Understanding the Trajectories of Women who use Violence Through an Intersectional Feminist Analysis.

This article discusses the results of a collaborative research project aimed at understanding the life trajectories of women who have self-identified as having used violence in a context other than self-defense, which is an understudied topic. Based on semi-structured interviews and aided by an intersectional feminist framework applied to life course theory, we present a qualitative analysis of 26 women's experiences of violence, precarity, and services. The three groups of trajectories are distinguished by level of precarity as determined by the experience of violence in childhood, socioeconomic and family contexts, criminalization, intensity of violence, and whether the women received adequate support. This shows (1) the need for interventions to prevent the reproduction or aggravation of violence suffered and perpetrated; (2) the importance of considering the inter-related factors (gender, class race, etc.) that contribute to the women's precarity; and (3) that these factors must be considered to understand the contexts in which women have come to use violence, without trivializing or excusing it, but rather properly situating it with a view to better preventing and intervening in these situations. Our recommendations are aimed at ensuring that social work practices do not contribute to the enforcement of punitive measures, but support women in pursuing their path.

Factors Shaping Gay Men's Experience of Intimate Partner Violence: An Ecological View.

Gay men are particularly at risk for intimate partner violence (IPV). As regards the prevalence and unique consequences of IPV, many studies seek to understand the specific stressors faced by gay men, but few provide a more comprehensive perspective of IPV-related factors, including gay men-specific, general as well as protective factors. An ecological perspective was used to conduct a qualitative study aimed at identifying the different risk and protective factors related to IPV among gay men. We conducted individual semi-structured interviews with 23 gay men who acknowledge having experienced IPV by another man, as well as two focus groups with practitioners who provide services to this population. Our analysis led to a five-level ecological model, ranging from most proximal (e.g. prior victimization) to distal (e.g. conception of masculinity) factors, and including both general factors (e.g. power dynamics) and factors specific to gay men. Heterosexism emerged as an overarching contributing sociocultural factor. This study sheds new light on mechanisms whereby these factors affect the IPV experience, namely the risk of being victimized; the recognition of IPV victimization; and the response to the IPV experienced. These mechanisms are discussed along with heterosexism-related factors, and implications for research and practices are suggested.

Transthoracic needle biopsy versus surgical diagnosis for solid pulmonary nodules.

Background: When investigating solitary pulmonary nodules (SPN), non-surgical [such as transthoracic needle biopsy (TTNB)] or surgical biopsies can be performed. There is a paucity of data comparing these two approaches. Methods: This descriptive study is a retrospective analysis of a cohort of 149 patients who underwent TTNB and/or surgery for a SPN >8 mm but ≤3 cm between January and December 2016, at Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Our primary objective was to evaluate the proportion of patients investigated with TTNB vs. surgical diagnosis in our center. Secondary objectives were to examine the distribution of diagnoses (malignancy vs. benign lesion), to evaluate the proportion of TTNB that would yield a benign diagnosis and permit to avoid surgery, to evaluate if delays to surgery were longer when preoperative TTNB was performed, and if operative times were longer with upfront surgery. Results: In our cohort, 87 patients (58%) underwent TTNB, while 62 (42%) had an upfront surgical procedure. One hundred and twenty-eight patients (86%) had a malignant diagnosis. Thirteen patients out of the 87 biopsied (15%) avoided surgery owing to a benign biopsy result, or a non-specific diagnosis and a physician reassured enough to decide for radiological surveillance, while 5/62 patients (8%) who underwent upfront surgery had a benign diagnosis. There was no significant difference in delays from imaging to surgery or in operative time between patients with or without prior TTNB. Conclusions: In this unicentric retrospective cohort of patients investigated for SPN, the malignancy rate was high (86%), which seemed to limit the applicability of prediction models. Adherence to guidelines for the investigation of SPN by physicians seemed suboptimal. More real-world prospective studies are needed to compare non-surgical and surgical biopsies. There is also a need for simpler nodule evaluation algorithms.

Profiling the response to lumacaftor-ivacaftor in children with cystic between fibrosis and new insight from a French-Italian real-life cohort.

