June 4, 2019

New research projects to drive clinical adoption of novel cancer technologies and find ways to better deliver cancer services

10 projects to receive funding through OICR-CCO Health Services Research Network

Toronto (June 4, 2019) – The Ontario Institute for Cancer Research (OICR) today announced funding for 10 projects as part of the OICR-Cancer Care Ontario (CCO) Health Services Research Network (HSRN). As part of the HSRN, these projects are focused on optimizing the delivery of existing cancer services and guiding the dissemination of new practices and technologies in cancer prevention, screening and care in Ontario.

The funded projects, which involve 103 researchers and clinicians based at 29 institutions across Ontario, as well as five institutions outside of the province, focus on at least one of six priority areas: using real-world evidence to advance innovations; data infrastructure, integration and mobilization studies; use of artificial intelligence and digital health tools; the adoption of accepted best practices related to precision medicine; knowledge translation and dissemination; and population health studies.

“Improving the delivery of cancer-related healthcare and ensuring that new innovations are properly introduced into clinical use is an essential part of improving outcomes for cancer patients,” says Dr. Christine Williams, Deputy Director and Interim Head, Clinical Translation, OICR. “The projects funded today will help integrate more leading-edge technologies and practices – such as artificial intelligence, immunotherapies and precision medicine – into Ontario’s healthcare system. OICR is proud to help enable improvements in frontline care for the people of Ontario through these projects.”

In total, the projects announced today will receive more than $2.7 million in funding over the next two years. These projects were awarded funding after a competitive process, including review by an expert panel. Together, these projects are a key arm of OICR’s Clinical Translation initiative, which is driving the translation of research findings into patient impact by partnering with the healthcare system.

“I congratulate the researchers who have received funding today and laud their efforts to optimize how we prevent, diagnose and treat cancer in Ontario,” says Hon. Merrilee Fullerton, Ontario’s Minister of Training, Colleges and Universities. “As new technologies and best practices emerge, it is important that Ontario use its research expertise to deliver these advancements to the people as quickly and efficiently as possible.”

For details about the funded projects please visit: https://oicr.on.ca/research-portfolio/health-services-research/

Continue reading – New research projects to drive clinical adoption of novel cancer technologies and find ways to better deliver cancer services

November 22, 2018

Research examines healthcare experience for cancer patients who also have diabetes

Hospital waiting room

Dr. Lorraine Lipscombe investigates why the 20 per cent of cancer patients with diabetes often experience worse outcomes

Several studies show that health outcomes – such as overall survival and preventable hospitalizations – are worse for cancer patients who also have diabetes. However, the reasoning behind this disparity is unclear. Dr. Lorraine Lipscombe, an endocrinologist at Women’s College Hospital and Diabetes Canada Investigator Award holder, is investigating why these differences exist and what we can do to avoid preventable complications.

Continue reading – Research examines healthcare experience for cancer patients who also have diabetes

March 29, 2018

Canada’s largest health research platform teams up with University of Toronto to accelerate cancer and chronic disease research

The leaders of the CPTP stand in front of servers storing the Project's data.

Pictured (left to right): Dr. John Mc Laughlin, Executive Director of CPTP; Cindy Morton, Chief Executive Officer of the Canadian Partnership Against Cancer.; and Dr. Philip Awadalla, National Scientific Director of CPTP.

Canadian Partnership for Tomorrow Project (CPTP) enters a new era of scientific activity under the leadership of newly appointed National Scientific Director, Dr. Philip Awadalla

March 29, 2018 (Toronto) – The Canadian Partnership Against Cancer (“the Partnership”) today announced The University of Toronto’s Dalla Lana School of Public Health will be the new national scientific partner of the Canadian Partnership for Tomorrow Project (CPTP) – Canada’s national population cohort for precision health. This new scientific partner will enable a strong national scientific vision for CPTP and support leading-edge research on the possible causes of cancer and chronic diseases, leading to more made-in-Canada discoveries and breakthroughs. In addition, the University has announced that Ontario Institute for Cancer Research (OICR) will be its strategic partner to deliver the expertise and services needed to lead this key research platform.

