bill benefits since the law's enactment in 2008. Many returning veterans -- as well as service members in the active and reserve components of the armed forces -- will enroll in higher education to enhance their job prospects, achieve career goals, expand their knowledge and skill sets for both personal and career enrichment, and facilitate their transition to civilian life.How well prepared is higher education to serve these new students, and what changes has it made in response to the first wave of Post-9/11 GI Bill recipients on campus? Despite the long history of veterans' education benefits and presence of veteran students on campus, current research is still catching up to the veteran and military student population. This report represents the second assessment of the current state of programs and services for veterans and service members on campuses across the nation, based on survey results from 690 institutions

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

"Open the hurt locker and learn": Veterans Education and the Civil-Military Gap

The passage of the 2008 Post-9/11 GI Bill created the most complex policy iteration of the GI Bill to date. The bill’s payment structure forced closer interactions between the U.S. Department of Veterans Affairs (VA) and higher education institutions, as well as their representative associations. These relations are examined against the larger societal backdrop of a civil-military gap established in a robust literature of military sociology and specific research on civil-military relations. However, higher education researchers have not studied the policy relations between higher education associations and military- and veteran-serving agencies (e.g., the Department of Defense [DoD] and VA). This study’s purpose was to illuminate, using a case study design including both document analysis and interviews with participants from three higher education associations, the worlds of veterans education policy and associations representative of institutions charged with implementation. Narratives, counternarratives, and metanarratives were identified using a transformative research paradigm. Findings indicate that a civil-military gap exists in associations’ interactions with military- and veteran-serving agencies but relationships are dynamic and complicated by organizational cultural divides. The study contributes to the literature on higher education associations, providing evidence regarding the little-researched power and behind-the-scenes influence on national higher education policy. The second contribution is a focus on documenting dimensions of the civil-military gap in veterans education policy. However, results also indicated a dynamic, symbiotic and mutually dependent, and sometimes contentious relationship rather than a single, static gap. Against this constantly changing backdrop, associations attempted to influence the enactment of orderly veterans education policies befitting intended federal goals for student veterans and commonly accepted higher education practices. Yet the civil-military gap also disrupted associations’ capacity to implement veterans education policy including modes of operation among military- and veteran-serving agencies that hinder not only communication and Post-9/11 GI Bill benefit payment processing, but also realistic assessment and research on student veterans’ academic and social needs. The study proposes an action plan for research, policy and practice that higher education associations might use to attempt to bridge the civil-military gap in veterans education policy and enable veterans’ success in higher education

Place and nursing in remote northern communities : a historical perspective

Webcast sponsored by the Irving K. Barber Learning Centre and hosted by the School of Nursing at UBC. Following World War II, governments began extending healthcare to residents living in northern remote communities as a way to “modernize” the vast region and to pave the way for increased resource extraction. Small outpost nursing stations were established across the north where nurses, often working alone and facing a number of challenges, delivered health care services to the primarily Aboriginal population. However, the nurses’ roles and their perceptions of the communities where they worked were often ambiguous and contradictory, resulting in a mixed experience for nurses and patients alike. Drawing from the nurses’ personal correspondence and interviews, this presentation will examine the perspectives about the places where nurses worked and the people they provided services to during a time of significant change.Non UBCUnreviewedFacult

"Open the hurt locker and learn": Veterans Education and the Civil-Military Gap

The passage of the 2008 Post-9/11 GI Bill created the most complex policy iteration of the GI Bill to date. The bill’s payment structure forced closer interactions between the U.S. Department of Veterans Affairs (VA) and higher education institutions, as well as their representative associations. These relations are examined against the larger societal backdrop of a civil-military gap established in a robust literature of military sociology and specific research on civil-military relations. However, higher education researchers have not studied the policy relations between higher education associations and military- and veteran-serving agencies (e.g., the Department of Defense [DoD] and VA). This study’s purpose was to illuminate, using a case study design including both document analysis and interviews with participants from three higher education associations, the worlds of veterans education policy and associations representative of institutions charged with implementation. Narratives, counternarratives, and metanarratives were identified using a transformative research paradigm. Findings indicate that a civil-military gap exists in associations’ interactions with military- and veteran-serving agencies but relationships are dynamic and complicated by organizational cultural divides. The study contributes to the literature on higher education associations, providing evidence regarding the little-researched power and behind-the-scenes influence on national higher education policy. The second contribution is a focus on documenting dimensions of the civil-military gap in veterans education policy. However, results also indicated a dynamic, symbiotic and mutually dependent, and sometimes contentious relationship rather than a single, static gap. Against this constantly changing backdrop, associations attempted to influence the enactment of orderly veterans education policies befitting intended federal goals for student veterans and commonly accepted higher education practices. Yet the civil-military gap also disrupted associations’ capacity to implement veterans education policy including modes of operation among military- and veteran-serving agencies that hinder not only communication and Post-9/11 GI Bill benefit payment processing, but also realistic assessment and research on student veterans’ academic and social needs. The study proposes an action plan for research, policy and practice that higher education associations might use to attempt to bridge the civil-military gap in veterans education policy and enable veterans’ success in higher education