Université de Montréal
  • Montréal, Quebec, Canada
Recent publications
Urban tree planting initiatives have been blooming worldwide to help tackle climate change and nurture healthy living environments for people and biodiversity. Many initiatives are characterized by ambitious targets based on the number of trees planted but are not defined by clear objectives, which hampers the success of these initiatives in achieving the desired benefits. Growing an urban forest is a long-term endeavour that requires sustained commitment and support by urban communities to fully realize the provision and even distribution of multiple benefits. In this perspective article, we discuss the characteristics of tree planting initiatives and argue they should be better connected to urban forest management objectives. We propose seven principles that can help improve the success of tree planting initiatives by ensuring that the right types of trees are planted where they are needed most and where they will have the greatest impact. These principles include: (1) connecting initiatives with long-term management, including defining desired benefits, objectives, targets, and indicators; (2) facilitating community engagement on tree planting and maintenance; (3) focusing on tree canopy cover targets rather than on the number of trees planted; (4) focusing on post-planting care and encouraging retention of existing trees; (5) monitoring tree losses and gains to determine whether the specified targets are being met; (6) increasing species diversity, through careful species selection, as well as age and size diversity to enhance urban forest resilience; and (7) addressing the inequitable distribution of tree canopy, specifically where low tree cover overlaps with socioeconomic needs.
Introduction Despite the development of breast-conserving surgery in breast cancer treatment, there still remain indications for total mastectomy. Since mastectomy has a significant negative impact on the patients’ quality of life, breast reconstruction is increasingly popular. However, for patients with large ptotic breasts who do not choose tissue-based reconstruction techniques and prefer implant-based breast reconstruction, there is no single-stage breast reconstruction technique other than the classic technique using Acellular Dermal Matrix (ADM). Methods This study presents a novel technique for Nipple-Sparing Mastectomy (NSM) and Immediate Breast reconstruction (IBR) in 11 operations (in seven patients) whose treatment decision-making was based on NCCN guidelines. In this technique, the implant/tissue expander is covered by the pectoral muscle in the upper part and an autologous dermal flap in the lower part, replacing an ADM. The dermal flap is created from the de-epithelialized lower mastectomy flap in these large ptotic breasts. Maintaining the nipple-areola complex (NAC) is possible by re-implanting a free nipple split-thickness graft from the NAC of the ipsilateral breast prepared at the beginning of the operation. Results All seven patients had large ptotic breasts ranging from C cup to double D in size and grade 2 and higher breast ptosis. The mean BMI of the patients was 28 (range: 26-33). No major complications occurred postoperatively. There were three minor complications, all managed conservatively. Surgical indications were risk reduction surgery in three patients with BRCA mutations and therapeutic in the remaining patients (three multifocal invasive ductal carcinomas and one diffused ductal carcinoma in situ). None of the patients had a previous reduction mammoplasty as preparation for NSM, and all the patients underwent a single operation. No breast tissue remained under the NAC, which is ideal with the NSM technique. Conclusions The proposed technique is excellent for implant-based IBR in patients with large ptotic breasts. It eliminates the use of ADM mesh and reduces the cost and postoperative complication rate associated with ADM. Furthermore, using a free nipple graft technique can eliminate the need for a preparatory mastopexy. This technique can also theoretically reduce the risk of recurrence or new primary breast cancer as there are no remaining ducts beneath the nipple-areola complex.
