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IntroductionRecently, spatial differentiation has been considered as a subject of improvement for LCIA methods and their characterization models for local and regional impacts. It is generally recognized, depending on the goal and scope of the LCA study, that using region-specific and time-specific characterization factors in the case of impact categories such as acidification, eutrophication (aquatic and terrestrial), photochemical smog, toxicity, ecotoxicity and land-use might be useful (Pennington et al. 2004, Hauschild et al. 2003, Norris, 2003, Huijbregts et al. 2000. However, there is no worldwide consensus on which site-specific models should be used by stakeholders (Udo de Haes et al. 2002) and accounting spatial differentiation in LCIA remains complicated due to the lack of spatial distinction in most emissions and resource consumption inventory databases. Within the past 3 years, site-specificity in LCIA methods has increased significantly. No less than 4 methods have been released which include site-specificity in their characterization models at midpoint or damage levels (Table 1), but none of these methods can be applied to a Canadian geographical context without integrating a significant uncertainty.Despite what Young (2003) said could be termed as a rediscovery, Canada does not have characterization factors specific to its geographical context, thus far. The recent increase in LCA studies in Canadian industries and small and medium enterprises have placed the development of Canadian characterization factors at the forefront of LCA development in Canada. Most of the Canadian LCA studies published in the last 5 years use either generic characterization factors (Godin et al. 2004, Toffoletto et al. 2005 or simplified LCIA with only a quantification of emissions (Diamond et al. 1999). Stakeholders can also conduct LCIA in Canada using USEPA's TRACI method with US characterization factors. TRACI has the advantage of considering all North-American territory in some of its deposition models (Bare et al. 2003). Nevertheless, this still implies using site-specific factors that are not completely appropriate to the geographical context of the study. TRACI

Intensive care medical and nursing staff self-rate their communication skills as improved following attendance at the European Donor Hospital Education Programme (EDHEP) workshop. A prospective study was conducted to determine what impact EDHEP has on communication skills. Doctor-nurse pairs from 10 experimental and 10 control Intensive Care Units undertook two standardized simulated relative encounters (Breaking Bad News and Donation Request) at three measurement points (pre, post and follow-up). Nurses showed no change in communication skills. Experimental group doctors showed significant improvement in breaking bad news and requesting donation; most of these improvements were not maintained. Control group doctors showed some improvement in breaking bad news, indicating that participating in measurement by itself initiates some transient change in communication skills. Attendance at EDHEP does lead to significant improvement in some, but not all, communication skills essential in breaking bad news and requesting donation. Further research is necessary to determine what factors additional to EDHEP will contribute to enduring change in these particular skills.

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