Voxel‐based specific regional analysis system for Alzheimer’s disease utility as a screening tool for unrecognized cognitive dysfunction of elderly patients in diabetes outpatient clinics: Multicenter retrospective exploratory study

AIMS/INTRODUCTION: An efficient screening strategy for identification of cognitive dysfunction remains a clinical issue in the management of elderly adults with diabetes. A magnetic resonance imaging voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) has been developed as an automated brain morphometry system that includes the hippocampus. We carried out a multicenter retrospective study to evaluate the utility of VSRAD for screening cognitive dysfunction in diabetes outpatient clinics. MATERIALS AND METHODS: We enrolled patients with diabetes aged >65 years who underwent brain magnetic resonance imaging scans for the purpose of a medical checkup between November 2018 and May 2019. Patients who were already suspected or diagnosed with mild cognitive impairment and/or dementia as well as those with a history of cerebrovascular disease were excluded. RESULTS: A total of 67 patients were enrolled. Five patients were diagnosed with mild cognitive impairment or dementia (clinical cognitive dysfunction). Patients with clinical cognitive dysfunction showed a significantly higher z-score in VSRAD analysis (2.57 ± 0.47 vs 1.15 ± 0.55, P < 0.01). The sensitivities and specificities for diagnosis of clinical cognitive dysfunction were 80 and 48% for the Mini-Mental State Examination, 100 and 89% for the z-score, and 100 and 90% for the combination of the Mini-Mental State Examination score and z-score, respectively. CONCLUSIONS: VSRAD analysis can distinguish patients with clinical cognitive dysfunction in the elderly with diabetes, and also shows reasonable sensitivity and specificity compared with the Mini-Mental State Examination alone. Thus, VSRAD analysis can be useful for early identification of clinical cognitive dysfunction in the elderly with diabetes

Outcomes of patients who developed subsequent solid cancer after hematopoietic cell transplantation

To characterize the outcomes of patients who developed a particular subsequent solid cancer after hematopoietic cell transplantation (HCT), age at cancer diagnosis, survival, and causes of death were compared with the respective primary cancer in the general population, using data from the national HCT registry and population-based cancer registries in Japan. Among 31 867 patients who underwent a first HCT between 1990 and 2013 and had progression-free survival at 1 year, 713 patients developed subsequent solid cancer. The median age at subsequent solid cancer diagnosis was 55 years, which was significantly younger than the 67 years for primary cancer patients in the general population (P < .001). The overall survival probability was 60% at 3 years after diagnosis of subsequent solid cancer and differed according to cancer type. Development of most solid cancers was associated with an increased risk of subsequent mortality after HCT. Subsequent solid cancers accounted for 76% of causes of death. Overall survival probabilities adjusted for age, sex, and year of diagnosis were lower in the HCT population than in the general population for colon, bone/soft tissue, and central nervous system cancers and did not differ statistically for other cancers. In conclusion, most subsequent solid cancers occurred at younger ages than primary cancers, emphasizing the need for cancer screening at younger ages. Subsequent solid cancers showed similar or worse survival compared with primary cancers. Biological and genetic differences between primary and subsequent solid cancers remain to be determined

Policy change in nuclear energy : a comparative analysis of West European countries

