Neuropsychological dysfunction related to earlier occupational exposure to mercury vapor

We assessed the neuropsychological test performances of 26 patients (mean age = 41.5 ± 6.1 years; mean years of education = 9.8 ± 1.8; 20 males) diagnosed with chronic occupational mercurialism who were former workers at a fluorescent lamp factory. They had been exposed to elemental mercury for an average of 10.2 ± 3.8 years and had been away from this work for 6 ± 4.7 years. Mean urinary mercury concentrations 1 year after cessation of work were 1.8 ± 0.9 µg/g creatinine. Twenty control subjects matched for age, gender, and education (18 males) were used for comparison. Neuropsychological assessment included attention, inhibitory control, verbal and visual memory, verbal fluency, manual dexterity, visual-spatial function, executive function, and semantic knowledge tests. The Beck Depression Inventory and the State and Trait Inventory were used to assess depression and anxiety symptoms, respectively. The raw score for the group exposed to mercury indicated slower information processing speed, inferior performance in psychomotor speed, verbal spontaneous recall memory, and manual dexterity of the dominant hand and non-dominant hand (P < 0.05). In addition, the patients showed increased depression and anxiety symptoms (P < 0.001). A statistically significant correlation (Pearson) was demonstrable between mean urinary mercury and anxiety trait (r = 0.75, P = 0.03). The neuropsychological performances of the former workers suggest that occupational exposure to elemental mercury has long-term effects on information processing and psychomotor function, with increased depression and anxiety also possibly reflecting the psychosocial context.

Effect of smoking habits on sleep

To evaluate the effect of smoking habits on sleep, data from 1492 adults referred to the Sleep Institute were accessed and divided into 3 categories of smoking status: current, former and non-smokers. Categories of pack-years (<15 and ≥15) defined smoking severity. The association of smoking status and smoking severity with sleep was analyzed for sleep parameters, especially apnea and hypopnea index (AHI) ≥5, more than 5% of total sleep time (TST) spent with oxyhemoglobin saturation (SaO2) <90%, and arousal index. The arousal index was higher among current (21 ± 17) and former smokers (20 ± 17) than non-smokers (17 ± 15; P < 0.04). Former smokers had a higher percent of TST at SaO2 <90% than non-smokers (9 ± 18 vs 6 ± 13; P < 0.04). Former smokers with pack-years ≥15 compared to <15 exhibited higher AHI (22 ± 24 vs 16 ± 21; P < 0.05) and arousal index (22 ± 19 vs 18 ± 15; P < 0.05). Current smokers with pack-years ≥15 compared to <15 exhibited higher arousal index (23 ± 18 vs 18 ± 16; P < 0.05) and percent of TST at SaO2 <90% (11 ± 17 vs 6 ± 13; P < 0.05). Smoking status and pack-years were not associated with AHI ≥5 on logistic regression analysis, but current smokers with pack-years ≥15 were 1.9 times more likely to spend more than 5% of TST at SaO2 <90% than non-smokers (95%CI = 1.21-2.97; P = 0.005). The variability of arousal index was influenced by gender, AHI and current smokers with pack-years ≥15 (all P < 0.01). Smoking habits seem to be associated with arousal and oxyhemoglobin desaturation during sleep, but not with AHI. The effect was more pronounced in current than former smokers.

Diabetic retinopathy is associated with early autonomic dysfunction assessed by exercise-related heart rate changes

Diabetic retinopathy has been associated with cardiac autonomic dysfunction in both type 1 and type 2 diabetes mellitus (DM) patients. Heart rate (HR) changes during exercise testing indicate early alterations in autonomous tonus. The aim of the present study was to investigate the association of diabetic retinopathy with exercise-related HR changes. A cross-sectional study was performed on 72 type 2 and 40 type 1 DM patients. Autonomic dysfunction was assessed by exercise-related HR changes (Bruce protocol). The maximum HR increase, defined as the difference between the peak exercise rate and the resting rate at baseline, and HR recovery, defined as the reduction in HR from the peak exercise to the HR at 1, 2, and 4 min after the cessation of the exercise, were determined. In type 2 DM patients, lower maximum HR increase (OR = 1.62, 95%CI = 1.03-2.54; P = 0.036), lower HR recovery at 2 (OR = 2.04, 95%CI = 1.16-3.57; P = 0.012) and 4 min (OR = 2.67, 95%CI = 1.37-5.20; P = 0.004) were associated with diabetic retinopathy, adjusted for confounding factors. In type 1 DM, the absence of an increase in HR at intervals of 10 bpm each during exercise added 100% to the odds for diabetic retinopathy (OR = 2.01, 95%CI = 1.1-3.69; P = 0.02) when adjusted for DM duration, A1c test and diastolic blood pressure. In conclusion, early autonomic dysfunction was associated with diabetic retinopathy. The recognition of HR changes during exercise can be used to identify a high-risk group for diabetic retinopathy.

