Listening to parents: The role of symptom perception in pediatric palliative home care.

OBJECTIVE: This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children. METHODS: In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase). RESULTS: Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R 2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0-10) and rated the child's death as highly peaceful (median 9). Significance of the results: The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.

Timing of visual stimuli in V1 and V5/MT: fMRI and TMS

Time perception is used in our day-to-day activities. While we understand quite well how our brain processes vision, touch or taste, brain mechanisms subserving time perception remain largely understudied. In this study, we extended an experiment of previous master thesis run by Tatiana Kenel-Pierre. We focused on time perception in the range of milliseconds. Previous studies have demonstrated the involvement of visual areas V1 and V5/MT in the encoding of temporal information of visual stimuli. Based on these previous findings the aim of the present study was to understand if temporal information was encoded in V1 and extrastriate area V5/MT in different spatial frames i.e., head- centered versus eye-centered. To this purpose we asked eleven healthy volunteers to perform a temporal discrimination task of visual stimuli. Stimuli were presented at 4 different spatial positions (i.e., different combinations of retinotopic and spatiotopic position). While participants were engaged in this task we interfered with the activity of the right dorsal V1 and the right V5/MT with transcranial magnetic stimulation (TMS). Our preliminary results showed that TMS over both V1 and V5/MT impaired temporal discrimination of visual stimuli presented at specific spatial coordinates. But whereas TMS over V1 impaired temporal discrimination of stimuli presented in the lower left quadrant, TMS over V5/MT affected temporal discrimination of stimuli presented at the top left quadrant. Although it is always difficult to draw conclusions from preliminary results, we could tentatively say that our data seem to suggest that both V1 and V5/MT encode visual temporal information in specific spatial frames.

The Spatial effects of transportation on industrial employment

This paper examines the direct and indirect impacts of transport infrastructure on industrial employment. We estimate regressions with spatial econometric methods using data from the Spanish regions for the period 1995-2008. We find that the density of motorways and the amount of port traffic (particularly general non-containerized and container traffic) are significant determinants of industrial employment in the region, while the effects of railway density and the amount of airport traffic are unclear. Our empirical analysis shows the existence of significant negative spatial spillovers for the density of motorways and levels of container port traffic while the impact of general non-containerized port traffic seems to be mainly local.

Combining T2-preparation with spectral and spatial selectivity for improved coronary MRA

