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In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collaborative identified premedical and academic medicine systems factors that represented opportunities for change. The premedical factors include financing and funding, information access, pre-health advisors, the Medical College Admission Test, support systems, foundational academics, and alternative career paths. The academic medicine factors include early identification, medical school recruitment and admissions, and leadership accountability. The authors offer several points of intervention along the medical education continuum, starting as early as elementary school through medical school matriculation, for institutional leaders to address these factors as part of their diversity strategy. The authors also present the Action Collaborative's process for leveraging collective impact to build an equity-minded action agenda focused on Black men. They describe their initial focus on pre-health advising and leadership accountability and next steps to develop an action agenda. Collective impact and coalition building will facilitate active, broad engagement of partners across sectors to advance long-term systems change.

Rates of dementia continue to increase along with life expectancy. As neither dementia’s causenor its cure is well understood from the perspective of medical science, further investigations ofcomplementary lifestyle and non-pharmaceutical interventions are imperative. Although arts-basedtherapies have been explored selectively, the significance of these interventions for persons withdementia (PwD) remains undervalued in both the general population and scientific literature. Thisstudy aims to examine one promising lifestyle intervention, the effect of intergenerational choirparticipation, on psychosocial and cognitive function for PwD. Participants (n = 32), in partnershipwith their family caregivers and local high school students, participated in an intergenerational choirfor as many as three choir seasons spanning up to 18 months of follow-up. Participants underwent anexpansive assessment of psychosocial, physiological, and cognitive function every four to six weeksas part of an intensive repeated measures design. Here, the potential benefits of choir for PwD wereexplored in relation to change for select cognitive (Mini-Mental State Examination: MMSE; TrailMaking Task A: TMT-A; Word Recall) and psychosocial (Patient Health Questionnaire: PHQ-9)indicators. Multilevel modelling was used to index initial levels (at baseline) and change (spanningup to eight follow-up assessments) in function for measures of global cognition, executive functioning,episodic memory, and depressive symptoms. Notably, no significant declines were observed for MMSEor TMT-A tasks. As expected, episodic memory function continued to decline, with a significantlessening of depressive symptoms and signs observed for the PHQ-9. These results suggest thatdespite the progressive nature of underlying neuropathology for dementia subtypes like Alzheimer’sDisease, preservation of select cognitive functions as well as mitigation of psychosocial comorbidities(depressive symptoms) is possible through participation in an intergenerational choir.

Using a qualitative design, this study examines changes in the caregiving relationship in ten siblings caring for a brother or sister with severe schizophrenia. Siblings reported mourning the loss ...

Background Symptoms of anxiety are common among pregnant and postpartum women, and 15%-20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta-analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy. Methods This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle-Ottawa Quality Assessment Scale for case-control studies was used to perform a quality assessment review. A random-effects meta-analysis was used to calculate the estimated average standardized mean differences. Results Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high-risk groups. Conclusions Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy.

Como o estudo da energia no teatro pode potencializar e ampliar o repertório do ator? A pesquisa, que busca apresentar reflexões e possibilidades de práticas cênicas voltadas para a formação contínua do intérprete, é desenvolvida a partir da análise de minhas experiências diretas com o diretor russo Jurij Alschitz - que considera energia como linguagem de cena - pesquisa bibliográfica, bem como análise de minha prática artístico-pedagógica. Sendo Alschitz um herdeiro de certa escola russa iniciada por Stanislávski, busco entender a filiação do termo energia no Sistema, tecendo relações com as inspirações que Stanislávski tomou do yoga. Proponho ainda cruzamentos entre as ideias desta escola russa e minha prática artístico-pedagógica, especialmente na investigação do uso das meditações ativas criadas pelo indiano Osho como contribuição ao treinamento energético do ator. E, posteriormente, caminhos para a utilização dos chakras na ampliação de repertório do artista cênico no trabalho com a palavra. Por suas ideias, referências e tema, a pesquisa insere-se em outros esforços de entrelaçamento de desenvolvimento artístico e humano na prática teatral. How can the study of Energy in theater enhance and broaden the actor\'s repertoire? The research, which seeks to present reflections and possibilities of scenic practices for the continuous formation of the performer, is developed from the analysis of my direct experiences with the Russian director Jurij Alschitz - who considers energy as a scenic language - bibliographical research, as well as analysis of my artistic-pedagogical practice. As Alschitz is an heir of a certain Russian school started by Stanislavski, I seek to understand the affiliation of the term energy in the System by studying its inspiration in Stanislavski\'s relationships with Yoga. I also propose intersections between the ideas of this Russian school and my artistic-pedagogical practice, especially in investigating the use of Active Meditations created by the Indian Osho as a contribution to energetical actor training. And ways to use the chakras to broaden the repertoire of the scenic artist in his work with the word. Due to its ideas, references and theme, the research is part of other efforts to intertwine artistic and human development in theatrical practice.

