Author: Renee Duncan

Publications Coordinator, Undersea and Hyperbaric Medical Society

The Academy of Underwater Arts & Sciences (AUAS) announces the AUAS/DAN Diving Medicine Scholarship

The Academy of Underwater Arts and Sciences (AUAS) announces the creation of the AUAS/DAN Diving Medicine Research Scholarship. Founded with matching funds from Divers Alert Network (DAN), this annual scholarship will encourage research on topics that expand the body of knowledge of human physiology in the marine environment.

NOGI Logo small“The scholarship was created through a generous initial donation from a NOGI Fellow, and with the matching funds from DAN will support important diving medicine research into the future,” stated Dan Orr, President of theAUAS. This annual scholarship provides financial support of up to $10,000. Requests for information or an application for the AUAS/DAN Diving Medicine Scholarship can be sent to info@auas-nogi.org.

Anyone wishing to make a tax deductible donation to support and expand this scholarship can do so through the Academy’s website: www.auas-nogi.org.

The Academy of Underwater Arts and Sciences is a 501(c)(3) non-profit, international, multidisciplinary organization dedicated to recognizing pioneers and leaders who have had a significant impact on the exploration, enjoyment, safety and preservation of the underwater world. The AUAS is committed to supporting its members as they pass on the stewardship of the sea to future generations. The AUAS recognizes individuals who have made significant career contributions to the sport, the industry and the world through presenting the NOGI Award annually, the oldest and most prestigious award in the diving world.

 

THE UHMS ACCREDITATION COUNCIL ANNOUNCES NEW CRITERIA FOR FACILITY ACCREDITATION WITH DISTINCTION

The Accreditation Council (AC) of the UHMS has formally approved a new set of objective criteria that must be met for a hyperbaric facility to be accredited With Distinction (WD).  There are now nine, differentially weighted focus areas (ranging from 1 to 2 points) that are assessed in making a WD award determination.  For a hyperbaric facility to be accredited WD, the facility must achieve a minimum score of 6 out of the available 10.5 points.  To qualify relative to a given WD criteria, criteria #1-#5 must be actively met at the time of the survey.  For criteria #6-#9, the facility must demonstrate it has met the criteria at some point within the preceding three-year period (within four years for facilities that were previously accredited with distinction).  The UHMS Board of Directors has determined that qualification for criteria #1 shall be mandatory for all facilities considered for WD recognition.  The balance of the required points may be obtained by meeting any combination of the remaining eight criteria.

Note that these new WD criteria will be applied to all accreditation surveys conducted after January 1, 2018.

The new WD criteria and associated point values are as follows:

#1. The hyperbaric facility Medical Director is certified in Undersea and Hyperbaric Medicine by the American Board of Emergency Medicine (ABEM), the American Board of Preventive Medicine (ABPM), or the American Osteopathic Conjoint Committee of Undersea and Hyperbaric Medicine (AOCUHM). (1 point – compliance with this element is mandatory)

#2. Through either direct provision or established formal procedures for inter-facility cooperation, ensure that all patients being seen and treated by the HBO2 facility seeking accreditation are afforded, when medically indicated, timely access to HBO2 therapy on a 24-hour per day, seven-day per week basis. (2 points)

#3. As evidenced by patient treatment records documenting the incorporation of critical care monitoring, ventilator management and/or IV infusion support during the performance of hyperbaric treatments and, concurrently, a review of existing provider credentialing files, the HBO2 facility has an adequately equipped chamber and the appropriately trained and experienced staff to provide HBO2 care to critically ill patients. (1.5 points)

#4. All eligible nurses and technicians providing clinical HBO2 care to patients are CHRN/CHT certified. (1 point)

#5. Active hyperbaric facility engagement in a Quality Improvement program (to include Process Improvement) that is:

  1. Initiated by the hyperbaric facility;
  2. Designed to create improvements in the quality of hyperbaric patient care or safety; and
  3. Evidenced by accumulated metrics, data, or impact assessments from ongoing or completed Quality Improvement projects. (1 point)

#6. Members of the hyperbaric facility deliver HBO2-focused presentations at local, regional, national or international conferences. (1 point)

#7. Hyperbaric medicine-related publication in textbooks, peer-reviewed journals, or other professionally referenced documents. (1 point)

