Effects of Micro- and Nanosilica on the Mechanical and Microstructural Characteristics of Some Special Mortars Made with Recycled Concrete Aggregates.

In this paper, we study the influence of densified microsilica and colloidal nanosilica admixtures on the mechanical strength and the microstructural characteristics of special mortars used for immobilizing radioactive concrete waste. The experimental program focused on the replacement of cement with micro- and/or nanosilica, in different proportions, in the basic composition of a mortar made with recycled aggregates. The technical criteria imposed for such cementitious systems, used for the encapsulation of low-level radioactive waste, imply high fluidity, increased mechanical strength and lack of segregation and of bleeding. We aimed to increase the structural compactness of the mortars by adding micro- and nanosilica, all the while maintaining the technical criteria imposed, to obtain a cement matrix with high durability and increased capacity for immobilizing radionuclides. The samples from all the compositions obtained were analyzed from the point of view of mechanical strength. Also, micro- and nanosilica as well as samples of the optimal mortar compositions were analyzed physically and microstructurally. Experimental data showed that the mortar samples present maximum compressive strength for a content between 6 and 7.5% wt. of microsilica, respectively, for a content of 2.25% wt. nanosilica. The obtained results suggest a synergistic effect of micro- and nanosilica when they are used simultaneously in cementitious compositions. Thus, among the analyzed compositional variants, the mortar composition with 3% wt. microsilica and 2.25% wt. nanosilica showed the best performance, with an increase in compressive strength of 23.5% compared to the control sample (without micro- and nanosilica). Brunauer-Emmett-Teller (BET) analysis and scanning electron microscopy (SEM) images highlighted the decrease in pore diameter and the increase in structural compactness, especially for mortar samples with nanosilica content or a mixture of micro- and nanosilica. This study is useful in the field of recycling radioactive concrete resulting from the decommissioning of nuclear research or nuclear power reactors.

[Recommendations for the diagnostic and therapy of behavioural and psychological symptoms of dementia (BPSD)].

INTRODUCTION: The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)¼ were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice.

[Qualitätsstandards in der Alterspsychiatrie]. / Standards de qualité en psychiatrie de la personne âgée.

Quality Standards in Old Age Psychiatry Abstract: Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

Résumé: Les normes et réglementations en matière de qualité prennent de plus en plus d'importance et sont encouragées dans le cadre de l'approbation des thérapeutiques, de la facturation et des incitations financières. Dans ce contexte, ces réglementations mettent l'accent, à des degrés divers, sur des critères de structure, de processus ou de résultats. Au nom de la Société Suisse de Psychiatrie et Psychothérapie de la Personne Âgée (SPPA) nous résumons dans ce document les éléments de qualité et regroupons les exigences qui en découlent en fonction du setting (ambulatoire, intermédiaire, stationnaire) et des critères de qualité structurelle (clé de répartition du personnel, infrastructure). Il existe une vaste matrice d'exigences dont la mise en œuvre requiert des efforts considérables, entre autres en raison de la pénurie de personnel qualifié et des ressources financières limitées des institutions et des cabinets médicaux. Les critères définis dans la matrice d'exigences devraient être développés et ancrés dans une «formation continue en psychiatrie de la personne âgée basée sur les compétences¼.

[Quality development in Consultation and Liaison Psychiatry and Psychosomatics].

INTRODUCTION: Quality or quality development and the corresponding regulations are becoming increasingly important in the Swiss healthcare system, in particular due to the link with aspects of permission for the provision of services and financing. In doing so, the focus is directed to varying degrees on structural, processual or outcome criteria. Specific quality aspects of the specialist area consultation-liaison psychiatry and psychosomatics (CLPP) are compiled and the indicators derived from them are grouped according to the quality criteria mentioned. There are numerous requirements, the implementation of which requires considerable efforts from the service providers, not least because of the shortage of specialists and limited financial resources. The requirements listed should be continuously evaluated and developed as well as sensibly anchored in regulation. Linking quality requirements with corresponding financial aspects within the framework of national tanning structures as well as national and cantonal permission regulations should be sought.

[Measures restricting freedom in the geriatric psychiatry].