Objective: Cognitive status has been linked to impaired gait velocity, and diminished social and physical engagement. To date, the potential moderating influence of lifestyle engagement on gait-cog...

Stigma represents one of the biggest barriers to living well with dementia following diagnosis. Social isolation is common as roles, friendships and opportunities to participate in the broader community disappear. An intergenerational dementia choir is a joyful activity that offers opportunities for learning, friendships and purposeful engagement towards common goals (e.g., regular social engagement, public concerts at season’s end). Data collection involved surveys and interviews with 32 dyads comprised of persons with dementia (PwD) and caregivers, as well as focus groups with 29 high school students. Results illustrate the development of a choir community across weeks of participation with far reaching benefits. Both caregivers and PwD experienced reductions in health risks and improvements in quality of life. Students’ understanding of dementia became more positive over time and new friendships developed. The discussion focuses on the need for meaningful and inclusive community activities for PwD and their caregivers.

RÉSUMÉCette étude qualitative explore les expériences vécues par des personnes âgées participant dans un programme d’arts visuels créatifs dans un établissement de soins de Victoria (Colombie-Britannique). Une approche par enquête narrative a été utilisée dans le cadre d’entretiens en personne menés avec dix résidents et trois membres du personnel du programme. Les activités du programme et l’exposition artistique qui y était associée ont aussi fait l’objet d’une observation systématique. Les résultats démontrent que le programme a stimulé le sentiment de communauté des participants et augmenté leur estime d’eux-mêmes, en tant qu’artistes. Une exposition artistique publique dans un centre communautaire a permis de souligner la valeur de leur production artistique et a conféré un sens et un but à leur implication dans le programme. Les résultats démontrent l’importance des programmes artistiques stimulant la créativité chez la population âgée. Ils illustrent aussi que les personnes vivant en institution peuvent prendre conscience des multiples dimensions de leur personnalité à travers l’expression artistique. Cette étude souligne la pertinence d’accroître l’accès à des programmes artistiques pour les individus vivant en établissements de soins.

Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.

Arts-based interventions represent an inexpensive, non-pharmacological, and non-invasive approach to help mitigate negative symptoms and improve quality of life for persons with dementia (PwD). The present study examined whether a social singing intervention can modulate patterns of cognitive change and whether select biopsychosocial indicators exhibit concomitant within-person time-varying covariation. Participants with dementia (n=32, mean age=79.6 years; 53% female) engaged weekly in the Voices in Motion project, an intergenerational, social-cognitive choral intervention spanning up to 18 months and 9 individual assessments. The Mini Mental State Examination (MMSE), gait velocity, and positive and negative affect were assessed using an intensive repeated-measures design, with multilevel models of change employed to disaggregate both between- and within-person effects. Across months of the social intervention, several significant within-person time-varying associations were observed; on occasions when a given individual performed one unit faster on gait velocity (p

Choir interventions confer psychological benefits for persons with dementia (PwD) and their caregivers. However, less is known about whether physiological function also exhibits improvements pursuant to such social-cognitive interventions. The present study, based upon a subsample of the Voices in Motion (ViM) project, explored whether participation in an intergenerational choir results in systematic improvements in gait velocity (indexed using a GAITRite computerized walkway) for both informal caregivers (n=14; 71.4% female) and PwD (n=14; 64.3% female). Longitudinal burst data from the first of three cohorts spanning 4 assessments over 3.5 months was analysed using multilevel modeling. Whereas caregivers exhibited significant improvements (p

