Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus--a prospective single-blinded randomised crossover trial.

Aims/hypothesis We assessed systemic and local muscle fuel metabolism during aerobic exercise in patients with type I diabetes at euglycaemia and hyperglycaemia with identical insulin levels.Methods This was a single-blinded randomised crossover study at a university diabetes unit in Switzerland. We studied seven physically active men with type I diabetes (mean +/- SEM age 33.5 +/- 2.4 years, diabetes duration 20.1 +/- 3.6 years, HbA(1c) 6.7 +/- 0.2% and peak oxygen uptake [VO2peak] 50.3 +/- 4.5 ml min(-1) kg(-1)). Men were studied twice while cycling for 120 min at 55 to 60% of VO2peak, with a blood glucose level randomly set either at 5 or 11 mmol/l and identical insulinaemia. The participants were blinded to the glycaemic level; allocation concealment was by opaque, sealed envelopes. Magnetic resonance spectroscopy was used to quantify intramyocellular glycogen and lipids before and after exercise. Indirect calorimetry and measurement of stable isotopes and counter-regulatory hormones complemented the assessment of local and systemic fuel metabolism.Results The contribution of lipid oxidation to overall energy metabolism was higher in euglycaemia than in hyperglycaemia (49.4 +/- 4.8 vs 30.6 +/- 4.2%; p<0.05). Carbohydrate oxidation accounted for 48.2 +/- 4.7 and 66.6 +/- 4.2% of total energy expenditure in euglycaemia and hyperglycaemia, respectively (p<0.05). The level of intramyocellular glycogen before exercise was higher in hyperglycaemia than in euglycaemia (3.4 +/- 0.3 vs 2.7 +/- 0.2 arbitrary units [AU]; p<0.05). Absolute glycogen consumption tended to be higher in hyperglycaemia than in euglycaemia (1.3 +/- 0.3 vs 0.9 +/- 0.1 AU). Cortisol and growth hormone increased more strongly in euglycaemia than in hyperglycaemia (levels at the end of exercise 634 52 vs 501 +/- 32 nmol/l and 15.5 +/- 4.5 vs 7.4 +/- 2.0 ng/ml, respectively; p<0.05).Conclusions/interpretation Substrate oxidation in type I diabetic patients performing aerobic exercise in euglycaemia is similar to that in healthy individuals revealing a shift towards lipid oxidation during exercise. In hyperglycaemia fuel metabolism in these patients is dominated by carbohydrate oxidation. Intramyocellular glycogen was not spared in hyperglycaemia.

Nicotine vaccines for smoking cessation.

