Revising the Cannabis Use Disorders Identification Test (CUDIT) by means of Item Response Theory.

Cannabis use among adolescents and young adults has become a major public health challenge. Several European countries are currently developing short screening instruments to identify 'problematic' forms of cannabis use in general population surveys. One such instrument is the Cannabis Use Disorders Identification Test (CUDIT), a 10-item questionnaire based on the Alcohol Use Disorders Identification Test. Previous research found that some CUDIT items did not perform well psychometrically. In the interests of improving the psychometric properties of the CUDIT, this study replaces the poorly performing items with new items that specifically address cannabis use. Analyses are based on a sub-sample of 558 recent cannabis users from a representative population sample of 5722 individuals (aged 13-32) who were surveyed in the 2007 Swiss Cannabis Monitoring Study. Four new items were added to the original CUDIT. Psychometric properties of all 14 items, as well as the dimensionality of the supplemented CUDIT were then examined using Item Response Theory. Results indicate the unidimensionality of CUDIT and an improvement in its psychometric performance when three original items (usual hours being stoned; injuries; guilt) are replaced by new ones (motives for using cannabis; missing out leisure time activities; difficulties at work/school). However, improvements were limited to cannabis users with a high problem score. For epidemiological purposes, any further revision of CUDIT should therefore include a greater number of 'easier' items.

Etes-vous serein face à votre placement? Une étude pilote

Introduction: Des unités d'attente de placement ont vu le jour pour¦répondre à la pénurie de lits d'hébergement de long séjour dans le¦Canton de Vaud et désengorger les hôpitaux aigus. Pour les patients¦qui y sont admis, la décision de placement intervient au sortir d'une¦hospitalisation aiguë, laissant peu de temps à la personne pour¦cheminer face à cette décision. Cette étude pilote vise à investiguer¦le degré de sérénité de ces patients face à l'hébergement de longue¦durée et déterminer s'il existe une relation avec la durée d'attente ou¦le décès en unité d'attente.¦Population et méthode: Personnes âgées (N = 78) admises dans¦une structure d'attente et préparation à l'hébergement de longue¦durée après un séjour hospitalier aigu. Des données démographiques,¦fonctionnelles, cognitives et affectives ont été récoltées dans les 4¦semaines après l'admission. La sérénité ressentie face à l'hébergement¦longue durée a été évaluée à l'aide d'une échelle de type Likert à¦quatre niveaux (pas du tout/plutôt pas/plutôt/tout à fait serein).¦Résultats: Les patients étaient âgés de 85.6 ans en moyenne, 74%¦(58/78) étaient des femmes, 47% (37/78) avaient des troubles cognitifs¦et 35% (27/78) des troubles dépressifs. Globalement 24% (19/78)¦des patients se déclaraient peu ou pas du tout sereins face au¦placement. Comparés aux patients sereins, ces 19 patients étaient¦significativement (p <.05) moins âgés (83.2 ± 1.0 vs 86.8 ± 6.5 ans),¦plus dépendants dans les activités de la vie quotidienne (BAVQ 2.5 ±¦1.7 vs 3.5 ± 1.6), plus déprimés (GDS 15-items 7.0 ± 3.5 vs 4.4 ± 3.0),¦et avaient plus souvent des antécédents de chutes (95% vs 75%). En¦analyse multivariée, le manque de sérénité restait significativement¦associé à une dépendance plus élevée dans les BAVQ, à un score¦GDS plus élevé ainsi qu'aux antécédents de chute. Il n'y avait pas de¦différence significative en termes de durée moyenne de séjour avant le¦placement (90.0 ± 57.3j vs 87.8 ± 73.2, médianes 85 vs 57, P = .45), ni¦de mortalité dans l'unité d'attente (5% vs 5%) entre les deux groupes¦de patients.¦Conclusion: Près d'un quart des patients en unité d'attente se¦déclarent peu sereins face à la perspective du placement. Ces patients¦sont plus dépendants, ont des antécédents de chutes et sont plus¦déprimés, ce qui souligne l'importance d'une identification précoce de¦ces patients afin de leur offrir un soutien dans cette période difficile de¦transition dans leur parcours de vie.

