The truth about GMF’s

“Created to improve access, Montreal clinics often turn away patients,” published in the Gazette on February 15, 2017, is a misleading and misrepresentative article. It makes false assumptions and reaches incorrect conclusions.
The article states that “there are 86 family medicine groups in Montreal that rely on government funding to stay open longer than private doctors’ offices.” The author contends that “fewer than half the clinics are actually open seven days a week.”
The reality is GMFs are neither super-clinics nor general walk-ins. They are grouped, private, family medicine practices that offer care to a defined, registered patient population. Emphasis is placed on assiduité, fidélisation and prise en charge. In other words, GMFs prioritize their own patients while super-clinics or GMF-reseau (known previously as cliniques-reseau) are designed primarily for patients who do not have a family doctor.
These distinctions are available at: and
GMFs do not all receive the same funding and are not expected to maintain the same number of operating hours or days. While larger GMFs are open 68 hours/week, smaller GMFs only need to be open 5 or 6 days/week.
Yes – GMF walk-in clinics generally extend appointments to non-registered patients whenever possible. “All” patients can come irrespective of age, gender or medical history. Clinics, doctors, nurses are all working to improve access and help patients in need. But the GMF is not a “general” walk-in clinic – and hasn’t been since their inception in the early 2000s.
At the end of the day, the article should have asked – “can patients obtain timely appointments with their own family doctor?” Bottom line – register with a family doctor.








Update on Measles


Update on Measles
-No cases reported in Canada in 2017
-11 cases reported in Canada in 2016
-In January 2017, 23 people from 6 states (California, Colorado, Florida, New Jersey, New York, and Pennsylvania) were reported to have measles.
-In 2016, 70 people from 16 states were reported to have measles.
• The majority of people who got measles were unvaccinated.
• Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.
• Travelers with measles continue to bring the disease into the U.S. and Canada
• Measles can spread when it reaches a community where groups of people are unvaccinated.
What is Measles?
Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine.
How is it transmitted?
Measles is transmitted via droplets from the nose, mouth or throat of infected persons.
What are the symptoms?
Initial symptoms, which usually appear 10–12 days after infection, include high fever, a runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Can it be severe?
The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhea and related dehydration, and severe respiratory infections such as pneumonia.
Is it still common?
While global measles deaths have decreased by 75 percent worldwide in recent years — from 544,000 deaths in 2000 to 146,000 in 2013 — measles is still common in many developing countries, particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
Can measles be prevented?
Yes. The measles vaccine has been in use since the 1960s. It is safe, effective and inexpensive. WHO (World Health Organization) recommends immunization for all susceptible children and adults for whom measles vaccination is not contraindicated.
What is the global plan?
Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020. WHO is the lead technical agency responsible for coordination of immunization and surveillance activities supporting all countries to achieve this goal.

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  • The Global Vaccine Action Plan (GVAP) ― endorsed by the 194 Member States of the World Health Assembly in May 2012 ― is a framework to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities.
  • GVAP aims to strengthen routine immunization to meet vaccination coverage targets; accelerate control of vaccine-preventable diseases with polio eradication as the first milestone; introduce new and improved vaccines and spur research and development for the next generation of vaccines and technologies.

Recent Measles Outbreaks

  • 2015: The United States experienced a large, multi-state measles outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious. Analysis by CDC scientists linked the virus type to a large measles outbreak in the Philippines in 2014.
  • 2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio.
  • 2011: More than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak.
  • msls2map

Médecine de proximité


“The goal of proximity medicine is to keep as many services as possible within people’s reach.”

Dr. Marie-Dominique Beaulieu, former President of the College of Family Physicians of Canada, presented a compelling vision for Family Medicine at the Dr. Ian McWhinney Lecture last September. Entitled “The perils and the promise of proximity,” Dr. Bealieu issues a sincere wake-up call to family doctors, to move “beyond our current understanding of patient-centered care into the realm of partnerships with patients, wherever they are in their lives or communities.”


“Medicine is coming up against a wall.”