BACKGROUND: By reducing the amount of nicotine that reaches the brain when a person smokes a cigarette, nicotine vaccines may help people to stop smoking or to prevent recent quitters from relapsing. OBJECTIVES: The aims of this review are to assess the efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type of adverse events associated with the use of nicotine vaccines. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Review Group specialised register for trials, using the term 'vaccine' in the title or abstract, or in a keyword (date of most recent search April 2012). To identify any other material including reviews and papers potentially relevant to the background or discussion sections, we also searched MEDLINE, EMBASE, and PsycINFO, combining terms for nicotine vaccines with terms for smoking and tobacco use, without design limits or limits for human subjects. We searched the Annual Meeting abstracts of the Society for Research on Nicotine and Tobacco up to 2012, using the search string 'vaccin'. We searched Google Scholar for 'nicotine vaccine'. We also searched company websites and Google for information related to specific vaccines. We searched clinicaltrials.gov in March 2012 for 'nicotine vaccine' and for the trade names of known vaccine candidates. SELECTION CRITERIA: We included randomized controlled trials of nicotine vaccines, at Phase II and Phase III trial stage and beyond, in adult smokers or recent ex-smokers. We included studies of nicotine vaccines used as part of smoking cessation or relapse prevention interventions. DATA COLLECTION AND ANALYSIS: We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, blinding of participants and personnel, reporting of outcomes, and completeness of follow-up.Our primary outcome measure was a minimum of six months abstinence from smoking. We used the most rigorous definition of abstinence, and preferred cessation rates at 12 months and biochemically validated rates where available. We have used the risk ratio (RR) to summarize individual trial outcomes. We have not pooled the current group of included studies as they cover different vaccines and variable regimens. MAIN RESULTS: There are no nicotine vaccines currently licensed for public use, but there are a number in development. We found four trials which met our inclusion criteria, three comparing NicVAX to placebo and one comparing NIC002 (formerly NicQbeta) to placebo. All were smoking cessation trials conducted by pharmaceutical companies as part of the drug development process, and all trials were judged to be at high or unclear risk of bias in at least one domain. Overall, 2642 smokers participated in the included studies in this review. None of the four included studies detected a statistically significant difference in long-term cessation between participants receiving vaccine and those receiving placebo. The RR for 12 month cessation in active and placebo groups was 1.35 (95% Confidence Interval (CI) 0.82 to 2.22) in the trial of NIC002 and 1.74 (95% CI 0.73 to 4.18) in one NicVAX trial. Two Phase III NicVAX trials, for which full results were not available, reported similar quit rates of approximately 11% in both groups. In the two studies with full results available, post hoc analyses detected higher cessation rates in participants with higher levels of nicotine antibodies, but these findings are not readily generalisable. The two studies with full results showed nicotine vaccines to be well tolerated, with the majority of adverse events classified as mild or moderate. In the study of NIC002, participants receiving the vaccine were more likely to report mild to moderate adverse events, most commonly flu-like symptoms, whereas in the study of NicVAX there was no significant difference between the two arms. Information on adverse events was not available for the large Phase III trials of NicVAX.Vaccine candidates are likely to undergo significant changes before becoming available to the general public, and those included in this review may not be the first to reach market; this limits the external validity of the results reported in this review in terms of both effectiveness and tolerability. AUTHORS' CONCLUSIONS: There is currently no evidence that nicotine vaccines enhance long-term smoking cessation. Rates of serious adverse events recorded in the two trials with full data available were low, and the majority of adverse events reported were at mild to moderate levels. The evidence available suggests nicotine vaccines do not induce compensatory smoking or affect withdrawal symptoms. No nicotine vaccines are currently licensed for use in any country but a number are under development.Further trials of nicotine vaccines are needed, comparing vaccines with placebo for smoking cessation. Further trials are also needed to explore the potential of nicotine vaccines to prevent relapse. Results from past, current and future research should be reported in full. Adverse events and serious adverse events should continue to be carefully monitored and thoroughly reported.

Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial.

BACKGROUND: A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. METHODS/DESIGN: The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention-to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. DISCUSSION: Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ACTRN12612000909820).

L’envers du miroir: le verlan, une histoire d’ouf!

Des de ja fa uns quants anys existeix un fenomen lingüístic a França que encara avui dia no deixa de sorprendre ni de cridar l'atenció; es tracta d'una parla, o més aviat d’un argot que s’anomena verlan. El verlan, doncs, és un argot que troba el seu origen als barris marginals dels afores de les ciutats (les banlieues), i per la qual cosa s’associa normalment a la classe baixa i marginal d’aquestes. Així, aquest argot es va convertir en un autèntic “art del parlar” del sector juvenil del segle XX, el qual era utilitzat bàsicament per marcar una diferència de classe social i que els seu parlants es poguessin comunicar entre ells sense que ningú altre que no formés part del seu entorn pugui entendre el què deien. El verlan és un argot que es caracteritza per fer una inversió de les paraules, però tot i que sembli inventada, aquesta inversió de fonemes es fa segons unes regles i en funció del nombre de síl•labes del terme. Els mitjans de comunicació van contribuir molt en l’expansió d’aquest argot, però el moviment hip-hop va ser un dels principals mitjans d’expansió, ja que va "vulgaritzar" el verlan i va difondre’l a totes les capes de la societat a partir de les seves peculiars cançons. Així doncs, la pregunta que molts ens plantegem és la de si el verlan és realment una amenaça per al francès estàndard o no.

Reporting of methodologic information on trial registries for quality assessment: a study of trial records retrieved from the WHO search portal

