Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)
Miller synthesizes Karen Horney's model of submission, aggression and withdrawal, Jean Baker Miller's concept of relational being, Julia Kristeva's idea of psychic space, and Kelly Oliver's notions on social support to advance a penetrating analysis of the fiction of Paule Constant.
Are public and private standards affecting farmer knowledge and moving farm practices toward food safety and environmental sustainability in China? We surveyed 355 apple farmers involved in chains supplying a diversity of retailing points, including supermarkets. Using a multivariate regression model, we find no measurable evidence that the certification schemes of farm bases and agribusiness companies lead to improved apple growers’ knowledge regarding pest and disease management. The observed behavioral changes are mainly prompted by delegated decision-making towards leaders of farm (...) bases, which raises questions on the long-term changes in farmers’ practices and on the fundamental values and ethics of China’s agrofood system that is governed through the standards. (shrink)
Ont contribué au volume : David Allen, Gabriel Bergounioux, Claude Blanckaert, Jacqueline Carroy, Jean François Chiantarretto, Françoise Couchard, Gérard Lagneau, Sophie-Anne Leterrier, Laurent Muchielli, Jean Yves Pautrat, Paule Petitier, Jacques Postel, Jacques Rancière, Marc Renneville, Nathalie Richard et Geneviève Vermès. A priori, loin de la problématique des relations entre les sexes, ce recueil de textes issu d'un colloque organisé par la Société française pour l'histoire des s..
Angiogenesis is a complex morphogenetic process regulated by growth factors, but also by the force balance between endothelial cells traction stresses and extracellular matrix viscoelastic resistance. Studies conducted with in vitro angiogenesis assays demonstrated that decreasing ECM stiffness triggers an angiogenic switch that promotes organization of EC into tubular cords or pseudo-capillaries. Thus, mechano-sensitivity of EC with regard to proteases secretion, and notably matrix metalloproteinases , should likely play a pivotal role in this switching mechanism. While most studies analysing strain (...) regulation of MMPs used cell cultured on stretched membranes, this work focuses on MMP expression during self-assembly of EC into capillary-like structures within fibrin gels, i.e. on conditions that mimics more closely the in vivo cellular mechanical microenvironment. The activity of MMP-2 and MMP-9, two MMPs that have a pivotal role in capillaries formation, has been monitored in pace with the progressive elongation of EAhy926 cells that takes place during the emergence of cellular cords. We found an increase of the zymogen proMMP-2 that correlates with the initial stages of EC cords formation. However, MMP-2 was not detected. ProMMP-9 secretion decreased, with levels of MMP-9 kept at a rather low value. In order to analyse more precisely the observed differences of EAhy926 response on fibrin and plastic substrates, we proposed a theoretical model of the mechano-regulation of proMMP-2 activation in the presence of type 2 tissue inhibitor of MMPs . Using association/dissociation rates experimentally reported for this enzymatic network, the model adequately describes the synergism of proMMP-2 and TIMP-2 strain activation during pseudo-capillary morphogenesis. All together, these results provide a first step toward a systems biology approach of angiogenesis mechano-regulation by cell-generated extracellular stresses and strains. (shrink)
Hertwig and Ortmann have made a laudable effort to bring together experimental practices in economics and in psychology. Unfortunately, they ignore one of the primary objectives of psychological research, which is an analytic description of general cognitive processes. Among experimental practices in probability judgment tasks they discussed, we will focus hereafter on enactment of scripts and repetition of trials.
Sans doute était-il un peu trop ambitieux de vouloir couvrir en 120 pages un siècle de cinéma fait par des femmes, d'autant plus que les rares ouvrages précédents sur le sujet (Françoise Audé en 1981 et Paule Lejeune en 1986) avaient assez bien couvert les décennies antérieures jusqu'au milieu des années 1980. Outre le fait donc que le choix de la période est discutable, l'approche qui se veut à la fois descriptive et analytique manque parfois de pertinence et de (...) réelle méthodologie. L.. (shrink)
Plusieurs générations de chercheurs internationaux interrogent l’esthétique de Merleau-Ponty suivant deux axes : d’une part, le dialogue constant et passionné avec des arts (peinture, littérature, cinéma) et ses protagonistes (Cézanne, Proust, Claude Simon) qui est à l’origine de l’esthétique de Merleau-Ponty, et dans d’autre part, l’impact de la pensée merleau-pontienne sur les arts, depuis le Minimal Art américain en passant par le Body Art et la danse contemporaine. Tandis que certaines contributions s’intéressent, en s’appuyant sur les inédits, au rapport jusqu’ici (...) moins étudié que Merleau-Ponty entretenait avec la musique, mais aussi avec la photographie, d’autres contributions jaugent l’héritage merleau-pontien dans des arts sur lesquels il n’a pas lui-même écrit (la sculpture, la danse ou le théâtre). Ce volume propose donc une première synthèse générale du rapport de Merleau-Ponty aux arts, tout en en indiquant les lignes de fuite et les horizons qui en font aujourd’hui, cinquante ans après sa mort, toute l’actualité. -/- Contributions d’Emmanuel Alloa, Ronald Bonan, Fabrice Bourlez, Mauro Carbone, Lambert Dousson, Eliane Escoubas, Barbara Formis, Paule Gioffredi, Adnen Jdey, Stefan Kristensen, Rosamaria Salvatore, Jenny Slatman, Bernhard Waldenfels, Benedetta Zaccarello. (shrink)