The Game of Queer Family Life: Exploring 2SLGBTQI+ Parents' Experiences of Cisheteronormativity, Racism, and Colonialism Through Digital Storytelling in Ontario, Canada

In this article we describe and analyze five videos created through an arts-informed research project, Precarious Inclusion: Studying Ontarian 2SLGBTQI+ parents' experiences childrearing in a post-legal parity framework. Precarious Inclusion used interviews and digital storytelling to investigate Ontario 2SLGBTQI+ parents' current experiences of inclusion and exclusion when navigating institutional and social interactions in everyday life in a post-legal parity context. The study centrally explored how intersecting identities with regards to sexuality, gender, geography, disability, class, race, Indigeneity, and ethnicity intersect with structural forces to influence 2SLGBTQI+ parents' inclusion and exclusion experiences. We examine research creation activities that supported 2SLGBTQI+ parents in making short videos about their experiences of parenting. Our analysis of the five videos created by Indigenous, racialized, trans, nonbinary, Two-Spirit, and disabled parents show how consistent experiences of exclusion mark 2SLGBTQI+ parents' everyday lives. We deepen theorizations of the material and psychological impacts of exclusion for 2SLGBTQI+ families through foregrounding three themes: 1) the operations of racism, white supremacy, and colonialism in makers' lives; 2) misrecognition and its psychic effects of bifurcation and disjuncture; and 3) love, joy, and multi-species kinship as powerful sites of healing and belonging. We further demonstrate how parents used their videos as self-advocacy for resisting precarious inclusion.

The third shift: Addressing emotion work in couple therapy

Research on the gendered division of household work in western political economies often neglects its emotional dimensions. This conceptual paper draws on concepts of emotion work and feminist care ethics to explore gendered and intersecting divisions of emotions and emotional work in couple relationships and their implications for couple therapy. Although emotion work has been studied in workplace settings, less attention has been paid to inequalities in the privatized realm of interpersonal relationships, including romantic and filial ones. Women and feminine partners' culturally presumed expertise in emotions typically positions them as carrying primary responsibility for managing emotions in intimate relationships. Couple therapy is an important site of interaction that can both support and, potentially, disrupt the invisibility and gendering of emotion work in intimate relationships, thus shedding light on recurring patterns of women's subordination and exploitation. We conclude by advancing suggestions for addressing gendered and intersectional dimensions of emotion work in therapy practice.

The problem of heteronormativity in family-based health promotion: centring gender transformation in Ontario, Canada

OBJECTIVES

Social scientists have demonstrated that family health work is interlinked with heteronormative gender inequities. Yet family-based public health interventions rarely incorporate a gender transformative approach or address heteronormativity as a potential health barrier in North America. Instead, attention to gender surfaces primarily in family health interventions conducted in low- to middle-income countries with majority Black and racialized populations. The objective of this article is to establish the importance of designing health interventions that account for heteronormative relations in Ontarian families by drawing on empirical data from the Guelph Family Health Study (GFHS).

METHODS

We draw on data (February-October 2019) from (1) semi-structured interviews with 20 families and with 4 health educators facilitating the GFHS home visits and (2) observational data of 11 GFHS home visits and 1 health educator training day. Informed by gender transformation theory, data were analyzed and coded to understand the impact of gender, sexuality, and place in family health interventions.

RESULTS

Pre-existing heteronormative parenting relations were reinforced through GFHS participation: the GFHS was mother-led, increasing some mothers' stress levels. Fathers tended to consider paid work a justification for disengaging from the GFHS, and their detachment sometimes obstructed mothers' intervention efforts. Health educators (all women) were caught in these relations, feeling like because of their gender, they were viewed by parents as confidants and marriage counsellors.

CONCLUSION

Findings emphasize the need for expanding the epistemic and methodological approaches to family-based health interventions, changing the demographic and geographic emphasis within the field, and designing interventions that focus on societal-level changes. Heterosexuality has not been analyzed as a risk factor within the public health field, but our findings indicate the need for further study.

