Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton

OBJECTIVES: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents. DESIGN AND METHODS: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed. RESULTS: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring. CONCLUSION: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. It should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents

Rural Expressway Intersection Synthesis of Practice and Crash Analysis, 2004

This report presents a national synthesis of rural expressway, two-way stop -controlled (TWSC) intersection safety strategies and intersection designs and an analysis of Iowa expressway TWSC intersection crash characteristics. A rural expressway is a multi-lane highway with a divided median and with mostly at -grade intersections, although some intersections may be grade separated. The synthesis of intersection strategies is conducted in two parts. The first is a literature review and the second part is a national survey of strategies currently being applied by state transportation agencies. The characterization of crash patterns at TWSC expressway intersections is examined through the analysis of 5 years of crash data at 644 intersections.

Linking genetic and species diversities in a community of freshwater gastropods

Summary Biodiversity is usually studied through species or genetic diversities. To date, these two levels of diversity have remained the independent .fields of investigations of community ecologists and population geneticists. However, recent joint analyses of species and genetic diversities have suggested that common processes may underlie the two levels. Positive correlations between species diversity and genetic diversity may arise when the effects of drift and migration overwhelm selective effects. The first goal of this thesis was to make a joint investigation of the patterns of species and genetic diversity in a community of freshwater gastropods living in a floodplain habitat. The second goal was to determine, as far as possible, the relative influences of the processes underlying the patterns observed at each level. In chapter 2 we investigate the relative influences of different evolutionary forces in shaping the genetic structure of Radix balthica populations. Results revealed that the structure inferred using quantitative traits was lower or equal to the one inferred using neutral molecular markers. Consequently, the pattern of structure observed could be only due to random drift, possibly to uniform selection, but definitely not to selection for local optima. In chapter 3, we analyze the temporal variation of species and genetic diversities in five localities. An extended period of drought occurred at the end of the study period leading to decay of both species and genetic diversities. This parallel loss of diversity following a natural perturbation highlighted the role sometimes predominant of random drift over selection on patterns of biodiversity in a floodplain habitat. In chapter 4, we compare the spatial genetic structures of two sympatric species: Radix balthica and Planorbis carinatus. We found that R. balthica populations are weakly structured and have moderate to high values of gene diversity. In contrast, P. carinatus populations are highly structured and poorly diverse. Then we measured correlations between various indices of species and genetic diversity using genetic data .from the two species. We found only one significant correlation: between species richness and gene diversity of P. carinatus. This result highlights the .need to use genetic date from more than one species to infer correlations between species and genetic diversities. Overall, this thesis provided new insights into the common processes underlying patterns of species and genetic diversity. Résumé La biodiversité est généralement étudiée au niveau de la diversité génétique ou spécifique. Ces deux niveaux sont restés jusqu'à maintenant les domaines d'investigation séparés des généticiens des populations et des écologistes des communautés. Cependant, des analyses conjointes des diversités génétique et spécifique ont récemment suggéré que des processus similaires pouvaient influencer ces deux niveaux. Des corrélations positives entre les diversités génétique et spécifique pourraient être dues aux effets de migration et de dérive qui dominent les effets sélectifs. Le premier but de cette thèse était de faire une étude conjointe des diversités génétique et spécifique dans une communauté de gastéropodes d'eau douce. Le second objectif était de déterminer les influences relatives des différents processus liés à chaque niveau de diversité. Dans le chapitre 2 nous cherchons à déterminer quelles forces évolutives influencent la structure génétique de quatre populations de Radix balthica. La structure mesurée sur des traits quantitatifs s'est révélée être plus faible ou égale à celle mesurée avec des marqueurs moléculaires neutres. La structure observée pourrait ainsi être due uniquement à la dérive génétique, potentiellement à la sélection uniforme, mais en aucun cas à la sélection locale pour différents optima. Dans le chapitre 3 nous analysons la variation temporelle des diversités génétique et spécifique dans cinq localités. Une récente période de sécheresse a causé une diminution parallèle des deux niveaux de diversité. Cette perturbation à mis en évidence le rôle parfois prépondérant de la dérive par rapport à celui de la sélection dans le déterminisme de la biodiversité dans un écosytème alluvial. Dans le chapitre 4, nous comparons la structure génétique spatiale de deux espèces vivant en sympatrie : Radix balthica et Planorbis carinatus. Les populations de R. balthica sont peu structurées et présentent un niveau de diversité relativement élevé alors que celles de P. carinatus sont fortement structurées et peu diversifiées. Nous avons ensuite mesuré différentes corrélations entre les diversités génétique et spécifique, mais la seule relation significative a été trouvée entre la richesse spécifique et la diversité génétique de P. carinatus. Ainsi, cette thèse a permis de découvrir de nouveaux aspects des processus qui influencent en parallèle la diversité aux niveaux génétique et spécifique.

Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey.

BACKGROUND: Predicting outcome of breast cancer (BC) patients based on sentinel lymph node (SLN) status without axillary lymph node dissection (ALND) is an area of uncertainty. It influences the decision-making for regional nodal irradiation (RNI). The aim of the NORA (NOdal RAdiotherapy) survey was to examine the patterns of RNI. METHODS: A web-questionnaire, including several clinical scenarios, was distributed to 88 EORTC-affiliated centers. Responses were received between July 2013 and January 2014. RESULTS: A total of 84 responses were analyzed. While three-dimensional (3D) radiotherapy (RT) planning is carried out in 81 (96%) centers, nodal areas are delineated in only 51 (61%) centers. Only 14 (17%) centers routinely link internal mammary chain (IMC) and supraclavicular node (SCN) RT indications. In patients undergoing total mastectomy (TM) with ALND, SCN-RT is recommend by 5 (6%), 53 (63%) and 51 (61%) centers for patients with pN0(i+), pN(mi) and pN1, respectively. Extra-capsular extension (ECE) is the main factor influencing decision-making RNI after breast conserving surgery (BCS) and TM. After primary systemic therapy (PST), 49 (58%) centers take into account nodal fibrotic changes in ypN0 patients for RNI indications. In ypN0 patients with inner/central tumors, 23 (27%) centers indicate SCN-RT and IMC-RT. In ypN1 patients, SCN-RT is delivered by less than half of the centers in patients with ypN(i+) and ypN(mi). Twenty-one (25%) of the centers recommend ALN-RT in patients with ypN(mi) or 1-2N+ after ALND. Seventy-five (90%) centers state that age is not considered a limiting factor for RNI. CONCLUSION: The NORA survey is unique in evaluating the impact of SLNB/ALND status on adjuvant RNI decision-making and volumes after BCS/TM with or without PST. ALN-RT is often indicated in pN1 patients, particularly in the case of ECE. Besides the ongoing NSABP-B51/RTOG and ALLIANCE trials, NORA could help to design future specific RNI trials in the SLNB era without ALND in patients receiving or not PST.

Using a blog to create and support a Community of Inquiry in Secondary Education

Understanding how blogs can support collaborative learning is a vital concern for researchers and teachers. This paper explores how blogs may be used to support Secondary Education students’ collaborative interaction and how such an interaction process can promote the creation of a Community of Inquiry to enhance critical thinking and meaningful learning. We designed, implemented and evaluated a science case-based project in which fifteen secondary students participated. Students worked in the science blogging project during 4 months. We asked students to be collaboratively engaged in purposeful critical discourse and reflection in their blogs in order to solve collectively science challenges and construct meaning about topics related to Astronomy and Space Sciences. Through student comments posted in the blog, our findings showed that the blog environment afforded the construction of a Community of Inquiry and therefore the creation of an effective online collaborative learning community. In student blog comments, the three presences for collaborative learning took place: cognitive, social, and teaching presence. Moreover, our research found a positive correlation among the three presences –cognitive, social and teaching– of the Community of Inquiry model with the level of learning obtained by the students. We discuss a series of issues that instructors should consider when blogs are incorporated into teaching and learning. We claim that embedded scaffolds to help students to argue and reason their comments in the blog are required to foster blog-supported collaborative learning.

Effects of the sewage pollution in the structure and dynamics of the community of Cystoseira mediterranea (Fucales, Phaeophyceae)

We performed a study on the specific composition, structure, and dynamics of two Cystoseira mediterranea communities from the north-western Mediterranean submitted to different degrees of pollution. The structural complexity (species richness, specific distribution, and species and pattern diversity) and biomass production were lower in the polluted site. In this station, opportunistic algae (mainly Ulva rigida) loomed, and Mesophyllum lichenoides and some encrusting brown algae increased their cover. Other species (Jania rubens, and some Ceramiales) decreased their abundance when compared with the polluted site

Diversity and structure of the tree community of a fragment of tropical secondary forest of the brazilian Atlantic Forest domain 15 and 40 years after logging

Two adjacent tracts of tropical secondary forest, situated in Itambé do Mato Dentro, south-eastern Brazil, which had been regenerating for 15 and 40 years after clearing, were compared with the purpose of detecting differences in species diversity and composition, species guild composition (regeneration, stratification and dispersion), and stand structure. Four and three 1,125 m² plots laid on the 15- and 40-year-old stands, respectively, sampled 2,430 trees with diameter at the base of the stem > 5 cm. The number of species (S = 199) was high for this forest type and significantly higher for the older stand. Tree density was significantly higher in the younger stand, particularly for smaller trees, whereas the two stands did not differ in both basal area and volume per hectare. Trees of shade-tolerant and understory species were significantly more abundant in the older stand. Though sharing a large proportion of species (49%), the two stands differed significantly in the abundance of many species. Live stumps probably contributed to the relatively quick restoration of some forest characteristics, particularly species diversity, basal area and volume.

