Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011.

BACKGROUND AND PURPOSE: Surgical clipping of unruptured intracranial aneurysms (UIAs) has recently been challenged by the emergence of endovascular treatment. We performed an updated systematic review and meta-analysis on the surgical treatment of UIAs, in an attempt to determine the aneurysm occlusion rates and safety of surgery in the modern era. METHODS: A detailed protocol was developed prior to conducting the review according to the Cochrane Collaboration guidelines. Electronic databases spanning January 1990-April 2011 were searched, complemented by hand searching. Heterogeneity was assessed using I(2), and publication bias with funnel plots. Surgical mortality and morbidity were analysed with weighted random effect models. RESULTS: 60 studies with 9845 patients harbouring 10 845 aneurysms were included. Mortality occurred in 157 patients (1.7%; 99% CI 0.9% to 3.0%; I(2)=82%). Unfavourable outcomes, including death, occurred in 692 patients (6.7%; 99% CI 4.9% to 9.0%; I(2)=85%). Morbidity rates were significantly greater in higher quality studies, and with large or posterior circulation aneurysms. Reported morbidity rates decreased over time. Studies were generally of poor quality; funnel plots showed heterogeneous results and publication bias, and data on aneurysm occlusion rates were scant. CONCLUSIONS: In studies published between 1990 and 2011, clipping of UIAs was associated with 1.7% mortality and 6.7% overall morbidity. The reputed durability of clipping has not been rigorously documented. Due to the quality of the included studies, the available literature cannot properly guide clinical decisions.

« Recueil de matières de finance pour l'instruction du Roy, par M. D. C[HANDÉ]. Tome Ier. — 1722 ».

Contient : Abrégé chronologique des monnoies ; Dissertation sur la livre de compte ; Ferme du tabac ; Francs-fiefs ; Amortissemens ; Huitième et sixième denier ecclésiastique ; Insinuations laïques ; Controlle des actes des notaires ; Petits scels ; Cartes à jouer

Individual difference factors and men's attraction to female body features /

Existing research on attraction to body features has suggested that men show general preferences for women with lower waist-to-hip ratios (WHR), larger breasts, and slender body weights. The present study intended to expand on this research by investigating several individual difference factors and their potential contribution to variation in what men find attractive in female body features. Two hundred and seventy-three men were assessed for sex-role identity, 2D:4D digit ratios (a possible marker of prenatal exposure to androgens, and thus masculinization), physical attractiveness, early sexual experiences (as indices of early sexual conditioning), and early family attitudes toward body features, as well as their current preferences for WHR, breast size, weight, and height in women. For WHR, as predicted, physical attractiveness, early sexual experiences, and lower (more masculine) right-hand 2D:4D ratios significantly predicted current preferences for more feminine (lower) WHR. Early sexual experiences significantly predicted later preferences for breast size; in addition, more masculine occupational preferences and lower (more masculine) left-hand 2D:4D ratios predicted preferences for larger breasts. Participants' height, education level, Unmitigated Agency (masculinity) scores, and early sexual experiences significantly predicted current preferences for height. Finally, early sexual experiences significantly predicted current preferences for weight. The results suggest that variation in preferences for women's bodily features can be uniquely accounted for by a number of individual difference factors. Strengths and weaknesses of the study, along with implications for future research, are discussed.

The Midnight express phenomenon : a historical materialist approach to the reception of the film Midnight express /

