Program awareness, administrative burden, and non-take-up of Québec’s supplement to the work premium

Program take-up is a necessary condition for program effectiveness. Yet, non-take-up is a significant challenge for many social programs, including Québec’s Supplement to the Work Premium (SWP), a refundable tax credit targeted toward long-term welfare clients. Based on interviews with 21 public actors and 46 program participants and nonparticipants, this study explains how low program awareness, the low value of the benefit and the significant administrative burden borne by potential and actual participants contribute to the non-take-up of the SWP in this sample. Moreover, four policy implications and recommendations that can inform the design, implementation, and evaluation of social programs, are derived from this study

La résilience de jeunes adultes après une prise en charge par les services de protection de la jeunesse : une perspective interactionniste

La présente thèse s’intéresse à des jeunes ayant un passé de prise en charge par la protection de la jeunesse au Québec (Canada) au moment où, atteignant leur majorité, ils se voient confrontés aux divers défis rattachés à la période de transition vers l’âge adulte. L’objectif est d’étudier comment, durant cette période, ces jeunes avec un passé particulier s’adaptent à leur situation. Comment voient-ils cette transition? Quels éléments des situations et quels processus utilisent-ils pour rendre compte de leur adaptation? Renvoyant à une adaptation positive en contexte de risque ou d’adversité, le concept de résilience sert de cadre pour explorer de telles questions. Dans une perspective interactionniste qui donne une place centrale à l’acteur ainsi qu’aux significations - élaborées dans les interactions sociales - que ce dernier accorde au monde qui l’entoure, l’étude explore l’adaptation positive de ces jeunes selon leur propre point de vue et non à partir des critères élaborés par les chercheuses ou chercheurs selon des normes sociales bien établies. La collecte de données s’est faite par des entretiens semi-dirigés auprès de 18 jeunes ayant entre 18,5 ans et 19,5 ans. L’analyse qualitative des récits a porté sur six domaines de vie (choisis a priori, selon la littérature) généralement associés au passage à la vie adulte ainsi que sur tout autre élément considéré comme un défi par ces jeunes. Cette analyse a fait ressortir plusieurs processus à travers lesquels s’élabore un discours de résilience. Ils sont de deux types : les processus d’élaboration d’un « cadre normatif » qui intègre les critères (mis en valeur par les jeunes) qui servent à juger de la qualité de l’adaptation et les processus d’appréciation positive d’aspects des situations vécues relativement à ces critères. Ces processus, illustrés dans le récit des jeunes, permettent de négocier de façon créative une adaptation positive aux situations rencontrées dans un discours de résilience qui révèle en même temps une identité positive et une présentation positive de soi.The Resilience of Young Adults Transitioning Out of Child Welfare : An Interactionist Perspective. This study investigated transition to adulthood of youths who have left the care of child welfare services in Québec. What is already a challenging transition can be even more so for youth who were in care. The primary goal was to understand how these youths are adjusting in this transition. How do they see this transition? Which aspects of their situation and which processes account for their adaptation? The concept of resilience, defined broadly as positive adaptation in the face of adversity, served as a basis for exploring these questions. Within an interactionist perspective, which places central importance on the actor and the meaning that is given to the world, this study explored the positive adaptation of youths from their own point of view, rather than from criteria defined by researchers according to well established social norms. Data collection consisted of 18 semi-structured interviews with youths aged 18.5 to 19.5 years. Qualitative analysis of these interviews focused on six life domains (determined a priori based on the literature) generally associated with the transition to adulthood, as well as other challenges identified by the participants themselves. Findings suggest some processes through which a discourse of resilience emerges. Two types of processes were identified: (1) the elaboration of a “normative framework” that integrates criteria valued by youths themselves which were used as the basis for judging the quality of their adaptation, and (2) processes valuing positive aspects of the situation based on these criteria. These processes, illustrated by the accounts of the youths, enable them to negotiate a positive adaptation in a creative way within a discourse of resilience that reveals a positive identity as well as a positive presentation of self

Practical approach to early postoperative management of lung transplant recipients

Meticulous attention to detail during the early postoperative period after lung transplantation is crucial for the overall success of the procedure. It starts in the intensive care unit with the initiation of immunosuppression, implementation of anti-infective strategies and stabilisation of respiratory function. The subsequent days and weeks on the regular ward focus on titration of immunosuppressive drugs, vigilant fluid management, early mobilisation and initiation of physiotherapy. In parallel, the lung transplant recipients are actively taught about self-monitoring and self-management strategies to allow for a smooth transition to outpatient follow-up care. This article intends to communicate the practical aspects and principles of the patient management used at the authors' centre on a daily basis by a multi-disciplinary transplant team, having at its core both a transplant pulmonologist and a thoracic surgeon. It focuses on the first month after lung transplantation, but does not cover surgical techniques, rare complications or long-term management issues of lung transplant recipients. The target audience of this practical guide are advanced trainees of pulmonology, thoracic surgery, intensive care, anaesthesiology and other clinicians involved in the early postoperative care of lung transplant recipients either in the intensive care unit or on the peripheral ward

L’adoption et le suivi de la performance d’une mesure interministérielle : le cas du supplément à la prime au travail

