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People suffering from schizophrenia cannot easily access employment in European countries. Different types of vocational programs coexist in France: supported employment, sheltered employment (ShE), and hybrid vocational programs. It is now acknowledged that the frequent cognitive impairments constitute a major obstacle to employment for people with schizophrenia. However, cognitive remediation (CR) is an evidence-based nonpharmacological treatment for these neurocognitive deficits.
RemedRehab was a multicentric randomized comparative open trial in parallel groups conducted in eight centers in France between 2013 and 2018. Participants were recruited into ShE firms before their insertion in employment (preparation phase). They were randomly assigned to cognitive training Cognitive Remediation for Schizophrenia (RECOS) or Treatment As Usual (TAU). The aim of the study was to compare with the benefits of the RECOS program on access to employment and work attendance for people with schizophrenia, measured by the ratio: number of hours worked on number of hours stipulated in the contract.
Seventy-nine patients were included in the study between October 2018 and September 2019. Fifty-three patients completed the study. Hours worked / planned hours equal to 1 or greater than 1 were significantly higher in the RECOS group than in the TAU group.
Participants benefited from a RECOS individualized CR program allows a better rate of work attendance in ShE, compared to the ones benefited from TAU. Traditional vocational rehabilitation enhanced with individualized CR in a population of patients with schizophrenia is efficient on work attendance during the first months of work integration.
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.
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.
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.
Self-similar solutions to the compressible Euler equations with nonlinear conduction are considered as particular instances of unsteady radiative deflagration – or ‘ablation’ – waves with the goal of characterizing the actual hydrodynamic properties that such flows may present. The chosen family of solutions, corresponding to the ablation of an initially quiescent perfectly cold and homogeneous semi-infinite slab of inviscid compressible gas under the action of increasing external pressures and radiation fluxes, is well suited to the description of the early ablation of a target by gas-filled cavity X-rays in experiments of high energy density physics. These solutions are presently computed by means of a highly accurate numerical method for the radiative conduction model of a fully ionized plasma under the approximation of a non-isothermal leading shock wave. The resulting set of solutions is unique for its high fidelity description of the flows down to their finest scales and its extensive exploration of external pressure and radiative flux ranges. Two different dimensionless formulations of the equations of motion are put forth, yielding two classifications of these solutions which are used for carrying out a quantitative hydrodynamic analysis of the corresponding flows. Based on the main flow characteristic lengths and on standard characteristic numbers (Mach, Péclet, stratification and Froude numbers), this analysis points out the compressibility and inhomogeneity of the present ablative waves. This compressibility is further analysed to be too high, whether in terms of flow speed or stratification, for the low Mach number approximation, often used in hydrodynamic stability analyses of ablation fronts in inertial confinement fusion (ICF), to be relevant for describing these waves, and more specifically those with fast expansions which are of interest in ICF. Temperature stratification is also shown to induce, through the nonlinear conductivity, supersonic upstream propagation of heat-flux waves, besides a modified propagation of quasi-isothermal acoustic waves, in the flow conduction regions. This description significantly departs from the commonly admitted depiction of a quasi-isothermal conduction region where wave propagation is exclusively ascribed to isothermal acoustics and temperature fluctuations are only diffused.
Evidence-based data on prevalence and risk factors of suicidal intentions and behavior in dementia are as scarce as the data on assisted dying. The present literature review aimed on summarizing the current knowledge and provides a critical discussion of the results.
A systematic narrative literature review was performed using Medline, Cochrane Library, EMBASE, PSYNDEX, PSYCINFO, Sowiport, and Social Sciences Citation Index literature.
Dementia as a whole does not appear to be a risk factor for suicide completion. Nonetheless some subgroups of patients with dementia apparently have an increased risk for suicidal behavior, such as patients with psychiatric comorbidities (particularly depression) and of younger age. Furthermore, a recent diagnosis of dementia, semantic dementia, and previous suicide attempts most probably elevate the risk for suicidal intentions and behavior. The impact of other potential risk factors, such as patient's cognitive impairment profile, behavioral disturbances, social isolation, or a biomarker based presymptomatic diagnosis has not yet been investigated. Assisted dying in dementia is rare but numbers seem to increase in regions where it is legally permitted.
Most studies that had investigated the prevalence and risk factors for suicide in dementia had significant methodological limitations. Large prospective studies need to be conducted in order to evaluate risk factors for suicide and assisted suicide in patients with dementia and persons with very early or presymptomatic diagnoses of dementia. In clinical practice, known risk factors for suicide should be assessed in a standardized way so that appropriate action can be taken when necessary.