#8. Provision of instruction in Undersea and Hyperbaric Medicine.  To satisfy this criterion, one or more of the following must be in place and exercised on a recurring basis:

  1. An ACGME-approved Undersea and Hyperbaric Medicine Fellowship; or
  2. Educational programs that support clinical rotations, clerkships or electives for students or staff (i.e., physicians, nurses, technologists, respiratory therapists, etc.), so long as the programs have:
  3. A developed course content;
  4. Are approved by the governing body or through a collaborative education agreement with an academic institution; and
  5. Are overseen and presented by qualified instructors (i.e., UHM board-certified physicians, certified hyperbaric registered nurses, certified hyperbaric technologists); or
  6. Educational courses, lectures and presentations that either:
  7. Are ACGME-, NBDHMT- or UHMS-approved for CEU/CME credits in Undersea and Hyperbaric Medicine; or
  8. Provide training that can be applied in support of formal qualification by a UHM certifying board (e.g., ABMS, NBDHMT). (1 point)

#9. Research in the field of hyperbaric medicine that is conducted both:

  1. Under an IRB-approved human use, IACUC-approved animal use or institutionally-approved equipment test and evaluation protocol; and
  2. With the intent to publish or present in UHM professional venues. (1 point)

Direct questions to the Quality Assurance & Regulatory Affairs office of the Undersea and Hyperbaric Medical Society via email at tom@uhms.org or beth@uhms.org; or call +1-210-404-1553, ext 105; fax +1 (210) 404-1535.

 

 

 

UHMS Seeks New Director of Hyperbaric Facility Accreditation Program

After 16 years of dedicated service, Tom Workman, the current accreditation program director, has announced his intention to retire from the UHMS effective January 1, 2018. While he will be missed, his retirement creates an exciting opportunity for a replacement to take the foundation that he created and raise the program to an even higher level. Timing is right, as the entire accreditation process is in transition – a revised manual is in the works, dedicated software to manage various aspects the accreditation program is under development and the geometric growth predicted in the early days is now happening. There is no better way to have an impact on these changes than to be directly involved as they occur.

What will the position offer the new director? Too much to describe in this short announcement, but if you are looking for the opportunity to get directly involved in all aspects of hyperbaric medicine, this might be the right fit for the right person. The director will be engaged with organizations that span our field: the Joint Commission, Det Norske Veritas, the National Board of Diving & Hyperbaric Medical Technology, the American Society of Mechanical Engineers, the National Fire Protection Association, the Baromedical Nurses Association, International Certifications and various federal, state and local organizations that have an impact on our community. The new director will have the honor of getting to know some of the brightest minds in medicine and work directly with a growing pool of the most talented doctors, nurses and technologist in hyperbaric medicine who unselfishly serve as accreditation program surveyors – all of this while serving as an instrument to improve the quality of care and patient safety in hyperbaric facilities across the country.

Primary requirements for the position are a bachelor’s degree or higher; previous health care management experience; hypo/hyperbaric technology experience; knowledge of industry codes and standards; and ever-present computer literacy. A detailed job description will be posted on the UHMS website at http://www.uhms.org, so if you are interested in learning more about this exciting opportunity, do not hesitate to review it. For additional details, please contact John Peters, UHMS Executive Director at jpeters@uhms.org or by calling 877-533-8467, ext 100.

UHMS Members featured in local news story about hyperbaric treatment

UHMS members Dr. Marc Robins and Associate Annette Gwilliam of Intermountain’s Utah Valley Hospital were featured in a local new story on the benefits of hyperbaric oxygen therapy.

The news feature profiled success stories from Eric Anderson and Barbara Allen, both patients of Dr. Robins, who received HBO2 therapy and demonstrated measurable healing. Both were happy to talk about their experiences.

KSL-TV, an NBC-affiliated television station located in Salt Lake City, Utah, ran the story, oddly referring to HBO2 therapy as a ‘bygone’ technology that has regained new life.

UHMS members know hyperbaric oxygen therapy is alive and well. The broadcast does end with the statement that HBO2 is approved for 14 illnesses. So, not so bygone after all.

