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Éric Boutilier is a bilingual photo journalist, freelance columnist and television producer in Northern Ontario... he is also an advocate for improving rail service in Northern Ontario. Éric and I have a conversation about the challenges facing not just small towns, but the very network that once stitched our country together.
As an artist, she's always been a bit of a shapeshifter. Over the course of her wildly diverse career, she's touched on numerous different genres, been signed to a series of major record labels, and made music under several monikers. Her journey has taken her from a tiny community on Nova Scotia's Cape Breton Island, to the bright lights of Los Angeles at age 20, to the City of Light – Paris, France. Her latest work sees her returning to Canada, coming back to her musical roots in many, taking ownership of her art and her story, and reverting to her real nickname and surname, Goldie Boutilier. We were lucky enough to catch up with Goldie during a breathless 2024 tour which saw her paired up for a run of dates across the continent with Orville Peck. And this autumn sees her rolling back through these parts – this time on her debut North American headlining tour, to celebrate the release of her brilliant new album, out September 27th – The Actress. Her latest music is inspired by some of the music she grew up hearing – ranging from Tammy Wynnette to Fleetwood Mac, Alison Krauss to the Twin Peaks soundtrack. The songs are informed by the transformations and heartbreaks she's undergone over the years and by her profoundly disturbing real-life experience -- living out the youthful dream of signing a major label deal and moving to L.A. As we'll hear, show business can be a cold, cruel, predatory enterprise; one that many artists only triumph over by reclaiming their narrative and artistic selves, on their own terms. That's what Goldie has done in her recent evolution, beginning with her arresting 2022 EP Cowboy Gangster Politician, carrying on through 2023's Emerald Year, and now The Actress. If Goldie's wild career arc were a Hollywood screenplay, it might seem a little too far-fetched to be believable. But, as Goldie sings on the title track to her new EP: "I am the actress, and you're in my movie." Host: Grant Stovel | Producer: Scott Zielsdorf | Graphics: Craig Taffs | Music: Doug Hoyer Mixing for this session provided by Brendan Cross.
I'm back in Chicago for Lollapalooza!! This gigantic music festival took place August 1-4 right out my front door in Chicago's Grant Park. I'm totally psyched to bring you loads of interviews with some of the music industry's biggest talents. This first part of the four-part series of in-person interviews kicks off with the wonderful and talented Goldie Boutilier. Goldie is no stranger to success and has had several career incarnations along the way, giving her a unique perspective — and she wants to share that knowledge and excitement with younger artists!! Goldie is a believer in the power of manifestation — and I'm all about that!Grant Perez, who performs under the name grentperez, began as a YouTube star as a kid… fast forward 5-6 years when Grant wins the 2024 ARIA award for Emerging Songwriter of the Year!! Grant's energy and enthusiasm is super infectious and his humble vibe is super refreshing.The National Parks has been following their bliss and using nature as a muse since they all first met in Provo, Utah over a decade ago. Their commitment to the outdoors is as evident in the music as it is in their chosen band name, and they have built a massive following with their Pop Folk/Americana vibe.To round out this Part 1 episode is LA-based Cale Tyson, whose Pop Folk vibe is infused with humor and authenticity. Leaving Nashville and the Traditional Country route behind, Cale set out for the Wild West of Los Angeles to carve out a new chapter in his multi-varied career. Cale is a chill dude with a great sense of humor — he's the perfect Roadcase guest!!
We remember the life of Guy Boutilier on a Friday edition of Fort McMurray Matters. We chat with Sheldon Germain who worked closely with Guy throughout his time in politics. We also chat with Curtis Phillips, who followed Guy's passion for local sports in the Fort McMurray Wood Buffalo region.
Game recognizes game . and in this episode were joined by one of the coolest people to come out of cape breton ,, Goldie Boutilier . She's a fuckin legend . no legit, look her up on instagram @yunggoldilox . I can't believe we grew up in the same place. anyway as perrrrr usual, WATCH this podcast at www.swearnet.com For everything Tracy & Martina related, go to www.tracyandmartina.com and don't forget to come see us in Alberta! Tour dates and tickets are on our website :-)
So, occasionally on the podcast, I speak directly to the series director of the Apple TV+ series "The Snoopy Show" Rob Boutilier. And it turns out he was listening. And he said he'd be happy to come on the podcast. And he did! On this very episode! Episode 98! And I do my best to make him not regret that! Listen and see if I pulled it off. We've also got This Month in Peanuts History an an episode of "Peanuts by Schulz" called "Nobody Likes Me". Thanks to Rob Boutilier! Thanks to Kevin McLeod at Incompetech.com for creative commons use of his songs "Mining by Moonlight", "Bass Walker" and "Hidden Agenda". Thanks to Sean Courtney for the "This Month in Peanuts History" theme. Thanks to Nick Jones for the use of his song "25% Off". Thanks to Henry Pope for the use of his "Linus & Lucy" remix. Support the show at patreon.com here. carnivalofgleecreations.com
In episode #225, we welcome two-time presenter at TCS Live, Paul Boutilier. He has worn a lot of hats during his career, but currently works as a Defenceman Specialist, consulting with approximately 40 defenceman, several of whom are current NHL super stars through his company, the 44 Second group. As you'll find out in this episode, you'll be hard-pressed to find someone who has thought as much about playing defence as Paul has. Listen as shares his methods for improving a Dman's posture, why the funnel approach to defending should be flipped, and the importance of helping players understand concepts by writing it down.
Week 1 of Unholy Month kicks off as clown expert Wesley Boutilier returns to help us stomach the incredibly saccharine and equally preachy Christian clown video about (checks notes) obedience, Gingerbrook Fare! --- https://linktr.ee/ChannelKRTPodcast Edited by Jacob Miller Show logo by Marissa Thorburn: https://twitter.com/KermitWaz0wski Show theme by Andy HG and Tyler Green
Chase and Timothy talk with Mark Boutilier about his style history, how fashion can be a form of entertainment, and how he uses strong opinions to start conversations. Follow: Mark Boutilier on TikTok, Instagram, & YouTube @mark_boutilier Customer Service Podcast on Instagram @customerservicepod Canoe Club on Instagram & YouTube @shopcanoeclub www.shopcanoeclub.com
Greg and Sheba react to the Election results (:38). Jessica Bell, NDP for University-Rosedale (10:00). Global news Alex Boutilier & Sean O'Shea give their thoughts to the Election ( 19:16) and Dave Woodard takes a look at Andrea Horwath's future (28;19) See omnystudio.com/listener for privacy information.
Greg and Sheba react to the Election results (:38). Jessica Bell, NDP for University-Rosedale (10:00). Global news Alex Boutilier & Sean O'Shea give their thoughts to the Election ( 19:16) and Dave Woodard takes a look at Andrea Horwath's future (28;19)
In the third episode of our Candid Career Conversations series, ASUG Talks sits down with Allison Boutilier, project delivery manager at Marine Atlantic. She talks about her path to IT, her experiences working in the male-dominated IT field, and her work at Marine Atlantic.
On our new weekly lightning round mini ep with Mark Boutilier, we're fucking around with NFTs, Goku drinking lean print on demand tees, novelty boxing, working a 9 to 5, grail jawnz, hitting 50k on IG, rebooting your wardrobe, Carti posing, watermarks, sneaker saran wrap, losing all your followers, Yeezys and much more. For more Throwing Fits, check us out on Patreon: www.patreon.com/throwingfits.
The future is now old men! This week, the boys are playing host to the next generation via one of their favorite sons, content creator Mark Boutilier. Mark came all the way to NYC to debrief us on an honest assessment of our TikTok, olds being cringe, Gen Z trend forecasting, disrupting the men's style digital landscape, bubbling brands, viral videos, content performance, screen time, creating content full-time, dream gigs and collaborations, grail jawnz, stylish celebs, style FAQs, hacking the algorithm, being a big fish in a small pond back home in Atlanta, the relevance of NYFW, how a young jawnz enthusiast can land a girlfriend, sponcon bags and much more on this boyishly charming episode of The Only Podcast That Matters™. For more Throwing Fits, check us out on Patreon: www.patreon.com/throwingfits. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Interview episodes are back!! To kick off the first interview of 2022 I invited Mark Boutilier. For those who don't know Mark he creates content on the three major social media platforms: YouTube, Tik Tok, and Instagram and has amassed over 100,000 accumulate followers. In this episode we break down his life, his content, and his journey.(www.edwardjoiner.com)Mark's IG: https://www.instagram.com/mark_boutilier/Mark's Tik Tok: https://www.instagram.com/mark_boutilier/Mark's YouTube: https://www.youtube.com/channel/UCm0_QSKFCVex1bXrzbVokUA
On this edition of the UNH WildCast Powered by Unitil, hear from SAAC co-presidents Faith Bonett and Ava Boutilier along with a bonus talk with women's soccer coach Steve Welham.