Fracture systems of Rotliegend gas fields in and at the margins of the northern Broad Fourteens Basin in the Dutch offshore are described in terms of orientation, frequency, origin and type, and in relation to larger-scale structures. First, fracture data collected from core and image logs have been corrected to account for the bias related to the 1-D sampling. Second, these results were integrated with data on fracture cements and diagenesis in order to assess the timing of the fracture network development.
On the basis of their regional extent three phases of fracturing and four orientation trends can be distinguished in the basin:
(1) at Triassic times and related to early diagenesis and burial, NW-SE to NNW-SSE and NE-SW to ESE-WNW particulate-shear fractures developed;
(2) during the Mid-Kimmerian and related to the main burial stage, shear-related and dilational-shear-fault-related fracturing occurred parallel with larger-scale faults;
(3) during the Cretaceous and related to uplift, NW-SE and NE-SW joints propagated; a regional joint system developed outside the Jurassic rift basin, preferentially oriented E-W to ESE-WNW; these joints have not been dated accurately.
The fault-related shear fractures tend to compartmentalise the reservoirs, whereas the regional joints tend to enhance reservoir flow properties. These fracture systems are thought to play a negative or positive role, respectively, but only in fields with poor reservoir quality. Consequently, in such cases small-scale fractures should be taken into account in field development planning.
Positron emission tomography (PET) imaging of brain amyloid beta is now
clinically available in several countries including the United States and
the United Kingdom, but not Canada. It has become an established technique
in the field of neuroimaging of aging and dementia, with data incorporated
in the new consensus guidelines for the diagnosis of Alzheimer disease and
predementia Alzheimer’s disease–related conditions. At this point, there are
three US Food and Drug Administration– and European Union–approved tracers.
Guided by appropriate use criteria developed in 2013 by the Alzheimer’s
Association and the Society of Nuclear Medicine and Molecular Imaging, the
utility of amyloid imaging in medical practice is now supported by a growing
body of research. In this paper, we aimed to provide an update on the 2012
Canadian consensus guidelines to dementia care practitioners on proper use
of amyloid imaging. We also wished to generate momentum for the industry to
submit a new drug proposal to Health Canada. A group of local, national, and
international dementia experts and imaging specialists met to discuss
scenarios in which amyloid PET could be used appropriately. Peer-reviewed
and published literature between January 2004 and May 2015 was searched.
Technical and regulatory considerations pertaining to Canada were
considered. The results of a survey of current practices in Canadian
dementia centers were considered. A set of specific clinical and research
guidelines was agreed on that defines the types of patients and clinical
circumstances in which amyloid PET could be used in Canada. Future research
directions were also outlined, notably the importance of studies that would
assess the pharmaco-economics of amyloid imaging.
Pathogenic invasion by Escherichia coli and Salmonellae remains a constant threat to the integrity of the intestinal epithelium and can rapidly induce inflammatory responses. At birth, colostrum consumption exerts numerous beneficial effects on the properties of intestinal epithelial cells and protects the gastrointestinal tract of newborns from pathogenic invasion. The present study aimed to investigate the effect of colostrum on the early and late inflammatory responses induced by pathogens. The short-term (2 h) and long-term (24 h) effects of exposure to heat-killed (HK) E. coli and Salmonella enterica Typhimurium on gene expression in the porcine intestinal epithelial cell (IPEC-J2) model were first evaluated by microarray and quantitative PCR analyses. Luciferase assays were performed using a NF-κB-luc reporter construct to investigate the effect of colostrum whey treatment on the activation of NF-κB induced by HK bacteria. Luciferase assays were also performed using NF-κB-luc, IL-8-luc and IL-6-luc reporter constructs in human colon adenocarcinoma Caco-2/15 cells exposed to dose–response stimulations with HK bacteria and colostrum whey. Bovine colostrum whey treatment decreased the expression of early and late inflammatory genes induced by HK bacteria in IPEC-J2, as well as the transcriptional activation of NF-κB-luc induced by HK bacteria. Unlike that with colostrum whey, treatment with other milk fractions failed to decrease the activation of NF-κB-luc induced by HK bacteria. Lastly, the reduction of the HK bacteria-induced activation of NF-κB-luc, IL-8-luc and IL-6-luc by colostrum whey was dose dependent. The results of the present study indicate that bovine colostrum may protect and preserve the integrity of the intestinal mucosal barrier in the host by controlling the expression levels of early and late inflammatory genes following invasion by enteric pathogens.
