Yes / Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements. / We gratefully acknowledge financial support from the Health Foundation (grant number 1274233).

Emerging clinical evidence implicates cellular senescence in the pathogenesis of various inflammatory conditions including inflammatory bowel diseases (IBDs), demonstrating that the intestinal stem cell crypts of patients with early Crohn’s disease exhibit markers positive for cell cycle inhibitor proteins. This phenomenon coupled with chronic systemic inflammation, a term coined “inflammaging," triggers many age-related pathologies and accelerates mortality. Our research evaluates the efficacy of interventions that target these death-resistant senescent cells to improve overall health and vitality. Particularly, we investigated the effects of Fisetin, a potent flavanoid with senolytic properties, in a dextran sodium sulfate (DSS) induced mouse model of colitis. Our findings reveal that Fisetin significantly inhibits senescence and inflammation in the colon while simultaneously enhancing the relative abundance of beneficial microbes, especially Akkermansia muciniphila, showcasing its potential for managing IBDs. Additionally, given the profound restoration of the microbiome and the central role of resident microbes in the production of metabolites essential for facilitating immunomodulation, we extended our investigations to further explore the effects of fecal microbiota transplant (FMT) from long-living Ames dwarf mice, characterized by low inflammatory status, into normal mice. Our results show notable shifts in microbial diversity, indicating that FMT may combat dysbiosis, a precursor to several conditions, including autoimmune, metabolic, and neurodegenerative diseases. Lastly, our exploration of potential anti-aging pharmacological interventions including Metformin (MF) and Trodusquemine (MSI-1436) during the postnatal window has demonstrated robust transcriptomic alterations of key biomarkers in the GH/Igf1 axis, such as Pi3k, Akt, and Mtor, suggesting delayed aging and improved liver function in young mice. These epigenetic changes underscore that early-life pharmacological interventions may forestall the onset of age-related metabolic disorders. All in all, there remains an urgent need for breakthroughs that can enhance healthspan to ensure that the rapidly growing population of older adults enjoys life in these extended years

The literature shows that school attendance matters. Time engaged with instruction is highly correlated to student achievement (Brophy, 1988; Fisher et al., 2015; Northwest Regional Educational Laboratory, 2001). However, students who are suspended and expelled from school lose instructional time in the classroom (Belway, Hodson, Losen, Keith II, and Morrison, 2015; Scott and Barrett, 2004). Suspensions result in decreased student attendance by removing the student from the learning environment (Noltemeyer, Ward, and Mcloughlin, 2015). The use of in-school suspension (ISS), out-of-school suspension (OSS), and expulsion are referred to as exclusionary discipline (Belway et al., 2015). Educational leaders are unintentionally contributing to the achievement gaps that the No Child Left Behind (NCLB) legislation intended to close by not addressing student suspensions and expulsions (Belway et al., 2015). This study used quantitative data with an ex post facto design to determine if the implementation of school-wide positive behavioral interventions and supports (PBIS) resulted in a change in student absences, office discipline referrals, and suspensions in one middle school and to determine what difference, if any, was there in student absences, office discipline referrals, and suspensions between a school implementing PBIS and a school not implementing PBIS. Two suburban middle schools in one Virginia school division were included in this study. Following the conceptual framework for this study, it was anticipated that implementation of PBIS would decrease student absences, office discipline referrals, and suspensions. The results of the study revealed that there was a reduction in office discipline referrals following the first year of implementation in the PBIS Middle School. When comparing a school that implemented PBIS to one that did not, this study found that student suspensions decreased by the second year of implementation in the school that implemented PBIS. This study also yielded other findings that were inconsistent with existing research. The results of this study are of significance for education leaders who want to decrease student office discipline referrals and suspensions / Ed. D. / The literature shows that school attendance matters where time engaged with instruction is highly correlated to student achievement (Brophy, 1988; Fisher et al., 2015; Northwest Regional Educational Laboratory, 2001). However, a common means of dealing with student misbehavior in school is the issuance of a referral to the office that may result in a student suspension (Belway, Hodson, Losen, Keith II, & Morrison, 2015; Scott & Barrett, 2004). Office discipline referrals and suspensions result in decreased student attendance by removing the student from the learning environment (Noltemeyer, Ward, & Mcloughlin, 2015). Educational leaders are unintentionally contributing to gaps in student achievement by removing students from the learning environment. This study investigated whether the implementation of a behavioral framework, school-wide positive behavioral interventions and supports (PBIS), resulted in a change in student absences, office discipline referrals, and suspensions in one middle school and explored what difference, if any, was there in student absences, office discipline referrals, and suspensions between a school implementing PBIS and a school not implementing PBIS. Two suburban middle schools in one Virginia school division were included in this study. It was anticipated that implementation of PBIS would decrease student absences, office discipline referrals, and suspensions. The results of the study revealed that there was a reduction in office discipline referrals following the first year of implementation in the school implementing PBIS. When comparing a school that implemented PBIS to one that did not, this study found that student suspensions decreased in the PBIS school by the second year of implementation. This study also yielded other findings that were inconsistent with existing research. The results of this study are of significance for education leaders who want to decrease student office discipline referrals and suspensions.

