Delineating Dementia with Lewy Bodies: Can Magnetic Resonance Imaging Help?

As future treatments increasingly target the protein chemistry underlying the different dementias, itbecomes crucially important to distinguish between the dementias during life. Neither specific proteinnor genetic markers are as yet available in clinical practice. However, neuroimaging is an obviouscandidate technique that may yield enhanced diagnostic accuracy when applied to thedementias. The physiopathology and anatomopathology is complex in dementia with Lewy bodies(DLB). Besides the relative sparing of medial temporal lobe structures in DLB in comparison toAlzheimer's disease, no clear signature pattern of cerebral atrophy associated with DLB has beenestablished so far. Among others, one reason may be the difficulty in visualizing the small brainnuclei that are differentially involved among the dementias. While we think that structural magneticresonance imaging neuroimaging should be part of the diagnostic workup of most dementia syndromesdue to its usefulness in the differential diagnosis, its contribution to a positive diagnosis ofDLB is as yet limited. The development of different neuroimaging techniques may help distinguishreliably DLB from other neurodegenerative disorders. However, in order to become accepted as partof standard care, these techniques must still prove their effectiveness under routine conditions suchas those encountered by the general practitioner.

Analyse de la prise en charge médicale et de l'impact économique des patients ayant présentés des coûts extrêmes dans un hôpital universitaire [Analysis of the medical management and the economic impact of patients who have represented extreme costs at a university hospital]

Les coûts de traitement de certains patients s'avèrent extrêmement élevés, et peuvent faire soupçonner une prise en charge médicale inadéquate. Comme I'évolution du remboursement des prestations hospitalières passe à des forfaits par pathologie, il est essentiel de vérifier ce point, d'essayer de déterminer si ce type de patients peut être identifié à leur admission, et de s'assurer que leur devenir soit acceptable. Pour les années 1995 et 1997. les coûts de traitement dépassant de 6 déviations standard le coût moyen de la catégorie diagnostique APDRG ont été identifiés, et les dossiers des 50 patients dont les coûts variables étaient les plus élevés ont été analysés. Le nombre total de patients dont I'hospitalisation a entraîné des coûts extrêmes a passé de 391 en 1995 à 328 patients en 1997 (-16%). En ce qui concerne les 50 patients ayant entraîné les prises en charge les plus chères de manière absolue, les longs séjours dans de multiples services sont fréquents, mais 90% des patients sont sortis de l'hôpital en vie, et près de la moitié directement à domicile. Ils présentaient une variabilité importante de diagnostics et d'interventions, mais pas d'évidence de prise en charge inadéquate. En conclusion, les patients qualifiés de cas extrêmes sur un plan économique, ne le sont pas sur un plan strictement médical, et leur devenir est bon. Face à la pression qu'exercera le passage à un mode de financement par pathologie, les hôpitaux doivent mettre au point un système de revue interne de I'adéquation des prestations fournies basées sur des caractéristiques cliniques, s'ils veulent garantir des soins de qualité. et identifier les éventuelles prestations sous-optimales qu'ils pourraient être amenés à délivrer. [Auteurs] Treatment costs for some patients are extremely high and might let think that medical care could have been inadequate. As hospital financing systems move towards reimbursement by diagnostic groups, it is essential to assess whether inadequate care is provided, to try to identify these patients upon admission, and make sure that their outcome is good. For the years 1995 and 1997, treatment costs exceeding by 6 standard deviations the average cost of their APDRG category were identified, and the charts of the 50 patients with the highest variable costs were analyzed. The total number of patients with such extreme costs diminished from 391 in 1995 to 328 in 1997 (-16%). For the 50 most expensive patients, long stays in several services were frequent, but 90% of these patients left the hospital alive, and about half directly to their home. They presented an important variation in diagnoses and operations, but no evidence for inadequate care. Thus, patients qualified as extreme from an economic perspective cannot be qualified as such from a medical perspective, and their outcome is good. To face the pressure linked with the change in financing system, hospitals must develop an internal review system for assessing the adequacy of care, based on clinical characteristics, if they want to guarantee good quality of care and identify potentially inadequate practice.