INTRODUCTION: Clinical trials for CFTR modulators consider mean changes of clinical status at the cohort level, and thus fail to assess the heterogeneity of the response. We aimed to study the different response profiles to lumacaftor-ivacaftor according to age in children with cystic fibrosis (CF). METHODS: A mathematical framework, including principal component analysis, data clustering, and data completion, was applied to a multicenter cohort of 112 children aged 6-18 years, treated with lumacaftor-ivacaftor. Studied parameters at baseline and 6 months included body mass index (BMI), number of days of antibiotics (ATB), Sweat test (ST), forced expiratory volume in 1 s expressed in percentage predicted (ppFEV1 ), forced vital capacity (ppFVC), and forced expiratory flow at 25%-75% of FVC (ppFEF25-75 ). RESULTS: Change in ppFEV1 was the most significant parameter in characterizing response heterogeneity among the 12-18-year-old patients. Patients with minimal changes in ppFEV1 were further separated by change in BMI and ATB course. In the 6-12-year-old children both BMI and ppFEV1 evolution were the most relevant. ST change was not associated with a clinical response. CONCLUSIONS: Change in ppFEV1 , BMI, and ATB course are the most relevant outcomes to discriminate clinical response profiles in children treated with lumacaftor-ivacaftor. Prepubertal and pubertal children display different response profiles.

Low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia (LOW-TMP): protocol for a phase III randomised, placebo-controlled, dose-comparison trial.

INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection of immunocompromised hosts with significant morbidity and mortality. The current standard of care, trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 15-20 mg/kg/day, is associated with serious adverse drug events (ADE) in 20%-60% of patients. ADEs include hypersensitivity reactions, drug-induced liver injury, cytopenias and renal failure, all of which can be treatment limiting. In a recent meta-analysis of observational studies, reduced dose TMP-SMX for the treatment of PJP was associated with fewer ADEs, without increased mortality. METHODS AND ANALYSIS: A phase III randomised, placebo-controlled, trial to directly compare the efficacy and safety of low-dose TMP-SMX (10 mg/kg/day of TMP) with the standard of care (15 mg/kg/day of TMP) among patients with PJP, for a composite primary outcome of change of treatment, new mechanical ventilation, or death. The trial will be undertaken at 16 Canadian hospitals. Data will be analysed as intention to treat. Primary and secondary outcomes will be compared using logistic regression adjusting for stratification and presented with 95% CI. ETHICS AND DISSEMINATION: This study has been conditionally approved by the McGill University Health Centre; Ethics approval will be obtained from all participating centres. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04851015.

[The benefits of nature in the age of anthropocene education]. / Les bienfaits de la nature à l'ère de l'éducation en anthropocène.

Few children today enjoy regular contact with nature. The youngest children go from home to nursery school without having the opportunity to dip their hands in the earth or to watch the leaves of a tree playing with the wind. After several months of Covid-19 developing new variants, the situation has worsened. This makes it all the more important to demonstrate the benefits of welcoming toddlers outdoors.

A randomized double-blind feasibility study comparing cetirizine and diphenhydramine in the prevention of paclitaxel-associated infusion-related reactions: the PREMED-F1 study.

