Psychodynamic aspects of communication skills training: a pilot study

Goals of work:: Communication between patients and oncology clinicians is a key element of cancer care. Emotionally charged consultations may trigger clinicians' defense mechanisms, protecting them from painful emotions. Defense mechanisms, however, may also hamper the recognition of patients' suffering. This pilot study aims to explore clinicians' defense mechanisms observed in communication skills training (CST). Patients and methods:: A verbatim transcription of videotaped interviews with simulated patients were evaluated before (N = 10) and after CST (N = 10) with the defense mechanism rating scales (DMRS). Main results:: A wide variety of defense mechanisms were observed such as obsessional (e.g. intellectualisation) or disavowal (e.g. denial or projection). Immature defense mechanisms decreased after CST. Conclusions:: A wide variety of defense mechanisms are operant in oncology clinicians facing challenging interviews with simulated patients. Defense mechanisms may be modified by CS

Leveraging study of robustness and portability of spoken language understanding systems across languages and domains: the PORTMEDIA corpora

International audienceThe PORTMEDIA project is intended to develop new corpora for the evaluation of spoken language understanding systems. The newly collected data are in the field of human-machine dialogue systems for tourist information in French in line with the MEDIA corpus. Transcriptions and semantic annotations, obtained by low-cost procedures, are provided to allow a thorough evaluation of the systems' capabilities in terms of robustness and portability across languages and domains. A new test set with some adaptation data is prepared for each case: in Italian as an example of a new language, for ticket reservation as an example of a new domain. Finally the work is complemented by the proposition of a new high level semantic annotation scheme well-suited to dialogue data

Revue des réglementations applicables au stockage et au transport des matières dangereuses au Québec

