Inappropriate medication use in long-term care facility residents with advanced Alzheimer’s disease and other dementias

Les personnes atteintes de démence sévère, résidant dans un centre d’hébergement et de soins de longue durée (CHSLD) et approchant la fin de leur vie, ne reçoivent pas systématiquement des soins palliatifs, malgré que ce niveau de soins soit le plus approprié. La plupart de ces personnes reçoivent également un grand nombre de médicaments dont les effets indésirables peuvent contribuer à des souffrances évitables. Une approche axée sur les soins palliatifs serait possiblement associée à une réduction de la charge médicamenteuse et, du même coup, à une prescription plus appropriée. Les objectifs de ce projet de recherche étaient de décrire l’usage des médicaments chez les résidents atteints de démence sévère en CHSLD, de comparer leur usage de médicaments à des critères de pertinence et d’évaluer si la mise en œuvre d’une approche axée sur les soins palliatifs était associée aux médicaments prescrits. Cette étude décrit l’usage des médicaments chez 215 sujets atteints de démence sévère et en fin de vie qui ont participé à une étude d’intervention quasi expérimentale menée dans quatre CHSLD du Québec sur la mise en œuvre d’une approche axée sur les soins palliatifs. L’utilisation des médicaments a été comparée à trois listes de critères pertinents publiés, soit ceux de Holmes, Rancourt et Kröger, en utilisant des statistiques descriptives. Les analyses sur l’usage de 412 médicaments différents chez 120 sujets du groupe expérimental et 95 sujets du groupe témoin ont montré que cette approche axée sur les soins palliatifs n’est pas associée à une prescription plus appropriée des médicaments chez ces personnes particulièrement vulnérables.

Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC): a randomized, multicenter, phase II trial SAKK 41/07.

BACKGROUND: We conducted a randomized, phase II, multicenter study to evaluate the anti-epidermal growth factor receptor (EGFR) mAb panitumumab (P) in combination with chemoradiotherapy (CRT) with standard-dose capecitabine as neoadjuvant treatment for wild-type KRAS locally advanced rectal cancer (LARC). PATIENTS AND METHODS: Patients with wild-type KRAS, T3-4 and/or N+ LARC were randomly assigned to receive CRT with or without P (6 mg/kg). The primary end-point was pathological near-complete or complete tumor response (pNC/CR), defined as grade 3 (pNCR) or 4 (pCR) histological regression by Dworak classification (DC). RESULTS: Forty of 68 patients were randomly assigned to P + CRT and 28 to CRT. pNC/CR was achieved in 21 patients (53%) treated with P + CRT [95% confidence interval (CI) 36%-69%] versus 9 patients (32%) treated with CRT alone (95% CI: 16%-52%). pCR was achieved in 4 (10%) and 5 (18%) patients, and pNCR in 17 (43%) and 4 (14%) patients. In immunohistochemical analysis, most DC 3 cells were not apoptotic. The most common grade ≥3 toxic effects in the P + CRT/CRT arm were diarrhea (10%/6%) and anastomotic leakage (15%/4%). CONCLUSIONS: The addition of panitumumab to neoadjuvant CRT in patients with KRAS wild-type LARC resulted in a high pNC/CR rate, mostly grade 3 DC. The results of both treatment arms exceeded prespecified thresholds. The addition of panitumumab increased toxicity.

Comparing ESL electronic and face-to-face pre-writing conferences and first drafts : discourse, participation, and idea transfer /

This study was a comparative investigation of face-toface (i.e., proximate) and computer-mediated written (i.e., graphic) pre-writing conferences. The participants in this study were advanced English as a second language students. The 2 types of conferences were compared in terms of textual features, participation, and the . degree to which they were on topic. Moreover, drafts written after the 2 types of conferences were compared in terms of textual features, and the degree to which they were related to the conferences. Students produced an equivalent amount of discourse in an equivalent amount of time in the 2 types of conferences. The discourse in graphic conferences displayed greater lexical range, and some evidence suggests that it was less on-topic. Both these results likely occurred because the graphic conferences contained more discourse demonstrating interactive competence. Participation in graphic conferences was found to be as balanced or more balanced among students, and among students and the group leader combined. Overall, the drafts produced after the 2 types of conferences were of equivalent length and topical range, but some evidence suggests that drafts written after proximate conferences were more related to the conferences.