Obtaining high quality images of the spinal cord with MRI is difficult, partly due to the fact that the spinal cord is surrounded by a number of structures that have differing magnetic susceptibility. This causes inhomogeneities in the magnetic field, which in turn lead to image artifacts. In order to address this issue, linear compensation gradients can be employed. The latter can be generated using an MRI scanner's first order gradient coils and adjusted on a per-slice basis, in order to correct for through-plane (“z”) magnetic field gradients. This approach is referred to as z-shimming. The aim of this study is two-fold. The first aim was to replicate aspects of a previous study wherein z-shimming was found to improve image quality in T2*-weighted echo-planar imaging. Our second aim was to improve upon the z-shimming approach by including in-plane compensation gradients and adjusting the compensation gradients during the image acquisition process so that they take into account respiration-induced magnetic field variations. We refer to this novel approach as realtime dynamic shimming. Measurements performed in a group of 12 healthy volunteers at 3 T show improved signal homogeneity along the spinal cord when using z-shimming. Signal homogeneity may be further improved by including realtime compensation for respiration-induced field gradients and by also doing this for gradients along the in-plane axes.
Purpose To understand the relationship between ambient air pollution and the onset of balance problems. Design Population-based prospective cohort study. Methods Baseline and 3-year follow-up data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort included adults aged 45–85 years old recruited from 11 sites across 7 provinces. Data on air pollution came from the Canadian Urban Environmental Health Research Consortium. Annual mean levels of ozone, fine particulate matter (PM2.5), and sulfur dioxide for each participant's postal code were estimated from satellite data. Balance was measured at both time points using the one-leg balance test with those who could not stand on one leg for at least 60 s defined as failing the balance test. Our outcome was the new development of failing the balance test at follow-up in those who passed the balance test at baseline. Logistic regression was used. Results Of the 12,158 people who could stand for 60 s on one leg at baseline, 18% were unable to do so 3 years later. In single pollutant models, living in an area with higher ozone levels was associated with the 3-year onset of balance problems (odds ratio (OR) = 1.13 per interquartile range of ozone, 95% CI 1.02, 1.24) after adjustment for demographic, lifestyle, and health variables. In a multipollutant model, the association with ozone increased slightly (OR = 1.16, 95% CI 1.04, 1.30). There were no associations with PM2.5 or sulfur dioxide. Conclusion Our findings provide longitudinal evidence that higher ozone levels are associated with the odds of developing balance problems over a 3-year period. Further work should attempt to confirm our findings and explore the potential mechanism of action.
Background Collecting duct carcinoma (CDC) is biologically more aggressive than clear cell renal cell carcinoma (ccRCC). We tested for differences in cancer specific mortality (CSM) rates according to CDC vs. ISUP (International Society of Urological Pathology) 4 ccRCC histological subtype. We hypothesized that the survival disadvantage still applies, even after most detailed adjustments. Methods Within Surveillance, Epidemiology, and End Results database (2004–2018), we identified 380 CDC vs. 6273 ISUP 4 ccRCC patients of all stages. Propensity score matching (age, sex, race/ethnicity, T, N, and M stages, nephrectomy, and systemic therapy status), Kaplan-Meier plots and multivariable Cox regression models were used. Results All 380 CDC were matched (1:2) with 760 ISUP4 ccRCC patients. Prior to matching CDC patients exhibited higher rates of lymph node invasion (37.6 % vs. 14.7 %, p < 0.001), and of distant metastases (40.8 % vs. 30.4 %, p < 0.001). Systemic therapy rates were higher in CDC (29.5 % vs. 20.5 %, p < 0.001). However, nephrectomy rates were higher in ISUP4 ccRCC patients (97.5 % vs. 84.7 %, p < 0.001). After matching, in multivariable Cox regression models addressing CSM, CDC was associated with a HR of 1.5 (p < 0.001) in the overall population vs. 1.9 (p = 0.014) in stage I-II vs. 1.4 (p = 0.022) in stage III vs. 1.6 in stage IV (p < 0.001), relative to ISUP4 ccRCC. Conclusion CDC patients exhibited 40–90 % higher CSM than their ISUP4 ccRCC counterparts in the overall analysis, as well as in stage specific analyses. The CSM disadvantage applies despite higher rates of systemic therapy in CDC patients.
