Showing papers by "David Cohen published in 2009"

The Ordeal of Equality: Did Federal Regulation Fix the Schools?

Abstract: * The Transformation of Title I? * Policy and Practice * Practice Failure and Policy * Federal Policy and Classroom Practice * Mission Revised * Policy and Capability: Title I and Standards-Based Reform * Title I: Past, Present, and Future * Notes * Bibliography * Index

Cost-effectiveness of radiofrequency catheter ablation compared with antiarrhythmic drug therapy for paroxysmal atrial fibrillation.

Abstract: Background— Radiofrequency catheter ablation (RFA) has emerged as an important treatment strategy for atrial fibrillation (AF). The potential cost-effectiveness of RFA for AF, relative to antiarrhy...

Long-term outcome of presymptomatic testing in Huntington disease.

Abstract: Our study on long-term outcome of presymptomatic testing for Huntington disease had two aims: the comparison of the psychological well-being and social adjustment of carriers and non-carriers of the mutation, and the identification of psychological determinants to improve care/support of testees. We performed a cross-sectional study of 351 persons who underwent presymptomatic testing. Those who had motor signs were excluded from the comparison of asymptomatic carrier and non-carriers. A structured interview including five self-report scales and the MINI (Mini International Neuropsychiatric Inventory) was proposed to detect a psychopathology or problem with social adjustment.We interviewed 119 testees (53%), 62 non-carriers and 57 carriers after a mean delay of 3.7 years (range: 0.32 to 8.9) after their result. Depression was frequent in asymptomatic carriers (58%). Interestingly, the self reported impact of the test showed that 27% of non-carriers did not cope well with a favourable result, and a significant percentage of non-carriers (24%) were depressed during follow-up. Multivariate analysis showed that only a previous episode of depression was predictive of depression after genetic testing in both carriers and non-carriers of the HD mutation (P<0.0001).Psychological support is necessary for all testees regardless of the result of their presymptomatic test, because psychiatric care is often needed by both carriers and non-carriers.

The Limits of Cost-Effectiveness Analysis

Abstract: The competitive worldwide economic environment and ever-increasing costs of health care have created a setting in which understanding costs and making sure that we achieve good value in health care are paramount. One approach to seeking value is through the use of cost-effectiveness analysis. Although this science is now several decades old, it has been refined over the last several years, with increasingly sophisticated statistical and standardized methods.1,2 Is cost-effectiveness analysis useful? Does it help in medical decision making and in allocation of scarce resources? In the accompanying article, “Cost, Effectiveness, and Cost-Effectiveness” Diamond and Kaul3 argue that cost-effectiveness analysis is not a useful approach. Although we agree with many of the points that Diamond and Kaul raise, we do not agree with their conclusion. Cost-effectiveness analysis involves an assessment of both cost and effectiveness. The distribution of each needs to be understood. A cost-effectiveness analysis is only as valid as its underlying measures of effectiveness and cost, a discussion that is beyond the scope of this article. However, the methods to make these assessments vary considerably. There are standards for cost-effectiveness, but at times, perfectly adhering to these standards is not realistic, and compromises are often made that may be entirely scientifically legitimate.4 Cost-effectiveness is, by nature, incremental. Thus, it is necessary to look at the added costs compared with a control group. Selection of the appropriate control group is a challenge itself. At times, the appropriate control is placebo, and at other times, it is active therapy; the appropriate control is dependent on the clinical question being asked. However, when cost-effectiveness analysis is conducted using data from a clinical trial, the selection of the control group will not be a decision that the analyst can affect (at least after the trial has been completed). When …

Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia

Abstract: The use of electro-convulsive therapy (ECT) in adolescents is controversial, and few studies have been conducted to assess its efficacy and safety in this population. We report the case of a 19-year-old boy who received two series of ECT, one at 15 and another at 16, for intractable catatonic schizophrenia. Since the age of 17, he has required treatment combining clozapine and maintenance ECT. The course showed a sustained moderate improvement. The treatment permitted the patient to regain some autonomy with moderate adverse effects. ECT remains an uncommon treatment in adolescents, and the current case supports the view that it should not be banned in young people.

Psychiatric and cognitive phenotype in children and adolescents with myotonic dystrophy

Abstract: Myotonic dystrophy type 1 (DM1) is the most frequent inherited neuromuscular disorder. The juvenile form has been associated with cognitive and psychiatric dysfunction, but the phenotype remains unclear. We reviewed the literature to examine the psychiatric phenotype of juvenile DM1 and performed an admixture analysis of the IQ distribution of our own patients, as we hypothesised a bimodal distribution. Two-thirds of the patients had at least one DSM-IV diagnosis, mainly attention deficit/hyperactivity disorder and anxiety disorder. Two-thirds had learning disabilities comorbid with mental retardation on one hand, but also attention deficit, low cognitive speed and visual spatial impairment on the other. IQ showed a bi-modal distribution and was associated with parental transmission. The psychiatric phenotype in juvenile DM1 is complex. We distinguished two different phenotypic subtypes: one group characterised by mental retardation, severe developmental delay and maternal transmission; and another group characterised by borderline full scale IQ, subnormal development and paternal transmission.