Proximity medicine is not simply geographic access – it is a medical approach “that can take into consideration individuals in their entirety and in their complexity, support them in their journey, and place them at the heart of the health care system.” Dr. Beaulieu laments that “technological developments are distancing us from the knowledge, skills, and know-how we need to cope with the challenges facing us.”

The Four Challenges:
1. action on the social determinants of health;
2. timely access to care;
3. care transitions and service integration; and
4. overdiagnosis and overtreatment—our practice of maximally intrusive medicine.

1. Social determinants of health
“We are not all born equal”
Family physicians need to take specific actions aimed at social determinants and by adopting non-stigmatizing practices. This can be accomplished by applying for income supplements, advocating for change in our communities, supporting resources and fostering social participation. Most importantly, ensuring all services are accessible to all our patients, regardless of their sociodemographic characteristics.
2. Accessibility
“We have built fortified castles around our clinics”
Dr. Beaulieu notes that to many, “the concept of service quality referred primarily to whether practices conformed to guidelines rather than to comprehensiveness, timely access, or continuity of care.” To the contrary, timely access to care is not a luxury, but a necessity – or as she writes, “one of the pillars of the patient’s Medical Home.”
3. Care transitions
“The hospital is part of the community and needs to build bridges with services and professionals outside its walls… How do we persuade hospitals to be part of the proximity medicine community?”
“Fragmentation of care is a scourge, one of the primary causes of gaps in care and medical errors.” Care transitions, whether from home to hospital or hospital to home, need to be seamless.
4. Overdiagnosis and overtreatment: “maximally disruptive medicine.”
“Being a patient has become a full-time job”
Dr. Beaulieu laments that over-testing and over-diagnosis have plunged medicine and society into “a vortex from which we cannot extract ourselves without a drastic change in culture.”
“We offer people increasingly complex treatment plans. We interfere with their work, their leisure, and their lives overall. “
The cure: parsimonious medicine not personalized medicine. Evidence-based approaches that propose interventions that offer real differences for patients. “We need a medicine that truly involves patients as full partners in their own diagnoses and care, which is what proximity medicine is all about. We need darn good clinicians.”  Medicine based on “sound clinical judgment…medicine that tolerates uncertainty.”

In the end, I agree with Dr. Josh Tepper, CEO and President of Health Quality Ontario:



Can Fam Physician. 2016 Dec; 62(12): 964–968.

Further Cuts to Important Services

Please read this powerful article published on CBCNews Montreal about more vital services being cut in our neighborhood…

The Douglas Hospital has suspended a successful program to treat teenagers with serious mental health problems, saying it’s exploring more “cost-effective” options over the next year.

The treatment, called dialectical behavior therapy (DBT), helps patients cope with severe depression, suicidal thoughts, eating disorders and self-harming.

It also includes group therapy and invites parents in to learn how to support and talk to their child.

‘The years from hell’

Andrea, whose last name CBC has agreed to conceal to protect her child’s privacy, said her 16-year-old daughter was part of the last group to go through the program.

She’s devastated other families no longer have access to DBT at the Douglas, which she calls a “miracle” program that “gave us our daughter back.”

“How can the government do this?” asked Andrea. “How can you let these kids just flounder like that?”

Andrea describes 2013 to 2015 as “the years from hell.”

Andrea says the first signs of her daughter’s mental health struggles began in Grade 7, when she became moody and withdrawn, often difficult to coax out of her room. (CBC)

When her daughter Jessica started Grade 7, she became increasingly withdrawn – no longer spending time with her friends and losing interest in everything.

“She just wasn’t her,” said Andrea. “There was no spark in her.”

Jessica had always been a strong student, but her grades started to slip.

A mediocre mark on a test or a critical remark from a teacher could easily send her into a tailspin.

After one of a series of visits to the emergency room at the Montreal Children’s Hospital for suicidal thoughts in May, 2015, Jessica refused to go home.

“I didn’t think I’d be safe if I was at home,” said Jessica. “I did not feel I was strong enough to take care of myself in a way that I should.”

