No abstract

To control the spread of severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, many hospitals have strict visitor restriction policies. These policies often prohibit both parents from visiting at the same time or having grandparents or other family members visit at all. We discuss cases in which such policies created ethical dilemmas and possibly called for compassionate exceptions from the general rules.

Resilient infrastructure systems are essential for cities to withstand and rapidly recover from natural and human-induced disasters, yet electric power, transportation, and other infrastructures are highly vulnerable and interdependent. New approaches for characterizing the resilience of sets of infrastructure systems are urgently needed, at community and regional scales. This article develops a practical approach for analysts to characterize a community's infrastructure vulnerability and resilience in disasters. It addresses key challenges of incomplete incentives, partial information, and few opportunities for learning. The approach is demonstrated for Metro Vancouver, Canada, in the context of earthquake and flood risk. The methodological approach is practical and focuses on potential disruptions to infrastructure services. In spirit, it resembles probability elicitation with multiple experts; however, it elicits disruption and recovery over time, rather than uncertainties regarding system function at a given point in time. It develops information on regional infrastructure risk and engages infrastructure organizations in the process. Information sharing, iteration, and learning among the participants provide the basis for more informed estimates of infrastructure system robustness and recovery that incorporate the potential for interdependent failures after an extreme event. Results demonstrate the vital importance of cross-sectoral communication to develop shared understanding of regional infrastructure disruption in disasters. For Vancouver, specific results indicate that in a hypothetical M7.3 earthquake, virtually all infrastructures would suffer severe disruption of service in the immediate aftermath, with many experiencing moderate disruption two weeks afterward. Electric power, land transportation, and telecommunications are identified as core infrastructure sectors.

This paper addresses the dilemmas of participant sampling and recruitment for deliberative science policy projects. Results are drawn from a deliberative public event that was held in April and May, 2007. The research objective of The BC Biobank Deliberation was to assess deliberative democracy as an approach to legitimate policy advice from a subset of British Columbians concerning the secondary use of human tissues for prospective genomic and genetic research. The overall goal was to have participants identify key values that should guide a biobank in British Columbia. This paper assesses our team's group decision-making processes concerning participant sampling for the 2007 event. Results presented here should allow the reader to critically examine our team's choices and could also be used to assist advocates of deliberative democracy and others who may wish to propose similar events in the future.

Canada’s vast geography, and centralized delivery of cancer care and clinical trials create barriers for trial participation for patients in remote and rural settings. The development and implementation of a framework that enables safe and regulatory compliant trial participation through local healthcare providers would benefit Canadian patients, clinicians, trial sponsors and the health care system. To address this issue, representatives of Canada’s cancer clinical trial community met to identify key challenges and develop recommendations for remote patient participation in trials. A structured literature review identified remote/rural trial delivery models. A panel of expert stakeholders reviewed the models and participated in a workshop to assess health system readiness, identify needed processes, tools and mechanisms, and develop recommendations for a Canadian framework for decentralized clinical trial conduct. The Canadian Remote Access Framework for clinical Trials (CRAFT) represents a risk-based approach used by site investigators to delegate responsibilities for a given trial to satellite health centres within a hub-and-spoke “trial cluster”. The Framework includes specific recommendations to ensure research experience, capacity, regulatory compliance and patient safety. Canada’s cancer care and telemedicine systems can be leveraged to enable broader access to clinical trials for patients who are geographically remote from cancer centres. CRAFT’s risk-based framework is based on other successful models of remote trial patient management and is in the pilot implementation phase in Canada.