The current issue of The North Shore News volume 22-05 published March 6th, 2026.
Covering North Shore local news, politics, sports and other newsworthy events.

Quebec’s Ministère de l’Environnement, de la Lutte contre les changements climatiques, de la Faune et des Parcs has released the results of its most recent environmental sampling at the Stablex hazardous waste treatment site, concluding that current activities comply with provincial regulations and do not pose a risk to public health.
The findings were made public on February 24, 2026, following repeated requests from Liza Poulin, mayor of Blainville, where the Stablex facility is located.
Joint Sampling in September 2025
According to the ministry, sampling took place over three days, September 9, 10 and 11, 2025. Both ministry officials and representatives of Stablex conducted simultaneous water sampling at 20 different locations across the site.
Samples were collected from groundwater and surface water in a variety of materials and settings, including sand, clay, bedrock and drainage ditches. The ministry subsequently compared its laboratory results with those obtained by the company.
The ministry reported that, with the exception of a chloride-related anomaly already under monitoring, the results were consistent with existing environmental standards. Other variations observed in the data were described as isolated and not concerning. According to the ministry, no similar readings for those elements have been recorded in the past decade.
Regulatory Oversight
Stablex operates a facility specializing in the treatment and stabilization of hazardous industrial residues. Such sites are subject to ongoing environmental monitoring under Quebec law, including groundwater and surface water quality controls designed to detect potential contamination.
The MELCCFP stated that the results of the September 2025 sampling confirm compliance with environmental regulations currently in force. The ministry added that the data indicate the company’s activities do not represent a health risk to nearby populations.
While the announcement affirms regulatory compliance, it also reflects continued public attention surrounding the facility. Municipal officials in Blainville have previously called for transparency and close oversight, particularly in light of broader discussions about waste management capacity and environmental safeguards in the region.
Chloride Monitoring
The ministry acknowledged one anomaly related to chloride levels. Chlorides can originate from various sources, including industrial processes and road salt. Officials noted that the evolution of this parameter is already being tracked, suggesting it does not constitute a newly identified issue.
No additional exceedances or long-term contamination trends were reported.
Ongoing Monitoring
Environmental monitoring at hazardous waste facilities is typically conducted on a recurring basis to ensure that containment systems function as intended and that surrounding soil and water resources remain protected.
The ministry did not indicate any enforcement action or corrective measures resulting from the September sampling campaign. Instead, it emphasized that the observed results align with regulatory thresholds and that no risk to human health has been identified.
Municipal authorities have not announced additional local measures in response to the findings, but the publication of the data follows requests for transparency from the city’s administration.
Further monitoring is expected to continue as part of the ministry’s standard oversight of the site.
The City of Lorraine is inviting residents to take part in the second edition of its community event, “Autour d’un brunch,” scheduled for March 15 at the Centre culturel Laurent G. Belley.
The initiative brings together citizens and members of the municipal council around a shared meal in an informal setting. According to the city, the event is intended to create opportunities for conversation, exchange and connection between elected officials and residents outside of formal council meetings.
While municipal councils typically interact with the public through structured sessions and official consultations, events such as this provide a different format, one centered on accessibility and direct dialogue. By inviting residents to sit down with council members in a relaxed environment, the city is offering a space where questions, concerns and ideas can be discussed more informally.
Organizers describe the Sunday brunch setting as a way to encourage conviviality and strengthen community ties. The event is positioned as a spring gathering, with several time slots offered to accommodate as many participants as possible. This staggered format aims to increase access while maintaining manageable group sizes.
Participation is reserved exclusively for residents of Lorraine. Both adults and children are welcome, reflecting the city’s emphasis on inclusive community activities.
Although the event is social in nature, it also carries civic significance. Opportunities for direct interaction between elected officials and residents can help foster transparency, reinforce trust in local governance and encourage broader engagement in municipal life. In smaller municipalities in particular, such initiatives can contribute to a stronger sense of shared responsibility and belonging.
Additional details, including participation information and available time slots, are available through the city’s official communication channels.
The Centre intégré de santé et de services sociaux des Laurentides, the regional health authority serving the Laurentides region north of Montreal, has formally introduced the president and vice-president of its establishment board of directors, confirming leadership appointments that have been in effect since late 2024.
