Elders and End-of-Life Medical Decisions: Legal Context, Psychological Issues, and Recommendations to Attorneys Serving Seniors

Much more than the disposition of worldly goods must be considered when preparing legal documents for end-of-life situations. This article stresses the necessity of client autonomy in preparing dispositional gifts as well as decision planning for medical care and treatment for senior citizens, and also explains the concept of Generatively: the desire to contribute to the well-being of . . . future generations

Northwestern Ontario Indian childrens' [sic] scores on the WISC in relation to the normative population.

Because Indian children of Northwestern Ontario attend schools designed for children of white, North-American families, they are frequently given the Wechsler Intelligence Scale for Children. This research was undertaken to find out in what ways they differ from the standardization norms published by Wechsler

Prevention of Alzheimer's disease in high risk groups: statin therapy in subjects with PSEN1 mutations or heterozygosity for apolipoprotein E epsilon 4

Because cerebrospinal fluid (CSF) abnormalities in presymptomatic subjects with PSEN1 (presenilin 1) mutations may be observed 4 to 12 years prior to the estimated age at onset, it is possible to test putative therapies on the CSF analytes that correlate with neurodegeneration during this presymptomatic window of clinical opportunity. It is also possible to test the same therapy on a comparison group with increased risk status conferred by both hyperlipidemia and heterozygosity for apolipoprotein Eε4. To our knowledge, the only putative therapy thus far tested in such a common design has been statin therapy. The results of these tests show increases in soluble amyloid precursor protein (sAPP)α correlating with statin-induced decreases in serum cholesterol levels in the non-PSEN1 subjects. This result could be one functional correlate for part of the substantial risk reduction for late onset Alzheimer\u27s disease recently reported in the Rotterdam study, a large, long-term prospective statin trial. Statin therapy significantly decreased both sAPPα and sAPPβ in presymptomatic PSEN1 subjects. Initially, elevated phospho-tau levels in PSEN1 subjects did not further increase during the 2 to 3 years of statin therapy, possibly indicative of a prophylactic effect. These results suggest that large and longer term trials of statin therapy correlating changes in CSF biomarker levels with clinical course may be warranted in both presymptomatic PSEN1 and non-PSEN1 subjects

A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success

Objective: To describe the activities performed by people involved in clinical decision support (CDS) at leading sites. Materials and methods We conducted ethnographic observations at seven diverse sites with a history of excellence in CDS using the Rapid Assessment Process and analyzed the data using a series of card sorts, informed by Linstone's Multiple Perspectives Model. Results: We identified 18 activities and grouped them into four areas. Area 1: Fostering relationships across the organization, with activities (a) training and support, (b) visibility/presence on the floor, (c) liaising between people, (d) administration and leadership, (e) project management, (f) cheerleading/buy-in/sponsorship, (g) preparing for CDS implementation. Area 2: Assembling the system with activities (a) providing technical support, (b) CDS content development, (c) purchasing products from vendors (d) knowledge management, (e) system integration. Area 3: Using CDS to achieve the organization's goals with activities (a) reporting, (b) requirements-gathering/specifications, (c) monitoring CDS, (d) linking CDS to goals, (e) managing data. Area 4: Participation in external policy and standards activities (this area consists of only a single activity). We also identified a set of recommendations associated with these 18 activities. Discussion All 18 activities we identified were performed at all sites, although the way they were organized into roles differed substantially. We consider these activities critical to the success of a CDS program. Conclusions: A series of activities are performed by sites strong in CDS, and sites adopting CDS should ensure they incorporate these activities into their efforts

Burnout: exploring the differences between U.S. and international medical graduates.