Arctic rabies is an ongoing threat to human populations and domestic animals inpolar regions, where Arctic foxes (Vulpes lagopus) are the main reservoir hosts. Human-driven changes in resource availability are shifting the distribution of Arctic foxes and these changes may affect the risk of rabies transmission and spread. Our understanding of the effects of broad-scale movement strategies in Arctic foxes and spatial distribution of resources on contact patterns among Arctic foxes, and their consequences on the dynamics of rabies epidemiology remains limited, in part, due to the difficulty of obtaining contact data from such remote and expansive regions. In this perspective, we built a spatially explicit agent-based model coupled with hidden Markov models to explore how Arctic fox movement behavior, combined with Arctic fox population density, resource availability and rabies transmission dynamics, affects the risk of infectious contact between Arctic foxes across heterogeneous landscapes. The model was parameterized using a combination of unique field data collected in the Canadian High Arctic and published studies from other Arctic regions. A sensitivity analysis was performed to assess the effects of multiple model input parameters on contact rates among Arctic foxes. Our results showed that cumulative contact rates per fox were driven by predictors related to rabies transmission dynamics and fox carrying capacity, while unique contact rates per fox and unique infectious contact rates per rabid fox were best predicted by parameters associated with rabies transmission dynamics, fox movement behavior, and fox carrying capacity. Ultimately, our study provides new insights into the ecological drivers of rabies transmission and may inspire further research on modelling cost-effective rabies prevention strategies in the Arctic.
(S)-ketamine-induced rapid-acting antidepressant effects have revolutionized the pharmacotherapy of major depression; however, this medication also produces psychotomimetic effects such as timing distortion. While (R)-ketamine produces fewer dissociative effects, its antidepressant actions are less studied. Depression is associated with time overestimation (i.e., subjectively, time passes slowly). Our recent report suggests that while (S)-ketamine induces an opposite effect, i.e., time underestimation, the (R)-isomer does not affect timing. It has been suggested that opioid receptors are involved in the antidepressant effect of ketamine. In the present study we tested (R)- and (S)-ketamine, and fluoxetine as a positive control in the differential-reinforcement-of-low-rate (DRL) 72-s schedule of reinforcement in male rats following naloxone pretreatment. DRL classic metrics as well as peak deviation analyses served to determine antidepressant-like actions and those associated with timing. We report antidepressant-like effects of (S)-ketamine (30-60 mg/kg) that resemble fluoxetine's (2.5-10 mg/kg), as both compounds increased reinforcement rate and peak location (suggesting increased performance), reduced premature responses (suggesting time underestimation) and decreased Weber's fraction (suggesting increased timing precision). (R)-ketamine (30, but not 60 mg/kg) increased only the reinforcement rate and peak location but did not affect timing. Only fluoxetine decreased burst responses, suggesting decreased impulsivity. Naloxone pretreatment did not block ketamine enantiomers’ actions, but unexpectedly, increased fluoxetine’ performance. Thus, while all three medications produced antidepressant-like effects in DRL 72-s, fluoxetine- and (S)- but not (R)- ketamine-induced time underestimation (the subject experiences the time as passing quickly). The potentiation of DRL performance of fluoxetine by naloxone was unexpected and warrants clinical studies.