Cardiovascular disease is the leading cause of death worldwide. Within this subset, coronary artery disease (CAD) is the most prevalent. Magnetic resonance angiography (MRA) is an emerging technique that provides a safe, non-invasive way of assessing CAD progression. To generate contrast between tissues, MR images are weighted according to the magnetic properties of those tissues. In cardiac MRI, T2 contrast, which is governed by the rate of transverse signal loss, is often created through the use of a T2-Preparation module. T2-Preparation, or T2-Prep, is a magnetization preparation scheme used to improve blood/myocardium contrast in cardiac MRI. T2-Prep methods generally use a non-selective +90°, 180°, 180°, -90° train of radiofrequency (RF) pulses (or variant thereof), to tip magnetization into the transverse plane, allow it to evolve, and then to restore it to the longitudinal plane. A key feature in this process is the combination of a +90° and -90° RF pulse. By changing either one of these, a mismatch occurs between signal excitation and restoration. This feature can be exploited to provide additional spectral or spatial selectivity. In this work, both of these possibilities are explored. The first - spectral selectivity - has been examined as a method of improving fat saturation in coronary MRA. The second - spatial selectivity - has been examined as a means of reducing imaging time by decreasing the field of view, and as a method of reducing artefacts originating from the tissues surrounding the heart. Two additional applications, parallel imaging and self-navigation, are also presented. This thesis is thus composed of four sections. The first, "A Fat Signal Suppression for Coronary MRA at 3T using a Water-Selective Adiabatic T2-Preparation Technique", was originally published in the journal Magnetic Resonance in Medicine (MRM) with co-authors Ruud B. van Heeswijk and Matthias Stuber. The second, "Combined T2-Preparation and 2D Pencil Beam Inner Volume Selection", again with co-authors Ruud van Heeswijk and Matthias Stuber, was also published in the journal MRM. The third, "A cylindrical, inner volume selecting 2D-T2-Prep improves GRAPPA-accelerated image quality in MRA of the right coronary artery", written with co-authors Jerome Yerly and Matthias Stuber, has been submitted to the "Journal of Cardiovascular Magnetic Resonance", and the fourth, "Combined respiratory self-navigation and 'pencil-beam' 2D-T2 -Prep for free-breathing, whole-heart coronary MRA", with co¬authors Jerome Chaptinel, Giulia Ginami, Gabriele Bonanno, Simone Coppo, Ruud van Heeswijk, Davide Piccini, and Matthias Stuber, is undergoing internal review prior to submission to the journal MRM. -- Les maladies cardiovasculaires sont la cause principale de décès dans le monde : parmi celles-ci, les maladies coronariennes sont les plus répandues. L'angiographie par résonance magnétique (ARM) est une technique émergente qui fournit une manière sûre, non invasive d'évaluer la progression de la coronaropathie. Pour obtenir un contraste entre les tissus, les images d'IRM sont pondérées en fonction des propriétés magnétiques de ces tissus. En IRM cardiaque, le contraste en T2, qui est lié à la décroissance du signal transversal, est souvent créé grâce à l'utilisàtion d'un module de préparation T2. La préparation T2, ou T2-Prep, est un système de préparation de l'aimantation qui est utilisé pour améliorer le contraste entre le sang et le myocarde lors d'une IRM cardiaque. Les méthodes de T2-Prep utilisent généralement une série non-sélective d'impulsions de radiofréquence (RF), typiquement [+ 90°, 180°, 180°, -90°] ou une variante, qui bascule l'aimantation dans le plan transversal, lui permet d'évoluer, puis la restaure dans le plan longitudinal. Un élément clé de ce processus est la combinaison des impulsions RF de +90° et -90°. En changeant l'une ou l'autre des impulsions, un décalage se produit entre l'excitation du signal et de la restauration. Cette fonction peut être exploitée pour fournir une sélectivité spectrale ou spatiale. Dans cette thèse, les deux possibilités sont explorées. La première - la sélectivité spectrale - a été examinée comme une méthode d'améliorer la saturation de la graisse dans l'IRM coronarienne. La deuxième - la sélectivité spatiale - a été étudiée comme un moyen de réduire le temps d'imagerie en diminuant le champ de vue, et comme une méthode de réduction des artefacts provenant des tissus entourant le coeur. Deux applications supplémentaires, l'imagerie parallèle et la self-navigation, sont également présentées. Cette thèse est ainsi composée de quatre sections. La première, "A Fat Signal Suppression for Coronary MRA at 3T using a Water-Selective Adiabatic T2-Preparation Technique", a été publiée dans la revue médicale Magnetic Resonance .in Medicine (MRM) avec les co-auteurs Ruud B. van Heeswijk et Matthias Stuber. La deuxième, Combined T2-Preparation and 2D Pencil Beam Inner Volume Selection", encore une fois avec les co-auteurs Ruud van Heeswijk et Matthias Stuber, a également été publiée dans le journal MRM. La troisième, "A cylindrical, inner volume selecting 2D-T2-Prep improves GRAPPA- accelerated image quality in MRA of the right coronary artery", écrite avec les co-auteurs Jérôme Yerly et Matthias Stuber, a été présentée au "Journal of Cardiovascular Magnetic Resonance", et la quatrième, "Combined respiratory self-navigation and 'pencil-beam' 2D-T2 -Prep for free-breathing, whole-heart coronary MRA", avec les co-auteurs Jérôme Chaptinel, Giulia Ginami, Gabriele Bonanno , Simone Coppo, Ruud van Heeswijk, Davide Piccini, et Matthias Stuber, subit un examen interne avant la soumission à la revue MRM.