Abnormal cortical network activation in human amnesia: A high-resolution evoked potential study.

Little is known about how human amnesia affects the activation of cortical networks during memory processing. In this study, we recorded high-density evoked potentials in 12 healthy control subjects and 11 amnesic patients with various types of brain damage affecting the medial temporal lobes, diencephalic structures, or both. Subjects performed a continuous recognition task composed of meaningful designs. Using whole-scalp spatiotemporal mapping techniques, we found that, during the first 200 ms following picture presentation, map configuration of amnesics and controls were indistinguishable. Beyond this period, processing significantly differed. Between 200 and 350 ms, amnesic patients expressed different topographical maps than controls in response to new and repeated pictures. From 350 to 550 ms, healthy subjects showed modulation of the same maps in response to new and repeated items. In amnesics, by contrast, presentation of repeated items induced different maps, indicating distinct cortical processing of new and old information. The study indicates that cortical mechanisms underlying memory formation and re-activation in amnesia fundamentally differ from normal memory processing.

The association between body mass index and patients' experiences with inpatient care.

OBJECTIVE: To explore the association between patients' body mass index (BMI) and their experiences with inpatient care. DESIGN: Cross-sectional. Mail survey. SETTING: University Hospital of Geneva. PARTICIPANTS: Questionnaires were mailed to 2385 eligible adult patients, 6 weeks after discharge (response rate = 69%). MAIN OUTCOME MEASURES: Patients' experiences with care were measured using the Picker inpatient survey questionnaire. BMI was calculated using self-reported height and weight. Main dependent variables were the global Picker patient experience (PPE-15) score and nine dimension-specific problem scores, scored from 0 (no reported problems) to 1 (all items coded as problems). We used linear regressions, adjusting for age, gender, education, subjective health, smoking and hospitalization, to assess the association between patients' BMI and their experiences with inpatient care. RESULTS: Of the patients, 4.8% were underweight, 50.8% had normal weight, 30.3% were overweight and 14.1% were obese. Adjusted analysis shows that compared with normal weight, obesity was significantly associated with fewer problematic items in the surgery-related information domain, and being underweight or overweight was associated with more problematic items in the involvement of family/friends domain. The global PPE-15 score was significantly higher (more problems) for underweight patients. CONCLUSIONS: Underweight patients, but not obese patients, reported more problems during hospitalization.

Factor analysis of the North American Spine Society outcome assessment instrument: a study based on a spine registry of patients treated with lumbar and cervical disc arthroplasty.

BACKGROUND CONTEXT: Studies involving factor analysis (FA) of the items in the North American Spine Society (NASS) outcome assessment instrument have revealed inconsistent factor structures for the individual items. PURPOSE: This study examined whether the factor structure of the NASS varied in relation to the severity of the back/neck problem and differed from that originally recommended by the developers of the questionnaire, by analyzing data before and after surgery in a large series of patients undergoing lumbar or cervical disc arthroplasty. STUDY DESIGN/SETTING: Prospective multicenter observational case series. PATIENT SAMPLE: Three hundred ninety-one patients with low back pain and 553 patients with neck pain completed questionnaires preoperatively and again at 3 to 6 and 12 months follow-ups (FUs), in connection with the SWISSspine disc arthroplasty registry. OUTCOME MEASURES: North American Spine Society outcome assessment instrument. METHODS: First, an exploratory FA without a priori assumptions and subsequently a confirmatory FA were performed on the 17 items of the NASS-lumbar and 19 items of the NASS-cervical collected at each assessment time point. The item-loading invariance was tested in the German version of the questionnaire for baseline and FU. RESULTS: Both NASS-lumbar and NASS-cervical factor structures differed between baseline and postoperative data sets. The confirmatory analysis and item-loading invariance showed better fit for a three-factor (3F) structure for NASS-lumbar, containing items on "disability," "back pain," and "radiating pain, numbness, and weakness (leg/foot)" and for a 5F structure for NASS-cervical including disability, "neck pain," "radiating pain and numbness (arm/hand)," "weakness (arm/hand)," and "motor deficit (legs)." CONCLUSIONS: The best-fitting factor structure at both baseline and FU was selected for both the lumbar- and cervical-NASS questionnaires. It differed from that proposed by the originators of the NASS instruments. Although the NASS questionnaire represents a valid outcome measure for degenerative spine diseases, it is able to distinguish among all major symptom domains (factors) in patients undergoing lumbar and cervical disc arthroplasty; overall, the item structure could be improved. Any potential revision of the NASS should consider its factorial structure; factorial invariance over time should be aimed for, to allow for more precise interpretations of treatment success.