Purpose To estimate the shape and number of mechanical efficiency (ME) trajectories from childhood to adolescence; and verify whether ME trajectory membership can be predicted by sex, biological maturation, body weight, body composition and physical activity (PA) in childhood. Methods Data from QUALITY, an ongoing cohort study on the natural history of obesity, were used. Participants attended a baseline visit (8–10 years, n = 630) and follow-up visits two years (n = 564), and seven years (n = 377) later. ME was assessed by an incremental cycling test at 50w (ME50w, %) and at VO2peak (MEVO2peak, %). Group-based trajectory analysis for ME and a logistic regression were performed. Results Mean age of the 454 participants (boys = 54%) was 9.7 ± 0.9 years at baseline. Two distinct ME50w trajectories were identified and all tended to decrease. No distinct trajectories emerged for MEVO2peak; average MEVO2peak increased over time. Thus, the difference between MEVO2peak (∆) at baseline and follow-up was calculated for correlation analysis. Trajectory groups were labeled “Low-Decreaser” and “High-Decreaser” (Reference) for ME50w, describing the starting point and slope. High-Decreasers were mostly prepubertal girls, had lower body weight and fat free mass index, lower PA and lower VO2peak at baseline (χ²or t-test, p < 0.05). Girls were less likely to be Low-Decreasers (OR = 0.56, 95%CI = 0.42–0.74), while having overweight/obesity predicted a greater likelihood of classification in the Low-Decreaser trajectory (OR = 2.38, 95%CI = 1.16–4.88). Those with higher PA were more likely to be Low-Decreasers (OR = 1.02, 95%CI = 1.01–1.04). Finally, concerning MEVO2peak, sex, biological maturation, body weight, zBMI, fat free mass index, PA and VO2peak were positively correlated with ∆ MEVO2peak. Conclusions We found evidence that excess weight at baseline predicts low levels of ME in childhood and adolescence. Additionally, higher PA at baseline is not related to higher ME50w levels. More research is needed to identify different approaches to explore this measure in transition to adulthood.
There is a significant overlap in symptomology between individuals with deficits in attention and learning, which is explained by the co-dependent dynamic between the two cognitive constructs. Within this dynamic, attentional resources are allocated to salient stimuli while learning mechanisms distinguish relevant from irrelevant information. Moreover, individuals with deficits in higher-order cognition (i.e., intelligence) can demonstrate difficulties in attention and learning. The Multiple Object-Tracking (MOT) task is a sensitive and versatile measure of attention that has characterized individual differences in attention as a function of higher-order cognition. Exploiting the traditional MOT task’s ability to characterize the allocation of attentional resources to task demands, the current study compared learning exhibited on an attention-based task across neurodevelopmental conditions defined by deficits in attention (attention-deficit/hyperactivity disorder; ADHD), learning (specific learning disorder; SLD), and intelligence (intellectual developmental disorder; IDD). Children and adolescents (N = 101) completed 15 sessions on a Multiple Object-Tracking (MOT) task where performance trajectories were analyzed using latent growth curve modeling and conditioned by the presence of ADHD, SLD, or IDD while controlling for performance on a separate measure of attention, age, and sex. The sample, characterized by below-average IQ and problematic levels of attention, exhibited an effect of learning on MOT. However, individuals with an IDD diagnosis demonstrated decreased baseline MOT capability while ADHD and SLD profiles exhibited decreased slopes, relative to other neurodevelopmental conditions. Taken together, the results demonstrate distinct linear performance trajectories between neurodevelopmental conditions defined by deficits in attention, learning, and intelligence. The current study provides additional evidence to repurpose the traditional MOT task as a descriptor of attention and discusses alternative uses for the paradigm. Overall, these results suggest an eclectic approach that considers attention, learning, and higher-order cognition when diagnosing ADHD, SLD, or IDD.
Objectives: We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours). Methods: We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care. Results: A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy. Conclusion: The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology‐Head and Neck Surgery to develop statements for a target population of children aged 2‐18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug‐induced sleep endoscopy, surgical management, and postoperative care. The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
Background and study aims Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (biopsy forceps [BF] or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies. Our aim was to evaluate the performance of VSE when compared to ER and BF-based measurement. Methods We conducted a preclinical randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and BF. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5-, 10-, and 20-mm thresholds. Results A total of 360 measurements were performed. The relative accuracy of BF, ER, and VSE was 78.9 % (95 %CI = 76.2–81.5), 78.4 % (95 %CI = 76.0–80.8), and 82.7 % (95 %CI = 80.8–84.8). VSE had significantly higher accuracy compared to BF ( P = 0.02) and ER ( P = 0.006). VSE misclassified a lower percentage of polyps > 5 mm as ≤ 5 mm (9.4 %) compared to BF (15.7 %) and ER (20.9 %). VSE misclassified a lower percentage of ≥ 20 mm polyps as < 20 mm (8.3 %) compared with BF (66.7 %) and ER (75.0 %). Of polyps ≥10mm, 25.6 %, 25.5 %, and 22.5 % were misclassified as <10 mm with ER, BF, and VSE, respectively. Conclusions VSE had significantly higher relative accuracy in measuring polyps compared to ER or BF assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds.