We're back with another Patreon classic! This week, Mark Boutilier returns to the pod to talk everything from what he's been up to, to heading out to NYC for NYFW. Thanks so much to Mark for joining us, and thank you everyone for listening! Subscribe to the Patreon for more!
Buffy MacNeil Boutilier is the Mi'Kmaw Education teacher at East Antigonish Education Centre. She has seen first hand the intergenerational trauma of the residential schools. Which is why earlier this year she decided to use music to start a dialogue. She wrote a song called "Somebody Pray" and she says it is a call for healing. Buffy explains how her song is rooted in her own identity and in those who inspired her.
Dr. Brian Goldman celebrates an unsung hero of the pandemic: Maria Boutilier, a housekeeper in the ER at the Halifax Infirmary Hospital. Dr. Sam Campbell is a doctor in the ER. He's amazed at what Maria accomplishes all in day's work.
On this week's episode of Conservative Roundup, Aidan is proud to be joined by fellow media host Rob Boutilier of the popular social media page, Patriotic Dad. Today Aidan and Rob discuss the current political landscape, the oil and gas sector, and Western politics
Rugrats is back! Hold on to your diapies and grab a snack for this absolute treat of an episode with the executive producers of Rugrats! The iconic Nickelodeon show is back and ready for a whole new generation! We cover what's changed, what hasn't, and what's in store for the future (no spoilers!). This is a nostalgia bomb of epic proportions and a total love-fest. Enjoy!
Eryk Casemiro and Kate Boutilier are the executive producers of the new CG animated Rugrats reboot series. It premieres this Thursday May 27th on Paramount+. Casemiro and Boutilier are excited to return to this franchise - and hope fans do the same. They also talk about how they want to appeal to a new generation and why these characters have a lasting impact.
Today’s Missing Monday/Tuesday episode is about the disappearance of two marines from a base in Millington, TN. The first disappearance occurred in June of 1978 when Gary Boutilier went for a ride on his motorcycle and never returned. The second disappearance occurred in December of 1988 when Kevin Raney visited his unidentified girlfriend’s home. When he arrived her boyfriend (yes, you read that correctly) was there and invited Kevin inside......he hasn’t been seen since. For a list of our sources, please click here. Don't forget to like us, love us, share us, and review us on Apple podcasts and/or all other platforms of your choosing. Follow us on all the platforms below:Facebook: https://www.facebook.com/eerieabsurd/Instagram: https://www.instagram.com/eerie_absurd/and a barely used Twitter: https://twitter.com/eerie_absurd
In this episode, The Digital Cowboy has invited Mark Boutilier to discuss his rise to internet fame, shorts, the upcoming trends, and much more.
In this special April Fools Day episode, we're joined by our pal Wesley Boutlier (Viewist, @ET_nocontext) for a deep dive into the amazing LGBT-friendly children's show about clowns running a TV studio that you've never heard of! We also discuss Mr. Bill's clown status, mediocre dog puppets, and even throw in some E.T talk! --- https://linktr.ee/ChannelKRTPodcast Edited by Tyler Green Wesley's video on Clown TV: https://youtu.be/kGwufNGf8W0 Wesley on Twitter: https://twitter.com/WesleyBout Show logo by Marissa Thorburn: https://twitter.com/KermitWaz0wski Show theme by Your Friend Jebb: https://www.facebook.com/YourFriendJebb/
Season 2 Episode 05 Sheldon Clare and Jordan Vandenhoff chat with Rob Boutilier Support the show (https://www.paypal.com/donate?hosted_button_id=8VYNVH8ABZK88)
In this episode of the UNH WildCast Powered by Unitil, host Mike Murphy talks with senior Football player Evan Horn on his return to the Wildcats, plus Women's Hockey goalie/captain/SAAC co-president Ava Boutilier discusses her hectic and rewarding experience as a student-athlete. Plus, Women's Gymnastics coach Lindsey Bruck Ayotte previews the start of the season, and Associate Athletic Director for Business Development Taylor McCarthy explains how fans can stay involved in a socially distant way through the virtual memberships and 'Cat Cutouts.Cat Cutoutshttps://learnforlife.unh.edu/portal/events/reg/participantTypeSelection.do?method=load&entityId=151443538Virtual Membershipshttps://unhwildcats.com/sports/2020/12/12/VirtualMemberships.aspx
Season 3 has almost come to an end, but we've still got a couple of excellent episodes in the pipeline! Starting those off is a guest appearance by fashion TikTok legend Mark Boutilier! Listen in as we talk with Mark about everything from his start on TikTok itself to how he found his legendary Purdue summer camp tee. Thank you so much to Mark for joining us, and thank you everyone for listening!
Today on Human First Podcast (@humanfirst.podcast), Alia is joined by Vanessa Boutilier. At the age of 21, Vanessa experienced a mental disruption that admitted her into the psychiatric ward. Upon her admittance, Vanessa was diagnosed with schizophrenia (now revised to schizoaffective bipolar disorder), a diagnosis that is now very much intertwined into her life. On this episode, Vanessa walks us through her experience with schizophrenia, and how with support, self-love and a strong will to live, has enabled her to live a rich and meaningful life.
In our first episode, we will be a conversation with Brother and Sister Genealogis Team Lynda Villanova Gleason and Larry Villanova from Connecticut as they discuss their mother's life in an Orphanage in Halifax in the 1930's - Forty's and how her memories of Halifax and her love for the Church that ran the Orphanage she was placed in 1939. In 2019 this lead them to visit Nova Scotia in search of How They Got Here and how they discovered how her Love for that Church was a connection built almost 2 centuries earlier in her family history. Places Mentioned in This Episode Nova Scotia Halifax: St. Pauls Church, St Paul's Home for Girls Tower Rd. Public Gardens Lunenburg: St. John's Anglican Church Mill Village Port Medway Surnames Mentioned in This Episode Rafuse, Moreau, Miller, Boutilier, Villanova, Gleason People of Historical Significance Mentioned in This Episode Rev. Jean-Baptiste Moreau George VI Queen Elizabeth “Queen Mother” Resources Mentioned in This Episode: South Shore Genealogical Society, Nova Scotia Archives, Halifax Library, Newspapers, Ancestry and Ancestry DNA Music: TRIBUTE TO O'CAROLAN by Luna Bujalesky Licensed under Creative Commons BY Attribution 4.0 License Upcoming Episodes Dec 9, 2020 - A Purpose for Everything Importance of Setting Goals and Objectives Dec 23, 2020 - Holiday Show Holiday Traditions / Memories - Gift Ideas for the Genealogist in Your Family Jan 6, 2021 - New Years What are your Family History Resolutions --- Send in a voice message: https://podcasters.spotify.com/pod/show/how-we-got-here/message
Jordan Vandenhoff chats with Rob Boutilier PatrioticDadNAS Guns and Ammo N.A.S. Guns and Ammo 8B-1874 Highway 20 Road East Fonthill, ON L0S 1E6 T (905) 370-0200Support the show (https://www.paypal.com/donate?hosted_button_id=8VYNVH8ABZK88)
Today's episode celebrates all things Zayde Wisdom! We're thrilled to bring Marcus Boutilier from The Hockey Writers, who has covered the Kingston Frontenacs, Zayde's OHL team. We talk about his development, what he could bring to the Flyers lineup, and get a few behind the scenes stories about Zayde on and off the ice!SHOW NOTES:Follow us @LockedonFlyersFlyers Get Wisdom From the Kingston Frontenacs by Marcus BoutilierDucks & Golden Knights Reverse Retro JerseysFlyers Fun Thing: Carter HartoweenSupport Us By Supporting Our Sponsors! Rock AutoAmazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you.Built BarBuilt Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKEDON,” and you'll get 20% off your next order.BuiltGoVisit BuiltGO.com and use promo code “LOCKED,” and you'll get 20% off your next order. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Today's episode celebrates all things Zayde Wisdom! We're thrilled to bring Marcus Boutilier from The Hockey Writers, who has covered the Kingston Frontenacs, Zayde's OHL team. We talk about his development, what he could bring to the Flyers lineup, and get a few behind the scenes stories about Zayde on and off the ice! SHOW NOTES: Follow us @LockedonFlyersFlyers Get Wisdom From the Kingston Frontenacs by Marcus Boutilier Ducks & Golden Knights Reverse Retro Jerseys Flyers Fun Thing: Carter Hartoween Support Us By Supporting Our Sponsors! Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKEDON,” and you’ll get 20% off your next order. BuiltGo Visit BuiltGO.com and use promo code “LOCKED,” and you’ll get 20% off your next order. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Episode 69 of the #MindVine Podcast features news, views and interviews related to #mental health, #mental illness and #recovery. In this episode we're talking with Rachel Boutilier, one of the participants in our fundraising and awareness campaign, Protecting Minds (www.protectingminds.ca). This #MindVine podcast is hosted by Darryl Mathers (@DarrylMathers).