Exposure models in Switzerland: an overview of the present situation

A survey was undertaken among Swiss occupational health and safety specialists in 2004 to identify uses, difficulties, and possible developments of exposure models. Occupational hygienists (121), occupational physicians (169), and safety specialists (95) were surveyed with an in depth questionnaire. Results obtained indicate that models are not used very much in practice in Switzerland and are reserved to research groups focusing on specific topics. However, various determinants of exposure are often considered important by professionals (emission rate, work activity), and in some cases recorded and used (room parameters, operator activity). These parameters cannot be directly included in present models. Nevertheless, more than half of the occupational hygienists think that it is important to develop quantitative exposure models. Looking at research institutions, there is, however, a big interest in the use of models to solve problems which are difficult to address with direct measurements; i. e. retrospective exposure assessment for specific clinical cases and prospective evaluation for new situations or estimation of the effect of selected parameters. In a recent study about cases of acutepulmonary toxicity following water proofing spray exposure, exposure models have been used to reconstruct exposure of a group of patients. Finally, in the context of exposure prediction, it is also important to report about a measurement database existing in Switzerland since 1991. [Authors]

Risk-based modelling of diffuse land use impacts from rural landscapes upon salmonid fry abundance

Research has demonstrated that landscape or watershed scale processes can influence instream aquatic ecosystems, in terms of the impacts of delivery of fine sediment, solutes and organic matter. Testing such impacts upon populations of organisms (i.e. at the catchment scale) has not proven straightforward and differences have emerged in the conclusions reached. This is: (1) partly because different studies have focused upon different scales of enquiry; but also (2) because the emphasis upon upstream land cover has rarely addressed the extent to which such land covers are hydrologically connected, and hence able to deliver diffuse pollution, to the drainage network However, there is a third issue. In order to develop suitable hydrological models, we need to conceptualise the process cascade. To do this, we need to know what matters to the organism being impacted by the hydrological system, such that we can identify which processes need to be modelled. Acquiring such knowledge is not easy, especially for organisms like fish that might occupy very different locations in the river over relatively short periods of time. However, and inevitably, hydrological modellers have started by building up piecemeal the aspects of the problem that we think matter to fish. Herein, we report two developments: (a) for the case of sediment associated diffuse pollution from agriculture, a risk-based modelling framework, SCIMAP, has been developed, which is distinct because it has an explicit focus upon hydrological connectivity; and (b) we use spatially distributed ecological data to infer the processes and the associated process parameters that matter to salmonid fry. We apply the model to spatially distributed salmon and fry data from the River Eden, Cumbria, England. The analysis shows, quite surprisingly, that arable land covers are relatively unimportant as drivers of fry abundance. What matters most is intensive pasture, a land cover that could be associated with a number of stressors on salmonid fry (e.g. pesticides, fine sediment) and which allows us to identify a series of risky field locations, where this land cover is readily connected to the river system by overland flow. (C) 2010 Elsevier B.V. All rights reserved.

The ghost of social environments past: dominance relationships include current interactions and experience carried over from previous groups.

Dominance hierarchies pervade animal societies. Within a static social environment, in which group size and composition are unchanged, an individual's hierarchy rank results from intrinsic (e.g. body size) and extrinsic (e.g. previous experiences) factors. Little is known, however, about how dominance relationships are formed and maintained when group size and composition are dynamic. Using a fusion-fission protocol, we fused groups of previously isolated shore crabs (Carcinus maenas) into larger groups, and then restored groups to their original size and composition. Pre-fusion hierarchies formed independently of individuals' sizes, and were maintained within a static group via winner/loser effects. Post-fusion hierarchies differed from pre-fusion ones; losing fights during fusion led to a decline in an individual's rank between pre- and post-fusion conditions, while spending time being aggressive during fusion led to an improvement in rank. In post-fusion tanks, larger individuals achieved better ranks than smaller individuals. In conclusion, dominance hierarchies in crabs represent a complex combination of intrinsic and extrinsic factors, in which experiences from previous groups can carry over to affect current competitive interactions.

Hyperfrontality and hypoconnectivity during refreshing in schizophrenia.

Anomalous activations of the prefrontal cortex (PFC) and posterior cerebral areas have been reported in previous studies of working memory in schizophrenia. Several interpretations have been reported: e.g., neural inefficiency, the use of different strategies and differences in the functional organization of the cerebral cortex. To better understand these abnormal activations, we investigated the cerebral bases of a working memory component process, namely refreshing (i.e., thinking briefly of a just-activated representation). Fifteen patients with schizophrenia and 15 control subjects participated in this functional magnetic resonance imaging (fMRI) study. Participants were told that whenever they saw a word on the screen, they had to read it silently to themselves (read and repeat conditions), and when they saw a dot, they had to think of the just-previous word (refresh condition). The refresh condition (in comparison with the read condition) was associated with significantly increased activation in the left inferior frontal gyrus and significantly decreased connectivity within the prefrontal cortex and between the prefrontal and parietal cortices in patients with schizophrenia in comparison with control subjects. These results suggest that prefrontal dysfunctions in schizophrenia might be related to a defective ability to initiate (rather than to execute) specific cognitive processes.