The adoption of advanced feed-in tariffs in Ontario : a case of institutional layering

En mai 2009, l’Ontario a adopté la Loi sur l’énergie verte et devint ainsi la première juridiction en Amérique du Nord à promouvoir l’énergie renouvelable par le biais de tarifs de rachat garantis. En novembre 2010, dans son Plan énergétique à long terme, la province s’est engagée à déployer 10,700 MW en capacité de production d’énergie renouvelable non-hydroélectrique par 2018. Il s’agit de la cible de déploiement la plus élevée dans ce secteur au Canada. Les infrastructures de production et de distribution d’électricité comprennent des coûts d’installation élevés, une faible rotation des investissements et de longs cycles de vie, facteurs qui servent habituellement à ancrer les politiques énergétiques dans une dynamique de dépendance au sentier. Depuis le début des années 2000, cependant, l’Ontario a commencé à diverger de sa traditionnelle dépendance aux grandes centrales hydroélectriques, aux centrales à charbon et aux centrales nucléaires par une série de petits changements graduels qui feront grimper la part d’énergie renouvelable dans le mix énergétique provincial à 15% par 2018. Le but de ce mémoire est d’élucider le mécanisme de causalité qui a sous-tendu l’évolution graduelle de l’Ontario vers la promotion de l’énergie renouvelable par le biais de tarifs de rachat garantis et d’une cible de déploiement élevée. Ce mémoire applique la théorie du changement institutionnel graduel de Mahoney et Thelen au cas du développement de politiques d’énergie renouvelable en Ontario afin de mieux comprendre les causes, les modes et les effets du changement institutionnel. Nous découvrons que le contexte canadien de la politique énergétique favorise la sédimentation institutionnelle, c’est-à-dire un mode changement caractérisé par de petits gains favorisant l’énergie renouvelable. Ces gains s’accumulent pourtant en transformation politique importante. En Ontario, la mise sur pied d’une vaste coalition pour l’énergie renouvelable fut à l’origine du changement. Les premiers revendicateurs de politiques favorisant l’énergie renouvelable – les environnementalistes et les premières entreprises d’approvisionnement et de service en technologies d’énergie renouvelable – ont dû mettre sur pied un vaste réseau d’appui, représentant la quasi-totalité de la société ontarienne, pour faire avancer leur cause. Ce réseau a fait pression sur le gouvernement provincial et, en tant que front commun, a revendiqué l’énergie renouvelable non seulement comme solution aux changements climatiques, mais aussi comme solution à maints autres défis pressants de santé publique et de développement économique. La convergence favorable d’un nombre de facteurs contextuels a certes contribué à la réussite du réseau ontarien pour l’énergie renouvelable. Cependant, le fait que ce réseau ait trouvé des alliés au sein de l’exécutif du gouvernement provincial s’est révélé d’importance cruciale quant à l’obtention de politiques favorisant l’énergie renouvelable. Au Canada, les gouvernements provinciaux détiennent l’ultime droit de veto sur la politique énergétique. Ce n’est qu’en trouvant des alliés aux plus hauts échelons du gouvernement que le réseau ontarien pour l’énergie renouvelable a pu réussir.

Millimeter-wave measurements of the complex dielectric constant of an advanced thick film UV photoresist

The first measurement of the relative permittivity (εr) and loss tangent (tan δ) of EPON™ SU-8 advanced thick film ultraviolet photoresist is reported at frequencies between 75–110 GHz (W-band). The problems associated with such a measurement are discussed, an error analysis given, and values of εr=1.725±0.08 and tanδ =0.02±0.001 are determined.

Content validation for level of use of feature rich systems: a Delphi study of electronic medical records systems

Introduction. Feature usage is a pre-requisite to realising the benefits of investments in feature rich systems. We propose that conceptualising the dependent variable 'system use' as 'level of use' and specifying it as a formative construct has greater value for measuring the post-adoption use of feature rich systems. We then validate the content of the construct as a first step in developing a research instrument to measure it. The context of our study is the post-adoption use of electronic medical records (EMR) by primary care physicians. Method. Initially, a literature review of the empirical context defines the scope based on prior studies. Having identified core features from the literature, they are further refined with the help of experts in a consensus seeking process that follows the Delphi technique. Results.The methodology was successfully applied to EMRs, which were selected as an example of feature rich systems. A review of EMR usage and regulatory standards provided the feature input for the first round of the Delphi process. A panel of experts then reached consensus after four rounds, identifying ten task-based features that would be indicators of level of use. Conclusions. To study why some users deploy more advanced features than others, theories of post-adoption require a rich formative dependent variable that measures level of use. We have demonstrated that a context sensitive literature review followed by refinement through a consensus seeking process is a suitable methodology to validate the content of this dependent variable. This is the first step of instrument development prior to statistical confirmation with a larger sample.