Jessica’s therapist suggested the dialectical behavior therapy program at the Douglas Hospital.

For the first six weeks, Jessica did one-on-one sessions, followed by 20 weeks of group therapy.

“You were in a room, surrounded by people who had things going on that were similar to you, who were feeling ways that you felt and would believe you if you said something,” said Jessica.

“They all understood.”

How DBT works

Together, the teens learn how to identify their triggers and break down potentially stressful situations into smaller steps.

Parents also attend the group sessions to learn new skills which they had to practise at home.

“They really teach you how to talk together again,” said Andrea. “So the bond that was kind of lost has been re-established. I feel we can talk to each other about everything and anything again.”

According to the regional health agency that now administers the Douglas Hospital, the DBT program has helped around 225 teens since 2001.

The Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym CIUSSS de l’Ouest-de-l’Île-de-Montréal) says a decision was made early this year by the DBT team to “temporarily pause” the program for one year, starting last April.

This step was taken in order to “examine new emerging best practices and enhance services provided to the clientele.”

A spokesperson for the CIUSSS de l’Ouest-de-l’Île-de-Montréal refused an interview but said in an email that some DBT services are still available on an individual and family basis.

However, the group portion is “very costly and time intensive” and is no longer being offered. Doctors who usually referred patients to the program were told to hold off this year.

‘We see very significant changes’

One of those doctors, Dr. Lila Amirali, the chief of child psychiatry at the Montreal Children’s Hospital, said she believes the DBT program at the Douglas is the only one of its kind for English-speaking teenagers with severe mood disorders.

Amirali said the combination of individual, group and family therapy is powerful.

“We see very significant changes,” said Amirali.

She said many of the adolescents in the program can go through intense mood swings in the space of a day.

She said some may be the life of the party, then something will happen that will cause them to become very suicidal. The program helps them to learn to use their judgement to make calmer, more sound decisions when they are feeling upset, she said.

“They learn how to adapt better,” said Amirali.

The chief of psychiatry said she wasn’t given any reason for the program’s suspension, but she’s hopeful it will be reinstated next year.

She acknowledges that every hospital is carefully scrutinizing how it uses its resources nowadays.

‘We have her back’

Until the fall, Jessica is still being followed individually by a therapist from the program.

Next month, she’s heading to Philadelphia for a month-long arts program – something that was unthinkable a year ago.

“This year, I am so excited. All I can think about is, just a few more weeks, and I’ll be there,” said Jessica.

Andrea and her husband did pay for private therapy prior to Jessica being admitted to the DBT program, but say the program made a huge difference.

“We have her back,” said Andrea, who no longer worries about what’s happening behind her daughter’s closed door.

Andrea contacted her MNA to raise her concerns about the DBT program’s suspension but was told the same thing: The program is just being put on hold temporarily.

“When people say they put something on pause, it’s never really on pause,” said a skeptical Jessica.

“Chances are, now that this program isn’t happening anymore, it won’t happen again for a long time, which is just terrible because there’s going to be people struggling because of this.”

She and her mother feel they have a responsibility to try and get the program back for other teens who need it right now.

Andrea pleads with the government to reassess its priorities.

“Step up and help these kids,” she said.

Check-ups matter!

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Check-ups matter!

My 15 year old daughter is a skillful debater. We have lively discussions about politics, religion, school, and the Marvel Cinematic Universe. But when she wants to win the debate, she conjures up an obscure reference in a fictitious journal to prove her point – definitively. After all, who can dispute a prestigious scientific publication?

This week, the healthy check-up in Quebec fell victim to a “meta-analysis.“ Experts confidently announced that “medical science no longer recommends these types of exams.“ Even the Minister of Health challenged “What does an annual visit prevent? Nothing.”

Specifically, these experts were citing a 2012 analysis by Lasse T Krogsbøll of the Cochrane Collaboration. His analysis of sixteen randomized studies concluded that “general health checks are unlikely to be beneficial.”