Le déterminisme linguistique en Russie actuelle

Résumé : Depuis la fin de la perestroïka s'est mis en place en Russie un discours identitaire qui, en linguistique, prend des formes extrêmes, reposant sur un strict déterminisme de la pensée par la langue. Les organismes de financement de la recherche scientifique soutiennent des projets qui étudient le rapport entre la grammaire russe et le « caractère national russe ». Des objets nouveaux apparaissent : « l'image linguistique russe du monde », « la personnalité linguistique », la « linguoculturologie ». Cet ensemble discursif construit dans l'imaginaire une identité collective rassurante, reposant sur l'idée que 1) tous les gens qui parlent la même langue pensent de la même façon; 2) les langues, donc les pensées collectives, sont imperméables entre elles, et donc intraduisibles. Cette tendance néo-humboldtienne dans la linguistique russe actuelle se déploie en toute méconnaissance de ses origines historiques : le Romantisme allemand dans son opposition à la philosophie des Lumières, le positivisme évolutionnisme d'Auguste Comte et la linguistique déterministe de l'Allemagne des années 1930.AbstractSince the end of perestroika, in linguistics in Russia, a new form of discourse has taken place, which stresses a very tight determinism of thought by language. The funding organizations of scientific research back up projects studying the relationship between Russiangrammar and the « Russian national character ». New objects of knowledge come to light : « the Russian linguistic image of the world », « linguistic personnality », « culturology ». This kind of discourse builds up an imaginary comforting collective identity, which relies on the principle that 1) all the people who speak the same language think the same way; 2) languages, hence collective kinds of thought, are hermetically closed to each other, and untranslatable. This neo-humboldtian trend in contemporary Russian linguistics has no knowledge of its historical origins : German Romanticism in its Anti-Enlightenment trend, evolutionnist positivism of Auguste Comte, and deterministic linguistics in Germany in the 1930s.

Compliance im öffentlichen Sektor : Untersuchung über den allfälligen Nutzen eines Compliance-Management-Systems in der öffentlichen Verwaltung am Beispiel des Bundesamtes für Gesundheit

Par Compliance, on entend l'ensemble des mesures organisationnelles d'une entreprise qui visent à assurer le respect des règles par l'entreprise et ses collaborateurs. Dans le secteur privé - surtout dans les banques et les assurances - la Compliance est un concept bien établi et le poste du Compliance Officer apparaît clairement dans l'organigramme des entreprises. Ce terme apparaît aussi de temps à autre au sein de l'administration fédérale, en relation avec la politique de gestion des risques et le système de contrôle interne (SCI) ; mais une introduction effective de la Compliance n'y a pas encore eu lieu (jusqu'ici). Les Américains ont l'habitude de dire « if you think compliance is expensive, try non compliance ». Cette déclaration, apparemment valable pour le secteur privé, peut-elle cependant être transposée telle quelle au secteur public ? L'introduction d'un système de management tel que la Compliance apporterait-elle effectivement une plus-value par rapport aux systèmes existants afin d'éviter les risques engendrant des conséquences juridiques ou causant une mauvaise réputation suite au non-respect de règles par des collaborateurs ? La présente étude se penche sur ces questions et analyse, sur la base de documents et d'interviews, quels éléments de la Compliance existent au niveau de la Confédération et au sein de l'Office fédéral de la santé publique (OFSP) et s'ils sont propres à atteindre les objectifs visés par la Compliance. Dans plusieurs domaines, on a pu constater des défauts et, par conséquent, un gros potentiel d'amélioration. Le problème principal est l'absence d'organisation au niveau de la Compliance. Cela complique la vue d'ensemble des risques juridiques et de ceux pouvant causer une mauvaise réputation qui existent au niveau de la Confédération et à l'OFSP et rend impossible un management homogène de ces risques. En conséquence et dans l'état actuel des choses, il pourrait s'avérer difficile d'éviter de manière durable la réalisation des risques susmentionnés au moyen des systèmes existants. D'un autre côté, la politique de gestion des risques au sein de la Confédération et l'introduction d'un système de contrôle interne (SCI) ont représenté les premiers pas en direction d'un système de gestion des risques intégré. La Compliance serait un complément idéal et pourrait - dans la mesure où la direction de l'Office la soutient et donne le bon exemple - contribuer à la réduction des risques décrits ci-dessus non seulement au niveau de la Confédération mais encore au sein de l'OFSP. La présente étude ne vise pas pour autant à critiquer les systèmes établis, mais bien plus à montrer le potentiel d'amélioration dont on pourrait tirer profit.

