Amplification of 9q34 in childhood adrenocortical tumors: a specific feature unrelated to ethnic origin or living conditions

Adrenocortical tumors (ACT) in children under 15 years of age exhibit some clinical and biological features distinct from ACT in adults. Cell proliferation, hypertrophy and cell death in adrenal cortex during the last months of gestation and the immediate postnatal period seem to be critical for the origin of ACT in children. Studies with large numbers of patients with childhood ACT have indicated a median age at diagnosis of about 4 years. In our institution, the median age was 3 years and 5 months, while the median age for first signs and symptoms was 2 years and 5 months (N = 72). Using the comparative genomic hybridization technique, we have reported a high frequency of 9q34 amplification in adenomas and carcinomas. This finding has been confirmed more recently by investigators in England. The lower socioeconomic status, the distinctive ethnic groups and all the regional differences in Southern Brazil in relation to patients in England indicate that these differences are not important to determine 9q34 amplification. Candidate amplified genes mapped to this locus are currently being investigated and Southern blot results obtained so far have discarded amplification of the abl oncogene. Amplification of 9q34 has not been found to be related to tumor size, staging, or malignant histopathological features, nor does it seem to be responsible for the higher incidence of ACT observed in Southern Brazil, but could be related to an ACT from embryonic origin.

Adrenocortical tumors in children

Childhood adrenocortical tumors (ACT) are rare. In the USA, only about 25 new cases occur each year. In Southern Brazil, however, approximately 10 times that many cases are diagnosed each year. Most cases occur in the contiguous states of São Paulo and Paraná. The cause of this higher rate has not been identified. Familial genetic predisposition to cancer (p53 mutations) and selected genetic syndromes (Beckwith-Wiedemann syndrome) have been associated with childhood ACT in general but not with the Brazilian counterpart. Most of the affected children are young girls with classic endocrine syndromes (virilizing and/or Cushing). Levels of urinary 17-ketosteroids and plasma dehydroepiandrosterone sulfate (DHEA-S), which are abnormal in approximately 90% of the cases, provide the pivotal clue to a diagnosis of ACT. Typical imaging findings of pediatric ACT consist of a large, well-defined suprarenal tumor containing calcifications with a thin capsule and central necrosis or hemorrhage. The pathologic classification of pediatric ACT is troublesome. Even an experienced pathologist can find it difficult to differentiate carcinoma from adenoma. Surgery is the single most important procedure in the successful treatment of ACT. The role of chemotherapy in the management of childhood ACT has not been established although occasional tumors are responsive to mitotane or cisplatin-containing regimens. Because of the heterogeneity and rarity of the disease, prognostic factors have been difficult to establish in pediatric ACT. Patients with incomplete tumor resection or with metastatic disease at diagnosis have a dismal prognosis. In patients with localized and completely resected tumors, the size of the tumor has predictive value. Patients with large tumors have a much higher relapse rate than those with small tumors.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

Is there a difference in artistic ability between learning -disabled students and "regular-class" students?

Research and practice regarding LO students usually has focussed upon defining and supplementing deficiencies rather than seeking unique talents and capability patterns for learning and expression. This study examined nine dimensions that may constitute artistic or creative talent and compared LDs with "regular-class" students, pair-wise and as groups, for levels and distributions of the dimensions. For 14 LO and 9 "regular-class" elementary-school subjects, both genders, data were taken by direct observation, from a standardized test and assessments by two practicing artists. Assessments by artists were in concord. LOs improved more in "Composition". No other significant class, age or gender-related differences were found.