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Effects of disturbed blood flow during exercise on endothelial function: a time course analysis

This study aimed to examine the time course of endothelial function after a single handgrip exercise session combined with blood flow restriction in healthy young men. Nine participants (28±5.8 years) completed a single session of bilateral dynamic handgrip exercise (20 min with 60% of the maximum voluntary contraction). To induce blood flow restriction, a cuff was placed 2 cm below the antecubital fossa in the experimental arm. This cuff was inflated to 80 mmHg before initiation of exercise and maintained through the duration of the protocol. The experimental arm and control arm were randomly selected for all subjects. Brachial artery flow-mediated dilation (FMD) and blood flow velocity profiles were assessed using Doppler ultrasonography before initiation of the exercise, and at 15 and 60 min after its cessation. Blood flow velocity profiles were also assessed during exercise. There was a significant increase in FMD 15 min after exercise in the control arm compared with before exercise (64.09%±16.59%, P=0.001), but there was no change in the experimental arm (-12.48%±12.64%, P=0.252). FMD values at 15 min post-exercise were significantly higher for the control arm in comparison to the experimental arm (P=0.004). FMD returned to near baseline values at 60 min after exercise, with no significant difference between arms (P=0.424). A single handgrip exercise bout provoked an acute increase in FMD 15 min after exercise, returning to near baseline values at 60 min. This response was blunted by the addition of an inflated pneumatic cuff to the exercising arm.

Punaisten naisten tiet. Valtiorikosoikeuteen vuonna 1918 joutuneiden Porin seudun naisten toiminta sota-aikana, tuomiot ja myöhemmät elämänvaiheet

Suomen sisällissotaan osallistui vuonna 1918 naisia molemmin puolin rintamaa erilaisissa tehtävissä. Taisteluiden jälkeen yli 5500 punaista naista joutui valtiorikosoikeuteen syytettynä valtiopetoksellisesta toiminnasta. Ne noin 2000 naista, jotka palvelivat punakaartissa aseistettuina, ovat pitkään hallinneet sitä kuvaa, joka suomalaisilla on ollut punaisista naisista. Sen sijaan on tiedetty hyvin vähän niistä naisista, joiden valkoiset katsoivat edistäneen valtiopetosta muilla keinoilla. Tässä tutkimuksessa tarkastellaan, millaisia olivat Porin seudulla ne kapinasta syytetyt naiset, jotka eivät olleet tarttuneet aseisiin ja mikä oli heidän myöhempi kohtalonsa. Työn ensimmäisessä osassa tutkitaan valtiorikosoikeuteen joutuneiden naisten taustaa, toimintaa sota-aikana ja tästä aiheutuneita välittömiä seuraamuksia. Millaisia henkilöitä päätyi valtiorikosoikeuden eteen tuomittavaksi? Millaisissa tehtävissä he olivat sota-aikana toimineet ja miksi? Mitkä seikat olivat oikeudessa raskauttavia, kun valtiorikostuomioita jaettiin? Työn jälkimmäisessä osassa tutkitaan, mitä punaisille naisille tapahtui sodan jälkeen ja miksi näin kävi. Sisällissodan jälkeistä maailmaa hahmotetaan etsimällä vastauksia seuraaviin kysymyksiin: Millainen oli se yhteiskunnassa vallinnut ajan henki, jonka vaikutuspiiriin naiset valtiorikosoikeudesta ja vankilasta palasivat? Miten yhteisö otti heidät vastaan? Miten heihin suhtauduttiin työmarkkinoilla? Miten käsiteltiin punaisia leskiä ja orpoja? Mitä punaisilta odotettiin kansalaisina ja miten heistä pyrittiin muokkaamaan yhteiskuntakelpoisia? Miten poliittisen elämän uudelleenvirittely onnistui ja kiinnostiko se enää näitä naisia? Miten suomalaisen yhteiskunnan muuttuessa myös sen suhtautuminen punaisiin muuttui? Millaisilla toimilla valtiovalta pyrki eri vaiheissa yhtenäistämään rikkirevennyttä kansaa ja miten se näkyi yksittäisten ihmisten elämässä? Ajan kuluessa asenteet muuttuivat ja naiset vanhenivat. Miten naiset kuvasivat kokemaansa myöhemmin omaisilleen? Kysymyksiä pohditaan paikallisesta, Porin seudun näkökulmasta, mutta niitä peilataan kuitenkin jatkuvasti valtakunnalliseen tilanteeseen. Kontekstualisoi- malla paikalliskokemukset laajempaan kokonaisuuteen on voitu paremmin selittää tapahtunutta, ja paikallistutkimuksen kautta on nähty myös koko maassa vallinneita yleisiä olosuhteita. Tutkimuksen kohteena on 267 Porista, Porin maalaiskunnasta ja Ulvilasta kotoisin olevaa naista, jotka joutuivat valtiorikosoikeuden tutkittaviksi. Keskeisimpänä lähdeaineistona ovat seurakuntien rippikirjat ja maistraattien henkikirjat sekä Kansallisarkiston, Kansan arkiston ja Työväen arkistojen sisällissotaa ja sen jälkeistä poliittista elämää valottavat kokoelmat. Tutkimuksen naisista enemmistö oli 18−37-vuotiaita työläisnaisia. Aiemmin rikoksista tuomittuja heidän joukossaan oli hyvin vähän. Suurin osa (n. 71 %) työskenteli punakaartin huollossa keittiö-, siivous- ja vaatetusosastoilla. Noin 21 % työskenteli sairaanhoidossa, ja loput kahdeksan prosenttia olivat punakaartin hallintoa avustavissa muissa tehtävissä. Naiset saivat pääosin lieviä, 2−3 vuoden ehdollisia tuomioita. Vain joka kymmenes nainen tuomittiin ehdottomaan rangaistukseen. Punakaartiin vasta pakomatkalla liittyneet ja kaartissa vähäisissä tehtävissä lyhytaikaisesti toimineet henkilöt vapautettiin syytteistä. Tutkimuksessani olen osoittanut, millaisia vaikeuksia paluu sodanjälkeiseen arkeen tuotti naisille. Varsinkin yksin lastensa kanssa jääneillä oli monenlaisia ongelmia. Sodan aikana levitetty propaganda oli osaltaan lisäämässä vaikeuksia. Toisaalta työtilanne parantui monen naisen osalta jo vuoden 1918 aikana, ja oman punaisen yhteisön tarjoama tuki helpotti arjesta selviytymistä. Elämä tasaantui, naiset perustivat perheitä ja osa palasi työelämään ja politiikkaan. Säilyneiden lähteiden valossa sisällissota näyttäisi radikalisoineen vain pienen osan naisista, kun taas enemmistö kannatti maltillisia sosialidemokraatteja tai jäi kokonaan pois politiikasta. Punaiseksi leimautuminen valtiorikosoikeudessa ei pakottanut naisia muuttamaan uudelle paikkakunnalle; Porin seudulla ja yleensä vielä omassa suvussakin oli riittävästi entisiä punaisia luomassa kollektiivista tukea. Myös valtiovalta pyrki rauhoittamaan poliittista tilannetta ja sopeuttamaan punaisia yhteiskuntaan monin uudistuksin. Naisten kannalta merkittävin myönnytys tapahtui jatkosodan aikana, kun punalesket lopulta oikeutettiin valtiollisen eläkkeen piiriin. Tämä tutkimus on ensimmäinen punaisista naisista laadittu eräänlainen kollektiivinen elämäkerta, jossa on tarkasteltu heidän sodanjälkeistä elämäänsä. Yhteenvetona voidaan todeta, että Porin seudulta valtiorikosoikeuteen joutuneet naiset olivat tavallisia työläisnaisia. Sota ja osallisuus siihen ei tätä asiaa muuttanut. Naiset sopeutuivat yhteiskuntaan nopeasti ja elivät pääosin tavallista työläisperheen arkea sodan jälkeenkin.