Dr. Larry Hopperton interviews Dr. Matthew Boutilier concerning his FOLD chapter on Engaging Adult Learners (October 4, 2020)
Dr. Larry Hopperton interviews Dr. Matthew Boutilier concerning his FOLD chapter on Engaging Adult Learners (October 4, 2020)
Dr. Larry Hopperton interviews Dr. Matthew Boutilier concerning his FOLD chapter on Engaging Adult Learners (October 4, 2020)
If you want to stay connected with Adam and Bryon you can like our Facebook pagewww.facebook.com/ehappodcast. You can also follow us on Twitter and Instagram @ehappodcast. Feel free to check out our website www.ehappodcast.com seeing as how you’re becoming mildly obsessed with us.You can contact Adam and Bryon via email at ehappodcast@gmail.com.If you feel like supporting the show, you can buy a t-shirt from our Teepublic store at www.ehappodcast.com/shop.If you don’t like wearing clothes and want exclusive content, you can support us on Patreon for the price of a $1 cup of coffee at www.patreon.com/ehap. Join the ranks of other fine Patreon supporters such as Mat, Theresa, Jarret, Julia, and Terin.This week’s music pick:If I Don’t Make It Home to The BoozeIf you enjoy the music on the show and happen to be an Apple Music subscriber, be sure to subscribe to our ever-growing Apple Music playlist. You can check that bad daddy out right here: https://itunes.apple.com/ca/playlist/everyone-has-a-podcast/pl.u-eaqfK2PEEq2015 - 2020 © Everyone Has A Podcast
Hey everybody! Welcome back for another great episode of Queer All Year! Today, we start out with our usual banter between Cat and McG, including a visit from Florida Man! For our main story, Cat goes into the details behind Boutilier v Immigration and Naturalization Service, a 1967 Supreme Court Case that paints a broader picture of a broken immigration system. Thank you so much and remember: We Love You! Check out our bonus material!
The guys talk about Junior hockey legend Stan Butler no longer being the Battalion Head Coach. Petes not being talked about enough, also Kirk not impressing Tate and SDA not impressing Cody. (30:00) Interview with Marcus Boutilier ,OHL Network's beat writer, about Kingston's recent hot streak of games, Shane Wright, Zayde Wisdom, Propp. Boutilier also adds his thoughts on the World Junior and comments on what he has seen so far at the camp. (53:00) Paige Martin, Rogers TV host, spoke about the feeling around the London Knights, Antonio Stranges, Connor McMichael, who will step up while players are gone to World Juniors, and Ryan Merkley not getting a camp invite.
I sat down with content creator Wesley Boutilier about how he got into films and making content. Become a Patron: www.patreon.com/thenerdcorps Visit our website! www.thenerdcorps.com We have merch! Support the nerds by buying a piece of merch! https://teespring.com/stores/the-nerd-corps Join our official Facebook group for nerd discussions! www.facebook.com/groups/thenerdcorps Follow us on Twitter! www.twitter.com/thenerdcorps_ Follow us on Instagram! www.instagram.com/thenerdcorps Logo done by Alex Almeida, follow her to see her work www.twitter.com/Zans_Zone Intro by Nikki SilentUschi, email her for business inquiries at silentuschi@gmail.com Theme music by https://moamanofaction.bandcamp.com/album/fall-sampler https://www.twitter.com/circuitbird --- Support this podcast: https://anchor.fm/thenerdcorps/support
OHL Network Podcast Episode 2 With Marcus Boutilier (OHL Network) by Sam Hossack
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality.
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/lgbtq-studies
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality.
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
Focusing on six major Supreme Court cases during the 1960s and 1970s, Marc Stein's book Sexual Injustice (University of North Carolina Press, 2013) examines the generally liberal rulings on birth control, abortion, interracial marriage, and obscenity in Griswold, Eisenstadt, Roe, Loving, and Fanny Hill alongside a profoundly conservative ruling on homosexuality in Boutilier. In the same era in which the Court recognized special marital, reproductive, and heterosexual rights and privileges, it also upheld an immigration statute that classified homosexuals as "psychopathic personalities." Stein shows how a diverse set of influential journalists, judges, and scholars translated the Court's language about marital and reproductive rights into bold statements about sexual freedom and equality. Learn more about your ad choices. Visit megaphone.fm/adchoices
August 22nd – Alicia Boutilier, Chief Curator & Curator of Canadian Historical Art at the Agnes Etherington Art Centre joins us in studio to discuss the recent pilot project Art Worlds: A User’s Guide in collaboration with the Smith School of Business MBA Program. She also discusses exhibitions now under way as of August 25th, Continue Reading
R. v. Boutilier is a 2017 Supreme Court of Canada decision in which the Court had to determine whether Canada's dangerous offender designation regime is constitutional. Eric Purtzki is a criminal defence attorney in Vancouver who was counsel to Mr. Boutilier before the Supreme Court. We discuss how Canada's dangerous offender designation regime works, the consequences of being designated a dangerous offender, his arguments at the Supreme Court, and the decision.
Massachusetts poet and educator Nancy Boutilier wants you to break free of the constraints keeping you from writing — and creating. Learn her techniques and crack open your creative chi. What are you feeding your writer? What’s your diet? I ask [my students] to keep a log of their diet. I ask them to write down — what have you read this week? Jane Kenyon said: Be a good steward of your gifts. This whole quote is about attitudes and actions... there’s a goodness to this, living a good life.
The Belleville Senators of the American Hockey League are incredibly fortunate to have one of the game's brightest teachers, educators, and listeners on their staff in Paul Boutilier. Paul's been around the block, both as a player in the NHL and worlds beyond, and also as a coach, spending over 20 years at the Canadian University hockey level with the St. Mary's Huskies and Dartmouth University in Halifax.
Dr. Paul Wang: Welcome to the monthly podcast, On The Beat for Circulation: Arrhythmia, and Electrophysiology. I'm Dr. Paul Wang, Editor in Chief, with some of the key highlights from this month's issue. We'll also hear from Dr. Suraj Kapa, reporting on new research from the latest journal articles in the field. This month's issue of Circulation: Arrhythmia, and Electrophysiology has a number of groundbreaking and fascinating articles. Let's start with the first article by Christopher Andrews and Associates on the novel use of noninvasive electrocardiographic imaging in patients with arrhythmogenic right ventricular cardiomyopathy. The authors compared 20 genotyped arrhythmogenic right ventricular cardiomyopathy patients to 20 control patients using electrocardiographic imaging, ECGI, a method for noninvasive cardiac electrophysiology mapping. They found that ARVC patients had a longer ventricular activation duration, with a mean of 52 milliseconds versus 42 milliseconds with a p-value of 0.007, as well as a prolonged mean epicardial activation recovery interval, a surrogate for local action potential duration with a median of 275 milliseconds versus 240 milliseconds with a p-value of 0.014. In addition, the authors observed abnormal epicardial activation breakthrough locations with regions of nonuniform conduction and fractionated electrograms. These abnormal activation patterns correlated with late gadolinium enhancement using cardiac magnetic resonance scar imaging. This study suggests that electrocardiographic imaging may be a promising tool for the diagnosis and follow-up of patients with ARVC. In the next article, Thomas Fink and Associates report the results of the prospective randomized Alster-Lost AF trial, comparing ablation strategies in patients with symptomatic persistent or long-standing persistent atrial fibrillation. The study compared standalone pulmonary vein isolation, the PVI-only approach, with a stepwise approach of PVI followed by complex fractionated atrial CFAE ablation and linear ablation, the substrate modification approach. Patients were randomized one-to-one to each study group. The primary study endpoint was freedom from recurrence of any atrial tachyarrhythmia at 12 months after a 90-day blanking period. 118 of 124 enrolled patients were analyzed. 61 in the p-value only group and 57 in the substrate modification group. The pulmonary vein isolation only group had a one-year freedom from arrhythmia recurrence of 54%, which was similar to the 57% recurrence rate in the substrate modification group, p = 0.86. Thus, this study confirms in a population of persistent and long-standing persistent atrial fibrillation that there is no significant benefit to the addition of CFAE ablation to pulmonary vein isolation only. In the next paper, John Papagiannis and associates studied AV nodal reentrant tachycardia in patients with congenital heart disease. In this multi-centered, retrospective study, the authors compared catheter ablation of AV nodal reentrant tachycardia in 51 patients with complex congenital heart disease, with 58 patients with simple congenital heart disease. There was no significant difference between the groups in terms of growth parameters, the use of 3D imaging, or type of ablation, radio frequency versus cryoablation. The procedure times, fluoroscopy times were longer in the complex group compared to the simple group. There were also significant differences between the groups in terms of acute success of ablation, 82% versus 97%; the risk of AV block, 14% versus 0%; and the need for chronic pacing, all significant in favor of the simple congenital heart disease group. There were no permanent AV block observed in patients who underwent cryoablation. After a mean, 3.2 years of follow up, the long-term success was 86% in the complex group, and 100% in the simple group, p = 0.004. Thus, the authors concluded that the complexity of congenital heart disease affects the outcome of AV nodal reentrant tachycardia catheter ablation. In the next paper, Moloy Das and associates studied whether the presence of abnormal intra-QRS peaks would indicate altered activation and might predict ventricular arrhythmias in cardiomyopathy patients. The authors examined the 99 patients with ischemic or nonischemic cardiomyopathy undergoing primary prevention ICD implantation, with a mean left ventricular ejection fraction of 27%. After a median follow up of 24 months, 20% of patients had arrhythmic events. Using a multivariate, Cox regression model that included age, left ventricular ejection fraction, QRS duration, and QRS peaks, only QRS peaks was an independent predictor of arrhythmic events with a hazard ration of 2.1. ROC analysis revealed that a QRS peak value of greater than or equal to 2.25 identified arrhythmic events with a greater sensitivity than QRS duration, 100% versus 70%, with p < 0.05, and a negative predictive value of 100%, compared to 89% for QRS duration, p < 0.05. Thus, the authors concluded that this novel QRS morphology index may be a promising additional tool