For the story and to see Marc and Annette on camera, see:

http://www.ksl.com/?sid=43952527&nid=148&title=bygone-navy-technology-used-for-healing-wounds

The Hyperbaric Medicine Department is a UHMS-accredited facility with distinction, the Utah Valley Regional Medical Center Joint Commission-accredited and the Intermountain group a UHMS Corporate Partner.

 

 

RISK MANAGEMENT AND THE USE OF HYPERBARIC OXYGEN CHAMBERS

Special Report from the Safety Committee

TOM WORKMAN and JIM BELL, UHMS Safety Committee

Over the past four decades we have seen a geometric growth in the number of clinical hyperbaric medicine facilities. The numbers have grown, from approximately 27 facilities in the early 1970s to now more than 1,350 hospital-based programs. There is no reliable estimate of the number of non-hospital based facilities in operation. For the most part, facilities that are a part of a healthcare system are well regulated; those in non-healthcare rated occupancies, such as health spas, commercial office buildings and homes, much less so.

Areas of concern

A segment of the community that presents the highest level of concern is based on the use of portable, fabric, low-pressure hyperbaric chambers that do not meet existing safety codes such as the National Fire Protection Association (NFPA) 99, Health Care Facilities Code. These types of chambers, while cleared by the FDA as a Class II medical device,
do not comply with American Society of Mechanical Engineers, Pressure Vessels for Human Occupancy -1 (ASME PVHO-1) hyperbaric chamber design and fabrication code (as required by NFPA 99) nor with the installation and operational requirements mandated in NFPA 99.

A confounding problem is that local authorities having jurisdiction (AHJs) are not aware that these devices are being used in their jurisdiction. When a traditional hyperbaric chamber is installed, installation permits, and other paperwork are required, and accordingly, AHJs are appropriately notified. There is no comparable notification process for these low-pressure chambers, as they are delivered by a commercial carrier (such as FedEx) and require no traditional installation. Plus, they can be operational within 15-30 minutes of receipt. Because of this, there is no mechanism to notify the AHJ of their presence, and thus they routinely operate “under the radar” of the established regulatory community. There are estimated to be more than 10,000 such hyperbaric chambers in use throughout the country.

Additional examples of non-compliance . . .

Other examples of non-compliance to NFPA 99 are numerous. For example, NFPA 99 requires that the exhaust from a hyperbaric chamber be piped to the exterior of the building housing the chamber. These low-pressure chambers, however, vent to the ambient space in the room in which they are located.

Perhaps the most concerning risk is that these chambers are frequently used with oxygen concentrators to increase the concentration of oxygen that the patient breathes while in the chamber. When used in this configuration, the concentration of oxygen inside the chamber often exceeds the NFPA 99 limit of 23.5%. Operation of hyperbaric chambers with atmospheres containing more than 23.5% oxygen requires the patient to be grounded. Patients treated in these portable chambers are rarely, if ever, electrically grounded. This is exacerbated by facility operators who encourage or allow patients to take into the chamber with them their tablet, cell phone, laptop, and similar devices. The use of these types of electrical devices in a hyperbaric chamber is strictly prohibited by NAPA 99.

. . . and a recent example

The death of a young autistic boy from North Carolina (June 9, 2011) might have been avoided had these low-pressure chambers been regulated as required. As noted above, they do not comply with the well-established design and fabrication code, ASME PVHO-1, Safety Standard for Pressure Vessels for Human Occupancy. North Carolina mandates compliance to this code. NFPA 99 mandates compliance to this code. The Life Safety Code (NFPA 101) invokes compliance to the hyperbaric requirements noted in NFPA 99, which also mandates compliance through reference. Therefore, if properly regulated, hyperbaric chambers of this type would not have been allowed to operate in North Carolina.

The National Fire Protection Association recently highlighted the importance of this issue in the January/February issue of its magazine, NFPA Journal. The story, entitled “The Air In There,” provides a general overview of the hazards and challenges associated with hyperbaric chambers and informs local authorities having jurisdiction about the magnitude of the problem while offering suggestions on how to deal with it.

“This is an area of health care that a lot of AHJs may not know that much about,” said Scott Sutherland, executive editor of NFPA Journal. “With these types of facilities proliferating, though, it’s important for AHJs to understand the potential hazards. I think our story does a good job of describing those hazards and of explaining why this is an area of concern right now.”