Clinical and genetic markers in disease progression – a study among subjects with obstructive lung diseases

Asthma, COPD, and asthma and COPD overlap syndrome (ACOS) are chronic pulmonary diseases with an obstructive component. In COPD, the obstruction is irreversible and the disease is progressive. The aim of the study was to define and analyze factors that affected disease progression and patients’ well-being, prognosis and mortality in Chronic Airway Disease (CAD) cohort. The main focus was on COPD and ACOS patients. Retrospective data from medical records was combined with genetic and prospective follow-up data. Smoking is the biggest risk factor for COPD and even after the diagnosis of the disease, smoking plays an important role in disease development and patient’s prognosis. Sixty percent of the COPD patients had succeeded in smoking cessation. Patients who had managed to quit smoking had lower mortality rates and less psychiatric diseases and alcohol abuse although they were older and had more cardiovascular diseases than patients who continued smoking. Genetic polymorphism rs1051730 in the nicotinic acethylcholine receptor gene (CHRNA3/5) associated with heavy smoking, cancer prevalence and mortality in two Finnish independent cohorts consisting of COPD patients and male smokers. Challenges in smoking cessation and higher mortality rates may be partly due to individual patient’s genetic composition. Approximately 50% of COPD patients are physically inactive and the proportion was higher among current smokers. Physically active and inactive patients didn’t differ from each other in regard to age, gender or comorbidities. Bronchial obstruction explained inactivity only in severe disease. Subjective sensation of dyspnea, however, had very strong association to inactivity and was also associated to low health related quality of life (HRQoL). ACOS patients had a significantly lower HRQoL than either the patients with asthma or with COPD even though they were younger than COPD patients, had better lung functions and smaller tobacco exposure.

Recueil de copies de pièces.