The organization announced that Rola Helou serves as board chair, while Martin Levac has been named vice-chair. Both bring senior management experience from outside the health institution, reflecting the governance model adopted across Quebec’s public health network.
Governance Background
Under Quebec’s health system structure, CISSS organizations are responsible for coordinating hospital care, long-term care, youth protection, rehabilitation services and community health programs within their territories. Their establishment boards provide oversight, strategic direction and accountability, working alongside executive management.
Rola Helou has been involved in the CISSS des Laurentides governance structure for over a decade. According to the organization, she has sat on its board since 2015 and became chair in October 2024. Her background combines education and public administration. She previously served as executive director of the First Nations Adult Education School Council and has held multiple board roles in the health and social services sector.
Helou holds a master’s degree in education from McGill University and a master’s degree in public administration from the École nationale d’administration publique. She is currently director general of Solution S.O.A.R., a consulting firm.
Martin Levac, the newly appointed vice-chair, has built his career in financial management and risk oversight. Since 2017, he has served as general manager of the Caisse Desjardins du Réseau de la santé, a financial cooperative serving members of Quebec’s health sector. He has worked within the Desjardins network for more than 20 years.
Levac holds a master of business administration from the Université du Québec à Montréal and a digital marketing certification from HEC Montréal. In addition to his professional roles, he is involved in community initiatives, according to the CISSS.
Experience at a Time of Pressure
The appointments come as Quebec’s health institutions continue to face sustained operational and financial pressures. Across the province, CISSS and CIUSSS organizations are navigating workforce shortages, service backlogs and the implementation of reforms aimed at improving access and accountability.
While the Laurentides region has experienced rapid demographic growth over the past decade, health infrastructure and staffing levels have struggled at times to keep pace. Regional facilities, including hospitals and long-term care centres, have reported periodic strain, particularly during winter months when respiratory illnesses increase demand.
Board leadership in this context carries responsibility for overseeing governance, financial stewardship and alignment with provincial directives issued by the Ministry of Health and Social Services. The chair and vice-chair do not manage day-to-day operations, which fall under executive leadership, but they play a key role in strategic oversight and institutional accountability.
In a statement issued by the organization, Benoît Major, associate president and chief executive officer of CISSS des Laurentides, said the complementary experience of the two appointees would strengthen the board’s capacity to support the institution’s mandate of delivering care and services to the region’s population.
Oversight and Public Expectations
Public scrutiny of health governance has intensified in Quebec in recent years, particularly following system-wide challenges exposed during the COVID-19 pandemic and subsequent reform efforts. Boards are expected to demonstrate transparency, ensure responsible use of public funds and contribute to measurable improvements in patient care.
Helou’s prior board experience within the CISSS may offer continuity in governance, while Levac’s background in finance and risk management aligns with broader provincial efforts to reinforce fiscal oversight across health institutions.
Neither appointment signals a shift in operational leadership, but together they complete the current executive and governance structure of the CISSS des Laurentides board.
As the Laurentides region continues to grow and age, the performance of its public health network will remain closely watched by residents and provincial authorities alike. The effectiveness of board governance, including the roles now held by Helou and Levac, will be assessed not by announcements but by outcomes in service delivery, accessibility and financial stability in the years ahead.
The City of Boisbriand has directed residents to updated provincial guidance on keeping domestic birds, warning that allowing chickens and other birds to roam freely on unfenced property is prohibited under Quebec regulations.
In a recent public notice, the municipality referred citizens to information published by Quebec’s Ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec, which oversees animal health and biosecurity across the province. The reminder comes amid the continued presence of avian influenza in Quebec’s wild bird populations.
Confinement Is Mandatory
Under the provincial Regulation respecting sanitary conditions for places where captive birds are kept, domestic birds must be confined at all times. They must be housed inside a building or kept within an outdoor enclosure that prevents them from leaving the owner’s property.
The objective of the rule is to limit contact between domestic birds, such as backyard hens, and wild birds that may carry disease. According to MAPAQ, migratory waterfowl, including wild ducks and geese, pose a particular risk because they can contaminate feed and water sources.
Birds must be fed and watered indoors or through protected feeders and drinkers that prevent access by migratory waterfowl. The use of surface water, such as rainwater, stream water, pond water or other untreated surface sources, is prohibited for drinking or cleaning purposes. Only properly constructed groundwater wells that comply with Quebec environmental regulations may be used.