Perception du timing pubertaire et comportements à risque chez des adolescents suisses

Il faut distinguer timing pubertaire objectif (TPO ; comparaison du timing pubertaire réel d'un sujet avec celui d'un groupe de référence) et timing pubertaire subjectif (TPS ; perception subjective par le sujet de son timing pubertaire par rapport à celui de ses pairs). Chez l'adolescente, la ménarche est couramment utilisée comme marqueur du TPO. La littérature s'intéressant aux variations physiologiques (normales) du timing pubertaire montre qu'un TPO précoce est corrélé chez les adolescentes avec de nombreux problèmes de santé (p.ex. dépression, abus de substances, comportements à risques, niveau d'études inférieur). Un TPO tardif chez l'adolescente serait quant à lui associé à une meilleure réussite scolaire. Les diverses hypothèses expliquant ces corrélations sont brièvement décrites dans notre travail. Certaines hypothèses impliquent des facteurs objectifs tels les changements du corps à la puberté, alors que d'autres privilégient des facteurs plus subjectifs, dans le registre de la perception de soi. A ce jour, la littérature ne s'est que très peu intéressée au TPS en soi. Une adolescente percevant son timing pubertaire comme précoce est-elle à risque même si sa puberté survient objectivement au même âge que la majorité de ses pairs ? L'objectif de ce travail est de rechercher d'éventuelles corrélations entre TPS et adoption de comportements à risque chez des adolescentes rapportant un TPO dans la moyenne. Nos données proviennent de l'enquête SMASH 2002, une étude par questionnaire auto-administré conduite parmi un échantillon de 7548 adolescentes et adolescents suisses âgés de 16-20 ans. Des 3658 adolescentes de l'échantillon initial, nous ne sélectionnons que les 1003 d'entre elles qui ont répondu à la question sur le TPS et qui ont rapporté un âge à la ménarche de 13 ans, soit la moyenne et la médiane de l'âge à la ménarche rapporté par les 3658 adolescentes de l'échantillon initial. Ces 1003 adolescentes sélectionnées sont considérées comme ayant un TPO dans la moyenne. Ces 1003 adolescentes sont séparées en 3 groupes en fonction de leur TPS (précoce/correspondant à la moyenne/tardif). A l'aide d'analyses bivariées et logistiques, nous comparons ces 3 groupes en termes d'adoption de comportements à risque dans le champ de la sexualité (précocité des rapports sexuels) et dans celui de la consommation de substances (tabac, cannabis, drogues dures). Nos résultats montrent principalement qu'une perception de précocité pubertaire est associée avec une précocité des premiers rapports sexuels et de l'usage de drogues dures. A l'inverse, les adolescentes percevant leur puberté comme tardive rapportent moins fréquemment des rapports sexuels avant 16 ans que les adolescentes percevant leur puberté comme dans la moyenne. Les implications cliniques sont les suivantes : face à une adolescente percevant sa puberté comme étant ou ayant été précoce, le praticien devrait investiguer l'existence de comportements à risque même si la puberté survient ou est survenue à un âge similaire à ce qui est retrouvé chez la majorité des pairs. En effet, notre étude suggère que même si cette adolescente se trompe en percevant sa puberté comme précoce, la probabilité de comportements à risque est augmentée dans le champ de la sexualité et de la consommation de substances. Nos résultats suggèrent aussi que l'association retrouvée dans la littérature entre précocité objective de la puberté et comportements à risque chez les adolescentes n'est pas uniquement médiée par les changements corporels pubertaires mais qu'un facteur psychologique tel que la perception subjective est également impliqué.

Individual Perception of Organizational Values

The objective of this master’s thesis was to examine how corporate values come true among the white-collar employees in the case organization. It was also studied if values were perceived similarly in the different departments. Impact of organizational position and education on value orientation was tested through hypotheses based on earlier values research. There are only few value scales available for measuring organizational values. The empirical study results indicate that personnel’s perception of organizational values can be measured statistically. When defining the scale it is utmost important to link the questions and claims close to the employees’ daily working environment. In this study, Work ethic appeared as the strongest organizational value reflecting respondents’ commitment to their duties. Related to corporate values, Performance was perceived as the strongest value and Emphasis on people the weakest. Value consensus between the departments varied. According to the previous research organizational position and educational level has an impact on value perceptions. In this study, employees in superior position or with higher education perceived organizational values to come true better than subordinates or employees with lower education. Empirical data (N=229) was collected by a web-based survey questionnaire among white-collar employees in the case organization in April 2008. Statistical analyses were performed by SPSS programme.