Music performance anxiety among full-time music students

Introduction Music performance anxiety (MPA, often referred to as "stage fright") is one of the leading severe medical problems among musicians. For about 15-25% of musicians MPA is a serious problem. Particularly high levels of MPA are observed among music students. Musical performance can induce negative emotions, including anxiety, which in some individuals can approach extreme levels of terror and take the form of panic attack, impair the quality of the performance, lead to avoidance of performance situations, and consequently have debilitating effects on the career. Coping efforts used by musicians in their attempts to manage MPA, such as sedatives, alcohol, and β-blockers can have deleterious health side-effects. Music ranks high in the cultural and economic life of Switzerland. In ten university music schools, students from all around the world are educated to become professional musicians. Despite the importance of musical education in Switzerland, data concerning the phenomenon of MPA are largely lacking. Goal and Methods The main goal of this research was to survey the occurrence, experience, and management of MPA among full-time music students in French Swiss conservatories. A questionnaire was developed based on the literature and interviews with music students and teachers and distributed to all the students of the conservatories of Fribourg, Geneva, Lausanne, and Neuchâtel in the spring 2007. 194 students (61% women) returned the questionnaire. Results The size of the problem: MPA is a major problem for 1/3 of the students (ranks 3 and 4). The consequences of MPA: 22% and 35% of the students think that they have failed exams and auditions, respectively, because of MPA. Further, 25% of the students have already avoided performing and 11% have interrupted public performances because of MPA. Coping with MPA: 90% of the students have never used alcohol prior to performing, whereas 97% and 81%, respectively, have never used recreation drugs and medication. The majority of students use relaxation exercises, respiratory exercises, and meditation techniques to prepare themselves. About ¾ of the students think that the use of alcohol and recreational drugs to manage MPA is never justified. 53% of the students think that the use of medication is justified on some occasions. Need for information and support: 66% of the students would like to receive more support and help to cope with music performance situations. This support should mainly come from their teachers and specialists. 53% of the students know nothing or little about possible means for the management of MPA. About 50% consider themselves not at all or little informed about the possible risks associated with the consumption of alcohol, recreational drugs, and medication for the management of performance situations. 89% would like to know more about MPA and 94% think that this topic should be discussed much more in their musical education at the conservatory. Conclusions The results of this survey indicate that MPA is a major problem for 1/3 of the students with serious consequences on their career. There is a huge need for more information and support on how to manage the stress due to performance situations. The use of alcohol, recreational drugs, and medication is modest but the students are poorly informed about possible side-effects of these coping strategies. It seems clear that more should be done in the French Swiss conservatories about music performance anxiety to inform, educate, and prepare the students for their future professional career.

A search for the origin of cadmium in the soil of the Swiss Jura

The top soil of a 14.5 km(2) region at la Chaux-de-Fonds in the Swiss Jura is exceptionally rich in cadmium. It contains an average of 1.3 mg per kg of soil. The spatial distribution of the metal has no simple pattern that could be explained by atmospheric deposition or agricultural practices. Thin soil contained most of its Cd at the surface; in thicker soil Cd is mainly concentrated between 60 and 80 cm depth. No specific minerals or soil fractions could account for these accumulation, and the vertical distribution of Cd is best explained by leaching from the topsoil and further adsorption within layers of nearly neutral pH. The local Jurassic sedimentary rocks contained too little Cd to account for the Cd concentrations in the soil. Alpine gravels from glacial till were too sparse in soils to explain such a spreading of Cd. Moreover this origin is contradictory with the fact that Cd is concentrated in the sand fraction of soils. The respective distributions of Fe and Cd in soils, and soil fractions, suggested that the spreading of iron nodules accumulated during the siderolithic period (Eocene) was not the main source of Cd. Atmospheric deposition, and spreading of fertiliser or waste from septic tanks seem the only plausible explanation for the Cd concentrations, but at present few factors allow us to differentiate between them.