Persons with dementia (PwD) experience challenging neuropsychiatric symptoms (NPS) as their illness progresses. Antipsychotic drugs (APD) have been regularly used in residential care to manage this issue despite the risk of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to continued inappropriate APD use when managing NPS in PwD. Culture of care consists of sets of norms, beliefs, and cognitive frames which inform clinical practice and care delivery. The study also considers organizational readiness for change in examining the implementation of alternate non-pharmaceutical practices to address the issue of NPS. Findings were obtained from three Canadian residential care facilities that worked on reducing inappropriate use of APD. Data came from interviews with 16 licenced practical nurses, 12 nurses, 17 health care assistants, 3 activity leaders, 3 directors of care, 10 physicians, and 14 family members. We found that care providers varied in their perceived capacity to implement novel care strategies and in the support received for innovative thinking and action. We also identified variations in how care providers informally share information on alternate strategies to manage NPS and in the contextual factors facilitating such communication. Finally, we found differences in how family members’ input was meaningfully integrated into care planning. Overall, the study shows how culture of care reflects entrenched responses to NPS but also evolves to support challenges to the decision to prescribe APD, non-pharmaceutical approaches to care, and the meaningful involvement of family members in care planning.

Community choir participation for persons with dementia (PwD) confers benefits to health status and well-being, including the benefit of socializing which can reduce feelings of loneliness and social isolation. Using Social Network Analysis (SNA), this study examines the benefits of participation in a community-based choir for 14 PwD and their caregivers in terms of the development of social relationships with other choir members, including high school students also participating in the choir. Data collection involves egocentric SNA methods whereby PwD are surveyed at 1, 3 and 5 months on the number and nature of their relationships and the attributes of their relational partners. The study examines how PwD interact with other individuals in the choir and how people they identify interact with one another. Data from in-depth qualitative interviews with PwD and caregivers offer further information on the quality and perceived benefits of these interactions.

Fibromyalgia is a chronic illness with primary symptoms of widespread pain and fatigue. Social media applications have become a recent resource allowing individuals with fibromyalgia to interact in a virtual community devoted to the illness. This study explores how such a community develops and maintains itself on Instagram and the ways it creates social capital for its users. Data are derived from Instagram posts and open-ended questionnaires completed by users living with fibromyalgia who use the application. Using content analysis and semiotic methodology, the study analyzes the diverse ways in which users shared their experiences with fibromyalgia, the management of its symptoms, and issues encountered in accessing health care systems. Instagram aids in the development of a community by facilitating intimate and supportive interactions about the illness and the creation of personalized day-to-day narratives accessible to all. Norms of trust, acceptance, and reciprocity characterize the diversity of interactions in this community.