<p dir="ltr">Providing parents of autistic children, or children at an increased likelihood of an autism spectrum disorder (ASD) diagnosis, with tools to foster their child's social communication can help promote positive development. This study explored the role of promoting parents’ social communication behaviors using a minimally intensive intervention, a Family Routines Intervention (FRI), in two modalities: book-based or clinic-based. FRI is an eight-week-long intervention that focuses on common family routines to promote social communication. Given previous parent-mediated intervention studies, we hypothesize greater changes in parent social communication behaviors within the clinic-based group. Participants in this study were parents of children who had or were at an elevated likelihood of an ASD diagnosis. Parents enrolled in the clinic-based (<i>n</i> = 29) or book-based (<i>n</i> = 15) modality. Video data were collected during two home visits (pre- and post-FRI) to evaluate changes in parent social communication behaviors across four family contexts: play, mealtime, bedtime, and diaper/clothing change. Parent-child interactions were coded for parent social communication behaviors. Results showed that our hypotheses were not supported – the clinic-based group did not have notable changes in social communication behaviors in any context after participating in FRI. Mealtime was the only context where there was an interaction of time and modality on parent social communication <i>F</i>(1,62) = 4.07, <i>p</i> = 0.048. However, it did not support our hypothesis that parents in the clinic-based modality would have greater increases in parent social communication totals in the mealtime context, rather we found parents in the book-based group showed improvements. Despite the lack of significant findings, our study examined family routines that are not commonly explored in the literature, such as bedtime and diaper/clothing routines. We anticipate that our investigation into these overlooked family routines will encourage researchers to examine family routines other than play when assessing parent-mediated interventions.</p>

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur. / Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal. / La thèse porte sur le développement et la mise à l'essai d'interventions pédagogiques en enseignement de l'art dramatique. Elle vise la réduction de problèmes comportementaux au moyen de l'application de concepts de la communication interactive et pragmatique. La recherche implique l'étude de la relation entre le fonctionnement de la communication et les procédés utilisés. La méthodologie adoptée est de type exploratoire avec niveau d'analyse qualitative. Elle permet de mettre au point 17 plans d'intervention regroupés par thèmes selon les caractéristiques des situations problématiques et d'établir des modes d'observation des effets produits en considérant un certain nombre de variables. La conclusion rappelle l'ensemble des procédés utilisés en art dramatique et indique que les techniques paradoxales peuvent contribuer à la réduction des problèmes de communication entre élève (s) et enseignant. Les limites de l'étude concernent le nombre restreint de procédés utilisés, la durée relative des changements et le temps nécessaire à l'élaboration et à la maîtrise de l'intervention. L'originalité de la thèse réside dans la métaphorisation de messages pédagogiques qui peuvent provoquer des changements autant chez les élèves que chez les enseignants.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12 month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12 second epochs 5 minutes before, during and 5 minutes after oral care. The mixed effect repeated measures ANOVA model indicated that there was a statistically significant increase in ICP in response to oral care (p=0.0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of pre-existing elevated ICP.