in sudden death risk stratification. In our next paper, Yoshiyasu Aizawa and associates studied J wave changes during atrial pacing in patients with and without idiopathic ventricular fibrillation. In eight patients with idiopathic ventricular fibrillation, and 17 patients without idiopathic ventricular fibrillation, having J waves, the J wave amplitude was measured before, during and after atrial pacing. All of the patients with ventricular fibrillation did not have any structural heart disease. The idiopathic ventricular fibrillation patients were younger than the non-idiopathic ventricular fibrillation patients, and had larger J waves with more extensive distribution. The J wave amplitude decreased from 0.35 millivolts to 0.22 millivolts when the R-R intervals shortened, a decrease of greater than, equal to 0.005 millivolts in the J wave amplitude was observed in six of eight idiopathic ventricular fibrillation patients while the J wave amplitudes were augmented in nine out of 17 non-idiopathic ventricular fibrillation subjects. The authors therefore concluded that the different response patterns of J waves to rapid pacing suggested different mechanisms that is early repolarization in idiopathic ventricular fibrillation patients, and conduction delay in non-idiopathic ventricular fibrillation patients. Our final paper of the month was written by Jim T. Vehmeijer and colleagues, who examined the utility of recent guidelines and consensus documents for ICD implantation for sudden death protection in adults with congenital heart disease. The authors examined an international, multi-center registry, having 25,790 adult congenital heart disease patients, and identified all sudden cardiac death cases, which were then matched to living controls by age, gender, congenital defect and surgical repair. They used conditional logistic regression models to calculate odds ratios, and receiver operating characteristic curves. In their first analysis, they identified 124 cases and 230 controls. In total, 41% of sudden cardiac death cases, and 17% of controls had an ICD recommendation based on the 2014 consensus statement on arrhythmias in adult congenital heart disease, with an odds ratio of 5.9. A similar analysis of the 2015 European Society of Cardiology guidelines showed that 35% of cases and 14% of controls had an ICD recommendation, respectively with an odds ratio of 4.8. The authors concluded that a minority of sudden cardiac death cases had an ICD recommendation according to these guidelines, while the majority of sudden cardiac death victims remained under-recognized, emphasizing the need for continued critical, clinical reasoning when deciding on ICD implantation in adult congenital heart disease patients. And now, here with the review of the highlights from the articles from journals throughout the world, in the past month is Dr. Suraj Kapa. Dr. Suraj Kapa: Thank you, Paul. Today we'll be discussing hard-hitting articles that have been published within the last month across the electrophysiologic literature. First, we'll be focusing on the topical area of atrial fibrillation, with an initial foray into the realm of anticoagulation. The first article we will be focusing on was published by Yao, et al., in the Journal of the American College of Cardiology in volume 69, entitled Non-Vitamin K Antagonist Oral Anticoagulant Dosing in Patients with Atrial Fibrillation and Renal Dysfunction. In the study, Yao, et al, demonstrated that the dosing of direct oral anticoagulants in a real world patient sample, with preexisting renal dysfunction was inappropriately dosed in as many as 43% of patients. Specifically, in these patients, there was overdosing of the direct oral anticoagulants. Moreover, as many as 13% of patients were underdosed. The overdosing of these patients led to increased bleeding risks, without an incremental stroke benefit compared with cohorts that were appropriately dosed. In turn, underdosing led to increased stroke risk without an incremental reduction in bleeding risk. These results are provocative in that they indicate, in a real life sample of patients, frequent inappropriate dosing of direct oral anticoagulants. This identifies the need for better guidelines, or better adherence to guidelines, in management of these patients to improve clinical outcomes. In another article with the realm of anticoagulation management of atrial fibrillation patients, was published by Labovitz, et al. in Stroke, in volume 48, entitled Using Artificial Intelligence to Reduce the Risk of Nonadherence in Patients on Anticoagulation Therapy. They demonstrated in a small randomized study that a smart phone based artificial intelligence program could be used to monitor anticoagulation adherence, and in fact, improve it. The program utilized features available on all smart phones to identify the patient, the medication, and active ingestion of the medication by the patient in real time. With this approach, they noted the plasma drug concentration levels indicated 100% adherence in the intervention group, namely those using the artificial intelligence program, while in the control group, only 50% of patients had adherence to the medications. Overall, there was an absolute improvement in adherence amongst patients on direct oral anticoagulants by as many as 67%. These findings are provocative given data suggestive of the lack of appropriate adherence to anticoagulant therapy amongst patients. Changing paths from anticoagulation management, the next article we choose to focus on was published within the realm of cardiac mapping in ablation for atrial fibrillation. It was published by Das, et al. in JACC: Clinical Electrophysiology in volume three, entitled Pulmonary Vein Re-Isolation as a Routine Strategy Regardless of Symptoms, The PRESSURE Randomized Controlled Trial. In this randomized trial, Das, et al, demonstrated that aggressive reevaluation of patients undergoing pulmonary vein isolation after index ablation for pulmonary vein reconnection, with the intent to re-ablate, significantly reduced arrhythmia recurrence. In addition, there was a commented improvement in quality of life. It has been well-recognized that even in the absence of clinical recurrence, a large number of patients, after index pulmonary vein isolation, may have pulmonary vein reconnection. However, it has always been unclear whether aggressive reevaluation and re-isolation of reconnected veins holds value, has been unclear. Further study is needed to evaluate the cost effectiveness and the risk-benefit ratio of such an invasive approach to reevaluate pulmonary vein isolation, irrespective of the evidence of clinical atrial fibrillation recurrence, however. Changing gears, with the realm of atrial fibrillation, we will now focus on risk stratification and management. Pathik, et al, in JACC: Clinical Electrophysiology, published in volume three, have progressed to complement their work on the role of risk stratification, and risk factor management in patients with atrial fibrillation, to evaluate the cost-effectiveness and clinical effectiveness of such risk factor management clinics in atrial fibrillation, that they termed the SENSE Study. They demonstrated that there was significant cost and clinical benefits to aggressive risk factor targeting clinics for patients with atrial fibrillation, specifically, utilizing supervised approaches to weight-loss, improvements in fitness and reduction in other clinical risk factors such as diabetes, hypertension, or other risks. The patients had a significantly decreased risk of arrhythmia occurrence. In addition to this, there was an actual incremental cost benefit of $62,000 for quality adjusted life year saved. These findings suggest that such an aggressive risk factor mediated approach to management of patients with atrial fibrillation holds significant promise, not just in the reduction of arrhythmia occurrence, but also in potential healthcare cost savings. Our next article within the realm of risk stratification and management relates to identification of patients with atrial fibrillation, in otherwise normal population-wide cohorts. Krivoshei, et al, in Europace volume 19, studied algorithms applied to information gathered on pulse-wave signals via smartphone-based LED light/camera lens. They demonstrated that using such a tool on patients, atrial fibrillation can be discriminated from sinus rhythm with sensitivity specificity of above 95%. We recognize the critical importance of early detection of atrial fibrillation, particularly in high-risk cohorts for stroke. Early identification of patients may identify those patients for initiation of anticoagulation, even if asymptomatic or minimally symptomatic. Our so-termed subclinical atrial fibrillation patients, which we identify by prior clinical trials, have an increased risk of stroke. However, the main hurdle to implementation of such technology has been the high cost, applied to traditional medical interventions. However, use of ever-advancing ambulatory technologies, such as smartphones or in the future, smart watches, may held the promise to identify atrial fibrillation via cheaper mechanisms. The last article within the realm of atrial fibrillation risk stratification and management that we'll choose to focus on is that by Gaeta, et al, published in Europace in volume 19. They performed a systematic review and meta-analysis of existing trials, regarding whether epicardial fat depot was associated with atrial fibrillation. They demonstrated via their meta-analysis that there is, in fact, a significant association between epicardial fat and atrial fibrillation risk, with more epicardial fat being associated with more persistent, rather than paroxysmal forms of atrial fibrillation, as well as any atrial fibrillation versus none. However, the role of epicardial fat in arrhythmogenesis remains unclear. While many studies suggest an association, causation remains to be proven. A recent review, however, published by Antonopoulos, et al, in the Journal of Physiology in June 2017, has multiple suggestive pathways by which paracrine effects of epicardial fat on the heart and vice versa, may lead to alterations in normal cardiac function. Thus, while this remains an association, there are evolving principles that might further support causation. Changing topics, we'll next focus on four major articles within the realm of ICDs, pacemakers, and CRT managements. Lyons, et al, in JACC: Heart Failure, volume five, studied the impact of current versus previous cardiac resynchronization therapy guidelines on the proportion of patients with heart failure eligible for therapy. They evaluated the effect of changing guidelines based on increased bodies of evidence, related to indications for resynchronization therapy on real world patient samples. They demonstrated that these further refined guidelines would decrease by as many as 15% those patients eligible for cardiac resynchronization therapy. However, while their study demonstrates that fewer patients may qualify, as far as receiving benefit from resynchronization therapy, at least two studies published in the same month have demonstrated that even amongst patients who meet guidelines, there is severe under-utilization/under-referral for such devices. These studies