Gendering of care and care inequalities in couple therapy

Reciprocal partner or spousal caregiving in romantic relationships has been identified as a key determinant of the quality of couple relationships. In this article, we interrogate this premise concerning the presumed reciprocity of caregiving in romantic relationships, focusing on cisgender heterosexual relationships and offering implications for relationships of all genders and sexualities. Looking beyond the conventional focus on individual or dyadic processes, we theorize imbalances in care as gendered. Feminists have repeatedly critiqued gender ideology that devalues caring labor and allocates it to women. Gendered power dynamics can lead to imbalances in care-seeking and care provision. We discuss how the gendering of care and care inequalities can manifest in couple therapy, illustrating with examples from recorded interactions. Implications for therapy practice are discussed.

105 EVALUATION OF A NEW PHYSIOTHERAPY-LED VESTIBULAR SERVICE EMBEDDED IN THE FALLS AND SYNCOPE UNIT

Background

Clinical presentations in the falls and syncope unit (FASU) are diverse and require a range of skillsets. Vestibular disorders amount to a significant proportion of presentations. In our FASU, we embedded a 0.5 FTE specialist physiotherapist with expertise in vestibular disorders to work alongside medical and nursing staff. We conducted a service evaluation of the activity of this new service.

Methods

Retrospective Service Evaluation Approval was granted by our Research & Innovation Office. Pseudonymised data was collected corresponding to all new FASU physiotherapy service attendances between August 2021 and May 2022. Descriptive statistics were complemented by a binary logistic regression model to establish independent predictors of more than one physiotherapy session being required over the period.

Results

There were 104 episodes recorded by the new service, corresponding to 101 unique patients. Mean age was 67.7 (SD 19.0, range 17-93), and 73.1% were women. 67% were treated and discharged in 1 session. On average, patients had had a mean of 2 falls prior to the consultation (range 0-25). 28.8% were using a walking aid, and 54.8% self-reported fear of falling. 25% of the referrals to the service were due to suspected vestibular disorders, 62% of which were directly treated by the physiotherapy service. The logistic regression model adjusting by age, sex, use of walking aid, number of falls, and fear of falling showed that only referral for vestibular disorder was an independent predictor of patients needing more than 1 physiotherapy treatment (OR 3.91, 95% CI 1.32-11.58, P=0.014).

Conclusion

Vestibular disorders are common in FASU, and a majority can be treated by a specialist physiotherapy service. Repeated vestibular maneuvers are often needed in such patients. A responsive, embedded physiotherapy service in FASU can directly address this need and further evaluation will focus on the impact of this service on avoidance of ED attendances.

110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC

Background

Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program.

Methods

A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed.

Results

The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination.

Conclusion

“Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”

The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.

281 PREVALENCE OF STOPPFALL FALLS-RISK-INCREASING DRUGS (FRIDS) IN PATIENTS PRESENTING TO HOSPITAL WITH A FALL

Background

Falls cause presentation and admission to hospital. Falls-Risk-Increasing-Drugs (FRIDs) are a modifiable risk factor. STOPPFalls criteria was developed, using an expert Delphi panel, to achieve consensus on a comprehensive list of FRIDs. The aim of this study was to identify the prevalence of STOPPFall PRIDs in patients presenting to hospital with falls and identify whether review by a specialist Falls and Syncope Service (FASS) reduces FRIDs.

Methods

This was a retrospective observational study. Patients ≥65 years reviewed by the hospital FASS in the emergency department (over 6-months) and in house (over 2-months), were included. Medication appropriateness at admission and discharge were assessed using STOPPFall criteria. Ethical approval was received from the local research and innovation office (ref7013).

Results

Of 156 patients, 87(55.8%) were ≥65 years; 46% female, mean age 78.1(SD7.5) years. The mean number of conditions was 4(SD4.4); the mean number of regular medications was 6.9(SD4.5). Reasons for referral to FASS included falls (34.5%), dizziness/near fall (35.6%), and transient loss of consciousness (29.9%). For 21.8% there was an associated injury; 11.5% a fracture. Thirty-seven (42.5%) had experienced at least one fall in the previous 12-months.

Sixty-four (73.6%) were on ≥1 STOPPFall FRID. The most common STOPPFall FRID prescribed to older adults were diuretics (24.1%), anti-depressants (20.7%) and benzodiazepines/benzodiazepine-related drugs (13.8%). At least 1 STOPPFall FRID was stopped in 31.3%. The most commonly deprescribed STOPPFall FRIDs were diuretics (20%), alpha blockers (6%) and benzodiazepines/benzodiazepine-related drugs (4.7%). Adults <65years (n=69) were more likely to be prescribed a STOPPFall FRID at admission than older adults (≥65years); 88.4% vs 73.6%, p=0.021.