Background: Although randomized clinical trials (RCTs) are considered the gold standard of evidence, their reporting is often suboptimal. Trial registries have the potential to contribute important methodologic information for critical appraisal of study results. Methods and Findings: The objective of the study was to evaluate the reporting of key methodologic study characteristics in trial registries. We identified a random sample (n = 265) of actively recruiting RCTs using the World Health Organization International Clinical Trials Registry Platform (ICTRP) search portal in 2008. We assessed the reporting of relevant domains from the Cochrane Collaboration’s ‘Risk of bias’ tool and other key methodological aspects. Our primary outcomes were the proportion of registry records with adequate reporting of random sequence generation, allocation concealment, blinding, and trial outcomes. Two reviewers independently assessed each record. Weighted overall proportions in the ICTRP search portal for adequate reporting of sequence generation, allocation concealment, blinding (including and excluding open label RCT) and primary outcomes were 5.7% (95% CI 3.0–8.4%), 1.4% (0–2.8%), 41% (35–47%), 8.4% (4.1–13%), and 66% (60–72%), respectively. The proportion of adequately reported RCTs was higher for registries that used specific methodological fields for describing methods of randomization and allocation concealment compared to registries that did not. Concerning other key methodological aspects, weighted overall proportions of RCTs with adequately reported items were as follows: eligibility criteria (81%), secondary outcomes (46%), harm (5%) follow-up duration (62%), description of the interventions (53%) and sample size calculation (1%). Conclusions: Trial registries currently contain limited methodologic information about registered RCTs. In order to permit adequate critical appraisal of trial results reported in journals and registries, trial registries should consider requesting details on key RCT methods to complement journal publications. Full protocols remain the most comprehensive source of methodologic information and should be made publicly available.

Lasten luvaton tuli – perusasteen oppilaat sytyttelijöinä

Tutkimus lasten ja nuorten luvattomasta tulen käsittelystä perustuu näkemykseen siitä, että ilmiöön voidaan puuttua tehokkaasti interventioin, jos toiminta havaitaan ajoissa. Ilmiötä sävyttää teon salailu ja neutralisaatio eli vähättely. Tulella tehtyjen tuhotöiden lisääntymistä ja muuttumista aggressiivisemmaksi voidaan ennalta ehkäistä ongelman tunnistamisella ja reagoimalla lasten häiriökäytökseen. Lasten ja nuorten luvatonta tulen käyttöä ei ole tutkittu Suomessa aiemmin. Työn ensimmäisessä osiossa tarkastellaan luvattomaan tulen käsittelyyn liittyviä teorioita (esim. Fineman 1980, 1995), kansainvälisiä näkökohtia, teonpiirteitä ja yksilön sisäisiä prosesseja. Lisäksi tarkastellaan perheen, koulun ja ystäväpiirin osuutta ilmiöön, niin sanotun Oregonin mallin mukaisesti (Oregon Treatment Strategies Task Force 1996, 16 – 47). Työn empiirisessä osiossa ilmiötä ja sen ilmenemistä lasten ja nuorten keskuudessa kuvataan oppilaiden, vanhempien ja opettajien näkökulmasta. Tutkimukseen osallistui 661 oppilasta perusasteen toiselta, viidenneltä ja kahdeksannelta luokalta, 341 vanhempaa ja 22 koulun työntekijää. Oppilaiden ja vanhempien aineisto kerättiin survey-tutkimuksella ja opettajat tutkittiin haastattelumenetelmällä. Lasten luvaton tulen käyttö on yleisempää kuin aiemmin on luultu. Vielä viidenteen luokkaan mennessä luvaton tulen käsittely oli yleisempää pojille kuin tytöille, mutta murrosikään tultaessa sukupuolierot vähenivät. Pojista 37 % ja tytöistä 25 % raportoi käsitelleensä tulta luvattomasti. Kaikkiaan kolmasosa oppilaista raportoi leikkineensä tulella. Yleisin tulen sytyttelypaikka oli oma koti tai kodin lähiympäristö, josta tulentekovälineet yleisimmin hankittiin pyytämällä tai ottamalla. Luvattomasti tulta käsitelleet oppilaat olivat häirinneet oppitunteja. Tilastollisesti merkitsevimmin runsasta luvatonta tulen käsittelyä ennusti omien tulentekovälineiden omistaminen ja häiriökäyttäytyminen koulussa. Vanhemmat eivät pitäneet lastensa tulen käyttöä merkittävänä vaarana. Aikuisten suhtautumista lasten luvattomaan tulen käyttöön sävytti tekojen vähättely eli neutralisaatio; vähättelyilmiö oli yhteinen sekä lapsille itselleen, vanhemmille että viranomaisille. Kasvattajilla ei ollut käytössään tehokkaita interventiomenetelmiä ongelman ratkaisemiseen. Viranomaisyhteistyöstä raportoitiin vain vähän. Pelastusviranomaisia ei juurikaan käytetty lasten luvattoman tulen käsittelyn interventiossa. Interventiota sävytti aikuisten käsitysten mukaan tapauskohtaisuus ja sattumanvaraisuus.

