Patterns of spontaneous activity in unstructured and minimally structured spinal networks in culture

The rhythmic activity observed in locomotion is generated by local neuronal networks in the spinal cord. The alternating patterns are produced by reciprocal connections between these networks. Synchronous rhythmic activity, but not alternation, can be reproduced in disinhibited networks of dissociated spinal neurons of rats. This suggests that a specific network architecture is required for pattern generation but not for rhythm generation. Here we were interested in the recruitment of neurons to produce population bursts in unstructured and minimally structured cultures of rat spinal cord grown on multielectrode arrays. We tested whether two networks, connected by a small number of axons, could be functionally separated into two units and generate more complex patterns such as alternation. In the unstructured cultures, we found that the recruitment of the neurons into bursting populations is divided into two steps: the fast recruitment of a "trigger network”, consisting of intrinsically firing cells connected in networks with short delays, and slow recruitment of the rest of the network. One or several trigger networks were observed in a single culture and could account for variable patterns of propagation. In the minimally structured cultures, a functional separation between loosely connected networks was achieved. Such separation led either to an independent bursting between the networks or to synchronized bursting with long and variable delays. However, no qualitatively novel pattern such as alternation could be generated. In addition, we found that the strength of reciprocal inhibitory connections was modulated by spontaneous activit

The effect of a transfer program for the elderly in Mexico City on co-residing children's school enrollment

This paper studies whether the increase in government transfers, induced by an old-age pension program for individuals age 70 and older in Mexico, affects co-residing children's school enrollment, using a regression discontinuity analysis. Results suggest that while household composition and other household-level characteristics do not change significantly at the cutoff age for program eligibility, co-residing children's school enrollment increases significantly. This suggests that public resources for older adults might generate benefits for other age groups. An additional finding is that the increase in school enrollment takes places mostly at the program eligibility cutoff and not before. Given that the program transfer is known and potentially anticipated by individuals who are only a few years away from being eligible, this suggests that households might have credit constraints

Efficiency of the lausanne clinical pathway for proximal femoral fractures.

Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process, and financial indicators. METHODS: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process, and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalization period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital. RESULTS: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators. CONCLUSION: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process, and financial factors

Spectrum of digoxin-induced ocular toxicity: a case report and literature review

BACKGROUND: Digoxin intoxication results in predominantly digestive, cardiac and neurological symptoms. This case is outstanding in that the intoxication occurred in a nonagenarian and induced severe, extensively documented visual symptoms as well as dysphagia and proprioceptive illusions. Moreover, it went undiagnosed for a whole month despite close medical follow-up, illustrating the difficulty in recognizing drug-induced effects in a polymorbid patient. CASE PRESENTATION: Digoxin 0.25 mg qd for atrial fibrillation was prescribed to a 91-year-old woman with an estimated creatinine clearance of 18 ml/min. Over the following 2-3 weeks she developed nausea, vomiting and dysphagia, snowy and blurry vision, photopsia, dyschromatopsia, aggravated pre-existing formed visual hallucinations and proprioceptive illusions. She saw her family doctor twice and visited the eye clinic once until, 1 month after starting digoxin, she was admitted to the emergency room. Intoxication was confirmed by a serum digoxin level of 5.7 ng/ml (reference range 0.8-2 ng/ml). After stopping digoxin, general symptoms resolved in a few days, but visual complaints persisted. Examination by the ophthalmologist revealed decreased visual acuity in both eyes, 4/10 in the right eye (OD) and 5/10 in the left eye (OS), decreased color vision as demonstrated by a score of 1/13 in both eyes (OU) on Ishihara pseudoisochromatic plates, OS cataract, and dry age-related macular degeneration (ARMD). Computerized static perimetry showed non-specific diffuse alterations suggestive of either bilateral retinopathy or optic neuropathy. Full-field electroretinography (ERG) disclosed moderate diffuse rod and cone dysfunction and multifocal ERG revealed central loss of function OU. Visual symptoms progressively improved over the next 2 months, but multifocal ERG did not. The patient was finally discharged home after a 5 week hospital stay. CONCLUSION: This case is a reminder of a complication of digoxin treatment to be considered by any treating physician. If digoxin is prescribed in a vulnerable patient, close monitoring is mandatory. In general, when facing a new health problem in a polymorbid patient, it is crucial to elicit a complete history, with all recent drug changes and detailed complaints, and to include a drug adverse reaction in the differential diagnosis

Factors associated with quality of life in elderly hospitalised patients undergoing post-acute rehabilitation: a cross-sectional analytical study in Switzerland.