This thesis examines the Midnight Express phenomenon focusing on the film's reception by audiences in Europe, North America, and Turkey between 1978-2003. Using and enhancing the "historical materialist approach" to film reception developed by Janet Staiger, the thesis considers the historical determinants of the film's nationally and culturally differential readings in different periods and of the transformations in those readings. The thesis argues that while Midnight Express was most likely read in the late 1970s as an attempt to reaffirm American social identity by projecting Turks as an instance of the negative Other, there has been an important shift in the reception of the film in the West during the 1990s due to the changes in the discursive contexts in which the film has been circulating. One does not observe any specific reference to Turkish prisons as a part of the issue of human rights violations in Turkey in the initial reception of the film by European and American critics, whereas these issues appear to be important constituents of a particular reception of the film in the West in the present. The thesis explains this shift by pointing to the constitution of a particular discourse on human rights violations in Turkey after 1980, and especially throughout the 1990s, which has become a part of the discursive repertoires of the Western audience. Therefore, the thesis argues that today, Midnight Express functions as a more legitimate political statement about Turkey in the eyes of some Western audiences than it had been in the 1970s. On the other hand, parallel to the increasing desire of Turkey to connect itself to the West, particularly to become a member of the European Union, one observes an immense increase in the belief in and defense against the negative effects of Midnight Express on Turkey's international representation since the 1990s. The historical and current discourses that audiences, both in Turkey and abroad, bring into play suggest that these audiences engage with Midnight Express by assuming or denying not only the subject positions constructed by the film text but also certain history-specific extra-filmic subject positions produced by other social and discursive formations.

The use of explicit algorithms and episodic context to teach subtraction to students with learning problems in mathematics /

This research attempted to address the question of the role of explicit algorithms and episodic contexts in the acquisition of computational procedures for regrouping in subtraction. Three groups of students having difficulty learning to subtract with regrouping were taught procedures for doing so through either an explicit algorithm, an episodic content or an examples approach. It was hypothesized that the use of an explicit algorithm represented in a flow chart format would facilitate the acquisition and retention of specific procedural steps relative to the other two conditions. On the other hand, the use of paragraph stories to create episodic content was expected to facilitate the retrieval of algorithms, particularly in a mixed presentation format. The subjects were tested on similar, near, and far transfer questions over a four-day period. Near and far transfer algorithms were also introduced on Day Two. The results suggested that both explicit and episodic context facilitate performance on questions requiring subtraction with regrouping. However, the differential effects of these two approaches on near and far transfer questions were not as easy to identify. Explicit algorithms may facilitate the acquisition of specific procedural steps while at the same time inhibiting the application of such steps to transfer questions. Similarly, the value of episodic context in cuing the retrieval of an algorithm may be limited by the ability of a subject to identify and classify a new question as an exemplar of a particular episodically deflned problem type or category. The implications of these findings in relation to the procedures employed in the teaching of Mathematics to students with learning problems are discussed in detail.

Nietzsche's will-to-power ontology : an interpretation of Beyond Good and Evil

Abstract: Nietzsche's Will-to-Power Ontology: An Interpretation of Beyond Good and Evil § 36 By: Mark Minuk Will-to-power is the central component of Nietzsche's philosophy, and passage 36 of Beyond Good and Evil is essential to coming to an understanding of it. 1 argue for and defend the thesis that will-to-power constitutes Nietzsche's ontology, and offer a new understanding of what that means. Nietzsche's ontology can be talked about as though it were a traditional substance ontology (i.e., a world made up of forces; a duality of conflicting forces described as 'towards which' and 'away from which'). However, 1 argue that what defines this ontology is an understanding of valuation as ontologically fundamental—^the basis of interpretation, and from which a substance ontology emerges. In the second chapter, I explain Nietzsche's ontology, as reflected in this passage, through a discussion of Heidegger's two ontological categories in Being and Time (readiness-to-hand, and present-at-hand). In a nutshell, it means that the world of our desires and passions (the most basic of which is for power) is ontologically more fundamental than the material world, or any other interpretation, which is to say, the material world emerges out of a world of our desires and passions. In the first chapter, I address the problematic form of the passage reflected in the first sentence. The passage is in a hypothetical style makes no claim to positive knowledge or truth, and, superficially, looks like Schopenhaurian position for the metaphysics of the will, which Nietzsche rejects. 1 argue that the hypothetical form of the passage is a matter of style, namely, the style of a free-spirit for whom the question of truth is reframed as a question of values. In the third and final chapter, 1 address the charge that Nietzsche's interpretation is a conscious anthropomorphic projection. 1 suggest that the charge rests on a distinction (between nature and man) that Nietzsche rejects. I also address the problem of the causality of the will for Nietzsche, by suggesting that an alternative, perspectival form of causality is possible.

