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Our study objective was to develop and validate a questionnaire assessing the knowledge, attitude, and practice (KAP) of family physicians regarding dementia care and dementia strategies in Canada. Using a multistage process with a panel of experts, we developed and distributed an 83-item questionnaire to 542 eligible family physicians in 42 interdisciplinary primary care teams participating in the Quebec Alzheimer Plan implementation. Altogether, 369 physicians (68%) returned questionnaires. Median item-specific non-response rate was 0.8 per cent (0.3%–8.1%). Exploratory factor analyses and scale correlation supported the questionnaire validity. The final questionnaire contained five factors and 31 items. The KAP questionnaire has proved to be a reliable instrument for assessing the KAP of family physicians regarding dementia care and dementia strategies. This questionnaire provides researchers, clinicians, managers, and decision-makers with a tool to assess an intervention, a program, or a policy change implemented in primary health care for patients with dementia.
Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH.
This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected.
Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient.
IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.
Background: There is currently little data on the incidence, clinical outcome and management of traumatic interhemispheric subdural hematomas (IHSDHs). Methods: All patients admitted with an acute subdural hematoma (SDH) over a 5-year period at a Level I trauma center were included. A detailed review of all cases of large IHSDH (≥7 mm) was performed to document clinical presentation, management and outcomes. Results: Of 1182 patients with acute subdural hematomas (SDHs), 420 had IHSDHs (24%), and 50 were large IHSDHs. For patients with large IHSDH, the average age was 76 years (±11) and 44% were female. The average GCS was 12 on presentation (±4), and the average GOSE was 4 (±2). 66% of patients had associated cranial/ intracranial injuries (fracture, subarachnoid/epidural/SDH) and 26% required operations for acute convexity SDH. Three patients required operations for their IHSDH by inter hemispheric approach. By 10 weeks, 82% had a complete resolution of the IHSDHs. Conclusions: IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is often appropriate to manage even large IHSDHs, as most resolve spontaneously. This study will help document the occurrence of falx syndrome, as well as the management and outcomes of larger IHSDHs.
Introduction. L’anacardier (Anacardium occidentale
L.) est surtout cultivé pour la production de l’amande ou noix de cajou mais aussi pour le
pseudofruit. Les insectes nuisibles à cette plante ont été étudiés au Pérou où celui-ci
est consommé. Matériel et méthodes. Des prélèvements ont été réalisés de 1998
à 2005 dans différentes localités du département de Loreto en Amazonie péruvienne afin
d’identifier les insectes ravageurs de l’anarcadier. Des observations de terrain et des
élevages au laboratoire ont permis de caractériser leurs dégâts et des éléments de la
bio-écologie pour chacun de ces insectes. Résultats. Sept espèces d’insectes
ont été identifiées, qui commettent des dommages notables : cinq espèces s’attaquent au
pseudofruit : Acanthocephala parensis (Hemiptera : Coreidae),
Anastrepha obliqua (Diptera : Tephritidae),
Conotrachelus sp. (Coleoptera : Curculionidae), Trigona
amalthea et T. amazonensis (Hymenoptera : Apidae). L’espèce
Aphis gossypii (Hemiptera : Aphididae) infeste l’inflorescence ainsi
que le fruit. Les larves de Macrocopturus cf. tristis
(Coleoptera : Curculionidae) se développent dans les bourgeons et les jeunes rameaux.
Trois espèces parmi celles qui ont été identifiées sont de nouveaux ravageurs qui
n’avaient pas été encore signalés. Sept espèces d’importance secondaire ont également été
observées. Conclusion. Compte-tenu du potentiel que représente la production
de pomme cajou et du développement possible de la culture de l’anacardier en Amazonie
péruvienne, une étude plus approfondie des insectes nuisibles à cette production est
This paper deals with the lack of interest shown by family medicine residents in Quebec (Canada) in home follow-up or monitoring of the elderly. By collecting and analyzing data from sixteen family medicine residents before and after their first experience of home follow-up, and from four medical supervisors, we found that residents experience a rapid loss of interest in this practice over a very short period. We show that this lack of interest stems first from the difficulty of applying the principle of patient-centered care, wherein medical interventions must meet the needs of the elderly in their entirety. Secondly, residents complain that they have to deal with many administrative tasks. They call for implementation of professional features to better integrate services such as case management.