The rules apply broadly to “captive birds,” a category that includes domestic poultry and certain wild birds kept in captivity for human consumption or whose products are consumed. Examples include chickens, turkeys, ducks, pigeons, quail, guinea fowl, geese, pheasants, ostriches, emus and rheas. Birds may be kept for farming or recreational purposes, but they remain subject to confinement and biosecurity requirements.
An additional restriction states that captive birds may not be kept at the same municipal address as migratory waterfowl.
Avian Influenza in Quebec
The municipal reminder comes as avian influenza, including the H5N1 strain, continues to circulate among wild birds in Quebec. Since April 2022, the virus has spread across multiple regions of the province, according to provincial authorities.
The Canadian Food Inspection Agency, or Canadian Food Inspection Agency, monitors and responds to cases of avian influenza nationwide. The agency has established emergency reporting lines for suspected outbreaks in domestic flocks.
Owners and keepers of birds are urged to closely monitor the health of their animals. Unusual mortality, sudden drops in egg production, respiratory distress, swelling or other signs of illness should prompt immediate consultation with a veterinarian. If veterinary assistance is unavailable, residents are instructed to contact the CFIA’s avian influenza emergency line at 450-768-6763 or call 1-844-ANIMAUX to reach MAPAQ’s reporting centre.
Residents who encounter sick or dead wild birds are also encouraged to report them through provincial channels.
Gatherings Discouraged
Authorities are currently advising against organizing bird gatherings, such as fairs, exhibitions, competitions or auctions. Such events can increase the risk of disease transmission between flocks.
MAPAQ has also published a formal advisory to poultry owners, which municipalities recommend sharing and posting in coops as a reminder of required measures.
A Growing Backyard Trend
Backyard chicken keeping has gained popularity in many Quebec municipalities in recent years, including suburban communities such as Boisbriand. While local bylaws often regulate the number of birds permitted and coop placement, provincial biosecurity rules apply regardless of municipal policy.
The current reminder underscores that bird owners are responsible not only for local compliance but also for adhering to provincial sanitary standards designed to protect both animal and public health.
Although avian influenza primarily affects birds, authorities maintain that rigorous prevention measures are essential to limiting its spread. Confinement, secure feeding practices and avoidance of surface water are considered basic safeguards.
Municipal officials have not announced new local restrictions, but by directing residents to provincial guidelines, Boisbriand is reinforcing that biosecurity obligations remain in force.
As the virus continues to be detected among wild bird populations, provincial authorities emphasize that prevention begins at the coop level.
On February 19, 2026, the City of Deux-Montagnes issued a reminder that may surprise some residents: feeding pigeons is prohibited within municipal limits. The announcement was not framed as a crackdown, but as a public-interest measure aimed at protecting the urban environment, public health, and overall quality of life.
At first glance, the gesture of feeding birds seems harmless, even tender. A retiree scattering crumbs in a park. A child delighted by the flutter of wings. A balcony feeder meant for songbirds. Yet in dense urban settings, small acts accumulate quickly. When food becomes predictable, pigeon populations concentrate. And when pigeons concentrate, consequences follow.
Pigeons, descendants of the rock dove, have thrived in cities precisely because urban landscapes mimic their natural cliffside habitats. High ledges, bridges, and rooftops offer ideal nesting grounds. Human activity provides abundant nourishment. When residents supplement that supply intentionally, reproduction rates rise and flocks expand beyond what the local environment can comfortably absorb.
The most visible effect is physical damage. Pigeon droppings are acidic. Over time, they corrode stone facades, ironwork, roofing materials and drainage systems. In Quebec’s freeze-thaw climate, this degradation accelerates. Gutters clog, water backs up, masonry weakens. What appears as a minor nuisance can translate into significant maintenance costs for property owners and municipalities alike. Historic buildings are particularly vulnerable, as restoration of weathered stone and ornamental detail is expensive and technically complex.
There is also the matter of daily livability. Large flocks generate noise and persistent odors. Balconies and sidewalks become coated in droppings. Seed scattered on the ground attracts not only pigeons but squirrels and other wildlife, compounding the issue. The City notes that even poorly designed bird feeders can inadvertently create feeding stations for pigeons if seeds spill freely or if the structure allows larger birds to perch easily.
