« L’Approche douce » : un programme de réadaptation pour les personnes âgées atteintes de maladies mentales chroniques

Les auteurs présentent ici « l'Approche douce », un programme de réadaptation destiné aux personnes âgées atteintes de maladies mentales chroniques qu'ils ont implanté dans une unité de géronto-psychiatrie d'un hôpital de New York. Une équipe multidisciplinaire aborde, par cette approche, le traitement des problèmes médicaux et des différentes formes de démence en orientant son action sur des activités quotidiennes récréatives et sociales, tant à l'intérieur qu'à l'extérieur du service et de l'hôpital. Le programme a pour objectif d'augmenter l'autonomie et de faciliter un éventuel retour à domicile de ces malades, à qui le personnel rappelle constamment l'importance de la médication.The authors report on "The Soft Approach", a program for chronic mentally ill elderly patients, which they have implemented in a gero-psychiatric unit in New York City. Using a professionnal team, their approach treats the medical problems, and the various degrees of dementia encountered, in a positive and coordonated effort centered around daily recreational and socializing activities; these include off-ward events and outings away from the hospital. The goals of the program are increased indépendance and eventual community living. The importance of their medication regime is stressed with patients throughout the program

Letter to Gim Gong

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Gim Gong's Mark

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Structural abnormalities in cortical volume, thickness, and surface area in 22q11.2 microdeletion syndrome: Relationship with psychotic symptoms.

Introduction22q11.2 deletion syndrome (22q11DS) represents one of the largest known genetic risk factors for psychosis, yet the neurobiological mechanisms underlying symptom development are not well understood. Here we conducted a cross-sectional study of 22q11DS to decompose cortical volume into its constituent parts, cortical thickness (CT) and surface area (SA), which are believed to have distinct neurodevelopmental origins.MethodsHigh-resolution T1-weighted scans were collected on 65 participants (31 22q11DS, 34 demographically comparable typically developing controls, 10-25 years old). Measures of cortical volume, CT, and SA were extracted from regions of interest using the FreeSurfer image analysis suite. Group differences and age-related trajectories in these structures, as well as their association with psychotic symptomatology, were assessed.ResultsRelative to controls, 22q11DS participants showed bilateral volumetric reductions in the inferior temporal cortex, fusiform gyrus, anterior cingulate, superior parietal cortex, and cuneus, which were driven by decreased SA in these regions. 22q11DS participants also had increased volumes, driven by increased CT, in bilateral insula regions. 22q11DS youth had increased CT in frontal regions, particularly middle frontal and medial orbitofrontal cortices. A pattern of age-associated cortical thinning was observed in typically developing controls in brain regions associated with visual and sensory information-processing (i.e., left pericalcarine cortex and fusiform gyrus, right lingual and postcentral cortices). However, this relationship was disrupted in 22q11DS participants. Finally, correlational analyses revealed that increased CT in right medial orbitofrontal cortex was associated with increased positive symptom severity in 22q11DS.ConclusionDifferential disruptions of CT and SA in distinct cortical regions in 22q11DS may indicate abnormalities in distinct developmental neural processes. Further, neuroanatomic abnormalities in medial frontal brain structures disproportionately affected in idiopathic schizophrenia were associated with psychotic symptom severity in 22q11DS youth, suggesting that disrupted biological processes in these cortical regions may underlie development of psychotic symptoms, both in 22q11DS and in the broader population

Trends in Human Spaceflight: Failure Tolerance, High Reliability and Correlated Failure History

In a half century of human spaceflight, NASA has continuously refined agency safety and reliability requirements in response to mission demands, critical failures, and technology development. Early spacecraft, including Mercury, Gemini and Apollo vehicles, were highly reliant on dissimilar redundancy and demonstrated test margins. Later programs, such as the reusable Space Transportation System (STS) and International Space Station (ISS), introduced probabilistic studies and isolated two-failure tolerance to improve robustness at the expense of added complexity. More recently, the Orion Multi-Program Crew Vehicle (MPCV) program adopted universal single-failure tolerance with two categorical exceptions; Zero-Failure Tolerant (0FT) and Design for Minimum Risk (DFMR) hardware. Failure tolerance variances are defined and managed in accordance with agency human-rating requirements, and require concurrence from program Technical Authorities (TA) as well as the MPCV Safety and Mission Assurance Safety and Engineering Review Panel (MSERP). To understand and reaffirm standards applied to Apollo, Space Shuttle and Orion vehicles, Orion and Deep Space Gateway Safety and Mission Assurance (S&MA) representatives conducted accelerated research to compare unique safety and reliability criteria against ground and flight anomalies, based on information contained in post-mission reports and the Problem Reporting and Corrective Action (PRACA) database. In some cases, high-profile failures and narrow escapes have reinforced decisions to maintain or adapt safety requirements. In others, empirical trends have highlighted the need for vigilance and innovative safety guidelines. Given the inability to achieve absolute compliance with evolving safety and reliability requirements, the team conducted a targeted review of DFMR and 0FT propulsion elements within the framework of changing system design, inspection, materials and process developments to formulate conclusions on technological maturity, failure density, and net changes in safety risk. Based on the aggregate performance of high-reliability and failure-tolerant systems, the authors have attempted to establish best practices and guidelines to inform future program decisions. On a somewhat cautionary note, this study is not intended to direct a universal set of requirements for future missions based on prior lessons learned. Spacecraft safety is a multi-variable problem, and attempts to mitigate past failures will not guarantee future success. However, this assessment offers a retrospective review of policy changes, implementation and effectiveness. In the future, NASA, European Space Agency (ESA) and industry partners may benefit from a more robust correlation between requirements and performance, as space-faring nations work toward more challenging, complex and long-duration commercial and deep-space ventures