Intérêt de l'abord sensorimoteur dans les pathologies autistiques sévères I: introduction aux travaux d'André Bullinger

Abstract: Resume L’abord sensorimoteur des pathologies autistiques severes a connu de nombreux developpements recents en particulier grâce a l’apport de psychologues developpementalistes. Nous proposons dans ce premier article : un rappel succinct des travaux d’Andre Bullinger sur les liens entre regulation tonique et representation de l’organisme, sur l’integration de l’axe corporel au cours du developpement et sur les aspects sensoriels precoces ; de degager en quoi ils eclairent la clinique si complexe des manifestations sensorielles et motrices de l’autisme, et comment ils permettent, a travers une modalite d’evaluation specifique – le bilan sensorimoteur – la formulation d’hypotheses de travail a finalite therapeutique.

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Abstract: Objectives: We sought to determine the economic value of early angiography and prophylactic angioplasty to prevent hemodialysis-access thrombosis. Background: End stage renal disease consumes more than 6% of the Medicare budget. There is a need to understand the financial impact of each component of care. Methods: We conducted an observational economic analysis of a closed cohort of 818 hemodialysis patients, of whom 560 were referred for 1437 consecutive radiographic procedures during an 8-year period. Patient-level, bottom-up microcosting methods provided supply and personnel costs before and after expansion of an angiographic referral program. Results: The rate of referral for malfunctioning but nonthrombosed hemodialysis accesses increased from 18.8 ± 8.8 to 48.3 ± 11.9 angiographic procedures per 100 patient-years (P < 0.001), which was associated with a decline in access thrombosis from 27.6 to 22.0 events per 100 patient-years (P = 0.029) and a net cost of $34,586 per 100 patient-years. The incremental cost-effectiveness ratio for invasive surveillance was $6,177 per thrombosis event avoided. The angiographic program expanded at the same time that the proportion of autogenous fistulas increased from 28.3% ± 11.3% to 59.7% ± 10.7% of total referrals (P = 0.0001). On multivariable logistic regression analysis, the expanded angiography program (P = 0.001) and the proportion of autogenous fistulas (P = 0.0001) were both independently associated with the reduction in access thrombosis. Conclusions: Given the incremental costs and the relatively modest benefits in preventing access thrombosis, preemptive angiographic management may represent a less efficient use of healthcare resources than increasing the number of patients with autogenous fistulas. © 2009 Wiley-Liss, Inc.

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Abstract: The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O’Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. A total of 80 subjects, aged 12–20 years, consecutively hospitalized for a manic or mixed episode. Socio-demographic and clinical data were extracted by reviewing patients’ charts. We used a multivariate analysis to evaluate short-term outcome predictors. The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirty-three (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.

Automatic Motherese Detection for Face-to-Face Interaction Analysis

Abstract: This paper deals with emotional speech detection in home movies. In this study, we focus on infant-directed speech also called "motherese" which is characterized by higher pitch, slower tempo, and exaggerated intonation. In this work, we show the robustness of approaches to automatic discrimination between infant-directed speech and normal directed speech. Specifically, we estimate the generalization capability of two feature extraction schemes extracted from supra-segmental and segmental information. In addition, two machine learning approaches are considered: k-nearest neighbors (k-NN) and Gaussian mixture models (GMM). Evaluations are carried out on real-life databases: home movies of the first year of an infant.

Troubles bipolaires de type I de l’adolescent : controverses et devenir à l’âge adulte