Public health considerations further complicate the picture. While the general risk to healthy individuals remains relatively low, accumulations of dried bird droppings can contain bacteria, fungal spores, and parasites. When such material becomes airborne, especially during cleaning or in enclosed areas, exposure pathways increase. Municipalities across Canada have increasingly emphasized prevention rather than reactive sanitation.
The bylaw in Deux-Montagnes extends beyond pigeons. It prohibits residents from feeding or attracting gulls, ducks, squirrels, or other wildlife living freely within city boundaries. Wildlife biologists consistently warn that artificial feeding disrupts natural behavior. Animals may lose their instinct to forage independently, become dependent on human presence, or display more aggressive interactions around food sources. In urban contexts, animals that associate humans with feeding are statistically more likely to enter into conflict situations, outcomes that rarely favor the animal.
Importantly, the City does not dismiss the interest many residents have in bird observation. Small songbirds such as chickadees and goldfinches can still be supported responsibly. The difference lies in feeder design and maintenance. Compact feeders with restricted access and minimal seed spillage significantly reduce the likelihood of attracting pigeons. In this way, urban birdwatching can coexist with ecological balance.
Deux-Montagnes is not alone in reinforcing such measures. Municipalities throughout Quebec and across Canada maintain similar regulations, reflecting a broader shift in urban environmental policy. The emphasis has moved from indulgent coexistence toward structured stewardship. Cities are complex ecosystems where infrastructure, wildlife, and human populations interact continuously. Minor disruptions can ripple outward quickly.
What makes this issue compelling is the contrast between intention and impact. Most individuals who feed pigeons do so out of kindness. They perceive vulnerability, particularly during winter months, and respond instinctively. Yet research on urban pigeon populations consistently demonstrates that cities provide ample food through waste streams and incidental human activity. Supplemental feeding does not rescue pigeons from scarcity; it increases density and accelerates breeding cycles.
Food availability directly influences population growth. In ecological terms, resource abundance determines carrying capacity. By introducing additional food into the system, residents unintentionally shift that balance.
The City’s message, therefore, is less about prohibition than about collective responsibility. Maintaining a healthy urban environment requires coordination. One balcony feeder, if improperly designed, can alter conditions for an entire building. One habitual feeding site can transform a quiet square into a congregation point for dozens of birds.
In modern municipal governance, sustainability is rarely dramatic. It is incremental and preventative. Deux-Montagnes’ reminder serves as a case study in how seemingly benign habits intersect with infrastructure management, environmental stewardship, and public health.
The image of pigeons rising in a flurry from a park bench may feel poetic. But in the calculus of urban life, even poetry has a cost.
The president and chief executive officer of Santé Québec, Geneviève Biron, spent two days in the Laurentides region earlier this month meeting frontline workers, administrators and local partners as part of a broader provincial outreach initiative.
The visit, held February 4 and 5, formed part of Santé Québec’s ongoing regional tour aimed at strengthening dialogue between provincial leadership and healthcare teams across Quebec. Biron was accompanied by members of her executive team and local officials from the Centre intégré de santé et de services sociaux, CISSS, des Laurentides.
Listening to the field
Over the course of the visit, the delegation stopped at several healthcare facilities across the region, including Hôpital de Mont-Laurier, the Centres multiservices de santé et de services sociaux in Rivière-Rouge, Sainte-Agathe and Argenteuil, as well as Hôpital de Saint-Jérôme and Hôpital de Saint-Eustache.
According to Santé Québec, the objective was to engage directly with healthcare professionals and better understand operational realities on the ground. Discussions focused on daily challenges facing medical and support teams, as well as opportunities to improve service delivery in a region characterized by geographic spread and varied community needs.
Since the establishment of Santé Québec, Biron and members of her executive team have made several visits to the Laurentides. The current tour reinforces what officials describe as an effort to maintain close ties with regional networks and ensure that provincial decisions reflect local realities.
Biron emphasized during the visit that strengthening communication between provincial leadership and regional teams is essential to responding effectively to population needs. Health authorities say ongoing exchanges with staff allow both the sharing of best practices and the identification of systemic issues requiring attention.
Regional collaboration
Benoît Major, associate president and chief executive officer of CISSS des Laurentides, highlighted the collaborative framework between the regional network and Santé Québec. He noted that the CISSS is fully integrated within the provincial structure and works daily with the central leadership team to address challenges and improve care delivery.