Contient : 1 « Proces verbal contenant la declaration que le marquis de La Fuente, ambassadeur extraordinaire du roy catholique [Philippe IV] pres du roy [Louis XIV], a faite à Sa Majesté de la part de son maistre, pour satisfaire Sa Majesté sur ce qui estoit arrivé en la ville de Londres le dixieme octobre de l'année 1661, entre les ambassadeurs de France et d'Espagne. 24 mars 1662 » ; 2 « Remonstrance faite au roy » Louis XIV par FREDERIC-MAURICE DE LA TOUR, « duc DE BOUILLON, pour son rang et seance » ; 3 « Requeste presentée au roy [Louis XIV] par LOUIS, prince DE COURTENAY, le 23 mars 1666 » ; 4 « Protestation de monsieur le prince DE COURTENAY et de messieurs ses enfans, faicte entre les mains du roy pour la conservation des droits de leur naissance, le unzieme de feuvrier mil six cens soixante deux » ; 5 « Second Placet de messieurs DE COURTENAY au roy » ; 6 Attestation de COME DE MEDICIS, duc de Florence, en faveur de Roccho de' Guerrini. « Datum Pisiae, anno M.D.LXIIII, die XV maii ». En latin ; 7 « Lettre de JACQUES [Ier], roy d'Angleterre, à Maurice, comte de Nassau, prince d'Oranges, par laquelle il luy done advis qu'il l'a associé à l'ordre de la Jartiere... De nostre cour de Westmunster, le 24 decembre 1612 » ; 8 « Commission de JACQUES [Ier], roy d'Angleterre, à Rudolphe Vinvod, chevalier, son ambassadeur vers messieurs les Estats generaux des provinces unies des Pays Bas, pour doner l'ordre de la Jartiere de sa part à Maurice, comte de Nassau, prince d'Oranges,... En nostre palais de Vestmunster, le 26 de decembre l'an de grace 1612 » ; 9 « Relation de ce qui s'est passé au chasteau de Windsor à la solennité de la feste de St Georges, et installation du prince de Dannemarc et du duc de Montmouth en l'ordre de la Jarretiere » ; 10 « Relation de ce qui s'est passé à Stokolm, lorsque le roy de Suede a receu l'ordre de la Jarretiere que luy avoit envoyé le roy d'Angleterre » ; 11 « Lettres patentes des roys LOUYS XII et HENRY III, par lesquelles il est dit que le pays d'Auxone est un comté et non pas vicomté, et defenses à toutes persones de l'apeller autrement que comté » ; 12 à 14 Trois pièces formant une « relation de ce qui s'est passé en l'assemblée generale du clergé » à « Pontoise, en l'an 1660, entre l'evesque d'Autun Louis Doni d'Attichy et l'abbé de Richelieu, [portant plainte contre] le dit evesque sur ce qu'il avoit escrit du cardinal [de Richelieu] dans son livre des Fleurs de l'histoire des cardinaux » ; 15 et 16 Deux pièces relatives à la même affaire ; 17 « Arrest du parlement de Bourdeaux contre les jurats qui avoient fait publier la paix accordée par le roy aux religionaires ». Mai 1626 ; 18 « Ordonnance de [J. LOUIS DE LA VALETTE], duc D'ESPERNON, portant defense à tous huissiers et sergents de mettre à execution l'arrest cy dessus... Faict à Bourdeaux, le 3 de may 1626 » ; 19 « Second Arrest du parlement de Bourdeaux contre l'ordonnance de monsieur le duc d'Espernon,... Faict à Bourdeaux en parlement, may 1626 » ; 20 « Seconde Ordonance de [J. LOUIS DE LA VALETTE], duc D'ESPERNON, contre l'arrest du parlement de Bourdeaux cy dessus... Faict à Bourdeaux, le 8 de may 1626 » ; 21 « Troisiesme Arrest du parlement de Bourdeaux, portant cessation de l'exercice de la justice pour l'expedition des affaires particulieres... Faict à Bourdeaux en parlement, le 12 may 1626 » ; 22 « Arrest de la cour de parlement de Bourdeaux, portant inhibitions et deffences au sieur duc d'Espernon de prendre et usurper à l'advenir les qualitez de tres haut et puissant prince et d'Altesse, et à toutes personnes de les luy bailler... Faict à Bourdeaux, en parlement, le huitiesme avril mil six cens cinquante » ; 23 à 25 Trois « Pieces concernants la preseance de la ville de Salins sur celle de Dole en l'assemblée des trois Estats du comté