Further words of reassurance were imported from the Maritimes where a media relations advisor for the Nova Scotia Department of Health and Wellness added ““We’re not aware of any concerns or issues since this change (eliminating the health annual check-up) took effect.“

And to allay any final concerns, the experts assured the public that when they “go to (the) doctors at any time for other reasons like an ankle injury or a bad chest infection, …a good doctor will use that opportunity to ask how things are going otherwise.“

With all this seemingly overwhelming scientific evidence condemning the relevance of the health check-up, why are we sad to see it go? Simply – because it shouldn`t.
We increasingly live in a world where human contact for the delivery of services is endangered – and it bothers us. Mail home delivery is threatened, bank branches are not profitable, established brick-and-mortar retail stores are restructuring. Seeing your doctor seemed immune – or at least it felt that it should be. Where else could a person go after accumulating a long “list“ of health problems full of fears, questions and concerns. Dr. Oz? Google? Just like the Crawleys in Downton Abbey, we all want a Dr. Carson to look out for and to look after us and our families. Someone who knows us, listens and cares.

The problem with scientific studies is that they are often misquoted and rarely read. The “definitive“ Cochrane review questioned whether general health checks in adults reduce morbidity and mortality from disease. It did not include geriatric trials. It did not study the value of the doctor-patient relationship. Most of the studies were not conducted in Canada, and according to the authors, “most of the trials were old, which makes the results less applicable to today`s settings because the treatments used for conditions and risk factors have changed.“

To be exact, nine of the fourteen studies included were conducted over thirty-five years ago. The most recent study was initiated twenty-five years ago. That`s like current Habs General Manager Marc Bergevin conducting the 2016 draft based on scouting reports from Sam Pollock and Irving Grundman in the 1970s and 1980s.

The Cochrane Review further qualifies its findings, commenting that “because the majority of the included studies were unblinded with considerable loss to follow-up, analysis of outcomes other than death and hospitalization may be subject to bias.“
Even the Canadian Task Force on the Periodic Health Examination from 1979, purportedly anti- check-up, recommended “ a specific strategy comprising a lifetime health care plan based on a set of age- and sex-related health protection packages.“ Maybe not annually, but more selectively.

Scientific meta-analyses are only as good as the data that is entered. There is lots of talk about the importance of Corsi scores in hockey, but as far as I can tell, neither the Pittsburgh Penguins nor the San Jose Sharks lead the NHL informatics race. Nevertheless, one of these two teams will be raise the Stanley Cup.

Interestingly, if experts are going to quote the merits of the Maritime experience, in which journal has this well-designed experiment been published?

In the end, we are quoting weak medical data from a generation ago, in another jurisdiction, with poor follow-up. None of these studies examine the essence of why general check-ups really matter. Seeing your family doctor on a routine basis fosters a trusting, lasting relationship. It does not exist to order tests; its existence provides comfort and security, knowledge and understanding. Health promotion is not a brochure or a pep-talk: it is a collaborative effort to live better. It is not a sprint, but a marathon.

Honestly, do “experts“ really expect family doctors to do a prostate exam because the patient conveniently limped in with an ankle sprain? Or discuss colorectal screening while the patient is febrile with a bad chest infection?

Air Canada (hopefully) does not wait for the airplane to make funny noises before checking it out. They don`t wait for one wing to fall off before checking the other. Routine maintenance is neither a luxury nor superfluous – it is common sense. Let`s not embrace a crisis-initiated medical model – but improve our efforts towards health promotion. Let`s design a system that rewards doctors for keeping healthy people healthy.

In the end, all the analysis to devalue the annual check-up simply cannot compete with the primal benefit of nurturing a meaningful, trusting, patient-physician relationship. Studies, even “scientific“ ones, need to be understood and properly applied.

Consider the 2003 systemic review of parachute use to prevent death and major trauma related to gravitational challenge published in the prestigious British Medical Journal. Despite a rigorous review, the authors “were unable to identify any randomised controlled trials of parachute intervention.“ As such, they concluded, “the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.”

Please use a parachute – and please continue to see your family physician for general check-ups.