Viestitaktiikan kehittyminen yhtymän viestijärjestelmän käyttöönoton jälkeen

Tutkimus käynnistyi Maanpuolustuskorkeakoulun taktiikan laitoksen esittäessä aihepiiriä tutkittavaksi. Tutkimuksen tavoitteena on ollut lisätä tietämystä viestitaktiikan kehittymisestä yhtymän viestijärjestelmän käyttöönoton jälkeen 1980 – 2000-luvuilla osana operatiivistaktisten toimintaperiaatteiden ja -tapojen kehittymistä. Tutkimuksella on pyritty syventämään tietämystä taktisten periaatteiden muutoksista viestitaktiikan näkökulmasta. Tutkimuksessa tarkasteltiin maavoimien YVI-järjestelmillä varustettujen yhtymien viestitaktiikkaa sekä niissä tapahtuneita muutoksia. Muutoksia tarkasteltaessa tutkimuksessa keskityttiin käsitykseen viestitaktiikasta, viestitaktisiin periaatteisiin sekä viestipäällikköön ja hänen toimintakenttäänsä. Viestitaktisia periaatteita ja niissä tapahtuneita muutoksia vertailtiin myös yleisiin taktisiin periaatteisiin ja niiden painotuksissa tapahtuneisiin muutoksiin. Tutkimus on luonteeltaan kvalitatiivinen. Tutkimusongelmia lähestyttiin fenomenografisella tutkimusotteella, jossa tavoitteena on kuvailla, analysoida ja ymmärtää erilaisia käsityksiä ilmiöistä sekä käsitysten keskinäisistä suhteista. Lähdeaineiston muodostivat 18 viestitaktiikan asiantuntijan kokemusperäiset käsitykset viestitaktiikasta ja sen kehittymisestä YVIjärjestelmien käyttöönoton jälkeen. Käsityksistä muodostettiin merkitys- ja kuvauskategorioiden sekä tutkijan esiymmärryksen pohjalta induktiivisen päättelyn avulla tutkimuksen varsinaiset johtopäätökset. Tutkimushenkilöiden käsitysten sekä taktiikan ja viestitaktiikan aikaisempien määritelmien perusteella johtopäätöksenä määritettiin, että viestitaktiikka on tehtävän toteuttamiseen käytettävissä olevan viestillisen kapasiteetin optimaalista suunnittelua, soveltamista ja käyttöä viestivoimana haluttujen päämäärien saavuttamiseksi ja viestitaisteluiden voittamiseksi. Viestitaktikointi edellyttää viestitaisteluun liittyvien keinojen tuntemista sekä taitoa soveltaa niitä käytännössä. Tutkimustulosten perusteella keskeisiksi viestitaktisiksi periaatteiksi tärkeysjärjestyksessä muodostuivat - päämäärän ja tehtävän selkeys - varautuminen odottamattomiin tilanteen vaihteluihin - yksinkertaisuus - aktiivisuus ja oma-aloitteisuus. Keskeisiksi merkitystään lisänneiksi viestitaktisiksi periaatteiksi muodostuivat - voimien vaikutuksen keskittäminen - joukkojen ja voimien jakaminen (reservi) - varautuminen odottamattomiin tilanteen vaihteluihin - salaaminen ja harhauttaminen - turvallisuus. Selkeimpänä viestipäällikön tehtävien muutoksena pidettiin siirtymistä yksityiskohtaisesta viestiyhteyksien suunnittelijasta kokonaisvaltaiseksi yhtymän viestitoiminnan johtajaksi. Tutkimustulosten ja aikaisempien määritelmien perusteella johtopäätöksenä määritettiin, että viestipäällikkö johtaa yhtymän viestitoimintaa komentajan antamien vaatimusten mukaisesti ja vastaa yhtymän johtoryhmän jäsenenä viestitaktisista ratkaisuista haluttujen päämäärien saavuttamiseksi ja viestitaisteluiden voittamiseksi. Viestipäälliköltä edellytetään viestitaisteluun liittyvien keinojen tuntemista sekä taitoa soveltaa niitä käytännössä. Tutkimuksen mukaan yhtymän viestitaktiikkaan merkittävimmin vaikuttaneita tekijöitä olivat yhtymän viestijärjestelmien käyttöönotto, uusien esikunta- ja viestiyksiköiden kehittäminen, kiinteän viestiverkon ja johtamisjärjestelmäalan merkityksen kasvaminen, käytettävien tekniikoiden kehittyminen sekä joukkojen ja johtoportaiden tiedonsiirtotarpeiden kasvaminen. Viestitaktiikan osalta voidaan todeta deterministisen näkemyksen taistelusta ja taistelutilasta muuttuneen yleisten taktisten periaatteiden muutosten mukaisesti aikaisempaa monimuotoisempaan ja rohkeampaan, voluntaarisempaan, suuntaan.