Santé et pauvreté: introduction de l'apprentissage transformateur dans les structures et les paradigmes de l’éducation médicale

Background: As a paradigm of education that emphasizes equity and social justice, transformative education aims to improve societal structures by inspiring learners to become agents of social change. In an attempt to contribute to transformative education, the University of Toronto MD program implemented a workshop on poverty and health that included tutors with lived experience of poverty. This research aimed to examine how tutors, as members of a group that faces structural oppression, understood their participation in the workshop. Methods: This research drew on qualitative case study methodology and interview data, using the concept of transformative education to direct data analysis and interpretation. Results: Our findings centred around two broad themes: misalignments between transformative learning and the structures of medical education; and unintended consequences of transformative education within the dominant paradigms of medical education. These misalignments and unintended consequences provided insight into how courses operating within the structures, hierarchies and paradigms of medical education may be limited in their potential to contribute to transformative education. Conclusions: To be truly transformative, medical education must be willing to try to modify structures that reinforce oppression rather than integrating marginalized persons into educational processes that maintain social inequity.Contexte : En tant que paradigme favorisant l’équité et la justice sociale, l’éducation axée sur la transformation vise à améliorer les structures sociétales en inspirant les apprenants à devenir des agents du changement social. Dans une visée d’éducation transformatrice, le programme de doctorat en médecine de l’Université de Toronto a mis en place un atelier sur le thème de la santé et la pauvreté auquel participaient des tuteurs ayant une expérience vécue de la pauvreté. Notre recherche visait à examiner comment les tuteurs, en tant que membres d’un groupe confronté à l’oppression structurelle, ont compris leur participation à l’atelier. Méthodes : Cette recherche qualitative s’est appuyée sur une méthodologie d’étude de cas et sur des données d’entrevue, en utilisant le concept d’éducation transformatrice comme prisme pour l’analyse et l’interprétation des données. Résultats : Nos résultats s’articulent autour de deux grands thèmes : les décalages entre l’apprentissage transformateur et les structures de l’éducation médicale, et les conséquences inattendues de l’éducation transformatrice au sein des paradigmes dominants de l’éducation médicale. Ces divergences et ces conséquences non voulues ont permis de constater que les cours qui sont ancrés dans les structures, les hiérarchies et les paradigmes contribueront peu à l’éducation transformatrice. Conclusions : Pour que l’éducation médicale soit véritablement transformatrice, il faut qu’il y ait une volonté de modifier les structures qui renforcent l’oppression plutôt que de faire entrer les personnes marginalisées dans des processus éducatifs qui perpétuent l’inégalité sociale.

Research-to-Practice Brief: Promising Evidence that Early Head Start Can Prevent Child Maltreatment

This brief addresses two main questions in a sample of Early Head Start eligible children: 1) the number and type of maltreatment episodes and 2) the impact of Early Head Start on child and family involvement in the child welfare system. These findings are especially important given the lack of scalable and effective preventive interventions. In addition, they are also timely given the recent interest in fostering collaborations between early care and education programs and child welfare agencies, agencies responsible for overseeing child protection from maltreatment (OHS & ACYF, 2010; ACYF & OHS, 2011; ACYF & OCC, 2011). The current study represents a first look at the impact of Early Head Start on child maltreatment. We are continuing to collect data and will have more information in the upcoming years

Effect of learning resources on Mendeley user adoption and productivity

Poster PresentationThis study was done to understand the user adoption pattern of a reference management tool such as Mendeley. Libraries can improve usage of reference management tools if they adopt a mix of learning support services. The study also found that structured support is more effective than ‘just-in-time’ support. Finally, support for early career researchers is more effective than for seasoned researchers. The results obtained from different Schools across North America were presented as a poster at the Special Libraries Association's Annual Library Conference in Boston in 2015.Special Libraries Association Annual Conference 201