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Elopement is a common and potentially dangerous form of problem behavior. Results of a functional analysis found that the elopement of a child with autism was maintained by access to stereotypy in the form of door play. We implemented functional communication training and contingency-based delays dependent on the absence of elopement and increased the amount of time the participant waited prior to engaging in stereotypy. We also conducted treatment-extension probes, with the participant waiting up to 10 min without elopement.

Paintings could offer insight into the varied experiences of people with different dementias. In this project, a single exercise - the painting of a group of objects in still-life - was used to capture artistic production in four artists with different diagnoses of dementia and four healthy artists. Whilst quantitative studies provide important insights into the neuroanatomical supports for artistic actions, autonomous art exercises may yield deeper understanding of the individual creative experience in the context of neurodegenerative disease.

BACKGROUND: Memory for music has attracted much recent interest in Alzheimer's disease but the underlying brain mechanisms have not been defined in patients directly. Here we addressed this issue in an Alzheimer's disease cohort using activation fMRI of two core musical memory systems. METHODS: We studied 34 patients with younger onset Alzheimer's disease led either by episodic memory decline (typical Alzheimer's disease) or by visuospatial impairment (posterior cortical atrophy) in relation to 19 age-matched healthy individuals. We designed a novel fMRI paradigm based on passive listening to melodies that were either previously familiar or unfamiliar (musical semantic memory) and either presented singly or repeated (incidental musical episodic memory). RESULTS: Both syndromic groups showed significant functional neuroanatomical alterations relative to the healthy control group. For musical semantic memory, disease-associated activation group differences were localised to right inferior frontal cortex (reduced activation in the group with memory-led Alzheimer's disease); while for incidental musical episodic memory, disease-associated activation group differences were localised to precuneus and posterior cingulate cortex (abnormally enhanced activation in the syndromic groups). In post-scan behavioural testing, both patient groups had a deficit of musical episodic memory relative to healthy controls whereas musical semantic memory was unimpaired. CONCLUSIONS: Our findings define functional neuroanatomical substrates for the differential involvement of musical semantic and incidental episodic memory in major phenotypes of Alzheimer's disease. The complex dynamic profile of brain activation group differences observed suggests that musical memory may be an informative probe of neural network function in Alzheimer's disease. These findings may guide the development of future musical interventions in dementia.

In France, the national health database (SNIIRAM) is an administrative health database that collects data on hospitalizations and healthcare consumption for more than 60 million people. Although it does not record behavioral and environmental data, these data have a major interest for epidemiology, surveillance and public health. One of the most interesting uses of SNIIRAM is its linkage with surveys collecting data directly from persons. Access to the SNIIRAM data is currently relatively limited, but in the near future changes in regulations will largely facilitate open access. However, it is a huge and complex database and there are some important methodological and technical difficulties for using it due to its volume and architecture.We are developing tools for facilitating the linkage of the Gazel and Constances cohorts to the SNIIRAM: interactive documentation on the SNIIRAM database, software for the verification of the completeness and validity of the data received from the SNIIRAM, methods for constructing indicators from the raw data in order to flag the presence of certain events (specific diagnosis, procedure, drug…), standard queries for producing a set of variables on a specific area (drugs, diagnoses during a hospital stay…). Moreover, the REDSIAM network recently set up aims to develop, evaluate and make available algorithms to identify pathologies in SNIIRAM.In order to fully benefit from the exceptional potential of the SNIIRAM database, it is essential to develop tools to facilitate its use.

Previous research demonstrates a genetic and behavioural link between eating disorders and autism spectrum disorders, and a recent study (Coombs et al. in Br J Clin Psychol 50:326-338, 2011) extends this link to typical populations, showing a positive correlation between behaviours in typically developing children. The purpose of the present study was to examine whether this relationship continues beyond development, by studying the link between behaviours in a non-clinical adult population.We examined associations between performance on measures relating to autistic traits and disordered eating. Undergraduate students, equally balanced by gender and by subject studied (i.e. humanity or science), completed three tasks: to measure autistic traits, participants were administered the Embedded Figures Test (EFT) and the Autism-Spectrum Quotient (AQ). Eating disorder symptomatology was measured by the Eating Attitudes Test (Eat-26).Our data revealed a significant positive correlation between scores on the AQ and Eat-26. Multiple linear regressions showed that higher scores on the AQ were particularly associated with higher scores on the BulimiaFood Preoccupation subscale of the Eat-26. EFT performance was positively related to behaviours associated with autism and eating disorders, although not reliably so.These data support the broader link between autistic traits and disordered eating in the non-clinical population, and demonstrate that it extends into adulthood (a time at which autistic behaviours can decrease). This work carries implications for the development of cognitive therapies for people with eating disorders.

Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

The main goal of the M4 protocol was to evaluate the efficacy of treatment excluding supratentorial radiation in patients with newly diagnosed medulloblastoma. All patients underwent surgical resection and received postoperative chemotherapy. Chemotherapy was adapted to the initial staging and pronostic factors (Group A: good-risk; Group B: poor-risk). Chemotherapy was started early after surgery, and consisted of two courses of the “eight drug in one day” regimen and two courses of high dose methotrexate. Radiotherapy was delayed until 5 (Group B) to 7 (Group A) weeks after the first course of chemotherapy. Radiotherapy was administered only to the posterior fossa and the spinal axis. Only l3 16 patients (18%) are alive and disease-free with a mean follow up of 6 years. The site of progression was supratentorial in 9 out of 13 patients and three patients had spinal and/or cerebrospinal fluid relapses. Only one patient had isolated posterior fossa relapse. The mean time to relapse was 484 days. We conclude that the chemotherapy regimens used in the M4 protocol do not allow the reduction of irradiation fields in patients with cerebellar medulloblastoma. In spite of long-term side effects on neurocognitive functions, supratentorial radiotherapy should remain a major component of medulloblastoma treatment.

Aim In 2003, the West of Scotland Cancer Awareness Programme (WoSCAP) launched their oral cancer campaign to raise public awareness of the disease in five NHS boards across the West of Scotland. The aim of this study was to evaluate the campaign by reviewing patients attending rapid access clinics in the 11 secondary care units across the five boards. Design Data were collected in 2004 during the second phase of the campaign via a two part self-completing questionnaire; the first part collected information from the patients and the second part from the clinicians, in rapid access clinics in the secondary care units. Results In total, 580 questionnaires were given out in the clinics with 538 completed patient sections (response rate 93%) and 500 completed clinician sections (response rate of 86%). More than two thirds of rapid access secondary care patients had seen a recent health campaign related to mouth cancer, and 46% responded that the campaign had encouraged them to seek advice more quickly. Of the patients examined in the clinics, 5% had a provisional diagnosis of a malignant lesion, 7% a potentially malignant lesion, and the majority of lesions were benign. The clinicians deemed 30% of the referrals to be inappropriate. Conclusions The results show a high percentage of patients attending rapid access clinics were aware of the campaign. However, there were a disproportionate number of inappropriate referrals to the rapid access clinics compared to genuinely urgent cases.

The response to vascular injury is a complex wound healing response involving cell proliferation, migration, remodeling and inflammation. In the present studies we employed a rat balloon angioplasty model of vascular injury to investigate the potential role of sphingolipid signaling in the response to vascular injury. The enzyme serine palmitoyltransferase (SPT) catalyzes the first committed step in de novo sphingolipid biosynthesis. We observed marked upregulation of expression of both SPT subunits in actively proliferating cells in injured vessels. This enhanced SPT expression occurs in de-differentiated fibroblasts and proliferating vascular smooth muscle cells. The upregulation is particularly apparent in the proliferating luminal edge of the neointima and the adventitial de-differentiated fibroblasts and may serve as a hallmark of this process. The possible functional consequences of this enzyme upregulation and its role in the response to vascular injury are suggested but remain to be determined.

Between 1976 and 1988, 17 patients suffering from tumours located in the third ventricular region were entered into a retrospective study. There were 11 males and 6 females aged from 2 to 30. These tumours were located in the pineal area (n = 12), in the floor of the third ventricle (n = 3), in the roof of the third ventricle (n = 1) and multiple midline tumours (n = 1). A ventriculoperitoneal shunt was performed in 13 patients. In 8 patients the tumour was operated upon directly. 2 patients did not undergo surgery. A histological examination was performed in 13 cases with identification of 9 germinomas, 2 pinealoblastomas and one astrocytoma. In one case the plasma and cerebro-spinal-fluid level of tumour markers (human beta chorionic gonadotrophin & alpha feto protein) were elevated. All patients received 45 to 60 grays by cobalt megavoltage irradiation on the tumoural volume, 8 of them receiving additional whole brain and spinal irradiation ranging from 30 to 36 grays. One patient had chemotherapy in addition to radiotherapy. The 5 years survival rate was 74% and the mean follow-up period was 5 years. Five deaths occurred: 1 during irradiation, 3 following a relapse and 1 unexplained death later on. There were no neurological sequelae related to irradiation but 7 patients (37%) had pituitary insufficiency. The irradiation dose level required to obtain local control, the methods of spinal prophylactic treatment and the role of chemotherapy are discussed.