Cette recherche doctorale se propose d'analyser les changements majeurs de politique d'énergie nucléaire dans tous les dix pays d'Europe occidentale ayant produit de l'énergie nucléaire à un niveau commercial (Belgique, Suisse, Allemagne, Espagne, Finlande, France, Italie, Pays-Bas, Suède et Royaume-Uni). Le modèle exploratoire contextualisé (bounded exploratory model) s'articule autour de cinq facteurs qui sont supposés impacter de manière conjoncturelle sur la politique d'énergie nucléaire. Ces cinq facteurs sont: la mobilisation des mouvements anti-nucléaires, les alliés anti-nucléaires parmi les partis politiques, la relation entre industrie nucléaire et le gouvernement, un changement d'arène politique, et les événements focalisants. La question de recherche principale est donc "Dans quelle(s) configuration(s) de ces facteurs observe-t-on un changement majeur de la politique d'énergie nucléaire?". Onze cas sont analysés en s'appuyant sur une méthode d'analyse formalisée, la Qualitative Comparative Analysis (QCA). Au total, trois principaux mécanismes de changement politique sont identifiés au terme de notre analyse. Les deux premiers s'articulent autour du concept d'événements focalisants (focusing events). Premièrement, les événements focalisants de type "I told you so" traduisent un processus de changement politique qui se retrouve "débloqué" grâce à ces chocs externes. Deuxièmement, les événements focalisants de type "Window of opportunity" traduisent un processus de changement politique initié par l'occurrence de tels chocs externes. Alors que le premier type d'événement focalisant se produit autour de la phase finale du processus de changement politique, le second type d'événement focalisant tend à se produire au début du processus de changement politique. Le troisième mécanisme, l'institutionalisation de l'enjeu de l'énergie nucléaire, fait référence à la pacification des mouvements anti-nucléaires en conjonction avec la présence d'alliés politiques parmi les partis politiques établis. Ces mécanismes mettent l'accent sur les principaux facteurs explicatifs, mais doivent être interprétés en prenant en compte l'ensemble des autres facteurs explicatifs, soit, en d'autres termes, en relation conjoncturelle avec ces derniers. Cette mise en contexte est facilitée par la méthodologie QCA. Cette recherche suggère également que c'est la non-mobilisation des mouvements anti-nucléaire qui facilite le processus de changement politique. En d'autres termes, c'est l'absence d'une forte mobilisation anti-nucléaire qui est observée avec une décision de sortie ou de moratoire dans le domaine de l'énergie nucléaire. Cette conclusion est à la fois contre-intuitive car elle va à l'encontre des hypothèses d'impact des mouvements sociaux sur le changement politique, et acquiesçante d'une récente tendance parmi les recherches sur l'impact des mouvements sociaux qui souligne le fait que les mouvements sociaux sont peut-être incapables d'influencer le changement politique, en particulier dans les domaines politiques dits de "hauts profils", telle que l'énergie nucléaire. / This dissertation analyses instances of major nuclear energy policy changes in all west European countries which have produced nuclear energy at a commercial level (Belgium, Switzerland, Germany, Spain, Finland, France, Italy, The Netherlands, Sweden and the United Kingdom). We propose a bounded exploratory model in which several factors are hypothesised to jointly impact on policy change: anti-nuclear mobilisation, anti-nuclear allies among political parties, the nuclear industry-state relationship, a shifting policy arena and focusing events. The main research question to be answered is thus "In which configuration(s) of these factors did major nuclear energy policy changes occur?". A total of eleven cases are compared with a formalised method, Qualitative Comparative Analysis (QCA) with the aim of identifying patterns of combinations among the five factors. Three mechanisms are highlighted at the end of our analysis. The first two mechanisms emphasise the role of focusing events (Birkland 1997, 2004). First, the "I told you so" focusing event mechanism refers to the unblocking of a stalemate situation by an external shock (such as a nuclear accident or the liberalisation of the electricity sector). Second, the "Window of opportunity" focusing event mechanism refers to the catalysing effect of such an external role. While the first mechanism tends to occur at the end of an ongoing debate on nuclear energy policy, the second type of focusing event initiates a process of problematisation of the nuclear energy issue, before resulting in an eventual major policy change. The third mechanism, the institutionalisation of the nuclear energy issue, points to a process whereby the pacification of the anti-nuclear mobilisation coupled with the presence of political allies among established political parties facilitate the occurrence of a major policy change. These mechanisms emphasise the role played by several explanatory factors, but should be interpreted in light of the other explanatory factors as well or, in other words, in conjunction with these latter. This contextualisation is facilitated by the use of the QCA methodology. This research also suggests that social movements need to be unmobilised in order to observe a major policy change. In other words, it is rather the NOT high mobilisation of anti-nuclear movements which is observed with the occurrence of a nuclear phase-out or a moratorium decision. This conclusion is both counter-intuitive because it goes against the powerful assumption that social movements do have an impact on the policy process, but at the same time reflects an emerging trend among social movement scholars who argue that movements may be powerless when it comes to influencing policy decisions, especially so-called "high-profile" policies such as nuclear energy.Doctorat en sciences politiques (POL 3) -- UCL, 200

