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Healthcare organizations should assess the relevance of both existing and new practices. Involving patients in decisions regarding which health technologies and interventions should be prioritized could favor a better fit between strategic choices and patients needs.
Following a systematic review of existing multi-criteria decision support tools and a consultation with hospital clinicians and managers, a set of potentially relevant criteria was identified. A three-round modified Delphi study was then conducted among four groups (hospital managers, heads of department, clinicians, and patient representatives) in order to reach consensus on criteria that should be considered in the tool.
In total, seventy-four participants completed the third round of the Delphi study. Consensus was obtained on twelve criteria. There were some significant differences between groups in priority scores given to criteria. Patient representatives differed significantly from other groups on two criteria. Their ranking of the accessibility criteria was higher, and their ranking of the organizational aspect criteria was lower than for the other groups.
Patient representatives can be involved in the development of a multi-criteria decision support tool to identify, evaluate and prioritize high value-added health technologies and interventions in order to enhancing clinical appropriateness The fact that accessibility aspects were more important for patient representatives calls for specific attention to these criteria when prioritizing health technologies or interventions. Furthermore, we need to ensure that the decisions made regarding the relevance of these technologies and interventions also reflect patients’ preferences.
Semantic deficits have been documented in the prodromal phase of Alzheimer's disease, but it is unclear whether these deficits are associated with non-cognitive manifestations. For instance, recent evidence indicates that cognitive deficits in elders with amnestic mild cognitive impairment (aMCI) are modulated by concomitant depressive symptoms. The purposes of this study were to (i) investigate if semantic memory impairment in aMCI is modulated according to the presence (aMCI-D group) or absence (aMCI group) of depressive symptoms, and (ii) compare semantic memory performance of aMCI and aMCI-D groups to that of patients with late-life depression (LLD). Seventeen aMCI, 16 aMCI-D, 15 LLD, and 26 healthy control participants were administered a semantic questionnaire assessing famous person knowledge. Results showed that performance of aMCI-D patients was impaired compared to the control and LLD groups. However, in the aMCI group performance was comparable to that of all other groups. Overall, these findings suggest that semantic deficits in aMCI are somewhat associated with the presence of concomitant depressive symptoms. However, depression alone cannot account solely for the semantic deficits since LLD patients showed no semantic memory impairment in this study. Future studies should aim at clarifying the association between depression and semantic deficits in older adults meeting aMCI criteria. (JINS, 2011, 17, 865–874)
Background: The objectives of the study were to characterize and compare the cognitive profile and natural evolution of patients presenting late-onset psychotic symptoms (LOPS: onset ≥50 years old) to those of elderly patients (≥50 years old) with life-long/early-onset schizophrenia (EOS: onset <40 years old).
Methods: Neuropsychological profiles of 15 LOPS patients were compared to those of 17 elderly EOS patients and to those of two control groups (n = 11/group). The evolution of the two patient groups was compared using an independent diagnostic consensual procedure involving a geriatric psychiatry physician/clinician and a neuropsychologist blinded to the initial psychiatric diagnosis.
Results: EOS presented significant memory and executive impairments when compared to controls but there was no significant difference between LOPS and their controls when age and education were taken into account. However, a detailed inspection of normative data suggests more executive impairments in LOPS than in EOS. The clinical judgment of experts was in favour of significant cognitive deficits with or without dementia in most LOPS (82.3%–94.1%) and EOS (80.0%–93.3%) patients. Regarding evolution, mild cognitive impairment (MCI) and vascular cognitive impairment (VCI) were the most common clinical diagnoses made by geriatric psychiatry physicians/clinicians for the LOPS (40%). In addition, 20% of LOPS versus 5.9% of EOS patients met the diagnostic criteria for dementia by consensus of the experts. Cerebral abnormalities were confirmed (CT scan; SPECT) in 73.3% of LOPS patients.
Conclusion: The present results suggest cognitive deficits (mostly of executive functions) and vascular and neurodegenerative vulnerability in LOPS. Further studies with larger samples are needed to confirm the present findings.
This work aims at introducing modelling, theoretical and numerical studies related to a new downscaling technique applied to computational fluid dynamics.
Our method consists in building a local model, forced by large scale information computed thanks to a classical numerical weather predictor.