The stereo matching problem, while having been present for several decades, continues to be an active area of research. The goal of this research is to find correspondences between elements found in a set of stereoscopic images. With these pairings, it is possible to infer the distance of objects within a scene, relative to the observer. Advancements in this field have led to experimentations with various techniques, from graph-cut energy minimization to artificial neural networks. At the basis of these techniques is a cost function, which is used to evaluate the likelihood of a particular match between points in each image. While at its core, the cost is based on comparing the image pixel data; there is a general lack of consistency as to what image data representation to use. This paper presents an experimental analysis to compare the effectiveness of more common image data representations. The goal is to determine the effectiveness of these data representations to reduce the cost for the correct correspondence relative to other possible matches., {"references":["D. Marr, and T. Poggio. \"A computational theory of human stereo vision.\" Proceedings of the Royal Society of London B: Biological Sciences 204.1156 (1979): 301-328.","U. R. Dhond, and J. K. Aggarwal, \"Structure from stereo-a review.\" IEEE transactions on systems, man, and cybernetics 19.6 (1989): 1489-1510.","W. Grimson, \"Computational Experiments with a Feature Based Stereo Algorithm\", IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol.PAMI-7, No: 1, pp.17 - 34, Jan. 1985.","A. Fusiello, E. Trucco, A. Verri, \"Rectification with unconstrained stereo geometry.\" BMVC. 1997.","D Scharstein, R Szeliski, \"A taxonomy and evaluation of dense two-frame stereo correspondence algorithms.\" International journal of computer vision 47.1-3 (2002): 7-42.","Hirschmüller, Heiko, and Daniel Scharstein. \"Evaluation of cost functions for stereo matching.\" Computer Vision and Pattern Recognition, 2007. CVPR'07. IEEE Conference on. IEEE, 2007.","H. Hirschmuller, \"Stereo processing by semiglobal matching and mutual information.\" Pattern Analysis and Machine Intelligence, IEEE Transactions on 30.2 (2008): 328-341.","Kim, Junhwan, Vladimir Kolmogorov, and Ramin Zabih. \"Visual correspondence using energy minimization and mutual information.\" Computer Vision, 2003. Proceedings. Ninth IEEE International Conference on. IEEE, 2003.","Zitnick, C. Lawrence, and Takeo Kanade. \"A cooperative algorithm for stereo matching and occlusion detection.\" Pattern Analysis and Machine Intelligence, IEEE Transactions on 22.7 (2000): 675-684.\n[10]\tS. Birchfield, C. Tomasi. \"Depth discontinuities by pixel-to-pixel stereo.\" International Journal of Computer Vision 35.3\t (1999): 269-293.\n[11]\tŽbontar, Jure, and Yann LeCun. \"Stereo Matching by Training a Convolutional Neural Network to Compare Image Patches.\" arXiv preprint arXiv:1510.05970 (2015).\n[12]\tC. C. Pham, J. W. Jeon, \"Domain transformation-based efficient cost aggregation for local stereo matching.\" Circuits and Systems for Video Technology, IEEE Transactions on 23.7 (2013): 1119-1130.\n[13]\tQ. Yang, \"A non-local cost aggregation method for stereo matching.\" Computer Vision and Pattern Recognition (CVPR), 2012 IEEE Conference on. IEEE, 2012.\n[14]\thttp://vision.middlebury.edu/stereo/data\n[15]\tDe-Maeztu, Leonardo, Arantxa Villanueva, and Rafael Cabeza. \"Stereo matching using gradient similarity and locally adaptive support-weight.\" Pattern Recognition Letters 32.13 (2011): 1643-1651."]}

Cette etude a compare les correlats de la charge pour le conjoint et les soignants qui sont enfants adultes a deux moments dans le temps et a evalue si les correlats de T1 a T2 predit la charge. L’echantillon etait constitue de 878 soignants pour les adultes plus âges de la Colombie-Britannique auxquels on a prescrit des inhibiteurs de la cholinesterase. La charge a ete mesuree six mois apres la personne âgee a ete prescrit le medicament et un an plus tard ( n = 759). Les resultats suggerent que les enfants adultes sentent plus fort la charge que les conjoints a T1 et T2 , avec les enfants adultes, mais pas les conjoints, diminuant leur fardeau au fil du temps. Les correlats de la charge de T1 ont explique des quantites importantes de variance, revelant la correlation differentielle pour les deux groupes et l’importance des caracteristiques des soignants sur les caracteristiques des patients. La charge au T2 s’explique principalement par les facteurs de T2 , plus la charge de T1 , suggerant l’importance des facteurs relativement immediats des effets directs sur la charge des soignants. Les effets indirects etaient operationnels par la charge de T1 . ABSTRACT: This study compared the correlates of burden for spouse and adult child caregivers at two points in time and assessed whether correlates at T1 predicted burden at T2 . The sample consisted of 878 caregivers to older adults throughout British Columbia who were prescribed cholinesterase inhibitors. Burden was measured six months after the older adult was prescribed the medication and one year later ( n = 759). Findings suggest that adult children experience more burden than spouses at both T1 and T2 with adult children but not spouses decreasing their burden over time. Correlates of T1 burden explained significant amounts of variance, revealing differential correlates for the two groups and the importance of caregiver characteristics over patient characteristics. Burden at T2 is explained mostly by T2 factors, plus T1 burden, suggesting the importance of relatively immediate factors for direct effects on caregiver burden. Indirect effects operated through T1 burden.

