Preventing Indigenous youth homelessness in Canada: A qualitative study on structural challenges and upstream prevention in education.

Drawing on a partnership with a group of Indigenous youth experiencing homelessness in Vancouver, Canada, this study identifies four structural challenges that have impacted them and four actionable upstream strategies to further prevent youth housing precarity. As a secondary analysis of a community-engaged study with youth experiencing homelessness, we conducted a thematic analysis with qualitative data, which included qualitative interviews with five young people and researcher observations. The results reflect the racial, colonial, and economic concerns that impact Indigenous youth experiencing homelessness. The four actionable upstream solutions highlight human rights-based approaches to homelessness, ranging from advancing and strengthening public services, transitional justice processes, and cultural and socioeconomic safety. This study provides strategies to promote Indigenous youth wellbeing and decrease risk of housing precarity, while centering and drawing from youth knowledge production. Strengths and limitations of the study are also discussed.

Biphilic Organophosphorus Catalysis: Regioselective Reductive Transposition of Allylic Bromides via P(III)/P(V) Redox Cycling.

We report that a regioselective reductive transposition of primary allylic bromides is catalyzed by a biphilic organophosphorus (phosphetane) catalyst. Spectroscopic evidence supports the formation of a pentacoordinate (σ(5)-P) hydridophosphorane as a key reactive intermediate. Kinetics experiments and computational modeling are consistent with a unimolecular decomposition of the σ(5)-P hydridophosphorane via a concerted cyclic transition structure that delivers the observed allylic transposition and completes a novel P(III)/P(V) redox catalytic cycle. These results broaden the growing repertoire of reactions catalyzed within the P(III)/P(V) redox couple and suggest additional opportunities for organophosphorus catalysis in a biphilic mode.

First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation.

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

RéSUMé: Les besoins en santé mentale et les disparités rencontrés par les Premières Nations et les Inuits au Canada dépassent de loin ceux de la population générale, et pourtant, l'accès à des soins culturellement sécuritaires demeure un sérieux défi. Une des manières d'accéder aux soins de santé mentale est par le biais du programme de counselling en santé mentale des Services de santé non assurés (SSNA), géré par Services aux Autochtones Canada. Cependant, les évaluations de l'efficacité du programme de counselling en santé mentale des SSNA sont entièrement absentes de la littérature académique, ce qui est surprenant compte tenu que ce programme reçoit un financement fédéral important pour prendre en charge une population qui vit une marginalisation extrême. Le commentaire suivant présentera trois défis observés avec l'état actuel du programme dans les domaines de l'accessibilité des services, la nécessité d'une main-d'œuvre en santé mentale autochtone, et des soins culturellement sécuritaires. Pour chaque défi présenté, nous faisons des recommandations sur la manière d'améliorer le programme dans son état actuel. La conclusion de cet article plaide pour une évaluation plus large du programme de counselling en santé mentale des SSNA du point de vue de ses utilisateurs de services et des professionnels de la santé mentale inscrits. Ce type d'évaluation est conforme aux Appels à l'action décrits par la Commission de vérité et réconciliation du Canada.

Renal-Protective Urinoma Formation in a Newborn Boy With Posterior Urethral Valves.

Posterior urethral valves (PUV) are an uncommon urologic congenital anomaly in males often discovered antenatally and more rarely after birth. PUV can lead to obstructive nephropathy and voiding dysfunction, putting patients at increased risk for irreversible renal damage and subsequent progression to end-stage renal disease. Much of the renal damage caused by PUV is proportional to the amount of time that the kidney has been experiencing retrograde pressure. Although much debate exists within the field, spontaneous decompression within the collecting system (e.g., "pop-off" valve) such as urinoma formation or spontaneous ascites has been found to relieve pressure on and thus protect the kidney, decreasing the risk of progression to advanced stages of chronic kidney disease. Despite the significant mass effect on the renal parenchyma, the pressure-relieving function of urinoma formation is a net protective factor allowing renal function to be preserved. We report a unique case of antenatal detection of PUV in a male with postnatal complicated urinoma formation secondary to forniceal rupture. Remarkably, despite significant external compression of the kidney and the development of urosepsis from infection of the urinoma with a multidrug-resistant organism that required percutaneous drainage, renal function was preserved throughout the disease course. After ablation of the PUV and drainage of the septic urinoma, the patient recovered rapidly after intervention and was ultimately discharged in stable condition.