Continue reading – Canada’s largest health research platform teams up with University of Toronto to accelerate cancer and chronic disease research

January 5, 2017

Researchers disprove link between vasectomies and prostate cancer using Ontario health data

Doctor holding a tick

Are vasectomies safe? Some recent studies have found a link between vasectomies and the development of prostate cancer later in life. But new research using Ontario health data has challenged these studies and shown conclusively that there is no link, giving new peace of mind to those men who have undergone or are considering undergoing the procedure.

Continue reading – Researchers disprove link between vasectomies and prostate cancer using Ontario health data

June 16, 2016

Study examines mental health in common ethnic minorities in Ontario

Large Group of People

Ethnocultural minorities are more likely to report suffering from mental health issues but are less likely to access treatment, a study out of York University using Ontario Health Study (OHS) survey data has found.

Continue reading – Study examines mental health in common ethnic minorities in Ontario

June 6, 2016

Genomic Data Commons at University of Chicago heralds new era of data sharing for cancer research

Public launch of NCI-funded cancer-knowledge platform will bridge silos and enable broad collaboration among researchers

The Genomic Data Commons (GDC), a next-generation platform that enables unprecedented data access, analysis and sharing for cancer research, publicly launched at the University of Chicago on June 6, opening the door to discoveries for this complex set of diseases.

Continue reading – Genomic Data Commons at University of Chicago heralds new era of data sharing for cancer research

May 17, 2016

Dr. Eva Grunfeld named as Chair of new Canadian Institute of Health Research Institutes Advisory Board on Chronic Conditions

Dr. Eva Grunfield - Bio picture. The Canadian Institutes of Health Research (CIHR) named Professor Eva Grunfeld as the inaugural Chair of the new Institutes Advisory Board (IAB) on Chronic Conditions. In her role, Grunfeld, Giblon Professor and Vice Chair (Research) at the Department of Family and Community Medicine at U of T, will help determine the future directions of research in chronic disease in Canada.

The management and prevention of chronic diseases in Canada represents one of the biggest challenges to our healthcare system

“It’s a great opportunity to contribute to the development of the new IAB structure – the aim of which is to improve integration across CIHR Institutes,” said Grunfeld, who is physician-scientist and Director of the Knowledge Translation Research Network, Health Services Research Program, at the Ontario Institute for Cancer Research. “Particularly with chronic conditions, it’s important to coordinate and cooperate across disciplines, across health conditions, and across research pillars. I’m looking forward to working with the other IAB chairs, IAB and members, and Institute Directors to impact research on chronic conditions in Canada.”

Continue reading – Dr. Eva Grunfeld named as Chair of new Canadian Institute of Health Research Institutes Advisory Board on Chronic Conditions

November 18, 2015

The International Cancer Genome Consortium brings more genomic health data to researchers on the Amazon Web Services Cloud

Toronto – (November 18, 2015) The International Cancer Genome Consortium (ICGC) announced today that 1,200 encrypted cancer whole genome sequences are now securely available on the Amazon Web Services (AWS) Cloud for access by cancer researchers worldwide.

The Ontario Institute for Cancer Research (OICR), which houses the ICGC’s Data Coordination Center (DCC), copied ICGC genome data onto the AWS Cloud and is providing authorized researchers with credentials to access and analyze the data using secure mechanisms. The ICGC Data Access Compliance Office has established a framework that protects the confidentiality of research participants while working to ensure that the research will benefit future cancer patients.

The newly launched initiative means one of the world’s largest collections of cancer genome data is now more easily accessible to qualified researchers, which will enhance collaboration and potentially accelerate the development of new treatments for cancer patients.

Cloud solutions have become essential to genomics research because of the vast amount of data produced by researchers and the difficulties inherent in transferring such large datasets between sites. Projects can quickly grow to several petabytes in size, with each petabyte being the equivalent of data on 223,000 DVDs. Very few institutions around the world have the capacity to download such immense datasets for analysis, and this has limited the number of researchers who can access genome projects and the scope of what can be done with the data.

With cloud computing, researchers don’t need to download data. They can work with data and run experiments in the cloud, a flexible network of servers on the Internet, and access data in minutes rather than months. Data stored in the cloud has been shown to be as secure, if not more so, than data downloaded to local servers and hard drives. The set of 1,200 genomes now available on AWS is the first installment of ICGC data to be posted and is expected to grow several fold over the next 12 months with the addition of data from more cancer patients.