La gestion horizontale pose des enjeux significatifs, en particulier en ce qui a trait au suivi et à l’évaluation de la performance des programmes publics. Cette étude de cas porte sur le Supplément à la prime au travail (SPT), une mesure sociofiscale de type interministériel, qui n’a fait l’objet d’aucune évaluation de sa performance depuis son introduction en 2008. À partir d’entretiens qualitatifs avec des acteurs publics, nous tentons d’expliquer pourquoi le SPT a pris la forme d’une mesure sociofiscale gérée par trois organisations publiques (ministère des Finances du Québec, Revenu Québec et le ministère du Travail, de l’Emploi et de la Solidarité sociale). Nous analysons ensuite les implications de cette horizontalité pour le suivi et l’évaluation de la performance de la mesure. Nous concluons à un décalage entre les responsabilités officielles et officieuses pour l’évaluation du SPT, l’intérêt d’une telle évaluation pour les organisations impliquées, et leur capacité à la réaliser.Horizontal management raises significant challenges, particularly when assessing the performance of public programs. This case study focuses on Quebec’s Supplement to the Work Premium (SWP), a social and fiscal cross‐ministerial measure, which was never subjected to any performance assessment since its introduction in 2008. We report on findings from interviews with public servants and attempt to explain how the SWP became a social and fiscal measure managed by three public organizations (ministère des Finances du Québec, Revenu Québec and the ministère du Travail, de l’Emploi et de la Solidarité sociale). Then, we analyze the implementation and performance evaluation of the measure. We argue there is a disjuncture between official and informal responsibilities when assessing the SWP and between the interests of the organizations involved in the assessment

Superfluidity vs thermalisation in a nonlinear Floquet system

We show that superfluidity can be used to prevent thermalisation in Floquet nonlinear systems. Generically, periodic driving boils a many-body system to a featureless infinite temperature state. Fast driving is a known strategy to postpone Floquet heating with a large but always finite boiling time. In contrast, we show the existence, for a nonlinear quantum kicked rotor, of a continuous class of initial states which do not thermalise at all. This absence of thermalisation is associated to the existence of a superflow in momentum space.Comment: 7 pages, 5 figures, Supplementary materia

Lung transplantation for emphysema: impact of age on short- and long-term survival†

OBJECTIVES Overall, emphysema (EMP) is the most common indication for lung transplantation. The majority of patients present with chronic obstructive pulmonary disease (COPD) and less frequently with alpha-1 antitrypsin deficiency (A1ATD). We analysed the results of lung transplants performed for EMP in order to identify the impact of age on short- and long-term outcome. METHODS A retrospective analysis was undertaken of the 108 consecutive lung transplants for EMP performed at our institution from November 1992 to August 2013 (77 COPD, 31 A1ATD). Retransplantations were excluded. RESULTS The median age was 56 years (range 31-68). Thirty-day mortality rate was 3.7%. One- and 5-year survival rates in COPD and A1ATD recipients were comparable (P = 0.8). The 1- and 5-year survival rates for recipients aged <60 years old were significantly better than the age group of ≥60 years (91 and 79 vs 84 and 54%, P = 0.05). Since 2007, the 1- and 5-year survival for these two age groups were 96 and 92 vs 86 and 44%, respectively, P = 0.04, log-rank test). For the following parameters, we were not able to find any difference to affect survival rates: use of intraoperative extracorporeal membrane oxygenation, waiting list time, sex, graft size reduction, body mass index and diagnosis. In multivariate analysis, age at transplantation (≥60 years old) (HR 2.854; 95% confidence interval (CI) 1.338-6.08, P = 0.008) and unilateral lung transplantation (HR 15.2; 95% CI 3.2-71.9, P = 0.009) were independent risk factors for mortality. CONCLUSIONS COPD and A1ATD recipients have similar overall long-term survival. Recipients aged ≥60 years and unilateral lung transplants were risk factors for mortalit

β3-adrenoceptor agonist prevents alterations of muscle diacylglycerol and adipose tissue phospholipids induced by a cafeteria diet

BACKGROUND: Insulin resistance induced by a high fat diet has been associated with alterations in lipid content and composition in skeletal muscle and adipose tissue. Administration of β3-adrenoceptor (β3-AR) agonists was recently reported to prevent insulin resistance induced by a high fat diet, such as the cafeteria diet. The objective of the present study was to determine whether a selective β3-AR agonist (ZD7114) could prevent alterations of the lipid profile of skeletal muscle and adipose tissue lipids induced by a cafeteria diet. METHODS: Male Sprague-Dawley rats fed a cafeteria diet were treated orally with either the β3-AR agonist ZD7114 (1 mg/kg per day) or the vehicle for 60 days. Rats fed a chow diet were used as a reference group. In addition to the determination of body weight and insulin plasma level, lipid content and fatty acid composition in gastronemius and in epididymal adipose tissue were measured by gas-liquid chromatography, at the end of the study. RESULTS: In addition to higher body weights and plasma insulin concentrations, rats fed a cafeteria diet had greater triacylglycerol (TAG) and diacylglycerol (DAG) accumulation in skeletal muscle, contrary to animals fed a chow diet. As expected, ZD7114 treatment prevented the excessive weight gain and hyperinsulinemia induced by the cafeteria diet. Furthermore, in ZD7114 treated rats, intramyocellular DAG levels were lower and the proportion of polyunsaturated fatty acids, particularly arachidonic acid, in adipose tissue phospholipids was higher than in animals fed a cafeteria diet. CONCLUSIONS: These results show that activation of the β3-AR was able to prevent lipid alterations in muscle and adipose tissue associated with insulin resistance induced by the cafeteria diet. These changes in intramyocellular DAG levels and adipose tissue PL composition may contribute to the improved insulin sensitivity associated with β3-AR activation