A qualitative study of inclusion at a residential summer camp

The purpose of this qualitative case study was to understand the inclusion process at a Project Rainbow affiliated camp. Project Rainbow is a non-profit organization which promotes inclusion into children's camps in Ontario. This study was completed in order to provide stakeholders of the camping industry insight on how inclusive techniques can be implemented in residential camps. The researcher observed one camp's inclusion techniques for six days. The researcher observed three campers with disabilities and the camp staff and campers that interacted with them on a daily basis. While the researcher was at the camp, she interviewed nine staff members. The staff members consisted of the camp director, the inclusion coordinator, four camp counsellors, and three inclusion counsellors. An additional interview was conducted after arriving home from camp with the manager from Project Rainbow. The qualitative analysis program NVivo was used to help organize the analyzed data. The researcher found that in attempting to build a culture of inclusion, two important concepts are necessary. First, mutual leadership involved the camp director and Project Rainbow working together as a team to facilitate the inclusion process. Second, power of supportive relationships focused on inclusion being the responsibility of everyone, teamwork, and creating a welcoming environment. Hints at some potentially serious problems related to staff training, teamwork, and attitudes of non-disabled campers pointed to future research and policies which focus on the Ontario and Canadian Camping Associations' role in inclusion, in addition to camp in this study and Project Rainbow.

Predictors of primary health care utilization by former residents of institutions in Ontario

For years institutionalization has been the primary method of service delivery for persons with developmental disabilities (DD). However, in Ontario the last institution was closed on March 31, 2009 with former residents now residing in small, communitybased homes. This study investigated potential predictors of primary health care utilization by former residents. Several indirect measures were employed to gather information from 60 participants on their age, health status, adaptive functioning level, problem behaviour, mental health status and, total psychotropic medication use. A direct measure was used to gather primary health care utilization information, which served as the dependent variable. A stepwise linear regression failed to reveal significant predictors of health care utilization. The data were subsequently dichotomized and the outcomes of a logistic regression analysis indicated that mental health status, psychotropic medication use and, an interaction between mental health status and health status significantly predicted higher primary health care usage.

Effectiveness of personal planning for residents re-entering the community during the facility initiative in Ontario

This paper reports on the relocation of people with intellectual disabilities (ID) from large-scale provincially run institutions that took place in Ontario as part of the Facility Initiative. Three case studies were examined in order to report on this process as experienced by those who lived and worked through it. Specifically, the planning process conducted by the Ministry of Community and Social Services (MCSS) to assist each person with hislher transition to community living was examined using the current standard of practice in person- centered planning approaches. Effectiveness was evaluated as the ability to apply a person-centered approach across settings and people, as well as what factors facilitated or hindered its application. Results show that, in general, the personal plans do not appear to reflect the pre-transition experience of the person. Also, the transitional planning process did not appear person-centered nor facilitate further person-centered planning in the community.

Emergence of conscious awareness of underlying verbal and visual rules over time in moderate closed-head trauma patients

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999.5 E38 L64 2008

Examining Mentoring within a Particular Service Learning Context

My goal for this research project was to explore the levels of mentoring within a disability-focused service learning context known as the Special Needs Activity Program (SNAP). At present, research on mentoring within specific service learning contexts remains largely unexamined. In an effort to assess service learning and mentoring, I completed a comparative case study across three distinct years of SNAP. Undergraduate student leaders, known as coordinators, organize and implement SNAP as a thesis project. I focused specifically on the mentoring experience of particular coordinators of SNAP. My thesis presents and describes the findings of several levels of analysis across three SNAP coordinator cohorts. The analysis focused on key words, idiomatic expressions, patterns and dissonances. In my conclusion, I offer three metaphors that describe mentoring within the SNAP experience and relate these to my discussion about how mentoring functions as a component of service learning.