Conclusion

STOPPFall FRIDs are prevalent in fallers of all ages. Even one review by a specialist FASS leads to medication optimization. The effectiveness of STOPPFalls criteria in the prevention of falls should be evaluated further in intervention studies.

The politics of vulnerable masculinity in couple therapy

Couple therapy and related literature has problematized men's emotional inexpressiveness as constraining for men and as contributing to men's privileged and dominating position vis-à-vis women. Fostering men's emotionality in and outside of therapy has been proposed as a way to improve men's well-being and relationships and promote gender equality. Critical masculinity scholars have noted that many men now enact vulnerable ("softer") and emotional forms of masculinity. Yet, there is lack of insight into how such enactment may intersect with gender inequality. This article presents a critical thematic analysis of 30 transcribed videotaped couple therapy sessions focusing on the performance of men's affective masculinities and the political dimensions of men's increasing emotionality within couple therapy. The study shows that vulnerable masculinities, although argued as bearing the potential to foster relational and social change, may also obscure continuing commitment to dominant masculinity norms. Implications for practice are discussed.

Recovering Uncertainty: Exploring Eating Disorder Recovery in Context

Attending to the shades of grey in eating disorder recovery may help to illuminate possibilities for navigating recoveries in their full complexity and diversity. There is a need for more complexity and flexibility in understandings of the timelines, processes, endpoints, and versions of eating disorder recoveries. In this article, we explore eating disorder recovery as a dynamic, intercorporeal, and non-linear process. Drawing on interviews with 20 people doing significantly better than they were during a time of acute distress around food and body, we articulate "recoveries" in relation to four themes: Fuzzy Logics of Time, Not Only Recovered, Recovery is Not All Sunshine and Rainbows, and The Life of Recovery. These themes speak to the ways in which participants struggled to articulate the temporalities of their recoveries, situated recovery as one among many events and processes that shaped their being in the world, resisted "too perfect" articulations of recovery journeys/ endpoints, and described preferred versions of and open-ended guidelines for recovery. We argue that eating disorder recoveries are as complicated and messy as lives themselves and are equally entangled in social contexts. We suggest that articulations of recovery be attuned to power dynamics as they operate in dictating which performances of eating disorders and recovery will be honoured as "legitimate" and whose pathways to recovery will be respected.

204 FRAILTY BUT NOT AGE IS ASSOCIATED WITH IMPAIRED ORTHOSTATIC CEREBRAL OXYGENATION

Background

The effects of age and frailty on cerebrovascular function are poorly understood. Here we investigate the hypotheses that aging, and frailty are accompanied by impaired regulation of cerebral oxygenation during standing in a patient population of older adults.

Methods

We recruited patients from a national Falls and Syncope service. All patients underwent an active stand test (5–10 min lying, 3 min standing) with continuous monitoring of blood pressure (BP) and heart rate. Tissue saturation index (TSI) was concurrently measured using near-infrared spectroscopy and its recovery measured at 30s after standing. Frailty was assessed as a comorbidity count using a 27-item questionnaire. Robust linear regression was used to investigate the association between TSI, age and frailty in a multivariate model with covariate adjustment, including the concurrent BP values. A p-value <0.05 was considered significant.

Results

304 patients (median(IQR): 71(14) years, 57% females) were recruited. Age was not associated with cerebral oxygenation after standing (β: −0.001 (−0.017 0.015), p = 0.899), even after stratification by sex (males: β: −0.010 (−0.045 0.024), p = 0.558, females: β: 0.000 (−0.017 0.018), p = 0.967). Frailty, was associated with a lower TSI at 30s after standing (β: −0.153 (−0.248–0.058), p = 0.002). After sex stratification, no associations with frailty were observed in males (β: −0.052 (−0.226 0.123), p = 0.557), while frailer females demonstrated a lower TSI at 30 seconds after standing (β: −0.179 (−0.294–0.063), p = 0.003) despite BP correction.

Conclusion

Our results suggest alternative mechanisms of cerebral oxygenation regulation independent of blood pressure (and presumably cerebral autoregulation) are involved in frailty related impairments of brain haemodynamics which are also independent of ageing. Such impairments represent novel biomarkers of frailty and represent potentially novel modifiable risk factors (independent of BP management) of hypoperfusion related disorders in clinical ageing.

