Case management for frequent users of the emergency department: study protocol of a randomised controlled trial.

BACKGROUND: We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients' emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. METHODS/DESIGN: We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient's allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient's satisfaction will also be collected at the baseline and 12 months later. DISCUSSION: Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01934322.

Sociogenetics of fire ants

RÉSUMÉ GRAND PUBLIC La complexité des sociétés d'insectes (telles que les abeilles, les termites ou les fourmis) a depuis longtemps fasciné l'Homme. Depuis le débfit du XIXème siècle, de nombreux travaux observationnels, comportementaux et théoriques leur on été consacrés afin de mieux les décrire et comprendre. L'avènement de la biologie moléculaire à la fin du XXèrne siècle a offert de nouveaux outils scientifiques pour identifier et étudier les gènes et molécules impliqués dans le développement et le comportement des êtres vivants. Alors que la majorité de ces études s'est focalisée sur des organismes de laboratoire tel que la mouche ou les nématodes, l'utilisation de ces outils est restée marginale jusqu'à présent dans l'étude des sociétés d'insectes. Lors de ma thèse, j'ai développé des outils moléculaires permettant de déterminer le niveau d'activité de zo,ooo gènes chez la fourmi de feu, Solenopsis invicta, ainsi qu'une base de données et un portail en ligne regroupant les informations relatives à l'étude génétique des fourmis: Fourmidable. J'ai ensuite utilisé ces outils dans le cadre d'une étude comportementale chez la fourmis S. invicta. Dans les sociétés d'insectes, une hiérarchie peut déterminer le statut reproducteur des individus. Suite à la mort d'un dominant, les subordonnés entrent en compétition en vue d'améliorer leur statut. Un tel phénomène se produit au sein des colonies de S. invicta contenant une unique reine mère, des milliers d'ouvrières et des centaines de reines vierges ailées. A la mort de la reine mère, un grand nombre de reines vierges tentent de la remplacer en arrachant leurs ailes et en activant leurs organes reproducteurs plutôt que de partir en vol nuptial. Ces tentatives sont le plus souvent arrêtées par les ouvrières qui exécutent la plupart de ces reines sur la base de signaux olfactifs produits lors de l'activation des organes reproducteurs. Afin de mieux comprendre les mécanismes moléculaires impliqués, j'ai étudié l'activité de gènes au sein des reines au début de ce processus. J'ai ainsi déterminé que des gènes impliqués dans communication olfactive, le développement des organes reproducteurs et la métabolisation de l'hormone juvénile sont activês à ce moment là. La vitesse à laquelle les reines perdent leurs ailes ainsi que les niveaux d'expression de gènes sont ensuite liés à leur probabilité de survie. ABSTRACT : Honeybees, termites and ants occupy the "pinnacle of social evolution" with societies of a complexity that rivals our own. Humans have long been fascinated by social insects, but studying them has been mostly limited to observational and behavioral experiments. The advent of molecular biology first made it possible to investigate the molecular-genetic basis of development in model systems such as the fruit fly Drosophila melarcogaster or the roundworm Caenorhabditis elegans and subsequently their behavior. Molecular and genomic tools are now becoming available for the study of social insects as well. To permit genomic research on the fire ant, Solenopsis invicta, we developed a cDNA microarray that can simultaneously determine the expression levels of approximately 1oooo genes. These genes were assembled and bioinformatically annotated using custom pipelines. The obtained data formed the cornerstones for Fourmidable, a web portal centralizing sequence, gene annotation and gene expression data as well as laboratory protocols for research on ants. In many animals living in groups the reproductive status of individuals is determined by their social status. In species with social hierarchies, the death of dominant individuals typically upheaves the social hierarchy and