Living in the Skin That I Am: An Organizational Autoethnography of an Adult Educator's Plight to Survive the Stigma of Invisible and Episodic Disability in an Academy of Administritiva

Through the reflective lens of an adult educator with invisible and episodic disabilities, this paper has been written as an organizational autoethnography. Through a process of autoethnographical sensemaking, it is intended to illuminate important gaps in organizational theory. Feminist/relational care ethics, critical reflection, and transformative learning serve as the educational theories that comprise its framework. In telling my story, embodied writing and performance narrative are used to convey the felt existence of a body exposed through words—where my “abled” and “disabled” professional teaching and learning identities may be studied against the backdrop of organizational policies and procedures. Words used to describe unfamiliar experiences and situations shape meaning for which new meaning may emerge. At the conclusion of this paper, an alternative frame of reference—a view from the margins—may be offered to articulate authenticity in the expectancy of workplace equity for adult educators with disabilities. Taken collectively on a larger level, it is hoped that this research may provide a source of inspiration for systemic organizational change in adult learning environments.

The Experience of (In)Accessibility at University: What Disabled Graduate Students Reveal

Although the number of disabled students entering graduate school has increased in recent years, research pertaining to graduate students with disabilities remains underdeveloped. The purpose of this generic qualitative study is to better understand the experiences of (in)accessibility from the perspectives of three graduate students who self-identify as disabled or as having a disability(s) at one mid-sized university in Southern Ontario. The theoretical orientation was shaped by a social model of disability. The study was focused around the following major research question: What have been the experiences of (in)accessibility for three graduate students who self-identify as disabled or as having a disability(s) at one mid-sized university in Southern Ontario? Subquestions were organized around subcategories, such as (a) experiences related to accessibility, (b) experiences related to inaccessibility, and (c) insights related to future recommendations to enhance accessibility. The study found that (in)accessibility at university was related to (a) specific places on campus, (b) specific people on campus, and (c) the culture of awareness. A variety of educational initiatives were recommended to foster accessible practices and to develop a more accepting and disability-friendly culture on campus. Based on these findings, the Trickledown Effect Model was proposed as a means for promoting accessibility at university.

L’utilisation des services de centre de jour par les personnes âgées qui présentent des incapacités

