Panic attacks can be observed in a wide range of situations, but most common are those providing complex and unstructured stimulations, suggesting an impairment in attentional processing of visuo-spatial information. This study evaluated agoraphobics’ attentional processing of neutral (i.e., not anxiety-provoking) visuo-spatial stimulation. Twelve patients suffering from panic attacks with agoraphobia were compared with 22 normal controls on a computerized visual target discrimination task specifically designed for this study. Psychometric measures assessed the phobic avoidance, the level of depression and anxiety. The numbers of errors and reaction times were analysed with a three-way ANOVA (Group x target modality x number of stimulations). No between-group significant difference was found for the reaction time performance and the mean number of detection errors. However, an interaction effect was observed for this last variable depending on the target modality: agoraphobic patients made fewer omission errors than control subjects when the target was present among distractors, while they made more commission errors when the target was absent. Outcomes are discussed in terms of attentional hyperactivation related to anxiety and perseverative decision process in agoraphobic patients.

Improvement of the performance of renewable electronic devices is a crucial point for the consolidation of this emerging technology. Herein, we develop a supercapacitor based on cellulose, carbon nanotubes, and ionic liquids. A conductive paper prepared by simple acid hydrolysis of cellulose and carboxylated carbon nanotubes was used as an electrode. A cellulose sponge impregnated with 1-n-butyl-3-methylimidazolium bis(trifluoromethane sulfonyl)imide was used as a separator/electrolyte. Electrochemical tests were performed in a two-electrode cell that presented a specific capacitance of 34.37 F/g when considered the active mass and 97.9% of capacitance retention after 5000 charge/discharge cycles.

Introduction: Poor physicians’ knowledge of health care costs has been identified as an important barrier to improving efficiency and reducing overuse in care delivery. Moreover, costs of tests and treatments estimated with traditional costing methods have been shown to be imprecise and unreliable. We estimated the cost of frequent care activities in the emergency department (ED) using the time-driven activity-based costing (TDABC) method. Methods: We conducted a TDABC study in the ED of the CHUL, Québec city (77000 visits/year). We estimated the cost of all potential care activities (e.g. triage) provided to adult patients with selected urgent (e.g. pulmonary sepsis) and non urgent (e.g. urinary tract infection) conditions frequently encountered in the ED. Following Lean management principles, process maps were developed by a group of ED care providers for each care activity to identify human resources, supplies and equipment involved, and to estimate the time required to complete each process. Resource unit cost (e.g. cost per minute of a nurse) and overhead rate were calculated using financial information from fiscal year 2015-16. Estimated cost of each care activity (e.g. chest X-ray) including physicians’ charges was calculated by summing overhead allocation and the cost of each process (e.g. disinfection of the X-ray machine) as obtained by multiplying the resource unit cost by the time for process completion. Results: Process maps were developed for 14 conditions and 68 ED care activities. We estimated the costs of activities (CAN$) related to nursing (e.g. urinalysis and culture triage ordering $14.70), clerk tasks (e.g. patient registration $3.40), physicians (e.g. FAST scan $20.90), laboratory testing (e.g. CBC $6.30), diagnostic imaging (e.g. abdominal CT scan $146.50), therapy (e.g. 5 mg of iv morphine $20.40), and resuscitation (rapid sequence intubation with ketamine and succinylcholine $146.40). Overall, emergency physicians’ charges, personnel salaries and overheads accounted for 38%, 22% and 16% of all ED care costs, respectively. Conclusion: Our results represent an important step toward increasing emergency physicians’ awareness on the real cost of their interventions and empowering them to adopt more cost-effective practice patterns.

The Molène archipelago appears to be particularly rich in Neolithic and Bronze Age remains and an exceptional concentration of megaliths has been brought to light. Several settlements are confirmed by dry-stone structures or by shell middens. These data give precious indications on the occupation chronology of the area. Moreover they allow us, for the first time in Brittany, to reconstruct everyday life during the late Prehistoric period. A prerequisite to this reconstruction was a better understanding of the evolution of the environment during this period, which locally implies a better knowledge of paleogeographic changes related to Holocene sea-level rise as well as on floral and faunal resources.