The local model, compatible with the Navier-Stokes equations, is used
for the small scale computation (downscaling) of the considered
fluid. It is
inspired by Pope's works on turbulence, and consists in a so-called Langevin system of stochastic differential equations. We introduce
this model and exhibit its links with classical RANS models. Well-posedness, as well as mean-field interacting particle approximations and boundary condition issues are addressed. We present the numerical discretization of the stochastic downscaling method and investigate the accuracy of the proposed algorithm on simplified situations.
This study compares the normative expectations of 1315 Québécois survey-takers about the responsibilities of spouses and ex-spouses, on the one hand, and adult children and stepchildren, on the other hand, regarding the support they are to offer an elderly family member with incapacities. The comments of survey-takers in relation to fictional yet concrete scenario descriptions provided a basis with which to identify respondents' expectations along with the social factors surrounding these expectations. The results of this survey suggest that the nature and scale of support-related expectations vary according to the family tie with elderly relative. Expectations toward spouses are high and unmitigated, whereas expectations toward ex-spouses and adult stepchildren appear to be limited. Expectations toward adult children are more pronounced than those exhibited toward stepchildren. Where offspring are specifically concerned, expectations are strongly influenced by the given context; for this category of survey-taker, the demands of support should not interfere with their family life and career.
The structural evolution of UO2 during its oxidation to U3O8 at 250°C in air was studied by in-situ synchrotron X-ray diffraction on the D2AM-CRG beamline at ESRF. The aim of this study is to determine the phases that are likely to appear during the long-term storage of spent nuclear fuel. Our results are in disagreement with the literature in which the existence of an intermediate cubic phase is not reported. Instead, an α-U3O7 tetragonal phase (c/a < 1) was mentioned but not definitively observed. These previous interpretations may have been the result of poor instrumental resolution.
The effects of the new cyclin-dependent kinase inhibitors, roscovitine and olomoucine, on oocytes and eggs of Xenopus laevis were investigated and compared with those of 6-dimethylamino purine (6-DMAP). The inhibitory properties of 6-DMAP, olomoucine and roscovitine towards p34cdc2-cyclin B isolated from Xenopus eggs revealed K-IC50 values of 300, 40 and 10 μM respectively. The three compounds inhibited progesterone-induced maturation with M-IC50 values of 200, 100 and 20 μM. These values were consistent with the K-IC50 values but the ratio M-IC50/K-IC50 was higher for roscovitine and olomoucine than for 6-DMAP. The disappearance of spindle and condensed chromosomes without pronucleus formation was observed when 1 mM 6-DMAP was applied for 4 h at germinal vesicle breakdown or at metaphase II, whereas no effect was observed using 1 mM olomoucine or 50 μM roscovitine. Changes in the electrophoretic mobility of p34cdc2 and erk2 were observed only in homogenates of matured oocytes or eggs exposed for 4 h to 1 mM 6-DMAP. When the drugs were microinjected into matured oocytes, olomoucine (100 μM) and roscovitine (50 μM) induced pronucleus formation more efficiently than did 6-DMAP (100 μM). Taken together, these results demonstrate that Xenopus oocytes possess a lower permeability to olomoucine and roscovitine and that these new compounds are suitable for in vivo studies after germinal vesicle breakdown provided they are microinjected.
We have recently shown that the incubation of Xenopus laevis oocytes in procaine-containing solutions induced germinal vesicle breakdown without white spot formation and, in some cases, with the appearance of spindle and chromosomes in the cytoplasm. The present study was performed to determine whether M-phase promoting factor was involved in this unusual maturation. Procaine failed to induce maturation in the presence of 6-dimethylamino purine or roscovitine, which are both known to inhibit p34cdc2kinase. Histone H1 kinase activity was detected in procaine-treated oocytes but it was always lower than in progesterone-treated controls. A shift in p34cdc2 was observed in oocytes that had been exposed to procaine for 16h, but it was not detected in those exposed for 24h. Finally, cytoplasm transfer experiments demonstrated that the maturation promoting activity that occurred in oocytes incubated in procaine for 16h could induce maturation of recipient stage VI oocytes. This transferable activity was weaker than that from progesterone-treated controls since only 30% of the recipients underwent germinal vesicle breakdown and only a few spindles were observed, which were not always correctly located. Taken together these results demonstrate that M-phase promoting factor is involved in the procaine maturing effect despite some differences compared with progesterone-treated oocytes which might explain the particular type of maturation induced by this substance. The discovery of the mechanisms by which procaine is able to activate M-phase promoting factor might now help in the understanding of some steps in progesterone-induced maturation that have still to be elucidated.