We know much about caregiving women compared with caregiving men and caregiving spouses compared with caregiving adult children. We know less about the intersections of relationship and gender. This article explores this intersection through the well-being (burden and self-esteem) of caregivers to family members with dementia. Throughout British Columbia, Canada, 873 caregivers were interviewed in person for on average, over 1½ hours. The results reveal that daughters experience the highest burden but also the highest self-esteem, suggesting the role is less salient for their self-identities. Wives emerge as the most vulnerable of the four groups when both burden and self-esteem are considered. The data confirm the usefulness of the intersectionality framework for understanding co-occupancy of more than one status and indicate that positive cognitive well-being and negative affective well-being can be differentially related. Multivariate analyses confirm the importance of caregiver, not patient, characteristics for burden and self-esteem.

RÉSUMÉCette étude a exploré comment les immigrants âgés d’origine sud-asiatique, parlant le pendjabi (quatre groupes de discussion; 33 participants) de Surrey en Colombie-Britannique, perçoivent leur santé buccale et les problèmes connexes. L’analyse a relevé deux thèmes généraux: les interprétations de la condition bucco-dentaire et les défis de santé bucco-dentaire. Le thème des interprétations avait quatre sous-thèmes: les dommages causés par lewai, les perturbations causé par la carie, l’adaptation aux prothèses dentaires, et qualité de vie; alors que le thème des défis considérés: remèdes à domicile, dentisterie occidentale; et difficultés d’accès aux dentistes. Les participants ont expliqué les maladies bucco-dentaires en termes d’une infection systémique (resha) et ont dit préféré les remèdes faits maison pour diminuer les écarts de chaleur (wai) dans la bouche. Nous concluons que les immigrants âgés d’origine sud-asiatique parlant le pendjabi interprète la santé et les maladies bucco-dentaires dans un contexte mixte de traditions occidentales et Ayurvédique, et gèrent leur santé buccale au moyen de remèdes traditionnels faits maison, complémentés au besoin par des soins d’urgence dispensés au Canada.

Voice first technology offers older adults with dementia support that may maintain independence, reduce social isolation and improve quality of life (QoL). This study investigates the impact of a voice-controlled technology customized to the needs of participants living with dementia and their caregivers. A mixed methods design focused on psychosocial factors and usability characteristics. The purposive sample consisted of older adults with dementia (n=12) and their care partners (n=12)) living independently in the community. Validated measures for cognition, depression, caregiver burden, quality of life and usability were included. Qualitative in-home interviews were conducted to assess impact on social connections and independence. Results indicate that voice first technology can reduce caregiver burden and can support the independence and QoL of older adults with dementia. The discussion considers the value of low cost voice first technology as a way to support older adults with dementia and their caregivers.

Community choir participation for persons with dementia (PwD) confers benefits to health and well-being, including the benefit of socializing which can reduce feelings of loneliness and social isolation. Using the concept of social capital, this study examines the degree to which two intergenerational Voices in Motion choirs facilitate the development of social relationships between PwD, caregivers, and high school students. Data collection involved interviews with 17 dyads of PwD and caregivers, completion of a social relationship questionnaire, and focus groups with a total of 29 high school students. The results show a gradual increase in the level of interactions between all participants, with students in particular interacting more frequently with PwD. Over time, trust and reciprocity emerged within the choirs as more people shared information about themselves. Students’ understanding of dementia changed over time as they learned to appreciate PwD as unique human beings with rich life stories and experiences.