Sun Safety

It’s that time of year – school’s out, La Ronde is open and the sun is shining! So let’s take a look at how to stay safe in the sun!

 Sure there are definite benefits to sunlight:

 – It can help with mood (for example people with seasonal affective disorder have improved mood when they are exposed to sunlight, which is why sunlamps are used for therapy during winter months)

– UVB is an important ingredient for the skin to be able to make Vitamin D (all you need is 15 minutes to a couple hours depending on skin tone and on the amount of skin exposed to make more than 10,000 units of vitamin D!)

– Some skin conditions can improve in sunlight (eg. eczema, psoriasis) which is why PUVA is a treatment sometimes used by dermatologists for people with really severe cases

But don’t forget the risks!

– Dehydration! Heat exhaustion! Heat stroke!

– Sun burn

– Skin damage: sunburns, wrinkles, skin cancer!

– More sun burn

– Damage to eyes leading to cataracts and cancers of the eye

– Even more sun burn

            Ever had a really bad sunburn? It can be excruciating, it can blister and you can even get a fever. It’s not worth missing a few days of summer to sit at home covering yourself in aloe vera. So here’s what you can do to protect yourself!

1) Stay informed!

 – Check out the UV index each day (for example the weather network broadcasts it daily). More than 3? Protect yourself!

2) Avoid the times of day when the suns’ rays are strongest

 – 10am until 2pm is peak sunburn time

3) Wear a hat!!!

– I don’t care if hats don’t suit you. Do it. The tip of your nose will thank you.

4) Wear sunscreen – and wear it properly!

 – Choose broad spectrum sunscreens that cover UVA and UVB rays. Use at least SPF 15, but better to aim for SPF 30. Don’t bother with anything higher than SPF 50, the increase in sun protection is negligible (in fact the FDA is making companies in the US market products as 50+ because the difference between 50, 60, 70 and up is almost zilch!)

 – Put it everywhere and apply liberally

 – Reapply every 2 hours, or more often if you are swimming or sweating

 – Don’t forget the tops of ears, the tops of feet, backs of hands, back of the legs! And double up on the nose!!

5) Wear protective clothing

 – I hated it as a kid but wearing a t-shirt over my bathing suit at the beach saved me from a lot of burns!

6) Check your medications with your pharmacist

 – Some medications (for examples some antibiotics, chemotherapies, diabetes medications, heart medications, diuretics, antidepressants, anti-inflammatories, antihistamines, birth control pills and topical creams) can increase your sensitivity to the sun.

7) Drink LOTS of water – heat exhaustion can sneak up on you. Be on the lookout for warning signs, especially when doing physical activity in the sun.

            – Signs of heat exhaustion are: weakness, fainting, muscle cramps, headache, nausea and vomiting, cool clammy skin and fever

            – It’s important to prevent heat exhaustion by staying cool and drinking lots of water because heat exhaustion can lead to heat stroke, which can be dangerous.

8) And don’t forget about your eyes!

 – Wear sunglasses whenever possible

 – Check that they protect against UVA and UVB rays

What about kids??

All the same advice holds true for kids – but you have to be even more careful. Kids’ skin is extra sensitive to the sun and they are more at risk for getting dehydration and heat stroke.

 Basically follow all the aforementioned rules but BE MORE STRICT with little ones!

And what about babies under 6 months? Well, really they shouldn’t be in the sun. But that’s a lot easier said than done! So keep baby as protected from the sun as possible, remember that babies can burn from reflected sun or even dappled sun. Dress baby in loose, cool clothes and a hat to cover as much skin as possible. And then if you can’t avoid having baby in the sun definitely put a little bit of SPF 30 on only the sun exposed areas (like the hands or feet or face).

For more information check out the following:

The Canadian Pediatric Society

Health Canada

Canadian Dermatology Association


We Walk the Walk……We Talk the Talk

Have you seen Dr. Mike Evan’s video 23 ½ hours?  If not, I urge you to click on the link.  It will change your life.