Anti-predator adaptations in aquatic environments

Predation is an important selective force that has led to the evolution of a variety of fascinating anti-predator adaptations, such as many types of protective coloration and prey behaviours. Because the evolution of life has begun in the aquatic environment and many anti-predator adaptations are found already in relative primitive taxa, it is likely that many of these adaptations evolved initially in the aquatic environment. Yet, there has been surprisingly little research on the mechanisms and function of antipredator adaptations in aquatic systems. To understand the function of anti-predator adaptations and natural selection imposed on prey appearance and behaviour, I have investigated how protective coloration can be used, either as such or together with behavioural adaptations, to manipulate predator behaviour and decrease predation risk. To this end I conducted a series of behaviour ecological laboratory experiments in which I manipulated the visual appearance of artificial backgrounds and prey items. In paper I of this thesis, I investigated background choice as an anti-predator strategy, by observing the habitat choice of the least killifish (Heterandria formosa) between pairs of artificial backgrounds, both in the presence and absence of predation threat. It has been suggested that prey could decrease their risk of being detected by predators either by preferring backgrounds into which they blend or by preferring visually complex backgrounds. The least killifish preferred a background that matched their patterning to a background that mismatched it, showing that they are able to respond to cues of visual similarity between their colour pattern and the surrounding environment. Interestingly however, in female least killifish visual complexity of the background was a more important cue for habitat safety and may override or act together with background matching when searching for a safe habitat. It is possible that in females, preference for visually complex backgrounds is associated with lower opportunity costs than preference for matching backgrounds would be. Generally, the least killifish showed stronger preference while under predation threat, indicating that their background choice behaviour is an antipredator adaptation. Many aquatic prey species have eyespots, which are colour patterns that consist of roughly concentric rings and have received their name because they for humans often resemble the vertebrate eye. I investigated the anti-predator function of eyespots against predation by fish in papers II, III and IV. Some eyespots have been suggested to benefit prey by diverting the strikes of predators away from vital parts of the prey body or towards a direction that facilitates prey escape. Although proposed over a century ago, the divertive effect of eyespots has proven to be difficult to show experimentally. In papers II and III, I tested for divertive effect of eyespots towards attacking fish by presenting artificial prey with eyespots to laboratory reared three-spined sticklebacks (Gasterosteus aculeatus). I found that eyespots strongly influenced the behaviour of attacking sticklebacks and effectively drew their strikes towards the eyespots. To further investigate this divertive effect and whether the specific shape of eyespots is important for it, I tested in paper III the response of fish also to other markings than eyespots. I found that eyespots were generally more effective in diverting the first strikes of attacking fish compared to other prey markings. My findings suggest that the common occurrence of eyespots in aquatic prey species can at least partly be explained by the divertive effect of the eyespot shape, possibly together with the relative simple developmental mechanisms underlying circular colour patterns. An eyebar is a stripe that runs through the eye, and this pattern has been suggested to obscure the real eyes of the prey by visually blending parts of the eyes and head of the prey and by creating false edges. In paper III, I show that an eyebar effectively disrupts an eyelike shape. This suggests that eyebars provide an effective way to conceal the eyes and consequently obstruct detection and recognition of prey. This experiment also demonstrates that through concealment of the eyes, eyebars could be used to enhance the divertive effect of eyespots, which can explain the common occurrence of eyebars in many species of fish that have eyespots. Larger eyespots have been shown to intimidate some terrestrial predators, such as passerine birds, either because they resemble the eyes of the predator’s own enemy or because highly salient features may have an intimidating effect. In papers II and IV, I investigated whether the occurrence of eyespots in some aquatic prey could be explained by their intimidating effect predatory fish. In paper IV, I also investigated the reason for the intimidating effect of eyelike prey marks. In paper II, I found no clear intimidating effect of eyespots, whereas in paper IV, using a different approach, I found that sticklebacks hesitated to attack towards eyelike but not towards non-eyelike marks. Importantly, paper IV therefore presents the first rigorous evidence for the idea that eye mimicry, and not merely conspicuousness, underlies the intimidating effect. It also showed that the hesitation shown by fish towards eyelike marks is partly an innate response that is reinforced by encounters with predators. Collectively, this thesis shows that prey colour pattern and the visual appearance of the habitat influence the behaviour of fish. The results demonstrate that protective coloration provides numerous distinctive ways for aquatic prey to escape predation. Thus, visual perception and behaviour of fish are important factors shaping the appearance and behaviours of aquatic prey.