“This initiative brings together one of the world’s largest cancer genome datasets and one of the world’s leading cloud computing providers to create a powerful new resource for cancer researchers,” said Dr. Lincoln Stein, Director of the Informatics and Biocomputing Program at the Ontario Institute for Cancer Research and Director of the ICGC’s Data Coordination Center. “Now, far more researchers will have access to ICGC data, opening up the possibility of new discoveries and new breakthroughs in cancer research.”

The Pan-Cancer Analysis of Whole Genomes (PCAWG) project of the ICGC and The Cancer Genome Atlas (TCGA) is coordinating analysis of more than 2,800 cancer genomes, and is making extensive use of AWS and the genomes stored on Amazon Simple Storage Service (Amazon S3). Each genome is being characterized through a suite of standardized algorithms, including alignment to the reference genome, uniform quality assessment, and the calling of multiple classes of somatic mutations. Scientists participating in the research projects of PCAWG are addressing a series of fundamental questions about cancer biology and evolution based on these data.

“Making this data available and usable will enable more researchers across the world to ask questions and get answers that were previously out of reach,” said Matt Wood, General Manager of Product Strategy at Amazon Web Services, Inc. “Researchers can now explore these large and diverse datasets in unconstrained ways, without having to manage large amounts of physical infrastructure. Instead, they can focus on driving their state-of-the-art research forward.”

“Cancer research is becoming increasingly data-heavy. Compiling the data, organizing the data, analyzing the data, making the data available to all researchers—these are fundamental to making further progress in cancer genome research, and we are excited at the possibilities of working with innovative cloud-based computing systems to achieve these advances,” said Peter Campbell, Head of Cancer Genetics and Genomics at the Wellcome Trust Sanger Institute, who is helping to lead the PCAWG project.

“In the next year, it is estimated that 14 million people worldwide will learn that they have cancer. In order to accelerate our understanding of this disease and ultimately provide better treatment, it is critical that we develop solutions able to meet the scale of this challenge. Co-localizing ICGC data as well as other cancer genomics data sets like The Cancer Genome Atlas with secure and scalable computation resources represents a major step forward for both researchers and patients. With ICGC data available on AWS, we utilized the Seven Bridges platform to perform variant calling on hundreds of genomes weeks faster than would have been possible using local infrastructure,” said Deniz Kural, CEO of Seven Bridges Genomics and Principal Investigator of one of three NCI-funded Cancer Genomics Cloud pilot projects.

“This effort to provide the ICGC datasets on AWS will lower the barriers currently associated with computing on thousands of genomes. Users will have the ability to quickly analyze datasets within the cloud on highly scalable infrastructure. This is a paradigm shift from the old model of slowly downloading data to a user’s local infrastructure before any meaningful work can commence,” said Brian O’Connor, Managing Director of Cloud Computing at the Ontario Institute for Cancer Research.

“The ICGC Data Access Compliance Office (DACO) has been a forerunner in providing controlled, secure, and efficient access to cancer genomic data to members of the research community. It now welcomes the opportunity to further advance research for the benefit of all cancer patients by enabling controlled cloud access to ICGC genomic data stored on AWS. Throughout the process, DACO will implement a robust governance framework to ensure a high degree of privacy protection to patients’ genetic and health data,” said Yann Joly, Data Access Officer, ICGC DACO, McGill University.

“This exciting collaboration and new use for cloud technology is the future of cancer research. Ontario is proud to be part of this initiative through the Ontario Institute for Cancer Research and we look forward to seeing this relationship help cancer patients around the world,” said Reza Moridi, Ontario’s Minister of Research and Innovation.

There are currently 89 ICGC projects underway at research institutes in Asia, Australia, Europe, North America, and South America. These projects seek to identify the genomic drivers of cancer and will help to lay the foundation for developing treatments tailored to patients’ individual needs. The Consortium leads worldwide efforts to map the genomes of both common and rare cancers and has the goal of identifying cancer-causing mutations in more than 25,000 tumours representing more than 50 types of cancer of clinical and societal importance across the globe.

The ICGC develops policies and quality control criteria to help harmonize the work of member projects located in different jurisdictions. Data produced by ICGC projects are made rapidly and freely available to qualified researchers around the world via the cloud and through the ICGC Data Coordination Center at (http://dcc.icgc.org).

For more information and updates about ICGC activities, please visit the website at: www.icgc.org.