by Marzec, et al, in JAMA Cardiology, as well as by Randolph, et al, in American Heart Journal, demonstrated that there's frequent under-utilization and under-referral of patients meetings indications for resynchronization therapy. Keeping on the same topic in resynchronization therapy, Barra, et al, in Heart, volume 103, looked at sex-specific outcomes with addition of defibrillation to resynchronization therapy in patients with heart failure. They demonstrated in a multi-central observational cohort study that the addition of defibrillator resynchronization therapy in patients meeting primary prevention indications for device implant, primarily conferred benefit in men, rather than women. In the same month, Randolph, et al, in the American Heart Journal, demonstrated that resynchronization therapy offered potential greater benefits in women over men. Interestingly, this study by Barra, et al, conversely demonstrates that the concomitant addition of defibrillator therapy does not necessarily further improve outcomes on women, with the primary benefit being conferred to men. Whether this differential is effected by relative rates of arrhythmogenic myopathy is in men versus women remains unclear. However, the findings are provocative. Keeping within the realm of appropriateness of defibrillator therapies, Luni, et al, performed a meta-analysis of randomized controlled trials published in the Journal of Cardiovascular Physiology, in volume 28, on the mortality effect of ICDs in primary prevention in nonischemic cardiomyopathies, including six studies that met criteria. They found that while there was an overall significant survival benefit in patients receiving ICDs in the setting of nonischemic cardiomyopathy. Once accounting for those on adequate beta-blockade, and ACE or ARP 00:22:56 therapy, there was no statistical difference conferred by primary prevention ICD use. This complements an article published by Al-Khatib, et al, in JAMA Cardiology, in the same month, which also suggested that the overall mortality benefit was present in nonischemic patients, though in their case, they did not evaluate the granularity of appropriateness based on current management at the time of ICD implant. These findings further previous findings from a Danish study that the survival benefit of primary prevention ICD in nonischemic cardiomyopathy might not be anywhere near the same as those conferred with ischemic cardiomyopathy. However, the perceived lower relative mortality benefit, compared to earlier clinical trials, namely partly due to improvements in the clinical and pharmacologic management of such patients. The final paper we'll choose to focus on within the realm of device therapies was published by Doppalapudi, in the Journal of Cardiovascular Electrophysiology, in volume 28. They looked at the significant discrepancy between estimated and actual longevity in St. Jude Medical implantable cardioverter defibrillators. While amongst a small number of patients of only 40, they demonstrated that up to 74% of these patients had a significant discrepancy between actual and estimated battery life, specifically amongst current or promotes defibrillator devices. This discrepancy was most significant in the 18 months prior to reaching electrical replacement medication. These findings suggest the need for more frequent monitoring of such devices to look for rapid battery depletion. Switching topics away from device therapies, we next focus on the realm of sudden death in cardiac arrest. The first paper we'll focus on was published in Circulation, in volume 135, by Halliday, et al, and focused on the association between mid-wall late gadolinium enhancements, and sudden cardiac death in patients with dilated cardiomyopathy in mild and moderate left ventricular systolic dysfunction. In his publication, Halliday demonstrated that the presence of mid-wall late gadolinium enhancements on MRI identified patients at risk of sudden cardiac death, with a hazard ratio up to 35.9 for border sudden cardiac death, amongst dilated cardiomyopathy patients with such mid-wall dilated enhancements. The incremental value of MRI is evolving in the risk stratification of patients, though it has not quite met inclusion in guidelines for decision making regarding those who most benefit from ICDs. However, studies like this are provocative in the sense of identifying those patients most at risk. Within the realm of cardiac arrest, we next focus on the role of out-of-hospital cardiac arrest, and how to improve management of these patients. Boutilier, et al, published in Circulation, in volume 135, optimization of drone networks to deliver automated external defibrillators. They demonstrated via simulation model that using a drone network system to deliver AEDs to patients suffering sudden cardiac arrest could decrease the time to response by as much as six minutes and 43 seconds compared to traditional approaches, such as 911 in urban areas, or as much as 10 minutes and 34 seconds in rural areas. These findings are highly provocative. However, they need to be applied to clinical real world situations. The first attempt at such was actually published this month as well, by Claesson, et al, in the Journal of the American Medical Association, and demonstrated the feasibility of implementing a drone network within real world case example, and the efficacy of the same. These disruptive technologies have the potential to improve emergency care, and out of hospital cardiac arrest survival. Next, we move on to studies in electrophysiology. The first article we will focus on is by De Jesus, et al, published in Heart Rhythm, volume 14, on antiarrhythmic effects of interleukin 1 inhibition after myocardial infarction. De Jesus, et al, in this study, demonstrated that the use of anakinra and interleukin 1 beta antagonist would improve conduction velocity, calcium handling, spontaneous and inducible ventricular arrhythmias, and action potential duration dispersion, in canine models. These findings of potential antiarrhythmic effects were due to increased expression of connexin 43, and sarcoplasmic reticulum calcium ATPase. While in isolation, this might seem a general article, it complements multiple recent studies that suggest a significant role for targeting inflammatory pathways, not just in infarct pathogenesis, but in arrhythmogenesis. Lazzerini, et al, this month as well, demonstrated in the European Heart Journal, the link between systemic inflammation and arrhythmic risk based on a review of the existing literature. In addition, Yucel, et al, demonstrated in Nature Scientific Reports the relationship between lipopolysaccharides and electrophysiology dysfunction in stem cell direct cardiomyocytes, which they felt partly may be mediated through interleukin pathways. Finally, though as of yet unpublished, a clinically available interleukin 1 beta inhibitor, canakinumab, has been shown in preliminary data to reduce major cardiovascular events in a randomized, double-blind, placebo-controlled trial, when combined with optimal medical therapy in patients with post myocardial infarction. These potential clinical benefits complement translational benefits seen to date. However, whether these are conferred by primary inflammatory pathways, arrhythmogenic pathways, or interactions between both remains to be seen. The next article we will focus on is by Chauveau, et al, published in Circulation: Arrhythmia Electrophysiology, volume 10. They looked at induced pluripotent stem cells derived cardiomyocytes in producing in vivo biological pacemaker function. They demonstrated that in canines with atrioventricular block, injection of such derived cardiomyocytes into the epicardial surface of the heart, demonstrated inherent pacemaker activity with global cardiac activation. In fact, this activation in pacemaker activity increased over time, up to four weeks of maturation, and also demonstrated responsiveness to epinephrine and alterations with day and night variation. However, the intrinsic rates tend to be quite low, in the 50 to 60 beat per minute range. The potential to restore pacemaker activity in patients with severe conduction disease, holds the potential to dynamically progress options in care for patients with electrophysiologic disease. However, even though these findings are promising, significant remaining questions include ensuring the robustness of the heart rate conferred by these biologic pacemakers, the durability of pacemaker activity, and the arrhythmogenic potential of such interventions. Within the realm of cellular electrophysiology, the final article we will choose to focus on was published by Barbic, et al, in American Journal of Physiology, heart and Circulatory Physiology, in volume 312, entitled Detachable Glass Microelectrodes for Recording Action Potentials in Active Moving Organs. They demonstrated that a new glass microelectrode could allow for determinational cellular actional potential duration in actively moving organs. This is a profound potential advance in the physiologic evaluation of both in vitro and in vivo translational cellular models of cardiac activation. Traditional patch clamping action potential studies required immobilization of cells being studied, whether by mechanical or pharmacologic means. However, directed efforts to immobilize cells can alter electrophysiologic parameters. The ability to record cellular action potentials in actively moving cells, for example the beating heart, may offer studies of cellular electrophysiology, that more closely approximate real world physiology. Our next area of focus will be on genetic channelopathies, including long QT syndrome, Brugada, catecholaminergic polymorphic ventricular tachycardia and others. The article we choose to focus on this month, within this realm, was published by Pappone, et al, in Circulation: Arrhythmia and Electrophysiology, volume 10. They focus on electrical substrate elimination in 135 consecutive patients with Brugada syndrome. They demonstrated in this large cohort of patients that the arrhythmogenic electrical substrate associated with the Brugada syndrome primarily localized to the right ventricular epicardium, and an ablation of such region led to normalization of electrocardiogram and non-inducibility ventricular arrhythmias acutely in all patients, and over a long term in all but two patients. These findings complement prior work by Nademanee and others that support a role for targeting substrate in the region of the right ventricular epicardium, in preventing recurrent ventricular arrhythmias in patients with Brugada syndrome, and in normalizing the electrocardiographic Brugada pattern. At the translational level, prior work has demonstrated that the same SCN mutations associated with Brugada syndrome confer accentuated transmittal gradients within the realm of the right ventricle, along with preferential prolongations of action potentials in the right ventricular epicardial myocytes. However, it remains to be seen whether the specific genetic cause of individual patient's Brugada pattern or Brugada syndrome is associated with discreet pathologic and inter-ablation findings and success rates. Next, moving on to the realm of ventricular arrhythmias, we focus on three major articles published in the