Posttraumatic stress disorder symptoms might be destroying your intimacy : a test of mediational models in a community sample of couples

The present research focused on the pathways through which the symptoms of posttraumatic stress disorder (PTSD) may negatively impact intimacy. Previous research has confirmed a link between self-reported PTSD symptoms and intimacy; however, a thorough examination of mediating paths, partner effects, and secondary traumatization has not yet been realized. With a sample of 297 heterosexual couples, intraindividual and dyadic models were developed to explain the relationships between PTSD symptoms and intimacy in the context of interdependence theory, attachment theory, and models of selfpreservation (e.g., fight-or-flight). The current study replicated the findings of others and has supported a process in which affective (alexithymia, negative affect, positive affect) and communication (demand-withdraw behaviour, self-concealment, and constructive communication) pathways mediate the intraindividual and dyadic relationships between PTSD symptoms and intimacy. Moreover, it also found that the PTSD symptoms of each partner were significantly related; however, this was only the case for those dyads in which the partners had disclosed most everything about their traumatic experiences. As such, secondary traumatization was supported. Finally, although the overall pattern of results suggest a total negative effect of PTSD symptoms on intimacy, a sex difference was evident such that the direct effect of the woman's PTSD symptoms were positively associated with both her and her partner's intimacy. I t is possible that the Tend-andBefriend model of threat response, wherein women are said to foster social bonds in the face of distress, may account for this sex difference. Overall, however, it is clear that PTSD symptoms were negatively associated with relationship quality and attention to this impact in the development of diagnostic criteria and treatment protocols is necessary.

La stigmatisation reliée à la déficience auditive

Certaines personnes peuvent être stigmatisées quand elles présentent un attribut relié à une identité sociale qui est dénigrée dans un contexte particulier. Il existe plusieurs stéréotypes au sujet des personnes qui ont une perte d'audition. Le grand public associe souvent la perte d'audition à des comportements indésirables, au vieillissement et à une capacité intellectuelle réduite. Ces stéréotypes affectent négativement la participation des personnes ayant une perte auditive à diverses activités. Malgré les impacts évidents et importants que la stigmatisation a sur la participation sociale des personnes ayant une perte auditive et leur propension à recourir aux services de réadaptation, on constate une pénurie relative de recherche sur le stigmate lié à la perte d'audition. Ces dernières années, les chercheurs en sciences sociales ont fait de grands pas pour conceptualiser le stigmate selon la perspective des personnes qui sont la cible des attitudes nuisibles. La plupart de ces concepts peuvent s'appliquer au stigmate social lié à la perte d'audition. Le premier article de cette thèse tente de placer le stigmate lié à la perte d'audition dans un modèle de menace à l’identité induite par le stigmate (stigma-induced identity threat model). Ce chapitre explore comment les services pourraient être modifiés pour mieux soutenir les individus qui montrent des signes que leur identité personnelle est compromise à cause de leur perte d'audition. De façon générale, les buts de ce manuscrit sont a) de dresser un bref résumé de la question du stigmate lié à la perte d'audition ; b) de présenter un modèle spécifique de menace d'identité induite par le stigmate et d’incorporer des notions propres au stigmate lié à la perte d'audition à cette conceptualisation générale du stigmate et c) de réfléchir sur la pertinence de ce modèle pour la réadaptation audiologique. L'intention de la deuxième étude est de mieux comprendre comment le stigmate affecte les comportements de recherche d’aide des adultes ayant une perte d'audition acquise. Dix personnes ayant une perte d'audition, et appartenant à des groupes de soutien par les pairs ont participé à des entrevues semi-structurées audio-enregistrées. Les transcriptions de ces entrevues ont été analysées au moyen d’analyses thématiques. Les analyses ont indiqué que les répondants montre une plus grande propension à chercher de l'aide à la suite d’étapes charnières, où l’équilibre entre le stress négatif et l'énergie positive était rompu : a) un moment où le stress était de loin supérieur à l'énergie positive (première étape charnière) et b) un moment où l'énergie positive était de loin supérieure au stress négatif (deuxième étape charnière). On propose une série de représentations graphiques qui dépeignent comment les influences positives et négatives présentes dans l'environnement social et physique du répondant influencent la recherche d'aide. Le but de la troisième étude est d'identifier les facteurs qui amènent des individus à cacher ou révéler leur perte d'audition dans leur lieu de travail. Des entrevues semi-structurées ont été menées en utilisant une technique d’élicitation par photographies pour susciter des informations liées à la révélation de la perte d'audition. Les thèmes dégagés des entrevues incluent : l'importance perçue de la situation, la perception du sentiment de contrôle, l'affiliation à la communauté, le fardeau de communication et la présence de problèmes connexes à la perte d'audition. Les résultats de cette étude offrent un aperçu du monde caché des travailleurs ayant une perte d'audition. Cette étude sert à documenter certaines stratégies que les travailleurs avec une perte d'audition utilisent pour contrôler leur identité professionnelle et, plus spécifiquement, comment certains gèrent le dévoilement de leur perte d'audition dans leur lieu de travail. Les résultats fournissent des informations utiles pour le développement de programmes d'intervention appropriés pour des travailleurs ayant une perte d'audition.