Contexte: Les centres de jour offrent des interventions de groupe à des personnes âgées qui présentent des incapacités, dans le but de favoriser leur maintien à domicile. Des études récentes tendent à démontrer qu’une utilisation régulière du service serait nécessaire pour induire des effets bénéfiques. Objectifs: Cette recherche visait à documenter l’utilisation des centres de jour par des personnes âgées qui présentent des incapacités. Elle comportait trois principaux objectifs: 1) Caractériser les utilisateurs de centre de jour et ce qui les distingue des non-utilisateurs et analyser les déterminants de l’utilisation du centre de jour. 2) Explorer l’adéquation entre les activités offertes par les centres de jour et les caractéristiques d’autonomie et de santé des utilisateurs. 3) Définir les facteurs associés à la régularité de la participation. Méthodes: Cette recherche s’appuie sur une analyse secondaire de données recueillies auprès de 723 personnes âgées qui ont participé au projet de démonstration SIPA (Services intégrés pour personnes âgées) implanté dans deux CLSC de la région de Montréal. L’utilisation du centre de jour a été documentée pendant une période de six mois, auprès des cinq centres de jour existant sur ce même territoire. Des informations sur le fonctionnement des centres de jour ont été obtenues par des entrevues et des rencontres de groupe auprès de coordonnateurs de ces centres. Les données ont été analysées à l’aide de statistiques descriptives, d’analyses en regroupement et d’analyses de régression logistique et multiple. Résultats: Les résultats sont présentés dans trois articles, soit un pour chacun des objectifs. Article 1: La proportion d’utilisateurs de centre de jour est de 18,8% (IC-0,95: 16,0 à 21,7%). Les facteurs suivants augmentent la probabilité d’utiliser le centre de jour: être plus jeune (RC: 1,12; IC-0,95: 1,06 à 1,19); ne pas avoir une éducation universitaire (RC: 1,92; IC-0,95: 1,04 à 3,57); recevoir l’aide du CLSC pour les activités de vie quotidienne plus d’une fois par semaine (RC: 1,73 et 2,48 pour aide de deux à cinq fois par semaine et aide de six à sept fois par semaine respectivement; IC-0,95: 1,06 à 2,80 et 1,22 à 5,06); faire partie du bassin de desserte d’un centre de jour dont les coûts sont moins élevés (RC: 1,054 ; IC-0,95: 1,001 à 1,108 pour chaque augmentation de 1$); et pour les hommes seulement, avoir déjà subi un accident vasculaire cérébral et présenter davantage d’incapacités fonctionnelles (interaction entre le sexe et la présence d’un AVC: RC: 0,298; IC-0,95: 0,108 à 0,825; interaction entre le sexe et les capacités fonctionnelles mesurées à l’OARS: RC: 1,096; IC-0,95: 1,019 à 1,178). De plus, on observe une plus grande probabilité d’utiliser le centre de jour chez les personnes qui cohabitent avec une personne de soutien. Toutefois, cette relation ne s’observe que chez les personnes nées au Canada (interaction entre la cohabitation avec la personne de soutien et le pays de naissance: RC: 0,417; IC-0,95: 0,185 à 0,938). Article 2: Des analyses en regroupement ont permis de distinguer quatre profils de participants ayant des caractéristiques similaires: 1) les personnes fragilisées par un âge avancé et un grand nombre de problèmes de santé; 2) les participants plus jeunes et plus autonomes que la moyenne, qui semblent des utilisateurs précoces; 3) les personnes qui présentent des incapacités d’origine cognitive; et 4) celles qui présentent des incapacités d’origine motrice. Les activités de groupe des centres de jour ont été regroupées en huit catégories: exercices physiques; groupe spécifique pour un diagnostic ou un problème fonctionnel commun; activités fonctionnelles; stimulation cognitive; activités musicales ou de réminiscence; sports et jeux physiques; intégration sociale; prévention et promotion de la santé. Les activités les plus fréquentes sont les exercices physiques et les activités d’intégration sociale auxquelles ont participé plus de 90% des utilisateurs de centre de jour, et ce en moyenne à respectivement 78% (±23%) et 72% (±24%) de leurs présences au centre de jour. Les autres catégories d’activités rejoignent de 45% à 77% des participants, et ce en moyenne à 35% (±15%) à 46% (±33%) de leurs présences. La participation aux diverses catégories d’activités a été étudiée pour chaque profil d’utilisateurs et comparée aux activités recommandées pour divers types de clientèle. On observe une concordance partielle entre les activités offertes et les besoins des utilisateurs. Cette concordance apparaît plus grande pour les participants qui présentent des problèmes de santé physique ou des incapacités d’origine motrice et plus faible pour ceux qui présentent des symptômes dépressifs ou des atteintes cognitives. Article 3: Les participants au centre de jour y sont inscrits en moyenne à raison de 1,56 (±0,74) jours par semaine mais sont réellement présents à 68,1% des jours attendus. Les facteurs suivants sont associés à une participation plus régulière au centre de jour en termes de taux de présences réelles / présences attendues: ne pas avoir travaillé dans le domaine de la santé (b: ,209; IC-0,95: ,037 à ,382); recevoir de l’aide du CLSC les jours de fréquentation du centre de jour (b: ,124; IC-0,95: ,019 à ,230); être inscrit pour la journée plutôt que la demi-journée (b: ,209: IC-0,95: ,018 à ,399); lors de ses présences au centre de jour, avoir une moins grande proportion d’activités de prévention et promotion de la santé (b: ,223; IC-0,95: ,044 à ,402); et enfin, avoir un aidant qui présente un fardeau moins élevé pour les personnes avec une atteinte cognitive et un fardeau plus élevé pour les personnes sans atteinte cognitive (interaction entre la présence d’atteinte cognitive et le fardeau de l’aidant: b: -,008; IC-0,95: -,014 à -,044). Conclusion: Conformément à leur mission, les centres de jour rejoignent une bonne proportion des personnes âgées qui présentent des incapacités. Cette étude fait ressortir les caractéristiques des personnes les plus susceptibles d’y participer. Elle suggère la nécessité de revoir la planification des activités pour assurer une offre de services qui tienne davantage compte des besoins des participants, en particulier de ceux qui présentent des atteintes cognitives et des symptômes de dépression. Elle démontre aussi que l’intensité d’exposition au service semble faible, ce qui soulève la question des seuils d’exposition nécessaires pour induire des effets favorables sur le maintien à domicile et sur la qualité de vie de la clientèle cible.