PURPOSE: Cetirizine is a less sedative alternative to diphenhydramine for the prevention of infusion-related reactions (IRR) to paclitaxel. However, its use remains controversial. In this study, we assessed feasibility for a future definitive non-inferiority trial comparing cetirizine to diphenhydramine as premedication to prevent paclitaxel-related IRR. METHODS: This was a single-center randomized prospective feasibility study. Participants were paclitaxel-naive cancer patients scheduled to start paclitaxel chemotherapy. They were randomly assigned to receive either intravenous diphenhydramine 50 mg + oral placebo (control) or intravenous placebo + oral cetirizine 10 mg (intervention) for their first two paclitaxel treatments. The percentage of eligible patients completing a first paclitaxel treatment and the recruitment rate were assessed (feasibility outcomes). Drowsiness was measured at baseline and at selected time points using the Stanford Sleepiness Scale (SSS) (safety outcome). IRR events were also documented (efficacy outcome). RESULTS: Among 37 eligible patients, 27 were recruited and randomized (control 13; intervention 14) and 25 completed the study. The recruitment rate was 4.8 participants/month, meeting the primary feasibility target. Drowsiness was the main adverse effect associated with the premedication. The increase in drowsiness compared to baseline (ΔSSS) was greater in the diphenhydramine group compared to the cetirizine group (median ΔSSS 2 (IQR 3.25) vs median ΔSSS 0 (IQR 1), p < 0.01) when measured one hour after the premedication administration. One participant had an IRR and no unexpected serious adverse event occurred. CONCLUSION: The trial methods were feasible in terms of recruitment, retention, and safety. Cetirizine was significantly less sedating than diphenhydramine. IRR were infrequent and a larger trial is warranted to confirm non-inferiority for IRR prevention. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04237090 (22.01.2020).

IPV Perpetrator Groups: Client Engagement, and the Role of Facilitators.

Based on the emerging literature being developed in Motivational Interviewing that suggests certain group process factors and facilitator attributes predict treatment outcomes, this study sought to investigate the relationship between both client and facilitator ratings of the batterer intervention group experience. This study presents data from 16 group facilitators drawn from five agencies and 175 clients being served by these facilitators. The data gathered included both facilitator ratings of clients (i.e., Group Engagement Measure-GEM) and client ratings of facilitators and the group experience (i.e., Client Rating of Facilitator-CRF, Client Perceived Benefits of Group-CPBG). Results indicate that facilitators rated clients as being engaged in the group process across all the domains assessed by the GEM and that clients viewed the facilitators and group experiences favorably as assessed by the CRF and CPBG. There was no significant correlation between the GEM and CRF or the GEM and CPBG, but there was a strong, positive correlation between the CRF and CPBG. The results here support previous research findings suggesting a strong correlation between client engagement in the therapeutic process, based on their perception of the facilitator, and their perceived benefits of the group experience. Implications of the findings for improving empirical investigations of the batterer intervention group experience were explored and discussed.

Identification of an unusual cluster of human granulocytic anaplasmosis in the Estrie region, Québec, Canada in 2021.

Background: Human granulocytic anaplasmosis (HGA) is a potentially severe tick-borne infection caused by the bacterium Anaplasma phagocytophilum (A. phagocytophilum) of the genus Rickettsia. Here, we describe the epidemiological and clinical characteristics of an unusual cluster of HGA cases detected in the Estrie region in Québec, Canada, during the 2021 transmission season. Methods: Confirmed cases of HGA were defined as individuals with typical clinical manifestations and a positive polymerase chain reaction assay. The cases were interviewed using a structured questionnaire and clinical data was obtained from medical records. Results: A total of 25 confirmed cases were identified during the 2021 transmission season, thus constituting the largest known cluster of HGA in Canada. The most common symptoms reported were fever, fatigue and headaches. Laboratory investigations found that 20 (80%) of the patients had thrombocytopenia and 18 (72%) had leukopenia at presentation. Almost half of the patients required hospitalization (n=11, 44%), with a median duration of four days (interquartile range [IQR] 2.5-5 days), including one patient who required intensive care. No deaths were recorded during the study. Epidemiological investigation found that all cases were domestically acquired, and yard maintenance was the most prevalent at-risk activity identified. Only seven (28%) cases had been aware of a tick bite in the previous two weeks. Conclusion: Detection of this unusual cluster of HGA cases provides further evidence that A. phagocytophilum may now be established along the southern border of Québec. Clinicians should consider HGA when assessing patients with typical symptoms and recent exposure to high-risk environments for tick bite.

The longitudinal association between externalizing and internalizing problems: An exploration of the dual failure model.

