“An Art, Not a Science” : how do experienced clinicians differentiate autism from psychiatric conditions in adult women?

Introduction. Les femmes autistes sans déficience intellectuelle ni retard du langage ont une meilleure motivation sociale et des capacités langagières plus typiques que leurs homologues masculins. Ceci pourrait expliquer le sous-diagnostic des femmes autistes. Paradoxalement, l’autisme pourrait être surdiagnostiqué chez des populations psychiatriques avec des difficultés sociales. En effet, les critères de diagnostic demeurent assez larges, et cette condition relativement moins stigmatisée que plusieurs troubles psychiatriques. Il existe peu de directives pour les cliniciens hésitant à attribuer les difficultés adaptatives des femmes à (1) de l’autisme, (2) une condition psychiatrique, ou (3) les deux. Les aspects qualitatifs de cette condition, absents des manuels de diagnostic, sont systématiquement identifiés par les cliniciens rompus à l’exercice du diagnostic de l’autisme. Ainsi, notre étude vise à mieux caractériser les difficultés liées à l’évaluation des femmes adultes pour un diagnostic d’autisme, ainsi que les traits, comportements et outils spécifiques utilisés pour différencier l’autisme de conditions psychiatriques. Méthodes. Des entretiens semi-dirigés ont été effectués avec 20 psychiatres et psychologues experts en diagnostic de l’autisme chez les femmes, dans 7 pays différents. La méthode Framework a permis de révéler des thèmes adressant nos objectifs de recherche. Résultats. Selon nos participants, les femmes autistes semblaient avoir appris certaines contingences sociales leur permettant de paraître plus typique, et la question du diagnostic différentiel se posait souvent. Les cliniciens effectuaient donc des entretiens flexibles et longs, et validaient les informations apportées par la personne. Plusieurs des traits cités comme indicatifs de l’autisme reflétaient une connaissance clinique de l’autisme. Le trauma, ainsi que le trouble de personnalité limite, étaient considérés comme particulièrement difficiles à départager de l’autisme. Conclusion. L’évaluation pour autisme chez les femmes adultes présente des problématiques particulières que les cliniciens adressent en utilisant des boites à outils individuelles. Chez cette population, une capacité à proposer des pistes alternatives chez les personnes non-autistes s’étant auto-identifiées au spectre est primordiale.Introduction. Autistic women present with greater social motivation and more typical language abilities than their male counterparts, leaving them vulnerable to misdiagnosis or late diagnosis. Paradoxically, there is concern about potential overdiagnosis of autism in psychiatric populations presenting with social difficulties, as diagnostic criteria remain relatively vague and autism less stigmatizing than many psychiatric conditions. Little guidance exists to guide clinicians when deciding whether to attribute adaptative difficulties in adult women to (1) autism, (2) a psychiatric condition, or (3) both. Research suggests that autism is best reliably identified by expert clinicians having been exposed to a high number of autism cases, who notice qualitative aspects of the condition not included in diagnostic manuals. Thus, we aimed to better characterize the difficulties faced by clinicians in assessing adult women for autism, and the traits, behaviors and tools used to differentiate between autism and psychiatric conditions. Methods. Semi-structured interviews were conducted with 20 psychiatrists and psychologists from 7 different countries, experienced in autism diagnosis of adult women. The Framework Method was used to reveal themes relevant to our research goals. Results. According to participants, autistic women had learned certain social contingencies allowing them to appear more typical, which made differential diagnosis a frequent question. Clinicians recommended long, flexible assessments, and validating the information volunteered by the person. Many traits cited as indicative of autism reflected a clinical knowledge of autism. Trauma and Borderline Personality Disorder were cited as particularly difficult to differentiate from autism. Conclusion. Evaluating for autism in adult women presents with singular challenges which clinicians address using individual toolboxes. In this population, it may be crucial to have the capacity to offer alternative avenues for non-autistic people having self-identified with the spectrum

Reduction of risk for lifestyle diseases: group diet and physical activity intervention in the workplace

