Examining an Alternate Care Pathway for Mental Health and Addiction Prehospital Emergencies in Ontario, Canada: A Critical Analysis.

Paramedics in Ontario have largely been limited to transporting those with mental health or addiction (MHA)-related emergencies to the emergency department (ED). The ED has repeatedly been identified as a problematic and challenging setting for people with MHA needs. This article examines an innovative patient care model (PCM) established by the Middlesex-London Paramedic Service and its partners for specific MHA emergencies where patients were given options for care that included transportation to a Canadian Mental Health Association (CMHA) Crisis Centre or information for support. Qualitative and quantitative data that were utilized for regular reporting to the Ministry were included in the analysis. The findings indicated that the goals of reducing pressures on EDs and paramedic services, enhancing paramedics' ability to address MHA calls, and improving patient care experiences were met. This model improves patient autonomy and options for care, improves the means for addressing patients' social determinants of health, and offers transportation to a non-medicalized facility.

'Both Sides of the Argument'? A critical review of existing evidence on the illicit trade in tobacco products in Canada.

INTRODUCTION: The illicit trade in tobacco products (ITTP) is widely recognised as a substantial and complex problem in Canada. However, the independence of available data and quality of analyses remains unknown. Reliable and accurate data on the scale and causes of the problem are needed to inform effective policy responses. METHODS: We searched the scholarly and grey literature using keywords related to ITTP in Canada. We identified 26 studies published in English since 2008 that present original research drawing on primary data. We analysed these studies for their independence from the tobacco industry, methodology, findings and gaps in knowledge. RESULTS: The study finds 42% of the literature reviewed has links to the tobacco industry. These studies provide insufficient methodological detail, present higher estimates of the volume of ITTP and attribute the causes to higher rates of tobacco taxation. The classification of all indigenous tobacco sales as illicit, by both industry linked and independent studies, contributes to overestimates and serves the interests of transnational tobacco companies. There is need for independent and comprehensive data on the ITTP in Canada over time, across population groups and geographies. CONCLUSION: While there is evidence that the ITTP in Canada is a major and complex issue that requires effective tobacco control policies, there is a limited evidence base on which to develop such responses. This review finds industry-linked studies lack independence, employ biased methodologies and serve tobacco industry interests. Independent studies present more rigorous approaches, but primarily focus on youth and the province of Ontario.

Death and Taxes: The framing of the causes and policy responses to the illicit tobacco trade in Canadian newspapers.

The illicit tobacco trade accounts for 10% of the global cigarette market and results in US$31 billion in lost tax revenues annually. Despite legal prosecution of tobacco companies, and the introduction of new policy responses, the trade has reached an all-time high. Previous research documents how transnational tobacco companies have sought to influence government responses to the illicit trade in various countries through multiple means, including influencing of news media framing. This paper extends this analysis to Canada where the illicit trade is particularly problematic in scale and political complexity. Articles in Canadian newspapers, published from 2010-2015, were systematically searched (n=177) and analyzed to identify dominant frames, frame sponsors and policy positions related to the illicit tobacco trade. The results show that the most common frames present the issue in ways favourable to the industry. The most common non-governmental sponsors of these frames frequently have links to the tobacco industry, which are rarely disclosed. Findings indicate the need for Canadian media to be critical in its use of data sources amid industry efforts to shape public policy, and the importance of reframing policy discussions in public health terms based on independent evidence.

The atlas network: a "strategic ally" of the tobacco industry.

Amid growing academic and policy interest in the influence of think tanks in public policy processes, this article demonstrates the extent of tobacco industry partnerships with think tanks in the USA, and analyzes how collaborating with a network of think tanks facilitated tobacco industry influence in public health policy. Through analysis of documents from tobacco companies and think tanks, we demonstrate that the Atlas Economic Research Foundation, a network of 449 free market think tanks, acted as a strategic ally to the tobacco industry throughout the 1990s. Atlas headquarters, while receiving donations from the industry, also channeled funding from tobacco corporations to think tank actors to produce publications supportive of industry positions. Thirty-seven per cent of Atlas partner think tanks in the USA received funding from the tobacco industry; the majority of which were also listed as collaborators on public relations strategies or as allies in countering tobacco control efforts. By funding multiple think tanks, within a shared network, the industry was able to generate a conversation among independent policy experts, which reflected its position in tobacco control debates. This demonstrates a coherent strategy by the tobacco industry to work with Atlas to influence public health policies from multiple directions. There is a need for critical analysis of the influence of think tanks in tobacco control and other health policy sectors, as well as greater transparency of their funding and other links to vested interests. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

'Public enemy no. 1': Tobacco industry funding for the AIDS response.

This article analyzes the history of tobacco industry funding for the AIDS response - a largely ignored aspect of private donor involvement. Primary documents from the Legacy Tobacco Documents Library and AIDS organizations are analyzed, alongside existing literature on the tobacco control and AIDS responses. Research on the tactics of transnational tobacco companies has documented how they have used various charitable causes to subvert tobacco control efforts and influence public health policy. This raises questions, which this paper seeks to answer, about if donations by tobacco companies to AIDS organizations have been used for similar means, and if so how AIDS organizations have responded to tobacco industry overtures. Two examples illustrate how tobacco companies initially tried to use the AIDS response to counter tobacco control measures: (1) During the 1990s, Philip Morris, one of the largest corporate donors of the AIDS response in the USA, used its connections with AIDS organizations to create competition for health resources, improve its reputation, and market tobacco products to the LGBT community; (2) In both Latin America and sub-Saharan Africa, Philip Morris and British American Tobacco championed the AIDS response in order to delegitimize efforts to develop the World Health Organization's Framework Convention on Tobacco Control. However, from the late 1990s onwards, AIDS organizations began to refuse tobacco funding and partnerships - though these policies have been not comprehensive, as many tobacco companies still fund programs in sub-Saharan Africa. The article concludes that tobacco companies aimed to exploit competition between health issues, and use the high-profile AIDS response to improve their reputation and market access. However, AIDS organizations, adhering to broader health goals and drawing on extensive resources and networks, were able to shut the tobacco industry out of much of the response, though pockets of influence still exist. This demonstrates the importance of co-operation and policy convergence across health sectors and suggests that tobacco control advocates, and other charitable sectors that receive funding from the tobacco industry, may be able to draw lessons from the experiences of AIDS organizations.

Metabolic engineering of Aspergillus oryzae NRRL 3488 for increased production of L-malic acid.

Malic acid, a petroleum-derived C4-dicarboxylic acid that is used in the food and beverage industries, is also produced by a number of microorganisms that follow a variety of metabolic routes. Several members of the genus Aspergillus utilize a two-step cytosolic pathway from pyruvate to malate known as the reductive tricarboxylic acid (rTCA) pathway. This simple and efficient pathway has a maximum theoretical yield of 2 mol malate/mol glucose when the starting pyruvate originates from glycolysis. Production of malic acid by Aspergillus oryzae NRRL 3488 was first improved by overexpression of a native C4-dicarboxylate transporter, leading to a greater than twofold increase in the rate of malate production. Overexpression of the native cytosolic alleles of pyruvate carboxylase and malate dehydrogenase, comprising the rTCA pathway, in conjunction with the transporter resulted in an additional 27 % increase in malate production rate. A strain overexpressing all three genes achieved a malate titer of 154 g/L in 164 h, corresponding to a production rate of 0.94 g/L/h, with an associated yield on glucose of 1.38 mol/mol (69 % of the theoretical maximum). This rate of malate production is the highest reported for any microbial system.