Les pratiques sociales à domicile auprès des aînés gais : entre divulgation et dissimulation de l’identité homosexuelle

La recherche portant sur les expériences reliées aux services sociaux et de santé chez les aînés gais reçoit une attention croissante; cependant, les expériences dans le contexte des services à domicile demeurent peu documentées. Les deux principaux objectifs de cette étude sont d’explorer le vécu des aînés gais recevant des services à domicile relativement à leurs stratégies identitaires et de décrire leurs besoins spécifiques en vue de l’adaptation des pratiques sociales à domicile. Les propos de six aînés gais ont été recueillis dans la région de Montréal par entrevues semi-dirigées. Les résultats montrent que les expériences des aînés recevant des services à domicile sont généralement satisfaisantes; parmi eux, certains se sont sentis stigmatisés, mais seulement dans de rares moments et nous ont rapporté avoir plutôt vécu des situations les rendant mal à l’aise. Les résultats présentent aussi une utilisation variée des quatre stratégies identitaires (divulgation active, divulgation passive, dissimulation passive, dissimulation active) d’après une adaptation du modèle d’Eliason et Schope (2001). Si des facteurs individuels et interactionnels ont influencé les stratégies des aînés, ce sont cependant des facteurs contextuels (le type de service d’aide à domicile, le temps, le contexte social immédiat) qui ont pris une importance significative. Enfin, diverses pistes d’action sont à explorer pour l’adaptation des pratiques sociales auprès de cette population, notamment à l’égard de la formation des intervenants sociaux et de la santé, de l’amélioration de l’organisation des services à domicile, du développement de ressources spécifiques et de la contribution du travailleur social auprès des minorités sexuelles âgées.

Carcases and mites

Mites are involved in the decomposition of animal carcases and human corpses at every stage. From initial decay at the fresh stage until dry decomposition at the skeletal stage, a huge diversity of Acari, including members of the Mesostigmata, Prostigmata, Astigmata, Endeostigmata, Oribatida and Ixodida, are an integral part of the constantly changing food webs on, in and beneath the carrion. During the desiccation stage in wave 6 of M,gnin's system, mites can become the dominant fauna on the decomposing body. Under conditions unfavourable for the colonisation of insects, such as concealment, low temperature or mummification, mites might become the most important or even the only arthropods on a dead body. Some mite species will be represented by a few specimens, whereas others might build up in numbers to several million individuals. Astigmata are most prominent in numbers and Mesostigmata in diversity. More than 100 mite species and over 60 mite families were collected from animal carcases, and around 75 species and over 20 families from human corpses.