Policy change in nuclear energy : a comparative analysis of West European countries

Cette recherche doctorale se propose d'analyser les changements majeurs de politique d'énergie nucléaire dans tous les dix pays d'Europe occidentale ayant produit de l'énergie nucléaire à un niveau commercial (Belgique, Suisse, Allemagne, Espagne, Finlande, France, Italie, Pays-Bas, Suède et Royaume-Uni). Le modèle exploratoire contextualisé (bounded exploratory model) s'articule autour de cinq facteurs qui sont supposés impacter de manière conjoncturelle sur la politique d'énergie nucléaire. Ces cinq facteurs sont: la mobilisation des mouvements anti-nucléaires, les alliés anti-nucléaires parmi les partis politiques, la relation entre industrie nucléaire et le gouvernement, un changement d'arène politique, et les événements focalisants. La question de recherche principale est donc "Dans quelle(s) configuration(s) de ces facteurs observe-t-on un changement majeur de la politique d'énergie nucléaire?". Onze cas sont analysés en s'appuyant sur une méthode d'analyse formalisée, la Qualitative Comparative Analysis (QCA). Au total, trois principaux mécanismes de changement politique sont identifiés au terme de notre analyse. Les deux premiers s'articulent autour du concept d'événements focalisants (focusing events). Premièrement, les événements focalisants de type "I told you so" traduisent un processus de changement politique qui se retrouve "débloqué" grâce à ces chocs externes. Deuxièmement, les événements focalisants de type "Window of opportunity" traduisent un processus de changement politique initié par l'occurrence de tels chocs externes. Alors que le premier type d'événement focalisant se produit autour de la phase finale du processus de changement politique, le second type d'événement focalisant tend à se produire au début du processus de changement politique. Le troisième mécanisme, l'institutionalisation de l'enjeu de l'énergie nucléaire, fait référence à la pacification des mouvements anti-nucléaires en conjonction avec la présence d'alliés politiques parmi les partis politiques établis. Ces mécanismes mettent l'accent sur les principaux facteurs explicatifs, mais doivent être interprétés en prenant en compte l'ensemble des autres facteurs explicatifs, soit, en d'autres termes, en relation conjoncturelle avec ces derniers. Cette mise en contexte est facilitée par la méthodologie QCA. Cette recherche suggère également que c'est la non-mobilisation des mouvements anti-nucléaire qui facilite le processus de changement politique. En d'autres termes, c'est l'absence d'une forte mobilisation anti-nucléaire qui est observée avec une décision de sortie ou de moratoire dans le domaine de l'énergie nucléaire. Cette conclusion est à la fois contre-intuitive car elle va à l'encontre des hypothèses d'impact des mouvements sociaux sur le changement politique, et acquiesçante d'une récente tendance parmi les recherches sur l'impact des mouvements sociaux qui souligne le fait que les mouvements sociaux sont peut-être incapables d'influencer le changement politique, en particulier dans les domaines politiques dits de "hauts profils", telle que l'énergie nucléaire. / This dissertation analyses instances of major nuclear energy policy changes in all west European countries which have produced nuclear energy at a commercial level (Belgium, Switzerland, Germany, Spain, Finland, France, Italy, The Netherlands, Sweden and the United Kingdom). We propose a bounded exploratory model in which several factors are hypothesised to jointly impact on policy change: anti-nuclear mobilisation, anti-nuclear allies among political parties, the nuclear industry-state relationship, a shifting policy arena and focusing events. The main research question to be answered is thus "In which configuration(s) of these factors did major nuclear energy policy changes occur?". A total of eleven cases are compared with a formalised method, Qualitative Comparative Analysis (QCA) with the aim of identifying patterns of combinations among the five factors. Three mechanisms are highlighted at the end of our analysis. The first two mechanisms emphasise the role of focusing events (Birkland 1997, 2004). First, the "I told you so" focusing event mechanism refers to the unblocking of a stalemate situation by an external shock (such as a nuclear accident or the liberalisation of the electricity sector). Second, the "Window of opportunity" focusing event mechanism refers to the catalysing effect of such an external role. While the first mechanism tends to occur at the end of an ongoing debate on nuclear energy policy, the second type of focusing event initiates a process of problematisation of the nuclear energy issue, before resulting in an eventual major policy change. The third mechanism, the institutionalisation of the nuclear energy issue, points to a process whereby the pacification of the anti-nuclear mobilisation coupled with the presence of political allies among established political parties facilitate the occurrence of a major policy change. These mechanisms emphasise the role played by several explanatory factors, but should be interpreted in light of the other explanatory factors as well or, in other words, in conjunction with these latter. This contextualisation is facilitated by the use of the QCA methodology. This research also suggests that social movements need to be unmobilised in order to observe a major policy change. In other words, it is rather the NOT high mobilisation of anti-nuclear movements which is observed with the occurrence of a nuclear phase-out or a moratorium decision. This conclusion is both counter-intuitive because it goes against the powerful assumption that social movements do have an impact on the policy process, but at the same time reflects an emerging trend among social movement scholars who argue that movements may be powerless when it comes to influencing policy decisions, especially so-called "high-profile" policies such as nuclear energy.Doctorat en sciences politiques (POL 3) -- UCL, 200