Supporting Behavior Change After AECOPD – Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study’s aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients’ key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence – including but not limited to patients’ perspective – and health professionals’ perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated. Keywords: AECOPD, complex intervention, behavior, behavior change, intervention developmen

Clinical accuracy of instrument-based SARS-CoV-2 antigen diagnostic tests:a systematic review and meta-analysis

Background: During the COVID-19 pandemic, antigen diagnostic tests were frequently used for screening, triage, and diagnosis. Novel instrument-based antigen tests (iAg tests) hold the promise of outperforming their instrument-free, visually-read counterparts. Here, we provide a systematic review and meta-analysis of the SARS-CoV-2 iAg tests’ clinical accuracy. Methods: We systematically searched MEDLINE (via PubMed), Web of Science, medRxiv, and bioRxiv for articles published before November 7th, 2022, evaluating the accuracy of iAg tests for SARS-CoV-2 detection. We performed a random effects meta-analysis to estimate sensitivity and specificity and used the QUADAS-2 tool to assess study quality and risk of bias. Sub-group analysis was conducted based on Ct value range, IFU-conformity, age, symptom presence and duration, and the variant of concern. Results: We screened the titles and abstracts of 20,431 articles and included 114 publications that fulfilled the inclusion criteria. Additionally, we incorporated three articles sourced from the FIND website, totaling 117 studies encompassing 95,181 individuals, which evaluated the clinical accuracy of 24 commercial COVID-19 iAg tests. The studies varied in risk of bias but showed high applicability. Of 24 iAg tests from 99 studies assessed in the meta-analysis, the pooled sensitivity and specificity compared to molecular testing of a paired NP swab sample were 76.7% (95% CI 73.5 to 79.7) and 98.4% (95% CI 98.0 to 98.7), respectively. Higher sensitivity was noted in individuals with high viral load (99.6% [95% CI 96.8 to 100] at Ct-level ≤ 20) and within the first week of symptom onset (84.6% [95% CI 78.2 to 89.3]), but did not differ between tests conducted as per manufacturer’s instructions and those conducted differently, or between point-of-care and lab-based testing. Conclusion: Overall, iAg tests have a high pooled specificity but a moderate pooled sensitivity, according to our analysis. The pooled sensitivity increases with lower Ct-values (a proxy for viral load), or within the first week of symptom onset, enabling reliable identification of most COVID-19 cases and highlighting the importance of context in test selection. The study underscores the need for careful evaluation considering performance variations and operational features of iAg tests.</p

Immunogenicity of High-Dose vs. MF59-adjuvanted vs. Standard Influenza Vaccine in Solid Organ Transplant Recipients: The STOP-FLU trial.

BACKGROUND The immunogenicity of the standard influenza vaccine is reduced in solid-organ transplant (SOT) recipients, so that new vaccination strategies are needed in this population. METHODS Adult SOT recipients from nine transplant clinics in Switzerland and Spain were enrolled if they were >3 months after transplantation. High, with stratification by organ and time from transplant. The primary outcome was vaccine response rate, defined as a ≥4-fold increase of hemagglutination-inhibition titers to at least one vaccine strain at 28 days post-vaccination. Secondary outcomes included PCR-confirmed influenza and vaccine reactogenicity. RESULTS 619 patients were randomized, 616 received the assigned vaccines, and 598 had serum available for analysis of the primary endpoint (standard, n=198; MF59-adjuvanted, n=205; high-dose, n=195 patients). Vaccine response rates were 42% (84/198) in the standard vaccine group, 60% (122/205) in the MF59-adjuvanted vaccine group, and 66% (129/195) in the high-dose vaccine group (difference in intervention vaccines vs. standard vaccine, 0.20 [97.5% CI 0.12-1]; p<0.001; difference in high-dose vs. standard vaccine, 0.24 [95% CI 0.16-1]; p<0.001; difference in MF59-adjuvanted vs. standard vaccine, 0.17 [97.5% CI 0.08-1]; p<0.001). Influenza occurred in 6% the standard, 5% in the MF59-adjuvanted, and 7% in the high-dose vaccine groups. Vaccine-related adverse events occurred more frequently in the intervention vaccine groups, but most of the events were mild. CONCLUSIONS In SOT recipients, use of an MF59-adjuvanted or a high-dose influenza vaccine was safe and resulted in a higher vaccine response rate. TRIAL REGISTRATION Clinicaltrials.gov NCT03699839