The intake of a high-fat/high-fructose (HF/HFr) diet is described to be deleterious to cognitive performances, possibly via the induction of inflammatory factors. An excess of glucocorticoids is also known to exert negative effects on cerebral plasticity. In the present study, we assessed the effects of an unbalanced diet on circulating and central markers of inflammation and glucocorticoid activity, as well as their reversal by dietary cinnamon (CN) supplementation. A group of male Wistar rats were subjected to an immune challenge with acute lipopolysaccharide under a HF/HFr or a standard diet. Another group of Wistar rats were fed either a HF/HFr or a control diet for 12 weeks, with or without CN supplementation, and with or without restraint stress (Str) application before being killed. We evaluated the effects of such regimens on inflammation parameters in the periphery and brain and on the expression of actors of brain plasticity. To assess hypothalamic–pituitary–adrenocortical axis activity, we measured the plasma concentrations of corticosterone and the expression of central corticotrophin-releasing hormone, mineralocorticoid receptor, glucocorticoid receptor and 11β-hydroxysteroid dehydrogenase. We found that the HF/HFr diet induced the expression of cytokines in the brain, but only after an immune challenge. Furthermore, we observed the negative effects of Str on the plasma concentrations of corticosterone and neuroplasticity markers in rats fed the control diet but not in those fed the HF/HFr diet. Additionally, we found that CN supplementation exerted beneficial effects under the control diet, but that its effects were blunted or even reversed under the HF/HFr diet. CN supplementation could be beneficial under a standard diet, but deleterious under the unbalanced diet encountered in Western societies.
The spinetail devilray Mobula japanica was recorded for the first time in the south-eastern Pacific Ocean, from a single beach-washed specimen examined at Bahía Inglesa, Chile. The presence of this temperate-tropical species at about 27° south of its previously recorded range in the eastern Pacific Ocean may be explained by the absence of rigorous species-specific landing reports along the coasts of Peru and Chile. Alternatively, a strong warm phase of El Niño Southern Oscillation may have facilitated conditions allowing this epipelagic species to travel towards higher latitudes. This record increases the known range of M. japanica and the occurrence of mobulids in Chilean waters to three species. Photographs and morphometrics of the specimen are provided.
We measure the second normal-stress difference in suspensions of non-Brownian neutrally buoyant rigid spheres dispersed in a Newtonian fluid. We use a method inspired by Wineman & Pipkin (Acta Mechanica, vol. 2, 1966, pp. 104–115) and Tanner (Trans. Soc. Rheol., vol. 14, 1970, pp. 483–507), which relies on the examination of the shape of the suspension free surface in a tilted trough flow. The second normal-stress difference is found to be negative and linear in shear stress. The ratio of the second normal-stress difference to shear stress increases with increasing volume fraction. A clear behavioural change exhibiting a strong (approximately linear) growth in the magnitude of this ratio with volume fraction is seen above a volume fraction of 0.22. By comparing our results with previous data obtained for the same batch of spheres by Boyer, Pouliquen & Guazzeli (J. Fluid Mech., 2011, doi:10.1017/jfm.2011.272), the ratio of the first normal-stress difference to the shear stress is estimated and its magnitude is found to be very small.
Since 1987, the number of cases of salmonellosis caused by Salmonella enteritidis has considerably increased in Western Europe. Comparison of endemic animal strains isolated in Belgium from 1976–84 with strains isolated from 1987 on shows that the strains which cause the current epidemic have no features distinguishing them from the previously–isolated strains and that furthermore, they do not constitute a bacterial clone. They belong to 13 different lysotypes and in most cases remain sensitive to antibiotics. Nevertheless, the lysotype 33 which belongs to the phage type 4  has increased significatively. It encompasses 37 % of the animal strains isolated in Belgium from 1987–9, but only 7% of the strains isolated from 1976–84.
It is worth noting that the endemic as well as the epidemic strains contain a virulence plasmid sharing sequence similarities with the FIB and FIIA plasmid replicons and with the VirA and VirB virulence regions of the S. typhimurium virulent plasmid: pIP1350.