Read the complete NFPA Journal story at http://www.nfpa.org/news-and-research/publications/nfpa-journal/2017/january-february-2017/features/hyperbaric-chambers

The Food and Drug Administration (FDA) has posted a consumer update – “Hyperbaric Oxygen Therapy: Don’t Be Misled” –  for the use hyperbaric oxygen on its website http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm

It’s a growing concern

A casual search of the internet demonstrates the prolific use of low- pressure fabric chambers for indications that have not been proven. At the time of the posting the FDA had received 27 complaints from consumers over three years about treatment centers promoting hyperbaric chambers for uses not cleared by the agency.

Low-pressure fabric chambers are designed and have an FDA 510(K) premarket notification to be pressurized with air to treat acute mountain sickness. They are not built to ASME PVHO or NFPA 99 codes. However, they are routinely being operated outside of the FDA approval and NFPA codes and standards. The use of these chambers is sometimes referred to as mild hyperbaric oxygen therapy (mHBOT).

From a position of risk management we do not support the use of low-pressure portable fabric chambers for anything other than acute mountain sickness. Clinical hyperbaric oxygen therapy as defined by the Undersea and Hyperbaric Medical Society, Hyperbaric Oxygen Therapy Indications, 13th edition, requires that the patient breathe near 100% oxygen while inside a chamber pressurized to at least 1.5 atmospheres absolute. The low-pressure fabric chambers are not designed to provide this clinical dose of oxygen and pressure. Clinical hyperbaric oxygen chambers need to be designed, manufactured, housed and operated according to the FDA, NFPA and ASME-PVHO codes.

Jim Bell CHT/EMT/CFPS is Chair of the UHMS HBO2 Safety Committee; Tom Workman MS, CAsp, CHT, FAsM is UHMS Director of Quality Assurance and Regulatory Affairs and a dedicated committee member.

 

From the First Quarter 2017 issue of Pressure, the UHMS member newsletter. See the entire open-access document at:

https://www.uhms.org/publications/pressure-online.html

UHMS makes medicare reimbursement paper available to the public

The Hyperbaric Oxygen Therapy Registry (HBOTR) has released an important paper detailing its work in Medicare reimbursement issues, and it is now available to the public.

Go to: https://www.uhms.org/publications/uhm-journal/uhm-journal-ahead-of-print-public.html

“Rapid analysis of hyperbaric oxygen therapy registry data for reimbursement purposes,” a technical paper by Caroline E. Fife, Helen Gelly, David Walker and Kristen Allison Eckert is available as an epub-ahead-of-print download from the Undersea and Hyperbaric Medical Society.

Jointly sponsored by the UHMS and the US Wound Registry (USWR), the HBOTR recently provided national data quickly to the RUC on thousands of patients who underwent HBO2 in order to help establish a fair analysis of the physician work of hyperbaric chamber supervision.

The process is detailed in the paper and will be published in the September-October 2016 issue of Undersea and Hyperbaric Medicine, the journal of the UHMS.

DON’T FORGET THE UHMS LABOR DAY SALE!

Get 20% off all registrations August 29-September 5, 2016, on any educational programs at the UHMS Online Continuing Educational Portal.

Currently, there are more than 14 programs to choose from that include Fast-Tracks, Journal-Based CME and longer Symposiums on hyperbaric medicine, diving medicine and wound care.

Create a free account today!  

Already have an account?  Login any time to register for any of our educational programs.

WWW.COURSES-UHMS.ORG 

For more detailed info, just scroll down to the original release.

Enjoy a thoughtful and educational Labor Day!

UHMS and the US Wound Registry discuss Medicare reimbursement issues

The Hyperbaric Oxygen Therapy Registry (HBOTR) has released an important paper detailing its work in Medicare reimbursement issues.

“Rapid analysis of hyperbaric oxygen therapy registry data for reimbursement purposes,” a technical paper by Caroline E. Fife, Helen Gelly, David Walker and Kristen Allison Eckert is available as an epub-ahead-of-print download to members of the Undersea and Hyperbaric Medical Society. Just log in and go to:

https://www.uhms.org/publications/uhm-journal/uhm-journal-ahead-of-print.html

Jointly sponsored by the UHMS and the US Wound Registry (USWR), the HBOTR recently provided national data quickly to the RUC on thousands of patients who underwent HBO2 in order to help establish a fair analysis of the physician work of hyperbaric chamber supervision.