Persons living with dementia-related disorders (PwD) can experience challenging behavioural and psychological symptoms (BPSD) as their illness progresses. There is a continued reliance on antipsychotic drugs (APD) in long-term care to manage this issue despite the well-documented risks of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to efforts at reducing inappropriate APD use in managing BPSD within long-term care. Culture of care consists of shared norms, beliefs, and cognitive frames which guide clinical practice and inform the development and implementation of care strategies. Findings were obtained from three Canadian long-term care facilities working on reducing inappropriate use of APD. Data came from interviews with 6 nurses, 18 licenced practical nurses, 14 health care assistants, 4 activity leaders, 4 directors of care, 1 chaplain, and 10 physicians. We found that direct care providers initially varied in their perceived ability to develop and use alternate care strategies with health care assistants being most concerned about safety and exposure to violence. Change involved detective work and innovative thinking in assessing possible causes of BPSD beyond psychosis, including pain and feelings of confusion. Informal reciprocal patterns of communication emerged among health care assistants to identify effective non-pharmaceutical strategies to manage BPSD. Overall, the study shows how shared beliefs in the need for and value of alternate care practices among direct care providers along with the existence of effective informal communication can contribute to successful reduction in APD use when managing BPSD in PwD.

Informal caregivers provide 80% of the care needed to support community-dwelling older adults with dementia. Over time caregivers often face adverse effects on their health, quality of life and well-being; particularly those caring for someone with dementia. This study examines the impact of participation in the Voices in Motion (ViM) choir on caregiver burden, mood and quality of life. A measurement burst approach was used to investigate intraindividual variability on key psychosocial and health indicators. Results indicate that choir participation significantly improves caregiver well-being (e.g. mood, burden) and quality of life. Findings suggest that choirs offer significant caregiver support and respite. The discussion focuses the public policy and on the potential economic implications which suggests a shift is needed in the services available to older adults with dementia and their caregivers.

Background This study approaches the decision to donate blood as a dynamic process involving interplay between blood donors' personal motives, donors' social contexts, and the donor recruitment and retention activities of blood collection agencies. Study Design and Methods Data were gathered from four blood donation clinics using in-depth interviews with Canadian Blood Services employees, donors, and nondonors in 25 organizations participating in Life Link, a donor recruitment program that supports organizations to educate employees about the benefits of blood donation. Further data were obtained from ethnographic observations of blood collection and donor recruitment activities. Results Thematic analysis resulted in three umbrella themes: leveraging social networks, embedding the clinic in the community, and donating blood and social reciprocity. Donor recruitment activities at all four clinics enhanced awareness of blood donation in the workplace by using experienced donors to motivate their coworkers in making a first-time donation. Clinic employees reported varying success in improving awareness of blood donation in the broader community, in part because of varying employee engagement in community-wide activities and celebrations. Altruistic motives were mentioned by experienced donors, who also identified a desire to reciprocate to their community as another strong motive. Conclusion This study contextualizes donor recruitment and retention as involving activities that tie blood donation to meaningful aspects of donors' social networks and community. The findings point to the need for further analyses of the institutional dimensions of blood donation to develop effective strategies beyond appeals to altruism.

Neglect of the mouth can lead to impairment, disability, and discomfort; as a result, it can have a negative impact on quality of life in old age. Some minority groups in North America shoulder a disproportionate burden of dental impairment compared to people of European origins, possibly because of different cultural beliefs and a distrust of Western oral healthcare. This paper explores these factors in elderly Chinese immigrants through a meta-synthesis of selected literature that reveals a dynamic interplay of traditional Chinese beliefs about oral health, immigration, and structural factors mediating access to Western dentistry. It also identifies several conceptual issues and gaps in knowledge, offers avenues of research including the cross-cultural application of two recent models of oral health, and discusses various strategies for improving access to dental services for minority populations.

In this article, we examine the regulation of psychiatric patients becoming intoxicated from drinking excessive amounts of liquids at a large psychiatric asylum in Canada. We analyze how medical staff created a formalized diagnostic category and a specialized ward for its treatment. We consider the institutional context in which “water intoxication” was developed as a diagnostic category and we examine the impact of this diagnosis on the regulation of asylum patients. Finally, we discuss the patients’ opposition to treatment as well as the impact of “water intoxication” on their self-identity and institutional status.

