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Covering the spectrum of cognitive decline in aging using illustrative cases, from mild impairment to dementia, this set of case studies offers a wide-ranging guide for trainees and clinicians. This second volume includes updated research diagnostic criteria and details of new imaging technology, including novel biomarkers such as PET amyloid and tau, to inform readers in clinical practice. Each case includes a clinical history, examination findings and special investigations, followed by diagnosis and discussion, to encourage clinical reasoning, integrative thinking, and problem-solving skills. To reinforce diagnostic skills, the cases include careful analysis of individual presenting patterns and up-to-date information on diagnostic classification and tools. The reader will be able to distinguish patients who need reassurance, closer follow-up or immediate referral to specialized services. With an international authorship, this book is for trainees and clinicians in neurology, psychiatry and neuropsychology.
This chapter has two primary purposes. The first is to address the question of whether the psychology community has a responsibility to promote and protect human rights and, if so, what this means for psychology and for psychologists in the context of an increasingly globalizing world. The second is to examine how psychological ethics can support human rights in psychology and help further the promotion of human rights for the benefit of humanity. The chapter opens with a brief history of the origins and development of psychological ethics and human rights, and the implications of these histories for their contemporary meanings. Then, using the Universal Declaration of Ethical Principles for Psychologists and the Universal Declaration of Human Rights as the primary references, the ways in which psychological ethics and human rights complement and differ from each other are examined. The chapter ends with a series of recommendations for the integration of human rights into psychological ethics and for psychology’s involvement in the protection and promotion of human rights. The recommendations emphasize the importance of enlightened globalization, as well as the importance of psychology and the human rights movement working together to serve humanity.
Literature on the topic of trans older adults has documented a few anecdotal cases in which some trans people living with dementia forgot they transitioned and reidentified with their sex assigned at birth (“detransition”). Trans communities and their allies have encouraged trans people to engage in end-of-life planning, including the preparation of legal documents that state their wishes regarding gender identity and expression in the event of “incapacity” caused by dementia. While useful, we contend that end-of-life planning is often implicitly based on cisnormative and cognonormative (normative system based on cognitive abilities) assumptions. Such planning is founded on a stable notion of gender identity throughout the life course (“post-transition”) and assumes that the pre-dementia self is better equipped to make decisions than the “demented” self. We conclude by encouraging, based on an intersectional, trans-affirmative, crip-positive, and age-positive approach, respect for the agency of trans people with dementia.
The aim of this study was to examine the positive relationship between religiosity and fertility from the perspective of perceived consequences of parenthood. Previous studies in Germany have found that highly religious people ascribe higher benefits and lower costs to having children. Furthermore, the impact of costs and benefits on fertility is less pronounced among the highly religious. This study tested these mechanisms for fertility intentions and in the context of Poland – a country with a low fertility rate and high religiosity in comparison to other European countries. A sample of 4892 men and women of childbearing age from the second wave of the Polish version of the Generations and Gender Survey conducted in 2014/2015 was used. First, the extent to which perceived costs and benefits mediate the impact of religiosity on fertility intentions was analysed. Second, whether religiosity moderates the impact of perceived costs and benefits on fertility intentions was investigated. The results show that part of the positive effect of religiosity on fertility intentions can be explained by more-religious people seeing higher benefits of having children. Furthermore, but only in the case of women, religiosity moderates the impact of perceived costs on fertility intentions, suggesting that the effect of perceived costs decreases with increasing religiosity.
The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.
A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.
Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.
This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.
This work presents the results of physical and biological investigations at 27 biogeochemical stations of early winter sea ice in the Ross Sea during the 2017 PIPERS cruise. Only two similar cruises occurred in the past, in 1995 and 1998. The year 2017 was a specific year, in that ice growth in the Central Ross Sea was considerably delayed, compared to previous years. These conditions resulted in lower ice thicknesses and Chl-a burdens, as compared to those observed during the previous cruises. It also resulted in a different structure of the sympagic algal community, unusually dominated by Phaeocystis rather than diatoms. Compared to autumn-winter sea ice in the Weddell Sea (AWECS cruise), the 2017 Ross Sea pack ice displayed similar thickness distribution, but much lower snow cover and therefore nearly no flooding conditions. It is shown that contrasted dynamics of autumnal-winter sea-ice growth between the Weddell Sea and the Ross Sea impacted the development of the sympagic community. Mean/median ice Chl-a concentrations were 3–5 times lower at PIPERS, and the community status there appeared to be more mature (decaying?), based on Phaeopigments/Chl-a ratios. These contrasts are discussed in the light of temporal and spatial differences between the two cruises.
The complex hierarchical texture covering the lotus leaf is at the source of two of its extraordinary properties. While its water-repellent properties are now emblematic, the lotus is much less known for its extreme slipperiness. And for good reason: until the recent work of Martouzet et al. (J. Fluid Mech., vol. 892, 2020, R2), the effect of slippage on drop impact dynamics had never been demonstrated. This remarkable study unveils a complex interplay between wetting and friction, with counter-intuitive consequences. Hierarchical structures, which minimize the contact between the substrate and the droplets, are less efficient at repelling viscous liquids than simpler systems, because of the slip! A clever and original approach, based on a scaling analysis of the spreading time, is used to disentangle the different physical phenomena occurring during drop impact. This is an important step towards a better understanding of the crucial problem of drop impact dynamics on both wetting and non-wetting substrates.