Officials indicated that such visits serve not only to resolve operational concerns but also to highlight successful initiatives that could be replicated elsewhere in Quebec.
The Laurentides stop followed a similar visit to the Outaouais region. Santé Québec confirmed that the provincial tour will continue in the coming weeks, with the Capitale-Nationale region scheduled as the next destination.
The regional tour, described internally as “À l’écoute du terrain,” is intended to provide senior leadership with direct exposure to frontline realities as Quebec’s public health system continues to evolve under the Santé Québec governance structure.
On a quiet winter evening at the H.J. Hemens Public Library, the Town of Rosemère paused to formally recognize three of its youngest high-performance athletes, each of whom distinguished themselves on provincial, national, and international stages in 2025.
The ceremony, held on February 5, brought together families, municipal officials, and community members to celebrate cyclists Élodie Bédard, snowboard cross athlete Ellie Boudreau, and baseball player Elliot Lacoursière. The event culminated in a symbolic yet meaningful gesture: the signing of Rosemère’s Golden Book, a record reserved for individuals whose achievements become part of the town’s civic memory.
Presiding over the ceremony, Mayor Marie‑Elaine Pitre highlighted the broader significance of the recognition, noting that the athletes’ accomplishments extend beyond medals and rankings.
“These young people embody discipline, balance, and perseverance,” she said, emphasizing their ability to pursue elite-level sport while maintaining their academic commitments.
At just 13 years old, Élodie Bédard has already built an impressive résumé in competitive cycling. A Secondary II student at Académie Ste‑Thérèse, she competes with the Espoirs Laval cycling club and excels across multiple disciplines, including road cycling, track cycling, and cyclo-cross. Her standout performance at the Jeux du Québec in Trois-Rivières earned her four gold medals, while international victories in Belgium and a top-five finish at the Canadian Cyclo-Cross Championships further underscored her rapid rise. She is also a scholarship recipient from the Aléo Foundation, recognizing both athletic and academic excellence.
Ellie Boudreau, also 13, has made her mark in snowboard cross, a discipline known for its technical difficulty and physical demands. Enrolled in the Sport-Études program at École Saint‑Gabriel and competing with Club Survolt Développement Athlétique, she captured national attention with a first-place finish at the Canadian Junior Nationals in the U13 category. Her season also included a provincial championship title and multiple honours at the Gala Québec Snowboard, where she was named female breakthrough athlete of the year.
Fourteen-year-old Elliot Lacoursière rounded out the trio, representing Rosemère on the baseball diamond. A student at Collège Boisbriand, he plays with the Red Sox des Laurentides and was a key contributor to his team’s success in 2025. Their season included gold medals at both the Jeux du Québec and the Nicolet tournament, as well as a silver medal at the Quebec International Baseball Classic. During the ceremony, officials noted not only his on-field performance but also his leadership and team spirit.
The Golden Book itself holds a special place in Rosemère’s institutional life. Traditionally reserved for distinguished visitors and residents who have made notable contributions in various fields, it functions as a living archive of the town’s collective achievements, preserving moments that reflect its values and aspirations.
For the three young athletes, the evening was less about ceremony than affirmation: a public acknowledgment that their dedication, often unfolding far from home at competitions and training facilities, resonates deeply within their community.
As Rosemère continues to invest in youth development, the signatures added on February 5 stand as a reminder that excellence can emerge early, and that local support remains a powerful force behind national and international success.
As temperatures gradually returned to seasonal levels, regional health officials in the Laurentides confirmed that a broad set of winter protection measures had been effectively deployed during the coldest weeks of the season to support people experiencing homelessness.
Throughout the winter, the CISSS des Laurentides coordinated a region-wide response aimed at reducing the risks associated with prolonged exposure to extreme cold. Central to that effort was the distribution of more than 750 emergency winter kits, each containing essential items such as mittens, thermal emergency blankets and hand warmers. These kits were delivered through community partners working directly with vulnerable populations across the territory.
The response also relied heavily on a system of “extreme cold alerts,” which were issued whenever the perceived temperature dropped to −27°C or lower. Since November, more than a dozen alerts were triggered, prompting rapid mobilization among shelters, outreach teams and social service organizations to ensure individuals were not left outdoors in dangerous conditions.