A social-cognitive model of monitoring and its relationship to behaviour in a naturalistic observation : development and individual differences

years 8 months) and 24 older (M == 7 years 4 months) children. A Monitoring Process Model (MPM) was developed and tested in order to ascertain at which component process ofthe MPM age differences would emerge. The MPM had four components: (1) assessment; (2) evaluation; (3) planning; and (4) behavioural control. The MPM was assessed directly using a referential communication task in which the children were asked to make a series of five Lego buildings (a baseline condition and one building for each MPM component). Children listened to instructions from one experimenter while a second experimenter in the room (a confederate) intetjected varying levels ofverbal feedback in order to assist the children and control the component ofthe MPM. This design allowed us to determine at which "stage" ofprocessing children would most likely have difficulty monitoring themselves in this social-cognitive task. Developmental differences were obselVed for the evaluation, planning and behavioural control components suggesting that older children were able to be more successful with the more explicit metacomponents. Interestingly, however, there was no age difference in terms ofLego task success in the baseline condition suggesting that without the intelVention ofthe confederate younger children monitored the task about as well as older children. This pattern ofresults indicates that the younger children were disrupted by the feedback rather than helped. On the other hand, the older children were able to incorporate the feedback offered by the confederate into a plan ofaction. Another aim ofthis study was to assess similar processing components to those investigated by the MPM Lego task in a more naturalistic observation. Together the use ofthe Lego Task ( a social cognitive task) and the naturalistic social interaction allowed for the appraisal of cross-domain continuities and discontinuities in monitoring behaviours. In this vein, analyses were undertaken in order to ascertain whether or not successful performance in the MPM Lego Task would predict cross-domain competence in the more naturalistic social interchange. Indeed, success in the two latter components ofthe MPM (planning and behavioural control) was related to overall competence in the naturalistic task. However, this cross-domain prediction was not evident for all levels ofthe naturalistic interchange suggesting that the nature ofthe feedback a child receives is an important determinant ofresponse competency. Individual difference measures reflecting the children's general cognitive capacity (Working Memory and Digit Span) and verbal ability (vocabulary) were also taken in an effort to account for more variance in the prediction oftask success. However, these individual difference measures did not serve to enhance the prediction oftask performance in either the Lego Task or the naturalistic task. Similarly, parental responses to questionnaires pertaining to their child's temperament and social experience also failed to increase prediction oftask performance. On-line measures ofthe children's engagement, positive affect and anxiety also failed to predict competence ratings.

Extending relAPS to first order logic

RelAPS is an interactive system assisting in proving relation-algebraic theorems. The aim of the system is to provide an environment where a user can perform a relation-algebraic proof similar to doing it using pencil and paper. The previous version of RelAPS accepts only Horn-formulas. To extend the system to first order logic, we have defined and implemented a new language based on theory of allegories as well as a new calculus. The language has two different kinds of terms; object terms and relational terms, where object terms are built from object constant symbols and object variables, and relational terms from typed relational constant symbols, typed relational variables, typed operation symbols and the regular operations available in any allegory. The calculus is a mixture of natural deduction and the sequent calculus. It is formulated in a sequent style but with exactly one formula on the right-hand side. We have shown soundness and completeness of this new logic which verifies that the underlying proof system of RelAPS is working correctly.

