Public telesurveillance service for frail elderly living at home, outcomes and cost evolution: a quasi experimental design with two follow-ups

BACKGROUND: Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home. METHODS: A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center. RESULTS: A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months. CONCLUSION: The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient

Identification of rehabilitation needs after a stroke: an exploratory study

Affiliation: Jacqueline Rousseau : École de réadaptation, Faculté de médecine, Université de MontréalBACKGROUND:Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community.METHODS:The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results.RESULTS:Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation.CONCLUSION:Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations

Eutrophisation en milieu lagonaire : compte-rendu subvention CORDET no 94 T 09

La finalité du programme ANTROPIC est de dresser un bilan des conditions du milieu (eutrophisation, hypersédimentation) dans la zone la plus urbanisée du lagon de Tahiti, de proposer des outils de diagnostic de l'état de l'environnement lagonaire utiles pour la gestion du milie

1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

The Canadian Forces’ (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities. On Jan. 12, 2010, a 7.0-magnitude earthquake occurred in Haiti. The intensity of the earthquake and the frailty of the buildings in most of the country combined to cause extensive structural damage and casualties.1,2 An intense multinational relief effort followed. The Canadian Forces (CF) contributed by sending a contingent of more than 2000 personnel.3 This included 1 Canadian Field Hospital (1 CFH), the CF deployable field hospital. While 1 CFH itself provided the core nucleus of staff for the hospital, 21 reserve and regular forces units across Canada also provided personnel. The full contingent of 117 CF members was first assembled in Petawawa, Ont., home of 1 CFH. Ninety-seven were medical or dental personnel, including medics; dental, laboratory, x-ray and operating room (OR) technicians; pharmacists; nurses; physicians; and surgeons. The remaining 20 were from various nonmedical trades, including signallers, truckers, mechanics, logisticians and others. From Petawawa, the unit moved by ground to Canadian Forces Base Trenton and then by air to Port-Au-Prince on the recently acquired CC-177 aircraft. The first elements of 1 CFH arrived in theatre on January 21. It was decided to position 1 CFH in Léogane, a hard-hit town near the epicentre of the earthquake. Over the next few days, the hospital personnel arrived and contributed to establishing the hospital. Security was provided by 3 Battalion Royal 22e Régiment and naval personnel from the HMCS Athabaskan. Once it was fully operational, the hospital had a 100-bed ward, a 4-bed intensive care unit, radiology and dental suites, a primary care section, a laboratory and 2 ORs (Fig. 1). The first OR became functional on January 29. There were 2 surgical teams, each consisting of an anesthesiologist, general surgeon, orthopedic surgeon, OR technician and OR nurses. This paper discusses our surgical experience during this deployment

The β‐1,3‐glucanosyltransferases (Gels) affect the structure of the rice blast fungal cell wall during appressorium‐mediated plant infection

[EN] The fungal wall is pivotal for cell shape and function, and in interfacial protection during host infection and environmental challenge. Here, we provide the first description of the carbohydrate composition and structure of the cell wall of the rice blast fungus Magnaporthe oryzae. We focus on the family of glucan elongation proteins (Gels) and characterize five putative β-1,3-glucan glucanosyltransferases that each carry the Glycoside Hydrolase 72 signature. We generated targeted deletion mutants of all Gel isoforms, that is, the GH72+, which carry a putative carbohydrate-binding module, and the GH72− Gels, without this motif. We reveal that M. oryzae GH72+ GELs are expressed in spores and during both infective and vegetative growth, but each individual Gel enzymes are dispensable for pathogenicity. Further, we demonstrated that a Δgel1Δgel3Δgel4 null mutant has a modified cell wall in which 1,3-glucans have a higher degree of polymerization and are less branched than the wild-type strain. The mutant showed significant differences in global patterns of gene expression, a hyper-branching phenotype and no sporulation, and thus was unable to cause rice blast lesions (except via wounded tissues). We conclude that Gel proteins play significant roles in structural modification of the fungal cell wall during appressorium-mediated plant infection.SIWe acknowledge BBSRC grant BB/J008923/1

Response properties in a model for granular matter

We investigate the response properties of granular media in the framework of the so-called {\em Random Tetris Model}. We monitor, for different driving procedures, several quantities: the evolution of the density and of the density profiles, the ageing properties through the two-times correlation functions and the two-times mean-square distance between the potential energies, the response function defined in terms of the difference in the potential energies of two replica driven in two slightly different ways. We focus in particular on the role played by the spatial inhomogeneities (structures) spontaneously emerging during the compaction process, the history of the sample and the driving procedure. It turns out that none of these ingredients can be neglected for the correct interpretation of the experimental or numerical data. We discuss the problem of the optimization of the compaction process and we comment on the validity of our results for the description of granular materials in a thermodynamic framework.Comment: 22 pages, 35 eps files (21 figures

Large scale genome assemblies of Magnaporthe oryzae rice isolates from Italy

We report long-range sequencing of nine rice-infecting Magnaporthe oryzae isolates from different rice-growing regions of Italy using Oxford Nanopore Technology. We aquired chromosome-level genome assemblies, polished with Illumina short reads, and removed mitochondrial sequences to improve the quality of the assemblies.We provide the genome assemblies to the public with open access

Spatial dynamics of firms (In French)

This paper is a survey of the literature about the spatial dynamics of firms. In a first part, we discuss about the traditional theories of location. We review the insights of these theories but also their limits. In particular, we stress the necessity to organize a true dialog between the approaches focusing on firms\' organization, and those who are focusing on the territorial dimension. In other words, we stress that it is a necessity to cross Industrial dynamics and Regional science. In this perspective, the second part of the paper explores the contribution of the Economics of Proximities’ approach. After a presentation of the French school of proximity, we apply this framework to some key current issuesIndustry, Space, Location, Firm, Proximity