Ok, now that you have watched it you know what to do.  Why not do it with it us?  Every single day of the work week, weather pending, we walk at lunch time.  The benefit of walking with Group Santé Kildare is that there will always be a healthcare professional walking with you.  Our professionals include nurses, dietitians and over 20 doctors.  Imagine how motivating it would be to walk with people who practice what they preach!

Dr. Mike explains in his video that you don’t even have to do the 30 minutes of walking consecutively.  You can stay fit by doing three 10-minute slots  or two 15-minute session powerwalks.  Keep your intensity at a moderate pace. Your heart rate should be elevated and you are sweating a bit, you can talk but not carry on a whole conversation.    If you are not sure about your pace, you can always sport a heart monitor like the new Fitbit Charge HR.  It also tracks steps taken (10,000/day is ideal), calories burned and quality of sleep. 

Sometimes walking in a group can break the isolation and monotony of walking alone.  Your healthcare professionals will provide a hefty dose of motivation and encouragement.  Come join us!  Bring a water bottle and a good pair of walking shoes. Let’s go!




Is stress really bad for you?

I’m sure we have all heard that stress is bad for you. As a nurse, I have been warning people that chronic stress is bad for your health and can cause cardiovascular disease and cognitive deficits.

But what if we weren’t seeing the whole picture? What if the way we think about stress is what is affecting our health?

That’s the message in the TED talk by Kelly McGonigal, a health psychologist. According to her TED talk individuals who reported high levels of stress in the past year were more likely to die ONLY IF they also perceived stress as bad for you! That means that just changing the way you think about stress can save your life. Rather than view stress as a bad thing think about stress, think of it as a way of your body preparing you to rise to a challenge.

Dr. McGonigal also discussed research that shows the hormone oxytocin (known as the cuddle hormone) is released when we are stressed. This hormone causes us to seek out social support when we are stress and also helps repair the heart muscle from stress related injury. This means that reaching out to people you care about when you are stressed can help protect you against the negative effect of stress.

This TED talk really made me re-think how I think about stress. Check it out! It could change your mind too and save a life!

Pop Quiz

What medical treatment can do all of the following?

  • Decrease knee pain and disability due to arthritis
  • Help control sugar in diabetes
  • Decrease hip fractures in post menopausal women
  • Control high blood pressure
  • Reduce anxiety and depression
  • And improve overall quality of life


If you guys exercise, you are right!

Check out this great video by Dr. Mike Evans called 23 1/2 Hours about the benefits of 30 minutes of daily activity:

The current Canadian Activity Guidelines suggest adults get 150 minutes/week of moderate to vigorous activity and children should get 60 minutes of physical activity a day.  For the full guidelines see the link below:



Is Sugar Addictive?

Lately you hear a lot about how sugar is addictive just like some drugs.  But is there any scientific evidence to prove this?


It turns out that there may be some truth to this.  Studies have shown that sugar and other highly palatable foods can induce rewards and cravings the way some drugs do.  And, although more research is needed in humans, there is clear evidence in non humans that sugar and sweet foods can be even more rewarding than addictive drugs!

I have to say that from my personal experience I can see how sugary foods are addictive!  Staying away takes a lot of willpower.  So what can you do to get over your sugar addiction?

  • Try cutting down your sugar intake slowly, your taste buds will adjust to lower levels of sugar over time and you will crave it less
  • Choose healthy sweet treats.  Try eating fruit instead of the cookie, put some fruit puree on your oatmeal instead of sugar.  Although fruit has sugar it also has fiber that helps slow the digestion so your sugar level doesn’t rise too quickly
  • Try adding protein to each meal.  Healthy protein like lean chicken, nuts, eggs, low fat yogourt, and beans are great.  they help you feel full longer so you won’t be hungry and crave carbs


WebMD has a great slide show with information and tips on sugar addiction.  Check it out:


Reference: Ahmed, S.H., Guillem, K., & Vandaele, Y. (2013). Sugar addiction: pushing the drug-sugar analogy to the limit. Current Opinion in Clinical Nutrition and Metabolic Care, 16 (4), 434–439.