The Dual Failure Model suggests that peer victimization (social failure) and academic difficulties (academic failure) mediate the association between externalizing and later internalizing problems. The present study sought to better understand why children with externalizing problems develop later internalizing problems by testing the Dual Failure Model using a sample of 744 children (aged 6 to 10 at Time 1 [T1]), of whom 434 (44.7% girls) presented with high levels of conduct problems at study inception. Both parent and teacher ratings of externalizing and internalizing problems support the social failure pathway, but not the academic failure pathway. Children with externalizing behaviors at T1 who developed internalizing problems 2 years later did so via their experiences of peer victimization. These results apply for both boys and girls and do not vary according to child age at T1 or the level of conduct problems at study inception. These findings underscore the importance of early screening and intervention for externalizing behavioral problems in order to reduce subsequent peer victimization and internalizing problems. Findings regarding the consequences of internalizing are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Practitioners' Views on IPV and Its Solutions: An Integrative Literature Review.

There are ongoing debates in the scientific community and in practice settings about how intimate partner violence (IPV) should be defined and understood and about how various interventions must be carried out. If these debates are to bear fruit, however, we must first gain a comprehensive understanding of each stakeholder's viewpoints on IPV and its solutions. This article seeks to contribute to this goal by summarizing empirical studies investigating how practitioners who work with IPV perpetrators understand the problem and its solutions. Based on an integrative review of the literature, it focuses on how practitioners define IPV and its causes, how they perceive the perpetrators and victims, and on the solutions they put forward in order to work against this social problem. The limitations of our current knowledge are outlined as well as the implications of this review for IPV debates.

Salmonella enterica serotype enteritidis in French Polynesia, South Pacific, 2008-2013.

Outbreaks of Salmonella enterica serotype Enteritidis infections associated with eggs occurred in French Polynesia during 2008-2013. Molecular analysis of isolates by using clustered regularly interspaced short palindromic repeat polymorphisms and multilocus variable-number tandem-repeat analysis was performed. This subtyping made defining the epidemic strain, finding the source, and decontaminating affected poultry flocks possible.

An ecological examination of factors influencing men's engagement in intimate partner violence groups.

This article examines the findings of an ecological analysis of the factors influencing men's engagement in intimate partner violence (IPV) groups. Individual interviews and two focus groups were conducted with men who participated in group programs in two agencies in Canada. Our qualitative analysis of interviews and focus groups suggested that both individual and program-related factors were determinants in the men's engagement. These findings drew our attention to the influence of certain factors outside of the group therapy, in particular organizational practices. Implications for practice are explored, in particular the role of time in the intervention, and implications for research and limitations are discussed.

B cell activating factor (BAFF) and T cells cooperate to breach B cell tolerance in lupus-prone New Zealand Black (NZB) mice.

The presence of autoantibodies in New Zealand Black (NZB) mice suggests a B cell tolerance defect however the nature of this defect is unknown. To determine whether defects in B cell anergy contribute to the autoimmune phenotype in NZB mice, soluble hen egg lysozyme (sHEL) and anti-HEL Ig transgenes were bred onto the NZB background to generate double transgenic (dTg) mice. NZB dTg mice had elevated levels of anti-HEL antibodies, despite apparently normal B cell functional anergy in-vitro. NZB dTg B cells also demonstrated increased survival and abnormal entry into the follicular compartment following transfer into sHEL mice. Since this process is dependent on BAFF, BAFF serum and mRNA levels were assessed and were found to be significantly elevated in NZB dTg mice. Treatment of NZB sHEL recipient mice with TACI-Ig reduced NZB dTg B cell survival following adoptive transfer, confirming the role of BAFF in this process. Although NZB mice had modestly elevated BAFF, the enhanced NZB B cell survival response appeared to result from an altered response to BAFF. In contrast, T cell blockade had a minimal effect on B cell survival, but inhibited anti-HEL antibody production. The findings suggest that the modest BAFF elevations in NZB mice are sufficient to perturb B cell tolerance, particularly when acting in concert with B cell functional abnormalities and T cell help.

Assessment of pain after elective abortion relating to the use of misoprostol for dilatation of the cervix.

OBJECTIVE: Our objective was to compare the use of misoprostol to that of laminaria tents for dilatation of the cervix before a surgical elective abortion (EAB) during the first trimester, with regard to the pain caused (1) during insertion, for both methods, (2) immediately before the EAB, and (3) one hour after the procedure. METHODS: One hundred two women were recruited at Clinique de planification des naissances du Centre hospitalier universitaire de Québec, CHUL pavilion, between March 1, 2006 and March 1, 2007, for a tracking study. Fifty-three women were given 400 microg of misoprostol intravaginally, three to four hours before the EAB, and a laminaria tent was inserted in 49 women, 16 to 24 hours before the EAB. A visual analog scale was used to determine the pain score. RESULTS: One hour after EAB, severe pain was reported in 6% of the participants who were given misoprostol. The pain score post-EAB was 3.8 times higher in women who were given misoprostol than in those who had a laminaria tent inserted (P = 0.004). The pain score during insertion of the dilatation method was 33 times higher with the laminaria tent than with misoprostol (P < 0. 001), and 30% of women who had a laminaria tent inserted felt severe pain. CONCLUSION: While misoprostol may increase pain after EAB in a small percentage of women, it remains an efficient, easy to use, low-cost method for dilating the cervix before an EAB. It is one of the options that may be offered to women when a pre-EAB dilatation of the cervix is required, after discussing its benefits and disadvantages with them.

Immune mechanisms leading to abnormal B cell selection and activation in New Zealand Black mice.

Polyclonal B cell activation is a hallmark of the immune dysregulation in New Zealand Black (NZB) mice. We have previously shown that the splenic B cell activation is associated with increased CD80 expression. Here we show that abnormal expansions of CD80-expressing GC, CD5(+), marginal zone (MZ) precursor and MZ B cells produce this increase. To investigate the role of BCR engagement in the generation and activation of these populations, a non-self-reactive Ig Tg was introduced onto the NZB background. NZB Ig-Tg mice lacked Tg CD5(+) and peanut agglutinin(+) B cells, confirming the role of endogenous Ag in their selection. Although the increased proportion of MZ B cells was retained in NZB Ig-Tg mice, CD80 expression on these cells was reduced as compared to non-Tg NZB mice, suggesting a role for BCR engagement with endogenous Ag in their activation. Examination of CD40L-knockout NZB mice showed no difference in the abnormal activation or selection of the B cell populations, with the exception of GC cells, as compared to wild-type NZB mice. Thus, polyclonal B cell activation in NZB mice does not require CD40 engagement, but results, in part, from dysregulated BCR-specific mechanisms.

Aberrant IgM signaling promotes survival of transitional T1 B cells and prevents tolerance induction in lupus-prone New Zealand black mice.

New Zealand Black (NZB) mice develop a lupus-like syndrome. Although the precise immune defects leading to autoantibody production in these mice have not been characterized, they possess a number of immunologic abnormalities suggesting that B cell tolerance may be defective. In the bone marrow, immature self-reactive B cells that have failed to edit their receptors undergo apoptosis as a consequence of Ig receptor engagement. Splenic transitional T1 B cells are recent bone marrow emigrants that retain these signaling properties, ensuring that B cells recognizing self-Ags expressed only in the periphery are deleted from the naive B cell repertoire. In this study we report that this mechanism of tolerance is defective in NZB mice. We show that NZB T1 B cells are resistant to apoptosis after IgM cross-linking in vitro. Although extensive IgM cross-linking usually leads to deletion of T1 B cells, in NZB T1 B cells we found that it prevents mitochondrial membrane damage, inhibits activation of caspase-3, and promotes cell survival. Increased survival of NZB T1 B cells was associated with aberrant up-regulation of Bcl-2 after Ig receptor engagement. We also show that there is a markedly increased proportion of NZB T1 B cells that express elevated levels of Bcl-2 in vivo and provide evidence that up-regulation of Bcl-2 follows encounter with self-Ag in vivo. Thus, we propose that aberrant cell signaling in NZB T1 B cells leads to the survival of autoreactive B cells, which predisposes NZB mice to the development of autoimmunity.