de Bourgogne », de 1654 à 1658 ; 26 « Lettres patentes du roy HENRY II du 30 aoust 1556, portant adjudication de la preseance et presidence d'un president de la chambre des comptes de Dijon sur un conseillier du parlement [tant] en la chambre du domaine que dans les assemblées du parlement et de la chambre... Doné à Fonteinebleau, le 30 jour d'aoust 1556 » ; 27 Lettres patentes du roi HENRI II sur le même sujet. « Doné à Chantilly, le 24 mars 1557 » ; 28 « Extraict des registres de la chambre des comptes à Dijon », portant entérinement desdites lettres, « le 6 d'avril 1557, avant Pasques » ; 29 « Lettres par lesquelles le roy HENRY III done à M. Benigne de La Verne, president au parlement de Dijon, l'ordre de chevalerie, l'accolée et ceintq militaire... Doné à Blois, le sixiesme jour d'avril, l'an de grace mil cinq cent soixante et dix sept » ; 30 Enregistrement desdites lettres. « Doné à Dijon, le cinquiesme jour du mois de juin mil cinq cent soixante et dix sept » ; 31 « Coppies des chartres, verifications et enregistremens faits les 19 juillet 1642 et es années 1643 et 1644, pour l'union des terres et comtez de Bury, Donzain, Molineuf, Blemars en Blaisois, en une seule et mesme conté, et nommées par le roy le comté de Rostaing, en faveur de Mre Charles, marquis de Rostaing, au lieu du marquisat de Rostaing » ; 32 « Provisions de chevalier de grace des ordres militaires de Nostre Dame du Mont Carmel et de St Lazare pour Anthoine de Caboud,... Donné à La Benisson Dieu, le premier jour de decembre mil six cent soixante trois » ; 33 « Confirmation des privileges des ordres militaires de Nostre Dame du Mont Carmel et de St Lazare par le roy LOUYS XIV,... Donné à Paris, au mois d'avril mil six cent soixante quatre » ; 34 Serment fait par GALOYS DE BARAT-CHENCEAU d'observer les deux voeux ajoutés par le pape aux cinq articles du premier voeu de la milice chrétienne de Notre-Dame et St-Michel. « Datum Sti Albini, die sexto octobris, anno milesimo sexcentesimo vigesimo tertio » ; 35 Relation du différend intervenu entre Charles de Bourbon, comte de Soissons, et Maximilien de Béthune, marquis de Rosny, en août 1603 ; 36 « Reglement faict par le roy [LOUIS XIV] entre les officiers du parlement de Dijon et Mr le comte d'Amanzé, lieutenant de roy en Bourgongne au bailliage de Dijon... Faict à Versailles, le VIIe jour de juillet 1674 » ; 37 « Factum pour les gardes de la franchise de la lignée d'Eude le maire de Challo Sainct Maz » ; 38 « Lettres de chevalerie » et « d'accollade du Sr colonnel Fegelly, 1613 » ; 39 « Confirmation des armes de François de Bellegarde, seigneur de Monts, capitaine du chasteau de Nice, par l'empereur CHARLES V, qui y adjouste un aigle de sable à deux testes... Datum Bruxellis, die XIII mensis septembris, anno M.CCCCC.XL ». En latin ; 40 à 42 « Patentes par lesquelles le collier de [l']ordre de la Cosse de Geneste » est accordé à Geoffroy de Belleville, Victor de Lichtereielde, et Robert de Mauny. 6 juillet 1378, 17 décembre 1398 et 7 mars 1406 ; 43 Lettre de BERNARD DE NOGARET, « duc D'EPERNON,... De Lyon, ce 5e octobre 1656 » ; 44 Lettre de BERNARD DE NOGARET, « duc D'ESPERNON, à Mr le president Fyot, contenant son demeslé avec monsieur le comte de Montrevel,... A Bourg, ce 25 septembre 1656 » ; 45 « Reglement faict par le roy LOUYS [XIV] entre Mr le duc d'Espernon et Mr le comte de Montrevel, pour le faict de leurs charges... Faict à Compiegne, le quinziesme de may mil six cent cinquante sept » ; 46 « Brevet de soixante et quinze mille livres donées par le roy LOUYS [XIV] à Mr le comte de Montrevel,... Quinziesme jour de may mil six cens cinquante sept » ; 47 « Arrest du conseil portant reglement pour la seance aux Estatz entre Mr le gouverneur, Mr le premier president et Mr l'evesque d'Autun... Faict à Dijon, le sixiesme