Escherichia coli and salmonella strains with plasmids conferring resistance to gentamicin and apramycin have been isolated with increasing frequency both from cattle and hospital patients in Belgium. The apramycin-gentamicin resistance plasmids were characterized in recipient strains by their profiles and molecular weights using agarose gel electrophoresis, by their antimicrobial resistance patterns and by replicon typing using a series of DNA probes specific for the genes controlling their systems of replication. Overall, most of the plasmids differed in their DNA electrophoretic patterns. Seventeen different antimicrobial resistance profiles were observed, and there were six different types of replicons. However, two replication genes predominated and had a preferential distribution in different bacterial species. The rep FIC.a plus rep Q multireplicon was found mainly in plasmids recovered from gentamicin- and apramycin-resistant E. coli while replicon of the type rep FIC.b largely prevailed in S. typhimurium. Identical replication genes were found in most animal and human strains, hence suggesting a high homology between apramycin- gentamicin plasmids in these communities. Finally, our results indicate that the rapid spread of apramycin-gentamicin-resistance in several species of Enterobacteriaceae isolated from animals and from humans in Belgium is not due to a single plasmid, but rather that the gene encoding AAC(3)-IV is carried by various replicons.
An integrated model developed by ArcelorMittal and
NSC to predict the microstructural evolution of austenite in
conventional and microalloyed HSLA steels during multi-pass
hot rolling is described. The prediction of austenite grain size,
recrystallized fraction, residual strain and precipitation state
are given. Applications of this model during mono-deformation
tests and during multi-pass rolling are presented.
The plant. The aguaje (Mauritia flexuosa L.f.) is an Amazonian palm in the process of domestication to be cultivated as a dwarf form. In Peruvian Amazonia, it has a major impact on the economic, social and ecological systems. Fruit are sold and take part in the economy of Peruvian Amazonia. The insects. In this survey, the authors present 18 species of insect pests observed in eight different localities in the surroundings of the city of Iquitos (Loreto, Peru) between 2000 and 2003. Among those species, four develop in the pulp of the fruit, two are borers of the rachillae, one is a borer of the trunk and the petioles of the young leaves, two species bore the rachillae and floral buds, one develops in buds of female flowers and another damages the base of the roots; eight of those species are considered as the most important pests: Eupalamides cyparissias Fab., Antiteuches kerzhneri Rider, Stenoma sp., Clinodiplosis sp., an unidentified species of Cecidomyiidae, Tyrannion sp. and two unidentified species of Curculionidae. Discussion. The cultivation of the dwarf aguaje is a good alternative to the cutting of the native palms to harvest the fruit, but the cultivated palms are damaged by insects. The planters must learn to know those pests to control them. The biology and the ecology of the new pests are currently being studied.
The plant. The aguaje (Mauritia flexuosa L. f.) is an Amazonian palm which grows naturally on flooded soils, forming dense gatherings called aguajales in Peru. It can reach a height of 35–40 m. Each tree has an average of 8 inflorescences per year and each inflorescence produces about 900 fruits. This palm is in the domestication process. A dwarf form, recently discovered, could permit the improvement of the methods of production. The fruit. The fruit is an ellipsoid oval-shaped drupe, covered by red or dark red-coloured cornea scales. It measures (5 to 7) cm long and (4 to 5) cm in diameter. The pulp has a high content of β-carotene (260 mg·100 g–1 of pulp). Marketing. Marketing is carried out for fruits coming from the natural environment. There is a local consumption of approximately 150 t·month–1 and it can be of raw or processed fruit. For this fruit’s demand, it is necessary to cut down approximately 24 000 palms a year. Discussion. The aguaje has big social and economical importance to these regions' inhabitants. It represents great potential for the national as well as the international market. The Research Institute of the Peruvian Amazon (IIAP) is devel-oping technologies for agronomical management of the species, and for production and proc-essing of the fruit. Studies on aguaje growth and genetic diversity in the natural conditions also have to be carried out.
This chapter first reviews different models of family therapy for eating disorders, then reviews and synthesizes the evidence from uncontrolled trials and randomized controlled trials. The goal of structural family therapy is to alter the overall structural organization of the family through limiting pathological patterns of family interaction, by challenging alliances between parents and children that limit parental effectiveness, by encouraging development of stronger sibling subsystems and by encouraging more open communication. As involvement of family members appears to be important when treating adolescents with bulimia nervosa (BN), cognitive-behavioural therapy (CBT) for BN has recently been modified for this age group. Intervention for eating disorders involving several families at the same time is a relatively new approach that has most commonly been seen in the psychiatric literature in the area of schizophrenia. The importance of families in treatments for adolescent eating disorders must be underscored.