We examined the quality of care provided to older persons with frailty in five Canadian provinces, using administrative health data. In each province, we identified two cohorts of older persons with frailty: decedents and living persons. Using decision rules, we considered individuals to be frail if they were long-term care residents, terminally ill, or met at least two of seven domains, which were based on frailty scales, geriatrician discussions, and health service utilization indicators. We assessed quality of care using selected quality indicators: decrease in length of hospital stay, decrease in the number of in-patient readmissions, decrease in the number of emergency department visits, increase in the level of family physician continuity of care, decrease in the use of mechanical ventilation, and decrease in the number of admissions to intensive care. Using regression analyses, we also found male sex and older age were associated with poorer quality of care in both cohorts. This study provides baseline data for evaluating future efforts to improve the quality of care provided to older persons with frailty.

We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

The water balance of the mountainous Durance river catchment, French Alps, is simulated from 1981 to 1994 with a soil-vegetation-atmosphere transfer (SVAT) model. Particular attention is paid to the snow-cover evolution using a detailed model of the snowpack evolution. The results are validated by comparison of the simulated discharges calculated by the SVAT with daily observations at three gauging stations located in the watershed. Three different spatial resolutions are used (1, 8 and 46 km) in order to evaluate the impact on the surface-water-budget results. Comparison with the finest resolution indicates the need for sub-grid-scale parameterization for the model with larger resolution.

The rising number of older people living with disabilities and chronic diseases has increased home care needs. Studies and reviews exploring preventive approaches have proliferated, creating a need for a synthesis of evidence. We conducted a systematic review of systematic reviews to evaluate the effectiveness of preventive home visiting approaches for older people. Of the 5,973 citations identified in over 30 scientific and grey literature databases, 10 papers met all inclusion criteria. Systematic reviews were considered if they included controlled trials comparing interventions with and without professional home care. We found that interventions often included comprehensive geriatric assessments and follow-up visits. Results indicate that multidimensional preventive home visiting programs might have the potential to reduce mortality, in particular for younger subjects, and show a potential to improve functional autonomy, but these findings should be interpreted with caution due to the diversity of the interventions analysed.

Shallow-water tropical corals can be used to calibrate the radiocarbon timescale. In this paper, we present a new data set based on the comparison between 14C ages and U-Th ages measured in fossil corals collected offshore the island of Tahiti during the Integrated Oceanic Drilling Program (IODP) Expedition 310. After applying strict mineralogical and geochemical screening criteria, the Tahiti record provides new data for 2 distinct time windows: 7 data for the interval between 29 and 37 cal kyr BP and 58 for the last deglaciation period, notably a higher resolution for the 14–16 cal kyr BP time interval. There are 3 main outcomes of this study. First, it extends the previous Tahiti record beyond 13.9 cal kyr BP, the oldest U-Th age obtained on cores drilled onshore in the modern Tahiti barrier reef. Second, it strengthens the data set of the 14–15 cal kyr BP period, allowing for better documentation of the 14C age plateau in this time range. This age plateau corresponds to a drop of the atmospheric 14C synchronous with an abrupt period of sea-level rise (Melt Water Pulse 1 A, MWP-1 A). The Tahiti 14C record documents complex changes in the global carbon cycle due to variations in the exchange rates between its different reservoirs. Third, during the Heinrich event 1, the Tahiti record disagrees with the Cariaco record, but is in broad agreement with other marine and continental data.

The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year period (T1, T2, T3); 482 people aged 75 years or older from 2 communities, 272 in the experimental and 210 in the control group, were followed. Analyses were conducted using parametric and non-parametric statistics, a generalized linear model, and Cox regression for survival analysis. A declining trend in institutionalization was observed and the desire to be institutionalized was lower in the study group. When absence of deterioration on follow-up was analysed in terms of the level of autonomy, the ISD network produced positive effects on the frailer clientele at T1, effects that tended to be maintained at T2. In regard to caregivers' burden, the ISD network seemed to have been effective, with caregivers' burden being less at T1 and T2. The ISD network did not have a marked effect on the utilization of services. The ISD network did, in fact, produce some effects that should be seen as important for the elderly population.