Beyond Prejudice : conservation in the City : a case study from Switzerland

Conservation in the city is challenging because of a continued view that the urban realm is antithetical to nature. This was clearly the case when the first Swiss National Park was established at the beginning of the 20th century. New Swiss legislation brought new approaches to the establishment of natural parks, in particular by including human activities as a logical component in their development. In 2010, a Federal think tank discussed opportunities for launching a new kind of park: the Urban Natural Park. This paper reports an analysis of this discussion, together with the study of the literature dealing with conservation in the city and natural parks. It shows that a clear antagonism between city and nature still remains present, reflected in an implicit hierarchy hidden in the designation of natural parks: wild nature is nominated as the best nature; if not wild, the best nature is identified as rural; if neither wild nor rural, nature is thought not to be the concern of natural park policy. The Swiss Biodiversity Strategy implemented in 2012 is a recent recognition of the importance of urban nature for biodiversity conservation. This recognition, however, condemns urban nature to a special status, situated outside the usual framework of conservation management. I conclude by arguing that anti-urban bias must be addressed because it inhibits effective conservation strategy, prevents the identification of existing environmental qualities of cities and, eventually, has negative impacts on biological conservation outside the city because it fosters urban spreading.

Swiss Democracy on the Web 2010 : Society and Politics in a Connected Age

The rapid adoption of online media like Facebook, Twitter or Wikileaks leaves us with little time to think. Where is information technology taking us, our society and our democratic institutions ? Is the Web replicating social divides that already exist offline or does collaborative technology pave the way for a more equal society ? How do we find the right balance between openness and privacy ? Can social media improve civic participation or do they breed superficial exchange and the promotion of false information ? These and lots of other questions arise when one starts to look at the Internet, society and politics. The first part of this paper gives an overview of the social changes that occur with the rise of the Web. The second part serves as an overview on how the Web is being used for political participation in Switzerland and abroad. Le développement rapide de nouveaux médias comme Facebook, Twitter ou Wikileaks ne laisse que peu de temps à la réflexion. Quels sont les changements que ces technologies de l'information impliquent pour nous, notre société et nos institutions démocratiques ? Internet ne fait-il que reproduire des divisions sociales qui lui préexistent ou constitue-t-il un moyen de lisser et d'égaliser ces mêmes divisions ? Comment trouver le bon équilibre entre transparence et respect de la vie privée ? Les médias sociaux permettent-ils de stimuler la participation politique ou ne sont-ils que le vecteur d'échanges superficiels et de fausses informations ? Ces questions, parmi d'autres, émergent rapidement lorsque l'on s'intéresse à la question des liens entre Internet, la société et la politique. La première partie de ce cahier est consacrée aux changements sociaux générés par l'émergence et le développement d'Internet. La seconde fait l'état des lieux de la manière dont Internet est utilisé pour stimuler la participation politique en Suisse et à l'étranger.

Eager for fairness or revenge: psychological altruism in economics

To understand the human capacity for psychological altruism, one requires a proper understanding of how people actually think and feel. This paper addresses the possible relevance of recent findings in experimental economics and neuroeconomics to the philosophical controversy over altruism and egoism. After briefly sketching and contextualizing the controversy, we survey and discuss the results of various studies on behaviourally altruistic helping and punishing behaviour, which provide stimulating clues for the debate over psychological altruism. On closer analysis, these studies prove less relevant than originally expected because the data obtained admit competing interpretations such as people seeking fairness versus people seeking revenge. However, this mitigated conclusion does not preclude the possibility of more fruitful research in the area in the future. Throughout our analysis, we provide hints for the direction of future research on the question.

Can GAP-43 interact with brain spectrin?

The growth-associated and presynaptic protein GAP-43 is important for axonal growth during brain development, for synaptic plasticity and in axonal regeneration [Benowitz, Routtenberg, TINS 12 (1987) 527]. It has been speculated that such growth may be mediated by cytoskeletal proteins. However, the interaction of GAP-43 with proteins of the presynaptic terminals is poorly characterized. Here, we analyze GAP-43 binding to cytoskeletal proteins by two different biochemical assays, by blot overlay and sedimentation. We find that immobilized brain spectrin (BS) is able to bind GAP-43. In contrast, little binding was observed to microtubule proteins and other elements of the cytoskeleton. Since GAP-43 is located presynaptically, it may bind to the presynaptic form of BS (SpIISigma1). It is attractive to think that such an interaction would participate in the structural plasticity observed in growth cones and adult synapses.