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L’impulsivité, souvent décrite comme élevée chez les patients alcoolo-dépendants (AD), est un concept complexe qui jouerait un rôle important dans le développement de l’AD [1] et augmenterait les risques de rechutes [2]. L’impulsivité est considérée, selon les auteurs, comme un facteur de vulnérabilité psychopathologique ou comme une conséquence de l’AD [3] potentiellement en lien avec l’altération fréquemment observée des fonctions exécutives. Les liens spécifiques entre impulsivité et anomalies cérébrales chez les sujets AD n’ont que très peu été étudiés à l’heure actuelle [4]. Cette étude a pour objectif d’étudier les liens entre impulsivité et fonctions exécutives dans l’alcoolo-dépendance.
Méthodes
Cinquante-sept patients AD sans complications neurologiques et 44 volontaires sains (VS), appariés en âge, sexe et années de scolarité, ont bénéficié d’une batterie de tests évaluant les fonctions exécutives. L’impulsivité a été mesurée par une échelle d’auto-évaluation (Barratt Impulsiveness Scale). Parmi ces 101 sujets, 21 AD et 15 VS ont bénéficié d’une IRM cérébrale 3 T.
Résultats
Les AD déclaraient une impulsivité plus importante que les VS, et présentaient une altération de leurs fonctions exécutives. Seule l’inhibition était associée à l’impulsivité lorsque les deux groupes étaient examinés ensemble. Les AD présentaient une atrophie cortico-sous-corticale et des corrélations négatives entre impulsivité et volume de substance grise ont été retrouvées dans les régions frontales, préfrontales, et insulaires.
Conclusion
Nos données suggèrent que l’impulsivité serait en partie liée à l’inhibition. Chez les AD, l’impulsivité serait donc à la fois prémorbide et en lien avec l’altération des processus d’inhibition due à la consommation chronique d’alcool. Les atteintes cérébrales des AD pourraient être à l’origine de difficulté à s’autoévaluer et d’une atteinte de la métacognition.
Les déficits neuropsychologiques consécutifs à l’alcoolo-dépendance affectent principalement la mémoire épisodique, la mémoire de travail et les capacités visuospatiales, ainsi que les fonctions exécutives et motrices [1,2]. Ces déficits présents notamment en début de sevrage peuvent conduire à un bénéfice limité des ateliers psychothérapeutiques et entraver le maintien de l’abstinence des patients alcoolo-dépendants [3,4]. Ainsi, une évaluation neuropsychologique étendue conduite après sevrage semble essentielle afin d’orienter la prise en charge clinique de ces patients. Cependant, peu de services d’addictologie ont les ressources humaines et financières pour conduire une telle évaluation chez chaque patient. L’objectif de cette étude était donc d’examiner la validité et les qualités psychométriques d’un outil de dépistage : le BEARNI (pour Brief Examination of Alcohol-Related Neuropsychological Impairments). Cet outil a été spécialement développé pour être accessible au personnel soignant non psychologue dans l’objectif de conduire un dépistage rapide des déficits neuropsychologiques consécutifs à l’alcoolo-dépendance. Une batterie neuropsychologique étendue a servi de référence (gold standard) pour déterminer le profil cognitif des patients alcoolo-dépendants et examiner les qualités psychométriques du BEARNI. L’analyse factorielle exploratoire a permis de valider la structure interne de BEARNI en mettant en évidence 5 facteurs expliquant 60 % de la variabilité et reflétant les capacités visuospatiales, les fonctions exécutives, la mémoire verbale et la mémoire de travail verbale. La standardisation de chacun des sub-tests et des scores totaux à BEARNI, conduite par l’intermédiaire de courbes ROC, a mis en évidence que cet outil de dépistage présente une bonne efficacité diagnostique dans le dépistage des atteintes cognitives et motrices présentes chez les patients alcoolo-dépendants après sevrage. Cette étude montre la pertinence de l’utilisation de BEARNI en pratique clinique pour détecter la présence de troubles neuropsychologiques chez les patients alcoolo-dépendants et permettre d’orienter ceux ayant besoin d’une évaluation neuropsychologique étendue.
This paper discusses results from the second phase of the European Ice Sheet Modelling Initiative (EISMINT). It reports the intercomparison of ten operational ice-sheet models and uses a series of experiments to examine the implications of thermomechanical coupling for model behaviour. A schematic, circular ice sheet is used in the work which investigates both steady states and the response to stepped changes in climate. The major finding is that the radial symmetry implied in the experimental design can, under certain circumstances, break down with the formation of distinct, regularly spaced spokes of cold ice which extended from the interior of the ice sheet outward to the surrounding zone of basal melt. These features also manifest themselves in the thickness and velocity distributions predicted by the models. They appear to be a common feature to all of the models which took part in the intercomparison, and may stem from interactions between ice temperature, flow and surface form. The exact nature of these features varies between models, and their existence appears to be controlled by the overall thermal regime of the ice sheet. A second result is that there is considerable agreement between the models in their predictions of global-scale response to imposed climate change.