Inter-annual variations in the floristic and population structure of an herbaceous community of "caatinga" vegetation in Pernambuco, Brazil

The influence of climatic variations on the herbaceous component of the "caatinga" vegetation was examined in the state of Pernambuco, Brazil. A total of 105 1 × 1 m-plots were established, of which 35 were in a level micro-habitat, 35 in a riparian micro-habitat, and 35 in a stony microhabitat. During two consecutive years all herbaceous plants in these plots were counted, measured (height and diameter), and collected for identification. The Shannon-Wiener diversity index and the equitability were calculated for each year, as well as the density, frequency, dominance, total basal area and importance index for each species. The total annual pluviometric was 819.5 and 448.8 mm in 2002 and 2003, respectively. The herbaceous flora in the study area was composed of 71 species, of which 58 were sampled in the plots. The families with the greatest species richness were Malvaceae (8 species), Euphorbiaceae (7), Poaceae (6), Convolvulaceae (4), Fabaceae (4), and Portulacaceae (4). The diversity indices were 2.66 and 3.01 nats ind-1 in 2002 and 2003, respectively. The density, frequency, dominance and importance value of herbaceous populations, as well as, the height and diameter of plants were low in the dryer year. The riparian group was the most isolated of the microhabitats examined, both in terms of its floristic and its population structure. Annual seasonal climatic variations greatly modified these populations structure during the course of this study, emphasizing the fact that long-term studies are needed in order to better understand the dynamics of the herbaceous component of the "caatinga" vegetation.

Structure and dynamics of a woody plant community of a tropical semi-deciduous seasonal forest in the "Estação Ecológica do Panga", municipality of Uberlândia, Minas Gerais, Brazil

Studies of plant community dynamics are essential in understanding the demographic patterns of species since changes in demographic rates can affect the floristic composition and future structure. The purpose of the present study was to analyze the changes in the community structure and floristic composition of woody plants in a tropical semi-deciduous forest in Uberlândia in central Brazil, during a 10-years period. The data were collected in 1989 and in 2000 in 50 quadrats (10 m x 10 m) where all trees with a minimum circumference at breast height of 10 cm were sampled. In 1989, 93 species and 1103 individuals were registered. Over a period of 10 years, seven new species were added to the community, although eight disappeared. The main change that occurred during this period in the floristic composition was the replacement of savannah species occurring in forest gaps by those from the forest understory.

Effect of practice and span length on the dual-task coordination executive test

The measure "mu", proposed as an index of the ability to coordinate concurrent box-crossing (BC) and digit-span (DS) tasks in the dual task (DT), should reflect the capacity of the executive component of the working memory system. We investigated the effect of practice in BC and of a change in the digit span on mu by adding previous practice trials in BC and diminishing, maintaining or increasing the digit sequence length. The mu behavior was evaluated throughout three trials of the test. Reported strategies in digit tasks were also analyzed. Subjects with diminished span showed the best performance in DT due to a stable performance in DS and BC in the single- and dual-task conditions. These subjects also showed a more stable performance throughout trials. Subjects with diminished span tended to employ effortless strategies, whereas subjects with increased span employed effort-requiring strategies and showed the lowest means of mu. Subjects with initial practice trials showed the best performance in BC and the most differentiated performance between the single- and dual-task conditions in BC. The correlation coefficient between the mu values obtained in the first and second trials was 0.814 for subjects with diminished span and practice trials in BC. It seems that the within-session practice in BC and the performance variability in DS affect the reliability of the index mu. To control these factors we propose the introduction of previous practice trials in BC and a modification of the current method to determine the digit sequence length. This proposal should contribute to the development of a more reliable method to evaluate the executive capacity of coordination in the dual-task paradigm.

Education, sport and myth in the community of Glengarry, Ontario : the athletic career of Roderick R. McLennan. 260 St. Catharines, Ont. : Faculty of Education, Brock University ;

This study examined how the athletic career of Roderick R. McLennan contributed to the popularization and subsequent development of Caledonian games in Ontario during the latter nineteenth century. Initially, the development of Caledonian games during the 1800s was examined to provide a contextual framework for McLennan's career. This investigation revealed that the games emerged from rural athletic events at pioneer working bees in the first quarter of the nineteenth century to regional sporting events by the mid-1800s, and finally into annual federated Caledonian games in 1870. Noteworthy primary source material for this chapter included the John MacGillivray Papers at the National Archives of Canada, the Scottish American Journal (NY) and the files retained by the Glengarry Sport Hall of Fame in Maxville, Ontario. Following the investigation of Caledonian games, McLennan's early athletic career was studied. Analysis of the Roderick and Farquhar McLennan Papers at the Archives of Ontario and the newspapers from the period revealed that McLennan rose to popularity in 1865 through a "Championship of the World" hammer throwing match in Cornwall and two "Starring Tours". The next chapter examined the height of McLennan's career through an investigation of the Roderick McLennan versus Donald Dinnie rivalry of the early .. n 1870s. It was detennined that the rivalry between McLennan and Dinnie, the champion athlete of Highland games in Scotland, was a popular attraction and had an impact on the Toronto and Montreal games of 1870 and the Toronto games of 1872. Finally, the athletic records established by McLennan during the 1860s and 1870s were investigated. These records were examined through the context of a media controversy over McLennan's feats that developed in the early 1880s between two newspapers. This controversy erupted between the Toronto Mail and the Spirit of the Times. Caledonian games in Canada have only been briefly examined and a thorough examination of prominent Canadian figures in this context has yet to be undertaken. This study unearths a prominent Canadian athlete of Scottish decent and details his involvement in the Caledonian games of nineteenth century Ontario.

Dynamics of Infaunal Benthic Community of the Contenental Shelf of North-Eastern Arabian Sea

In this study dynamics of infaunal benthic community of the continental shelf of north-eastern Arabian sea. The benthic (under water sea) organisms play an important role in the marine food chain. It can be concluded that seasonal differences in the benthic community was observed in lower depths and absent in deeper depths. Increased richness and diversity during pre-monsoon may be related to the increased primary production which inturn influenced by the increased nutrient input due to winter convection. No single ecological factor could be considered as a master factor. In general the area supports moderately high benthic production and diversified community.

Studies on the macrobenthic community of Cochin backwaters with special reference to culture of Eriopisa chilkensis (Gammaridae-Amphipoda)

This thesis Entitled studies on the macrobenthic community of cochin backwaters with special reference to culture of eriopisa chilkensis (Gammaridae- amphipoda).Benthic organisms are usually studied for environmental impact assessment, pollution control and resource conservation. The benthic monitoring component has three major objectives: 1) characterize the benthic communities to assess the estuarine health, 2) determine seasonal and spatial variability in benthic communities, and 3) detect changes in the estuarine community through examination of changes in abundances of specific indicator taxa and other standard benthic indices.Cochin backwaters situated at the tip of the northern Vembanad lake is a tropical positive estuarine system. The backwaters of Kerala support as much biological productivity and diversity as tropical rain forest and are responsible for the rich fishery potential of Kerala. Backwaters also act as nursery grounds for commercially important prawns and fishes.The thesis has been subdivided into seven chapters. The first chapter gives a general introduction about the topic and also highlights the scope and purpose of the study. The second chapter covers the methodology adopted for the collection and analysis of water quality parameters, sediment and the macrobenthic fauna.Chapter 3 deals with hydrographic features, sediment characteristics and the spatial variation and abundance of macrobenthic fauna in the Cochin estuary.Chapter 4 explains the impact of organic enrichment on macrobenthic popUlation in the Cochin estuary and includes the comparison of the present data with the earlier work in this region.Chapter 5 deals with seasonal variability in abundance of macrobenthic species in the estuary. The study was conducted from 9 stations during three seasons (pre-monsoon, monsoon and post-monsoon) in 2003.Chapter 6 deals with Life history and Population Dynamics of Eriopisa chilkensis Chilton (Gammaridae-Amphipoda). The life cycle of the gammarid amphipod Eriopisa chilkensis from the Cochin estuary, south west coast of India was studied for the first time under laboratory conditions.

ALPS Workshop 4 p18 Examples of practice incidents

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Evaluating the 'threat' effects of grade repetition exploiting the 2001 reform by the French-speaking community of Belgium. 'Evaluación de los efectos de 'amenaza' de la repetición de grado aprovechando la reforma del año 2001 por la comunidad francófona de Bélgica'.

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