Les directives psychiatriques anticipées (DPA) et le rôle de l’autonomie

Bien que les directives psychiatriques anticipées (DPA) soient ancrées dans l’éthique de l’autonomie, le lien entre les deux reste imprécis. Les DPA sont des documents juridiques qui permettent aux personnes qui vivent avec un problème de santé mentale de spécifier leurs préférences de traitement advenant une incapacité future. Le rapport entre l’autonomie et les DPA a été abordé en termes tant légaux et éthiques que philosophiques, mais il n’a pas été clairement opérationnalisé sur le plan clinique. L’autonomie est une valeur éthique fondamentale qui englobe la notion d’indépendance face à des influences contrôlantes externes, ainsi que la capacité mentale de prendre ses propres décisions. Les personnes qui vivent avec un problème de santé mentale ont parfois besoin d’aide pour bien comprendre leurs droits éthiques et juridiques en matière de choix autonome, alors que les intervenants professionnels doivent être mieux formés quant à l’importance de l’autonomie dans leur pratique clinique. La capacité de consentir au traitement est le préalable d’ordre mental qui assure que les personnes ayant des troubles mentaux sont en mesure de rédiger des DPA en toute connaissance de cause, alors que l’autonomie est la valeur qui leur donne le pouvoir de contribuer à leur rétablissement.Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one’s personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.Aunque las directivas psiquiátricas anticipadas (DPA) se encuentran ancladas en la ética de la autonomía, la relación entre ambas es imprecisa. Las DPA son documentos jurídicos que permiten a las personas que viven con un problema de salud mental especificar sus preferencias de tratamiento en el caso de una incapacidad futura. La relación entre la autonomía y las DPA se aborda en términos tanto legales y éticos como filosóficos, pero no ha sido claramente puesta en operación en el plan clínico. La autonomía es un valor ético fundamental que engloba la noción de independencia frente a las influencias controladoras externas, así como la capacidad mental de tomar sus propias decisiones. Las personas que viven con un problema de salud mental en ocasiones necesitan ayuda para comprender sus derechos éticos y jurídicos en materia de elección autónoma, mientras que los interventores profesionales deben tener una mejor formación en cuanto a la importancia de la autonomía en la práctica clínica. La capacidad de consentir al tratamiento es la condición mental previa que asegura que las personas con trastornos mentales están en condiciones de redactar las DPA con todo conocimiento de causa. La autonomía les otorga el poder de contribuir a su restablecimiento.Apesar das Diretrizes Psiquiátricas Antecipadas (DPA) estarem enraizadas na ética da autonomia, o elo entre os dois ainda é vago. As DPA são documentos jurídicos que permitem às pessoas, que vivem com um problema de saúde mental, especificar suas preferências de tratamento no caso de uma inaptidão futura. A relação entre a autonomia e as DPA foi abordada em termos tanto legais e éticos quanto filosóficos, mas não foi claramente operacionalizada no plano clínico. A autonomia é um valor ético fundamental que engloba a noção de independência diante das influências controladoras externas, assim como a capacidade mental de tomar suas próprias decisões. As pessoas que vivem com um problema de saúde mental precisam, às vezes, de ajuda para compreender bem seus direitos éticos e jurídicos no que diz respeito à escolha autônoma, ao passo que os profissionais devem ser melhor formados quanto à importância da autonomia em sua prática clínica. A capacidade de consentir no tratamento é o requisito de ordem mental que garante que as pessoas que possuem transtornos mentais sejam capazes de redigir suas DPA em conhecimento de causa, já que a autonomia é o valor que lhes dá o poder de contribuir para seu próprio restabelecimento

Hydrodynamic Coupling of Two Brownian Spheres to a Planar Surface

We describe direct imaging measurements of the collective and relative diffusion of two colloidal spheres near a flat plate. The bounding surface modifies the spheres' dynamics, even at separations of tens of radii. This behavior is captured by a stokeslet analysis of fluid flow driven by the spheres' and wall's no-slip boundary conditions. In particular, this analysis reveals surprising asymmetry in the normal modes for pair diffusion near a flat surface.Comment: 4 pages, 4 figure

Ice island thinning : rates and model calibration with in situ observations from Baffin Bay, Nunavut