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs. Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and logistic regression analysis for our categorical definition of burnout. Results: Two hundred twenty-two residents responded for a response rate of 59%. Personal, work or patient- related burnout was common among residents, particularly among USMGs. The most common form of burnout was work-related. Forty nine percent of USMGs have work burnout compared to 26% of IMGs (p \u3c 0.01). In multivariate analysis, being an IMG reduced odds of work-related and of total burnout by 50% (OR 0.5 C.I 0.25-0.99). Perceived mastery was associated with reductions in all subscales of burnout (p \u3c 0.05). Stress and low QoL related to personal and work burnout scores (p \u3c 0.01). Conclusion: Work-related burnout is more common among USMGs than in IMGs. Although mastery, QoL and stress were correlates of burnout among all residents, these factors did not explain the difference. Future studies should evaluate the role of medical school structure and curriculum on differences in burnout rates between the two groups

Study protocol: can a school gardening intervention improve children's diets?

BACKGROUND: The current academic literature suggests there is a potential for using gardening as a tool to improve children's fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT) devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS) Campaign for School Gardening, to determine if it has an effect on children's fruit and vegetable intake. METHOD/DESIGN: Trial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as "Partner Schools" and the other to receive the less intensive intervention as "Associate Schools". Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention "Associate Schools" or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET) to collect data on dietary intake and a questionnaire exploring children's knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school's gardening activities. DISCUSSION: The results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children's fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children's diets and school based interventions. TRIAL REGISTRATION: ISRCTN11396528

Isolated virtualised clusters: testbeds for high-risk security experimentation and training

International audienceAdequate testbeds for conducting security experiments and test under controlled, safe, repeatable and asrealistic- as-possible conditions, are a key element for the research and development of adequate security solutions and the training of security personnel and researchers. In this paper, we report on the construction and operations of isolated virtualised testbeds used in two separate security research labs in Canada and France, as part of a joint collaborative effort. The main idea was to use mid- to large-scale isolated computing clusters to obtain high levels of scale, manageability and safety by heavily leveraging virtualisation technology, open-source cluster management tools and a network architecture separating experiment and control traffic. Both facilities have been used for conducting different types of security research experiments, including in-lab reconstructions of botnets, denial-of-service attacks, and virus detection experimentation. They have also been used for teaching and training students in experimental security methods. We describe these facilities and the criteria that we used to design them, the research and training activities that were conducted, and close by discussing the lessons learned and the pros and cons of this approach

Grandi Byen-supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: Study protocol for a randomized controlled trial

BACKGROUND: Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development. METHODS: We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions. DISCUSSION: This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally. TRIAL REGISTRATION: NCT04785352 . Registered March 5, 2021 at https://clinicaltrials.gov/

The case for in-the-lab botnet experimentation: creating and taking down a 3000-node botnet

International audienceBotnets constitute a serious security problem. A lot of effort has been invested towards understanding them better, while developing and learning how to deploy effective counter-measures against them. Their study via various analysis, modelling and experimental methods are integral parts of the development cycle of any such botnet mitigation schemes. It also constitutes a vital part of the process of understanding present threats and predicting future ones. Currently, the most popular of these techniques are “in-the-wild” botnet studies, where researchers interact directly with real-world botnets. This approach is less than ideal, for many reasons that we discuss in this paper, including scientific validity, ethical and legal issues. Consequently, we present an alternative approach employing “in the lab” experiments involving at-scale emulated botnets. We discuss the advantages of such an approach over reverse engineering, analytical modelling, simulation and in-the-wild studies. Moreover, we discuss the requirements that facilities supporting them must have. We then describe an experiment in which we emulated a close to 3000-node, fully-featured version of the Waledac botnet, complete with a reproduced command and control (C&C) infrastructure. By observing the load characteristics and yield (rate of spamming) of such a botnet, we can draw interesting conclusions about its real-world operations and design decisions made by its creators. Furthermore, we conducted experiments where we launched sybil attacks against the botnet. We were able to verify that such an attack is, in the case of Waledac, viable. However, we were able to determine that mounting such an attack is not so simple: high resource consumption can cause havoc and partially neutralise the attack. Finally, we were able to repeat the attack with varying parameters, in an attempt to optimise it. The merits of this experimental approach is underlined by the fact that it is very difficult to obtain these results by employing other methods