Neuropsychological predictors of treatment outcome in obsessive compulsive disorder (OCD)

Contexte: En dépit de la preuve substantielle pour l'efficacité générale de la thérapie cognitivo-comportementale pour le trouble obsessionnel-compulsif (TOC), il existe une controverse à propos de l'amélioration de certains déficits neuropsychologiques dans ce trouble. Objectif: Le but de cette étude est d'évaluer: 1) la corrélation de la gravité du TOC et les résultats des tests neuropsychologiques et 2) l'amélioration clinique et neuropsychologique des patients souffrant de TOC qui ont terminé avec succès leur traitement. Méthode: Cette étude évalue les fonctions neurocognitives et l'état clinique de 27 participants du groupe TOC et 25 participants du groupe témoin. La fonction neurocognitive de chaque participant a été évaluée en utilisant le test de Rey-Osterreich Figure complexe (RCFT), le test de fluidité D-KEFS et l’essai Cardebat-D. Nous avons également, utilisé l'inventaire d'anxiété de Beck (IAB), l’Inventaire de dépression de Beck (IDB) et l'échelle d'obsession-compulsion de Yale-Brown (Y-BOCS) pour vérifier la présence de l'anxiété et de la dépression avec le TOC et la gravité des symptômes chez les patients souffrant de TOC. Résultats: Notre étude conclut qu’il y une différence significative de la fonction de la mémoire selon le score au sous test de copie entre les participants souffrant de TOC et le groupe témoin. De plus, nous avons constaté une différence considérable dans le score de rappel immédiat et différé du RCFT avant et après le traitement dans le groupe de TOC. Conclusion: En résumé, la présente étude a démontré que les patients atteints de TOC ont des troubles cognitifs spécifiques et que la thérapie cognitivo-comportementale serait un traitement qui pourrait améliorer, au moins, certaines dysfonctions neurocognitives.

Mental health treatment seeking by military members with posttraumatic stress disorder : findings on rates, characteristics, and predictors from a nationally representative Canadian military sample

Objective: The goal of this study was to identify rates, characteristies, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD). Method: Our sample was drawn from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable. Results: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without. Conclusions: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.

Les admissions hospitalières pour les infections urinaires: tendances temporelles, fardeau économique et facteurs prédicateurs de mauvaise évolution des patients

Résumé Introduction: Les infections urinaires (IU) sont les infections bactériennes les plus fréquentes chez les patients hospitalisés. Cette étude décrit les tendances temporelles d'admission et de mortalité liées aux hospitalisations pour les IU, ainsi que le fardeau économique associé. Les prédicteurs de mauvaise évolution clinique et de mortalité sont examinés par la suite. Méthodes: Les données ont été extraites à partir de la base de données du NIS entre le 1er janvier 1998 et le 31 décembre 2010. 1,717,181 hospitalisations liées aux IU ont été retenues. L'incidence et la mortalité ont été calculées et stratifiées selon le sexe, l'âge et la présence de sepsis. Les frais médians et totaux pour les hospitalisations sont calculés et ajustés pour l'inflation. Finalement, les prédicteurs d'avoir un sepsis induit par les IU et de mortalité sont examinés avec une analyse par régression logistique multivariée. Résultats: L'incidence globale d'hospitalisation et la mortalité associées aux IU voit une croissance annuel estimé (EAPC) de +4.764 et +4.610 respectivement (p<0.0001). L'augmentation d'incidence est le plus marquée pour les patients âgés de 55 à 64 ans (EAPC = +7.805; p<0.0001). Les frais médians par hospitalisation ont augmenté de $10 313 en 1998 à $21 049 en 2010 (EAPC +9.405; p<0.0001). Les frais globaux pour les hospitalisations des IU ont augmenté de $8.9 milliard en 1998 à $33.7 milliard en 2010 (EAPC +0.251; p<0.0001). Les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité (p<0.0001). Conclusion: L'incidence et la mortalité associées aux IU ont augmenté au cours de la dernière décennie. Les frais médians ajustés pour l'inflation ainsi que les frais globaux ont augmenté progressivement au cours de la période d'étude. Dans la cohorte étudiée, les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité. Ces données représentent des indicateurs de qualité de soins qui pourraient permettre d'adapter certaines politiques de soins de santé aux besoins des sous-populations plus vulnérables.

Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Supply response and Cost of production of natural rubber- an econometric study

The study deals with the short and long term supply response of the natural rubber in India and to analyse the macro economic environment of NR industry and causative factors of the rubber price crash. It determines the minimum cost of production of natural rubber and to forecast the potential production of NR in India. There is positive response of short run and long run supply to prices. Since correlation analysis show close association between international and domestic price level, international price changes will have its domestic echo. Production and consumption will sustain its rising trend. This makes plans for increasing production estimates show that a mid way level i.e. the range between Rs.32-Rs.38 will give a fair enough profit to the grower in the present situation and provide for the viable sustenance of rubber cultivation. Identification of the SWOT of rubber cultivation would help in supporting rubber cultivation if remedial measures are undertaken with the true spirit. This would help Indian rubber to attain global competitiveness. Then the inflow of valuable foreign exchange will overcome the other economic drawbacks of rubber cultivation

Simple Low-cost Planar Antenna for Indoor Communication under the Bluetooth Protocol

A single-feed rectangular-ring microstrip antenna is proposed for indoor communication under the Bluetooth protocol. The dimensions of the antenna together with the location of the feed point are optimized through field simulations in order to cover the Bluetooth bandwidth and to avoid linear polarization. The performance and the efficiency of the antenna are illustrated in a real indoor environment

Reactive loaded microstrip leaky wave antenna for low cost beam steering applications

A novel fixed frequency beam scanning microstrip leaky wave antenna is reported. The beam scanning at fixed frequency is achieved by reactive loading. Simulation and measured results shows frequency scanability of 80° as well as fixed frequency beam steering of 68° over the −10 dB impedance band of 4.56–5.06 GHz.

