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This article builds upon the concept of the trilateral networks of the triple-helix model in order to understand the role of organizations that operate in the spaces between institutions of higher education, industrial firms, and government agencies. Organizations situated in this interstitial space between public and private entities have been found to actively influence the formation of academy-industry-government relationships through the exchange of actors, resources, and commerce. These 'intermediating organizations' are often nonprofit organizations, including professional associations, foundations, consortia, independent research support organizations, and special interest groups. In this study a new conceptual model is proposed and illustrated through the use of examples of intermediating organizations in North America.

In response to the growing number of sustainability policies being enacted at higher education institutions, this article examines the relationship between policy and pedagogy, asking how policy texts can both enable and impede the implementation of sustainability pedagogy in higher education. To explore this question, we have undertaken a case study at the University of British Columbia, analyzing two campus-wide visionary policies that call for sustainability education: Trek 2010: A Global Journey and Inspirations and Aspirations: The Sustainability Strategy. We analyze these documents to show how the goals and strategies within them have the potential to affect the teaching and learning of sustainability across the university, directly and indirectly. Our analysis is coupled with a series of suggestions on how the policy process might be better executed in the future for more pedagogically effective sustainability policy. ; Dans un contexte d'augmentation significative des politiques de durabilité dans les institutions d'enseignement supérieur, cet article cherche à déterminer dans quelle mesure le contenu de ces politiques favorise ou nuit à la mise en oeuvre d'une pédagogie de la durabilité en milieu universitaire. En guise d'étude de cas, nous avons entrepris l'analyse de deux politiques de durabilité à l'Université de la Colombie-Britannique : « Trek 2010 : A Global Journey » et « Inspirations and Aspirations : The Sustainability Strategy ». Nous souhaitons démontrer comment les objectifs et les stratégies stipulés dans ce type de politiques peuvent influencer, directement ou indirectement, l'enseignement et l'apprentissage de la durabilité en milieu universitaire. Nous avons également inclus une série de suggestions visant à améliorer les processus d'élaboration des politiques de durabilité afin d'en assurer, à l'avenir, un meilleur arrimage au plan pédagogique.

Este trabajo compara la baja representación de las mujeres entre el personal académico de tiempo completo en México, Estados Unidos y Canadá, y resalta la importancia de definir políticas que atiendan esta problemática. Se basa en la encuesta internacional The Changing Academic Profession (CAP), aplicada durante 2007-08. La aplicación del cuestionario se basó en una muestra aleatoria de instituciones de educación superior y de académicos. La muestra quedó integrada por los siguientes académicos de tiempo completo 1,775 para México, 991 para los Estados Unidos y, 152 para Canadá. Las mujeres que están tratando de incorporarse o de permanecer en la carrera académica enfrentan barreras que se relacionan con aspectos socioculturales y estructurales y que en un momento dado conforman un techo de cristal. Se podría decir que las académicas que finalmente permanecen en la academia, no son sólo sobrevivientes del sistema educativo, sino que también se caracterizan como grupo demográfico-académico de manera distinta.

IntroductionPregnant women are often concerned about the impact of antidepressant medication use on their pregnancy, such as congenital abnormalities. This concern may vary in a way that depends on the class of antidepressant medication prescribed.
Objectives and ApproachThis study examined the rate of adherence and persistence to antidepressants based on the class of antidepressants prescribed during pregnancy This is a retrospective cohort study using population-based administrative data in Alberta– linking delivery record, hospitalization data, physician claims data, emergency department data, and prescription medication data. The eligible study population included women with depression who gave birth between 2012-2015, and were adherent (medication possession ratio ≥80%) to ≥ 2 consecutive antidepressant prescriptions during the preconception year (n=1,865). The rates of adherence and persistence (prescription refill gap ≤30 days) were calculated by medication class and were compared using chi-square tests.
ResultsDuring pregnancy, 834 (44.7%) women completely stopped taking antidepressants. Among those taking antidepressants, the overall rate of adherence was 62.6% (95% CI: 59.4%, 65.7%). The rate differed significantly by medication class (p<0.0001), with rate of 75.1% (95% CI: 68.3%, 80.9%) for serotonin-norepinephrine inhibitors, 60.9% (95% CI: 57.2%, 64.5%) for selective serotonin reuptake inhibitors, 42.9% (95% CI: 19.9%, 69.2%) for non-selective monoamine reuptake inhibitors, and 37.5% (95% CI: 22.4%, 55.4%) for the atypical antidepressants. Similarly, 40.7%, (95% CI: 37.5, 44.0) of women were persistent to antidepressants up to the full pregnancy period – similar to the adherence pattern, the rate differed significantly by medication class.
Conclusion/ImplicationsAdherence to and persistence in using antidepressants is low during pregnancy and it varies by medication class, possessing to the worsening of depression symptoms. This could be improved by conducting more research on drug safety during pregnancy and translating research evidence into treatment decision and correcting mothers' misperceptions towards antidepressants.

IntroductionMedical therapy to maintain disease remission is important in pregnant women with inflammatory bowel disease (IBD), as disease flares can predispose adverse materno-fetal outcomes. However, women with IBD are more concerned about medication exposure on their newborn during pregnancy, and often discontinue their medications.
Objectives and ApproachWe assessed the rate of disease flare on medication adherence pattern during pregnancy for women with IBD. Validated case definition was used to identify women with IBD from the Albertan's hospitalization, emergency room, and physician claims databases (2010-2016). Pharmaceutical Information Network provided the dispensed medications. Adherence to medication was defined by medical possession ratio (MPR)≥0.8. Women with two consecutive prescriptions and MPR≥0.8 during pre-conception were included. Disease flare was defined by ≥1 hospitalization or emergency visit for IBD, or ≥1 prescription for steroids/rectal therapy. Chi-square tests and log binomial regression were used; covariates included age, drug class, and IBD subtypes.
ResultsOf the 370 women identified with IBD, 170 (45.9%) women were adherent to maintenance IBD medications in the one year prior to pregnancy. During pregnancy, 47 (27.6%; 95% CI: 21.4% to 34.9%) women, who demonstrated adherence in the pre-conception period, discontinued or were not adherent to their IBD medications, and 67 (39.4%; 95% CI: 32.3% to 47.0%) women had a disease flare during pregnancy. There was no significant difference between adherence to medication during pregnancy and a disease flare during pregnancy (p=0.38). In comparing women who were not adherent or discontinued their medication to those that were adherent, the adjusted relative risk ratio for a disease flare during pregnancy was 1.22 (95% CI: 0.81 to 2.04).
Conclusion/ImplicationsThe rate of disease flare during pregnancy was not significantly different for women with IBD that were adherent or not-adherent to their IBD medications during pregnancy. Future analysis will assess the rate of disease flare on medication adherence pattern prior to pregnancy.

IntroductionVaccinating pregnant patients for neonatal protection needs to be integrated into prenatal care as new vaccines emerge. Uptake of influenza vaccine, universally recommended in pregnancy, is low. Immunization was offered and administered to pregnant women at point of care (POC) during two flu seasons at an urban tertiary care center.
Objectives and ApproachPrimary objective is to determine if POC impacts immunization rate during flu season among a cohort of pregnant women by location and gestational age. Secondary objectives are to examine the pattern of influenza-like illnesses (ILI) among vaccinated and unvaccinated women, and to describe pilot outcomes of POC. Four consecutive influenza seasons (2014/2015, 2015/2016, 2016/2017, 2017/2018) will be examined using seven databases: a) Clinibase, b) National Ambulatory Care Reporting System; C) Discharge Abstract Database; d) Physician Claims; e) Alberta Perinatal Health Program; f) Calgary Zone Public Health; and g) Pharmaceutical Information Network. Outcomes will be examined descriptively using frequencies and proportions.
ResultsBased on the preliminary analysis, approximately 10, 000 visits among 2,500 women occurred during each flu season at the four obstetric care locations: two outpatient clinics and two inpatient units. The proportion of pregnant women who received the flu vaccine ranged from 15-21% during the first three flu seasons. Majority of the women received the vaccine at the flu campaigns (range 48-67%), followed by pharmacy (20-32%). For the 2017-2018 season, year to date uptake rates in outpatient clinics are significantly higher. Final results on additional outcomes will be available by September 2018.
Conclusion/ImplicationsIn completing this study, we hope to better understand the patterns of immunization uptake in pregnancy by place of immunization and gestational age, i.e. identifying optimal "window of opportunity". Results will inform the infrastructure needed to collect data on vaccines administered during pregnancy and linkage to maternal and infant outcomes.

BackgroundExisting association between mental disorders and suicidality is mostly based on cross- sectional studies, using clinical samples.
Objective and methodsWe examined the patterns of association between mental disorders and subsequent suicide in a representative sample of the Canadian household population. This is a retrospective cohort study that used data from the Canadian Community Health Survey 2002 linked to the Death Database 2000-2011 and the Hospitalization Database 1999/2000-2012/2013) (N=27,000). Mental disorders (past-year major depressive episodes (MDE), bipolar disorders (BPD), anxiety disorders (AD), and substance-dependent (SD)) were diagnosed in the survey data using the Composite International Diagnostic Interview. Subsequent suicide events (deaths/hospitalizations for suicide attempts) were identified using ICD-10-CA codes. Time-to-event data were analyzed using competing-risk regression models, adjusting for age, sex, marital status, and educational attainment. Due to the violation of the proportional hazard assumption, the models were stratified into two strata. Sampling weights were used to ensure representation of the target population.
ResultsOf 27,000 respondents, mental disorders were diagnosed in 15.0% respondents and 0.4% had suicide events. Each mental disorder was significantly associated with an increased risk of suicide. The strength of association between mental disorder and suicide weakened over-time for MDE, SD, but not for BPD and AD. For example, using the time-to-event cut-off 4-year, the hazard ratio (HR) for MDE was 6.02 (95% CI=2.65,13.68) in the first 4-year, whereas, it was 2.03 (95% CI=0.91,4.53) after 4-year. The HRs of suicide for BPD were 16.95 (95% CI=6.88,41.75) and 15.81 (95% CI=5.89,42.45) before and after 4-year.
Conclusions/ImplicationsFindings reflect improvement of suicide-risk over-time for people with MDE and SA and the persisting risk for people with BPD and AD. Our findings underscore the importance of early management of mental disorders for effective suicide prevention, and requirement of longer-term follow-up for people with BPD and AD.

This article is concerned with the differences in REB policy and application processes across Canada as they impact multi-jurisdictional, higher education research projects that collect data at universities themselves. Despite the guiding principles of the Tri-Council Policy Statement 2 (TCPS2) there is significant variation among the practices of Research Ethics Boards (REBs) at Canada's universities, particularly when they respond to requests from researchers outside their own institution. The data for this paper were gathered through a review of research ethics applications at 69 universities across Canada. The findings suggest REBs use a range of different application systems and require different revisions and types of oversight for researchers who are not employed at their institution. This paper recommends further harmonization between REBs across the country and national-level dialogue on TCPS2 interpretations. ; Cet article étudie les différences entre politiques institutionnelles en matière d'éthique à la recherche et les procédures d'évaluation qui encadrent les travaux des comités d'éthique à la recherche (CER), en particulier lorsqu'il s'agit de projets de recherche en sciences sociales menés dans des universités de différentes provinces. Malgré l'adhésion générale aux principes directeurs du deuxième Énoncé de politique des trois Conseils (EPTC2), les pratiques des CER diffèrent, en particulier lorsqu'il s'agit de répondre à des chercheurs issus d'autres universités. Cette étude s'appuie sur une analyse des demandes d'évaluation soumises aux CER de 69 universités canadiennes. Les résultats suggèrent que les CER utilisent différents mécanismes de dépôt, exigent différents niveaux de révision et supervisent différemment les études dirigées par des chercheurs d'autres établissements. Cet article recommande une plus grande harmonisation des procédures des CER canadiens.

IntroductionPreterm birth (birth <37 weeks of gestation) is common. While the clinical conditions leading to preterm birth are heterogeneous, most studies examining the short- and long-term consequences of preterm birth on child health and development, only consider the gestational age at delivery, and not the underlying mechanism of preterm birth.
Objectives and ApproachMaternal hospitalization and perinatal data for deliveries occurring in Alberta, Canada in 2004, 2009, and 2014 were linked to identify underlying mechanisms for delivery (i.e., infection/inflammation (I/I), placental dysfunction (PD), both, or neither). Linked hospitalization, emergency department, and physician claims data were used to assess child health outcomes up to age 10. Chi-square tests were used to assess differences in the absolute rate of each outcome stratified by gestational age at delivery and underlying mechanism for delivery. Logistic regression was used to assess relative differences following adjustment for confounders compared to term infants without exposure to I/I or PD.
ResultsA total of 134,424 children were included in the analysis. For preterm births occurring <32 weeks of gestation, no differences were observed in child health outcomes based on the underlying mechanism of preterm birth. However, infants born at 32-33 weeks following PD compared to I/I had significantly higher odds (PD:69.1%, OR=29.7, 95% CI:25.7-34.2 vs. I/I:47.2%, OR=18.7, 95% CI:16.8-20.9) of neonatal morbidity; while those born at 34-36 weeks had increased odds of neonatal morbidity (PD:21.1%, OR=5.1, 95% CI: 4.7-5.5 vs. I/I:16.2%, OR=3.7, 95% CI:3.4-3.9) and developmental disabilities (PD:3.3%, OR=2.2, 95% CI:1.8-2.6 vs. I/I:1.6%, OR=1.7, 95% CI:1.4-2.0). No differences were observed in mortality by sub-type of preterm birth; however, as expected perinatal mortality rates were significantly more common in preterm than term births.
Conclusion/ImplicationsBoth the short- and long-term outcomes of preterm birth differ by the underlying mechanism leading to preterm delivery. Having a clearer prognosis for infants born preterm may promote the use of clinical interventions earlier for children at increased risk, leading to improved child health and development.

Data pooling from pre-existing multiple datasets can be useful to increase study sample size and statistical power to answer a research question. However, individual datasets may contain variables that measure the same construct differently, posing challenges for data pooling. Variable harmonization, an approach that can generate comparable datasets from heterogeneous sources, can address this issue in some circumstances. As an illustrative example, this paper describes the data harmonization strategies that helped generate comparable datasets across two Canadian pregnancy cohort studies– the All Our Families and the Alberta Pregnancy Outcomes and Nutrition.
Variables were harmonized considering multiple features across the datasets: the construct measured; question asked/response options; the measurement scale used; the frequency of measurement; timing of measurement, and the data structure. Completely matching, partially matching, and completely un-matching variables across the datasets were determined based on these features. Variables that were an exact match were pooled as is. Partially matching variables were synchronized across the datasets considering the frequency of measurement, the timing of measurement, and response options. Variables that were completely unmatching could not be harmonized into a single variable.
The variable harmonization strategies that were used to generate comparable cohort datasets for data pooling are applicable to other data sources. Future studies may employ or evaluate these strategies. Variable harmonization and pooling provide an opportunity to increase study power and the utility of existing data, permitting researchers to answer novel research questions in a statistically efficient, timely, and cost-efficient manner that could not be achieved using a single data source.