My Condolences; Mourning, Decay and Intimacy in John Donne’s Songs and Sonnets

In John Donne\u27s poetry on death, he describes grave as this intimate, secluded or safe location. Donne seems to believe that death is not the antithesis to love or intimacy, but rather a final place for two people to meet. His poetry, in an attempt to alleviate the fears surrounding death, romanticize and idealize decay. But this brings forth new questions; How is this intimacy that Donne describes affected by the funeral and the mourning process

Évaluation infirmière orientée vers la santé mentale : développement d’un programme de soutien clinique visant le renforcement des capacités des infirmières en santé communautaire

Introduction :  L’évaluation de l’état de santé effectuée par une infirmière joue un rôle clé dans le parcours de rétablissement d’une personne avec une problématique de santé mentale. Or, l’application d’une telle évaluation centrée sur les besoins d’une personne avec une problématique de santé mentale demeure un défi pour plusieurs infirmières exerçant dans un contexte de santé communautaire. Objectifs :  Décrire le processus de développement d’un programme visant à 1) renforcer les capacités des infirmières en santé communautaire à appliquer les bonnes pratiques en matière d’évaluation infirmière auprès des personnes avec une problématique de santé mentale; et 2) renforcer les capacités des acteurs de soutien à accompagner les infirmières dans l’application des bonnes pratiques d’évaluation. Démarche et évaluation : Une recherche participative de type laboratoire vivant a été privilégiée pour développer le programme en partenariat avec des acteurs de soutien clinique d’un établissement de santé du Québec. Le programme est développé en trois phases : 1) La phase de conceptualisation a permis de faire émerger un premier modèle du programme impliquant les stratégies suivantes : auto-évaluation de sa pratique, formation didactique, réflexions de groupe et individuelles, discussion de cas clinique et rétroaction. 2) La phase de prototypage (automne 2022) sera effectuée avec environ 6 infirmières et 3 acteurs de soutien qui seront invités à discuter de la faisabilité et de l’acceptabilité des stratégies initiales. 3) Le développement final sera réalisé (hiver 2023) avec une trentaine d’infirmières et acteurs de soutien afin d’affiner les stratégies et activités de même que de documenter les effets perçus du programme. Retombées anticipées : Le projet permettra, entre autres, de former des leaders et champions en matière d’évaluation infirmière pour les personnes vivant avec des problématiques de santé mentale au sein des organisations, mais également de mieux comprendre l’impact des stratégies de soutien clinique sur la qualité des pratiques infirmières.Introduction :  L’évaluation de l’état de santé effectuée par une infirmière joue un rôle clé dans le parcours de rétablissement d’une personne avec une problématique de santé mentale. Or, l’application d’une telle évaluation centrée sur les besoins d’une personne avec une problématique de santé mentale demeure un défi pour plusieurs infirmières exerçant dans un contexte de santé communautaire. Objectifs :  Décrire le processus de développement d’un programme visant à 1) renforcer les capacités des infirmières en santé communautaire à appliquer les bonnes pratiques en matière d’évaluation infirmière auprès des personnes avec une problématique de santé mentale; et 2) renforcer les capacités des acteurs de soutien à accompagner les infirmières dans l’application des bonnes pratiques d’évaluation. Démarche et évaluation : Une recherche participative de type laboratoire vivant a été privilégiée pour développer le programme en partenariat avec des acteurs de soutien clinique d’un établissement de santé du Québec. Le programme est développé en trois phases : 1) La phase de conceptualisation a permis de faire émerger un premier modèle du programme impliquant les stratégies suivantes : auto-évaluation de sa pratique, formation didactique, réflexions de groupe et individuelles, discussion de cas clinique et rétroaction. 2) La phase de prototypage (automne 2022) sera effectuée avec environ 6 infirmières et 3 acteurs de soutien qui seront invités à discuter de la faisabilité et de l’acceptabilité des stratégies initiales. 3) Le développement final sera réalisé (hiver 2023) avec une trentaine d’infirmières et acteurs de soutien afin d’affiner les stratégies et activités de même que de documenter les effets perçus du programme. Retombées anticipées : Le projet permettra, entre autres, de former des leaders et champions en matière d’évaluation infirmière pour les personnes vivant avec des problématiques de santé mentale au sein des organisations, mais également de mieux comprendre l’impact des stratégies de soutien clinique sur la qualité des pratiques infirmières