past month. The first article is published by Vaseghi, et al, in the Journal of the American College of Cardiology, volume 69, entitled Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. They demonstrated that cardiac sympathetic denervation may be an effective therapy in many patients with intractable ventricular arrhythmias, with a greater than 50% reduction in sustained VT, ICD shock, transplant or death over one year follow-up. Not only this but nearly one third of patients no longer required antiarrhythmics. However, bilateral sympathectomy is far superior over left sided only sympathectomy. Furthermore, advanced heart failure and VT cycle length were associated with poor outcomes. These findings suggest a role for bilateral sympathectomy in management of patients presenting with intractable ventricular arrhythmias. However, patient identification and selection in terms of the ideal cohorts for such therapy, and how to identify such cohorts remains to be seen. Our next article regards advances in attaining epicardial access. Di Biase, et al, published in Heart Rhythm, volume 14, the initial international multi-centered human experience with the novel epicardial access needle embedded with a real time pressure frequency monitor to facilitate epicardial access. They looked specifically at feasibility and safety of this novel approach. While in only 25 patients, they did demonstrate that epicardial access can be successfully obtained with only one complication of a delayed pericardial effusion. With evolving indications for epicardial access, including for left atrial appendage occlusion, epicardial ganglia modulation, and ventricular arrhythmia mapping and ablation, development of novel tools to minimize the risks associated with epicardial ablation, particularly in individuals who do not perform it routinely, is critical. However, whether these variable approaches hold significant advances in randomized trials, beyond traditional approaches, remains to be seen. Within the realm of ventricular arrhythmias, the last article we will choose to focus on was published by Acosta, et al, in Europace, volume 19. They looked at the long-term benefit of first line peri-implantable cardioverter-defibrillator implant ventricular tachycardia substrate ablation in secondary prevention patients. This study complemented prior data from SMASH-VT supporting a role for early ablation to reduce future arrhythmia events in patients receiving defibrillators. In their study, they demonstrated that early ablation was associated with a decreased recurrence of ventricular arrhythmias and defibrillary shocks over an average of almost four years. However, it addressed patients with lower ejection fractions, namely less than 35%, received less benefit. Though this was mostly conferred by while having similar frequency of VT recurrence, having an overall lower burden compared to those who did not have ablation. Practice patterns continue to vary in the decision making with regards to performing early ablation in such patients. Furthermore, whether or not a mortality benefit exists with early ablation remains relatively unclear and unproven. However, there's an evolving body of evidence to support the notion that aggressive, early intervention with invasive procedures in patients receiving ICDs, and at high risk for ventricular arrhythmias, may make sense. The final article we will focus on that has been published in the past month, is published by Turagam, et al, in the International Journal of Cardiology, volume 236, entitled Practice Variation in the Re-initiation of Dofetilide: an Observational Study. Turagam, et al, surveyed 347 providers in the U.S. and worldwide, and demonstrate significant practice variability when re-initiating dofetilide. They know that up to 21% of providers always admit patients to the hospital for dofetilide re-initiation, while 37% of physician admit patients less than 10% of the time. Interestingly, the duration off of dofetilide ranging anywhere from three days to more than a year, did not necessarily significantly affect the rate of decision to re-initiate dofetilide, after prior cessation. One key finding of this was the 4% of physicians reporting major adverse events with drug re-initiation in patients. This was despite the vast majority of these patients tolerating de novo initiation. Given the prolific effects of antiarrhythmetic drugs, strategies to reduce those potential risks are critical. In fact, multiple groups such as the Cardiac Safety Research Consortium, within the same month, had sought to publish recommendations for long-term electrocardiographic monitoring, in drug developments. It must be realized the consideration of the impact of antiarhythmetic drug managements may not always be well outlined by existing protocols. And thus, further study is likely required to inform current clinical practice. It was my pleasure to introduce to you some of the major heart hitting articles published in the part month across the electrophysiologic literature. While none of this is really touching on every single major advance, we hope to identify those that hold potential, measure immediate clinical potential, or those that hold potential for future advancements within our field. Thank you. Dr. Paul Wang: I hope you enjoyed this month's podcast On the Beat, Circulation: Arrhythmia and Electrophysiology. We've had a number of groundbreaking and fascinating studies. See you next month.
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Dr. Carolyn Lam: Welcome to Circulation on the Run your weekly podcast summary and backstage pass to the journal and it's editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Is it time to end our debates on short versus long duration of dual anti-platelet therapy? Well I will be discussing this with two very special guests in just a moment. But first here is your summary of this week's journal. The first paper tells us that HDL particle number may serve as a biomarker of residual risk when assessed on statin therapy. First author Dr. Khera, corresponding author Dr. Mora from Brigham and Women's Hospital and colleagues of the JUPITER trial assessed HDL cholesterol levels, apolipoprotein A-1, cholesterol efflux capacity and HDL particle number at baseline and 12 month in a nested case control study of the JUPITER trial. That was a randomized primary prevention trial that compared rosuvastatin to placebo in individuals with normal LDL but increased CRP levels. In the current study the authors found that cholesterol efflux capacity was moderately correlated with HDL cholesterol, apoA-I, and HDL particle number. Baseline HDL particle number was inversely associated with incident cardiovascular disease, while there was no significant association for baseline cholesterol efflux capacity, HDL or apoA-I levels. On-statin cholesterol efflux capacity was inversely associated with incident cardiovascular disease but HDL particle number again emerged as the strongest predictor. Thus for both baseline and on-statin analyses, HDL particle number was the strongest of four HDL-related biomarkers as an inverse predictor of incident events and biomarker of residual risk. Whether therapies designed to enhance cholesterol efflux capacity or an increased HDL particle number can also reduce cardiovascular risk however remains uncertain. The next study sheds light on mechanisms underlying the de-differentiation and lineage conversion of adult human fibroblast into functional endothelial cells. First author Dr. Zhang, corresponding authors Dr. Rehman and Malik from University of Illinois College of Medicine first generated CD34+ progenitors by de-differentiating adult human skin fibroblasts and showed that these intermediate progenitors could give rise to endothelial cells as well as erythrocytes. They then showed that lineage conversion of fibroblasts via partial de-differentiation recapitulated in part the embryonic development of the vasculature as evidenced by up regulation of anti-aging enzyme telomerase and the bi-lineage potential of the generated progenitors. Importantly they showed that transcription factor SOX17 functioned as a switch which regulated the cell fate of CD34+ progenitors towards an endothelial versus erythroid lineage. Finally implanted fibroblast derived CD34+ progenitors stably engrafted to form functional human blood cells in mice that improved cardiac function after myocardial infarction. Thus the molecular switch SOX17 provides a means to optimize the generation of endothelial cells for vascular tissue regeneration or disease modeling. What do drones have to do with out of hospital cardiac arrest? Well in this next study by first author Dr. Boutilier corresponding author Dr. Chan and colleagues from University of Toronto, the authors hypothesized that a drone network designed with the aid of a mathematical model combining both optimization and queuing could reduce the time to AED arrival. Using data from over 50,000 historical out of hospital cardiac arrests covering over 26,000 square kilometers in Ontario, Canada, they found that a drone network designed to reduce the median AED arrival time by three minutes relative to the historical 911 response could also reduce the 90th percentile of the AED arrival time by between 6 minutes and 43 seconds in most urban regions and 10 minutes and 34 seconds in most rural regions. Thus this study tells us that drone delivered AEDs have the potential to be a transformative innovation in the provision of emergency care to cardiac arrest patients especially those who arrest in a private or rural setting. The next study provides thresholds for ambulatory blood pressure among African Americans. Dr. Ravenall and colleagues from New York University School of Medicine analyzed data from the Jackson Heart Study, a population-based cohort comprised exclusively of African-American adults and of whom more than 1000 participants completed ambulatory blood pressure monitoring at baseline. Based on the outcome derived approach for systolic blood pressure and a regression derived approach for diastolic blood pressure, the following definitions corresponded to clinic blood pressure of 140/90 and were proposed as ambulatory blood pressure definitions for African Americans. Daytime blood pressure above 140/85, 24 hour blood pressure above 135/80 and nighttime blood pressure above 130/75 mmHg. Note that these ambulatory blood pressure thresholds identified for African Americans were higher than those from published recommendations mainly derived in European, Asian and South American populations. The use of these ambulatory blood pressure thresholds for African Americans will lead to a lower prevalence of daytime, 24 hour and nighttime hypertension compared with the current published recommendations. The next paper provides pre-clinical evidence of a novel target in plaque information in atherosclerosis. Dr. Stachon and colleagues from Heart Center Friburg University in Germany hypothesized a functional role of the signal axis ATP binding to purinogenic receptor P2X7 in inflammasone activation and chronic inflammation driving atherosclerosis. In an elegant series of experiments they showed that P2X7 receptor activation was crucial for inflammasone assembly and interleukin-1-beta secretion. The