The impact of "early" nineteenth-century globalization on foreign trade in the Southern Cone: A study of British trade statistics

This paper deals with the impact of "early" nineteenth-century globalization (c.1815-1860) on foreign trade in the Southern Cone (SC). Most of the evidence is drawn from bilateral trades between Britain and the SC, at a time when Britain was the main commercial partner of the new republics. The main conclusion drawn is that early globalization had a positive impact on foreign trade in the SC, and this was due to: improvements in the SC's terms of trade during this period; the SC's per capita consumption of textiles (the main manufacture traded on world markets at that time) increased substantially during this period, at a time when clothing was one of the main items of SC household budgets; British merchants brought with them capital, shipping, insurance, and also facilitated the formation of vast global networks, which further promoted the SC's exports to a wider range of outlets.

Spinning welfare: The gains from process innovation in cotton and car production

Economists and economic historians want to know how much better life is today than in the past.Fifty years ago economic historians found surprisingly small gains from 19th century US railroads,while more recently economists have found relatively large gains from electricity, computers and cellphones. In each case the implicit or explicit assumption is that researchers were measuring the valueof a new good to society. In this paper we use the same techniques to find the value to society ofmaking existing goods cheaper. Henry Ford did not invent the car, and the inventors of mechanisedcotton spinning in the industrial revolution invented no new product. But both made existing productsdramatically cheaper, bringing them into the reach of many more consumers. That in turn haspotentially large welfare effects. We find that the consumer surplus of Henry Ford s production linewas around 2% by 1923, 15 years after Ford began to implement the moving assembly line, while themechanisation of cotton spinning was worth around 6% by 1820, 34 years after its initial invention.Both are large: of the same order of magnitude as consumer expenditure on these items, and as largeor larger than the value of the internet to consumers. On the social savings measure traditionally usedby economic historians, these process innovations were worth 15% and 18% respectively, makingthem more important than railroads. Our results remind us that process innovations can be at least asimportant for welfare and productivity as the invention of new products.

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.

Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.

Quetiapine affects neuropeptide Y and corticotropin-releasing hormone in cerebrospinal fluid from schizophrenia patients: relationship to depression and anxiety symptoms and to treatment response.

Cumulative evidence indicates that neuropeptides play a role in the pathophysiology of schizophrenia. Early data showed increased neuropeptide Y (NPY) in cerebrospinal fluid (CSF) from schizophrenia patients and data from rodents show that antipsychotic drugs modulate NPY levels in and release from selected rat brain regions. In view of these findings we investigated whether the atypical antipsychotic quetiapine, originally used as an antipsychotic but subsequently shown to be efficient also in major depressive disorder and in both poles of bipolar disorder, would affect NPY-like immunoreactivity (-LI), and corticotropin-releasing hormone (CRH)-LI levels in CSF of schizophrenia patients. NPY-LI and CRH-LI in CSF were determined in 22 patients with schizophrenia. Lumbar puncture was performed at baseline and again after 4 wk of quetiapine treatment (600 mg/d). Patients were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at weekly intervals. Quetiapine treatment was associated with a significant increase in NPY-LI (p<0.001) and decrease in CRH-LI (p<0.01). Stepwise multiple regression analysis revealed that ΔNPY-LI and ΔCRH-LI levels predicted 63% (p<0.001) of the variability of the ΔPANSS total score, ΔNPY-LI 42% (p<0.05) of the ΔPANSS anxiety items (G2) and ΔCRH-LI 40% (p=0.05) of the ΔPANSS depression items (G6). These results suggest that while quetiapine's effects on monoamines are probably related to its antipsychotic properties, the modulation of NPY and CRH accounts for its antidepressant and anxiolytic effects and can be markers of response.