Decolonizing Disability Through Activist Art

This paper mobilizes activist art at the intersections of disability, non-normativity, and Indigeneity to think through ways of decolonizing and indigenizing understandings of disability. We present and analyze artwork produced by Vanessa Dion Fletcher, the first Indigenous disability-identified Artist-in-Residence for Bodies in Translation (BIT), a research project that uses a decolonized, cripped lens to cultivate disabled, D/deaf, fat, Mad, and aging arts on the lands currently known as Canada. We begin by setting the context, outlining why disentangling the disability, non-normativity, and Indigeneity knot is a necessary and urgent project for disability studies and activisms. Drawing on Indigenous ontologies of relationality, we present a methodological guide for our reading of Dion Fletcher's work. We take this approach from her installation piece Relationship or Transaction?, which, we argue, foregrounds the need for white settlers to turn a critical gaze on transactional concepts of relationship as integral to a decolonized and an indigenized analysis of disability and non-normative arts. We then centre three original pieces created by Dion Fletcher to surface some of the intricacies of the Indigeneity/disability/non-normativity nexus that complicate recent discussions about recuperating Indigenous concepts of bodymind differences across white supremist settler colonial regimes on Turtle Island (North America) that seek to debilitate Indigenous bodies and lives. We intervene in these debates with reflections on what might be created—and what we might learn—when the categories of Indigeneity and (Western conceptions of) disability and non-normativity are understood as contiguous, particularly focusing on meaning-making within Dion Fletcher's developing oeuvre.

Recent CO2 levels promote increased production of the toxin parthenin in an invasive Parthenium hysterophorus biotype

Recent carbon dioxide (CO₂) concentrations promoted higher parthenin concentrations in an invasive Parthenium hysterophorus biotype. Mean concentrations of parthenin, an allelopathic and defensive sesquiterpene lactone, were 49% higher at recent (~400 ppm) than at mid-twentieth-century (~300 ppm) CO₂ concentrations, but did not vary in a non-invasive biotype, suggesting that recent increases in atmospheric CO₂ may have already altered the chemistry of this destructive weed, potentially contributing to its invasive success.

Cerebral perfusion responses to active standing are attenuated in patients with vasovagal syncope

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council (IRC): Government of Ireland Postgraduate Scholarship Programme 2018, Dublin, Ireland Fundació Universitària Agustí Pedro i Pons, Universitat de Barcelona, Barcelona, Spain

Background

Syncope is a transient loss of consciousness due to cerebral hypoperfusion. While traditionally peripheral haemodynamics are monitored during clinical assessment of syncope, relatively little is known about cerebrovascular haemodynamics during orthostasis in patients with syncope.

Purpose

Here we investigated whether young patients with syncope present an altered cerebral perfusion when compared to healthy controls. Given potential hyper-reactivity of the autonomic nervous system previously reported in these patients, we hypothesise that an overly active cerebral autoregulation will be present in patients with syncope.

Methods

Consecutive patients were prospectively recruited from a National Falls and Syncope Unit, and a convenience sample of young healthy community dwelling adults was recruited from a local university (16-30 years). Participants performed a 3 minute active stand test with continuous measurement of beat-to-beat peripheral haemodynamics (blood pressure (BP), heart rate (HR)) and changes in concentration of oxygenated Δ[O2Hb] and deoxygenated Δ[HHb] haemoglobin were derived from a near-infrared spectroscopy (NIRS) monitor. Baseline, steady state and other time domain features were derived for Δ[O2Hb] (nadir, overshoot, overshoot-to-nadir, overshoot-to-nadir recovery rate) and Δ[HHb] (peak, trough, peak-to-trough, peak-to-trough recovery rate) and multiple linear regression was used to compare differences between the two groups correcting for covariates (p < 0.05 significant).

Results

Patients (n = 40) were younger (20(5.5) vs 23(1) years, p = 0.003) than controls (n = 17) and were well matched in gender, weight, height, BMI and resting haemodynamics. Patients had a smaller Δ[O2Hb] overshoot-to-nadir difference (β: -0.749, CI:(-1.593 0.094), p = 0.08), a slower Δ[O2Hb] recovery rate (β: -0.186, CI:(-0.388 0.016), p = 0.071), and smaller Δ[HHb] peak-to-trough difference (β: -0.530, CI:( -0.921 0.138), p = 0.018) and slower Δ[HHb] recovery rate (β: -0.151, CI: (0.244 0.057), p = 0.008).