Study objectives: Giftedness is a multidimensional condition. It is increasingly put forward that gifted children (GC) could be a population at high risk for sleep problems. The current study investigated GC and typically developing children (TDC) for their habitual sleep, night-to-night sleep variability, and parental reports of child sleep. Methods: The sample consisted of 62 GC (31 girls; mean age = 9.63 ± 1.71 years) and 62 TDC (31 girls; mean age = 9.68 ± 1.68 years). Groups were age- and sex-matched. Giftedness was identified using Renzulli's three-factor definition of giftedness. Sleep duration, quality, and night-to-night variability were assessed using actigraphy. Parents were asked to complete the short-form version of the Children's Sleep Habits Questionnaire to report on their child's sleep. Groups were compared with independent sample t-tests and chi-square analyses. Results: GC displayed lower sleep efficiencies, more wake time after sleep onset, and more night-to-night sleep variability than TDC. GC were found to experience less social jetlag compared to TDC and they also showed more clinically significant sleep problems as reported by parents. Conclusions: Sleep maintenance and stability tend to be challenged in GC. While there is growing evidence that greater sleep variability is associated with poorer physical and emotional health, studies have yet to examine these associations in GC specifically to get a better understanding of giftedness. Overall, there is a need for research focused on both predictors and consequences of sleep patterns and sleep variability in GC.
Background High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy improved performance in the clinical setting. Methods Advanced anaphylaxis scenarios were designed by a panel of emergency, intensive care unit, anesthesiology and allergy-immunology specialists and then adapted for the adult allergy clinic setting. This simulation activity included a first part in the high-fidelity simulation-training laboratory and a second at the adult allergy clinic involving actors and a high-fidelity mannequin. Participants filled out a questionnaire, and qualitative interviews were performed with staff after they had managed cases of refractory anaphylaxis. Results Four nurses, seven allergy-immunology fellows and six allergy/immunologists underwent the simulation. Questionnaires showed a perceived improvement in aspects of crisis and anaphylaxis management. The in-situ simulation revealed gaps in the process, which were subsequently resolved. Qualitative interviews with participants revealed a more rapid and orderly response and improved confidence in their abilities and that of their colleagues to manage anaphylaxis. Conclusion High-fidelity simulations can improve the management of anaphylaxis in the allergy clinic and team confidence. This activity was instrumental in reducing staff reluctance to perform high-risk challenges in the ambulatory setting, thus lifting a critical barrier for implementing oral immunotherapy at our adult center.
Digital technology offers several opportunities to improve access to professional expertise in primary care, and the offer of various “virtual” services has exploded in the past few years. The aim of this study was to evaluate the implementation of a direct-to-consumer on-line pharmacy consultation service (Ask Your Pharmacist - AYP) to a universal phone consultation service led by the universal public health system in Quebec (811 Info-Santé), through a direct bridge. Semi-structured interviews were conducted with clinician users of the service, and stakeholders involved in this pilot project funded by the Ministry of Economy (n = 22); documents were also analyzed, and content of the question was asked through the AYP service. Adoption of the service was low, and it suggests a poor alignment between the need and the service as implemented. Further research should investigate the mechanisms for an appropriate integration of digital services for primary care universal consultation services.