jour de novembre mil six cens cinquante huict » ; 48 Lettres closes par lesquelles « LOUIS » XIV reconnaît aux « tresoriers generaux de France en la generallité de Bourgongne » le privilége de lui parler debout. Dijon, 15 novembre 1658. Copie ; 49 « Extraict des registres du conseil privé du roy », énonçant que « les tresoriers generaulx de France en Bourgongne et Bresse, au bureau des finances de Dijon... doresnavant porteront des robbes ». Paris, le 15 février 1678 ; 50 « Lettre de concession du roy LOUYS XI à Galeas, duc de Milan, de porter les armes escartelées de France et du serpent... Doné en nostre ville de Chartres, le cinquiesme jour de novembre, l'an de grace 1467 » ; 51 « Ordonnances de l'ordre de la Toison d'or ». 1429 à 1531 ; 52 Mémoire du pas d'armes de l'arbre de Charlemagne, près Dijon, publié par Pierre de Beaufremont, en 1443 ; 53 « Erectio Matisconensis comitatus in Franciae parriam, in gratiam Joannis Matisconensis et Pictaviensis comitis... Datum apud S. Dionysium in Francia, anno Domini M.CCC.LIX, mense septembris ». En latin ; 54 Preuves généalogiques de François Damas, baron de Thianges, pour être reçu dans l'ordre du St-Esprit ; 55 « Arest doné le 5 de may 1633 contre [Charles de Lorraine], duc d'Elboeuf, et[Charles] marquis de La Vieuville, degradés de l'ordre du St Esprit » ; 56 « Arrest du mesme jour doné au chapitre de l'ordre du St Esprit, sur la preseance des chevaliers » ; 57 Traité entre Charles-Emmanuel, duc de Savoie, et l'électeur palatin, relativement au titre d'Altesse Royale que l'électeur accorde au duc. « Ratisbonae, die 5 junii anni 1666 ». En latin ; 58 « Decretum consistoriale S. D. N. URBANI papae VIII de titulis S. R. E. cardinalium, die X junii M.DC.XXX, in consistorio secreto ». En latin ; 59 « Protestation de MAURICE, cardinal DE SAVOYE, servant de response à la lettre à luy escritte par le college des cardinaux touchant le titre d'eminentissime, et escrite par le dit cardinal à Mr Castracani, nonce de Sa Saincteté resident à Turin... D'Asti, questo 24 settembre 1630 ». En italien ; 60 « Extraict des registres des deliberations particulierement faites en la chambre de la noblesse, pendant l'assemblée des Estats de Bourgongne, tenus en la ville de Dijon, es mois de may et juin mil six cens soixante cinq » ; 61 « Copie tirée de l'original de la lettre en espagnol de ST AUNEZ à don Gabriel de Loupion, vice roy de Catalogne. 1666 » ; 62 Vers satiriques sur François d'Aubusson, comte de La Feuillade ; 63 « Provisions de la charge de mareschal de France pour [Antoine Coeffier], marquis d'Effiat,... Doné à Paris, le Ier jour de janvier, l'an de grace 1631 » ; 64 « Discours des rangs et preseances, par BERNARD DE GIRARDI, sieur DU HAILLAN » ; 65 « Lettres de noblesse accordées par le roy LOUIS [XIV] à M. Le Brun, premier peintre de Sa Majesté... Données à Paris, au mois d'octobre, l'an de grace 1662 » ; 66 Lettres de comte palatin accordées par FERDINAND III à Samuel Guichenon. « Datum in civitate nostra Viennae, die prima julii anno millesimo sexcentesimo quinquagesimo primo ». En latin ; 67 Lettres de chevalier de l'ordre de St-Maurice et St-Lazare, accordées par CHARLES-EMMANUEL, duc DE SAVOIE, à Samuel Guichenon. « Datas Augustae Taurinorum, die 20 maii 1661 ». En latin ; 68 « Reglement faict par le roy [LOUIS XIII] pour le rang et seance des princes enfants naturels des roys et de ceux issus des maisons souveraines estrangeres... A Fontainebleau, le 15e jour de septembre 1629 » ; 69 « Copie des lettres ou privilege de noblesse que les Venitiens donnerent à feu monseigneur de Joieuse, qui fut tué à la bataille de Coutras, passant par Venize au mois d'aoust 1583 ». En latin ; 70 « Recueil de divers passages pour justifier de l'ancienne confraternité des citoyens de Rome avec ceux d'Autun »