The hydrolysis of H2N(CH2)2NH(CH2)3Si(oMe)3 with a stoichiometric amount of water results in loss of the -OMe groups after two days and formation of a mixture of species mainly with empirical formula, [H2N(CH2)2NH(CH2)3Si(O)3]. The reaction of representative examples of metal salts, e.g. Cu(NO1.5)2, and metal-organic compounds, [(NBD)RhCl]2, with the amino-group of the amine functionalized polysiloxanes [H2N(CH2)2NH(CH2)3Si(O)1.5] has been demonstrated. These species undergo thermal decomposition in air, typically at 200°C, with complete loss of the organic supporting ligands. On heating to 450°C in O2, sintering occurs to form large, ∼1μm, sized silica particles which contain highly dispersed, ∼4nm sized metal-containing particles. The surface areas range from 228 to 583 m2/g. After reduction, the rhodium species is active towards catalytic hydrogenation of pyrene.
The reactions of metal oxides including CuO, ZnO, V2O5, and PbO with 1,1,1,5,5,5-hexaflouro- 2,4-pentanedione (hfacH) were investigated. A hot-wall reactor was used to react hfacH with metal oxide powders to form sufficient quantities of volatile reaction products for characterization by Infrared Spectroscopy (IR), Elemental Analysis (EA), Nuclear Magnetic Resonance (NMR), Mass Spectroscopy (MS), Thermogravimetric Analysis and Differential Thermal Analysis (DTA). PbO, ZnO and CuO powders reacted rapidly at 200 °C to form the corresponding metal β-diketonates and V2O5 reacted to give OV(hfac)2. A differential cold-wall reactor was to used to measure etch rates of CuOx films as a function of temperature and hfacH partial pressure. AES and XPS analysis of the laser ablation deposited CuOx film annealed in an O2 atmosphere revealed that the film was composed of CuO and Cu2O. Etch rates of up to a I l.βm/min at hfacH partial pressure of 1 Torr at 270 °C were obtained. Laser induced etching of the same CuOx film with hfacH showed evidence of copper oxide removal.
Three new methods for dry etching of copper at temperatures below 200°C have been developed. The first relies on the formation of volatile CICu(PR3)2 species via reaction of PR3 with CuCI where R = ethyl, and butyl. The second relies on the reaction of Cu(hfac)2 and neutral ligands L such as butyne, pentyne or bistrimethylsilylacetylene to form (hfac)CuL. The last approach involves reaction of CuO with hexafluoroacetylacetone (hfacH) to form Cu(hfac)2 and water. These approaches have provided etch rates as high as 1 μm/min at 150°C.
Cet écrit prend la relève de deux articles déjà parus dans New Testament Studies. Le premier est celui d'Albert Vanhoye, ‘Structure du Benedictus’. Le second est celui de Pierre Auffret, ‘Note sur la structure littéraire de Lc 1, 68–79’. Le deuxième est une critique systématique du premier et fait sûrement avancer la recherche sur plusieurs points. Le présent article est le résultat à la fois d'une analyse détaillée des deux articles en question et d'une analyse personnelle du texte même du cantique de Zacharie. Notre analyse fournira deux structures nouvelles qui s'ajouteront à celles d'A. Vanhoye et de P. Auffret. Trois de ces quatre structures se présenteront comme complémentaires en ce sens qu'elles orienteront vers un contenu de pensée de première importance.
A 22 year-old man died from multiple cerebral abscesses due to Petriellidium boydii 4 ½ months after an episode of near drowning. The autopsy showed dissemination to heart and kidney. This patient had no immunocompromising disease but was treated with corticosteroids. The treatment of this condition with ventricular shunting and amphotericin B is discussed and compared with the experience often other cases reported in the literature.
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