November 18, 2015

The International Cancer Genome Consortium brings more genomic health data to researchers on the Amazon Web Services Cloud

Toronto – (November 18, 2015) The International Cancer Genome Consortium (ICGC) announced today that 1,200 encrypted cancer whole genome sequences are now securely available on the Amazon Web Services (AWS) Cloud for access by cancer researchers worldwide.

The Ontario Institute for Cancer Research (OICR), which houses the ICGC’s Data Coordination Center (DCC), copied ICGC genome data onto the AWS Cloud and is providing authorized researchers with credentials to access and analyze the data using secure mechanisms. The ICGC Data Access Compliance Office has established a framework that protects the confidentiality of research participants while working to ensure that the research will benefit future cancer patients.

The newly launched initiative means one of the world’s largest collections of cancer genome data is now more easily accessible to qualified researchers, which will enhance collaboration and potentially accelerate the development of new treatments for cancer patients.

Cloud solutions have become essential to genomics research because of the vast amount of data produced by researchers and the difficulties inherent in transferring such large datasets between sites. Projects can quickly grow to several petabytes in size, with each petabyte being the equivalent of data on 223,000 DVDs. Very few institutions around the world have the capacity to download such immense datasets for analysis, and this has limited the number of researchers who can access genome projects and the scope of what can be done with the data.

With cloud computing, researchers don’t need to download data. They can work with data and run experiments in the cloud, a flexible network of servers on the Internet, and access data in minutes rather than months. Data stored in the cloud has been shown to be as secure, if not more so, than data downloaded to local servers and hard drives. The set of 1,200 genomes now available on AWS is the first installment of ICGC data to be posted and is expected to grow several fold over the next 12 months with the addition of data from more cancer patients.

“This initiative brings together one of the world’s largest cancer genome datasets and one of the world’s leading cloud computing providers to create a powerful new resource for cancer researchers,” said Dr. Lincoln Stein, Director of the Informatics and Biocomputing Program at the Ontario Institute for Cancer Research and Director of the ICGC’s Data Coordination Center. “Now, far more researchers will have access to ICGC data, opening up the possibility of new discoveries and new breakthroughs in cancer research.”

The Pan-Cancer Analysis of Whole Genomes (PCAWG) project of the ICGC and The Cancer Genome Atlas (TCGA) is coordinating analysis of more than 2,800 cancer genomes, and is making extensive use of AWS and the genomes stored on Amazon Simple Storage Service (Amazon S3). Each genome is being characterized through a suite of standardized algorithms, including alignment to the reference genome, uniform quality assessment, and the calling of multiple classes of somatic mutations. Scientists participating in the research projects of PCAWG are addressing a series of fundamental questions about cancer biology and evolution based on these data.

“Making this data available and usable will enable more researchers across the world to ask questions and get answers that were previously out of reach,” said Matt Wood, General Manager of Product Strategy at Amazon Web Services, Inc. “Researchers can now explore these large and diverse datasets in unconstrained ways, without having to manage large amounts of physical infrastructure. Instead, they can focus on driving their state-of-the-art research forward.”

“Cancer research is becoming increasingly data-heavy. Compiling the data, organizing the data, analyzing the data, making the data available to all researchers—these are fundamental to making further progress in cancer genome research, and we are excited at the possibilities of working with innovative cloud-based computing systems to achieve these advances,” said Peter Campbell, Head of Cancer Genetics and Genomics at the Wellcome Trust Sanger Institute, who is helping to lead the PCAWG project.

“In the next year, it is estimated that 14 million people worldwide will learn that they have cancer. In order to accelerate our understanding of this disease and ultimately provide better treatment, it is critical that we develop solutions able to meet the scale of this challenge. Co-localizing ICGC data as well as other cancer genomics data sets like The Cancer Genome Atlas with secure and scalable computation resources represents a major step forward for both researchers and patients. With ICGC data available on AWS, we utilized the Seven Bridges platform to perform variant calling on hundreds of genomes weeks faster than would have been possible using local infrastructure,” said Deniz Kural, CEO of Seven Bridges Genomics and Principal Investigator of one of three NCI-funded Cancer Genomics Cloud pilot projects.