Perfil dos Turistas que Visitam a Ilha de São Vicente

O presente trabalho tem por objectivo definir o perfil do turista que visitou a ilha de São Vicente e avaliar o grau de satisfação do turista enquanto consumidor de diferentes bens e serviços, nos meses de Maio e Junho do decorrente ano. Para se fazer uma abordagem qualitativa falou-se da problemática do mercado turístico - procura e oferta turística – e a importância da segmentação desse sistema turístico juntamente com algumas teorias do comportamento do consumidor. Por sua vez, para o estudo do perfil e satisfação dos turistas utilizou-se uma abordagem quantitativa, através da aplicação de questionários no Aeroporto Internacional Cesária Évora e entrevistas aos estabelecimentos hoteleiros, 150 e 7 respectivamente. Após a análise explicativa, com base na bibliografia seleccionada, nas entrevistas e questionários realizados, os resultados da pesquisa indicam que estudar o perfil e a satisfação dos turistas permite fazer um levantamento de diversas variáveis importantes como, por exemplo, a nacionalidade do turista, a principal razão e objectivo da viagem e o que gostaram, ou desejavam ver no destino. E assim, entender-se o perfil do visitante e propor-se estratégias, que contribuam para um planeamento sustentável do desenvolvimento turístico na região pretendida. A complexidade do processo de decisão do turista por um ou outro destino é que verdadeiramente motiva esta pesquisa. The objective of the following work is to define the profile of a tourist that visited São Vicente, and evaluate the levels of satisfaction of the tourist as a consumer of different items and services, on May and June of the current year. For a quality methodological approach, the problematic of the touristic industry (demand and touristic offer) – the essential of subdivision of these touristic systems alongside with the principles of the consumer behavior were discussed. In continuity, to define the profile and satisfaction of the tourists, a quantity approach was also used, through the application of questionnaires at the International Airport Cesária Évora and interviews throughout hotel establishments, 150 and 7 respectively. After an explanatory analyses, based on a selected bibliography, the applied interviews and questionnaires, the outcome of this research shows that by studying the profile and the satisfaction of the tourists allows to have variable important results, for example, the tourist´s nationality, the main reason and objective of the trip and what they enjoyed or would like to see on their destination. Thus, understanding the visitor´s profile and suggesting strategies, that contributes for a sustainable planning of a touristic development on the intended region. The process complexity of the decision making of the tourist for one destination is truly the main motivation for this research.

Welcome To Medicare Physical Exam, September 2007

Medicare will cover a one-time preventive physical exam within the first six months that you have Part B. This benefit is for all Medicare beneficiaries including those under age 65. How much does the exam cost? You pay 20% of the Medicare approved amount after you meet the yearly Part B deductible ($131 for 2007). Since this exam may be your first Medicare-covered service, you could meet your entire Part B deductible for the year. Medicare will cover the exam if performed by a physician, physician assistant, nurse practitioner, or clinical nurse specialist. What should I expect during the exam? The “Welcome to Medicare Physical” will include the following: 1. A review of your medical and social history. 2. A review of your potential risk factors for depression. 3. A review of your functional ability and level of safety. 4. Blood pressure, height, weight and vision test 5. An electrocardiogram (EKG) 6. Education and counseling on the above five items. 7. A written plan explaining screenings and other recommended preventive services. All seven elements must be documented in order for the physical to be covered by Medicare. The exam does not include clinical laboratory tests. Medicare will pay for a one-time ultrasound screening for abdominal aortic aneurysms for beneficiaries who are at risk (has a family history or a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime.) Only Medicare beneficiaries who receive a referral from the Welcome to Medicare physical exam will be covered for this benefit. There is no Part B deductible, but you or your supplemental insurance will be responsible for the coinsurance. What should I take to the exam? You should bring the following when you go to your “Welcome to Medicare” physical exam: • Medical records, including immunization records (if you are seeing a doctor for the first time) • Family health history • A list of current prescription drugs, how often you take them, and why.

