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Objective: To answer frequently asked questions about management of end-stage pneumonia, poor nutritional intake, and dehydration in advanced dementia. Sources of information: Ovid MEDLINE was searched for relevant articles published until February 2015. No level I studies were identified; most articles provided level III evidence. The symptom management suggestions are partially based on recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia. Main message: Feeding tubes are not recommended for patients with end-stage dementia. Comfort feeding by hand is preferable. Use of parenteral hydration might be helpful but can also contribute to discomfort at the end of life. Withholding or withdrawing artificial nutrition and hydration is generally not associated with manifestations of discomfort if mouth care is adequate. Because pneumonia usually causes considerable discomfort, clinicians should pay attention to symptom control. Sedation for agitation is often useful in patients with dementia in the terminal phase. Conclusion: Symptomatic care is an appropriate option for end-stage manifestations of advanced dementia. The proposed symptom management guidelines are based on a literature review and expert consensus. © 2015, College of Family Physicians of Canada. All rights reserved. Source

Objective: To review the issues with setting goals of care for patients with advanced dementia, describe the respective roles of the physician and the patient's family in the decision-making process, and suggest ways to support families who need more information about the care options. Sources of information: Ovid MEDLINE was searched for relevant articles that were published before March 7, 2014. There were no level I studies identified; most articles provided level III evidence. Main message: For patients with advanced dementia, their families have an important role in medical decision making. Families should receive timely information about the course of dementia and the care options. They need to understand that a palliative approach to care might be appropriate and does not mean abandonment of the patient. They might also want clarification about their role in the decision-making process, especially if withholding or withdrawing life-prolonging measures are considered. Conclusion: Physicians should consider advanced dementia as a terminal disease for which there is a continuum of care that goes from palliative care with life-extending measures to symptomatic interventions only. Clarification of goals of care and family education are of paramount importance to avoid unwanted and burdensome interventions. © 2015, College of Family Physicians of Canada. All rights reserved. Source

Alamargot D.,University Paris Est Creteil | Morin M.-F.,University Of Sherbrookeqc
Human Movement Science

We sought to ascertain how handwriting with a plastic-tipped pen on the screen of a digital tablet affects graphomotor execution in students, compared with handwriting on paper with a ballpoint pen. We predicted that the modification to propriokinesthetic feedback induced by the screen/plastic tip combination would differently disturb younger and older students, who rely on perceptual feedback either to form letters (former) or to adjust movement execution (latter). Twenty-eight students from Grades Two and Nine were asked to handwrite the alphabet and their names and surnames under the two conditions. Kinematics were recorded using the tablet, controlled by Eye and Pen software. Results showed that handwriting on the tablet surface with a plastic-tipped pen primarily affected pen pauses in the second graders and pen movements in the ninth graders, suggesting a disturbance in segment trajectory calculation in the younger participants and reduced control of muscular adjustment in the older children. © 2015 Elsevier B.V.. Source

Landon-Cardinal O.,California Institute of Technology | Yoshida B.,California Institute of Technology | Poulin D.,University Of Sherbrookeqc | Preskill J.,California Institute of Technology
Physical Review A - Atomic, Molecular, and Optical Physics

A two-dimensional topologically ordered quantum memory is well protected against error if the energy gap is large compared to the temperature, but this protection does not improve as the system size increases. We review and critique some recent proposals for improving the memory time by introducing long-range interactions among anyons, noting that instability with respect to small local perturbations of the Hamiltonian is a generic problem for such proposals. We also discuss some broader issues regarding the prospects for scalable quantum memory in two-dimensional systems. © 2015 American Physical Society. Source

Adkar-Purushothama C.R.,Universite de Sherbrooke | Brosseau C.,University Of Sherbrookeqc | Gigu E Re T.,Universite de Sherbrooke | Sano T.,Hirosaki University | And 2 more authors.
Plant Cell

The tomato (Solanum lycopersicum) callose synthase genes CalS11-like and CalS12-like encode proteins that are essential for the formation of callose, a major component of pollen mother cell walls; these enzymes also function in callose formation during pathogen infection. This article describes the targeting of these callose synthase mRNAs by a small RNA derived from the virulence modulating region of two Potato spindle tuber viroid variants. More specifically, viroid infection of tomato plants resulted in the suppression of the target mRNAs up to 1.5-fold, depending on the viroid variant used and the gene targeted. The targeting of these mRNAs by RNA silencing was validated by artificial microRNA experiments in a transient expression system and by RNA ligase-mediated rapid amplification of cDNA ends. Viroid mutants incapable of targeting callose synthase mRNAs failed to induce typical infection phenotypes, whereas a chimeric viroid obtained by swapping the virulence modulating regions of a mild and a severe variant of Potato spindle tuber viroid greatly affected the accumulation of viroids and the severity of disease symptoms. These data provide evidence of the silencing of multiple genes by a single small RNA derived from a viroid. © 2015 American Society of Plant Biologists. All rights reserved. Source

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