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January 03, 2017; 88 (1) Article

Risk of fractures after stroke

Results from the Ontario Stroke Registry

Moira K. Kapral, Jiming Fang, Shabbir M.H. Alibhai, Peter Cram, Angela M. Cheung, Leanne K. Casaubon, Marla Prager, Melissa Stamplecoski, Brennan Rashkovan, Peter C. Austin
First published November 23, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003457
Moira K. Kapral
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Jiming Fang
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Shabbir M.H. Alibhai
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Peter Cram
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Angela M. Cheung
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Leanne K. Casaubon
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Marla Prager
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Melissa Stamplecoski
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Brennan Rashkovan
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Peter C. Austin
From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
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Full PDF
Citation
Risk of fractures after stroke
Results from the Ontario Stroke Registry
Moira K. Kapral, Jiming Fang, Shabbir M.H. Alibhai, Peter Cram, Angela M. Cheung, Leanne K. Casaubon, Marla Prager, Melissa Stamplecoski, Brennan Rashkovan, Peter C. Austin
Neurology Jan 2017, 88 (1) 57-64; DOI: 10.1212/WNL.0000000000003457

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Article Information

vol. 88 no. 1 57-64
DOI: 
https://doi.org/10.1212/WNL.0000000000003457
PubMed: 
27881629

Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
0028-3878
Online ISSN: 
1526-632X
History: 
  • Received May 6, 2016
  • Accepted in final form September 22, 2016
  • First Published November 23, 2016.

Article Versions

  • Previous version (November 23, 2016 - 11:00).
  • You are viewing the most recent version of this article.
Copyright & Usage: 
© 2016 American Academy of Neurology

Author Disclosures

    1. Moira K. Kapral, MD, MSc, FRCPC,
    2. Jiming Fang, PhD,
    3. Shabbir M.H. Alibhai, MD, MSc, FRCPC,
    4. Peter Cram, MD, MBA,
    5. Angela M. Cheung, MD, PhD, FRCPC,
    6. Leanne K. Casaubon, MD, MSc, FRCPC,
    7. Marla Prager, BSc,
    8. Melissa Stamplecoski, BSc,
    9. Brennan Rashkovan and
    10. Peter C. Austin, PhD
  1. Moira K. Kapral, MD, MSc, FRCPC,
  2. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. Circulation Quality of Care and Outcomes. Guest Editor, 2015. Stroke. Editorial Board. 2009 to 2015.

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. 1. Project funding from the Heart and Stroke Foundation of Canada, Grant #BR7520. 2. Career Investigator Award from the Heart and Stroke Foundation of Canada

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  3. Jiming Fang, PhD,
  4. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  5. Shabbir M.H. Alibhai, MD, MSc, FRCPC,
  6. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. Canadian Institutes of Health Research, Grant:An RCT and economic analysis of three exercise delivery methods in men with prostate cancer on ADT., October 2013 ? September 2018, $781,091, Grant # MOP130252, Role: Principal investigator.

    Research Support, Academic Entities:
    1. University of Toronto Division of Urology

    Research Support, Foundations and Societies:
    1. 1. Prostate Cancer Canada 2. Prostate Cancer Canada 3. Canadian Cancer Society

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  7. Peter Cram, MD, MBA,
  8. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. Clinical orthopaedics and related research, editorial board, 2014-present Journal of hospital medicine, associate editor, 2016- present No funding for either role

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. US National Institutes of Health, 2002-present US Department of Veterans Affairs, 2011-2015

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  9. Angela M. Cheung, MD, PhD, FRCPC,
  10. Scientific Advisory Boards:
    1. Amgen Eli Lilly Merck

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. CIHR Senior Investigator Award Canada Research Chair in Musculoskeletal and Postmenopausal Health

    Research Support, Academic Entities:
    1. University of Toronto

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  11. Leanne K. Casaubon, MD, MSc, FRCPC,
  12. Scientific Advisory Boards:
    1. 1) Non-profit: TEMPO-1 trial DSMB member (trial run through University of Calgary @ Foothills Hospital) (no personal compensation)

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. 1) Commercial: Medtronic; independent neurological assessor for SURTAVI trial; consultant fees; $2000 CAD (over 2 years)

    Speakers' Bureaus:
    1. NONE

    Other activities:
    1. 1) Commercial: NoNO Inc.; site Principal Investigator for FRONTIER trial of NA-1 (no personal compensation)

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  13. Marla Prager, BSc,
  14. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  15. Melissa Stamplecoski, BSc,
  16. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  17. Brennan Rashkovan and
  18. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. NONE

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. NONE

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. NONE

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. NONE

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  19. Peter C. Austin, PhD
  20. Scientific Advisory Boards:
    1. NONE

    Gifts:
    1. NONE

    Funding for Travel or Speaker Honoraria:
    1. NONE

    Editorial Boards:
    1. Associate editor of the journal

    Patents:
    1. NONE

    Publishing Royalties:
    1. NONE

    Employment, Commercial Entity:
    1. NONE

    Consultancies:
    1. consultant to non-profit researchers. Not related to the subject of the paper.

    Speakers' Bureaus:
    1. NONE

    Other Activities:
    1. NONE

    Clinical Procedures or Imaging Studies:
    1. NONE

    Research Support, Commercial Entities:
    1. NONE

    Research Support, Government Entities:
    1. Canadian Institutes of Health Research (CIHR)

    Research Support, Academic Entities:
    1. NONE

    Research Support, Foundations and Societies:
    1. Heart and Stroke Foundation of Canada

    Stock/Stock Options/Board of Directors Compensation:
    1. NONE

    License Fee Payments, Technology or Inventions:
    1. NONE

    Royalty Payments, Technology or Inventions:
    1. NONE

    Stock/Stock Options, Research Sponsor:
    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:
    1. NONE

    Legal Proceedings:
    1. NONE

  1. From the Institute for Clinical Evaluative Sciences (M.K.K., J.F., P.C., M.S., P.C.A.), Toronto; Department of Medicine, Division of General Internal Medicine (M.K.K., S.M.H.A., P.C., A.M.C., M.P.), Institute of Health Policy, Management and Evaluation (M.K.K., S.M.H.A., P.C., A.M.C., P.C.A.), and Department of Medicine, Division of Neurology (L.K.C.), University of Toronto; Division of General Internal Medicine and Geriatrics and Toronto General Research Institute (M.K.K., S.M.H.A., P.C., A.M.C.), Osteoporosis Program and Centre for Excellence in Skeletal Health Assessment (M.K.K., S.M.H.A., A.M.C.), and Department of Medicine, Division of Neurology (L.K.C.), University Health Network, Toronto; and Schulich School of Medicine and Dentistry (B.R.), University of Western Ontario, London, Canada.
  1. Correspondence to Dr. Kapral: moira.kapral{at}uhn.ca
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