Doxorubicin-Based Chemotherapy for the Palliative Treatment of Adult Patients with Locally Advanced or Metastatic Soft-Tissue Sarcoma: A Meta-Analysis and Clinical Practice Guideline

Purpose. To make recommendations for the use of doxorubicin-based chemotherapy in patients with soft-tissue sarcoma

Preparation of Mn-fiber standards for the efficiency calibration of the delayed coincidence counting system (RaDeCC)

Author Posting. © The Author(s), 2010. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Marine Chemistry 121 (2010): 206-214, doi:10.1016/j.marchem.2010.04.009.Precise measurements of the short lived radium isotopes 223Ra and 224Ra by means of the delayed coincidence counting system (RaDeCC) rely on an efficiency calibration of this system using Mn-fiber standards for which radium activities are exactly known. We prepared seventeen different standards by placing Mn-fibers in seawater spiked with various amounts of 227Ac (with 223Ra in radioactive equilibrium), 228Th (in radioactive equilibrium with 232Th and 224Ra) and 226Ra. We tested for quantitative adsorption of 227Ac and 228Th on the Mn-fibers by: (1) measuring 227Ac and 232Th in the residual solutions after preparing the Mn-fiber standards and (2) monitoring their 223Ra and 224Ra activities over a period of ~100 days. In the residual solutions, the activities of 227Ac and 232Th were < 1.0 % and < 5.3 %, respectively, of the activities initially added to the Mn-fibers. Our results indicate that Milli-Q water washing of the Mn-fibers is the major source of our observed losses of thorium. Measurements of 227Ac standards over 1½ years indicate a significant decrease of measurable 223Ra with time prohibiting the long-term use of 227Ac Mn-fiber standards. We found the 224Ra efficiency to be independent of the range of 227Ac, 228Th and 226Ra activities on the Mn-fibers standards used. The efficiency determination for 223Ra, however, may be biased in the case of relatively high 224Ra activities due to insufficient correction of chance of coincidence. Thus we suggest using a single 227Ac Mn-fiber standard for the efficiency determination for 223Ra.M. Charette and H. Dulaiova were supported by a grant from the National Science Foundation (OCE- 0751461)

Intégration et inclusion : interconnexions et oppositions dans deux domaines éducatifs au Québec

Plusieurs systèmes éducatifs dans le monde, comme c’est le cas au Québec, tendent vers l’adoption de politiques d’éducation inclusive qui visent à répondre de façon équitable aux besoins de tous les élèves. Alors que le paradigme d’éducation inclusive concernait initialement les élèves qui présentaient des handicaps ou considérés comme ayant des besoins particuliers, il englobe maintenant d’autres sous-groupes d’élèves, dont les élèves minorisés sur les plans de la diversité ethnoculturelle, religieuse et linguistique. Cet article propose une lecture critique de l’évolution du paradigme de l’éducation inclusive et du concept d’intégration dans deux domaines éducatifs au Québec : celui de l’adaptation scolaire et celui qui concerne la diversité ethnoculturelle, religieuse et linguistique (ERL). L’exploration du chemin parcouru dans les deux domaines éducatifs illustre l’ancrage de l’évolution des concepts dans les débats sociaux, qui eux-mêmes s’articulent selon des courants politiques, des sensibilités particulières de la société, et qui se reflètent dans les pratiques des milieux scolaires. La conclusion invite le milieu de la recherche et les autorités éducatives à contribuer à la clarification des concepts et des paradigmes, en leur rappelant que ces derniers peuvent enfermer les individus et les groupes dans des rapports sociaux parfois teintés de dynamique de domination

Supportive housing and forensic patient outcomes

In Canada, Review Boards are mandated to evaluate individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) on an annual basis and render 1 of 3 dispositions: (a) custody, (b) conditional discharge, or (c) absolute discharge. To promote social reintegration, conditional discharge can be ordered with the condition to live in supportive housing. However, NCRMD accused face great barriers to housing access as a result of the stigma associated with the forensic label. The goal of this study was to evaluate the role of housing in the clinical and criminal trajectories of forensic patients as they reintegrate into the community. Data for this study were extracted from a national study of individuals found NCRMD in Canada (Crocker, Nicholls, Seto, Côté, et al., in press). The present study focuses on a random sample of NCRMD accused in the province of Québec, who were under a conditional discharge disposition during the study period (n = 837). Controlling for sociodemographic, clinical, and criminal variables, survival analysis showed that individuals placed in independent housing following a conditional discharge from the Review Board were 2.5 times more likely to commit a new offense, nearly 3 times more likely to commit an offense against a person, and 1.4 times more likely to be readmitted for psychiatric treatment compared with individuals residing in supportive housing. These results point to the influence housing can have on the trajectories of forensic patients, above and beyond a range of clinical, criminological, and sociodemographic factors

The use of risk and need factors in forensic mental health decision-making and the role of gender and index offense severity