A qualitative case study of the processes of peer education in a young adult tobacco control initiative, Leave the Pack Behind

Peer education involves peers offering credible and reliable information about sensitive life issues through the means of an informal peer group setting (Topping & Ehly, 1998). The purpose of this instrumental case study was to examine the processes of peer education through the exploration of two teams within a young adult tobacco control initiative, Leave the Pack Behind (LTPB). This qualitative case study examined two peer education teams over an eight-month period. Interviews, focus groups and observations were conducted with 12 participants across two peer education teams. Findings show the complexities of the processes of peer education including a connection between the stages of change and the changing role of the peer educator across stages of the empowerment process. Peer education teams and factors in the macro environment were also found to impact the process of peer education. This study provides a new definition for the process of peer education: peer education is a fluid process of knowledge exchange in which peer educators adopt different styles of facilitation as people move through stages of empowerment and change. This study contributes to the academic hterature upon the processes of peer education by providing a definition, a model and an overall understanding through an ecological and empowerment framework. The findings from this study suggest peer educators can be further trained to: use specific peer educational approaches that fit with student smoker's stage of change; better understand their position as a peer educator on the LTPB team; understand the reciprocal relationship between the macro environment and the peer education teams having an effect on one another.

Dancing politics : connecting women's experiences of rave in Toronto to ageism and patriarchy

Based on a critical analysis of recent Canadian and British media, academic, and political representations of rave, in conjunction with the author's and ten female interviewees' past experiences as active rave participants, the purpose of this thesis is to show the ways that rave can be understood as political. Drawing on a post-structural understanding of politics, which understands macro social issues and micro personal experiences as intimately linked and inseparable, this thesis fills a gap in the existing rave literature by explicitly drawing out (a) the ways that active rave participation is entangled in dominant understandings of age and gender-appropriate activities, and (b) the implications that these entanglements have on the ways that some women experience and construct their past active rave participation. Specifically, the author examines the ways that age and gender intersect and inform the discourses on which research participants drew to describe and rationalize their experiences of becoming, being, and ceasing to be active rave participants in Toronto, Ontario, Canada. At the same time that the majority of research participants' introductions to rave followed heterosexualized and heternormative patterns, they also constructed active rave participation as a way to challenge popular representations of rave as an inappropriate activity, especially for young women. When rationalizing the cessation of their active rave participation, however, these women reproduced depictions of rave participation as a transitory and juvenile phase where older women are particularly misplaced. The various ways that these women simultaneously challenged, experienced, and facilitated dominant ageist and patriarchal discourses about who does and does belong in rave are interpreted as evidence that micro rave experiences cannot be divorced from macro discriminatory discourses, and that "the personal is political."

Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.

The nature of avidyÄ in Buddhism and VedÄ nta

This thesis deals with the nature of ignorance as it was interpreted in the Upani~adic tradition, specifically in Advaita Vedanta, and in early and Mahayana Buddhism , e specially in the Madhyamika school of Buddhism. The approach i s a historical and comparative one. It examines the early thoughts of both the upanis.a ds and Buddhism abou t avidya (ignorance), shows how the notion was treated by the more speculative and philosphically oriented schools which base d themselves on the e arly works, and sees how their views differ. The thesis will show that the Vedinta tended to treat avidya as a topic for metaphysical s peculation as t he s chool developed, drifting from its initial e xistential concerns, while the Madhyamika remained in contact with the e xistential concerns evident in the first discourses of the Buddha. The word "notion" has been chosen for use in referring t o avidya, even though it may have non-intellectual and emotional connotations, to avoid more popular a lternatives such as "concept" or "idea". In neither the Upani,ads, Advaita Vedanta, or Buddhism is ignorance merely a concept or an idea. Only in a secondary sense, in texts and speech , does it become one. Avidya has more to do with the lived situation in which man finds himself, with the subjectobject separation in which he f eels he exists, than with i i i intel lect ual constr ucts . Western thought has begun to r ealize the same with concerns such as being in modern ontology, and has chosen to speak about i t i n terms of the question of being . Avidya, however, i s not a 'question' . If q ue stions we r e to be put regarding the nature of a vidya , they would be more of t he sort "What is not avidya?", though e ven here l anguage bestows a status t o i t which avidya does not have. In considering a work of the Eastern tradition, we f ace t he danger of imposing Western concepts on it. Granted t hat avidya is customari ly r endered i n English as ignorance, the ways i n which the East and West view i gno rance di f f er. Pedagogically , the European cultures, grounded in the ancient Greek culture, view ignorance as a l ack or an emptiness. A child is i gnorant o f certain t hings and the purpose o f f ormal education , in f act if not in theory, is to fill him with enough knowledge so that he can cope wit h t he complexities and the e xpectations of s ociety. On another level, we feel t hat study and research will l ead t o the discovery o f solutions, which we now lack , for problems now defying solut i on . The East, on the o t her hand, sees avidya in a d i fferent light.Ignorance isn't a lack, but a presence. Religious and philosophical l iterature directs its efforts not towards acquiring something new, but at removing t.he ideas and opinions that individuals have formed about themselves and the world. When that is fully accomplished, say the sages , t hen Wisdom, which has been obscured by those opinions, will present itself. Nothing new has to be learned, t hough we do have t o 'learn' that much. The growing interest in t he West with Eastern religions and philosophies may, in time, influence our theoretical and practical approaches to education and learning, not only in the established educati onal institutions, but in religious , p sychological, and spiritual activities as well. However, the requirements o f this thesis do no t permit a formulation of revolutionary method or a call to action. It focuses instead on the textual arguments which attempt to convince readers that t he world in which they take themselves to exist is not, in essence, real, on the ways i n which the l imitations of language are disclosed, and on the provisional and limited schemes that are built up to help students see through their ignorance. The metaphysic s are provisional because they act only as spurs and guides. Both the Upanisadic and Buddhist traditions that will be dealt with here stress that language constantly fails to encompass the Real. So even terms s uch as 'the Real', 'Absolute', etc., serve only to lead to a transcendent experience . The sections dealing with the Upanisads and Advaita Vedanta show some of the historical evolution of the notion of avidya, how it was dealt with as maya , and the q uestions that arose as t o its locus. With Gau?apada we see the beginnings of a more abstract treatment of the topic, and , the influence of Buddhism. Though Sankhara' S interest was primarily directed towards constructing a philosophy to help others attain mok~a ( l iberation), he too introduced t echnica l t e rminology not found in the works of his predecessors. His work is impressive , but areas of it are incomplete. Numbers of his followers tried to complete the systematic presentation of his insi ghts . Their work focuses on expl anat i ons of adhyasa (superimposition ) , t he locus and object of ignorance , and the means by which Brahman takes itself to be the jiva and the world. The section on early Buddhism examines avidya in the context o f the four truths, together with dubkha (suffering), the r ole it p l ays in t he chain of dependent c ausation , a nd t he p r oblems that arise with t he doctrine of anatman. With t he doct rines of e arly Buddhism as a base, the Madhyamika elaborated questions that the Buddha had said t e nded not t o edi f ication. One of these had to do with own - being or svabhava. Thi s serves a s a centr e around which a discussion o f i gnorance unfolds, both i ndividual and coll ective ignorance. There follows a treatment of the cessation of ignorance as it is discussed within this school . The final secti on tries to present t he similarities and differences i n the natures o f ignorance i n t he two traditions and discusses the factors responsible for t hem . ACKNOWLEDGEMENTS I would like to thank Dr. Sinha for the time spent II and suggestions made on the section dealing with Sankara and the Advait.a Vedanta oommentators, and Dr. Sprung, who supervised, direoted, corrected and encouraged the thesis as a whole, but especially the section on Madhyamika, and the final comparison.