Clinician-led conversations about future care priorities occur infrequently with end-stage renal disease (ESRD) patients on dialysis. This was a pilot study of structured serious illness conversations using the Serious Illness Conversation Guide (SICG) in a single dialysis clinic to assess acceptability of the approach and explore conversation themes and potential outcomes among patients with ESRD. Twelve individuals with ESRD on dialysis from a single outpatient dialysis clinic participated in this study. Participants completed a baseline demographics survey, engaged in a clinician-led structured serious illness conversation, and completed an acceptability questionnaire. Conversations were recorded, transcribed and thematically analyzed. The average age of participants was 68.8 years. The conversations averaged 20:53 in length. Ten participants (83%) felt that the conversation was held at the right time in their clinical course and eleven participants (91%) felt that it was worthwhile. Most participants (73%) reported neutral feelings about clinician use of a printed guide. Eleven participants (91%) reported no change in anxiety about their illness following the conversation, and five participants (42%) reported that the conversation increased their hopefulness about future quality of life. Thematic analysis revealed common perspectives on dialysis including that participants view in-center hemodialysis as temporary, compartmentalize their kidney disease, perceive narrowed life experiences and opportunities, and believe dialysis is their only option. This pilot study suggests that clinician-led structured serious illness conversations may be acceptable to patients with ESRD on dialysis. The themes identified can inform future serious illness conversations with dialysis patients.
Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Methods & procedures: Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24 h; acute: 24-72 h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia. What this paper adds: What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.
Background A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. Objective The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. Methods This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. Results A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. Conclusions The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn.
Objective: To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational-age (SGA) among pregnant women and people living with HIV in Canada. Methods: Data for this retrospective cohort study was analyzed from the Canadian Perinatal HIV Surveillance Program from 1990-2020. Association between ART and risk of PTD (<37 weeks) and SGA (<10th percentile) was explored using mixed effects logistic regression and time-dependent Cox's proportional hazards models. Results: Overall there were 14.9% (654/4379) PTD and 18.5% (732/3947) SGA cases. A higher risk of PTD was observed with non-nucleoside reverse transcriptase inhibitor (NNRTI) (adjusted hazard ratio (aHR) =1.73, p=0.019) and boosted protease inhibitor (PI)-based regimens (aHR=1.68, p=0.007) compared to integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA compared to ART initiation post conception at 1-14 weeks (adjusted odds ratio (aOR) =0.69, p=0.024) and > 14 weeks (aOR=0.70, p=0.005). Conclusion: INSTI-based ART regimens were associated with lower risk of PTD compared to other regimens, and ART initiation before conception was associated with a lower risk of SGA. These findings, with overall safety data, should be considered when providing pregnancy counselling to people living with HIV.
Computerized cognitive training tools are an alternative to preventive treatments related to cognitive impairment and aging. In this study, the transfer of 3D multiple object tracking (3D-MOT) training on manual dexterity concerning fine and gross motor skills in 38 elderly participants, half of them with mild cognitive impairment (MCI) and the other half with mild dementia (MD) was explored. A total of 36 sessions of the 3D-MOT training program were administered to the subjects. The Montreal Cognitive Assessment (MoCA) test was used to assess the baseline cognitive status of the participants. Two batteries of manual motor skills (GPT and MMDT) were applied before and after the 3D-MOT training program. The results showed an interaction effect of training and improvement in manual dexterity tests, from the first training session until the fifteenth session, and after this range of sessions, the interaction effect was lost. However, the training effect continued to the end of the thirty-six-session program. The experimental results show the effect of cognitive training on the improvement of motor skills in older adults. This type of intervention could have a broad impact on the aging population in terms of their attention, executive functions, and therefore, their quality of life.
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18,906 members
Lauren Weiss
  • Department of Physics
Guylaine Le Dorze
  • School of Speech Pathology and Audiology
Almer Van der Sloot
  • Institute for Research in Immunology and Cancer
Guillaume Dumas
  • Department of Psychiatry
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Guy Breton, recteur
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www.umontreal.ca
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