provides an opportunity for subordinate individuals to improve their social status. Such a phenomenon occurs in the monogyne form of S. invicta, where colonies typically contain a single wingless reproductive queen, thousands of workers and hundreds of winged non-reproductive virgin queens. Upon the death of the mother queen, many virgin queens shed their wings and initiate reproductive development instead of departing on a mating flight. Workers progressively execute almost all of them over the following weeks. The workers base their collective decision on pheromonal cues associated with the onset of reproductive development of the virgin queens which occurs after orphaning. We used the aforementioned tools to determine that genes putatively involved in processes including olfactory signaling, reproductive development and Juvenile Hormone metabolism are differentially expressed at the onset of competition. Additionally, we found that queens that initiate reproductive development faster and, to a certain extent, shed their wings faster after orphaning are more likely to become replacement queens. These results provide candidate genes that are putatively linked to competition outcome. To determine the extent to which specific genes affect different aspects of life in ant colonies, functional tests such as gene activation and silencing will still be required. We conclude by discussing some of the challenges and opportunities for molecular-genetic research on ants. RÉSUMÉ Les sociétés d'abeilles, de termites et de fourmis sont d'une complexité proche de celle de la nôtre et ont depuis longtemps fasciné l'Homme. Cependant, leur étude était jusqu'à présent limitée aux observations et expériences comportementales. L'avènement de la biologie moléculaire a d'abord rendu possible l'étude moléculaire et génétique du développement d'organismes modèles tels que la mouche Drosophila melanogaster ou le nématode Caenorhabditis elegans, puis dans un second temps de leur comportement. De telles études deviennent désormais possibles pour les insectes sociaux. Nous avons développé une puce à ADN permettant de déterminer simultanément les niveaux d'expression de 1oooo gènes de la fourmi de feu, Solenopsís invicta. Ces gènes ont été séquencés puis assemblés et annotés à l'aide de pipelines que nous avons développés. En se basant sur les informations obtenues, nous avons créé un portail web, Fourmidable. Ce portail vise à centraliser toutes les informations de séquence, d'annotation et d'expression de gènes, ainsi que les protocoles de laboratoire utilisés pour la recherche sur les fourmis. Par la suite, nous avons utilisé les outils développés pour étudier un aspect particulier de S. invicta. Chez les animaux grégaires, une hiérarchie sociale peut déterminer le statut reproducteur des individus. Suite à la mort d'un individu dominant, les individus subordonnés peuvent entrer en compétition en vue d'améliorer leur statut. Un tel phénomène se produit au sein des colonies monogynes de S. invicta, qui contiennent habituellement une unique reine mère, des milliers d'ouvrières et des centaines de reines vierges ailées. Suite à la mort de la reine mère, dominante, un grand nombre de reines vierges, subordonnées, perdent leurs ailes et activent leurs organes reproducteurs au lieu de partir en vol nuptial. Au cours des semaines suivantes, les ouvrières exécutent la plupart de ces reines sur la base de signaux olfactifs produits lors de l'activation des organes reproducteurs. Afin de mieux comprendre les mécanismes moléculaires impliqués, nous avons étudié l'expression de gènes au début de cette compétition. Nous avons identifié 297 gènes différemment exprimés, dont l'annotation indique qu'ils seraient impliqués dans des processus biologiques dont la communication olfactive, le développement des organes reproducteurs et la métabolisation de l'hormone juvénile. Par la suite, nous avons déterminé que la vitesse à laquelle les reines perdent leurs ailes en début de compétition ainsi que les niveaux d'expression de gènes sont corrélés à la probabilité de survie des reines. Nous concluons en discutant des opportunités offertes par la recherche génétique sur les fourmis ainsi que les défis qu'elle devra surmonter.

Risk of mental disorders in children of parents with alcohol or heroin dependence: a controlled high-risk study.

Aim: To assess the specific effect of alcohol dependence (AD) or heroin dependence (HD) in patients and their spouses on the risk of psychopathology in their 276 6.0- to 17.9- year-old children (mean 11.3 years). Methods: The sample included 101 offspring of patients with AD, 23 of patients with HD, and 152 of medical controls, as well as their 2 parents. Participants were assessed using semistructured diagnostic interviews and family history reports by psychologists blind to patient diagnoses. Results: Children of HD and AD patients had largely elevated rates of recurrent major depressive disorder. Children of HD patients were also at an increased risk for attention deficit hyperactivity disorder and substance use disorders (SUD). There were interactions between SUD in the 2 parents to increase the risk of SUD in offspring. Conclusions: These results emphasize the need for prompt identification and treatment of these children and highlight the need to pay clinical attention not only to the patient, but also to the co-parent in order to optimize prevention in offspring.

The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial.

AIMS: To evaluate the effect of a structured preoperative preparation on child and parent state anxiety, child behavioural change and parent satisfaction. BACKGROUND: It is estimated that around 50-70% of hospitalised children experience severe anxiety and distress prior to surgery. Children who are highly anxious and distressed preoperatively are likely to be distressed on awakening and have negative postoperative behaviour. Although education before surgery has been found to be useful mostly in North America, the effectiveness of preoperative preparation programme adapted to the Australian context remains to be tested. DESIGN: This single-blind randomised controlled study was conducted at a tertiary referral hospital for children in Western Australia. METHODS: Following ethics approval and parental consent, 73 children and one of their carers (usually a parent) were randomly assigned into two groups. The control group had standard practice with no specific preoperative education and the experimental group received a preoperative preparation, including a photo file, demonstration of equipment using a role-modelling approach and a tour. RESULTS: The preoperative preparation reduced parent state anxiety significantly (-2·32, CI -4·06 to -0·56, p = 0·009), but not child anxiety (-0·59, CI -1·23 to 0·06, p = 0·07). There was no significant difference in child postoperative behaviour or parent satisfaction between the groups. There was a significant two-point pain score reduction in the preoperative preparation group, when compared with the control group median 2 (IQR 5) and 4 (IQR 4), respectively (p = 0·001).¦CONCLUSIONS: Preoperative preparation was more efficient on parent than child. Although the preoperative preparation had limited effect on child anxiety, it permitted to decrease pain experience in the postoperative period.¦RELEVANCE TO CLINICAL PRACTICE: Parents should be actively involved in their child preoperative preparation.

Audit report on the Westory Fire Agency for the year ended June 30, 2011

Audit report on the Westory Fire Agency for the year ended June 30, 2011

Special investigation of the City of Denison Fire Department for the period July 1, 2005 through March 31, 2010

Special investigation of the City of Denison Fire Department for the period July 1, 2005 through March 31, 2010

Controlled expression of recombinant proteins in Physcomitrella patens by a conditional heat-shock promoter: a tool for plant research and biotechnology.

The ability to express tightly controlled amounts of endogenous and recombinant proteins in plant cells is an essential tool for research and biotechnology. Here, the inducibility of the soybean heat-shock Gmhsp17.3B promoter was addressed in the moss Physcomitrella patens, using beta-glucuronidase (GUS) and an F-actin marker (GFP-talin) as reporter proteins. In stably transformed moss lines, Gmhsp17.3B-driven GUS expression was extremely low at 25 degrees C. In contrast, a short non-damaging heat-treatment at 38 degrees C rapidly induced reporter expression over three orders of magnitude, enabling GUS accumulation and the labelling of F-actin cytoskeleton in all cell types and tissues. Induction levels were tightly proportional to the temperature and duration of the heat treatment, allowing fine-tuning of protein expression. Repeated heating/cooling cycles led to the massive GUS accumulation, up to 2.3% of the total soluble proteins. The anti-inflammatory drug acetyl salicylic acid (ASA) and the membrane-fluidiser benzyl alcohol (BA) also induced GUS expression at 25 degrees C, allowing the production of recombinant proteins without heat-treatment. The Gmhsp17.3B promoter thus provides a reliable versatile conditional promoter for the controlled expression of recombinant proteins in the moss P. patens.

Insuffisance rénate chronique: attitudes et pratiques de dépistages en l'absence d'etudes randomisées. [Chronic kidney disease: screening attitude and practice in the absence of randomized controlled trials].

Au vu de l'augmentation de la prévalence de l'insuffisance rénale chronique (IRC), une détection précoce a été proposée. Certaines organisations de santé proposent des mesures de détection précoce (par exemple : taux de filtration glomérulaire). L'efficacité du dépistage de l'IRC n'est cependant pas connue puisqu'aucune étude randomisée contrôlée n'a été conduite. Si le test de dépistage de l'IRC est simple et peu onéreux, un dépistage n'est justifié que s'il améliore le pronostic par rapport à l'absence de dépistage avec un rapport risques-bénéfices favorable et un rapport coût-efficacité acceptable. Sur la base d'études observationnelles et de modèles de rapport coût-efficacité, le dépistage de l'IRC doit être proposé chez les patients hypertendus et/ou diabétiques mais pas dans la population générale. [Abstract] Given the increasing prevalence of chronic kidney disease (CKD), early detection has been proposed. Some organizations recommend CKD screening. Yet, the efficacy of CKD screening is unknown given the absence of randomized controlled trial conducted so far. While CKD screening tests (e.g., glomerular filtration rate) are simple and inexpensive, CKD screening can only be justified if it reduces CKD-related mortality and/or CKD-related morbidity compared to no screening. In addition, CKD screening must provide more benefits than risks to the participants and must be cost-effective. Based on observational studies and cost-effectiveness models, CKD screening has to be proposed to high risk population (patients with hypertension and/or diabetes) but not to the general population.

Current status of a model system: the gene Gp-9 and its association with social organization in fire ants.

The Gp-9 gene in fire ants represents an important model system for studying the evolution of social organization in insects as well as a rich source of information relevant to other major evolutionary topics. An important feature of this system is that polymorphism in social organization is completely associated with allelic variation at Gp-9, such that single-queen colonies (monogyne form) include only inhabitants bearing B-like alleles while multiple-queen colonies (polygyne form) additionally include inhabitants bearing b-like alleles. A recent study of this system by Leal and Ishida (2008) made two major claims, the validity and significance of which we examine here. After reviewing existing literature, analyzing the methods and results of Leal and Ishida (2008), and generating new data from one of their study sites, we conclude that their claim that polygyny can occur in Solenopsis invicta in the U.S.A. in the absence of expression of the b-like allele Gp-9(b) is unfounded. Moreover, we argue that available information on insect OBPs (the family of proteins to which GP-9 belongs), on the evolutionary/population genetics of Gp-9, and on pheromonal/behavioral control of fire ant colony queen number fails to support their view that GP-9 plays no role in the chemosensory-mediated communication that underpins regulation of social organization. Our analyses lead us to conclude that there are no new reasons to question the existing consensus view of the Gp-9 system outlined in Gotzek and Ross (2007).

Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics.

OBJECTIVE: Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder. METHOD: The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and supportive counselling + placebo (Supp + Placebo; n = 28). A fourth group of young people who did not agree to randomization were also followed up (monitoring: n = 78). Baseline characteristics of participants are provided. RESULTS AND CONCLUSION: The present study improves on the previous studies because treatment was provided for 12 months and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared. Issues associated with recruitment and randomization are discussed.

Duloxetine inhibits effects of MDMA ("ecstasy") in vitro and in humans in a randomized placebo-controlled laboratory study.

This study assessed the effects of the serotonin (5-HT) and norepinephrine (NE) transporter inhibitor duloxetine on the effects of 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy) in vitro and in 16 healthy subjects. The clinical study used a double-blind, randomized, placebo-controlled, four-session, crossover design. In vitro, duloxetine blocked the release of both 5-HT and NE by MDMA or by its metabolite 3,4-methylenedioxyamphetamine from transmitter-loaded human cells expressing the 5-HT or NE transporter. In humans, duloxetine inhibited the effects of MDMA including elevations in circulating NE, increases in blood pressure and heart rate, and the subjective drug effects. Duloxetine inhibited the pharmacodynamic response to MDMA despite an increase in duloxetine-associated elevations in plasma MDMA levels. The findings confirm the important role of MDMA-induced 5-HT and NE release in the psychotropic effects of MDMA. Duloxetine may be useful in the treatment of psychostimulant dependence. TRIAL REGISTRATION: Clinicaltrials.gov NCT00990067.