Conclusion

Patients with syncope had signs of an attenuated cerebral oxygenation response to an AS when compared to controls. We hypothesise that this is due to hyper-reactive cerebral autoregulation mechanism, which might be related to a hyper-sensitive autonomic system. Furthering our understanding of vasovagal syncope physiology can help inform future interventions and treatments. This study shows the clinical value of measuring cerebral perfusion using NIRS, an easy to use and readily applicable tool, in the assessment of syncope. Abstract Figure. Cerebral oxygenation upon standing

Do patients with syncope have a hyper-reactive autonomic nervous system?

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council (IRC): Government of Ireland Postgraduate Scholarship Programme 2018, Dublin, Ireland Fundació Universitària Agustí Pedro i Pons, Universitat de Barcelona, Barcelona, Spain.

Background

The origin of syncope, a transient loss of consciousness due to cerebral hypoperfusion, remains unclear. Recent studies suggest that a hypersensitive autonomic nervous system might be involved in the pathophysiology of vasovagal syncope (VVS).

Purpose

Here we test the hypothesis that patients with VVS have a hyper-reactive autonomic nervous system by investigating the peripheral haemodynamic responses during a standing (AS) test in a group of young VVS patients vs a control group.

Methods

A prospective sample of consecutive patients from a National Falls and Syncope Unit was recruited, and a convenience sample of young healthy community dwelling adults was recruited from a local university (16-30 years). Participants performed a 3 minute AS with continuous measurement of beat-to-beat blood pressure (BP), heart rate (HR), and cerebral oxygenation measured with near infrared spectroscopy. Baseline, steady-state and other time domain features were obtained for systolic BP (SBP) (i.e. nadir, overshoot, overshoot-to-nadir, overshoot-to-nadir recovery rate) and for HR (i.e. peak, trough, peak-to-trough, peak-to-trough recovery rate). Multiple linear regression was used to compare these features between patients and controls while correcting for covariates (p < 0.05 significant).

Results

Forty patients and 17 controls were included, the former group being younger ((20(5.5) vs 23(1) years, p = 0.003). During steady-state standing SBP was higher as compared to controls (β: 6.853, CI: (0.713 12.993), p = 0.029). Patient data trended toward lower steady-state HR (β: -5.262, CI:(-11.201 0.677), p = 0.081), together with a larger peak-to-trough difference (β: 7.212, CI:(1.329 -15.754), p = 0.096).

Conclusion

These results tend to support the hypothesis and previous literature suggesting the presence of autonomic hyper-reactivity in patients with syncope, presenting as an exaggerated peripheral circulatory response to standing. Understanding the pathophysiology of VVS can help us improve its assessment and develop better treatment pathways for these patients. Abstract Figure.

Healthcare providers' engagement with eating disorder recovery narratives: opening to complexity and diversity

Interdisciplinary healthcare providers (HCPs) receive only minimal training in identifying, referring for and treating eating disorders and may feel ill-prepared to manage them. There is a need for brief interventions that prepare HCPs for work with people with eating disorders, particularly when they do not fit stereotypes about who might experience an eating disorder. One method for enacting brief interventions that make change in this realm is using digital stories (short videos) to generate awareness and knowledge. In this article, we discuss the results of a pilot study exploring the impact of viewing digital stories created by people in eating disorder recovery and their supporters on an interdisciplinary group of HCPs. We showed five stories to 22 HCPs who filled out qualitative prequestionnaires and postquestionnaires about their experiences of viewing the films and how they conceptualised recovery. Providers found the stories evocative; the stories appear to have complexified their perspectives on recovery. HCPs desired more diverse, detailed and lengthy stories, indicating that pursuing digital storytelling for HCP education and awareness may hold promise. Through centring the voices of people with eating disorders and in recovery, digital stories may also provide new ways of talking about recovery that open up possibilities for embracing difference.

Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

BACKGROUND

Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission.

AIM

To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness.

DESIGN

Pre- and post-cohort study.

METHODS

Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS).

RESULTS

There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4-24.0] days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030).