Bovine colostrum is well known for its beneficial properties on health and development. It contains a wide variety of bioactive ingredients that are known to promote a number of cellular processes. Therefore the use of colostrum whey as a feed additive to promote intestinal health has been proposed, yet little is known about mechanisms implicated in its beneficial properties on intestinal epithelial cells. In the present paper, casein were removed from bovine colostrum and the remaining liquid, rich in bioactive compounds, was evaluated for its capacity to modulate cellular processes in porcine intestinal epithelial cell line IPEC-J2 and human colon adenocarcinoma cell line Caco-2/15. First, we verified the effect of colostrum whey and cheese whey on processes involved in intestinal wound healing, including cell proliferation, attachment, morphology and migration. Our results showed that colostrum whey promoted proliferation and migration, and decreased specifically the attachment of Caco-2/15 cells on the culture dish. On the other hand, cheese whey induced proliferation and morphological changes in IPEC-J2 cells, but failed to induce migration. The gene expression profile of IPEC-J2 cells following colostrum whey treatment was evaluated by microarray analysis. Results revealed that the expression of a significant number of genes involved in cell migration, adhesion and proliferation was indeed affected in colostrum whey-treated cells. In conclusion, colostrum specific bioactive content could be beneficial for intestinal epithelial cell homoeostasis by controlling biological processes implicated in wound healing through a precise gene expression programme.
The role of self generated magnetic fields in the transport of a heat wave following a nanosecond laser irradiation of a solid target is investigated. Magnetic fields are expected to localize the electron carrying the heat flux but at the same time are affected in their evolution by the heat flux itself. We performed simultaneous measurements of heat wave propagation velocity within the target and magnetic fields developing on the target surface. These were compared to results obtained by numerical magneto-hydrodynamic modeling, including self-generated B fields. The comparison shows that longitudinal heat flow is overestimated in the simulations. Similarly, but most notably, the radial expansion of the magnetic fields is underestimated by the modeling. The two are likely linked, the more pronounced radial drift of B-fields induces a rotation of heat flux in the radial direction, and corresponding longitudinal heat flux inhibition. This suggests the need for improving present modeling of self-generated magnetic fields evolution in high power laser-matter interaction.
The role of heterotrophic biofilm of water–sediment interface in detoxification processes was tested in abiotic and biotic conditions under laboratory conditions. Three toxicants, a herbicide (Diuron), a fungicide (Dimethomorph) and an insecticide (Chlorpyrifos-ethyl) have been tested in water percolating into columns reproducing hyporheic sediment. The detoxification processes were tested by comparing the water quality after 18 days of percolation with and without heterotrophic biofilm. Tested concentrations were 30 μg.L−1 of Diuron diluted in 0.1% dimethyl sulfoxide (DMSO), 2 μg.L−1 of Dimethomorph and 0.1 μg.L−1 of Chlorpyrifos-ethyl. To characterise the detoxification efficiency of the system, we performed genotoxicity bioassays in amphibian larvae and rotifers and measured the respiration and denitrification of sediments. Although the presence of biofilm increased the production of N-(3,4 dichlorophenyl)-N-(methyl)-urea, a metabolite of diuron, the toxicity did not decrease irrespective of the bioassay. In the presence of biofilm, Dimethomorph concentrations decreased compared with abiotic conditions, from 2 μg.L−1 to 0.4 μg.L−1 after 18 days of percolation. For both Dimethomorph and Chlorpyrifos-ethyl additions, assessment of detoxification level by the biofilm depended on the test used: detoxification effect was found with amphibian larvae bioassay and no detoxification was observed with the rotifer test. Heterotrophic biofilm exerts a major influence in the biochemical transformation of contaminants such as pesticides, suggesting that the interface between running water and sediment plays a role in self-purification of stream reaches.
Combining Bisphophonates (BPs) and Calcium Phosphate Cement (CPC) to form a new medical device for the local treatment of Osteoporosis is a promising challenge. Our formulation was optimized from an apatitic-type CPC and we have shown that the best solution consists in introducing the bisphosphonate (Alendronate) in the calcium deficient apatite (CDA), a solid component of the cement, through a chemical exchange reaction. The cement obtained was characterized by 31P NMR and high frequency impedance for monitoring the CPC setting. The presence of Alendronate in the cement was also demonstrated by 31P NMR which has been also used to characterize the chemical transformation of α-TCP (main component of the apatitic cement) during the setting process. BP absorption/desorption experiments have been realized on cement blocks, under continuous flow condition, to model the release profile of the Alendronate. In vivo experiments showed promising results in terms of resorbability of the Alendronate–loaded cement while promoting new bone formation. The same methodology is considered to introduce gallium, a potential inhibitor of osteoclastic resorption, in a CPC formulation. First experiments have shown that gallium can be incorporated in calcium phosphate ceramics (i.e. β-TCP) where gallium is part of the network.