Medicare reimbursement rates for all physician services are established via a complex methodology utilizing data provided by the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC), which values the “relative work” and practice expense of CPT codes and makes recommendations regarding valuations to the Centers for Medicare and Medicaid Services (CMS).

The authors note: “It is vital that hyperbaric practitioners engage in registry submission if they are to survive the titanic shift in healthcare payment reform under MACRA (Medicare Access & Chip Reauthorization Act of 2015).”

Participation in a Qualified Clinical Data Registry (QCDR) can satisfy the requirement for specialty registry participation under “Meaningful Use” of an Electronic Health Record and counts as 15% of the provider’s total score in MACRA’s Merit Based Incentive Payment System (MIPS). Hyperbaric practitioners who report quality measures through the HBOTR can earn bonus points for the Quality Reporting portion of MIPS (50% of the total score), particularly if they report safety, appropriate use, or outcome quality measures. While no such hyperbaric measures are available in the Physician Quality Reporting System, the UHMS developed hyperbaric safety, outcome, and appropriate use measures in partnership with the USWR, which can be reported through that QCDR and whose data become part of the HBOTR.

To read the paper in its entirety, go to: https://www.uhms.org/publications/uhm-journal/uhm-journal-ahead-of-print.html

Enjoy the fruits of your LABOR with 20% off registration on all UHMS online educational programs August 29-September 5, 2016

Work hard. Save now.

You work hard, and the UHMS would like to reward you with 20% off all registrations August 29-September 5, 2016, on any educational programs at the UHMS Online Continuing Educational Portal.  Currently, there are more than 14 programs to choose from that include Fast-Tracks, Journal-Based CME and longer Symposiums on hyperbaric medicine, diving medicine and wound care.

Benefits of fulfilling your CME/CEU requirements with UHMS Online Education:

  • Work at your own pace and start and stop as you like
  • Receive CME/CEU credit immediately upon completion of the program
  • Access the program anywhere there is an internet connect and supported browser
  • All programs are accredited by UHMS for Physician CME, NBDHMT Category A/B, Nursing/RRT contact hours and MOC for ABPM Physicians
  • Up-to-date content from internationally recognized expert faculty
  • UHMS Members receive significant discounts up to 40%
  • Receive your “12 for 12” recommended hours for less than $150!

Create a free account today!  

Already have an account?  Login any time to register for any of our educational programs!

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Symposium on Hyperbaric Medicine and Wound Management (20 CME/CEU Hours)
Click here to access and purchase the course now

Mayo Clinic Hyperbaric Medicine 2015 (15.50 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 1 (2 CME/CEU hours)
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UHM Journal-Based CME Volume 42, Issue 2  (2 CME/CEU hours)
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UHM Journal-Based CME Volume 42, Issue 3  (2 CME/CEU hours)
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UHM Journal-Based CME Volume 42, Issue 4  (2 CME/CEU hours)
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UHM Journal-Based CME Volume 42, Issue 5  (2 CME/CEU hours)
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UHM Journal-Based CME Volume 42, Issue 6  (2 CME/CEU hours)
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UHM Journal-Based CME Volume 43, Issue 1  (2 CME/CEU hours)
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Fast Track 1: Best Practices in Hyperbaric Medicine and Wound Care: GRADE, CPG’s, Future Research (4 CME/CEU hours)
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Fast Track 2: Wound Care: NPWT, Surgical Treatment of Wounds, Case Studies (4.5 CME/CEU hours)
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Fast Track 3: Diver Fatalities, Fitness to Dive, Stresses in Diving and Case Studies (4.5 CME/CEU hours)
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Fast Track 4: Hyperbaric Facility Operations (Staffing roles, UHMS Accreditation, Practice Models and NFPA Update) (4.5 CME/CEU hours)
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Fast Track 5: Diabetic Foot Ulcers (DFU), Venous Ulcers and Fluorescence Vascular Angiography (FVA) in Hyperbaric Medicine and Wound Care (5.5 CME/CEU hours)
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Accreditation Statement:
The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

*Hours may vary depending on accrediting organization.  Please see table of contents for full designation statements.  Registration costs vary for Associate Members, Regular Members and Non-Members.