lack of P2X7 in mice abolished inflammasone activation in atherosclerotic lesions. P2X7 was expressed in murine and human atherosclerotic lesions. LDL receptor deficient mice lacking P2X7 receptor had reduced plaque inflammation and were less prone to develop atherosclerosis. Thus this study shows that P2X7 inhibition could be a treatment strategy against plaque inflammation in atherosclerosis. The next paper describes the first prospective clinical study of adenosine use in pediatric and young adult patients after heart transplantation. Now prior to this study adenosine was relatively contraindicated post-transplant due to a presumed risk of prolonged atrioventricular block in denervated hearts. In the current study first author Dr. Flyer corresponding author Dr. Silver and colleagues from Columbia University performed a single center prospective clinical study testing whether adenosine caused prolonged asystole after transplant and if it was effective in blocking AV nodal conduction in healthy heart transplant recipients aged 6 months to 25 years presenting for routine cardiac catheterization. Following catheterization, a transvenous pacing catheter was placed and adenosine was given following a dose escalation protocol until AV block was achieved. Eighty patients completed adenosine testing. And no patient required rescue ventricular pacing. AV block was observed in 77 patients with the median longest AV block of 1.9 seconds and the mean duration of adenosine effect of 4.3 seconds. Thus, this study suggests that adenosine may be safe and effective in patients post transplantation and establishes both a safe and effective starting dose of 25mcg/kg or 1.5mg for patients weighing 60kg and more. It also establishes a stepwise therapy escalation plan to avoid prolonged bradycardia. Although patients after heart transplantation may require less adenosine to achieve AV block it appears to be safe and effective as therapy for evaluation and or treatment of tachycardia in this population. Well those were your summaries, now for our feature discussion. Today for our feature discussion we are talking about a very familiar situation, dual anti-platelet therapy following coronary intervention and the decision of long versus short duration of therapy. A debate we've heard many times but according to the perspective piece in today's journal, maybe a debate we should end. And I am so pleased to have the author, Dr. Glenn Levine from Baylor College of Medicine as well Dr. Laura Mauri associate editor from Brigham and Women's Hospital. Welcome both. Dr. Laura Mauri: Thank you Carolyn. Dr. Glenn Levine: Thank you. Dr. Carolyn Lam: Glenn would you like to start by presenting your case. It's time to end a dualistic short versus long duration of DAPT debate. I really like that title, tell us more. Dr. Glenn Levine: Thank you Carolyn. The point we make in our editorial is that over the last five or six years there have been studies comparing what I term standard, which is usually about 12 months DAPT versus shorter duration DAPT and there are other studies comparing standard DAPT versus longer duration DAPT. Those generated important information in different people interpret them in different ways. What though has happened over the last several years is certainly for both educational and entertainment value at meetings as well in editorials, the idea of how long people should be treated with DAPT has been oversimplified to whether all patients should be treated with short duration or long duration. And Laura herself knows that as she has been in many of these debates. While I think that initially that was educational and entertaining, I think these days people understand those points and a greater issue is in that we should treat some people with short duration, some with what I call standard and some with long duration. And rather than debating whether everyone should treated with short or everyone should be treated with long, I think what we need to focus on now is which patients should be treated with short duration, which are probably best treated with a standard duration and which are best treated with prolonged or extended duration DAPT. And that in a nutshell is the main point that we make in this perspective editorial. Dr. Carolyn Lam: Laura, so do you agree? Dr. Laura Mauri: I couldn't agree more. I think clinicians really are looking for guidance and what happens at these debates is you see these polarizing opinions that debaters are asked to defend when in actuality there's such a wide spectrum of what individual patients need. And the real question I think going forward is how to end these debates and how to provide really more tailored information so clinicians and patients can make better decisions together. And I think that's really where the piece that Glenn has written really helps direct us. Dr. Carolyn Lam: Yeah, Glenn, I mean are we talking about the usual risk versus benefits and precision metsan or individualized risk assessment here? Dr. Glenn Levine: Yeah, what we're talking about is looking at the ischemic risks which are primarily leg stent thrombosis or spontaneous MI versus the bleeding risks which is obviously bleeding and balancing them. And there clearly are decision tools available to clinicians. Laura has pioneered the DAPT score which is an incredibly user friendly and easy tool to use to assess which patients should be continued with prolonged DAPT or not. And there are also some other tools out there including the Paris registry score perhaps a little more complex and then there's also now the precise DAPT score which one can at least assess bleeding risk and indirectly assess the ischemic and bleeding risk. But really I think that is the focus now on balancing bleeding and ischemic risks and having pools to allow clinicians to easily do that. Dr. Carolyn Lam: That's true. Now do you think guidelines have to catch up or have they caught up? Dr. Glenn Levine: Our DAPT duration guideline was coming out just as Laura's DAPT score was about to be published, several months after it had been presented. And we did mention the DAPT score in our paper, it was too early to formally incorporate it into the guidelines. Nevertheless, the way our guidelines are written, they clearly give practitioners the option for individualizing therapy based on ischemic and bleeding risk and Laura's DAPT score fits perfectly into what we aim to do, namely to encourage practitioners to assess patients on an individual level and assess what duration of DAPT is best. Dr. Carolyn Lam: I do have a question for Laura here though. I see Asian patients, I'm talking to you here from Singapore. And sometimes you wonder the trial situations and what you derive there. How does it differ from real world and how is it impacting your practice for example Laura? Dr. Laura Mauri: That's a great question. I think you have a number of points there. One is the generalized ability or results from one trial across the world where you might have many different patient populations. And while the DAPT score was an international trial it would be interesting to see more data coming out from other different countries. And as you know there are trials in Asia that have looked at randomized DAPT duration as well. I think now that we have better access to information especially in cardiology globally, we can get that information and better tailor therapy. When we look at any one randomized trial the results might seem kind of black and white and to certain extent so do guideline recommendations but we are getting better at using the results from randomized trials to really identify risk factors. I think that with time we'll be able to either validate the DAPT score in other patient populations or develop tailored scores from unique data sets. I think the challenge really is making sure that we still get good randomized evidence for our treatment decisions but then when we have treatments that have both benefit and risk that we identify which sub-populations of patients really do achieve most of the benefit. And then the other populations that might be harmed. And that's really what we try to do with this score. And I think what you'll see, you asked about precision medicine which usually we think about using genetics but I think there's so much just really basic information that we have about patient lesion characteristics and other specific factors that we record routinely in their medical records that we can use and you'll see this, I think more and more frequently across different areas of investigation and in cardiovascular medicine. One really interesting example recently was this French trial. Data was used to be able to predict, very similar to what we did, but to predict which patients would benefit from lower blood pressure without the risk of more aggressive treatment. Dr. Carolyn Lam: Yeah, I love the way you put that. Those are really words of wisdom, I do think that that is the way cardiovascular medicine is gonna move. Glenn, how do you put all this into practice for yourself? Dr. Glenn Levine: I think whether or not I formally calculate a DAPT score or Paris registry score, I think clearly we integrate the factors in those scores into our everyday practice. And clearly there are patients who are at high bleeding and low ischemic risk and vice versa. I would also encourage listeners to in addition to all the scores, one has to think about the consequences of a recurrent MI or stent thrombosis. Obviously someone who has stent thrombosis of a proximal LED lesion, if they already have a depressed EF or occluded RCA, those consequences are likely much more dire then someone who occludes say at a distal OM3 stent who has the normal ejection fraction. It also encourages them to think about the consequences of stent thrombosis as well as the consequences of a recurring MI. Dr. Laura Mauri: Just to make it clear, we know that clinicians have always tried to balance these different risks of ischemia and bleeding when faced with this decisions. I think the challenge really has been the limited amount of information that we've had to be able to do that. And so we've really just used kind of our gut until recently when we've had several large randomized data sets to be able to look to. And what that's done is it's given us the ability to construct these new tools to be able to make practice more data driven. Now still individualized but based on data that's tailored to our patients. And so I think we can use that to be able to improve outcomes. That being said, we don't want to rely on a statistic or a score alone and things like the DAPT score are based on patients like the ones that were enrolled into the randomized trial. Those were patients who could take longer anti-platelet therapy. It helps to identify who can take it for longer. But there are patients who get anti-coagulation or have other serious bleeding risks who really are going to benefit from new technologies to be able to shorten anti-platelet therapy. Dr. Carolyn Lam: Well thank you Glenn once again for a wonderful perspective piece that has really got us thinking about situations even beyond dual anti-platelet therapy. Thank you Laura for your insights and thank you listeners for joining us today. Join us again next week.