Identidad, percepción de vitalidad etnolingüística y comunicación intergrupal en Cataluña: An identity and ethnolinguistic perception vitality study in Catalonia

Catalan has drawn considerable attention given its impressive institutional support and increased usage since the restoration of the Generalitat of Catalonia. We report a study on 112 Catalan-speaking students who were administered the"subjective vitality questionnaire". Results show (and these are compared with reports 20 years ago) that it continues to gain momentum and status, even with the International stature of Spanish. The theoretical and pragmatic significance of these findings are discussed in terms of vitality"s role in shaping Language choices (Catalan vs. Castilian) in everyday communication as well as the societal level in forging Language policies for communicating in Catalan in business, political, educational, and media arenas

A missing spatial link in institutional quality

History tells that institutions evolve gradually over time, pushing new ideas across borders and cultures. Globalisation is argued to accelerate this process. We examine the spatial links of different political institutions across borders. Applying various tests for spatial proximity, we do not find evidence of contemporaneous spatial links. This result is robust to various measures of distance and of cultural proximity across countries. Instead, when we analyse long run dynamics diffusion of institutions seems to occur only gradually.

Inventors on the move: tracing inventors’ mobility and its spatial distribution

This paper aims to provide insights into the phenomenon of knowledge flows. We study one of the main mechanisms through which these flows occur, i.e., the mobility of highly-skilled individuals. We focus on the geographical mobility of inventors across European regions. Thus, patent data are used to trace the pattern of inventors’ mobility across european regions, to track down focuses of attraction of talent throughout the continent, and to study their distribution across the space. To do so, we gather information from PCT patent documents and we first match the names which seemed to belong to the same inventor and then we create a new algorithm to decide whether each patent applied for under each name belongs to the same inventor.

General Equilibrium Long-Run Determinants for Spanish FDI: A Spatial Panel Data Approach

While general equilibrium theories of trade stress the role of third-country effects, little work has been done in the empirical foreign direct investment (FDI) literature to test such spatial linkages. This paper aims to provide further insights into long-run determinants of Spanish FDI by considering not only bilateral but also spatially weighted third-country determinants. The few studies carried out so far have focused on FDI flows in a limited number of countries. However, Spanish FDI outflows have risen dramatically since 1995 and today account for a substantial part of global FDI. Therefore, we estimate recently developed Spatial Panel Data models by Maximum Likelihood (ML) procedures for Spanish outflows (1993-2004) to top-50 host countries. After controlling for unobservable effects, we find that spatial interdependence matters and provide evidence consistent with New Economic Geography (NEG) theories of agglomeration, mainly due to complex (vertical) FDI motivations. Spatial Error Models estimations also provide illuminating results regarding the transmission mechanism of shocks.

Spatial and Temporal Trends in Sunshine Duration over Western Europe

This work analyzes sunshine duration variability in the western part of Europe (WEU) over the 1938– 2004 period. A principal component analysis is applied to cluster the original series from 79 sites into 6 regions, and then annual and seasonal mean series are constructed on regional and also for the whole WEU scales. Over the entire period studied here, the linear trend of annual sunshine duration is found to be nonsignificant. However, annual sunshine duration shows an overall decrease since the 1950s until the early 1980s, followed by a subsequent recovery during the last two decades. This behavior is in good agreement with the dimming and brightening phenomena described in previous literature. From the seasonal analysis, the most remarkable result is the similarity between spring and annual series, although the spring series has a negative trend; and the clear significant increase found for the whole WEU winter series, being especially large since the 1970s. The behavior of the major synoptic patterns for two seasons is investigated, resulting in some indications that sunshine duration evolution may be partially explained by changes in the frequency of some of them

Un análisis comparativo del papel del bucle fonológico versus la agenda visoespacial en el cálculo en niños de 7-8 años = A comparative analysis of the phonological loop versus the visuo-spatial sketchpad in mental arithmetic tasks in 7-8 y.o. children