Depuis une dizaine d’années, l’entraînement cognitif est un type d’intervention non pharmacologique qui s’est développé afin de favoriser la réhabilitation après un traumatisme crânien ou un accident vasculaire cérébral. Le but de cette intervention est l’amélioration du fonctionnement cognitif par la répétition d’exercices généralement informatisés . Cette intervention peut être envisagée dans le traitement du Trouble de Déficit de l’Attention/Hyperactivité (TDA/H) car ce trouble est associé à un déficit du fonctionnement cognitif . À ce jour, la majorité des études TDA/H portent sur l’entraînement de la mémoire de travail par le programme Cogmed. Mais, les résultats des études sont controversés quant à l’impact du programme sur : le fonctionnement cognitif, les symptômes liés au TDA/H et les performances scolaires . Face à ces constats, une première étude est réalisée au Québec auprès d’enfants présentant un Trouble de Déficit de l’Attention/Hyperactivité (TDA/H). Une seconde étude est réalisée en France auprès d’adultes présentant ce même trouble. L’objectif principal commun de ces deux études est d’évaluer l’efficacité d’un entraînement de la mémoire de travail assisté par ordinateur (Cogmed) sur les symptômes liés au TDA/H et le fonctionnement cognitif auprès (1) d’enfants, et (2) d’adultes présentant un TDA/H. Les objectifs secondaires de l’étude réalisée auprès d‘enfants sont d’évaluer l’efficacité du programme sur le rendement scolaire. Pour l’étude réalisée auprès d’adultes, les objectifs secondaires sont d’évaluer les effets du programme sur : (1) la symptomatologie anxieuse et (2) dépressive. Les deux études sont réalisées en double insu et comprennent une assignation aléatoire des participants. Pour chacune des deux études un groupe témoin actif durant lequel les participants réalisent également des exercices d’entraînement assistés par ordinateur est constitué. Toutefois, dans ce programme les exercices d’entraînement demeurent à un niveau de difficulté limité, ce qui a pour impact d’en réduire les effets. Les résultats de ces deux études sont présentés.
Measuring slow and little changes in schizophrenia is not easy. Authors have censed criterias of improvement in psychiatry, psycho-dynamic literature, and communautary mental health programs for severe mentally ill people. After being clasified following psycho-dynamic point of view, 24 items are defined, covering all the fields of clinical expresion of chronic psychotic states. Most of items have three levels of intensity, following a nearly quantitative manner. More than 100 patients were quotated by several clinicians. Statistic study show a good sensibility to usual changes obtained by five-years periods of treatment. Usually only 4 items among 25 change in five years. That explains under-estimation of improvement among psychotic chronic patients receiving long-term complex comunautary, psychotherapic and psychopharmacologic treatments. Reliability of quotation is tested by measuring Kappas, and appears rather good. Multi-dimensional analysis give an eight-dimensions model of description of schizophrenic chronic states. This confirms need of more complex models to describe slow and little changes in chronic states than to show improvement of acute psychosis. Authors compare their first clasification following psycho-pathological hypothesis of improvement criterias, the groups of criterias that change together with time, and the stucture by criterias of the eight axes.
Training for use appears rather easy for psychiatric teams because each three levels of the 25 items is generally defined by many features. Using this methodic description of chronic states help to perceive the homeostatic and balanced aspects of the clinic stability. So chronic states can be thinked otherwise than immobility.
There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer’s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here.
The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer’s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria.
Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.
La mémoire de travail est une fonction cognitive souvent affectée, dans le contexte d’un TDAH . L’entraînement de la mémoire de travail par le programme informatisé Cogmed est une intervention qui est proposée auprès des patients présentant un TDAH . Le but de cette intervention est l’amélioration de la mémoire de travail par la répétition d’exercices généralement informatisés . Les résultats des études évaluant les effets du programme Cogmed auprès de participants présentant TDAH, indiquent que cette intervention améliore la mémoire de travail . Cependant, selon ces auteurs le maintien des effets de cette intervention sur plusieurs mois ne sont pas attestés. Afin de pallier à cette limite, deux études sont présentées. L’une est réalisée en France auprès d’adultes présentant un TDAH et la seconde au Québec auprès d’enfants présentant ce même trouble. L’objectif de ces études est d’évaluer le maintien des effets à six mois d’un entraînement de la mémoire de travail assisté par ordinateur (Cogmed) sur les symptômes liés au TDAH, la mémoire de travail, le raisonnement non verbal, l’inhibition et les capacités attentionnelles. Le maintien des effets pour la compréhension de la lecture et le raisonnement mathématique est également évalué auprès des enfants. Pour les deux études, les participants sont assignés aléatoirement dans une des deux conditions suivantes :
– le groupe d’entraînement Cogmed ;
– un groupe témoin actif (version placebo du programme), durant cette version les mêmes activités que celles proposées par le programme Cogmed sont effectuées.