Letter from J.E.A. Masters to Josiah Masters, November 11, 1812

Transcription: Encampment Plattsburgh My Dear Uncle Nov. 11th 1812 We are making every possible preparation to invade Canada. I have no doubt but we march in six days. From the best information I can get it is not contemplated to attack the Isle aux Noix – We shall take into the field 2500 infantry between 3 & 4 hundred cavalry 25 light artillery & 150 artillerists; of the malitia I have no accurate knowledge there is more than 1000 of them, the number of regular troops is mentioned you may rely on as being nearly correct I cannot state to a man as I have not had an opportunity of being the consolidated returns of the different corps. It is said that a [corps formed?] of volunteers are to join us from Vermont. I think it doubtful I believe that we shall have no great difficulty in going to Montreal as to the ultimate policy of the [act it is?] not my duty to judge. Confidential our troops are raw particularly in loading and firing they are much deficient. The 6th and 15th will be able to act with some considerable ... of precision and accuracy the remaining infantry—badly disciplined. Should any thing [occur?] with me my fate be unfortunate the [little?] property willed me by my grandfather will secure you the amount I owe you. General Dearborn I understand is at Burlington on his way here. Some of the prisoners that were taken at Queenstown have [arrived?] at Montreal probably. [Ensign Rich?] is among them. Several officers here became acquainted with him soon after he received his [two illegible words] & speak highly of him. [Always?] affectionately yours J. E. A. Masters P.S. I shall write you again before we march excuse this [scrawl?] my hand are too cold to write a fair hand we shall have here near [400?] sick that are not able to march J. E. A. Masters The [Hon.?] Josiah Masters [Schaghticoke?] N.Y. N. B. Nov. 13th We have orders to be prepared to march on the 15th at 12 oclock. Our baggage will be contained as much as possible. The officers carry no baggage except what they carry in their knapsacks. I am in fine health and am able [Hand?] most any [illegible word] My love to all affectionately Your nephew J. E. A. Masters

Grant of Permission for lease of military lands from Sir Robert Prescott to Thomas Clark, 1798-1801.