Primary nonHodgkin’s lymphoma of the testis is a localized disease in 50 per cent of the cases. Clinical records and pathological material from 9 stage IE cancer patients treated at our institutions were reviewed. All but 1 patient had B cell type lymphomas of intermediate (6) or high (3) grade according to the Working Formulation. Mean survival was 49 months and actuarial survival was 74 per cent at 5 years. Chemotherapy differed with time and frequently was associated with subdiaphragmatic involved field and prophylactic contralateral testis radiotherapy. In view of the good prognosis of patients receiving doxorubicin-based chemotherapy and recent reports on low stage nonHodgkin’s lymphoma we recommend an aggressive brief therapy for stage IE lymphoma of the testis after orchiectomy.

We review a new case of spermatic cord liposarcoma followed over a period of two years. After simple excision and 50 grays of radiotherapy had a local recurrence one year later; the patient a wide radical orchiectomy was then performed. A review of the literature illustrates the various clinicopathological data and their prognosis. The various treatments described are also analysed.

The results of palliative chemotherapy applied to 123 patients with disseminated soft tissue sarcomas are reviewed with the recent literature data. With the exception of embryonal rhabdomyosarcomas of children, which are considered separately, the response of these tumors to chemotherapy is poor but not negligible. The association of several active drugs should permit substantial progress, especially in the initial stage of local treatment, when the number of disseminated cells is still reduced. A follow-up of controlled clinical studies must specify the modalities of multidisciplinary treatment in an effort to reduce regional recurrence or metastasis.

Rubidazone is a semisynthetic antibiomitotic close to daunorubicin and doxorubicin. Fifty two patients with various advanced cancers received rubidazone intravenously at the initial unitary dose of 200 mg/m2 in a single injection at three week intervals; this base line dosage had been adapted in function of leuko-platelet variations observed between the injections. An objective improvement was noted in 18 patients out of 51 evaluable patients (34% of the cases), 6 times the regression of tumoral volume was greater than 50 per cent but not complete (3 breast adenocarcinomas and 3 lymphomas). Manifestations of intolerance-toxicity were minor on the haematologic side (32%); however, they were relatively frequent from the digestive (63%) and general (82%) point of view; symptoms of cardiac disturbances (21%), responsible for the discontinuation of the chemotherapy, necessitate careful attention in the management of the treatment. The comparison of the results of this trial with those obtained by trials using other drugs belonging to the same chemical family don't show, for solid tumors, any difference in efficacy between rubidazone, daunorubicin or duborimycin; however, the difference is very striking with doxorubicin which showed more efficacy (6.5% as 29% of regression greater than 50%). Owing to the conditions of admission and the very strict criteria of analysis in this study, it would seem useful to go into details regarding the interest of rubidazone in lymphomas (only one failure has been recorded out of 6 treated cases).

Duborimycin is a new antimitotic agent approaching danorubicin and adriamycin in activity which has been tried on 151 patients suffering from cancer of different types, is an advanced local/regional stage and/or metastatic disease. It was administered intravenously every fortnight in a mean unit dose of 400 mg, and the duration of the treatment ranged from 2 to 52 weeks. Objective improvement was registered in 56 patients of the 135 cases in whcih the results were assessed (around 41.4% of cases). In 4 cases the regression of tumour volume was greater than 50% (one of these cases was in melanoma, the other a sarcoma) and in 2 cases regression was complete (a squamous cell carcinoma and an embryonal testicular tumour). The subjective effects were appreciable in 53 of the 115 cases which could be studied (46%) and above all in the refractory pain of bony secondaries from breast cancer (a favourable response in 78% of cases). Manifestations of intolerance/toxicity were of a minor nature on the haematologic side, that cardiologic ones relatively frequent (18% of treated cases) and occasionally serious (2 cases of asystole). Great care is therefore necessary in supervision of the treatment. However, the first results obtained by this line of approach, notably in chemo-resistant forms of tumour such as melanoma and sarcomas, utilizing the very strict criteria in one analysis encourage further study of duborimycin in cases of this sort (preferably in association and in accordance with protocols of comparative trials) so that its place in cancer chemotherapy may be more precisely defined.