The results obtained through paleogeographic reconstructions show that the archipelago since 4500 bc was already disconnected from the mainland. The megalithic monuments must therefore have been erected and used by islanders present on the archipelago from the middle of the 5th to the 2nd millennium bc. The distribution of the megalithic tombs reveals landscape occupation strategies which respond to both cultural choices and natural constraints. Throughout the entire period, geographic isolation has continued to increase, although it did not imply strong cultural specificities. Nevertheless, the increasing remoteness of the islands has fostered the search for livelihoods based on the intense exploitation of coastal resources. Despite their focus on the sea, these people did not neglect what inland areas could offer as evidenced by the early agro-pastoral practices in the archipelago.

The still ever increasing demand for sedation and/or analgesia for diagnostic and therapeutic procedures puts high pressure on anaesthesia care providers all over Europe. Since the capacity to provide that service by anaesthetists is limited in most European countries, guidelines for non-anaesthetist doctors who want to sedate patients on a high-quality level and especially in a safe way are mandatory. This paper, produced by a working party of the European Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS), gives direction to those practitioners who feel responsibilities in this area of medicine. Close cooperation with anaesthesiologists seems mandatory to achieve and sustain a high-quality standard for our patients undergoing medical or surgical procedures under sedation.

Patients expected to need at least three units of blood for their elective cardiovascular or orthopaedic surgery, were allocated randomly to receive intravenous (i.v.) Epoetin alfa 600 IU kg−1 (n = 27), 300 IU kg−1 (n = 30) or placebo (n = 23), on days 1, 4 and 7. Provided haemoglobin ≥ 11 g dL−1, one unit of blood was collected on days 1, 4, 7, 11 and 14. Iron supplementation was given throughout the study. Surgery was scheduled between days 18 and 21. Significantly more patients treated with Epoetin alfa (100% for 600 IU kg −1 ; 97% for 300 IU kg−1) were able to donate ≥ 4 units of blood compared with placebo (78%) (P = 0.011 and P = 0.032). No significant differences were seen in total patient exposure to homologous blood (7.4%, 3.3% and 17.4%, respectively). Mean red cell volume donated (P = 0.005 for 600 IU kg−1 ; P = 0.158 for 300 IU kg−1 both vs. placebo) and production (P < 0.001 and P = 0.012, respectively) were dose related. Twenty-four patients became iron deficient. No differences in the incidence of adverse events were seen between the groups.

The GALLEX collaboration aims at the detection of solar neutrinos in a radiochemical experiment employing 30 tons of Gallium in form of concentrated aqueous Gallium-chloride solution. The detector is primarily sensitive to the otherwise inaccessible pp-neutrinos. Details of the experiment have been repeatedly described before [1-7]. Here we report the present status of implementation in the Laboratori Nazionali del Gran Sasso (Italy). So far, 12.2 tons of Gallium are at hand. The present status of development allows to start the first full scale run at the time when 30 tons of Gallium become available. This date is expected to be January, 1990.

This study evaluates the effect of a specially designed, physician-oriented handbook of antimicrobial use on the prescribing patterns of a group of 50 doctors at a university hospital. Data were evaluated over a period of one-and-one-half years, before and after the distribution of the handbook. For the purposes of this study, antimicrobial therapy was classified: 1) inappropriate if it violated one of a number of recognized principles of antimicrobial therapy, 2) appropriate if it agreed with specific recommendations or alternatives given in the distributed reference handbook, and 3) acceptable if it was neither inappropriate nor appropriate as defined by the handbook. An initial survey of antimicrobial prescribing patterns was made. Five months later the handbook was distributed. A two-week orientation program, consisting of the distribution and promotion of the problem-oriented, pocket-sized handbook of appropriate antimicrobial therapy, was conducted. The handbook, which was developed by the authors and reviewed and approved by a panel of infectious disease specialists, presented guidelines for appropriate and efficacious usage of antimicrobial agents as most currently accepted in common clinical infections. Subsequent surveys were then conducted two weeks, three months, and six months after distribution of the handbook. A statistically significant difference (p <0.01) in antimicrobial prescribing patterns was noted between the survey conducted two weeks after the introduction of the handbook and the other surveys. In this survey, while therapy classified inappropriate decreased from 45% to 28%, therapy considered appropriate as recommended increased from 33% to 53%. The findings of this study demonstrated that the introduction and promotion of the handbook decreased abuse and increased proper use of antimicrobial therapy, although the effect is sustainable for only a short duration—no longer than three months. These results indicate the need for a vigorous, updated program to achieve and maintain current appropriate antibiotic therapy in clinical medicine.