Loss of ability to work and ability to live independently in Parkinson's disease.

OBJECTIVE: Ability to work and live independently is of particular concern for patients with Parkinson's disease (PD). We studied a series of PD patients able to work or live independently at baseline, and evaluated potential risk factors for two separate outcomes: loss of ability to work and loss of ability to live independently. METHODS: The series comprised 495 PD patients followed prospectively. Ability to work and ability to live independently were based on clinical interview and examination. Cox regression models adjusted for age and disease duration were used to evaluate associations of baseline characteristics with loss of ability to work and loss of ability to live independently. RESULTS: Higher UPDRS dyskinesia score, UPDRS instability score, UPDRS total score, Hoehn and Yahr stage, and presence of intellectual impairment at baseline were all associated with increased risk of future loss of ability to work and loss of ability to live independently (P ≤ 0.0033). Five years after initial visit, for patients ≤70 years of age with a disease duration ≤4 years at initial visit, 88% were still able to work and 90% to live independently. These estimates worsened as age and disease duration at initial visit increased; for patients >70 years of age with a disease duration >4 years, estimates at 5 years were 43% able to work and 57% able to live independently. CONCLUSIONS: The information provided in this study can offer useful information for PD patients in preparing for future ability to perform activities of daily living.

Work values, endogenous sentiments and redistribution

We examine the interactions between individual behavior, sentiments and the social contract in a model of rational voting over redistribution. Agents have moral "work values". Individuals' self-esteem and social consideration of others are endogenously determined comparing behaviors to moral standards. Attitudes toward redistribution depend on self-interest and social preferences. We characterize the politico-economic equilibria in which sentiments, labor supply and redistribution are determined simultaneously. The equilibria feature different degrees of "social cohesion" and redistribution depending on pre-tax income inequality. In clustered equilibria the poor are held partly responsible for their low income since they work less than the moral standard and hence redistribution is low. The paper proposes a novel explanation for the emergence of different sentiments and social contracts across countries. The predictions appear broadly in line with well-documented differences between the United States and Europe.

Mechanical external work and recovery at preferred walking speed in obese subjects

PURPOSE: The aim of this study was to compare the mechanical external work (per kg) and pendular energy transduction at preferred walking speed (PWS) in obese versus normal body mass subjects to investigate whether obese adults adopt energy conserving gait mechanics. METHODS: The mechanical external work (Wext) and the fraction of mechanical energy recovered by the pendular mechanism (Rstep) were computed using kinematic data acquired by an optoelectronic system and were compared in 30 obese (OG; body mass index [BMI] = 39.6 +/- 0.6 kg m(-2); 29.5 +/- 1.3 yr) and 19 normal body mass adults (NG; BMI = 21.4 +/- 0.5 kg m(-2); 31.2 +/- 1.2 yr) walking at PWS. RESULTS: PWS was significantly lower in OG (1.18 +/- 0.02 m s(-1)) than in NG (1.33 +/- 0.02 m s(-1); P <or= 0.001). There was no significant difference in Wext per unit mass between groups (OG: 0.36 +/- 0.03 J kg(-1) m(-1); NG: 0.31 +/- 0.02 J kg(-1) m(-1); P = 0.12). Rstep was significantly lower in OG (68.4% +/- 2.0%) compared with NG (74.4% +/- 1.0%; P = 0.01). In OG only, Wext per unit mass was positively correlated with PWS (r = 0.57; P < 0.001). CONCLUSION: Obese adults do not appear to alter their gait to improve pendular energy transduction and may select slower PWS to reduce mechanical and metabolic work.

Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems.

ABSTRACT: BACKGROUND: Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD. METHODS: A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings. RESULTS: In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA. CONCLUSION: This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.

The Academic Work and Careers in Europe : Trends, Challenges, Perspectives

This book explores the perceptions of academic staff and representatives of institutional leadership about the changes in academic careers and academic work experienced in recent years. It emphasizes standardization and differentiation of academic career paths, impact of new forms of quality management on academic work, changes in recruitment, employment and working conditions, and academics' perceptions of their professional contexts. The book demonstrates a growing diversity within the academic profession and new professional roles inhabiting a space which is neither located in the core business of teaching and research nor at the top level management and leadership. The new higher education professionals tend to be important change agents within the higher education institutions not only fulfilling service and bridging functions but also streamlining academic work to make a contribution to the reputation and competitiveness of the institutions as a whole. Based on interviews with academic staff, this book explores the situation in eight European countries: Austria, Croatia, Finland, Germany, Ireland, Romania, and Switzerland.