An investigation of the shortcomings of the CONSORT 2010 statement for the reporting of group sequential randomised controlled trials: a methodological systematic review

Background It can be argued that adaptive designs are underused in clinical research. We have explored concerns related to inadequate reporting of such trials, which may influence their uptake. Through a careful examination of the literature, we evaluated the standards of reporting of group sequential (GS) randomised controlled trials, one form of a confirmatory adaptive design. Methods We undertook a systematic review, by searching Ovid MEDLINE from the 1st January 2001 to 23rd September 2014, supplemented with trials from an audit study. We included parallel group, confirmatory, GS trials that were prospectively designed using a Frequentist approach. Eligible trials were examined for compliance in their reporting against the CONSORT 2010 checklist. In addition, as part of our evaluation, we developed a supplementary checklist to explicitly capture group sequential specific reporting aspects, and investigated how these are currently being reported. Results Of the 284 screened trials, 68(24%) were eligible. Most trials were published in “high impact” peer-reviewed journals. Examination of trials established that 46(68%) were stopped early, predominantly either for futility or efficacy. Suboptimal reporting compliance was found in general items relating to: access to full trials protocols; methods to generate randomisation list(s); details of randomisation concealment, and its implementation. Benchmarking against the supplementary checklist, GS aspects were largely inadequately reported. Only 3(7%) trials which stopped early reported use of statistical bias correction. Moreover, 52(76%) trials failed to disclose methods used to minimise the risk of operational bias, due to the knowledge or leakage of interim results. Occurrence of changes to trial methods and outcomes could not be determined in most trials, due to inaccessible protocols and amendments. Discussion and Conclusions There are issues with the reporting of GS trials, particularly those specific to the conduct of interim analyses. Suboptimal reporting of bias correction methods could potentially imply most GS trials stopping early are giving biased results of treatment effects. As a result, research consumers may question credibility of findings to change practice when trials are stopped early. These issues could be alleviated through a CONSORT extension. Assurance of scientific rigour through transparent adequate reporting is paramount to the credibility of findings from adaptive trials. Our systematic literature search was restricted to one database due to resource constraints.

Livre expressão :para que te quero? o interesse público no ensino do Jornalismo

The main objective of this research was studying the meanings of the freedom of expression and what professors of Journalism think about the way those meanings are used in pedagogical practices. The term freedom of expression is commonly used in journalism even though it is not so studied, consequently we don t have a word to define it. Therefore, we related the term freedom of expression in Journalism teaching to the condition as the object of this study, aiming to establish a connection among the term, the right, free expression and the endurance of the right. The theorical support to understand the dynamic of the meanings of the freedom of expression in the social practice of Journalism teaching was based in the Hegeliana dialetic theorical principles and in the language philosophy more specifically in Bakhtin s perspective from which we can mention the social auditorium, immediate conditions of production and a wider social horizon as the main categories of analysis. This study is a qualitative research with an interacionist perspective anchored in a semi-structured interview as a privileged method of data collecting made with ten professors from Journalism graduation. The analysis reveals that, in the interviewers perspective, there would be a deceiving practice from freedom of expression in the journalism teaching in which emerges either in speeches with handbills spreading the fear and/or under a stimulus form to concealment

A quantitative and qualitative evaluation of reports of clinical trials published in six Brazilian dental journals indexed in the Scientific Electronic Library Online (SciELO)

Introduction: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals many of which provide open access to full-text articles. This library includes a number of dental journals some of which may include reports of clinical trials in English, Portuguese and/or Spanish. Thus, SciELO could play an important role as a source of evidence for dental healthcare interventions especially if it yields a sizeable number of high quality reports. Objective: The aim of this study was to identify reports of clinical trials by handsearching of dental journals that are accessible through SciELO, and to assess the overall quality of these reports. Material and methods: Electronic versions of six Brazilian dental Journals indexed in SciELO were handsearched at www.scielo.br in September 2008. Reports of clinical trials were identified and classified as controlled clinical trials (CCTs - prospective, experimental studies comparing 2 or more healthcare interventions in human beings) or randomized controlled trials (RCTs - a random allocation method is clearly reported), according to Cochrane eligibility criteria. Criteria to assess methodological quality included: method of randomization, concealment of treatment allocation, blinded outcome assessment, handling of withdrawals and losses and whether an intention-to-treat analysis had been carried out. Results: The search retrieved 33 CCTs and 43 RCTs. A majority of the reports provided no description of either the method of randomization (75.3%) or concealment of the allocation sequence (84.2%). Participants and outcome assessors were reported as blinded in only 31.2% of the reports. Withdrawals and losses were only clearly described in 6.5% of the reports and none mentioned an intention-to-treat analysis or any similar procedure. Conclusions: The results of this study indicate that a substantial number of reports of trials and systematic reviews are available in the dental journals listed in SciELO, and that these could provide valuable evidence for clinical decision making. However, it is clear that the quality of a number of these reports is of some concern and that improvement in the conduct and reporting of these trials could be achieved if authors adhered to internationally accepted guidelines, e. g. the CONSORT statement.