Utilização do target costing na determinação do preço de venda: O caso da Alvo, s.a.

Com a crescente competitividade no mundo empresarial, os preços dos produtos passaram a exercer um papel fundamental na expansão e sobrevivência das empresas. Consequentemente, hoje em dia é o mercado que determina o preço de venda de um produto, devendo a empresa produzir ao menor custo possível para garantir o retorno financeiro desejado. O objectivo do trabalho é verificar se os procedimentos de Target Costing podem ser aplicados nas Pequenas e Médias Empresas industriais, em São Vicente, cuja actividade também se destina à produção de produtos alimentícios. Como produto teste foi selecionado o produto A, confecçionado pela empresa Alvo, SA. Para atingirmos os objectivos foram utilizadas várias técnicas e métodos de pesquisa, tais como: levantamento bibliográfico, entrevista, conversas informais, questionário, levantamento de dados nos documentos financeiros da empresa ALVO, SA. Para entendermos e aplicarmos o processo de Target Costing recorreu-se à literatura do mesmo. Foi aplicado um questionário para ver a percepção dos clientes da empresa objecto de estudo, quanto ao preço que considerariam ideal pagar por cada quilograma do produto A adquirida. A entrevista realizada com o director geral da ALVO, SA acompanhada com os dados obtidos do departamento de contabilidade serviram como um meio de conhecer a empresa e o seu funcionamento, realçando informações sobre a fixação do preço venda dos seus produtos, a gestão de custos, entre outros. Antes de testar, através de um caso prático, a aplicação do Target Costing, verificou-se, primeiramente, sua aplicação em termos teóricos, testando os seus princípios e premissas para o produto A, na Empresa ALVO, SA. Como resultado constactou-se que os procedimentos de Target Costing podem ser aplicados, tanto na teoria como na prática, nas Pequenas e Médias Empresas industriais, em São Vicente, cuja actividade se destina a produção do produto A. With the increasing competition in the business world, the prices of products have come to play a key role in the expansion and survival of businesses. Consequently, today the selling price of a product is determined by the market so companies should produce at the lowest possible cost to ensure the desired financial return. The purpose of this paper work is to verify if the Target Costing’s procedure can be applied in small and medium business enterprises in São Vicente, whose activity is production of food. For that, product A was selected for tests. In order to achieve these objectives, some techniques and research methods like bibliographic analysis, interviews, informal conversations, questionnaires and analysis of the financial documents of ALVO, SA that is the subject of this case study, were utilized. With the intention of understanding and applying the Target Costing process we also resorted to a detailed reading of related bibliography. A questionnaire was applied in order to know the customers’ opinions about the ideal price for each kilogram of product A. The interview with the managing director of ALVO, SA, combined with the data obtained in the accounting department, was also used as a way to know the company, and it ’s functioning, highlight ing items such as: selling price format ion, cost management, among other aspects. Before testing, through a practical case study, the use of the Target Costing, the theoretical application was firstly verified by testing its principles and assumptions. Secondly, the application of the Target Costing’s process was shown step by step concerning product A at ALVO SA company. As a result we came to the conclusion that procedures used with Target Costing can be applied, in theory and in practice, in small or medium-sized industrial enterprises, in São Vicente, where product A is being manufactured.