In the aging literature, social isolation has been primarily defined in terms of reduced support network size and low frequency of social contacts. Having a small social support network is associated with social isolation and an increased risk of physical and emotional vulnerability. However, this conceptualization ignores the contributions of a host of other factors, including life experiences, family dynamics, and long-term patterns of socialization. This paper argues that alongside quantitative assessments of support systems, the application of a life course perspective is needed to understand small social networks as lived experience. We report on findings from 28 in-depth interviews with older adults identified as being at risk of social isolation on the basis of the self-reported size of their social networks. We discuss these participants' experiences in the context of significant life course transitions such as marriage and widowhood.

Since their introduction, clinicians have been engaging in debates over the therapeutic benefits of cholinesterase inhibitors (ChEIs) in Alzheimer's disease and related dementias (ADRD). Against this backdrop of controversy, caregivers' views and experiences have been largely ignored. This has occurred despite the fact that this group may provide insights into these drugs in ways not captured by clinical research. To address this gap in knowledge, the current study examines 25 caregivers' narratives about the treatment of relatives diagnosed with mild to moderate ADRD and treated with ChEIs. The findings reveal an appraisal of cholinergic effects whereby caregivers question the benefits of the drugs, generally not knowing whether to attribute stabilization or improvements to them or not but also fearing termination of the drug ‘just in case’ there is some benefit. Caregivers justify their belief in ChEIs' long-term effectiveness primarily by invoking non-medicated prognostic scenarios of more rapid decline and loss of self. In addition, the study explores the meaning caregivers attribute to ChEI effects vis-a-vis a pharmaceutical discourse which frames these drugs as a source of hope.

This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.

This article is a contribution to widening the focus of moral panic studies. Our aim is to advance recent attempts to link moral panic studies to the criminological literature on moral regulation. We argue that moral panics should be conceptualized as volatile expressions of long-term moral regulation processes. To substantiate these conceptual and theoretical arguments, we examine claims-making activities about the threat posed by British youth who don hooded tops in public places.

Family caregivers are the backbone of long-term care for older adults living with dementia in the community. Over time, the physical, psychological, social and economic impacts of living with dementia can adversely impact caregiver health, quality of life and well-being. Choir participation is a joyful, meaningful and supportive activity that can improve quality of life and well-being. This study examines the impact of participation in a dementia-friendly community-based choir on caregiver stress, burden and quality of life. A burst measurement design allows between and within-individual analyses that increase our understanding of the impact of the choir on caregiver burden and quality of life. Analyses will explore the cost-benefits of the choir as a novel intervention for caregiver support and respite. The discussion will focus on the policy and program implications for family caregivers and their community-dwelling care recipient.

Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.

Giving Blood represents a new agenda for blood donation research. It explores the diverse historical and contemporary undercurrents that influence how blood donation takes place, and the social meanings that people attribute to the act of giving blood. Drawing from empirical studies conducted in the United States, Canada, France, Australia, China, India, Latin America and Africa, the book’s chapters turn our attention to the evolution of blood donation worldwide, examining: 1) the impact of technology advances on blood collection practices; 2) the shifting approaches to donor recruitment and retention; 3) the governance and policy issues associated with the establishment of blood clinics; 4) the political and legal challenges of regulating blood systems. This innovative examination moves the focus from individual explanations of rates of blood donation to a social, structural explanation. It will appeal to international scholars and students working in the areas of sociology, medical anthropology, health care, public policy, socio-legal studies, comparative politics, organizational management, health and illness, the history of medicine, and public health ethics.

This research explores the experiences of older adults participating in an innovative visual arts program at a long-term care facility in Victoria, British Columbia, Canada. The program offers participants an opportunity to explore their creativity and identity as artists. Conceptually, the study draws from Tornstam’s gerotranscendance framework (Tornstam, 2005) and the theory of meaning (Frankl, 1963). A narrative inquiry approach was used with data collected through face-to-face interviews and observations of 10 residents and three staff involved in the visual arts program. Findings indicate that the program fostered a sense of community among participants and enhanced their quality of life. The public exhibition of their art work at a community-based art exhibit, validated the merit of their work and gave meaning and purpose to their participation in the program. Findings contribute to a greater understanding of the importance of arts programs that foster creativity in later life and resonate with Tornstam’s (2005) argument that older people living in institutions can experience multiple dimensions of the self through individualized forms of expression. This study concludes by highlighting the need to increase access to arts programs for older people living in residential care.