Stewart Boutilier, longtime host of Alive & Dread, shares stories of the very beginning of CFUV.
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This Show: Mark Boutilier, our first Reverbnation winner for the month of January joins us from Nova Scotia! Mark shares his music and talk to us about his new record, and his plans for his first tour! Included in the interview are his songs "Make A Memory" and "Something to Talk About", the title track from his new record.
In a democracy, elected officials of all stripes are generally expected to primarily represent their constituents. However party policy sometimes makes it difficult to perform that task, particularly when their party form the government Progressive Conservative MLAs in Alberta often find themselves having to make a choice of either speaking for their constituents, or act, which arguably is the norm, as the government's mouthpiece to the constituents. In July 2009, Guy Boutilier, at the time a P.C. MLA for Ft. McMurray-Wood Buffalo, spoke up on behalf of the people he represents, regarding an earlier promised, but postponed Long Term Care facility in Ft. McMurray and was promptly ejected from the P.C. caucus. The speaker will express his views on several issues and explain the events leading to him now serving Ft. McMurray-Wood Buffalo as an Independent MLA at the Alberta Legislature. Speaker: Guy Boutilier Guy Boutilier has a rare combination of Private, Public and Academic experience. He worked in the Oil Sands Industry for Syncrude Canada as a Financial Analyst 1978-83. Mr. Boutilier served as Fort McMurray's youngest mayor after two terms on city Council, before successfully entering provincial politics in 1997. Responsibilities the past 12 years includes: Minister of Municipal Affairs, Minister of Environment and Minister of International Intergovernmental and Aboriginal relations. Guy chaired the Cabinet Committee on Climate Change, when he addressed the U.N. COPs 10 in Buenos Aires, Argentina on that topic. Mr. Boutilier currently also teaches part-time at the School of Business at University of Alberta. He has a MPA Masters degree in Public Administration from Harvard University, a BBA Business degree from St.F.X. University and a B.Ed Education degree with honors from St Mary's University in Halifax. Guy and his wife Gail have a 2 year old son Marc. Moderator: Knud Petersen
In a democracy, elected officials of all stripes are generally expected to primarily represent their constituents. However party policy sometimes makes it difficult to perform that task, particularly when their party form the government Progressive Conservative MLAs in Alberta often find themselves having to make a choice of either speaking for their constituents, or act, which arguably is the norm, as the government's mouthpiece to the constituents. In July 2009, Guy Boutilier, at the time a P.C. MLA for Ft. McMurray-Wood Buffalo, spoke up on behalf of the people he represents, regarding an earlier promised, but postponed Long Term Care facility in Ft. McMurray and was promptly ejected from the P.C. caucus. The speaker will express his views on several issues and explain the events leading to him now serving Ft. McMurray-Wood Buffalo as an Independent MLA at the Alberta Legislature. Speaker: Guy Boutilier Guy Boutilier has a rare combination of Private, Public and Academic experience. He worked in the Oil Sands Industry for Syncrude Canada as a Financial Analyst 1978-83. Mr. Boutilier served as Fort McMurray's youngest mayor after two terms on city Council, before successfully entering provincial politics in 1997. Responsibilities the past 12 years includes: Minister of Municipal Affairs, Minister of Environment and Minister of International Intergovernmental and Aboriginal relations. Guy chaired the Cabinet Committee on Climate Change, when he addressed the U.N. COPs 10 in Buenos Aires, Argentina on that topic. Mr. Boutilier currently also teaches part-time at the School of Business at University of Alberta. He has a MPA Masters degree in Public Administration from Harvard University, a BBA Business degree from St.F.X. University and a B.Ed Education degree with honors from St Mary's University in Halifax. Guy and his wife Gail have a 2 year old son Marc. Moderator: Knud Petersen
In a democracy, elected officials of all stripes are generally expected to primarily represent their constituents. However party policy sometimes makes it difficult to perform that task, particularly when their party form the government Progressive Conservative MLAs in Alberta often find themselves having to make a choice of either speaking for their constituents, or act, which arguably is the norm, as the government's mouthpiece to the constituents. In July 2009, Guy Boutilier, at the time a P.C. MLA for Ft. McMurray-Wood Buffalo, spoke up on behalf of the people he represents, regarding an earlier promised, but postponed Long Term Care facility in Ft. McMurray and was promptly ejected from the P.C. caucus. The speaker will express his views on several issues and explain the events leading to him now serving Ft. McMurray-Wood Buffalo as an Independent MLA at the Alberta Legislature. Speaker: Guy Boutilier Guy Boutilier has a rare combination of Private, Public and Academic experience. He worked in the Oil Sands Industry for Syncrude Canada as a Financial Analyst 1978-83. Mr. Boutilier served as Fort McMurray's youngest mayor after two terms on city Council, before successfully entering provincial politics in 1997. Responsibilities the past 12 years includes: Minister of Municipal Affairs, Minister of Environment and Minister of International Intergovernmental and Aboriginal relations. Guy chaired the Cabinet Committee on Climate Change, when he addressed the U.N. COPs 10 in Buenos Aires, Argentina on that topic. Mr. Boutilier currently also teaches part-time at the School of Business at University of Alberta. He has a MPA Masters degree in Public Administration from Harvard University, a BBA Business degree from St.F.X. University and a B.Ed Education degree with honors from St Mary's University in Halifax. Guy and his wife Gail have a 2 year old son Marc. Moderator: Knud Petersen
In a democracy, elected officials of all stripes are generally expected to primarily represent their constituents. However party policy sometimes makes it difficult to perform that task, particularly when their party form the government Progressive Conservative MLAs in Alberta often find themselves having to make a choice of either speaking for their constituents, or act, which arguably is the norm, as the government's mouthpiece to the constituents. In July 2009, Guy Boutilier, at the time a P.C. MLA for Ft. McMurray-Wood Buffalo, spoke up on behalf of the people he represents, regarding an earlier promised, but postponed Long Term Care facility in Ft. McMurray and was promptly ejected from the P.C. caucus. The speaker will express his views on several issues and explain the events leading to him now serving Ft. McMurray-Wood Buffalo as an Independent MLA at the Alberta Legislature. Speaker: Guy Boutilier Guy Boutilier has a rare combination of Private, Public and Academic experience. He worked in the Oil Sands Industry for Syncrude Canada as a Financial Analyst 1978-83. Mr. Boutilier served as Fort McMurray's youngest mayor after two terms on city Council, before successfully entering provincial politics in 1997. Responsibilities the past 12 years includes: Minister of Municipal Affairs, Minister of Environment and Minister of International Intergovernmental and Aboriginal relations. Guy chaired the Cabinet Committee on Climate Change, when he addressed the U.N. COPs 10 in Buenos Aires, Argentina on that topic. Mr. Boutilier currently also teaches part-time at the School of Business at University of Alberta. He has a MPA Masters degree in Public Administration from Harvard University, a BBA Business degree from St.F.X. University and a B.Ed Education degree with honors from St Mary's University in Halifax. Guy and his wife Gail have a 2 year old son Marc. Moderator: Knud Petersen