L'autisme est un trouble universel et plusieurs études confirment la présence de l'autisme en Inde. Il y a de plus en plus d'études en Inde mais il manque encore d'informations précises sur les types d'interventions les plus utilisés. La qualité de vie des parents d'enfant avec autisme, reste un champ de recherche, encore peu exploité au niveau international. La qualité de vie parentale peut apporter une richesse d'informations afin d'adapter au mieux les interventions aux besoins de l'enfant et de sa famille. Les représentations sociales sur l'autisme nous permettent d'identifier des cognitions liées à l'autisme chez les parents et des professionnels indiens. Dans cette étude nous décrivons les caractéristiques de 15 enfants les interventions mise en place et la qualité de vie des mères et nous analysons les liens entre ces trois aspects. Nous établissons également une comparaison entre l'Inde et la France. Les résultats montrent des liens entre le nombre d'heures d'interventions et les caractéristiques adaptatives et psychologiques de l'enfant ainsi qu'avec la qualité de viedes mères. L'étude comparative montre des différences dans le profil adaptatif des enfants et les interventions des deux pays. Une deuxième partie aborde les questions des représentations sociales de l'autisme de 30 parents et 30 professionnels indiens et montre des différences entre les représentations des deux groupes. / Autism has been now established to be universal and several studies have confirmed the presence of Autism in India. There are an increasing number of studies in India but there is not much precise information on the most commonly used intervention techniques. The quality of life of parents of children with autism is an area of research that has not been sufficiently exploited despite its potential to influence intervention techniques and its adaptation to the child's and the family's unique situation. Social representations of autism will allow us to identify cognitions of parents and professionnels related to autism. In this study, we describe the characteristics of 15 children with autism, the quality of life of their mothers and the intervention techniques used. We also study the relationship between these three factors. A comparative study of these aspects between India and France is done. The results show links between the hours of interventions and the children's adaptive behaviour and psychological characteristics as well as with the quality of life of mothers. The comparative study shows differences in adaptive behaviour and intervention techniques between the two countries.A second part of the study deals with social representation of autism in 30 parents and professionals of autism. This study shows differences in the representations between the two groups.