This study aimed at (a) developing a restraint reduction program, (b) describing its implementation in long-term care units, and (c) examining its effects on care staff's perceptions of and knowledge about the use of restraints. The program was composed of three parts: consciousness-raising meetings, staff education, and clinical follow-up. The study was a randomized, controlled clinical trial with eight intervention care units (five nursing homes) and 11 controls (five additional nursing homes). Care staff was surveyed at two time intervals over a 7-month period (pre- and post-test intervention; intervention care units: N = 171 [T0] and N = 158 [T1]; controls: N = 181 [T0] and N = 166 [T1]). The implementation of the program was successful and results showed significant changes in care staff perceptions of and knowledge about the use of restraints.

We performed a cost-effectiveness analysis to evaluate whether a pediatrician who suspects an inherited disease of amino acid metabolism should refer the child to a specialist in inborn errors of amino acid metabolism or should prescribe the usual screening test, chromatography of amino acids. Actual hospital costs were used to value the referral, the tests, and the complications that occur when the diagnosis is not recognized. The percent of confirmed diagnoses was chosen as a measure of effectiveness. We conclude that it is more cost-effective for a pediatrician to refer the child to a specialist, that the best strategy in the absence of a referral is to prescribe thin-layer chromatography, and that the least cost-effective strategy is to perform ion-exchange chromatography immediately.

A cross-cultural investigation of the influence of target-language in babbling was carried out. 1047 vowels produced by twenty 10-month-old infants from Parisian French, London English, Hong Kong Cantonese and Algiers Arabic language backgrounds were recorded in the cities of origin and spectrally analysed. F1-F2 plots of these vowels were obtained for each subject and each language group. Statistical analyses provide evidence of differences between infants across language backgrounds. These differences parallel those found in adult speech in the corresponding languages. Implications of an early build-up of target-language-oriented production skills are discussed.

In the field of visual double stars, a long term follow-up is required, since their orbital periods may reach several centuries. Created in 1981 within the Société Astronomique de France (SAF) with the support of the late Paul Muller (1910-2000), the Commission des Etoiles Doubles provides the framework for the necessary collaboration between professional and amateur astronomers, through generations. The late Dr. Paul Baize (1901-1995) was a model for its members. Several professional astronomers became scientific advisors of the Commission and have guided many works made by amateurs.

The CEA, in coordination with IPEV and LUAN, will prepare an experiment to study frost formation on surfaces in radiative cooling in the winter. This experiment has been shipped to be installed at Concordia before the 2007 winter period. It will be controlled from Concordia winterover personal, through PC server that will locally archive data from WEBcams and several local heat regulators. This experiment will be used to give recipes on the way to compensate with heaters the radiative cooling from the sky and maintain instrument surfaces at temperature just above icing conditions. The individual regulators proposed in this experiment will be usable as standalone ice protection systems for existing and future telescopes.