Cardiovascular disease is a major cause of death in most Westernised countries. The prevalence of obesity, type 2 diabetes mellitus and cancers is rapidly increasing. Older people with elevated blood lipids, obesity and DNA damage are at high risk of developing these diseases. There is a plethora of research to support the claim that a healthy diet and increased physical activity can reduce the risk of increased body fatness, diabetes and generally improve health. However, most interventions require intensive one to one advice. The aim of this study was to measure the effect of a group approach to advising on changes in lifestyle with particular attention to foods high in fibre. The study spanned a period of 12 weeks with a follow up session at 52 weeks to ascertain sustainability. The study: This study was a 12 week longitudinal intervention study with a follow up after 52 weeks. Measurements of anthropometry (skin folds, girths, weight and height), blood pressure, body fat by bio impedance and fasting blood (lipids, glucose and insulin) were made at weeks 0, 3, 6, 9,1 2 and 52. The participants were asked to complete a food frequency questionnaire and a physical activity questionnaire at each of the 6 measuring sessions and to provide an indication of what the goals that they had set and if they had accomplished them after 9,12 and 52 weeks. Between measurements at weeks 0 and 3 the volunteers were left to follow their usual food and activity pattern. Then as a group they were given a diet and exercise talk and provided with written material and pedometers to increase motivation. After measurement at week 6 they were randomly divided into two groups. The first group (A) were prescribed and provided with kiwifruit at a dose of 100g/30 kg body weight for three weeks while the second group (B) continued with the changes in diet and physical activity. Following measurement at week 9 group A abstained from kiwifruit while Group B added the kiwifruit to their diet and the measurements repeated. After 52 weeks, with only emails as ongoing communication, they were remeasured. Results For this multicultural, relatively middle aged group of 53 staff (28 women, 25 men) of mean age 46 years, measurable and statistically significant metabolic gains were made in the lipid profile over 12 weeks. Total cholesterol, LDL cholesterol, triglycerides and the ratio of total cholesterol to HDL all decreased and HDL increased significantly. Total cholesterol decreased from 5.6(±1.1) mean (±SD) mmol/L at baseline to 5.3(±1.1) mmol/L at week 12 (p<0.001); LDL cholesterol decreased from 3.5(±0.97) mmol/L at baseline to 3.3(±0.94) mmol/L at week 12 (p<0.001); and total cholesterol to HDL ratio decreased from 4.0(±1.1) to 3.7(±0.9) (p<0.001). In the 36 who were measured at 52- week follow- up these changes persisted. With the other outcome measures glucose showed a statistically but not biologically significant decrease over the 12 week period and body composition, blood pressure and insulin showed no significant change. The kiwifruit crossover had no apparent affect on the measures of any of the measurements reported. The participants reported that they increased fruit and vegetable and oily fish consumption and increased physical activity. These increases took place over the initial 12 week period and were maintained over 52 weeks. Conclusion: This study has shown that changes in diet and physical activity can favourably influence blood biochemistry even without accompanying changes in percentage body fat and weight. Furthermore, small, manageable lifestyle changes can result in biochemical changes persisting over 52 weeks

Application of Hydroforming Process in Sheet Metal Formation

This article deals with the theory and application of a hydroforming process. Nowadays automobile manufacturers use high strength sheet metal plates. This high strength steel sheet metal plates are strain hardened in the process of metal forming. With the use of high strength steel, cars are made lightweight, which is intended for low fuel consumption because of high energy prices. Some examples of application of a hydroforming process are simulated with FEM

Pojava pozitivnog i negativnog elastičnog povrata pri savijanju lima od mateijala St1403 u V-alatu

Today there is widespread usage of high strength steels (HSS), and ultra high strength steels (UHSS) in the manufacturing industry. Especially in the automobile industry for the rigid and light weight chassis components made out of high strength steel. During sheet metal forming material undergoes plastic deformations and after the process of forming and taking out of the tool, formed sheet metal plate try to take previous position and elastically deforms. This deformation is called elastic spring-back. Special version of this elastically unloading is called spring-forward. It can be seen in V-die bending with small punch radius, and small punch angle which is shown in this paper.Danas postoji široka upotreba visoko čvrstih i ultra visoko čvrstih čelika u industriji. Posebno u automobilskoj industriji za izradu krutih i laganih komponenti karoserija automobila izrađenih od visoko čvrstih čelika. Tijekom oblikovanja metalnog lima dolazi do plastičnih deformacija i nakon završenog procesa i vađenja izratka iz kalupa oblikovani lim pokušava zauzeti prethodni oblik pri čemu se elastično deformira. Ta deformacija se naziva elastičan povrat. Poseban oblik elastičnog povrata je negativni povrat. Ova pojava se može vidjeti kod savijanja u V-alatu uz mali radijus vrha alata i malen kut žiga, što je pokazano u ovom radu

Statistical analysis of the V-tool bending process parameters in the bending of HC260Y steel

This paper presents statistical analysis of the parameters in the V-tool bending process of the HC260Y steel. Assessment of the mathematical model and analysis of variance (ANOVA) were performed within the design of experiments. The hydraulic testing machine Amsler and the developed V-tool were used in the experiments

Mechanical clinching process stress and strain in the clinching of EN-AW5754 (AlMg3), and EN AW-5019 (AlMg5) metal plates