Contexte : L'insuffisance cardiaque (IC) est un syndrome aux étiologies variées, et hétérogène dans ses présentations cliniques, dont l'incidence augmente avec l'âge et dont le pronostic reste sombre. Les facteurs pronostiques dans l'IC ont été largement décrits dans la littérature, en particulier dans l'IC à fraction d'éjection réduite (ICFER), à plus ou moins long terme. Des interventions thérapeutiques médicamenteuses, chirurgicales, ou complexes sont recommandées pour traiter ce syndrome. Objectifs : Les objectifs de ce travail étaient d'évaluer la valeur pronostique des marqueurs de fibrose chez les patients hypertendus, de décrire la survie et d'identifier les facteurs pronostiques chez les patients en IC, à très long terme chez les ICFER, et à 1 an chez les IC à fraction d'éjection préservée (ICFEP), et de mesurer l'impact sur les hospitalisations de 2 interventions complexes recommandées. Méthodes : Une première étude de cohorte a été menée chez des patients hypertendus, avec un recueil à l'inclusion des dosages sériques des marqueurs du renouvellement de la matrice extracellulaire cardiaque (MRMEC) et un suivi pendant 6 ans. Deux autres études de cohorte ont permis d'identifier les facteurs pronostiques de décès à 15 ans chez des patients ICFER (EPICAL), et à 1 an chez les ICFEP (Odin). Enfin, les données du PMSI ont permis de mesurer l'impact pronostique de la prise en charge dans une unité spécialisée (UTIC) et d'une prise en charge de type disease management (ICALOR). Résultats : La première étude a mis en évidence la valeur pronostique des MRMEC chez des patients hypertendus. L'étude EPICAL a montré que l'âge avancé, le diabète, l'insuffisance rénale chronique, l'ancienneté de l'IC, les antécédents de décompensation, la tachycardie, une fraction d'éjection réduite, et une hyponatrémie étaient associés à une mortalité plus élevée à 15 ans chez les ICFER. L'étude ODIN a montré la valeur pronostique négative de facteurs sociaux comme le fait de vivre seul ou la limitation des activités, chez les ICFEP. Enfin, les prises en charge en UTIC et par le réseau ICALOR étaient associées à une diminution des hospitalisations pour IC, mesurable à l'échelle populationnelle. Conclusion : Ces travaux permettent d'envisager de nouvelles pistes de prévention primaire et secondaire, afin de diminuer l'incidence, la morbidité et la mortalité liées à l'IC / Context: Heart failure (HF) is a heterogeneous syndrome with various aetiologies. HF incidence increases with age, and the prognosis remains poor. Prognostic factors have been widely described in the literature, especially in HF with reduced ejection fraction with short-term or mid-term follow-up. Medications, surgical interventions, and complex interventions are part of the current guidelines. Objectives: To assess the prognostic value of fibrosis markers in hypertensive patients; to describe the survival and to detect prognostic factors, first at 15 years in HF patients with reduced ejection fraction (HFREF), and second at one year in HF patients with preserved ejection fraction (HFPEF); and to assess the prognostic impact of 2 complex interventions on HF hospitalisations. Methods: Cardiac extracellular matrix serum markers (CEMSM) were assessed at baseline in a first cohort of hypertensive patients followed-up for 6 years. Two other cohort studies were used to detect prognostic factors associated with very-long term mortality in HFREF (EPICAL), and with 1-year mortality in HFPEF (Odin). And the national diagnostic related group database was used to assess the prognostic impact of a HF unit (UTIC) and a disease management programme (ICALOR). Results: The first cohort study highlighted the prognostic value of CEMSM in hypertensive patients. In EPICAL study, older age, diabetes mellitus, chronic renal failure, time from HF onset, history of hospitalisations for worsening HF, tachycardia, a low left ventricular ejection fraction, and hyponatraemia were associated with a higher mortality in HFREF patients. In Odin study, we highlighted the negative prognostic impact of social factors, such as living alone or daily activity limitation, in HFPEF patients. Both UTIC and ICALOR were associated with a decrease in HF hospitalisations compatible with a population impact. Conclusion: These studies offer new insights for primary and secondary prevention strategies that could eventually lead to decrease HF incidence, HF morbidity, and HF mortality

Evidence-based practices utilized by social workers working with veterans experiencing physical (e.g., spinal cord injuries and loss of limbs) and/or mental health (e.g., posttraumatic stress disorder, depression, substance use) issues are widely used with this vulnerable population. The number of social workers integrating animal-assisted interventions (AAI) or animal-assisted therapy (AAT) as a complementary intervention to these practices is extremely limited. A significant amount of research has been published on AAI and AAT, yet there is a gap in research regarding AAI and AAT as effective complementary approaches when working with veterans. The qualitative method utilized in this study was interviews in which MSWs and LCSWs were asked to share personal experiences while employed at veteran-supported agencies and/or non-profit organizations. The qualitative method of interviews and content analysis were used to help identify the themes and sub-themes of this study. The themes and sub-themes supported the phrases and statements drawn from the seven interviews conducted for this study. Findings supported in this study addressed the value of the human-animal bond, how integrating AAI and AAT with evidence-based practices can assist the veteran in improving quality of life (e.g., a decrease in social isolation, increase in social activity, decrease in substance use), and how important it is to recognize the need to provide the education in this field to social workers. Findings from this study can help to provide the foundation for future research, can underscore the value of offering and integrating AAI and AAT education into more MSW programs, and can contribute to establishing policy where those who can benefit by AAI and AAT are given access to it.