A Boolean Analysis of Movement Impact On Nuclear Energy Policy

The impacts of social movements on public policies have been studied extensively, yet yield mixed results. Some results point to a strong impact of social movements, while others conclude that they do not possess any observable, leverage on public policies. These mixed results may be linked to utilization of different methodological approaches. However, few studies have considered the possibility that movements may in fact prevent policy change. In this study, we argue that for high-profile policies such as nuclear energy, a low-key social mobilization is in some instances necessary for the occurrence of major policy changes. We further hypothesize that highly mobilized social movements may dampen the chance of major policy changes instead of promoting them. We briefly present the general model and the data before proceeding to the bounded exploratory analysis. This analysis raises questions about the role played by antinuclear movements in their quest for a major policy change. A theoretical explanation is then presented in an attempt to contribute to the clarification of the movement-policy debate

The Policy Impact of Social Movements: a Replication Through Qualitative Comparative Analysis

This article reanalyzes the data of a previous study on the policy impact of antinuclear, ecology, and peace movements in three countries with the aim of replicating its findings. Our goal is to see whether using a different analytical technique will yield similar results. The previous study, used a regression approach to time-series analysis. Here, the use qualitative comparative analysis (QCA) to analyze the previous study's data. Specifically, the test the two main hypotheses based on the joint-effect model of social movement outcomes: (1) that the policy impact of social movements is conditioned by the presence of powerful allies within the institutional arenas. by, the presence of a favorable public opinion. and/or by both factors simultaneously; and (2) that social movements are more likely, to have policy impacts when they address issues and policy, domains of low saliency. In addition, we compare the policy, impact of social movements across countries. Our analysis confirms to a large extent the findings of the earlier time-series analysis, namely, the strong explanatory power of the joint-effect model of social movement outcomes and the varying impact of different movements on public policy

Des cas logiques… contradictoires? Un piège de l’AQQC résolu à travers l’étude de la faisabilité politique de l’Allocation Universelle

L’objectif de cet article est double. D’une part, il vise à analyser les facteurs susceptibles d’influencer la faisabilité politique d’une Allocation Universelle. Nous observons, de façon surprenante, que sa visibilité publique est négativement associée à sa présence sur l’agenda politique. D’autre part, nous mettons en évidence un piège méthodologique de l’AQQC, très rarement traité bien qu’à l’origine de résultats incorrects : le problème des hypothèses simplificatrices contradictoires. Différentes manières de résoudre ce problème sont suggérées, et nous concluons en insistant sur l’importance d’un dialogue entre cas et théorie