Transcript (original spelling and grammar retained): By His Excellency Robert Prescott Esquire, Captain General and Governor in Chief in and over His Majestys Provinces of Upper and Lower Canada, General and Commander in Chief of all His Majesty’s forces in the Provinces of Upper and Lower Canada, Nova Scotia, New Brunswick and their several Dependencies and in the Island of Newfoundland &ca. &ca. &ca. I do hereby authorise and permit Thomas Clark of Queenstown in the County of Lincoln in the Province of Upper Canada merchant to take possession of all that Lot, piece and parcel of Land (being part of the land reserved by his Majesty for Military purposes) situate, lying and being at Queenstown in the Township of Newark, in the Home District in the said Province of Upper Canada, bounded and abutted as follows, that is to say beginning at the Distance of two Chains and ninety links from the South East End of his Majesty’s Store House, the said distance being measured along the Bank up Stream, thence South thirty nine degrees and an half West one Chain and fifty links thence south fifty degrees and an half East one Chain and thirty links thence North thirty nine degrees and an half East to the Edge of the Bank and from thence along the Bank to the place of beginning, containing thirty one perches and one hundred and twenty five square links and to occupy and hold the said Lot, piece and parcel of Land during pleasure subject nevertheless to the provisoes and Conditions herein after contained, that is to say. First on condition that it shall and may be lawful to and for His Majesty his Heirs and Successors and to and for the Commander in Chief of His Majesty Forces for the time being and to and for the Officer commanding his Majesty’s Forces in Upper Canada for the time being and to and for either of them to determine and make void this present permission to occupy during pleasure the said Lot, Piece or Parcel of Land above described at any time hereafter whenever he or they shall see fit so to do without any compensation or indemnification to the said Thomas Clark or any other Person or Persons whosoever for any Loss Injury or Damage which he the said Thomas Clark or any other Person or Persons whosoever may thereby sustain. Secondly on this further Condition that it shall and may be lawful to and for His Majesty his Heirs and Successors and to and for his and their Officers, Soldiers and Servants at any time hereafter by order of the Commander in Chief of His Majesty’s Forces for the time being or by order of the Officer commanding his Majesty’s forces in Upper Canada for the time being or by order of the Officer of His Majesty’s Corps of Royal Engineers commanding in the said Province of Upper Canada for the time being to enter upon the said Lot Piece and parcel of Land which the said Thomas Clark is hereby permitted to occupy during pleasure or upon any part thereof and to take down and from the said Lot piece and parcel of Land or from any part thereof to remove any dwelling House Store or other Buildings on the said Lot, piece or Parcel of Land or any part thereof erected and to remove any goods or Chattels on the said Lot piece and parcel of Land or on any part thereof or on any such dwelling House Store or other building found or being and that His Majesty his Heirs and Successors or any other Person or Persons whosoever shall not be liable or responsible to the said Thomas Clark or to any other Person or Persons whosoever for any Loss, Injury or Damage which he or they shall or may in such case sustain. Thirdly on this further Condition that the said Thomas Clark shall not erect on the said Lot Piece or Parcel of Land which the said Thomas Clark is hereby permitted to occupy during pleasure or upon any part thereof at any time or times hereafter any dwelling House store or other Building whatsoever of Stone or brick or of any other materials wood only exccepted and that if any dwelling House or Store or other building of Stone or brick or of any other materials except wood shall at any time be erected on the said Lot, piece or parcel of Land or upon any part thereof, then and in such case, this present permission and every Clause and Article thereof shall from thenceforth cease and determine and be absolutely and entirely null and void. And lastly on this further Condition that the said Thomas Clark or any other Person whosoever shall not assign this permission to occupy the said Lot, Piece or Parcel of Land above described to any Person of Persons whosoever, and if any such assignment shall be made by the said Thomas Clark or by any other Person in his right, or on his behalf, that then and in such case such assignment and this permission to occupy during pleasure the said Lot piece and parcel of Land above described, and every Clause and Article thereof shall from thenceforth cease and determine and be absolutely and entirely null and void. Given under my hand at the Castle of St. Lewis in the City of Quebec in the Province of Lower Canada this Ninth day of July in the year of our Lord one thousand seven hundred and ninety eight and in the thirty eighth year of His Majesty’s Reign. [Signed here by Robert Prescott] By Order of the Commander in Chief [Signed here by James Green (Illegible signature)] I the said Thomas Clark above named do hereby accept the above written Permission to occupy during pleasure the said Lot piece and parcel of Land above described upon and subject to the several Provisioes and Conditions above written and each and every of them severally and respectively. In witness whereof I have hereunto set my hand the Sixteenth day of August in the year of our Lord one thousand seven hundred and ninety eight and in the thirty eighth year of His Majesty’s Reign. [Signed here by Thomas Clark] Signed in the presence of [Illegible signature – looks like J. M Donell Lt. Col.] [Illegible – looks like 2d. Battn R. C. Sm?] [Signed here by C. Anderson] Whereas Inconveniences did arise from the peculiar situation of the Ground contiguous to the above described Lot of Land and the occupation thereof, if estimated by the above Limits would prove highly disadvantageous to Mr. Thomas Clark be it known that in consideration thereof we do permit the above Lot to extend one half Chain more in length up stream so as to comprehend the space allowed for the Road between Lots Two + Three, and we do hereby appropriate the said additional space wholly to the use of the said Thomas Clark. In witness whereof we have hereunto subscribed this Thirteenth Day of October in the Year of our Lord one thousand Eight Hundred and one. [Signed here by J. M’Donell Lt. Col] 2d. Battn. R. C. [in?] Com of Fort George + Dependencies Robt. Pilkington Captain Royal Engineers

'To do justice and judgement' : the place of passion in public life

Please consult the paper edition of this thesis to read. It is available on the 5th Floor of the Library at Call Number: Z 9999 P65 F47 2003

Development of a New Assessment System to Evaluate Students' English Communicative Capacities in China

The purpose of this study was to develop a new English assessment system to evaluate Chinese students' English communicative capacities. Since there is more interaction with people from English-speaking countries, Chinese people attach more importance to English oral skills, and a lot of Western English teaching methods were introduced into China to improve students' English communicative capacities. However, traditional paper-written examinations, like the English test of higher education entry examination, cannot evaluate it effectively. This study explored the perceptions of two Chinese English-language teachers and two Chinese students about English assessment system. A qualitative research method using telephone interviews was conducted in this study. The findings showed that the most possible ways to assess Chinese students' English communicative capacities were paper-written examination and person-machine conversations, although measures should be taken to improve these two models. On the other hand, the model of person-person conversation was the ideal assessment tool but was hard to achieve at the current stage.