Cost evaluation of cardiac magnetic resonance imaging versus coronary angiography for the work-up of coronary artery disease

Background: CMR has recently emerged as a robust and reliable technique to assess coronary artery disease (CAD). A negative perfusion CMR test predicts low event rates of 0.3-0.5%/year. Invasive coronary angiography (CA) remains the "gold standard" for the evaluation of CAD in many countries.Objective: Assessing the costs of the two strategies in the European CMR registry for the work-up of known or suspected CAD from a health care payer perspective. Strategy 1) a CA to all patients or 2) a CA only to patients who are diagnosed positive for ischemia in a prior CMR.Method and results: Using data of the European CMR registry (20 hospitals, 11'040 consecutive patients) we calculated the proportion of patients who were diagnosed positive (20.6%), uncertain (6.5%), and negative (72.9%) after the CMR test in patients with known or suspected CAD (n=2'717). No other medical test was performed to patients who were negative for ischemia. Positive diagnosed patients had a coronary angiography. Those with uncertain diagnosis had additional tests (84.7%: stress echocardiography, 13.1%: CCT, 2.3% SPECT), these costs were added to the CMR strategy costs. Information from costs for tests in Germany and Switzerland were used. A sensibility analysis was performed for inpatient CA. For costs see figure. Results - costs.Discussion: The CMR strategy costs less than the CA strategy for the health insurance systems both, in Germany and Switzerland. While lower in costs, the CMR strategy is a non-invasive one, does not expose to radiation, and yields additional information on cardiac function, viability, valves, and great vessels. Developing the use of CMR instead of CA might imply some reduction in costs together with superior patient safety and comfort, and a better utilization of resources at the hospital level. Document introduit le : 01.12.2011

The effects of teacher talk on students’ oral productions

The present study is a brief personal enquiry into the teaching and learning of EFL in the classroom with an orientation to action and personal professional development. It focuses on teacher talk, making special emphasis on questions, as well as on students’ resulting oral productions. The research contains samples of empirical data, which include their interpretations in the light of relevant research literature, and a more personal overall reflection of the teaching practice. Both the analysis and the reflections derive to a large extent from the self-observation paper 1 (SO1) and the Practicum portfolio (PP) developed within the TED Masters Degree practicum stages

Cooperative learning: learning to cooperate, cooperating to learn

This research project is an attempt to give arguments in favour of using cooperative learning activities in FL classrooms as an effective approach to learning. The arguments offered are presented from two different perspectives: the first one is based on the empirical study of three students working together to achieve a common goal. The second one is a compilation of the trainee teacher's experiences during her practicum periods in a high school regarding group work. This part is illustrated by some examples that emphasize that cooperative learning can facilitate learning, promote socialisation and increase students' self-esteem

Teacher strategies to elicit knowledge from students in the CLIL classroom: the purpose of questions in controlled patterns of teacher-student interaction

This Master Dissertation comprises two parts: a personal reflection and an empirical study. The personal reflection reviews the process of professionalization undergone by its author throughout the Master. The empirical study tackles teacher strategies to elicit knowledge from students in the CLIL classroom and more specifically the purpose of questions in controlled patterns of teacher-student interaction. The theories of relevant authors such as Vigotsky, Mercer and Tsui are used as a framework to analyze the data presented. The analysis shows the different strategies to elicit knowledge used by the teacher and the appropriateness of her questions in the analyzed interaction

The first steps of a secondary school teacher: experiences and studies of a student-teacher

This dissertation aims at fostering the professional development of the EFL teacher. This document compiles two small scale empirical studies carried out during the practicum periods of the TED's course. The first one is based on the role of the teacher's talk in the EFL classroom and the second one focuses on students’ small group talk, analysing the impact of cooperative learning in the EFL classroom by examining students' conversation. The following section gathers the teacher's personal reflections upon the process of professionalization. The paper concludes with a summary of the major findings and further professional improvement proposals

