Sexuality in the context of physical rehabilitation as perceived by occupational therapists

Introduction: One of the challenges for rehabilitation professionals is to discuss sexuality with their clients. The main objective of this study was to explore occupational therapists’ perceptions of the factors that influence their practice regarding the domain of sexuality, as well as the prioritization of these factors and the exploration of their needs. Methodology: Descriptive qualitative study who took place in Montreal, Canada. Two focus groups were realized with seven occupational therapists working in outpatient setting in two different rehabilitation centers for physical disabilities. The focus group guide was based on the Theoretical Domains Framework (TDF). The verbatims were coded using QDA-Miner software and analyzed according to the principles of the Framework approach. Results: The majority of participants were women (n = 6/7). Three main themes to answer the main objective emerged: (1) Occupational therapist’s intrinsic factors such as professional identity and knowledge/skills; (2) Contextual and process factors of practice, including assessment/analysis and human resources; (3) Client factors such as identity factors and capabilities. Several influencing factors that have a significant impact on practice have been prioritized, for instance, the perception of the skill level of occupational therapists, interdisciplinary collaboration, culture/language and openness of the client to the subject of sexuality. The needs related to the acquisition of knowledge/know-how, human resources and continuing education were raised by clinicians. Conclusion: There is a need in developing training tools to support clinical practice and to overcome the many barriers encountered by occupational therapists regarding the domain of sexuality

Implementation of a sexuality interview guide in stroke rehabilitation : a feasibility study

Background: Although people who sustain a stroke can experience sexual difficulties, few address them during rehabilitation. Objectives: Explore the feasibility of implementing a Sexuality Interview Guide (SIG) in stroke rehabilitation and describe the factors perceived as influencing its implementation. Materials and Methods: Using a mixed research design, the SIG was implemented for four months in a rehabilitation hospital. The frequency with which clinicians addressed sexuality and their level of comfort pre-post implementation was measured. Perceived factors influencing implementation were determined through individual interviews and focus groups with five stroke clients, 15 clinicians and a coordinator. A paired-specimen Wilcoxon test was used to explore differences in pre- post-level of comfort. Qualitative data was analyzed by two independent evaluators using thematic analysis. Results: The SIG was used 28 times and clinicians' level of comfort in addressing sexuality improved significantly (p = 0.001). The factors perceived as influencing implementation were: the acceptability of the SIG, the individual characteristics, the context of the rehabilitation hospital and the implementation process. Conclusion: This study showed that the SIG can be used in stroke rehabilitation and that, with sufficient financial and human resources, and training for clinicians, it would be feasible to implement it in usual care

Modelling of Electrical Conductivity of a Silver Plasma at Low Temperature

International audienceDuring the working of electrical fuses, inside the fuse element the silver ribbon first begins to melt, to vaporize and then a fuse arc appears between the two separated parts of the element. Second, the electrodes are struck and the burn-back phenomenon takes place. Usually, the silver ribbon is enclosed inside a cavity filled with silica sand. During the vaporization of the fuse element, one can consider that the volume is fixed so that the pressure increase appears to reach pressures higher than atmospheric pressure. Thus, in this paper two pressures, 1 atm and 10 atm, are considered. The electrical field inside the plasma can reach high values since the distance between the cathode surface and the anode surface varies with time. That is to say from zero cm to one cm order. So we consider various electrical fields: 102 V/m, 103 V/m, 5×103 V/m, 104 V/m at atmospheric pressure and 105 V/m at a pressure of 10 atm. This study is made in heavy species temperature range from 2,400 K to 10,000 K. To study the plasma created inside the electric fuse, we first need to determine some characteristics in order to justify some hypotheses. That is to say: are the classical approximations of the thermal plasmas physics justified? In other words: plasma frequency, the ideality of the plasma, the Debye-HÜckel approximation and the drift velocity versus thermal velocity. These characteristics and assumptions are discussed and commented on in this paper. Then, an evaluation of non-thermal equilibrium versus considered electrical fields is given. Finally, considering the high mobility of electrons, we evaluate the electrical conductivities

SUDAFRICA. Suroccidental. Mapas generales. 1782. 1:530000

Mapa de la antigua colonia alemana en la parte suroccidental de la actual Sudáfrica, comprendiendo desde el cabo de Buena Esperanza hasta la bahía de Lamberts, y desde la cordillera Olifants hasta la costa atlánticaEscalas gráficas de 6 millas alemanas [= 8,4 cm], 30 millas inglesas [= 9,1 cm] y 8 leguas náuticas [= 8,4 cm]. Coordenadas referidas al meridiano de Londres (E 17°45'--E 19°32'/S 32°07'-S 34°25')Orografía de perfil. Sondas batimétricasRelación de los principales accidentes geográficos indicados por clave alfabéticaTítulo rodeado por una escena sobre la caza de elefantes. Tres de estos animales aparecen representados sobre el map

Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016

Background: Schizophrenia is a severe psychiatric disorder associated with multiple psychiatric and non-psychiatric comorbidities. As adults with schizophrenia age, they may use many medications, i.e., have polypharmacy. While psychiatric polypharmacy is well documented, little is known about trends and patterns of global polypharmacy. This study aimed to draw a portrait of polypharmacy among older adults with schizophrenia from 2000 to 2016. Methods: This population-based cohort study was conducted using the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medication use according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia between 2000 and 2016. We calculated the total number of medications used by every individual each year and the age-standardized proportion of individuals with polypharmacy, as defined by the usage of 5+, 10+, 15+, and 20+ different medications yearly. We identified the clinical and socio-demographic factors associated with polypharmacy using robust Poisson regression models considering the correlation of the responses between subjects and analyzed trends in the prevalence of different degrees of polypharmacy. Results: From 2000 to 2016, the median number of medications consumed yearly rose from 8 in 2000 to 11 in 2016. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased from 2000 to 2016: 5+ drugs: 76.6%–89.3%; 10+ drugs: 36.9%–62.2%; 15+: 13.3%–34.4%; 20+: 3.9%–14.4%. Non-antipsychotic drugs essentially drove the rise in polypharmacy since the number of antipsychotics remained stable (mean number of antipsychotics consumed: 1.51 in 2000 vs. 1.67 in 2016). In the multivariate regression, one of the main clinically significant factor associated with polypharmacy was the number of comorbidities (e.g., Polypharmacy-10+: RR[2 VS. 0–1] = 1.4; 99% IC:1.3–1.4, RR[3–4] = 1.7 (1.7–1.8); RR[5+] = 2.1 (2.1–2.2); Polypharmacy-15+: RR[2 VS 0–1] = 1.6; 99% IC:1.5–1.7, RR[3–4] = 2.5 (2.3–2.7); RR[5+] = 4.1 (3.8–4.5). Conclusion: There was a noticeable increase in polypharmacy exposure among older adults with schizophrenia in recent years, mainly driven by non-antipsychotic medications. This raises concerns about the growing risks for adverse effects and drug-drug interactions in this vulnerable population

Interventions used by allied health professionals in sexual rehabilitation after stroke : a systematic review

Background: Although sexuality can be affected post-stroke, few individuals receive sexual rehabilitation because of clinicians’ lack of knowledge regarding evidence-based interventions. Objective: To document and describe the best available evidence supporting interventions that target post-stroke rehabilitation of sexuality. Methods: This systematic review searched the databases Medline, Embase, Psycinfo, CINAHL, Web of science, PEDRO and OTSeeker up to 29 May 2020. Inclusion criteria were: published studies with a sample composed of ≥ 50% stroke clients and describing an intervention that could be applied by an allied health professional. Data was extracted according to the PRISMA guidelines by two independent reviewers. Interventions were described according to the Template for intervention description and replication checklist. Results: Among the 2446 articles reviewed, 8 met the inclusion criteria. Two randomized controlled trials (RCT) and one non-RCT showed improvement in sexual functioning and satisfaction following a 30–45-minute structured rehabilitation program. Two other RCT showed significant improvement in sexual functioning with physical therapy oriented toward 1) structured physical and verbal sexual counseling and 2) pelvic floor muscle training. Three studies showed that interdisciplinary sexual rehabilitation improved satisfaction and sexual functioning; implementation of an interview script for clinicians improved the proportion of clients who addressed sexuality from 0 to 80% in 10 months; and two-day couple retreats improved perceived intimacy between couples. Conclusions: This review highlights promising interventions that could orient future research and improve the access to sexual rehabilitation services for post-stroke, with structured sexual rehabilitation and pelvic floor muscle training being the most strongly supported

A surveillance system to monitor excess mortality of people with mental illness in Canada

Objective: Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. Methods: We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. Results: We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. Conclusions: Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces

Kymatio: Scattering Transforms in Python

The wavelet scattering transform is an invariant signal representation suitable for many signal processing and machine learning applications. We present the Kymatio software package, an easy-to-use, high-performance Python implementation of the scattering transform in 1D, 2D, and 3D that is compatible with modern deep learning frameworks. All transforms may be executed on a GPU (in addition to CPU), offering a considerable speed up over CPU implementations. The package also has a small memory footprint, resulting inefficient memory usage. The source code, documentation, and examples are available undera BSD license at https://www.kymat.io