A Classification of Feminist Theories

In this paper I criticize Alison Jaggar’s descriptions of feminist political theories. I propose an alternative classification of feminist theories that I think more accurately reflects the multiplication of feminist theories and philosophies. There are two main categories, “street theory” and academic theories, each with two sub-divisions, political spectrum and “differences” under street theory, and directly and indirectly political analyses under academic theories. My view explains why there are no radical feminists outside of North America and why there are so few socialist feminists inside North America. I argue, controversially, that radical feminism is a radical version of liberalism. I argue that “difference” feminist theories – theory by and about feminists of colour, queer feminists, feminists with disabilities and so on – belong in a separate sub-category of street theory, because they’ve had profound effects on feminist activism not tracked by traditional left-to-right classifications. Finally, I argue that, while academic feminist theories such as feminist existentialism or feminist sociological theory are generally unconnected to movement activism, they provide important feminist insights that may become importanby showing the advantages of my classification over Jaggar’s views.

Détection des augmentations de 5 et de 10% de la dépense énergétique totale : comparaison des estimations de deux accéléromètres

L’obésité et la sédentarité sont considérées comme des problèmes importants de santé publique. L’augmentation de l’activité physique est une des stratégies recommandées pour obtenir un bilan énergétique positif dans les interventions de perte de poids. Deux accéléromètres, le Sensewear Armband (SWA) et l’Actical (ACT), sont des outils simples à utiliser en recherche clinique, mais à notre connaissance, aucune étude n’a évalué leur capacité à détecter des hausses de la dépense énergétique. De plus, très peu d’études, avec des résultats par ailleurs contradictoires, ont été effectuées afin de déterminer la fiabilité de ces accéléromètres pour la mesure de la dépense énergétique au repos et au cours d’une activité physique au vélo stationnaire. Ainsi, les objectifs de cette étude étaient: 1) évaluer, pendant 3 journées consécutives, la reproductibilité des valeurs de la dépense énergétique obtenues avec le SWA et l’ACT, au repos et au cours d’une activité physique de 45 minutes sur un vélo stationnaire, 2) déterminer la capacité de ces accéléromètres à détecter des hausses de 5% et 10 % de la dépense énergétique totale (DET) au moyen de la modification d’une activité physique au tapis roulant pendant 45 minutes. Cette étude transversale effectuée auprès de 20 sujets en santé, âgés de 20 à 32 ans et avec un IMC moyen de 23 kg/m2, consistait en 5 visites à la clinique. Les 3 dernières visites, sous supervision directe pendant 10 heures, comportaient des activités programmées sur le vélo stationnaire et la marche sur tapis roulant pendant 45 minutes. Les résultats montrent que le SWA et l’ACT donnent des valeurs reproductibles pour estimer la dépense énergétique au repos et la dépense énergétique au vélo (corrélations intra classe, p<0,001). Par contre, pour des hausses préétablies de la DET de 5% et 10%, les estimations respectives obtenues étaient de 1,4% et 7,8% avec le SWA et de 3,4% et 13,1% avec l’ACT. Le SWA sous-estime les hausses de 5% et de 10% et l’ACT sous-estime la hausse de 5% et surestime la hausse de 10% de la DET. Plus de recherches sont nécessaires avant de confirmer l’usage du SWA et de l’ACT dans l’estimation des hausses de la dépense énergétique totale.