Nestling barn owls beg more intensely in the presence of their mother than in the presence of their father

Nestling begging behaviour may be an honest signal of need used by parents to adjust optimally both feeding rate and within-brood food allocation. Although several studies showed that mothers and fathers can be differentially responsive to nestling begging behaviour with one parent showing a stronger tendency to feed the offspring that beg the most, little information is yet available on whether offspring beg for food at different intensities from the mother than father. In the present study, we investigated in nestling barn owls whether the intensity of vocal begging behaviour in the presence of the mother and in the presence of the father is different. A difference is expected because reproductive tasks are divided between the sexes with fathers bringing more food items to the nest than mothers. The results show that although mothers transfer their prey item to one of the offspring more rapidly than fathers once in their nestbox, nestlings begged more intensely in the presence of their mother than in the presence of their father. To our knowledge, this is the first empirical evidence that offspring vocalize to different levels in the presence of their mother than in the presence of their father.

Assessing the wish to die in elderly people.

Background: The wish to die has mainly been studied in terminally- ill young adults. In elderly persons, factors associated with the wish to die are likely to differ from those observed in younger people. Since the most frequently used scale -"The Schedule ofAttitudes Toward Hastened Death" (SAHD, Rosenfeld et al., 2000)- was previously used in terminally ill cancer or AIDS patients, its use in elderly people suffering from multiple comorbidities is problematic. The objectives of this study were 1) to adapt the SAHD for use in elderly people, 2) to develop a new instrument to assess patients' attitudes towards death 3) to test the relevance/acceptability of these instruments. Methods:An adapted version of the SAHD to the elderly population (SAHD-OLD) was obtained by analyzing all items of the instrument instrument in an interdisciplinary group of experts in geriatric care. Items were modified according to their relevance in elderly population. An instrument to assess patients' attitudes towards death was built on previous qualitative work performed by Schroepfer. These 2 instruments were subjected to cognitive testing in a convenience sample of 11 community-dwelling people (median age = 82 years; range 76-91). Results: The SAHD-OLD was obtained by modifying those items addressing palliative care issues (eg. irreversible consequences of stopping treatment) and systematically replacing "illness/disease" by "health problems". We expressed in statements the 6 categories identified by Schroepfer, and created instructions asking respondents to describe their current attitude towards death (Adapted Schroepfer). During cognitive testing, our sample assessed the SAHD-OLD and the Adapted Schroepfer as relevant for elderly people. Respondents judged these 2 instruments acceptable and appreciated the direct manner in which they addressed end of life issues. The opportunity to speak openly on this topic was welcomed. Conclusions: The SAHD-OLD and the Adapted Schroepfer seem promising instruments to assess the wish to die in elderly people suffering from multiple comorbidities. Preliminary results show good comprehension, high relevance and acceptability. Psychometric properties of the SAHD-OLD are currently being tested in a large sample of patients.

Hybrid consumption paths in the attribute space: A model and application with scanner data

This paper presents and estimates a dynamic choice model in the attribute space considering rational consumers. In light of the evidence of several state-dependence patterns, the standard attribute-based model is extended by considering a general utility function where pure inertia and pure variety-seeking behaviors can be explained in the model as particular linear cases. The dynamics of the model are fully characterized by standard dynamic programming techniques. The model presents a stationary consumption pattern that can be inertial, where the consumer only buys one product, or a variety-seeking one, where the consumer shifts among varied products.We run some simulations to analyze the consumption paths out of the steady state. Underthe hybrid utility assumption, the consumer behaves inertially among the unfamiliar brandsfor several periods, eventually switching to a variety-seeking behavior when the stationary levels are approached. An empirical analysis is run using scanner databases for three different product categories: fabric softener, saltine cracker, and catsup. Non-linear specifications provide the best fit of the data, as hybrid functional forms are found in all the product categories for most attributes and segments. These results reveal the statistical superiority of the non-linear structure and confirm the gradual trend to seek variety as the level of familiarity with the purchased items increases.