Industrial activity requires the production and the use of dangerous goods in the chemical plants. It also requires their transport between these installations. These products induce risks on the plants sites, but also between them, because of their transport while passing by the temporary storage sites and the loading and unloading activities. This report presents a review of regulations applicable to storage, handling, and transportation of dangerous goods in Quebec. These various laws/regulations will force the logistic choices of the companies which produce, use or transport dangerous goods (for example, obligation of a transport mode for particular dangerous goods, threshold quantity imposed for storage, obligation to transport, etc…). Thus, in the first part, we analyzed the regulations concerning public safety, environment, transport and work safety and security. We also flew over the American regulations taking into account the proximity of Canada with this country and the importance of north-south transport flow. In the second part of this report, we were more interested to explain the possible similarities, disparities and contradictions between each analyzed regulation. The complete version of this publication is confidential. NOTE This research was carried out within the framework of the research project GLOBAL. The objective of the “GLOBAL” research project set up by INERIS (National Institute of the Industrial Environment and the Risks) in France is to develop a methodology to evaluate the risk of storage and transportation of dangerous goods. Actually, industrial activity requires the production and the use of dangerous goods in the chemical plants. It also requires their transport between these installations. These products induce risks on the plants sites, but also between them, because of their transport. Today, regulations constrain on one hand chemical plants to minimise their risks and on the other hand the transport of dangerous goods. This is in this context that the present GLOBAL project will examine how the logistic strategies of the industrialists can influence the risks due to the transport of dangerous goods. For example, by minimising the quantities stored in the fixed installations, does one increase the risks due to transport and in this case, up to what extent? Thus the main objectives of the research are: first to examine new risks assessments methods in order top provide harmonised quantification of the chemical risks and to propose possible policies for the global decrease of risks. The collaboration of the CIRANO and the École Polytechnique de Montréal to the GLOBAL project consist, on the one hand, of several operations performed jointly with INERIS (our team taking care of the application in Quebec of these operations): Description of the activities of storage and transportation of dangerous goods (meetings with actors of the logistics chain of dangerous goods + survey by questionnaires) (operation A). Review of regulations applicable to the storage and transportation of dangerous goods (operation B); Review of existing databases on the accidents implicating dangerous goods (operation C); In addition, our team will work on the two following research themes: Economic evaluation of the costs of the transport of dangerous goods Analysis of the logistic strategies in a context of storage and transport of dangerous goods and economic incentive. It consist actually in trying to understand which are the costs associated with transport of dangerous goods and on the other hand understand the arbitration made by facilities in their logistic strategies, for example, transport versus storage but also in the choices of carriers, choice of itineraries, choice of transport mode,…. We would like to measure the economic cost of the transport of the dangerous goods, to know the factors which influence the logistic choices (for example, necessary training of the workers, working conditions, history of accidents, comparison of the amount of CSST premium, reputation of the carriers, etc.) and to evaluate if the fact of having a total knowledge of the risk (storage and transport) and of its potential impacts would modify the global decisions. The purpose is to study a few cases which might induce a transfer of risk from the fixed installations towards freight vehicles of dangerous goods, for example by decreasing the quantity stored in the fixed installations and by increasing the quantity stored temporarily in the bulks. It will consist in understanding the mechanisms of the transfer, judging their interest and their disadvantages, finding means of avoiding them if the disadvantages are significant, and then considering solutions of global management of the dangerous goods. This report presents the operation B of the GLOBAL project, i.e. “Review of regulations applicable to storage, handling, and transportation of dangerous goods in Quebec” (regulations concerning public safety, environment, transport and work safety and security). L’activité industrielle nécessite la production et l’emploi de matières dangereuses mais aussi le transport de celles-ci entre les installations fixes. Ces matières représentent donc des risques sur les sites industriels mais également entre ces sites du fait de leur transport en passant par les installations de stockage temporaire et les activités de chargement et de déchargement. Ce rapport dresse un état des lieux des réglementations qui s’appliquent au stockage, à la manipulation et au transport de matières dangereuses au Québec. Ces différentes lois/réglementations vont contraindre les choix logistiques des entreprises qui produisent, utilisent ou transportent des matières dangereuses (par exemple, obligation d’un mode de transport pour certaines matières dangereuses, quantité seuil imposée pour le stockage, obligation de transporter, etc…). Ainsi, dans un premier temps, nous avons analysé les réglementations touchant la Sécurité Publique, l’Environnement, le Transport et la Santé Sécurité au Travail. Nous avons survolé également les réglementations américaines compte tenu de la proximité du Canada avec ce pays et surtout de l’importance des flux de transport Nord/Sud. Dans un second temps, nous nous sommes intéressés davantage à expliquer les éventuelles concordances, disparités et contradictions entre chacune des réglementations analysées.) La version complète de ce rapport est confidentielle. NOTE Cette recherche a été effectuée dans le cadre du projet de recherche GLOBAL. L’objectif du projet de recherche « GLOBAL » mis en place par l’INERIS (Institut National de l’Environnement Industriel et des Risques) en France est de développer une méthodologie d’évaluation des risques permettant de prendre en compte globalement les risques liés au stockage et au transport des marchandises dangereuses. Cette méthode devrait permettre d’évaluer les effets des mesures prises en tenant compte des effets induits éventuels. Elle permettra aussi de donner une base plus objective aux décisions publiques en matière de maîtrise des risques technologiques (mesure de l’impact et des effets d’une réglementation existante, mise en place d’une nouvelle réglementation, « coordination » des réglementations existantes sous différents ministères – par exemple, Sécurité Publique, Transport, Santé, Environnement). La collaboration du CIRANO et de l’École Polytechnique de Montréal au projet « GLOBAL » de l’INERIS porte d’une part sur plusieurs opérations effectuées conjointement (notre équipe se chargeant de l’application québécoise de ces opérations) : Description des activités de stockage et de transport des matières dangereuses (rencontres des acteurs de la chaîne logistique de MD + enquête par questionnaires) (opération A); Revue des réglementations applicables au stockage et transport des matières dangereuses (opération B); Revue des bases de données existantes sur les accidents impliquant des matières dangereuses (opération C). D’autre part, notre équipe se chargera des deux volets de recherche suivants : Évaluation économique des coûts du transport de matières dangereuses; Analyse des stratégies logistiques dans un contexte de stockage et de transport de matières dangereuses et incitations économiques. D’une manière générale, il s’agira d’essayer de comprendre quels sont les coûts associés au transport de matières dangereuses et l’arbitrage fait par les entreprises dans leurs choix de stratégies logistiques, d’une part transport versus stockage mais aussi dans les choix des transporteurs, choix des itinéraires, choix du mode de transport,.... Nous allons chercher à savoir comment mesurer le coût économique du transport des produits dangereux et identifier quels sont les facteurs qui influencent les choix logistiques et si le fait d’avoir une connaissance globale du risque (stockage et transport) et de ses impacts potentiels modifierait les décisions. Cette analyse économique des stratégies logistiques des entreprises (contraintes et choix) devrait permettre de mettre en évidence les incitatifs (par le biais ou non de la réglementation) qui permettraient l’atteinte d’un optimum global (coût et risque minimisés). Ce rapport présente l’opération B du projet GLOBAL, c'est-à-dire la revue des réglementations applicables au stockage et au transport des matières dangereuses au Québec (réglementations touchant la Sécurité Publique, l’Environnement, le Transport et la Santé-Sécurité au Travail).dangerous goods, transport, storage, regulations, logistic, strategy, matières dangereuses, transport, stockage, réglementations, logistique, stratégie