CONCLUSION

This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Elements of a counter-exhibition: Excavating and countering a Canadian history and legacy of eugenics

Into the Light, a recently mounted collectively curated museum exhibition, exposed and countered histories and legacies of 20th-century "race betterment" pedagogies taught in Ontario's postsecondary institutions that targeted some groups of people, including Anishinaabe, Black, and other racialized populations, and disabled and poor people, with dehumanizing ideas and practices. This article advances understandings of the transformative potential of centralizing marginalized stories in accessible and creative ways to disrupt, counter, and draw critical attention to the brutal impacts of oppressive knowledge. The "counter-exhibition" prioritized stories of groups unevenly targeted by such oppression to contest and defy singular narratives circulating in institutional knowledge systems of what it means to be human. The authors draw on feminist, decolonial and disability scholarship to analyze the exhibition's curation for the ways it collectively and creatively: (1) brought the past to the present through materializing history and memory in ways that challenged archival silences; and (2) engaged community collaboration using accessible, multisensory, multimedia storytelling to "speak the hard truths of colonialism" (Lonetree) while constructing a new methodology for curating disability and access (Cachia). The authors show how the exhibition used several elements, including counter-stories, to end legacies of colonial eugenic violence and to proliferate accounts that build solidarity across differences implicated in and impacted by uneven power (Gaztambide-Fernández).

Difference-attuned witnessing: Risks and potentialities of arts-based research

In this paper, we interrogate notions of affect, vulnerability and difference-attuned empathy, and how they relate to bearing witness across difference—specifically, connecting through creativity, experiencing the risks and rewards of vulnerability, and witnessing the expression of difficult emotions and the recounting of affect-imbued events within an arts-based process called digital/multi-media storytelling (DST). Data for this paper consists of 63 process-oriented interviews conducted before and after participants engaged with DST in a research project focused on interrogating negative concepts of disability that create barriers to healthcare. These retrospective reflections on DST coalesce around experiences of vulnerability, relationality, and the risks associated with witnessing one’s own and others’ selective disclosures of difficult emotions and affect-laden aspects of experiences of difference. Through analysing findings from our process-oriented interviews, we offer a framework for understanding witnessing as a necessarily affective, difference-attuned act that carries both risk and transformative potential. Our analysis draws on feminist Indigenous (Maracle), Black (Nash) and affect (Ahmed) theories to frame emerging concepts of affective witnessing across difference, difference-attuned empathy, and asymmetrical vulnerability within the arts-based research process.

Living Dis/Artfully with and in Illness

This article experiments with multimedia storytelling to re-vision difference outside biomedical and humanistic frames by generating new understandings of living dis/artfully with illness. We present and analyze seven short videos created by women and trans people living with illness as part of an arts-based research project that aimed to speak back to hegemonic concepts of disability that create barriers to healthcare.¹ We call for a welcoming in of disability studies' disruptive and re-imaginative orientations to bodily difference to unsettle medicine's humanistic accounts. In turn, we advance medical post-humanistic approaches that call on disability studies to re-embody its theories and approaches.

The eating disorder recovery assemblage: Collectively generating possibilities for eating disorder recovery

In this paper, we explore the affective-discursive-material aspects of the supportive eating disorder recovery assemblage. We approach recovery as an “assemblage” to facilitate an understanding of how human (people, systems of care, etc.) and nonhuman (affect, discourses, etc.) forces generate possibilities or impossibilities for recovery. Moving away from framings of recovery as an individual achievement, we consider the relationality and dynamism of eating disorder recovery in interviews with 20 people in recovery and 14 supporters of people in recovery. We draw from experiential accounts to theorize a supportive eating disorder recovery assemblage in relation to trust and love mobilized in interactions and relationships. This supportive eating disorder recovery assemblage can scaffold new understandings of recoveries as multiple and co-produced. Supportive eating disorder recovery assemblages generate improvisational spaces, albeit loosely contained and bounded, for different pathways to and manifestations of “recoveries”. This work builds on a body of feminist scholarship on eating disorders/disordered eating that takes up gendered relationships of power in treatment settings, extending toward and analysing material, affective, embodied, and potentially affirming dimensions of care and emotion in participants’ lives.