En esta investigación se ha estudiado la relación entre dos subsistemas de la memoria de trabajo (buclefonológico y agenda viso-espacial) y el rendimiento en cálculo con una muestra de 94 niños españolesde 7-8 años. Hemos administrado dos pruebas de cálculo diseñadas para este estudio y seis medidassimples de memoria de trabajo (de contenido verbal, numérico y espacial) de la «Batería de Testsde Memoria de Treball» de Pickering, Baqués y Gathercole (1999), y dos pruebas visuales complementarias.Los resultados muestran una correlación importante entre las medidas de contenido verbaly numérico y el rendimiento en cálculo. En cambio, no hemos encontrado ninguna relación con las medidasespaciales. Se concluye, por lo tanto, que en escolares españoles existe una relación importanteentre el bucle fonológico y el rendimiento en tareas de cálculo. En cambio, el rol de la agenda viso-espaciales nulo

Role of Selected Spectral Attributes in the Perception of Synthetic Vowels

This thesis is an experimental study regarding the identification and discrimination of vowels, studied using synthetic stimuli. The acoustic attributes of synthetic stimuli vary, which raises the question of how different spectral attributes are linked to the behaviour of the subjects. The spectral attributes used are formants and spectral moments (centre of gravity, standard deviation, skewness and kurtosis). Two types of experiments are used, related to the identification and discrimination of the stimuli, respectively. The discrimination is studied by using both the attentive procedures that require a response from the subject, and the preattentive procedures that require no response. Together, the studies offer information about the identification and discrimination of synthetic vowels in 15 different languages. Furthermore, this thesis discusses the role of various spectral attributes in the speech perception processes. The thesis is divided into three studies. The first is based only on attentive methods, whereas the other two concentrate on the relationship between identification and discrimination experiments. The neurophysiological methods (EEG recordings) reveal the role of attention in processing, and are used in discrimination experiments, while the results reveal differences in perceptual processes based on the language, attention and experimental procedure.

Risk perception and stages of smoking acquisition = Percepción de riesgo y etapas de iniciación en el consumo de tabaco

The purpose of this descriptive survey was to investigate the risk perceptions of smoking in a sample of 1,510 Spanish adolescents(49.1% males; mean age = 14.03; SD = 1.28). In addition, the present research categorised adolescents into one of the fourstages of smoking acquisition, as described by the Transtheoretical Model of Change (TMC): Precontemplation (notthinking about trying smoking in the next 6 months), Contemplation (thinking about trying smoking in the next 6 months), Preparation (thinking about starting smoking in the next 30 days) and Action (smokers), by gender and age. The results showed that age and risk perceptions are important variables in the progression through the stages of change towards regular tobacco consumption (Action stage). These results clearly demonstrate the importance of starting antismoking campaigns at an early age to prevent smoking acquisition or the thought of starting in the near future. These findings also highlight the need to continuously remind adolescents about the negative consequences of smoking

Environmental factors, spatial variation, and specific requirements of Chironomidae in Mediterranean reference streams

Chironomidae spatial distribution was investigated at 63 near-pristine sites in 22 catchments of the Iberian Mediterranean coast. We used partial redundancy analysis to study Chironomidae community responses to a number of environmental factors acting at several spatial scales. The percentage of variation explained by local factors (23.3%) was higher than that explained by geographical (8.5%) or regional factors(8%). Catchment area, longitude, pH, % siliceous rocks in the catchment, and altitude were the best predictors of Chironomidae assemblages. We used a k-means cluster analysis to classified sites into 3 major groups based on Chironomidae assemblages. These groups were explained mainly by longitudinal zonation and geographical position, and were defined as 1) siliceous headwater streams, 2) mid-altitude streams with small catchment areas, and 3) medium-sized calcareous streams. Distinct species assemblages with associated indicator taxa were established for each stream category using IndVal analysis. Species responses to previously identified key environmental variables were determined, and optima and tolerances were established by weighted average regression. Distinct ecological requirements were observed among genera and among species of the same genus. Some genera were restricted to headwater systems (e.g., Diamesa), whereas others (e.g., Eukiefferiella) had wider ecological preferences but with distinct distributions among congenerics. In the present period of climate change, optima and tolerances of species might be a useful tool to predict responses of different species to changes in significant environmental variables, such as temperature and hydrology.