Toutefois, le niveau de difficulté demeure faible et constant à travers le temps, ce qui devrait avoir pour effet d’en restreindre l’efficacité. Les évaluations sont réalisées en double insu. Les résultats des effets du programme six mois après l’intervention seront présentés.
Dans le cadre de la sécurisation du circuit du médicament, une EPP a été réalisée pour mettre en évidence le nombre d’erreurs identifiées lors de la préparation des piluliers dans le cadre de la DJIN des patients hospitalisés en psychiatrie.
Matériels et méthode
Menée de janvier à décembre 2014, cette étude prospective a permis de recenser et de typer les erreurs identifiées lors de la préparation des piluliers. Quotidiennement et de manière aléatoire, 4 chariots sur 10 étaient entièrement contrôlés. Les 6 autres ne l’étaient que partiellement, à raison de 2 piluliers choisis au hasard par chariot. Les résultats obtenus correspondent au nombre d’erreurs rapporté au nombre d’ordonnances contrôlées, par service et par mois.
Résultats et discussion
En 2014, le pourcentage d’erreurs identifiées pour le service de psychiatrie est de 6,04 %, soit 1 erreur toutes les 26 lignes. Ce résultat est conforme aux données de la littérature (6–7 %)*, contrairement à celui obtenu pour l’ensemble de l’hôpital (7,78 %). En effet, le service de psychiatrie témoigne d’une certaine stabilité en raison d’une chronicité des pathologies traitées et d’une protocolisation des prises en charge. Les patients sont ainsi souvent suivis depuis longtemps et leur traitement ne change que ponctuellement. Cependant, malgré cette sécurité apparente, la vigilance de l’équipe soignante est essentielle : sur les 1300 ordonnances non contrôlées, 79 erreurs n’auraient donc pas été interceptées par la pharmacie, si le même pourcentage d’erreurs est appliqué.
Le double contrôle lors de la préparation des traitements est essentiel. Il permet d’intercepter les erreurs à la pharmacie, mais aussi dans le service clinique. À l’heure où l’exercice de l’infirmier est à la médicalisation, l’infirmier reste le dernier verrou avant le patient.
In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
Although radiocarbon (14C) dating is commonly used for archeological music instruments, little research has been conducted on modern instruments (16th–19th centuries). New technology, based on the Mini Carbon Dating System (MICADAS), enables some of the recurring challenges (e.g. sampling size) to be circumvented and paves the way for a new field of investigation. We here address the Indian instrumentarium, about which very little is known. We investigate the making and the restoration phases of two vina, a kinnari vina (E.1444), and a rudra vina or bin (E.997.24.1). By comparing 14C measurements made on several samplings of elements of the instruments with museological information, we were able to specify a unique calibrated interval of ages [1666 AD–1690 AD] for the kinnari vina, with a restoration phase [1678 AD–1766 AD] for the upper nut. The bin is likely attributed to the [1650 AD–1683 AD] interval.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
Entities seeking to establish statehood have used participation in sport to bolster their claims. Kosovo is the latest entity to use this strategy. Kosovo’s quest to join the Union of European Football Associations led to a 2017 Court of Arbitration for Sport decision examining whether Kosovo was sufficiently an “independent state.” This article considers how participation in sport plays a role in establishing a broader, contextual conceptualization of statehood. This article then applies this concept to case studies, with particular attention paid to Kosovo. Finally, the article examines sport’s gradual acceptance that it must work within the broader international political and legal world.
Background: In this retrospective claims analysis, real-world healthcare resource use (HRU) and costs among SMA type 1 (SMA1) patients were assessed. Methods: SMA1 patients were identified from Symphony Health’s Integrated Dataverse® (09/01/2016–08/31/2018). The study period spanned from the index date (date of first SMA1 diagnosis after nusinersen approval [12/23/2016]) until death/end of available data. HRU and costs per-patient-per-year (PPPY; 2018USD) were described during the study period for all patients and after treatment initiation for nusinersen-treated patients. Results: A total of 349 SMA1 patients (median age=1 year; 55.6% female) with median follow-up of 7.9 months were included. The proportion of patients receiving mechanical ventilation, nutritional support, and physical therapy/rehabilitation was 46.4%, 46.1%, and 22.6%. Patients had, on average, 59.4 days with medical visits/year (14.1 inpatient, 13.4 respiratory failure-related). The 45 nusinersen-treated patients had, on average, 56.6 days with medical visits/year (4.6 inpatient, 11.4 respiratory failure-related). Excluding nusinersen-related costs, mean healthcare costs PPPY were $137,627 (median: $43,167) for all patients and $92,618 ($29,425) for nusinersen-treated patients. Mean nusinersen-related costs were $191,909 ($144,487) per month for the first 3 months post-initiation and $36,882 ($16,132) per month thereafter. Conclusions: HRU and costs associated with SMA1 are substantial, even among patients treated with nusinersen.