Canadian legislation makes Review Boards (RBs) responsible for rendering dispositions for individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD) after considering public safety, the mental condition of the accused, and his/her potential for community reintegration. We reviewed 6,743 RB hearings for 1,794 individuals found NCRMD in the three largest Canadian provinces to investigate whether items from two empirically supported risk assessment measures, the Historical Clinical Risk Management‐20 and the Violence Risk Appraisal Guide, were considered. Less than half the items were included in expert reports or in RBs' reasons for dispositions, and consideration of these items differed according to gender and index offense severity of the accused. These items included evidence‐based risk factors and/or legally specified criteria: mental health, treatment, and criminal history. These results illustrate the gap between research on risk factors and the integration of this evidence into practice. In particular, we recommend the implementation of structured measures to reduce the potential for clinicians to be unduly influenced by gender and offense severity

Factors associated with review board dispositions following re-hospitalization among discharged persons found not criminally responsible

In the Canadian forensic mental health system, a person found Not Criminally Responsible on account of Mental Disorder (NCRMD) and given a conditional discharge returns to the community while remaining under the jurisdiction of a provincial/territorial Review Board. However, the individual can be re-hospitalized while on conditional discharge, for reasons such as substance use, violation of conditions, or violence. We investigated whether being rehospitalized has an impact on the factors associated with the subsequent Review Board disposition. Persons found NCRMD from the three largest Canadian provinces who were conditionally discharged at least once during the observation period were included in the sample (N=1,367). These individuals were involved in 2,920 disposition hearings; nearly one-third of patients (30%) were re-hospitalized after having been conditionally discharged by the Review Board. The factors examined included the scales of the Historical Clinical Risk Management-20 and salient behavior that occurred since the previous hearing, such as substance use or violence. The greater presence of clinical items resulted in a greater likelihood of a hospital detention decision at the next hearing. The effect was larger for the re-hospitalized group than for the group who successfully remained in the community since the last hearing. The results suggest that dynamic factors, specifically indicators of mental health, are heavily weighted by the Review Boards, consistent with the literature on imminent risk and in line with the NCRMD legislation

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 1 : context and methods

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD–accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD.Les membres du Projet national des trajectoires ont examiné les données longitudinales d’un vaste échantillon de personnes déclarées non criminellement responsables pour cause de troubles mentaux (NCRTM) afin d’évaluer la présence de différences provinciales en matière d’application de la loi, d’étudier les caractéristiques de personnes ayant une maladie mentale grave qui, ayant des démêlés avec la justice, sont déclarées non criminellement responsables, et d’examiner les trajectoires des accusés NCRTM à travers les systèmes de santé mentale et de justice pénale. Le présent document décrit la raison d’être du Projet national des trajectoires et les méthodes utilisées pour recueillir des données au Québec, en Ontario et en ColombieBritannique, les 3 provinces les plus populeuses du Canada et celles où se trouve la majorité des personnes déclarées NCRTM

The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 3 : trajectories and outcomes through the forensic system

Objective : To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions. Method : The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 and April 2005, followed until December 2008. Results : We found significant interprovincial differences in the trajectories of people found NCRMD, including time detained in hospital and time under the supervision of an RB. The odds of being conditionally or absolutely discharged by the RB varied across provinces, even after number of past offences, diagnosis at verdict, and most severe index offence (all covariates decreased likelihood of discharge) were considered. Conclusions : Considerable discrepancies in the application of NCRMD legislation and the processing of NCRMD cases through the forensic system across the provinces suggests that fair and equitable treatment under the law could be enhanced by increased national integration and collaboration.Objectif : Examiner les résultats du processus et des dispositions de la Commission d'examen (CE) pour les personnes déclarées non criminellement responsables pour cause de troubles mentaux (NCRTM) dans les 3 provinces les plus populeuses du Canada. Le Code criminel relève de la compétence du gouvernement fédéral, mais la justice pénale est administrée par les provinces et territoires. Il s'ensuit qu'une personne ayant un trouble mental qui a des démêlés avec la justice et qui est subséquemment placée sous la supervision d'une CE peut connaître différentes trajectoires dans différentes juridictions ou régions ou provinces. Méthode : Le Projet national des trajectoires a permis d'examiner 1800 hommes et femmes déclarés NCRTM en Colombie-Britannique (n = 222), au Québec (n = 1094) et en Ontario (n = 484) de mai 2000 à avril 2005, et de les suivre jusqu'en décembre 2008. Résultats : Nous avons constaté des différences interprovinciales significatives dans les trajectoires des personnes déclarées NCRTM, notamment le temps de détention dans un hôpital et le temps sous la supervision d'une CE. Les probabilités d'une libération conditionnelle ou absolue accordée par la CE variaient entre les provinces, même après examen du nombre d'infractions passées, du diagnostic au verdict, et des infractions répertoriées les plus graves (toutes les covariables réduisaient la probabilité d'une libération). Conclusions : Les écarts considérables dans l'application de la législation NCRTM et dans le traitement des cas NCRTM au sein du système psycho-olégal entre les provinces suggèrent qu'un traitement juste et équitable en vertu de la loi pourrait être amélioré par une plus grande intégration et collaboration nationale