Examining an Alternate Care Pathway for Mental Health and Addiction Prehospital Emergencies in Ontario, Canada: A Critical Analysis.

Paramedics in Ontario have largely been limited to transporting those with mental health or addiction (MHA)-related emergencies to the emergency department (ED). The ED has repeatedly been identified as a problematic and challenging setting for people with MHA needs. This article examines an innovative patient care model (PCM) established by the Middlesex-London Paramedic Service and its partners for specific MHA emergencies where patients were given options for care that included transportation to a Canadian Mental Health Association (CMHA) Crisis Centre or information for support. Qualitative and quantitative data that were utilized for regular reporting to the Ministry were included in the analysis. The findings indicated that the goals of reducing pressures on EDs and paramedic services, enhancing paramedics' ability to address MHA calls, and improving patient care experiences were met. This model improves patient autonomy and options for care, improves the means for addressing patients' social determinants of health, and offers transportation to a non-medicalized facility.

Critical ethnography and its others: Entanglement of matter/meaning/madness.

Beginning with a critical examination of the humanist assumptions of critical ethnography, this article interrogates and surfaces problems with the ontological and epistemological orientations of this research methodology. In drawing on exemplar empirical data from an arts-based project, the article demonstrates the limitations in the humanist-based qualitative research approach and advances a postdualist, postrepresentationalist direction for critical ethnography called entangled ethnography. Using data from a larger study that examined the perspectives of racialized mad artists, what is demonstrated in this inquiry is that the entanglement of bodies, objects, and meaning-making practices is central to working with the ontologically excluded, such as those who find themselves in various states of disembodiment and/or corporeal and psychic distribution. We propose the redevelopment of critical ethnography, extended by entanglement theory (a critical posthuman theory), and suggest that for it to be an inclusive methodology, critical ethnography must be conceptualized as in the process of becoming and always in regeneration, open to critique, extension, and redevelopment.

Toward an ontology of the mutant in the health sciences: Re/defining the person from Cronenberg's perspective.

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the 'person' or 'patient' that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken-for-granted definitions and assumptions of the 'person' from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the 'person' in nursing and beyond. Cronenberg's work explores bodily transformation and mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of 'the person'. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming-mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles.

Resilience in nursing education: an evolutionary concept analysis.

OBJECTIVES: Resilience is a complex concept that is extensively drawn upon in higher education, nursing included. The objective is to examine the concept of resilience and its use within nursing education. METHODS: Rodgers' evolutionary concept analysis was used to explore this concept. RESULTS: The current focus on fostering resilience in undergraduate nursing education predominantly focuses on educational interventions to support one's ability to self-care continues to be pervasive within the nursing literature. More recent dialogue encourages a more holistic approach that examine interventions from both individual and structural perspectives. CONCLUSIONS: Recommendations for future research are to examine the synergy between individual, contextual, and structural factors to support resilience in nursing students. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Based on the concept analysis, resilience is contextual. Therefore, nurse educators may support and foster nursing students' resilience by having increased awareness of both individual and structural perspectives of resilience.

From Subjective Opinion to Medical Fact: A Critical Discourse Analysis of Mental Health Nursing Education.

Using various methods and strategies of Critical Discourse Analysis, this article demonstrates how certain influential nursing texts generate a certain biomedical framing of the mental health nursing assessment. Accordingly, the mental health assessment in undergraduate nursing education becomes imbricated in processes of governance that legitimate psychiatric discourse by 1. Presenting the opinions and judgements of mental health professionals as objective scientific facts; 2. Utilizing grammatical mood and modality to convey a matter-of-fact urgency and necessity for psychiatric intervention that is made to appear largely through conjecture and passive logical leaps; and 3. Through hybrid fusion with other scientific and medical disciplines that lend credibility to psychiatry through association. While we largely focus on critique of the mental health assessment, we buttress this critique using two other institutional texts that draw on a psychiatric framing of mental health, to demonstrate how these texts reinforce and work in discursive cohesion with the mental health assessment. We conclude by discussing the implications of these consequences to nursing education and nursing students and educators alike.

Infrahuman madness: Mental health nursing and the discursive production of alterity.

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an "othered" identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out of its identity-based understanding and recontextualized as an inferior category of "the human," circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes-contradictory nature of the discipline's grappling with identity-based mental health concepts. We close with several implications for nursing policy, education, and practice.

Are Postoperative Infections in the First 12 Months after Wide Resection and Megaprosthetic Replacement Associated with the Survival of Osteosarcoma Patients? Results of a Multicenter Study.