“This effort to provide the ICGC datasets on AWS will lower the barriers currently associated with computing on thousands of genomes. Users will have the ability to quickly analyze datasets within the cloud on highly scalable infrastructure. This is a paradigm shift from the old model of slowly downloading data to a user’s local infrastructure before any meaningful work can commence,” said Brian O’Connor, Managing Director of Cloud Computing at the Ontario Institute for Cancer Research.

“The ICGC Data Access Compliance Office (DACO) has been a forerunner in providing controlled, secure, and efficient access to cancer genomic data to members of the research community. It now welcomes the opportunity to further advance research for the benefit of all cancer patients by enabling controlled cloud access to ICGC genomic data stored on AWS. Throughout the process, DACO will implement a robust governance framework to ensure a high degree of privacy protection to patients’ genetic and health data,” said Yann Joly, Data Access Officer, ICGC DACO, McGill University.

“This exciting collaboration and new use for cloud technology is the future of cancer research. Ontario is proud to be part of this initiative through the Ontario Institute for Cancer Research and we look forward to seeing this relationship help cancer patients around the world,” said Reza Moridi, Ontario’s Minister of Research and Innovation.

There are currently 89 ICGC projects underway at research institutes in Asia, Australia, Europe, North America, and South America. These projects seek to identify the genomic drivers of cancer and will help to lay the foundation for developing treatments tailored to patients’ individual needs. The Consortium leads worldwide efforts to map the genomes of both common and rare cancers and has the goal of identifying cancer-causing mutations in more than 25,000 tumours representing more than 50 types of cancer of clinical and societal importance across the globe.

The ICGC develops policies and quality control criteria to help harmonize the work of member projects located in different jurisdictions. Data produced by ICGC projects are made rapidly and freely available to qualified researchers around the world via the cloud and through the ICGC Data Coordination Center at (http://dcc.icgc.org).

For more information and updates about ICGC activities, please visit the website at: www.icgc.org.

February 26, 2021

Bringing AI-enabled cancer support to life

Text-based online support groups augmented with a new tool for detecting distress

Therapist-led online support groups can provide a safe space for people affected by cancer to discuss fear, normalize stress, build resilience and enhance coping. Cancer Chat Canada offers real time text-based support groups, but therapists who lead these groups often feel challenged to address the needs of each participant in the absence of visual cues. Recent Ontario-made advances in artificial intelligence (AI) may offer potential solutions.

In a paper recently published in JMIR Research Protocols, an Ontario-based research group outlines their new AI-enabled virtual therapy cofacilitator tool for online cancer support groups. The tool uses a machine learning algorithm based on interpreting patterns of speech and language to track support group participants’ progress in real-time, while providing feedback to the leading therapist.

The research initiative was supported by OICR through the OICR-Cancer Care Ontario (Ontario Health) Health Services Research Network, and led by Drs. Yvonne Leung and Mary Jane Esplen, experts in the psychological impact of cancer.

Workflow of how the chatbot works.

“Online support groups are accessible and effective at reducing cancer-related emotional distress, but it can be challenging to monitor individual participant distress and engagement while responding to multiple participants’ messages simultaneously,” says project lead Esplen, Professor and Vice-Chair, Equity and Mentorship in the Department of Psychiatry, University of Toronto and former Lead of the de Souza Institute. “With multiple participants typing at the same time, nuances of text messages and red flags for distress can sometimes be missed. Our tool serves as an AI-enabled cofacilitator that can enhance the therapist’s ability to address these concerns.”

With a tool that can detect and flag issues, therapists could prioritize concerns more effectively, provide more individualized support in real time, and direct treatment accordingly in a timely manner.

In 2020, the research group completed the first phase of their study, during which they developed the AI-enabled cofacilitator tool. Now, in the second phase, they are evaluating the tool’s effectiveness by scoring its ability to accurately output psychometric measures, such as fear, sadness and hopelessness.

“The goal is to visualize emotions and sentiments throughout therapy to make online group therapy more effective,” says first author Leung, who is an Assistant Professor at the University of Toronto. “We believe these tools and technologies can be used to strengthen person-centred care by attending to individual needs and expanding access to high-quality virtual health care. We’re delighted to be in the process of validating such a cutting-edge tool.”

Should effectiveness be demonstrated in their clinical studies, the group plans to integrate their AI-enabled cofacilitator into Cancer Chat Canada’s online psychosocial oncology services, and potentially adapt the cofacilitator algorithm for other cancer-related support services.

