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In 2017, The French National Authority for Health (HAS) created an open, online, systematic contribution process to enable patient and consumer groups (PCGs) to contribute to health technology assessment (HTA) carried out to aid public authorities in reimbursement and pricing decision making.
This retrospective study analyzes how French PCGs contributed to the HTA process within the HAS for the first 2 years of this new mechanism.
PCG contributions received between 01 January 2017 and 31 December 2018 and the recording of deliberations leading to reports of the corresponding HTAs were included. Analysis grids were designed by the investigators with 5 rounds of refinement tests on 10 random PCG contributions and the reports. Systematic data extraction was then performed separately by two investigators. PCG answers to the open-question templates and the related final HTA report published by the HAS were analyzed.
Seventy-nine contributions from 44 PCGs were received and analyzed by the HAS for 78 out of the 592 HTAs performed for drugs or medical devices during the 2-year period. Twenty-five percent of the HTAs performed for drugs received at least one contribution. The contributions covered quality-of-life aspects, access to care, and personal and family impact. Membership and budget of the contributing PCGs varied greatly.
The experience gained in the first 2 years demonstrates the feasibility of the process and the fact that PCG contribution actually provides relevant input on the patient perspective for HTAs used for reimbursement decisions. The challenges identified on the side of PCGs were time constraints and human resources.
The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.
We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.
Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.
The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.
The modern antiquities market uses radiocarbon (14C) dating to screen for forged objects. Although this fact shows the potential and power of the method, the circumstances where it is applied can be questionable and call for our attention. Here we present an outline of a call to radiocarbon laboratories for due diligence and best practice approaches to the analysis of antique objects requested by non-research clients.
To date, there has been no published textbook which takes into account changing sociolinguistic dynamics that have influenced South African society. Multilingualism and Intercultural Communication breaks new ground in this arena. The scope of this book ranges from macro-sociolinguistic questions pertaining to language policies and their implementation (or non-implementation) to micro-sociolinguistic observations of actual language-use in verbal interaction, mainly in multilingual contexts of Higher Education (HE). There is a gradual move for the study of language and culture to be taught in the context of (professional) disciplines in which they would be used, for example, Journalism and African languages, Education and African languages, etc. The book caters for this growing market. Because of its multilingual nature, it caters to English and Afrikaans language speakers, as well as the Sotho and Nguni language groups – the largest languages in South Africa [and also increasingly used in the context of South African Higher Education]. It brings together various inter-linked disciplines such as Sociolinguistics and Applied Language Studies, Media Studies and Journalism, History and Education, Social and Natural Sciences, Law, Human Language Technology, Music, Intercultural Communication and Literary Studies. The unique cross-cutting disciplinary features of the book will make it a must-have for twenty-first century South African students and scholars and those interested in applied language issues.
The exponential modality of linear logic associates to every formula A a commutative comonoid !A which can be duplicated in the course of reasoning. Here, we explain how to compute the free commutative comonoid !A as a sequential limit of equalizers in any symmetric monoidal category where this sequential limit exists and commutes with the tensor product. We apply this general recipe to a series of models of linear logic, typically based on coherence spaces, Conway games and finiteness spaces. This algebraic description unifies for the first time a number of apparently different constructions of the exponential modality in spaces and games. It also sheds light on the duplication policy of linear logic, and its interaction with classical duality and double negation completion.
Composite magnetoelectrics implemented as thin film heterostructures are discussed in view of their applicability as highly sensitive magnetic field sensors. Here, either PZT or AlN served as piezoelectric component. The magnetostrictive phase consisted of layer systems based on FeCo or (Fe90Co10)78Si12B10. All functional layers were deposited with thicknesses of a few micrometers on Si cantilever structures with typical lateral dimensions of 25 mm by 2.2 mm. Magnetoelectric coefficients as large as 6900 V/cm Oe and a limit of detection as low as 1 pT/(Hz)1/2 were measured. Currently, the best result demonstrates a detection limit of 500 fT/(Hz)1/2 at 958 Hz frequency using a set of two sensors for external noise suppression. A frequency conversion technique is proposed to broaden the applicability of resonant magnetoelectric sensors to a wider frequency range. Finally, the achieved sensor performance is evaluated with regard to typical magnetic field amplitudes in medical applications.
Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward.
A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later.
Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items.
ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.