Recent retrospective studies suggested that early postoperative infections might be associated with a survival benefit for extremity osteosarcoma patients, but the reported results have been conflicting. The files of 437 patients with a newly diagnosed, high-grade osteosarcoma of the extremities treated at 5 referral centers in Germany and Austria between 1989 and 2016 were retrospectively evaluated. All patients underwent multi-agent chemotherapy and limb-sparing tumor excision, followed by endoprothetic replacement. We used the Kaplan-Meier method to calculate survival curves, which we compared with the log-rank test. With a median follow-up of 100 months (interquartile range, 49-155 months), local recurrence (LR) probability, event-free survival (EFS), and disease-specific survival (DSS) after 5 years in this selected patient cohort amounted to 5%, 67%, and 79%, respectively, and 46 patients (10.5%) developed an early postoperative infection. We found no significant differences in LR, EFS, or DSS between patients with and without early infections, and there were no differences in known prognostic factors between the two groups. However, in subgroup analyses patients with a poor response to neoadjuvant chemotherapy and an early infection had a better DSS compared to patients without early infections (93% vs. 62% after 5 years, p = 0.044). Provided that our findings can be validated in separate patient cohorts, we believe that patient outcome after adjuvant immunomodulatory treatments in osteosarcoma patients should be evaluated and reported separately for good and poor responders to neoadjuvant chemotherapy in future studies.

Electrostatics Trigger Interfacial Self-Assembly of Bacterial Ice Nucleators.

Ice active bacteria can catalyze water freezing at high subzero temperatures using ice nucleating proteins (INPs) located at their outer cell walls. INPs are the most effective ice nucleators known and are of significant interest for agriculture, climate research, and freeze/antifreeze technologies. The aggregation of INPs into large ice nucleation sites is a key step for effective ice nucleation. It has been proposed that ice active bacteria can drive the aggregation of INPs and thereby trigger ice nucleation. However, the mechanism of INP aggregate assembly and the molecular processes behind the activation are still unclear. Both biochemical pathways and activation through electrostatics have been proposed based on experiments with lysed ice active bacteria. For a more direct view on the assembly of INPs, we follow the structure and water interactions of a synthetic model INP of the well-studied ice bacterium Pseudomonas syringae at the air-water interface as a function of the subphase pH. By combining sum frequency generation spectroscopy with two-dimensional infrared spectra, we conclude that self-assembly and electrostatic interactions drive the formation of ordered INP structures capable of aligning interfacial water.

Harnessing the power to bridge different worlds: An introduction to posthumanism as a philosophical perspective for the discipline.

Although it is argued that social justice is a core concern for the discipline, nursing has not generally played a leadership role in the responses to many of the greatest social problems of our time. These include the accelerated rate of climate change, pandemic threats, systemic racism, growing health and social inequities, and the regulation of new technologies to ensure an equitable future 'for all.' In nursing codes of ethics, administration, education, policies, and practice, social justice is often claimed to be a core value, yet it is rarely contextualized by philosophical or theoretical underpinnings. It appears that nurses' commitment to social justice may stem more from a penchant for 'doing good' than an attempt to explore, understand, and enact what is meant by social justice from an ontological, epistemological, and methodological perspective. We contend that the dominance of a human science perspective in nursing contributes to a narrow definition of health and relegates many issues central to social justice to the margins of nurses' care. In this article, we explore how the focus on 'the human' in the human science perspective may not only be limiting the capacity of nurses to develop strategies to adequately address social injustice, but in some instances, direct nurses to contribute to their very reproduction. We suggest that a critical interrogation of this human-centric hegemony can identify avenues of rupture and introduce posthumanism as an additional philosophical perspective for consideration to help bridge the human-social divide.

The Lived Experience of Postpartum Depression: A Review of the Literature.

Postpartum depression has been studied from a variety of perspectives and by many disciplines. The aim of this article is to review qualitative literature exploring the first-person accounts of women diagnosed with postpartum depression and highlight the absence of work in madness discourse. Searches of multiple databases (Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Sociology Database, Web of Science, Genderwatch, PILOTS, MedLine from PubMed, PsycINFO) were undertaken. There is a significant gap in literature that exists in relation to the lived experience of women diagnosed with postpartum depression who do not identify as mentally ill.

A World of Indifference/Un Monde D'Indifférence: Canadian Women's Experiences of Psychiatric Hospitalization/Expériences Canadiennes d'hospitalization psychiatrique au Canada.

This article presents findings and analysis stemming from a two-year qualitative study that explored, in their own voices, women's lived experience of psychiatric hospitalization. Feminist Standpoint Theory and Foucauldian analysis frame and provide the moorings for validity, methodology, and analysis of this woman-centred inquiry. The verbatim representation of lived experience, coupled with the coauthoring of this article with two of the study's participants provides an authentic articulation of participant standpoint. Furthermore, this approach creates a space in nursing scholarship in which the co-development of knowledge is also made possible. Overarching themes of docility-making, harm, betrayal, indifference, and resistance are presented and situated in a broader analysis of the hegemony of bio-psychiatric discourse and its colonization of nursing practice. In order to disrupt systems that fail to meet patient needs and fail to represent nursing's values and ethos, we shed light on the possible systemic factors behind the experience of "indifference".

Toward critical thinking as a virtue: The case of mental health nursing education.