The effects of the menstrual cycle and hormonal contraceptives on the central thermoeffector threshold temperatures and width of the interthreshold zone

Basal body temperature (BBT) and thermoeffector thresholds increase following ovulation in many women. This study investigated if solely central thermoregulatory alterations are responsible. Seven females in a non-contraceptive group (NCG) were compared with 5 monophasic contraceptive users (HCG) on separate accounts: pre-ovulation (Trial I; d 2-5) and post-ovulation (Trial 2; 4-8 d post-positive ovulation) for NCG, and active phase for HCG (d 2-5, d 18-21). During immersion in 28°C water to the axilla, participants exercised for 20-30 min on an underwater ergometer. After steadily sweating, immersion continued until metabolism increased two-fold due to shivering. Rectal (Tre) BBT was not different between trials for neither NCG (1: 37.34±0.16°C; 2: 37.35±0.27°C) nor HCG. At exercise termination, Tre forehead sweating cessation increased (P<0.05) in trial 2 irrespective of group (1: 37.55±0.39°C; 2: 37.90±0,46°C). Tre shivering onset did not increase (P>0.05) in trial 2 (1: 36.91±0.50°C; 2: 37.07±0,45°C). The widths of the interthreshold zone increased (P<0.05) in trial 2 (1: 0.64±0.22°C; 2: 0.82±0.37°C) due to the increased sweating threshold only. HCG cooled quicker (1: -l.15±0,43°C; 2: -1.00±0.50°C) than NCG participants (1: - 0.58±0.22°C; 2: -0.52±O.29°C), and tympanic (Tty) sweat thresholds were significantly (P<0.05) decreased (1: 34.76±0.54°C; 2: 35.39±0.61°C) versus NCG (l: 35.57±0.77°C; 2: 35.89±1.04°C). Lastly, Tre and Tty thresholds were significantly different (P

Minimal Contact Intervention for Tobacco Dependence

This study was conducted to measure the degree of adherence by public health care providers to a policy that requires them to implement minimal contact intervention for tobacco cessation with their clients. This study also described what components of the intervention may have contributed to the adherence of the policy and how health care providers felt about adhering to the policy. The intervention consisted of a policy for implementation of minimal contact intervention, changes to documentation, a health care provider mentor trained, a training session for health care providers, and ongoing paper and people supports for implementation. Data for this study were collected through a health care provider questionnaire, focus group interviews, and a compliance protocol including a chart audit. The findings of this study showed a high degree of adherence to the policy, that health care providers thought minimal contact intervention was important to conduct with their clients, and that health care providers felt supported to implement the intervention. No statistically significant difference was found between new and experienced health care providers on 17 of the 18 questions on the health care provider questionnaire. However there was a statistically significant difference between new and experienced health care providers with respect to their perception that “clients often feel like they have to accept tobacco cessation information from me.” Changes could be made to the minimal contact intervention and to documentation of the intervention. Implications for future research include implementation within other programs within Hamilton Public Health Services and implementation of this model within other public health units and other types of health care providers within Ontario.

Socio-demographic factors, smoking, symptoms, morbidities and pulmonary function and quality of life in individuals with a heavy smoking history

Objective: To determine which socio-demographic, exposure, morbidity and symptom variables are associated with health-related quality of life among former and current heavy smokers. Methods: Cross sectional data from 2537 participants were studied. All participants were at ≥2% risk of developing lung cancer within 6 years. Linear and logistic regression models utilizing a multivariable fractional polynomial selection process identified variables associated with health-related quality of life, measured by the EQ-5D. Results: Upstream and downstream associations between smoking cessation and higher health-related quality of life were evident. Significant upstream associations, such as education level and current working status and were explained by the addition of morbidities and symptoms to regression models. Having arthritis, decreased forced expiratory volume in one second, fatigue, poor appetite or dyspnea were most highly and commonly associated with decreased HRQoL. Discussion: Upstream factors such as educational attainment, employment status and smoking cessation should be targeted to prevent decreased health-related quality of life. Practitioners should focus treatment on downstream factors, especially symptoms, to improve health-related quality of life.