Despite increased pressure on shelter capacity during peak cold periods, regional authorities reported that community organizations remained fully mobilized and were able to accommodate those seeking refuge from the elements.
At the conclusion of the winter response, Benoît Major, Assistant Chief Executive Officer of the CISSS des Laurentides, publicly acknowledged the collective effort behind the initiative, emphasizing the importance of sustained collaboration between institutional services and community-based organizations in safeguarding the health and dignity of people experiencing homelessness.
In parallel with emergency interventions, the health authority had also made available a comprehensive directory of sheltering resources and a regional winter initiatives guide, tools that were used by outreach workers and service providers to direct individuals toward appropriate support.
With winter conditions now behind them, officials pointed to the season’s coordinated response as evidence of the region’s capacity to act quickly and cohesively in the face of extreme weather, underscoring the role of preparedness, partnership and timely intervention in protecting the most vulnerable members of the community.
A health care worker entrusted with the care of vulnerable seniors used his position to secretly photograph elderly patients in deeply degrading circumstances, according to court proceedings in Quebec. The acts, which occurred across multiple regions, have raised serious concerns about oversight, abuse of trust, and patient safety within care settings.
Court records show that the worker, who was employed as a personal support attendant through an agency, admitted to committing voyeurism against seniors under his care between November 2021 and January 2022. The incidents took place in health facilities in the Lanaudière and Laurentians regions, although authorities have not publicly identified the specific institutions involved or the exact number of victims.
During a recent appearance at the Joliette courthouse, prosecutors summarized evidence recovered from the worker’s cellphone. Sixteen photographs were presented to the court, several of which focused on the intimate body parts of elderly patients. Some images were taken while the individuals were asleep, confined to their beds, or standing with the aid of walkers. Eight of the photos depicted patients lying in their own excrement, a detail that underscored the extreme vulnerability of the victims and the humiliating nature of the acts.
The Crown requested the preparation of both a presentence report and a sexological assessment, arguing that a fuller psychological profile is necessary before sentencing. Defence counsel acknowledged that certain elements of the case raise legitimate concerns that warrant closer examination.
Sentencing hearings are expected in the coming weeks.
Prior Sexual Assault in Hospital Corridor
The voyeurism offences occurred shortly after a far more serious crime. In September 2021, while working at a hospital in Saint-Eustache, the same worker sexually assaulted a patient who was lying on a stretcher in an emergency room corridor.
The victim had been admitted due to severe alcohol intoxication and was described in court as extremely weak and unable to protect herself. Evidence showed that the worker assaulted her in full view of the corridor, exploiting both her condition and his role as a caregiver. The victim later reported the incident to a nurse.
In November 2024, François Landry, a judge of the Quebec Superior Court, sentenced the offender to three years in federal prison. In his ruling, the judge emphasized the gravity of the breach of trust, noting that the offender used his hospital employment to commit the crime.
Parole Denied, Deportation Possible
In August of the following year, the Parole Board of Canada denied both day parole and full parole. The Board assessed the offender as presenting a “moderate” risk of reoffending, while also noting a psychologist’s opinion that this assessment might underestimate the true level of risk.
Board members expressed concern over the offender’s lack of accountability. Despite the conviction, he initially continued to deny responsibility while incarcerated. He later acknowledged his actions during a parole hearing, attributing the sexual assault to stress and insisting he had no sexual disorder. The Board rejected this explanation, concluding that his statements appeared designed to improve his chances of release rather than reflect genuine remorse.
The Board also revealed that the offender attempted to leave Canada in the summer of 2023, despite a court order prohibiting travel. He reportedly described the attempted departure as a vacation.
Although the individual holds permanent resident status, he is not a Canadian citizen. As a result, he could face removal from the country on grounds of serious criminality. However, federal authorities have not yet initiated deportation proceedings.
A System Under Scrutiny
The case highlights systemic vulnerabilities in the protection of seniors and hospital patients, particularly when care is outsourced through staffing agencies. It also underscores the lasting harm caused when positions of trust are abused, often out of public view.
As the courts prepare to determine an appropriate sentence for the voyeurism offences, the case continues to reverberate through Quebec’s health care and justice systems, prompting renewed calls for stronger safeguards for society’s most vulnerable patients.