Funding: Instrument development and fieldwork were supported by the Northern Transportation Adaptation Initiative of Transport Canada, the Polar Knowledge Canada Safe Passage project (no. 1516-065), and Polar Knowledge Canada's Northern Scientific Training Program. Anna J. Crawford received personal funding from the Garfield Weston Foundation, the Natural Sciences and Engineering Research Council (Canada), and Environment and Climate Change Canada.A 130 km2 tabular iceberg calved from Petermann Glacier innorthwestern Greenland on 5 August 2012. Subsequent fracturing generated manyindividual large “ice islands”, including Petermann ice island (PII)-A-1-f, which drifted between Nares Strait and the North Atlantic.Thinning caused by basal and surface ablation increases the likelihood thatthese ice islands will fracture and disperse further, thereby increasing therisk to marine transport and infrastructure as well as affecting thedistribution of freshwater from the polar ice sheets. We use a uniquestationary and mobile ice-penetrating radar dataset collected over fourcampaigns to PII-A-1-f to quantify and contextualize ice island surface andbasal ablation rates and calibrate a forced convection basal ablation model.The ice island thinned by 4.7 m over 11 months. The majority of thinning (73 %) resulted from basal ablation, but the volume loss associated withbasal ablation was ∼12 times less than that caused by arealreduction (e.g. wave erosion, calving, and fracture). However, localizedthinning may have influenced a large fracture event that occurred along asection of ice that was ∼40 m thinner than the remainder ofthe ice island. The calibration of the basal ablation model, the first knownto be conducted with field data, supports assigning thetheoretically derived value of 1.2×10−5 m2∕5 s−1/5 ∘C−1 to the model's bulk heat transfercoefficient with the use of an empirically estimated ice–ocean interfacetemperature. Overall, this work highlights the value of systematicallycollecting ice island field data for analyzing deterioration processes,assessing their connections to ice island morphology, and adequatelydeveloping models for operational and research purposes.Publisher PDFPeer reviewe

Neutrinos and Gamma Rays from Galaxy Clusters

The next generation of neutrino and gamma-ray detectors should provide new insights into the creation and propagation of high-energy protons within galaxy clusters, probing both the particle physics of cosmic rays interacting with the background medium and the mechanisms for high-energy particle production within the cluster. In this paper we examine the possible detection of gamma-rays (via the GLAST satellite) and neutrinos (via the ICECUBE and Auger experiments) from the Coma cluster of galaxies, as well as for the gamma-ray bright clusters Abell 85, 1758, and 1914. These three were selected from their possible association with unidentified EGRET sources, so it is not yet entirely certain that their gamma-rays are indeed produced diffusively within the intracluster medium, as opposed to AGNs. It is not obvious why these inconspicuous Abell-clusters should be the first to be seen in gamma-rays, but a possible reason is that all of them show direct evidence of recent or ongoing mergers. Their identification with the EGRET gamma-ray sources is also supported by the close correlation between their radio and (purported) gamma-ray fluxes. Under favorable conditions (including a proton spectral index of 2.5 in the case of Abell 85, and sim 2.3 for Coma, and Abell 1758 and 1914), we expect ICECUBE to make as many as 0.3 neutrino detections per year from the Coma cluster of galaxies, and as many as a few per year from the Abell clusters 85, 1758, and 1914. Also, Auger may detect as many as 2 events per decade at ~ EeV energies from these gamma-ray bright clusters.Comment: Accepted for publication in Ap

Strong Attraction between Charged Spheres due to Metastable Ionized States

We report a mechanism which can lead to long range attractions between like-charged spherical macroions, stemming from the existence of metastable ionized states. We show that the ground state of a single highly charged colloid plus a few excess counterions is overcharged. For the case of two highly charged macroions in their neutralizing divalent counterion solution we demonstrate that, in the regime of strong Coulomb coupling, the counterion clouds are very likely to be unevenly distributed, leading to one overcharged and one undercharged macroion. This long-living metastable configuration in turn leads to a long range Coulomb attraction.Comment: REVTEX-published versio

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

Like-charge attraction through hydrodynamic interaction

We demonstrate that the attractive interaction measured between like-charged colloidal spheres near a wall can be accounted for by a nonequilibrium hydrodynamic effect. We present both analytical results and Brownian dynamics simulations which quantitatively capture the one-wall experiments of Larsen and Grier (Nature 385, p. 230, 1997).Comment: 10 pages, 4 figure

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

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 4 : criminal recidivism.

OBJECTIVE: To examine criminal recidivism rates of a large sample of people found not criminally responsible on account of mental disorder (NCRMD) in Canada's 3 most populous provinces, British Columbia, Ontario, and Quebec. Public concern about the dangerousness of people found NCRMD has been fed by media attention on high-profile cases. However, little research is available on the rate of reoffending among people found NCRMD across Canadian provinces. METHOD: Using data from the National Trajectory Project, this study examined 1800 men and women in British Columbia (n = 222), Ontario (n = 484), and Quebec (n = 1094) who were found NCRMD between May 2000 and April 2005 and followed until December 2008. RESULTS: Recidivism was relatively low after 3 years (17%). There were interprovincial differences after controlling for number of prior criminal offences, diagnosis, seriousness of the index offence, and supervision by the review boards. British Columbia (10%) and Ontario (9%) were similar, whereas Quebec had almost twice the recidivism (22%). People who had committed severe violent index offences were less likely to reoffend than those who had committed less severe offences. People from the sample were less likely to reoffend when under the purview of review boards, across all 3 provinces. CONCLUSION: The results of this study, along with other research on processing differences, suggest systemic differences in the trajectories and outcomes of persons found NCRMD need to be better understood to guide national policies and practice