1064 Sleep Patterns Among Urban Haitian Earthquake Survivors Who Experienced the Trauma of Nonpartner Sexual Violence: A Latent Class Analysis Approach

Introduction

Sleep health is crucial to recovery from trauma. Haiti’s Cité Soleil residents (approximately 350,000) live in extreme poverty and regularly experience or witness life-threatening events, including gang and non-partner sexual violence (NPSV). Differences in levels of sleep disturbance among men and women in resource-limited settings who survive disasters as well as NPSV are understudied. In a larger study in which we investigated trauma symptoms among 2010 Haiti earthquake survivors via the Trauma-symptom checklist -40 (N=526; 290 males, 236 females), we also assessed self-reported frequency of sleep disturbance symptoms using the measure’s sleep disturbance subscale, comparing the latter by NPSV victim status and by gender.

Methods

SAS enabled 3-Class Latent Class Analysis (LCA): Class 1 (“No symptoms”), Class 2 (“Some symptoms”), Class 3 (“All Symptoms)”.

Results

Distribution of class membership differed by gender (χ2 = 23.9, df = 2, p &lt; .0001). Proportions of respondents assigned to the three classes differed between genders (Females: Class 1, 29.2%; Class 2, 35.5%; Class 3, 35.3%); Males: Class 1, 25.7%; Class 2, 54.4%; Class 3, 19.9%). NPSV status influenced levels of sleep disturbance symptoms, and membership distribution differed across classes by gender (χ2 = 23.9, df = 2, p &lt; .0001). Class 2 membership was greater for men (65.9%), but class 3 membership was greater for women (59.3%). Women who experienced NPSV were statistically more likely members of sleep disturbance symptom classes (Class 2 or Class 3) than Class 1 (χ2= 14.9, df = 2, p = 0.0006). No difference was found in Class membership for men reporting NPSV (χ2= 1.6, df = 2, p = 0.45).

Conclusion

Investigating the sleep health of Cité Soleil residents adds to the body of literature on sleep health, sleep equity and gendered vulnerability. Findings suggest women in post-disaster settings, especially in LMICs, are at even greater risk for a variety of adverse health outcomes and for suboptimal sleep, even when local men have similar traumatogenic experiences, such as NPSV. Girls and women in post-disaster LMIC settings need trauma-informed sleep health promotion and NPSV-prevention.

Support

N/A

Difference Within and Without: Health Care Providers' Engagement With Disability Arts

Re•Vision, an assemblage of multimedia storytelling and arts-based research projects, works creatively and collaboratively with misrepresented communities to advance social well-being, inclusion, and justice. Drawing from videos created by health care providers in disability artist-led workshops, this article investigates the potential of disability arts to disrupt dominant conceptions of disability and invulnerable embodiments, and proliferate new representations of bodymind difference in health care. In exploring, remembering, and developing ideas related to their experiences with and assumptions about embodied difference, providers describe processes of unsettling the mythical norm of human embodiment common in health discourse/practice, coming to know disability in nonmedical ways, and re/discovering embodied differences and vulnerabilities. We argue that art-making produces instances of critical reflection wherein attitudes can shift, and new affective responses to difference can be made. Through self-reflective engagement with disability arts practices, providers come to recognize assumptions underlying health care practices and the vulnerability of their own embodied lives.

Healthcare Providers' Experiences as Arts-Based Research Participants: "I Created My Story About Disability and Difference, Now What?"

Little is known about the experiences of healthcare providers as research participants in qualitative studies employing methods that encourage disclosure of their own disabilities. In this paper, we describe the experiences and implications of creating personal stories of disability and difference for healthcare provider participants in an arts-based study. The study design is a supplementary secondary analysis of a subset of data from a larger study focused on transforming negative concepts of disability and difference entitled, Mobilizing New Meanings of Disability and Difference: Using Arts-Based Approaches to Advance Healthcare Inclusion for Women with Disabilities. This supplementary study explores the experiences and perspectives of 17 healthcare provider participants who completed semi-structured interviews following creation of a multi-media story about their experience of disability or difference. Using creative non-fiction methods, two narrative streams are identified about healthcare provider experiences and the impacts of participating. The first addresses shared positive experiences about the research. The second entails more ambivalent reflections on their involvement as participants. The tension between the two experiences generates considerations to forward a mutually beneficial alliance to disrupt ableist understandings in healthcare and reveals new meanings of disability that are agential and integral to the stories and storytellers themselves.