We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients' perceived quality of life. This was a cross-sectional analytical study. Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland. Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016. Exclusion criteria included significant cognitive disorder and terminal illness. Of 227 eligible participants, complete data were collected from 167. Perceived quality of life was measured using WHO Quality of Life Questionnaire-version for older people. Predictive factors were age, sex, functional status at admission, comorbidities, cognitive status, depressive symptoms, living conditions and satisfaction with care. A secondary focus was the association between spiritual needs and quality of life. Patients undergoing geriatric rehabilitation experienced a good quality of life. Greater quality of life was significantly associated with higher functional status (r <sub>s</sub> =0.204, p=0.011), better cognitive status (r <sub>s</sub> =0.175, p=0.029) and greater satisfaction with care (r <sub>s</sub> =0.264, p=0.003). Poorer quality of life was significantly associated with comorbidities (r <sub>s</sub> =-.226, p=0.033), greater depressive symptoms (r <sub>s</sub> =-.379, p<0.001) and unmet spiritual needs ( <i>r</i> <sub>s</sub> =-.211, p=0.049). Multivariate linear regression indicated that depressive symptoms (β=-0.961; 95% CIs -1.449 to 0.472; p<0.001) significantly predicted quality of life. Patient perceptions of quality of life were significantly associated with depression. More research is needed to assess whether considering quality of life could improve care plan creation

Abandonment of the EUR/CHF minimum exchange rate. How Swiss ski resorts were impacted and how they reacted to De-cisive new conditions

In the second part of the previous century, Switzerland could claim to be one of the most well-known destinations for winter sports in the world. Some of the world-famous resorts include Verbier, St. Moritz, and Davos-Klosters. These places have gained lasting recognition over many of the past dec-ades. Even though they have lost some of their lustre at times, Swiss winter sports resorts were able to attract numerous guests from both nationally and internationally, even during the difficult years of the recent financial crisis. All this allegedly changed, however, in January 2015, when the Swiss National Bank unexpectedly removed the peg with the euro. This move immediately shot the Swiss franc to become one of the best performing currencies in the world, and its value rose significantly. All the industries dependent on exports were expected to be hit very hard. This type of sudden increase in the value of their currency would have reflected very damagingly on their revenues, especially since the currency in decline was the one in which most Swiss companies trade. Tourism industry operators started complaining imme-diately, noting their inability to do anything with regard to the sudden change. They had no time to adjust. In hindsight, the much proclaimed end of the Swiss tourism industry did not materialise. The number of tourists from non-European nations has grown to record levels over the past two years. This might indicate the new focus that companies in the Swiss tourism industry have taken. It appears that they are attempting to divert the market attention towards developing nations. BRICS nations – along with the Gulf Nations – would be some of the best examples. Most importantly, it is possible to see that the number of tourists is going back up to previous levels. Politically, the nation was more or less happy with the overall outcome of the removal of the peg. There are no more fears of hyperinflation, and the EUR/CHF exchange rate stands at approximately the same level as during peg-times

The influence of the nature and position of atoms in organic compounds on the reactivity of the other atoms in the same molecule: the naphthalene series

The investigations have shown that in naphthalene compounds a. An influence is transmitted from one ring to the other. b. The behaviour of substituted aryl methyl bromides in the naphthalene series when substituents are present in the same ring is markedly similar to that of the corresponding compounds in the benzene series. c. Slight differences exist between the two aeries in the case of nuclear substituted halogen derivatives but, these are easily explicable by a theory based on the existence of tautomeric modifications in the naphthalene series. d. All the hydrolyses recorded are in accordance with the suggestion of Olivier, regarding the rates of hydrolysis of the bromides and substitution in the naphthalene nucleus

La importancia de corregir por el sesgo de selección en el análisis de las brechas salariales por género: un estudio para Argentina, Brasil y México

El estudio de las brechas salariales por género debe considerar el sesgo de selección, resultado de la decisión endógena de ingresar al mercado laboral. En caso de ser ignorado, este sesgo puede llevar a conclusiones erróneas con respecto al tamaño de las brechas y su evolución en el tiempo. Este trabajo analiza las brechas salariales en Argentina, Brasil y México en 2000 y 2008, y corrige el sesgo a partir del método de Heckman (1979). En particular, se explota el sexo del primogénito en la ecuación de selección para resolver el problema de identificación en la probabilidad de ingresar al mercado laboral. Los resultados indican un importante sesgo de selección positiva de diferente magnitud en el tiempo, en los tres países. Así, este trabajo resalta la importancia del problema de selección en la determinación de listas de rankeo de países, en cuanto a la equidad de género. Clasificación JEL: J16, J21, J71

Decision-making ethics in regards to life-sustaining interventions: when physicians refer to what other patients decide.

Health decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others. To explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation (CPR) or do-not-attempt-resuscitation orders (DNAR). We recorded forty-three physician-patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis. Reference to what other people decide in regards to CPR is used five times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient's preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders ("Patients tell us 'no futile care'"). By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group. Introducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms