What Is Possible If We Focus on Where Healthcare Is Going Instead of Where Medicine Has Been.

As Canadian leaders of the world's largest virtual care organization, we bring a national and a global perspective to our response to Falk's (2022) paper on virtual care in Canada in this issue. With more than 20 years of experience enabling virtual care and more than 90 million people accessing our virtual care services and tools in more than 170 countries, across more than 600 health systems and more than 70 clinical use cases, we have already done or witnessed first-hand many of the changes that Falk anticipates Canadians will contend with as we expand channels to and modalities of care beyond the incumbent monochannel of in-person, physician-mediated service delivery. In this essay, we respond to Falk's (2022) paper in three ways: (1) we disagree with the definition of virtual care; (2) we agree with - and expand on - the analysis and ideas; and (3) we reveal two gaps in Falk's analysis that will or should be at the forefront of the Canadian discourse.

Targeting improved patient outcomes using innovative product listing agreements: a survey of Canadian and international key opinion leaders.

Objectives: To address the uncertainty associated with procuring pharmaceutical products, product listing agreements (PLAs) are increasingly being used to support responsible funding decisions in Canada and elsewhere. These agreements typically involve financial-based rebating initiatives or, less frequently, outcome-based contracts. A qualitative survey was conducted to improve the understanding of outcome-based and more innovative PLAs (IPLAs) based on input from Canadian and international key opinion leaders in the areas of drug manufacturing and reimbursement.

Application of personalized medicine to chronic disease: a feasibility assessment.

Personalized Medicine has the potential to improve health outcomes and reduce the cost of care; however its adoption has been slow in Canada. Bridgepoint Health is a complex continuous care provider striving to reduce the burden of polypharmacy in chronic patients. The main goal of the study was to explore the feasibility of utilizing personalized medicine in the treatment of chronic complex patients as a preliminary institutional health technology assessment.

Intracellular segregation of phosphatidylinositol-3,4,5-trisphosphate by insulin-dependent actin remodeling in L6 skeletal muscle cells.

Insulin stimulates glucose uptake by recruiting glucose transporter 4 (GLUT4) from an intracellular pool to the cell surface through a mechanism that is dependent on phosphatidylinositol (PI) 3-kinase (PI3-K) and cortical actin remodeling. Here we test the hypothesis that insulin-dependent actin filament remodeling determines the location of insulin signaling molecules. It has been shown previously that insulin treatment of L6 myotubes leads to a rapid rearrangement of actin filaments into submembrane structures where the p85 regulatory subunit of PI3-K and organelles containing GLUT4, VAMP2, and the insulin-regulated aminopeptidase (IRAP) colocalize.

Exercise- and insulin-stimulated muscle glucose transport: distinct mechanisms of regulation.

In mammals, skeletal muscle is the primary target for the stimulation of glucose transport by a variety of activators. These include the hormone insulin and stimuli which increase energy demand such as exercise, hypoxia, and challenges to the oxidative chain. While it is known that both stimuli rapidly elevate glucose uptake into muscle by signalling the translocation of glucose transporters from intracellular stores to the plasma membrane, there are numerous contrasts between energy stressors and insulin in their mechanisms of glucose transport activation.