Nursing interventions designed to improve healthcare in general healthcare settings for adults living with mental illness: a scoping review

Abstract: People living with mental illness have difficulty obtaining quality physical care services. Nurses find it hard to fully assume their role and adopt a person-centered approach when they care for people with both physical and mental health problems. A scoping review was carried out to document the breadth and depth of literature on nurse interventions designed to improve nursing care in general healthcare settings for adults living with mental illness. Two researchers independently screened titles, abstracts and full documents to obtain publications, and the relevant data was extracted from individual studies. Of the 384 studies identified, 16 documents were included in the study. Few interventions have been the subject of scientific publications and they are scattered in their objectives and very heterogeneous in their content. Interventions are often included in a large program that may be difficult to apply in various care settings. There are many different nursing roles and activities in care-management and in support of behavioral changes although their main measured outcomes differ. This study highlights a tendency for interventions to relegate people with mental health problems to specialized services, which reinforces the dichotomization of services and does not favor a holistic and person-centered approach. There is an urgent need to develop and evaluate nursing interventions in general healthcare settings for adults living with mental illness. The development of relevant continuing education and training must take into account both the point of view of the people living with mental illness and that of nurses

Prolonged and unprolonged complex febrile seizures differently affect frontal theta brain activity

Objective: Studies have identified persistent cognitive and functional deficits, which could be linked to each other, in children with complex febrile seizures (FS). Our aim was to investigate differences in brain activity in children with a history of complex FS, through a study paradigm associated with the development of learning capacities and using electroencephalographic (EEG) signal. To further increase our understanding of these differences, complex FS were studied separately depending on their type. Method: EEG was recorded in 43 children with past FS. Brain activity associated with auditory learning was investigated using a habituation paradigm, in which repetition suppression (RS) is typically found following stimulus repetition. Auditory stimuli were repeated three times, and each presentation were analysed separately in the time-frequency (TF) domain. A mixedanalysis of variance was used to assess differences in spectral power between stimulus repetition and FS type (simple vs complex prolonged; CP vs complex unprolonged; CUP). Results: Repetition effects were found in the 3-6 Hz during 150-600ms time window after stimulus onset at frontal sites (F(2, 40)=5.645, p=0.007, η2p=0.220). Moreover, an interaction effect between stimulus repetition and FS type (F(4, 80)=2.607, p=0.042, η2p=0.115) was found. Children with CP FS showed greater increase in spectral power in response to the first stimulus presentation, while children with CUP FS failed to show a RS pattern. Significance: Our results show distinct abnormalities in brain activity to a habituation paradigm. We argue that these changes suggest children with CP FS may be hyperexcitable, while children with CUP FS show impaired habituation processes. Still, these differences may be associated with other clinical features linked to complex FS as well. Hence, the role of these differences in complex FS incidence and prognosis should be the subject of future studies

Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review

Background Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs. Objective This review aimed at identifying variables associated with frequent ED use by older adults. Methods For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence. A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. Conclusion Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty

DHX15-independent roles for TFIP11 in U6 snRNA modification, U4/U6.U5 tri-snRNP assembly and pre-mRNA splicing fidelity

International audienceThe U6 snRNA, the core catalytic component of the spliceosome, is extensively modified post-transcriptionally, with 2’-O-methylation being most common. However, how U6 2’-O-methylation is regulated remains largely unknown. Here we report that TFIP11, the human homolog of the yeast spliceosome disassembly factor Ntr1, localizes to nucleoli and Cajal Bodies and is essential for the 2’-O-methylation of U6. Mechanistically, we demonstrate that TFIP11 knockdown reduces the association of U6 snRNA with fibrillarin and associated snoRNAs, therefore altering U6 2′-O-methylation. We show U6 snRNA hypomethylation is associated with changes in assembly of the U4/U6.U5 tri-snRNP leading to defects in spliceosome assembly and alterations in splicing fidelity. Strikingly, this function of TFIP11 is independent of the RNA helicase DHX15, its known partner in yeast. In sum, our study demonstrates an unrecognized function for TFIP11 in U6 snRNP modification and U4/U6.U5 tri-snRNP assembly, identifying TFIP11 as a critical spliceosome assembly regulator