Symptoms and distress in children with advanced cancer: prospective patient-reported outcomes from the PediQUEST Study

PURPOSE: Thousands of children are living with advanced cancer; yet patient-reported outcomes (PROs) have rarely been used to describe their experiences. We aimed to describe symptom distress in 104 children age 2 years or older with advanced cancer enrolled onto the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study (multisite clinical trial evaluating an electronic PRO system).

METHODS: Symptom data were collected using age- and respondent-adapted versions of the PediQUEST Memorial Symptom Assessment Scale (PQ-MSAS) at most once per week. Clinical and treatment data were obtained from medical records. Individual symptom scores were dichotomized into high/low distress. Determinants of PQ-MSAS scores were explored using linear mixed-effects models.

RESULTS: During 9 months of follow-up, PQ-MSAS was administered 920 times: 459 times in teens (99% self-report), 249 times in children ages 7 to 12 years (96% child/parent report), and 212 times in those ages 2 to 6 years (parent reports). Common symptoms included pain (48%), fatigue (46%), drowsiness (39%), and irritability (37%); most scores indicated high distress. Among the 73 PQ-MSAS surveys administered in the last 12 weeks of life, pain was highly prevalent (62%; 58% with high distress). Being female, having a brain tumor, experiencing recent disease progression, and receiving moderate- or high-intensity cancer-directed therapy in the prior 10 days were associated with worse PQ-MSAS scores. In the final 12 weeks of life, receiving mild cancer-directed therapy was associated with improved psychological PQ-MSAS scores.

CONCLUSION: Children with advanced cancer experience high symptom distress. Strategies to promote intensive symptom management are indicated, especially with disease progression or administration of intensive treatments.

Advanced N-doped mesoporous molybdenum disulfide nanosheets and the enhanced lithium-ion storage performance

With the increasing interest in two-dimensional van der Waals materials, molybdenum disulfide (MoS2) has emerged as a promising material for electronic and energy storage devices. It suffers from poor cycling stability and low rate capability when used as an anode in lithium ion batteries. Here, N-doped MoS2 nanosheets with 2-8 atomic layers, increased interlayer distance, mesoporous structure and high surface area synthesised by a simple sol-gel method show an enhanced lithium storage performance, delivering a high reversible capacity (998.0 mA h g-1, 50 mA g-1), high rate performance (610 mA h g-1, 2 A g-1), and excellent cycling stability. The excellent lithium storage performance of the MoS2 nanosheets might be due to the better electrical and ionic conductivity and improved lithium ion diffusion which are related to their structural characteristics and high concentration N doping. The possible mechanism of the improved performance is proposed and discussed.

Robert Cornell, Technical Editor, Electronic Technician Magazine

New York Trade School graduate Robert Cornell is pictured at his desk in his position of Technical Editor, Electronic Technician Magazine. Original caption reads "Robert Cornell - Advanced Television 1954, was appointed Technical Editor of Electronic Technician Magazine in 1956 and has served with distinction since. He is President of CETA (Certified Electronic Technicians Association), which consists of alumni of the New York Trade School who are graduates of the Advanced Television Course. He was recently invited to serve a a member of the Attorney General's Committee seeking to establish safeguards to protect the public in the field of television servicing." Black and white photograph with caption to glued to reverse.

Nicholas Colon, Jr, Proprietor Tele-FM Television and Advanced Television Techniques graduate, 1954.

This is a photograph showing Nicholas Colon, Jr. a New York Trade School, Advanced Television Techniques graduate with an unnamed worker at his Tele-FM Television company. Original caption reads, "Nicholas Colon, Jr. - Advanced Television Techniques 1954, operates and up-to-date and successful television service shop. He is on the executive board of CETA (Certified Electronic Technicians Association). He prefers to employ graduate technicians of the New York Trade School Advanced Television Techniques course." Black and white photograph with caption glued to reverse.