13C—methyl formate : observations of a sample of high mass starforming regions including Orion—KL and spectroscopic characterization

We have surveyed a sample of massive star-forming regions located over a range of distances from the Galactic centre for methyl formate, HCOOCH3, and its isotopologues H13COOCH3 and HCOO13CH3. The observations were carried out with the APEX telescope in the frequency range 283.4-287.4 GHz. Based on the APEX observations, we report tentative detections of the 13C-methyl formate isotopologue HCOO13CH3 towards the following four massive star-forming regions: Sgr B2(N-LMH), NGC 6334 IRS 1, W51 e2 and G19.61-0.23. In addition, we have used the 1 mm ALMA science verification observations of Orion-KL and confirm the detection of the 13C-methyl formate species in Orion-KL and image its spatial distribution. Our analysis shows that the 12C/13C isotope ratio in methyl formate toward Orion-KL Compact Ridge and Hot Core-SW components (68.4±10.1 and 71.4±7.8, respectively) are, for both the 13C-methyl formate isotopologues, commensurate with the average 12C/13C ratio of CO derived toward Orion-KL. Likewise, regarding the other sources, our results are consistent with the 12C/13C in CO. We also report the spectroscopic characterization, which includes a complete partition function, of the complex H13COOCH3 and HCOO13CH3 species. New spectroscopic data for both isotopomers H13COOCH3 and HCOO13CH3, presented in this study, has made it possible to measure this fundamentally important isotope ratio in a large organic molecule for the first time.This work was supported by the National Science Foundation under grant 1008800. We are grateful to the Ministerio de Economia y Competitividad of Spain for the financial support through grant No. FIS2011-28738-C02-02 and to the French Government through grant No. ANR-08-BLAN-0054 and the French PCMI (Programme National de Physique Chimie du Milieu Interstellaire). This paper makes use of the following ALMA data: ADS/JAO. ALMA#2011.0.00009.SV.ALMAis a partnership of ESO (representing its member states), NSF (USA), and NINS (Japan), together with NRC (Canada) and NSC and ASIAA (Taiwan), in cooperation with the Republic of Chile. The Joint ALMA Observatory is operated by ESO, AUI/NRAO, and NAOJ. C.F. thanks Dahbia Talbi, Eric Herbst, and Anthony Remijan for enlightening discussions. Finally, we thank the anonymous referee for helpful comments

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Introduction Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. Methods We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. Results We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women. Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12). Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. Conclusions This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

INTRODUCTION Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat