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PAR VÉRONIQUE QUIRION Un nouveau jour Cette série documentaire originale s’intéresse au parcours de personnes trans tout au long de leur processus chirurgical d’affirmation de genre. Souvent nées dans un [...]

The United States is experiencing a mental health crisis and psychedelics (ketamine, LSD, MDMA, psilocybin) have emerged as a potential new drug class to add to the treatment armamentarium. Approximately [...]

Objective: To examine the relationship between care fragmentation and patient ratings of care quality and identify potentially actionable mediators. Data Sources/Study Setting: 2015 telephone survey of 1395 women Veterans with three or more visits in primary care and/or women's health care in the prior year at 12 Veterans Affairs (VA) medical centers. Study Design: Cross-sectional analysis. Data Collection/Extraction Methods: We operationalized lower care fragmentation as receiving VA-only care versus dual use of VA/non-VA care. Participants rated VA care quality (overall care, women's health care (WH), and primary care (PC)) and three aspects of their patient experience (ease of access to services, provider communication, and gender sensitivity of VA environments). We examined associations between care fragmentation and care ratings and applied the Karlson-Holm-Breen decomposition method to test for mediation by aspects of patients' experience. Principal Findings: Lower care fragmentation was associated with higher ratings of care quality (odds ratios [95% CI] for overall care: 1.57 [1.14;2.17]; WH: 1.65 [1.20;2.27]; PC: 1.41 [1.10;1.82]). Relationships were mediated by patient-rated provider communication and gender sensitivity (26-54 percent and 14-15 percent of total effects, respectively). Ease of access was associated with higher care ratings (odds ratios [95% CI] for overall care: 2.93 [2.25;3.81]; WH: 2.81 [2.15;3.68]; PC: 2.33 [1.63;3.33], in models with the three types of patient care experiences included), but did not mediate the association of care fragmentation and care ratings. Conclusions: Potential negative effects of care fragmentation on care quality ratings could be mitigated by attention to quality of patient-provider communication and gender sensitivity of VA environments. KEYWORDS access to care, gender, patient experience, patient-provider communication, Veterans, 1 | INTRODUCTION In the face of widely publicized access delays, the 2014 Veterans Access, Choice and Accountability Act created new provisions for Veteran access to care by increasing Veterans [...]

Para estimar la biomasa leñosa a partir de las existencias maderables en volumen obtenidas en inventarios forestales, se determinó la densidad básica de la madera en 59 especies arbóreas, para algunas de las cuales escasea la información publicada sobre las características de su madera. Se trata de especies pertenecientes a las familias Anacardiaceae, Burseraceae, Meliaceae, Rutaceae, Sapindaceae y Simaroubaceae, todas ellas incluidas en el orden Sapindales. La densidad básica se obtuvo a partir de muestras procedentes de inventarios forestales realizados en las dos últimas décadas en diversas regiones del Brasil. Se comprobó que la mayor parte de las especies analizadas (68%) presentan maderas livianas o semipesadas (densidad básica entre 0,51 y 0,80) aunque la densidad se mostró muy variable entre especies, desde 0,38 para Simarouba amara hasta 1,25 para Schinopsis lorentzii. Se encontró información bibliográfica sobre densidad básica de la madera para tres cuartas partes de las especies objeto de estudio, resultando que según referencias bibliográficas la madera analizada en este trabajo es 21% más densa que la procedente de las mismas especies en otras regiones. Este trabajo aporta información sobre especies de maderas poco conocidas hasta el momento. Así mismo, las especies arbóreas del orden Sapindales procedentes de Brasil y que fueron analizadas en este trabajo, destacan por la alta densidad básica de su madera, por lo que contribuyen de forma especialmente eficaz a la acumulación de biomasa y a la correspondiente fijación de carbono. The basic density of wood from 59 tree species was determined in order to estimate the weight of woody biomass from the volume of wood measured in forest inventories. Published information about wood properties of some of these species is scarce. The 59 species considered belong to the families Anacardiaceae, Burseraceae, Meliaceae, Rutaceae, Sapindaceae and Simaroubaceae, all of which are included in the order Sapindales. The basic density was determined in samples obtained in forest inventories performed in the last two decades in various regions of Brazil. Most of the species analyzed (68%) had light or semi-heavy wood (basic density between 0,51 and 0,80), although the density varied widely between species, ranging from 0,38 for Simarouba amara to 1,25 for Schinopsis lorentzii. A literature search revealed data on the basic density of the wood of three quarters of the species under study. According to this data, the wood considered in the present study is 21% more dense than wood from the same species growing in other regions. This study provides new information on wood of tree species about which very little was previously known. The analyzed Brazilian tree species in the order Sapindales were found to be important because of the high basic density of their wood. These trees thus contribute efficiently to biomass accumulation and to the corresponding carbon fixation. Palabras clave: bosque tropical densidad básica fijación de carbono inventario forestal tecnología de la madera Keywords: tropical forest basic density carbon fixation forest inventory wood technology, Introducción La cubierta forestal de Brasil es de 463 millones de hectáreas y 98% de esta cobertura son bosques naturales, localizados principalmente en el norte del país. Esta vasta extensión [...]

Background. Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). Different land-based rehabilitation approaches based on motor and cognitive strategies can be effective in treating FOG. Although there are data about the efficacy of aquatic therapy in ameliorating this phenomenon, no study has explored the combined effect of land-based therapies plus aquatic therapy in patients with PD who have FOG. Objective. The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether implementation with aquatic therapy (MIRT-AT) adds further benefits. Design. The design consisted of a single-blind, parallel-group, 1:1 allocation ratio, randomized trial. Setting. The Department of Parkinson Disease, Movement Disorders and Brain Injury Rehabilitation at 'Moriggia-Pelascini' Hospital (Gravedona ed Unid, Como, Italy) was used as the setting. Participants. Sixty hospitalized patients with PD who had FOG in Hoehn and Yahr stage 2 or 5-3 were included. Intervention. Sixty patients with PD + FOG were randomly assigned to 2 groups: 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT-AT. Measurements. The primary outcome measure was the Freezing of Gait Questionnaire; secondary- outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale, Timed Up and Go Test, and 6-Minute Walk Test. These measures were assessed both at admission and discharge. Results. Participants in the 2 groups had similar age, sex distribution, Hoehn and Yahr stage, and most-affected side. At baseline, no difference in outcome measures was observed between the 2 groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time x group interaction was observed. A betweengroup analysis showed nonsignificant differences between values at Tl and values at TO for all variables. Limitations. The limitations were the lack of a control group and follow-up. Conclusions. We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improves FOG in patients with PD. Although aquatic therapy could be considered a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation., I. Clerici, PT, Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Italy. R. Maestri, BME, Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri [...]

Abstract. Decision analysis has been with us for at least half a century. Over that time, it has developed from a theoretical paradigm for individual rational choice to a practical [...]

Interview Benjamin Locoge Photos Hélène Pambrun Deux heures avant d’entrer en scène, il arrive au théâtre des Nouveautés à la cool. Jean, baskets, casquette, Gérard Darmon s’installe dans sa loge, [...]