Desenvolupament d'eines per l'apliació de l'aprenentatge basat en projectes a l'enginyeria tècnica de telecomunicacions

El projecte d'innovació docent s'emmarca dintre de la línia de treball de l'Escola Politècnica Superior de Castelldefels. Aquesta escola, des de els seus inicis ha destacat per la seva aposta per la innovació docent i l'aplicació de mètodes pedagògics pioners arreu d'Espanya. El sistema d'ensenyament basat en el seguiment individualitzat de l'estudiant, facilitat per una bona relació professor/nombre d'estudiants (grups de 40 o 20 estudiants), l'avaluació continuada, que parteix de les activitats acadèmiques realitzades en una matèria, i l'avaluació curricular, que atén el rendiment global de l'estudiant, fan que el sistema fomenti el treball regular al mateix temps que l'informa en tot moment del seu progrés acadèmic. Per un altre banda, dintre del sistema educatiu de la nostra escola podem destacar l'aplicació de l'Aprenentatge Basat en Projectes (PBL), aplicat inicialment als estudis de Segon Cicle. D'acord amb aquest model, els alumnes aprenen realitzant projectes en grup. Les intervencions del professorat i els materials del curs estan orientats a donar suport a les necessitats dels projectes que es desenvolupen a cada moment. Tot seguint la línia de treball de l'escola i la seva adequació als criteris determinats en el Espai Europeu d'Educació Superior, aquest projecte segueix tres línies d’actuació: (1) incideix en l'aplicació del PBL dintre d'assignatures Optatives i en assignatures de primers cursos de la Titulació d'Enginyeria de Telecomunicacions, (2) estimular l’alumnat, a través de treballs interdisciplinaris i la utilització de les noves tecnologies, (3) generació de documentació adaptada als nous plans d’estudi. Aquestes línies d’actuació es desenvolupen per motivar els alumnes en els estudis d'enginyeria que estan cursant i fer-los veure l'aplicabilitat, en el camp de la recerca, de gran quantitat dels coneixements que van adquirint durant la seva formació dintre de la Universitat.

Projecte pilot d'innovació docent de l'assignatura Estructura de Computadors I

L'objectiu del projecte ha estat la millora de la qualitat docent de l'assignatura Estructura de Computadors I, impartida a la Facultat d'Informàtica de Barcelona (UPC) dins els estudis d'Enginyeria Informàtica, Enginyeria Tècnica en Informàtica de Sistemes i Enginyeria Tècnica en Informàtica de Gestió. S'ha treballat en quatre línies d'actuació: (i) aplicació de tècniques d'aprenentatge actiu a les classes; (ii) aplicació de tècniques d'aprenentage cooperatiu no presencials; (iii) implantació de noves TIC i adaptació de les ja emprades per tal d'habilitar mecanismes d'autoavaluació i de realimentació de la informació referent a l'avaluació; i (iv) difusió de les experiències derivades de les diferents actuacions. Referent a les dues primeres mesures s'avalua l'impacte de metodologies docents que afavoreixen l'aprenentatge actiu tant de forma presencial com no presencial, obtenint-se clares millores en el rendiment respecte a altres metodologies utilitzades anteriorment enfocades a la realització de classes del tipus magistral, en què únicament es posa a l'abast dels alumnes la documentació de l'assignatura per a què puguin treballar de forma responsable. Les noves metodologies fan especial èmfasi en el treball en grup a classe i la compartició de les experiències fora de classe a través de fòrums de participació. La mesura que ha requerit més esforç en aquest projecte és la tercera, amb el desenvolupament d'un entorn d'interfície web orientat a la correcció automàtica de programes escrits en llenguatge assemblador. Aquest entorn permet l'autoavaluació per part dels alumnes dels exercicis realitzats a l'assignatura, amb obtenció d'informació detallada sobre les errades comeses. El treball realitzat dins d'aquest projecte s'ha publicat en congressos rellevants en l'àrea docent tant a nivell estatal com internacional. El codi font de l'entorn esmentat anteriorment es posa a disposició pública a través d'un enllaç a la web.