Be safe and enjoy this Labor Day!

CUHMA registration is open

Important Notice from CUHMA regarding online meeting registration

It has come to our attention over the past few days that a glitch recently developed in the registration page on our website for the 7th CUHMA Annual Scientific Meeting.  Several people who were trying to register either received a terminal ‘error’ message when they tried to pay, or believe that they have registered and paid, but nothing came through on the website.

Our IT Manager has now corrected the glitch. Although it appears to have affected mainly American registrants, we are uncertain how widespread the problem was. We are therefore, asking anyone who either received the error message, OR did not receive an e-mail confirming their registration for the CUHMA conference, to please contact me at: drdeb1@ns.sympatico.ca. As a result of this glitch, the ASM Planning Committee has decided to extend the 10% early-bird discount on registration for this year’s conference until 27 Aug 2016.

This year’s conference will be held in Vancouver, BC, from 9-11 Sept 2016 at Simon Fraser University’s Segal Building, Harbour Centre.  Please go to our new website: www.cuhma.ca for registration.  Additional information includes:

Conference – This year’s conference will include both a Hyperbaric Medicine Day on Sat, 10 Sept 2016 and a Diving Medicine Day on Sun, 11 Sept 2016.  Morning and afternoon refreshment breaks and lunch are included with registration for the conference.  The final Scientific Program is now available on-line.  Block-bookings for discounted hotels in the area have now expired, however a list of hotels within 10 min walking distance of the conference venue are still listed on our website. In addition to the early-bird discount, current members of CUHMA receive an additional 10% discount on registration.  If you decide to join CUHMA at the time of registration, you will be entitled to this additional discount; membership can be applied for on-line at the same time as registration for the conference.

HETS (Hyperbaric Emergency Team Simulation) Pre-course – Scheduled for Fri, 9 Sept 2016, ‘early-bird’ registration has also been extended to 27 Aug 2016.  This intensive course is designed to meet the demands for certification and Continuing Professional Development in Hyperbaric Medicine. The new Diploma in Hyperbaric Medicine available shortly from the Royal College of Physicians and Surgeons of Canada requires the use of simulation in training.  The HETS course has now been approved for 22.5 MOC Section 3 (FRCPC) and 7.5 Mainpro+ (CCFP) study credits.  The course involves hands-on participation, decision-making skills and expert debriefing for multiple complex scenarios that cover key areas of expertise for both multi-place and mono-place hyperbaric chambers.  Watch an exciting teaser-trailer video of what to expect at:  https://cuhma.ca/events/hets-teaser-trailer. For more information and registration, click: https://cuhma.ca/events/hyperbaric-emergency-team-simulation. The course will be conducted at CESEI, Vancouver General Hospital (not the SFU Harbour Centre conference site).

Tour of Shearwater Research – A unique opportunity to learn more about the development and manufacturing of dive computers, Shearwater Research is offering a tour of their new facility in Richmond, BC on Fri, 9 Sept 2016 from 13.00 – 15.30h. There is no charge for this tour, and transportation will be provided to and from the Segal Building.

Welcome Reception – Hosted by Simon Fraser University at the beautiful Simon Fraser Observatory on Fri, 9 Sept 2016; a full buffet dinner is included courtesy of our hosts. Transportation to and from the Observatory will be provided from the Segal Building Harbour Centre conference site, departing at 18.30h.  The Welcome Reception is included with conference registration, but please indicate during registration whether or not you plan to attend so that we can plan for transportation accordingly.

Dinner & Awards Banquet – Always a highlight of each year’s scientific conference, this event will be held at the Segal Building conference site on Sat, 10 Sept 2016 from 19.00 – 22.00h.  The cost will be $65.00 per person for a unique buffet-style dinner, including wine and door prizes.  A wide variety of starters, entrees and desserts will be available.

Hope to see all of you in Vancouver!

Best regards,

Debbie L. Pestell, MD
Planning Committee, CUHMA 2016 Vancouver
Board of Directors, 2016 President-elect