Main group redox catalysis: reversible P(III)/P(V) redox cycling at a phosphorus platform.

A planar, trivalent phosphorus compound is shown to undergo reversible two-electron redox cycling (P(III)/P(V)) enabling its use as catalyst for a transfer hydrogenation reaction. The trivalent phosphorus compound activates ammonia-borane to furnish a 10-P-5 dihydridophosphorane, which in turn is shown to transfer hydrogen cleanly to azobenzene, yielding diphenylhydrazine and regenerating the initial trivalent phosphorus species. This result constitutes a rare example of two-electron redox catalysis at a main group compound and suggests broader potential for this nonmetal platform to support bond-modifying redox catalysis of the type dominated by transition metal catalysts.

The emotional impact of self-criticism on self-reflection and rumination.

OBJECTIVES: The goals of this study were to determine whether self-reflection is a beneficial exercise for highly self-critical individuals and to examine the effects of self-focused thought including reflection and rumination on mood. This was investigated by measuring the levels of self-criticism, as well as mood before and after exposure to a reflective prompt or a ruminative prompt. DESIGN: Experimental design with random assignment to reflection, rumination or control groups. METHODS: 243 participants from a sample recruited on prolific provided demographic information and completed measures of current mood and self-criticism. All participants were then asked to remember a time they made a mistake that had a significant impact on them and describe the mistake briefly. Participants were then randomly assigned to a self-focus condition (reflection, rumination or control). After being assigned and completing the prompt, their mood was measured again. RESULTS: Hierarchical multiple regressions were used to measure the potential combined effects of self-criticism and self-focused thought on change in emotion. The results showed that participants with high levels of maladaptive self-criticism (hated self-subscale) experienced a significant decrease in negative emotions, indicating improved mood. CONCLUSIONS: This suggests that reflection may be a beneficial exercise for highly self-critical individuals. Participants in the rumination group experienced no significant change in emotion, indicating how rumination can perpetuate negative affect and is therefore an important issue to be addressed in psychotherapy.

Feasibility and acceptability of Narrative Exposure Therapy to treat individuals with PTSD who are homeless or vulnerably housed: a pilot randomized controlled trial.

BACKGROUND: Diagnosed PTSD rates in people who are homeless are more than double that of the general population, ranging between 21 and 53%. Complex PTSD (cPTSD) also appears to be more common than PTSD. One treatment option is Narrative Exposure Therapy (NET), a brief trauma-focused psychotherapy which attempts to place trauma within a narrative of the person's life. Our primary aim was to assess the feasibility and acceptability of recruiting people to a randomized controlled trial (RCT) of NET alone compared to NET augmented by a genealogical assessment. We hypothesized that incorporating a genealogical assessment may be more effective than NET alone in a population with predominately complex PTSD. METHODS: This pilot RCT enrolled participants who were 18 years of age or older, currently homeless or vulnerably housed, and with active symptoms of PTSD. Participants were randomized to NET alone or NET plus a genealogical assessment. Rates of referral, consent, and retention were examined as part of feasibility. Demographic and clinical data were collected at baseline. Symptoms of PTSD, drug use, and housing status were re-assessed at follow-up visits. We conducted a thematic analysis of qualitative interviews of service providers involved in the study which explored barriers and facilitators of study participation. RESULTS: Twenty-two potential participants were referred to the study, with 15 consenting to participate. Of these, one was a screen failure and 14 were randomized equally to the treatment arms. One randomized participant was withdrawn for safety. Attrition occurred primarily prior to starting therapy. Once therapy began, retention was high with 80% of participants completing all six sessions. Seven participants completed all follow-up sessions. Service providers identified a clear need for the treatment and emphasized the importance of trauma-informed care, a desire to know more about NET, and more communication about the process of referral. CONCLUSION: Recruiting participants who were vulnerably housed to an RCT of a trauma-based therapy was possible. Once therapy had started, participants were likely to stay engaged. We will incorporate the results of this trial into a conceptual model which we will test in a factorial study as part of the optimization phase of MOST. TRIAL REGISTRATION: ClinicalTrials.gov NCT03781297 . Registered: December 19, 2018.