Abstract: Resume Contexte Le trouble bipolaire de l’enfant et de l’adolescent a donne lieu ces dernieres annees a de nombreuses controverses liees a l’usage extensif de ce diagnostic chez l’enfant prepubere. Pourtant, les etudes dans sa forme la mieux caracterisee – a savoir le trouble bipolaire de type I de l’adolescent – restent rares et les donnees sur le devenir a l’âge adulte limitees. Objectifs Decrire la phenomenologie des episodes maniaques et mixtes de l’adolescent et leur devenir a l’âge adulte dans une cohorte francaise. Methodes Quatre-vingt sujets, âges de 12 a 20 ans, hospitalises pour un episode maniaque ou mixte entre 1994 et 2003 ont ete recrutes. Les donnees cliniques et socio-demographiques de l’episode index ont ete colligees retrospectivement sur dossier. Tous les patients ont ete contactes en 2005-2006 pour une evaluation du devenir. Cinq ont refuse, 20 ont ete perdus et 55 ont pu etre evalues lors d’un examen standardise (67%) ou indirectement par telephone et via leur psychiatre traitant (33%). Resultats A l’episode index, l’echantillon etait caracterise par une tres grande severite, une proportion elevee de symptomes psychotiques (N = 50, 62.5%), une duree d’hospitalisation longue (moyenne = 80,4 jours), et dans l’ensemble une bonne amelioration symptomatique a la sortie. Plus d’episodes maniaques que mixtes ont ete diagnostiques chez les adolescents migrants et chez ceux presentant un retard cognitif. A distance (en moyenne 5 annees apres leur sortie), 35 patients avaient toujours un diagnostic vie entiere de trouble bipolaire. Huit ont change de diagnostic pour un trouble schizoaffectif et 11 pour une schizophrenie. La mortalite et la morbidite sont apparues severes puisqu’un sujet est decede d’un arret cardiaque, et que 91% des patients ont eu au moins une rechute. Les patients sans rechutes (N = 5) et ceux qui temoignaient du meilleur niveau de fonctionnement social (N = 19) appartenaient tous au groupe qui maintenait un diagnostic vie entiere de bipolarite. Bien que preliminaire, nos premieres donnees suggerent que l’examen psychologique associant evaluations cognitive et projective pourrait etre un indice pronostique du risque de transition schizophrenique. Conclusion Ces donnees suggerent que les episodes maniaques et mixtes de l’adolescent necessitent souvent une hospitalisation prolongee pour consolider l’amelioration en phase aigue. Contrairement aux donnees de la litterature sur les formes moins severes, des transitions du diagnostic vie entiere vers les troubles du spectre de la schizophrenie sont frequentes. Des analyses complementaires sont en cours pour determiner les facteurs pronostics de cette transition.

Intérêt de l’abord sensorimoteur dans les pathologies autistiques sévères. II : illustration clinique

Abstract: Resume L’abord sensorimoteur des pathologies autistiques severes a connu de nombreux developpements recents, en particulier grâce a l’apport des travaux d’Andre Bullinger. Nous proposons dans ce second article une illustration clinique partant du bilan sensorimoteur initial comme cle de voute des options therapeutiques en psychomotricite. La prise en charge, decidee a raison de deux seances hebdomadaires en salle et en piscine, permet d’illustrer les axes techniques et leurs implications au plan sensorimoteur. L’evolution sur deux annees tant au plan general que des donnees du bilan sensorimoteur est egalement presente.

Accountability in the Balance: Trials Before the Special Panels for Serious Crimes in East Timor 1999-2005

Abstract: From 2000-05 the United Nations operated a so-called 'hybrid' tribunal in East Timor to provide accountability to the Timorese people for crimes committed in their country in 1999 and to fulfil a number of other articulated goals as well. This chapter examines the political, legal and social context that shaped the creation, operation and function of this tribunal and evaluates its successes and failures, both in achieving justice for the Timorese people, as well as serving as a potential model for the other such tribunals. This analysis leads to the conclusion that, whatever a national government may choose to do, the United Nations should not create or cooperate with a justice process that does not meet the standards of the rule of law and respect for international principles of justice that that organisation purports to represent. In East Timor too often those standards were not met because of a lack of commitment and political will on the part of those in leadership positions in the UN and in the Timorese government to ensure that the justice process was worthy of that name.

Cost-effectiveness of alternative approaches to the management of chronic obstructive coronary artery disease.

Abstract: Chronic obstructive coronary artery disease (CAD) is a highly prevalent condition that results in premature mortality as well as substantial morbidity due to angina and reduced quality of life. Various treatment and revascularization strategies are available for managing this condition, including medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. These treatments are expensive and, given the high prevalence of chronic CAD, there is substantial cost involved in the management of this condition. Recent clinical trials comparing percutaneous coronary intervention with medical management and/or coronary artery bypass grafting, and their associated economic analyses, have generated new information regarding the relative value of these alternative treatment strategies. In this article, we review the basic concepts of cost-effectiveness analysis and the current evidence as it relates to the cost-effectiveness of percutaneous coronary intervention in the management of chronic obstructive coronary artery disease.

Abstract 4557: Mode of Death After Contemporary Percutaneous Coronary Intervention: A Report From the EVENT Multicenter Registry

Abstract: BACKGROUND When selecting clinical trial endpoints, some investigators prefer to use cardiovascular death (CVD) while others believe that all-cause mortality is more relevant. The frequencies of CV...