This paper reviews cross-cultural contributions to the study of Alzheimer's disease (AD) from the fields of epidemiology, psychology, and genetics. The growth of this literature in the last decade follows the development of reliable diagnostic criteria, measures of caregiver burden, and new methods for identifying AD genotypes. The paper shows the dominance of a perspective across specialties that represents AD as a disease that can be reliably identified independently from cultural context. The implications of this perspective are discussed in terms of how a neglect to account for indigenous interpretations of AD undermines the validity and usefulness of current findings. The paper proposes that ethnographic accounts of local interpretations of AD symptoms, caregiver burden, and genetics can contribute to the development of culturally sensitive instruments and the assessment of the psychosocial impact of genetic research across culture.

This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.

Bibliography: pages 118-121., In the field of computational mechanics, increases in computing power and enhancements in material and kinematic models have enhanced the feasibility of performing structural design optimisation for a wide range of applications. The work presented here was motivated by the current groundswell of research effort in computational optimisation. Design Sensitivity Analysis (DSA) crucially underpins much of structural optimisation and, as such, is focussed on more intently than the optimisation theory itself: various approaches to the Direct Differentiation Method (DDM) DSA procedure are investigated and computationally implemented. The procedures implemented were chosen so as to involve a range of important issues in computational sensitivity analysis, particularly * Shape and non-shape sensitivity analysis, * Total and Updated Lagrange-based DSA, * DSA of displacement and non-displacement based response functionals, * Multiparameter DSA. * DSA for large strain behaviour The primary objectives of this thesis are: I. Development of a design sensitivity formulation which, when discretised, resembles the standard displacement based kinematic element formulation, thus enabling the implementation of design sensitivity analysis in established Finite Element Analysis (FEA) codes as a 'pseudo'-element routine. II. lmplemention of several design sensitivity formulations and structural optimisation into the FEA code ABAQUS as a verification of the first objective. Numerical results provided in this work demonstrate the successful completion of the above-mentioned objectives. The discretised DSA formulations presented, as well as the 'pseudo'-element approach adopted, particularly in the case of shape DSA are entirely original. To the best of the author's knowledge, DSA and DSA-based structural optimisation had never before been attempted with ABAQUS. The research conducted here lays the foundation for potentially very fruitful future work.

The distribution of nigrothalamic projections was studied in the dog by using the autoradiographic tracing method. On the basis of a systematic series of tritiated amino acid injections into different portions of the substantia nigra, we found that the rostral three-fourths of the substantia nigra pars reticulata (SNr) gives rise to widespread thalamic projections. The nigrothalamic label, occupied a longitudinal band extending from rostral ventral anterior nucleus (VA) through to caudal mediodorsal nucleus (MD). In the dog, VA is histochemically identified as an acetylthiocholinesterase (AChE)-negative region and is distinct from the adjacent ventral lateral nuclei which stain positively for AChE. In rostral thalamus, the dense autoradiographic label was observed in rostral VA within the AchE-negative region lying alongside the mammillothalamic tract (MT). The adjacent AChE-positive ventral lateral nuclei did not contain autoradiographic label. In addition, homogeneously distributed silver grains were observed throughout the ventromedial nucleus (VM) bilaterally. More caudally, as the ventral lateral thalamic compartment emerges, label was also observed within the internal medullary lamina region, including the paralaminar portion of VA, the central lateral nucleus (CL), and the paralaminar portion of MD. Finally, in caudal thalamus, the central portion of MD, as well as the parafascicular nucleus (Pf), contained autoradiographic label. The overall nigrothalamic distribution observed in the dog was similar to the distribution of nigrothalamic projections in monkeys with one exception. Unlike that of primates, the distribution of nigral efferents is to the whole extent of VM in the dog as in other non-primate species. Overall, we found that nigral efferents primarily project to three main thalamic targets: the VA/MD region, VM, and the internal medullary lamina region, which includes dorsal CL and paralaminar VA and MD. We propose that these three nigrothalamic territories may constitute critical links subserving different functional channels.