In a synthesis article (see ref. below), the double star expert Paul COUTEAU put the work of French pioneers of double stars observation in the perspective of the double star work carried in the world. After Antoine Yvon VILLARCEAU and Camille FLAMMARION, one prominent pioneer of double stars was Robert JONCKHEERE (1888–1974), an amateur before circumstances prompted him to become a professional astronomer, who devoted his life to double stars. Kenneth Glyn Jones wrote a biography and Charles Fehrenbach his obituary. Jean-Claude Thorel studied his life and career in double star observations (see Section 10 below). In the 1930s, another precursor of the Commission des Étoiles Doubles, Maurice DURUY (1894–1984) invented the micrometer with a comparison star, and applied the diffraction micrometer invented by Ejnar Hertzsprung to the measure of double stars, which he regularly observed at Nancy with a 275-mm telescope, at Lyon with a 162-mm telescope and in his observatory of Beaume-Mêle with a 40-cm and later a 60-cm telescope at Le Rouret (Alpes–Maritimes). He measured standard pairs of the list of Paul Muller and published his measures in the Journal des Observateurs; these measures requested by Paul Muller aimed at comparisons of between observers. He also collaborated with the Webb Society of Great Britain; Glyn Jones published his astronomical biography. Already in 1924, the pediatrician Paul BAIZE (1901–1995) had started the measurement of double stars as an amateur. He was granted permission to measure them with the 38-cm of the Paris Observatory and made an impressive number of measures during his long “career" (24044). He also made orbit calculations and established a formula for the calculation of dynamic parallaxes in 1946. He wrote articles explaining new observation techniques devoted to double stars in the magazine L'Astronomie and continued his astronomical activity until the beginning of the 1990s. Glyn Jones published an astronomical biography of Paul Baize. In the 1960s, Bernard CLOUET and the late Robert SAGOT (1910–2006) made double star observations for the book which was then in preparation under the title La revue des constellations. Their measures remained unpublished; but publication of the measures made by Robert SAGOT is in preparation. At about the same time, the neurology professor Jacques LE BEAU (1908–1998) made the acquaintance of renowned professional astronomer Paul COUTEAU and learned from him how to measure double stars. Each year, he stayed for two weeks at Nice and conducted his observations with the 50-cm refractor of the Nice Observatory. In 1978, Paul COUTEAU published the first book in French devoted to double stars: L'observation des étoiles doubles visuelles. That book triggered the interest of more amateur astronomers for double stars and indirectly influenced the creation of a group of double star observers which was transformed into the Commission des Étoiles Doubles

Submillimetre (submm) astronomy is the prime technique to unveil the birth and early evolution of a broad range of astrophysical objects. It is a relatively new branch of observational astrophysics which focuses on studies of the cold Universe, i.e., objects radiating a significant – if not dominant – fraction of their energy at wavelengths ranging from ∼ 100 μm to ∼ 1 mm. Submm continuum observations are particularly powerful to measure the luminosities, temperatures and masses of cold dust emitting objects. Examples of such objects include star-forming clouds in our Galaxy, prestellar cores and deeply embedded protostars, protoplanetary disks around young stars, as well as nearby starburst galaxies and dust-enshrouded high-redshift galaxies in the early Universe.

Although many data are available concerning anticarcinogenic effects of industrial conjugated linoleic acid (CLA), few studies have reported the antitumour properties of CLA mixtures originating from ruminant products. The aim of the present study was to investigate the in vitro antiproliferative effects of beef CLA mixtures on breast, lung, colon, melanoma and ovarian human cancer cell lines. For this purpose, four fatty acid (FA) extracts prepared from beef lipid and varying in their CLA composition, their corresponding purified CLA-enriched fractions, and mixtures of pure synthetic CLA, the composition of which reproduced that of the four selected beef samples, were tested on cancer cell lines. Cancer cells were exposed for 48h to medium containing 100μm-FA and their proliferation was determined by quantifying cellular DNA content (Hoechst 33342 dye). Compared with cells incubated without FA, the number of cancer cells was reduced from 25 to 67% (P<0·0001) following FA treatment. Antiproliferative effects of CLA mixtures varied in magnitude according to the source of FA, the CLA composition and the cell lines. CLA mixtures naturally present in beef inhibited the proliferation of human cancer cell lines, a high content in cis-trans isomers allowing the most important antiproliferative effect. Beef total FA exhibited a greater growth-inhibitory activity than their corresponding CLA-enriched fractions. These results suggested that either beef FA other than beef CLA could possess antiproliferative properties and/or the existence of complementary effects of non-conjugated FA and CLA, which could favour the antiproliferative properties of beef total FA.