Extensive scrotal lymphangioma circumscriptum: A case report with successful treatment with staged CO2 laser ablation.

Scrotal lymphangioma circumscriptum (LC) is an uncommon, benign skin disorder with multiple treatment modalities. We present staged treatment of extensive LC of the scrotum using staged carbon dioxide (CO2) laser ablation. We achieved near complete resolution of lesions with excellent cosmesis in the span of four months, from presentation to treatment. Therefore, the use of staged CO2 laser ablation should be strongly considered when LC presents in the genitourinary (GU) system, as it can lead to good cosmetic outcomes and prompt symptomatic relief in a short period of time.

Large pelvic hematoma following UroLift procedure causing renal failure requiring dialysis.

The prostatic urethral lift procedure is a minimally invasive treatment option for lower urinary tract symptoms due to benign prostatic hyperplasia, with reported benefit of less adverse effects than traditional treatments. While complications are usually minimal, our patient developed a large pelvic hematoma and the first case of organ failure after prostatic urethral lift. He required temporary dialysis during his extended postoperative admission, and his chronic kidney disease permanently progressed from stage III to stage IV. This case highlights the need for research into the safest preoperative and operative approach for prostatic urethral lift procedures in patients with comorbidities.

Strain differences in coping behaviour, novelty seeking behaviour, and susceptibility to socially conditioned fear: a comparison between Wistar and Sprague Dawley rats.

The aim of the current study was to generate socially conditioned fear in two different strains of rat (Wistar, W and Sprague Dawley, SD) using social conflict, in order to investigate whether the magnitude of the conditioned fear responses in each strain was related to behaviour exhibited prior to or during fear induction (i.e. social conflict). On day one of the study, all intruders were assessed for exploratory activity in a novel environment. Twenty four hours following the novel environment test the locomotor activity of the intruders was assessed, while they underwent a single familiarisation exposure to the arena in which the conflict was subsequently to occur in. Twenty-four hours following familiarisation, intruders underwent either a 10 min social conflict or sham conflict session. One day later we examined the response of the intruders when they were returned to the vacant resident's cage. Upon return to the conflict context, we examined the intruder's ultrasonic distress vocalisations and the extent to which locomotor activity was inhibited. We found that W rats displayed significantly more immobility (i.e. conditioned fear) upon return to context than did SD rats (p < 0.05). Importantly, we observed that the differences in the two strains behaviour upon return to context appeared to be related to their quite different patterns of coping behaviour. The results of the current study indicate that preclinical between-strain comparisons potentially have much to offer in regard to understanding the basis of resilience to social stress.

Comparing the self concept of children with cerebral palsy to the perceptions of their parents.

PURPOSE: Understanding self concept is important for therapists treating children with cerebral palsy because knowing what children and parents think about perceived competencies and adequacies can be taken into account in determining treatment goals. This study investigated: (i) If differences existed between the self concept ratings of children with cerebral palsy compared to their parent's perception of their child's abilities and attributes, and (ii) the strength of association between the child and parent ratings. METHOD: Thirty children (14 females, 16 males; mean age 11 years 5 months, SD 2 years 6 months, range 8-16 years) with spastic hemiplegia or diplegia and gross motor skills classified as level I or II on the Gross Motor Function Classification System rated their self-concept using the Self-Perception Profile for Children questionnaire. Their parents completed the accompanying Parent Rating Scale. RESULTS: Group differences between the parents and children were found for the domains of Athletic Competence and Physical Appearance. There was either no relationship or a low level of association between the child and parent ratings in all five domains of self concept assessed. CONCLUSION: Parents were unable to evaluate their child's self concept accurately suggesting health professionals should gather such information from the child themselves.

Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain.