The Moraxella adhesin UspA1 binds to its human CEACAM1 receptor by a deformable trimeric coiled-coil

Moraxella catarrhalis is a ubiquitous human-specific bacterium commonly associated with upper and lower respiratory tract infections, including otitis media, sinusitis and chronic obstructive pulmonary disease. The bacterium uses an autotransporter protein UspA1 to target an important human cellular receptor carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1). Using X-ray crystallography, we show that the CEACAM1 receptor-binding region of UspA1 unusually consists of an extended, rod-like left-handed trimeric coiled-coil. Mutagenesis and binding studies of UspA1 and the N-domain of CEACAM1 have been used to delineate the interacting surfaces between ligand and receptor and guide assembly of the complex. However, solution scattering, molecular modelling and electron microscopy analyses all indicate that significant bending of the UspA1 coiled-coil stalk also occurs. This explains how UspA1 can engage CEACAM1 at a site far distant from its head group, permitting closer proximity of the respective cell surfaces during infection

Development, acceptability, and feasibility of an intervention for people living with type 2 diabetes to promote the adoption of a person-centered approach by nurses

Problématique: Les personnes vivant avec le diabète de type 2 ont à effectuer des changements de comportement exigeants pouvant entraîner des difficultés d'autogestion. Les lignes directrices recommandent aux professionnels de la santé d’adopter une approche centrée sur la personne (ACP) lorsqu’ils soutiennent l’autogestion des patients, mais celle-ci semble difficile à mettre en pratique. La carte conceptuelle (CC), un outil graphique visuel ayant démontré son efficacité en pédagogie, semble une avenue prometteuse pour faciliter l’adoption d’une ACP par les infirmières. Objectifs: 1- Coconstruire une intervention inspirée de la CC pour favoriser l'adoption d'une ACP; 2- Décrire sa mise en œuvre dans deux milieux de soins; 3- Explorer son acceptabilité et sa faisabilité à partir de l’expérience de personnes vivant avec le diabète de type 2 et d’infirmières. Méthodologie: L’étude est basée sur un modèle d'élaboration d'interventions infirmières fondées sur des données probantes. Pour l’objectif 1, deux rencontres de coconstruction ont été réalisées avec des experts. Pour les objectifs 2 et 3, deux infirmières ont été recrutées, puis formées à appliquer l’intervention. Dix patients présentant des difficultés d’autogestion ont expérimenté la nouvelle intervention à deux reprises. Un devis qualitatif descriptif selon une approche interprétative a été privilégié. Plusieurs méthodes de collecte des données ont été réalisées afin d’explorer l’acceptabilité et la faisabilité auprès des patients et des infirmières: observation des rencontres (n=5), récolte de documents (n=19), entretiens individuels semi-structurés (n=15) et entretiens dyadiques et de groupe (n=3). Une analyse des données par comparaison constante a permis de dégager des thèmes et des patterns. Résultats: Le processus de coconstruction a mené au développement d’une intervention de soutien à l'autogestion du diabète selon une approche centrée sur la personne (SAD-ACP), qui vise à intervenir à partir de ses besoins. L’intervention est jugée acceptable selon les personnes participantes et elle favorise l’utilisation d’une ACP par les infirmières. Cinq grands thèmes ressortent au sujet de l’acceptabilité, soit : expérience positive, cohérente avec les valeurs, s’adapter à une nouvelle façon de faire, nécessite un effort cognitif et émotif et plus efficace que les interventions usuelles. Concernant la faisabilité, des difficultés émergent à propos de la durée et de la formation nécessaires pour prodiguer l’intervention. Discussion: L’intervention SAD-ACP développée ainsi que la formation ont été améliorées en fonction de l’expérience des participants afin de parvenir à une version définitive qui facilitera sa mise en place et sa faisabilité future et pourra contribuer à améliorer le soutien à l’autogestion.Abstract : Problem: People living with type 2 diabetes have to make demanding behavior changes that can lead to self-management difficulties. The guidelines recommend that healthcare professionals adopt a person-centered approach (PCA) when they support patient’s self-management, but it seems difficult to put into practice. The concept map (CM), a visual graphic tool that has demonstrated its effectiveness in education field, seems a promising avenue to facilitate the adoption of PCA by nurses. Objectives: 1- Co-construct an intervention inspired by CM to promote the adoption of a PCA; 2- Describe its implementation in two healthcare settings; 3- Explore its acceptability and feasibility from the experience of patients and nurses. Methodology: The study is based on a model that aims at developing evidence-based nursing interventions. For Objective 1, two co-construction meetings were held with experts. For objectives 2 and 3, two nurses were recruited and then trained to apply the intervention. Ten patients with self-management difficulties experienced the new intervention twice. A qualitative descriptive interpretative approach was used. Several data collection methods were carried out in order to explore acceptability and feasibility with patients and nurses: observation of sessions (n = 5), collection of documents (n=19), semi-structured individual interviews (n = 15) and dyadic and group interviews (n = 3). An analysis of the data by constant comparison made it possible to identify themes and patterns. Results: The co-construction process led to the development of the Person-Centered Approach Diabetes Self-Management Support (PCA-DSMS) intervention, which aims to intervene based on the needs of the person. The intervention is deemed acceptable by the participants and promotes the use of PCA by nurses. Five main themes stand out in relation to acceptability: positive experience, consistent with personal values, having to adapt to a new way of doing things, requires cognitive and emotional effort, and more effective than usual interventions. Regarding feasibility, difficulties emerge over the length of time and training required to deliver the intervention. Discussion: The PCA-DSMS intervention developed as well as the training provided have been improved according to the experience of the participants in order to reach a final version that will facilitate its implementation and future feasibility and may help improve self-management support