Critical thinking in nursing is largely theorized as a clinically-based idea. In the context of mental health education, this presents a problem, given documented evidence of a shift to demedicalize mental illness. Using institutional ethnography, this article examines the critical thinking of nursing faculty in a baccalaureate nursing program in a Canadian university by way of focus group interviews, observation periods, and the analysis of a number of institutional and legislative texts. The findings suggest that the critical thinking of nursing faculty is caught within a constrained institutional-textual order. Drawing on critical theory and Foucauldian philosophy, recommendations for nursing education are made in order to diversify and extend critical thinking in mental health nursing.

Crazy Making: The Institutional Relations of Undergraduate Nursing in the Reproduction of Biomedical Psychiatry.

Undergraduate mental health nursing education has been extensively discussed among nursing scholars, educators, and curriculum experts. While various perspectives have weighed in on mental health nursing education in Canada, little attention has been paid to understanding the relationship between biomedical psychiatry and undergraduate nursing education. Using institutional ethnography, this article examines the social and textual relations which characterize this relationship. Beginning in the everyday teaching and learning work of faculty members and nursing students in a collaborative baccalaureate nursing program, the social organization of mental health nursing education is explicated and the textual processes are outlined. Findings suggest the presence of an institutional and discursive dominance of mental health nursing education by biomedical psychiatry. Implications for nursing education and recommendations to better balance mental health nursing education are outlined.

Riesgo aterogénico y enfermedades del corazón en mujeres de edad mediana / Atherogenic risk and heart diseases in middle-aged women

Objetivo: estimar el valor predictivo para las enfermedades del corazón de algunos factores de riesgo aterogénico en población femenina de edad mediana.Métodos: estudio transversal analítico realizado en un periodo de 24 meses en mujeres entre 40 y 59 años de edad pertenecientes al Policlínico Docente del municipio Cerro. Se aplicó una encuesta que recogió datos de la edad, historia personal de enfermedades cardiovasculares, factores de riesgo y etapa del ciclo reproductivo. Para el análisis de los datos, se empleó el método de regresión logística múltiple.Resultados: se encontró que con las enfermedades del corazón se asociaron la hipertensión arterial con un riesgo relativo de 2,299 e intervalo de confianza entre 1,251-4,225; 95 por ciento y la diabetes mellitus con un riesgo de 2,461 e intervalo de confianza entre 1,244-4,871; 95 por ciento.Conclusiones: en el desarrollo de enfermedades del corazón en la mujer de edad mediana tiene un peso mayor la presencia de comorbilidades y los estilos de vida no saludables y no la condición de posmenopausia como tal(AU)

Objective: to estimate the predictive value of some risk atherogenic factors for heart diseases in the middle-aged female population.Methods: a cross-sectional analytical study of women between 40 and 59 years of age assisted by the teaching polyclinic in El Cerro municipality was conducted. It comprised a survey to collect data on age, personal history of cardiovascular diseases, risk factors and stage of the reproductive cycle. The multiple regression method was used for data analysis.Results: it was found that the heart diseases were associated to blood hypertension, with relative risk of 2.299 (CI: 1.251-4.225; 95 percent) and to diabetes, with relative risk of 2.461 (CI: 1.244 - 4.871; 95 percent).Conclusions: in the middle-aged female population, co-morbidities and unhealthy lifestyles, which are very frequent in this population, play a major role in developing heart diseases and not the postmenopausal condition(AU)

Riesgo aterogénico y enfermedad cardio-cerebrovascular y arterial periférica en mujeres de edad mediana / Atherogenic risk and cardiovascular, cerebrovascular and arterial disease in mean age women

OBJETIVO: Caracterizar la población femenina de edad mediana del Policlínico Docente del Cerro en cuanto a la prevalencia de enfermedades del corazón, cerebrovascular y arterial periférica, así como de algunos factores de riesgo de aterosclerosis.MÉTODOS: Se realizó un estudio transversal y descriptivo en una muestra de 711 mujeres entre los 40 y 59 años de edad, pertenecientes al Policlínico Docente del Cerro. A todas se les aplicó una encuesta para recoger los siguientes datos: edad, historia personal de enfermedades cardiovasculares, factores de riesgo y etapa del ciclo reproductivo.RESULTADOS: Se encontró que de las 711 mujeres entrevistadas, el 47,25 por ciento eran posmenopáusicas; el 42,0 por ciento fértiles y el 10,7 por ciento perimenopáusicas....(AU)

OBJECTIVE: To characterize the mean age female population from the Cerro polyclinic as regards the heart, cerebrovascular and arterial peripheral diseases prevalence, as well as the risk factor of atherosclerosis.METHODS: A cross-sectional and descriptive study was conducted in a sample including 711 women aged between 40and 59, from the Cerro Teaching Polyclinic. A survey was made to collect the following data: age, personal history of cardiovascular diseases, risk factors and stage of reproductive cycle. RESULTS: From the 711 women interviewed the 47,25 percent was in the postmenopause phase; the 42,0percent was in the fertile phase and the 10,7 percentwas in the perimenopause phase...(AU)