BACKGROUND: Yoga has been shown useful in reducing chronic low back pain (CLBP) through largely unknown mechanisms. The aim of this pilot study is to investigate the feasibility of providing yoga intervention to a predominantly underserved population and explore the potential mechanisms underlying yoga intervention in improving CLBP pain. METHODS: The quasi-experimental within-subject wait-listed crossover design targeted the recruitment of low-income participants who received twice-weekly group yoga for 12 weeks, following 6-12 weeks of no intervention. Outcome measures were taken at baseline, preintervention (6-12 weeks following baseline), and then postintervention. Outcome measures included pain, disability, core strength, flexibility, and plasma tumor necrosis factor (TNF)-α protein levels. Outcomes measures were analyzed by one-way ANOVA and paired one-tailed t-tests. RESULTS: Eight patients completed the intervention. Significant improvements in pain scores measured over time were supported by the significant improvement in pre- and post-yoga session pain scores. Significant improvements were also seen in the Oswestry Disability Questionnaire scores, spinal and hip flexor flexibility, and strength of core muscles following yoga. Six participants saw a 28.6%-100% reduction of TNF-α plasma protein levels after yoga, while one showed an 82.4% increase. Two participants had no detectable levels to begin with. Brain imaging analysis shows interesting increases in N-acetylaspartate in the dorsolateral prefrontal cortex and thalamus. CONCLUSION: Yoga appears effective in reducing pain and disability in a low-income CLBP population and in part works by increasing flexibility and core strength. Changes in TNF-α protein levels should be further investigated for its influence on pain pathways.

A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm.

BACKGROUND: Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm. OBJECTIVE: To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy. METHODS: After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach. FINDINGS: Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments. CONCLUSIONS: In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people. CLINICAL IMPLICATIONS: Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions. TRIAL REGISTRATION NUMBER: NCT02718248.

Metastatic Paraganglioma Presenting as Incontinence in a 15-Year-Old Girl.

Chromaffin cell tumors are derived from neural crest cells and can produce and secrete catecholamines. Classic symptoms include headache, palpitations, diaphoresis, and hypertension. Diagnosis is typically in adulthood, and metastatic disease is rarely found. Genetic testing is suggested with young age, extra-adrenal tumors, malignant disease, or family history of associated tumors. Our young patient's presentation of incontinence is unique, but several other atypical findings can be accounted for relative to her germline mutation. Because of the rarity of our patient's case, follow-up procedure is undefined. Documenting atypical cases such as this is central to clinician awareness and development of follow-up protocol.

Continuing and ceasing leisure activities in later life: a longitudinal study.

PURPOSE: This study examined changes in leisure activities of older adults over an 8-year period, and associated sociodemographic and health characteristics. DESIGN AND METHODS: Data were from a longitudinal study conducted in Winnipeg, Manitoba, Canada; 380 respondents were interviewed in-person in both 1985 and 1993. Changes in ten specific activities and the overall number of activities continued were examined. RESULTS: Theater/movies/spectator sports and travel were the activities least likely to be continued over the 8-year period; watching television and reading were most likely to be continued. Characteristics significantly related to changes in activities were age, gender, education, and self-rated health in 1985 as well as changes in marital status, self-rated health, and functional ability between 1985 and 1993, although no consistent pattern emerged. IMPLICATIONS: Leisure education is discussed as a means of introducing modifications to enhance older adults' participation in desired activities. Directions for future research are highlighted.

A systematic review of the self-concept of children with cerebral palsy and perceptions of parents and teachers.

This systematic review aimed to determine if differences exist in how a child with cerebral palsy perceives their self-concept and how the child's abilities, behaviors, and attributes are perceived by their parents and teachers. Articles were identified by searching electronic databases. Two reviewers independently assessed the identified articles against predefined inclusion/exclusion criteria. The quality of included articles was assessed against four criteria of methodological rigor. Data were analyzed using effect sizes, meta-analysis, power calculations and independent t-tests. Three articles were included in the review. Meta-analysis indicated that parents of children with cerebral palsy rated their child's abilities and attributes lower than the child's rating (d = 0.66, 95% confidence interval 0.24-1.08). A second meta-analysis did not find a significant difference between the child's and teacher's ratings (d = 0.60, 95% confidence interval -0.44-1.64). These findings suggest that routine assessment of self-concept in children with cerebral palsy by pediatric physical therapists may enlighten the goal setting process of family-centered practice.