It took nearly two thousand years for society to recognize the Hippocratic insistence that “the doctor knows best”1 was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.2

Lakes in the semiarid Southern Interior Plateau of British Columbia, Canada are vulnerable to future climate-driven changes in water quantity and quality. However, few long-term monitoring records exist to assess the effects of varying hydroclimate conditions on lake function. We present a high-resolution multiproxy paleolimnological record containing subfossil diatoms, μXRF via ITRAX, and chlorophyll-a that spans the past 1800 years from Roche Lake in south-central British Columbia. Generalized additive models indicate that the diatom assemblages were associated with changes in lake level and the accompanying effects of atmospheric forcing on lake thermal structure, and that these forcing mechanisms had a weak relationship with primary production. We infer two pronounced arid periods between ca. AD 600–950 and ca. AD 1730–1950 that correspond to evidence of reduced lake mixing and enhanced anoxia, but variable patterns in primary production. Synthesis of regional proxy records suggests that inferences of moist but possibly warm conditions during the Medieval Climate Anomaly may have occurred because of a complex interaction between prolonged La Niña-like conditions and higher radiative forcing. Overall, lakes in this region are sensitive to changes in hydroclimate generated by interactions between external forcing and Pacific Ocean–atmosphere processes, and the resulting changes in aridity may have potentially negative consequences on salmonid habitat.

Pollen and diatom assemblages from well-dated sediment cores from three lakes forming a west-to-east transect across the boreal forest in northwest Ontario (Canada) were used to evaluate the timing and nature of the movement of the prairie–forest ecotone (PFE) across the Holocene. Changes in vegetation, temperature, and effective moisture were inferred from pollen and pollen-based transfer functions. Analyses indicated site-specific vegetational and climate changes across short spatial distances, with prolonged prairie-like conditions during the middle Holocene at the westernmost site. Increased reconstructed temperatures at this westernmost site occurred from ~9000 to 3000 cal yr BP, alongside increases in diatom-inferred lake levels beginning at ~6000 cal yr BP. The abundance of Quercus peaked concurrently with rising lake levels before declining to trace levels by ~3000 cal yr BP. Increases in the abundance of non-arboreal pollen between ~8500 and ~4500 cal yr BP at the more eastern lakes suggest relatively delayed and truncated PFE influence, before the reestablishment of primarily boreal taxa by ~4500 cal yr BP, coincident with diatom-inferred increases in lake levels. This study shows that the PFE moved both farther east and north than previously determined, but generally agrees with established patterns in vegetation from other studied regions along the PFE.

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.