This paper presents the results of Finite Element Method numerical simulation performed onEN-AW5754(AlMg3), EN AW-5019 (AlMg5) plates subjected to mechanical clinching. The goal was to observe differences between aluminum plates in the same tool; and to determine the possibility of using the constructed tool for the clinching of Al-Al material combinations. This tool construction is to be produced and tested in laboratory conditions, to elaborate prospective results, and reach additional conclusions

Statistical analysis of the V-tool bending process parameters in the bending of HC260Y steel

This paper presents statistical analysis of the parameters in the V-tool bending process of the HC260Y steel. Assessment of the mathematical model and analysis of variance (ANOVA) were performed within the design of experiments. The hydraulic testing machine Amsler and the developed V-tool were used in the experiments

Pojava pozitivnog i negativnog elastičnog povrata pri savijanju lima od mateijala St1403 u V-alatu

Today there is widespread usage of high strength steels (HSS), and ultra high strength steels (UHSS) in the manufacturing industry. Especially in the automobile industry for the rigid and light weight chassis components made out of high strength steel. During sheet metal forming material undergoes plastic deformations and after the process of forming and taking out of the tool, formed sheet metal plate try to take previous position and elastically deforms. This deformation is called elastic spring-back. Special version of this elastically unloading is called spring-forward. It can be seen in V-die bending with small punch radius, and small punch angle which is shown in this paper.Danas postoji široka upotreba visoko čvrstih i ultra visoko čvrstih čelika u industriji. Posebno u automobilskoj industriji za izradu krutih i laganih komponenti karoserija automobila izrađenih od visoko čvrstih čelika. Tijekom oblikovanja metalnog lima dolazi do plastičnih deformacija i nakon završenog procesa i vađenja izratka iz kalupa oblikovani lim pokušava zauzeti prethodni oblik pri čemu se elastično deformira. Ta deformacija se naziva elastičan povrat. Poseban oblik elastičnog povrata je negativni povrat. Ova pojava se može vidjeti kod savijanja u V-alatu uz mali radijus vrha alata i malen kut žiga, što je pokazano u ovom radu

Engaging Ethical Issues Associated with Research and Public Health Interventions During Humanitarian Crises: Review of a Dialogic Workshop

Compte-rendu / ReviewLe 7 novembre 2014, l’atelier intitulé Humanitarian Health Ethics Workshop a été tenu à l’Université McGill, à Montréal. Hébergé conjointement par le Consortium de recherche sur l’équité en santé de Montréal et le Humanitarian Health Ethics Network, l’événement comprenait six présentations et une discussion extensive entre les participants, incluant des chercheurs du Canada, de Haïti, de l’Inde, de la Suisse et des États-Unis. Les participants étaient de diverses disciplines, soit l’anthropologie, la bioéthique, la médecine, l’ergothérapie, la philosophie, la physiothérapie, les sciences politiques, l’administration et la santé publique. L’objectif de l’atelier était de créer un forum de discussion entre experts et praticiens qui s’intéressent à l’éthique dans la prestation de soins de santé, en recherche et dans les interventions de santé publique en cours de crise humanitaire. Ce compte rendu résume les présentations, les thèmes clés qui ont émergé des discussions de la journée et identifie des pistes de recherches futures.On November 7th, 2014 the Humanitarian Health Ethics Workshop was held at McGill University, in Montreal. Co-hosted by the Montreal Health Equity Research Consortium and the Humanitarian Health Ethics Network, the event included six presentations and extensive discussion amongst participants, including researchers from Canada, Haiti, India, Switzerland and the US. Participants had training in disciplines including anthropology, bioethics, medicine, occupational therapy, philosophy, physical therapy, political science, public administration and public health. The objective of the workshop was to create a forum for discussion amongst scholars and practitioners interested in the ethics of healthcare delivery, research and public health interventions during humanitarian crises. This review is a summary of the presentations given, key themes that emerged during the day’s discussions, and avenues for future research that were identified

Carl Schmitt, Jurista das Forças armadas: O Estado militar prussiano contra O Estado de direito burguês

Staatsgefüge und Zusammenbruch des Zweiten Reiches. Der Sieg des Bürgers über den Soldaten é um livro desconhecido de Carl Schmitt, enquanto ele é o mais revelador de suas paixões políticas. O jurista analisa o constitucionalismo alemão do Século 19 com a intenção de descobrir as causas do defeito de 1918. Os princípios da democracia ocidental tomam de assalto a constituição bismarckiana que era ela mesma um compromisso com esta democracia ocidental. Através da história e do direito constitucional wilhelmianos, ele quer mostrar como o trabalho destruidor do liberalismo contra o Estado militar provocou o afundamento do 2º Reich