A standard numerical experiment featuring the Ross Ice Shelf, Antarctica, is presented as a test package for the development and intercomparison of ice-shelf models. The emphasis of this package is solution of stress-equilibrium equations for an ice-shelf velocity consistent with present observations. As a demonstration, we compare five independently developed ice-shelf models based on finite-difference and finite-element methods. Our results suggest that there is little difference between finite-element and finite-difference methods in capturing the basic, large-scale flow features of the ice shelf. We additionally show that the fit between model and observed velocity depends strongly on the ice-shelf temperature field, for which there is presently little observational control. The main differences between model results are due to the equations being solved, the boundary conditions at the ice from and the discretization method (finite element vs finite difference).
For the first time high-quality coverage of the ERS-1 radar altimeter provides a very accurate surface topographic map covering 80% of the Antarctic ice sheet that can contribute significantly to glaciological studies such as ice-sheet flow modelling. The topography allows estimation of the ice-flow direction, the balance velocity and the basal shear stress. A relationship between shear stress, basal temperature and a parameter related to strain rate helps in mapping the behaviour anomalies of these parameters. Longitudinal stress, sliding, bedrock topography and variation in the pre-exponential factor of the flow law are found to play a major role in the ice-flow pattern. This relation can also be used to estimate rheological parameters: the Glen exponent n is found to be 1 for T < −10°C and 3–4 for higher temperatures, where Q is found to be 70 kJ mol−1.
The number of studies on electronic self-monitoring in affective disorder and other psychiatric disorders is increasing and indicates high patient acceptance and adherence. Nevertheless, the effect of electronic self-monitoring in patients with bipolar disorder has never been investigated in a randomized controlled trial (RCT). The objective of this trial was to investigate in a RCT whether the use of daily electronic self-monitoring using smartphones reduces depressive and manic symptoms in patients with bipolar disorder.
Method
A total of 78 patients with bipolar disorder according to ICD-10 criteria, aged 18–60 years, and with 17-item Hamilton Depression Rating Scale (HAMD-17) and Young Mania Rating Scale (YMRS) scores ≤17 were randomized to the use of a smartphone for daily self-monitoring including a clinical feedback loop (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for 6 months. The primary outcomes were differences in depressive and manic symptoms measured using HAMD-17 and YMRS, respectively, between the intervention and control groups.
Results
Intention-to-treat analyses using linear mixed models showed no significant effects of daily self-monitoring using smartphones on depressive as well as manic symptoms. There was a tendency towards more sustained depressive symptoms in the intervention group (B = 2.02, 95% confidence interval −0.13 to 4.17, p = 0.066). Sub-group analysis among patients without mixed symptoms and patients with presence of depressive and manic symptoms showed significantly more depressive symptoms and fewer manic symptoms during the trial period in the intervention group.
Conclusions
These results highlight that electronic self-monitoring, although intuitive and appealing, needs critical consideration and further clarification before it is implemented as a clinical tool.
Antarctic krill, Euphausia superba, normally live in social aggregations (schools) but rarely aggregate in laboratory tanks. In order to study the effect of stress on solitary living we tethered krill to wooden skewers and measured heart rate both when they were held isolated from conspecifics and when they were held at normal schooling distances (∼1 body length). Heart rate did not differ significantly with sex or body size. However, intermoult krill had a significantly lower heart rate than postmoult animals. When two individuals were held at schooling distance, with one slightly higher in the water column than the other, the heart rate of the higher individual slowed significantly (106–98 beats min−1), while that of the lower individual remained the same. We interpret these results to mean that krill living solitarily are stressed but will respond to neighbouring individuals by decreasing their metabolic rate and saving energy.
The prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having Clostridium difficile infection. Stools submitted for C difficile cytotoxin testing were screened for vancomycin-resistant enterococci (VRE). Isolates were speciated and characterized further by antibiotic susceptibility testing, DNA fingerprinting, and DNA:DNA hybridization for detection of specific vancomycin resistance genes. Of the 79 evaluable patients identified during a 3-month period, 16.5% were VRE-positive. The VRE isolates were genetically heterogeneous, although all carried the vanA gene. DNA fingerprinting data suggest that patient-to-patient transmission occurred, implicating colonized patients as potential reser voirs for VRE transmission. A positive C difficile cytotoxin assay and diabetes mellitus were the only identifiable risk factors associated with VRE colonization. Patients at risk for C difficile infection therefore may serve as reser voirs for VRE.
Controlling the size and distribution of silicon precipitates in aluminum alloy depositions is important for yield enhancement and reliability of small geometry metal interconnects. A non-contact and non-destructive thermal wave imaging technique is used to detect and evaluate size and density of silicon precipitates in AISi and AlSiCu alloys. The thermal wave results are corroborated with SEM and Auger data.
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