Processing of maize grain is known to modulate the site of starch digestion, thus the nature and amount of nutrients delivered for absorption. We assessed the effect of site of starch digestion on nutrient net fluxes across portal-drained viscera (PDV). Three steers, fitted with permanent digestive cannulas and blood catheters, successively received two diets containing 35 % starch as dent maize grain. Diets differed according to maize presentation: dry and cracked (by-pass, BP) v. wet and ground (control, C). Ruminal physicochemical parameters were not significantly affected. Between C and BP, the decrease in ruminal starch digestion was compensated by an increase in starch digestion in the small intestine. The amount of glucose and soluble α-glucoside reaching the ileum was not affected. The amount of glucose disappearing in the small intestine increased from 238 to 531 g/d between C and BP, but portal net flux of glucose remained unchanged (−97 g/d). The portal O2 consumption and net energy release were not significantly affected, averaging 16 % and 57 % of metabolizable energy intake, respectively. The whole-body glucose appearance rate, measured by jugular infusion of [6, 6-2H2]glucose, averaged 916 g/d. The present study shows that the increase in the amount of glucose disappearing in the small intestine of conventionally fed cattle at a moderate intake level induces no change in portal net flux of glucose, reflecting an increase in glucose utilization by PDV. That could contribute to the low response of whole-body glucose appearance rate observed at this moderate level of intestinal glucose supply.

In an effort to control ambulatory care costs, regulatory practice guidelines (références médicales opposables or RMOs) were introduced by law in France in 1993. RMOs are short sentences, negatively formulated (“it is inappropriate to \ldots”), covering medical and surgical topics, diagnosis, and treatment. Since their introduction, physicians who do not comply with RMOs can be fined. The fine is determined by a weighted combination of indices of harm, cost, and the number of violations.

The impact of the RMO policy on physician practice has been questioned, but so far few evaluations had been performed. At the end of 1997, only 121 physicians had been fined (0.1% of French private physicians). The difficulty of controlling physicians, the large number of RMOs, and the lack of a relevant information system limit the credibility of this policy.

The simultaneous development of a clinical guideline program to improve the quality of care and of a program to control medical practice can lead to a misunderstanding among clinicians and health policy makers. Financial incentives or disincentives could be used to change physician behavior, in addition to other measures such as education and organizational changes, if they are simple, well explained, and do not raise any ethical conflict. But these measures are dependent on the structure and financing of the healthcare system and on the socioeconomic and cultural context. More research is needed to assess the impact of interventions using financial incentives and disincentives on physician behavior.

Xylem maturation in elongating leaf blades of tall fescue (Festuca arundinacea) was studied using staining and microcasting. Three distinctive regions were identified in the blade: (1) a basal region, in which elongation was occurring and protoxylem (PX) vessels were functioning throughout; (2) a maturation region, in which elongation had stopped and narrow (NMX) and large (LMX) metaxylem vessels were beginning to function; (3) a distal, mature region in which most of the longitudinal water movements occurred in the LMX. The axial hydraulic conductivity (Kh) was measured in leaf sections from all these regions and compared with the theoretical axial hydraulic conductivity (Kt) computed from the diameter of individual inner vessels. Kt was proportional to Kh throughout the leaf, but Kt was about three times Kh. The changes in Kh and Kt along the leaf reflected the different stages of xylem maturation. In the basal 60 mm region, Kh was about 0.30±0.07 mmol s−1 mm MPa−1. Beyond that region, Kh rapidly increased with metaxylem element maturation to a maximum value of 5.0±0.3 mmol s−1 mm MPa−1, 105 mm from the leaf base. It then decreased to 3.5±0.2 mmol s−1 mm MPa−1 near the leaf tip. The basal expanding region was observed to restrict longitudinal water movement. There was a close relationship between the water deposition rate in the elongation zone and the sum of the perimeters of PX vessels. The implications of this longitudinal vasculature on the partitioning of water between growth and transpiration is discussed.