“We’re proud of the progress made so far,” says Esplen. “Our team was strategically built to incorporate different areas of expertise and different perspectives. We’ve tested each step along the way, and we look forward to building more tools to enhance patient therapy and care.”

Read more about the OICR-CCO Health Services Research Network on OICR News.

November 13, 2020

How an optimization algorithm can help Ontario detect opportunities for better cancer care

Drs. Katharina Forster, Timothy Chan and Claire Holloway.

Research team develops a Google maps-like algorithm to pinpoint when cancer patients may diverge from the standard course of treatment

Every cancer patient’s experience is unique but there are standard sequences of steps that help patients and their care teams navigate through screening, diagnosis, treatment and monitoring. These steps are published in pathway maps but are these maps followed in practice? Researchers supported by OICR’s Health Services Research Network, led by Drs. Timothy Chan and Claire Holloway, are working to answer that question.

Chan and collaborators at Ontario Health have developed new methods to measure the difference between a standard clinical pathway map and the actual care that a patient receives in practice. They leveraged real-world health data from Ontario patients to develop these methods, which could potentially be used to identify targets for quality-improvement initiatives.

“Pathway maps help optimize patient survival, healthcare costs and wait times at a population level,” says Holloway, co-principal investigator of the project and Provincial Clinical Lead of Disease Pathway Management (DPM) at Ontario Health.

“We have now derived a way to measure the alignment between actual care and the care described in a pathway map, analogous to measuring how a driver’s route differs from the Google Maps-suggested route,” says Chan, co-principal investigator of the project, Professor at the University of Toronto and Canada Research Chair in Novel Optimization and Analytics in Health.

To address this challenge, the team based their algorithm on an inverse optimization framework, a type of framework used to solve problems across a variety of disciplines, including telecommunications routing, medical radiation therapy planning, and investment portfolio management.

The research team first applied their methods to stage III colon cancer patient data and is now applying their methods to breast cancer care. The ultimate goal would be to use these methods across different cancer sites and potentially different diseases to help promote and implement best practices along the care continuum in Ontario’s healthcare system.

“We’re proud to apply our framework at a large scale to help provide meaningful quantitative measures of system efficiency and variation,” says Chan. “It’s exciting to see that these methods could allow Ontario Health to monitor and evaluate complex practice patterns at a population level.”

“Variations between a patient’s experience and the standard clinical pathway map isn’t necessarily a bad thing but it may prompt us to investigate further,” says Dr. Katharina Forster, Team Lead of DPM at Ontario Health. “We can look into why, when and where the variation is occurring.  In this way these new methods and tools are allowing us to generate hypotheses about the causes of variation so we can better understand our care practices, make data-driven decisions and ultimately improve our cancer care system.”

“Ultimately, we’re looking to measure, monitor and improve our system across the province,” says Holloway. “Our rich data in Ontario and our capabilities in machine learning are outstanding. Thanks to OICR, we can bring these disciplines together to make a positive impact on our health system.”

The Health Services Research Network is co-funded by OICR and Cancer Care Ontario, now part of Ontario Health.

August 29, 2019

Addressing high priority issues in cancer care

An image of the report cover. Text: Addressing high priority issues in cancer care

OICR and Cancer Care Ontario’s Health Services Research Network releases the 2019 Synthesis Report, summarizing 14 studies that address high priority issues in cancer care

An excerpt from the foreword by Drs. Christine Williams and Eva Grunfeld:

Optimal cancer care across Ontario cannot be solely provided by a clinician or implemented by a researcher, enacted by a policy maker or attained by a patient. To improve the delivery of cancer services, we need to work together with stakeholders from across our rich cancer care ecosystem and involve them in prioritizing concerns, designing interventions and implementing solutions. For these reasons, OICR and Cancer Care Ontario (CCO) teamed up to co-create the OICR-CCO Health Services Research Network (HSRN).

Now, a decade later, we present our second Synthesis Report with an additional 14 studies that have emerged from this network. These studies have addressed high priority issues in cancer care including the gap in follow up after a positive colorectal cancer screening test, and the challenges that cancer patients face with co-existing chronic conditions like diabetes. The studies have led to the development of new methods to determine the burden of cancer in Ontario, and new resources to facilitate health services research across the province. This report provides summaries of these studies and others and their impact to date.

Read more about the OICR-CCO HSRN.

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