Development of Innovative Low Cost Larviculture Technologies of the Giant Fresh Water Prawn,Macrobrachium Rosenbergii(De Man)

School of Industrial Fisheries, Cochin University of Science and Technology

Studies on the macrobenthos of mudbanks of Southwest cost of India

The present study was undsrtaken.with the objectives to assess the distribution and density of population of benthic animals with special reference to macrofauna from the south west coast of India from ' Malippursa 1 in the north to Alleppey in the south, to evaluate significant difference, if any, in the number and distribution of animals in th md bank regions and other intermittent stations, to examine the influence of bottom stability on the distribution of fauna, to observe the effect of the environmental parameters on the distribution pattern of nacrofauna, and to evaluate the nature and depthpwise distribution of the benthic fishery. The region selected for the investigation is one of the nest important fishing grounds in India for bottom fishing especially for prawns, covering a distance of about 60 kns in length.total number of thirty stations in five transects at right angles to the coast, each consisting of six stations were surveyed. The six stations in a transect were at depths of 5 m, 10m, 20:, 30:, 35m and 45m respectively formation of the Iudbanke, popularly known as 'Ghaknra' in the local language, is a peculiar phenomenon along the ooaet of Kerala and provides a good fishing ground.quantitative distribution of the mecrofauna chewed that the maximum number of organism was near the 35 n contour line in the first three profiles whereas in the fourth and fifth profiles it was at 20 n and 30 m depth respectively. The density of the fauna wee comparatively poor in shallow water etatione at depths 5-‘IO M.was a general decline in the numerical abundance and biomass of the bottom fauna in all the stations during the monsoon period. There has been very little yearly change in the composition of the fauna during the two years‘ study.

Investment analysis of chemical projects and development of standerdised mathematical co-relation for cost estimation of pressure vessels in chemical industry

The present study is intended to provide a new scientific approach to the solution of the worlds cost engineering problems encountered in the chemical industries in our nation. The problem is that of cost estimation of equipments especially of pressure vessels when setting up chemical industries .The present study attempts to develop a model for such cost estimation. This in turn is hoped would go a long way to solve this and related problems in forecasting the cost of setting up chemical plants.

A study of the cost structure of the cashew industry in kerala, karnataka and tamilnadu

Since the world demand for cashew kernels has been rising steadily for several years in the past, conferring significant price increase the processing of cashew remains a highly profitable lndustry. India being the earliest and largest supplier of cashew kernels in the world market it is our prestigious obligations to reestablish her pristine monopoly. Further the added importance ot the indutry in the Socio economic context of the State of Kerala makes various measures impervative in order to bring back to the industry its pristine glory at the late sixties to give a face lift and to stabilize the industry. This present study adopts a comprehensive frame work of analysis compassing the major issues involved in the cultivation, distribution, import, processing and marketing of cashew undcr the private and public sector, migration of the industry and the financial requirements of the industry.

Time and cost overruns of industrial projects in kerala

Poor project planning, implementation and control and the subsequent cost and time overruns are ubiquitous features that have been posing serious concern at all levels - state, national and international. It results in wastage of the nation's scarce resources and retards the socio-economic progress. Although several studies peripheral on project overruns have been made at the national level, no serious attempt has been made at the state level to identify the magnitude of overruns, their causes and impacts on industrial projects. The present study "Time and Cost Overruns of Industrial Projects in Kerala" is an earnest attempt to probe in depth the time and cost overruns and their impact on industrial projects. The study places emphasise on the identification of the real reasons behind the cost and time overruns. It also covers the present project management practices of industrial projects in Kerala.

Cost accountancy and cost control in hospitals

It is a fact that there now exists a sound framework of accounting theory to ascertain the working results and the investment status of hospitals. Yet, there is no system of accounting in practice to conduct its activities with utmost efficiency. No attempts have hitherto been made for the continuous improvement in the servics rendered by hospitals. Personal investments in hospitals have made the interaction of business to some extent.Planning, decision making and control assume increasing importance as hospitals grow in size and complexity. Moreover, wise and effective utilisation of resources should be ensured. The importance of cost cannot be overlooked in this context. Cost is the most effective factor in the determination of the prices of hospital services rendered. The important managerial functions have to rely heavily on accurate and timely cost information. More people can be provided with services if no services cost more than what is a must to provide the necessary level of care. The price paid for high cost technology for a few is no technology at all for the many. Hence no pains must be spared in ascertaining, presenting, controlling and reducing costs. An effective system of Cost Accountancy and Cost Control is imperative for the survival of hospitals in the intensely competitive conditions of today. The valuable objective of "better patient care" can be attained only if the management can make use of the various tools and techniques to ascertain, control and reduce each item of cost in hospitals. Constant efforts must be made by the management to continuously improve their services and bring down costs and prices of all hospital services. Cost Accountancy has made its impresssive impact on almost all the spheres of human activities. It is high time a comprehensive Cost Accountancy and Cost Control system be implemented in hospitals. The problem under study thus is the designing of a sound and full-fledged Cost Accountancy and Cost Control system that suits the requirements of hospitals. It is for the first time in India during the evolution of Cost Accountancy that a comprehensive cost system is tried in hospitals.