EFFECT of DIFFERENT SOLID AMOUNTS IN THE PHYSICAL and MICROSCOPICAL PROPERTIES of SiC POROUS CERAMICS

The presence of pores in ceramics is directly related to the chosen forming process. So, in the starch consolidation method, the ceramics show, after burning, pores with morphology similar to that presented by this organic material. on the other hand, the increase in solid load leads up to alterations in dispersion viscosity, increasing the thermal stresses during drying and sintering processes. In order to verify the solid percentage influence in ceramic final properties, samples were prepared with silicon carbide in different compositions using or not starch as binder agent and pore forming element. The characterization of the ceramic pieces was performed by superficial roughness measurements, porosity besides by optical and scanning electron microscopy. The results showed ceramics with SiC and starch presented physical and microscopic properties slightly higher in relation to those with only ceramic powder in their composition. The presence of organic material, agglomerated and foam during the forming were essential for the final properties of the studied samples.

Structural, electronic structure and magnetic studies of SmFe1-xNixO3 (x <= 0.5)

We present the structural, electronic structure and magnetic studies of Ni doped SmFeO3. The X-ray diffraction (XRD) studies confirm the single phase nature of the samples having orthorhombic Pbnm structure and the unit-cell volume is decreasing with the increase of Ni concentration. X-ray absorption spectroscopy (XAS) studies on O K. Fe L-3.2, Ni L-3.2 and Sm M-5.4 edges of SmFe1-xNixO3 (x <= 0.5) samples along with the reference compounds revealed the homo-valence state of Fe and Ni in these materials. From magnetization studies it has been observed the materials exhibit ferromagnetic and anti-ferromagnetic sub-lattices, which are strongly dependent on the thermo-magnetic state of the system. (C) 2010 Elsevier B.V. All rights reserved.

Alumina porous ceramics: mathematical behavior at different commercial starch concentration

Several researches have been developed in order to verify the porosity effect over the ceramic material properties. The starch consolidation casting (SCC) allows to obtain porous ceramics by using starch as a binder and pore forming element. This work is intended to describe the porous mathematical behavior and the mechanical resistance at different commercial starch concentration. Ceramic samples were made with alumina and potato and corn starches. The slips were prepared with 10 to 50 wt% of starch. The specimens were characterized by apparent density measurements and three-point flexural test associated to Weibull statistics. Results indicated that the porosity showed a first-order exponential equation e(-x/c) increasing in both kinds of starches, so it was confirmed that the alumina ceramic porosity is related to the kind of starch used. The mechanical resistance is represented by a logarithmic expression R = A + B/1+10((Log(x0)-P)C).

Preparation of Al2TiO5-Al2O3 and Al2TiO5-Al2O3-TiO2 Ceramics by High-Energy Ball Milling and Sintering

The present work reports on the preparation of Al2O3-TiO2 ceramics by high-energy ball milling and sintering, varying the molar fraction in 1:1 and 3:1. The powder mixtures were processed in a planetary Fritsch P-5 ball mill using silicon nitride balls (10 mm diameter) and vials (225 mL), rotary speed of 250 rpm and a ball-to-powder weight ratio of 5:1. Samples were collected into the vial after different milling times. The milled powders were uniaxially compacted and sintered at 1300 and 1500 degrees C for 4h. The milled and sintered materials were characterized by X-ray diffraction and electron scanning microscopy (SEM). Results indicated that the intensity of Al2O3 and TiO2 peaks were reduced for longer milling times, suggesting that nanosized particles can be achieved. The densification of Al2O3-TiO2 ceramics was higher than 98% over the relative density in samples sintered at 1500 degrees C for 4h, which presented the formation of Al2TiO5.

Synthesis and sintering of PZT ceramics

Lead zirconate powder, with Zr/Ti ratio of 50/50 was prepared by polymeric precursor method and doped with 3, 5 and 7 mol% of Sr+2 Or Ba+2, as well as by 0.2 to 5 mol% of Nb+5. The powder was calcined at 750 degrees C by 4 hours and milled during 1.5 h in isopropilic alcohol. Powders were characterized by surface area measurements (BET method), by infrared spectroscopy and by X-ray diffraction to characterize the crystal structure. Isostatically pressed samples were sintered in a dilatometer furnace by using a constant heating rate of 10 degrees C/min from ambient to 1200 degrees C. Synthetic air and air with water vapor were used as atmospheres. Both Sr+2 and Ba+2 substitute Pb+2 and favor the formation of rhombohedral phase. Otherwise, Nb+5 substitute preferentially Zr+4 favoring tetragonal phase. The concentration of dopants and the atmosphere influence the densification and the microstructure of the PZT, which alters the dielectric and piezoelectric properties of the ceramics.