Story-Making as Methodology: Disrupting Dominant Stories through Multimedia Storytelling

In this essay, we discuss multimedia story-making methodologies developed through Re•Vision: The Centre for Art and Social Justice that investigates the power of the arts, especially story, to positively influence decision makers in diverse sectors. Our story-making methodology brings together majority and minoritized creators to represent previously unattended experiences (e.g., around mind-body differences, queer sexuality, urban Indigenous identity, and Inuit cultural voice) with an aim to building understanding and shifting policies/practices that create barriers to social inclusion and justice. We analyze our ongoing efforts to rework our storytelling methodology, spotlighting acts of revising carried out by facilitators and researchers as they/we redefine methodological terms for each storytelling context, by researcher-storytellers as they/we rework material from our lives, and by receivers of the stories as we revise our assumptions about particular embodied histories and how they are defined within dominant cultural narratives and institutional structures. This methodology, we argue, contributes to the existing qualitative lexicon by providing innovative new approaches not only for chronicling marginalized/misrepresented experiences and critically researching selves, but also for scaffolding intersectional alliances and for imagining more just futures.

New Sexism in Couple Therapy: A Discursive Analysis

The persistence of gender inequality in postindustrial societies is puzzling in light of a plethora of changes that destabilize it, including shifts in economy, legislation, and the proliferation of feminist politics. In family relations, such persistence manifests as a disconnect between couples aspiring to be more egalitarian yet continuing to enact traditional gender roles and hierarchies. There is an emerging consensus that gender inequality persists because of people's continued reliance on sexist ideology or gendered assumptions that constitute women as innately distinct from and inferior to men. Sexist ideology changes its form to accommodate to changing socio-economic conditions. Contemporary forms of sexism are old ways of legitimizing male power articulated in new and creative ways, often by incorporating feminist arguments. To effectively recognize and address "new sexism," scholars and practitioners require new, innovative research frameworks. Our objective in writing this article is two-fold. First, we seek to advance discursive (i.e., focused on language in use) approaches to the study of sexism. Second, we present the results of a discursive analysis of "new" sexist discourse in the context of couple therapy. The study provides preliminary evidence that, despite endorsing egalitarian norms, couples studied continue to rely on gender binaries and remain entrenched in old-fashioned patterns of gender inequality. Implications of these results for the practice of couple therapy and for future research are discussed.

The Primacy of Discourse in the Study of Gender in Family Therapy

Family therapists and scholars increasingly adopt poststructural and postmodern conceptions of social reality, challenging the notion of stable, universal dynamics within family members and families and favoring a view of reality as produced through social interaction. In the study of gender and diversity, many envision differences as social constructed rather than as "residing" in people or groups. There is a growing interest in discourse or people's everyday use of language and how it may reflect and advance interests of dominant groups in a society. Despite this shift from structures to discourse, therapists struggle to locate the dynamics of power in concrete actions and interactions. By leaving undisturbed the social processes through which gendered and other subjectivities and relations of power are produced, therapists may inadvertently become complicit in the very dynamics of power they seek to undermine. In this article, we argue that discourse analysis can help family therapy scholars and practitioners clarify the link between language and power. We present published examples of discourse analytic studies of gender and sexism and examine the relevance of these ideas for family therapy practice and research.

Reduced axonal motor protein expression in non-lesional grey matter in multiple sclerosis

Background:

Multiple sclerosis (MS) is a neurological disease characterised by central nervous system inflammation, demyelination, axonal degeneration and neuronal injury. Preventing neuronal and axon damage is of paramount importance in attempts to prevent disease progression. Intact axonal transport mechanisms are crucial to axonal integrity and evidence suggests these mechanisms are disrupted in MS. Anterograde axonal transport is mediated to a large extent through the kinesin superfamily proteins. Recently, certain kinesin superfamily proteins (KIF5A, KIF1B and KIF21B) were implicated in MS pathology.

Objectives:

To investigate the expression of KIF5A, KIF21B and KIF1B in MS and control post-mortem grey matter.

Methods:

Using both quantitative real-time polymerase chain reaction (PCR) and Immunodot-blots assays, we analysed the expression of kinesin superfamily proteins in 27 MS cases and 13 control cases not linked to neurological disease.

Results:

We have shown significant reductions in KIF5A, KIF21B and KIF1B messenger ribonucleic acid (mRNA) expression and also KIF5A protein expression in MS grey matter, as compared to control grey matter.

Conclusion:

We have shown significant reductions in mRNA and protein levels of axonal motor proteins in the grey matter of MS cases, which may have important implications for the pathogenesis of neuronal/axonal injury in the disease.