Comparison between Short and Long Echo Time Magnetic Resonance Spectroscopic Imaging at 3T and 7T for Evaluating Brain Metabolites in Patients with Glioma

Three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) is a powerful non-invasive tool for characterizing spatial variations in metabolic profiles for patients with glioma. Metabolic parameters obtained using this technique have been shown to predict treatment response, disease progression, and transformation to a more malignant phenotype. The availability of ultra-high-field MR systems has the potential to improve the characterization of metabolites. The purpose of this study was to compare the metabolite profiles acquired with conventional long echo time (TE) MRSI at 3T with those obtained with short TE MRSI at 3T and 7T in patients with glioma. The data acquisition parameters were optimized separately for each echo time and field strength to obtain volumetric coverage within clinically feasible data acquisition times of 5-10 min. While a higher field strength did provide better detection of metabolites with overlapping peaks, spatial coverage was reduced and the use of inversion recovery to reduce lipid precluded the detection of lipid in regions of necrosis. For serial evaluation of large, heterogeneous lesions, the use of 3T short TE MRSI may thus be preferred. Despite the limited number of metabolites that it is able to detect, the use of 3T long TE MRSI gives the best contrast in choline/N-acetyl aspartate between normal appearing brain and tumor and also allows the separate detection of lactate and lipid. It may therefore be preferred for serial evaluation of patients with high-grade glioma and for detection of malignant transformation in patients with low-grade glioma

Health literacy and use of healthcare services among community-dwelling older adults living with chronic conditions

Objective: Only 12% of the Canadian older adults have adequate health literacy (HL) to understand and handle health information sufficiently. A descriptive correlation study was conducted to describe HL and to examine its relationship with healthcare services use among community-dwelling older adults living with chronic conditions in a distant region of Quebec, Canada. Methods: Data was collected through self-report instruments including the Health Literacy Questionnaire (HLQ), which assesses HL on nine dimensions. Results: Based on health characteristics of the nine HLQ dimensions, the results showed significant differences between subgroups of participants as well as a negative association between the HLQ dimension Appraisal of Health Information and the number of consultations with healthcare professionals (incidence rate ratio: 0.66; p = .027). Conclusions: The results highlight the need to improve older adults HL, in order to improve their health status and use of healthcare services