INTRODUCTION: Measures restricting freedom include physical restraints restricting movement and treatment without consent according to the Swiss Civil Code. Patients incapable of consenting to treatments and other measures of care and who are somatically multimorbid in addition to their mental illness are frequently encountered in the geriatric psychiatry inpatient setting. In this group of patients, physical restraints are repeatedly used to prevent falling and to quarantine patients due to infectious diseases. Frequently, treatment is conducted with the apparent agreement of the patient but which are to be recorded as measures restricting freedom due to the inability to give informed consent. The National Association for Quality Development in Hospitals and Clinics (ANQ) has introduced geriatric psychiatry as a separate department category; this differentiation should also be seen as an opportunity and invitation to take a differentiated look at measures restricting freedom in geriatric psychiatry.

[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]. / Biomarqueurs des pathologies neurodégénératives dans le diagnostic des troubles cognitifs - Revue et recommandations de Swiss Memory Clinics.

Established cerebrospinal fluid (CSF) biomarkers allow for earlier and more accurate etiological diagnosis of cognitive impairment. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published consensus recommendations. The results must be interpreted in the context of the other available history information and assessments. Blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice soon. Consequently, a broader usage of biomarkers is expected and may accelerate the development of individually tailored prevention and treatment approaches. This article provides the recommendations of the Swiss Memory Clinics for the use of biomarkers in clinical practice.

Les marqueurs du liquide céphalorachidien établis permettent un diagnostic des troubles cognitifs plus précoce et précis. Il est nécessaire de conseiller les patients avant et après un examen des biomarqueurs. Les procédures de la ponction lombaire et de traitement préanalytique des échantillons doivent suivre des recommandations publiées. L'interprétation des résultats prendra en compte les antécédents médicaux et les autres résultats d'examen disponibles. Des marqueurs sanguins pourraient être disponibles dans un avenir proche. Cela pourrait conduire à une utilisation plus large des biomarqueurs et accélérer le développement d'approches personnalisées de prévention et de traitement. Cet article présente les recommandations de Swiss Memory Clinics concernant l'utilisation des biomarqueurs en pratique clinique.

Ways of Coping with Stress among Patients with Depressive Disorders.

BACKGROUND: Experiencing stressful life events and ways of coping with them can predispose to the onset of depressive mood disorders, while depression itself can be responsible for severe stress and can weaken resilience to stressors. Thus, variables relevant to the onset of depressive episodes and the course of depression have significant relationships with coping strategies to stressors. The aim of this research was to evaluate the most commonly used stress-coping strategies in patients treated for depression compared to patients with anxiety disorders and to healthy subjects. METHODS: The multidimensional coping inventory (COPE Inventory) by C. S. Carver, M. F. Scheier, and J. K. Weintraub, covering 15 stress response strategies included in more general and overarching coping styles, was used in the study. RESULTS: Patients with depression differed from the healthy subjects in a statistically significant way. Statistical analysis showed that people with depression are less likely than healthy subjects to use Active Coping, Planning, Seeking of Instrumental and Emotional Social Support, Suppression of Competing Activities, and Positive Reinterpretation. In contrast, they are more likely to use Denial, Mental Disengagement, and Behavioral Disengagement compared to those not treated for mental disorders. The patients with depressive disorders, compared to the group of patients with anxiety disorders, scored significantly differently on stress coping strategies in only two types of actions taken in stressful situations. CONCLUSION: The patients with depression differed from the healthy subjects in terms of the highest number of the stress coping strategies assessed. Compared to the healthy individuals, a tendency toward an avoidant behavior style was prevalent among the depressed patients. There was no statistically significant difference between the patients with the first episode of the disease and recurrent depressive disorders in terms of stress coping strategies.

[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]. / Biomarker in der Diagnostik kognitiver Störungen ­ Empfehlungen der Swiss Memory Clinics.

Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice.

[Quality Standards in Old Age Psychiatry]. / Qualitätsstandards in der Alterspsychiatrie.

Quality Standards in Old Age Psychiatry Abstract. Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements, matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

Appropriate use criteria for dementia amyloid imaging in Switzerland - mini-review and statement on behalf of the Swiss Society of Nuclear Medicine and the Swiss Memory Clinics.

While FDG-PET imaging of the brain for the differential diagnosis of dementia has been covered by the compulsory health insurance in Switzerland for more than a decade, beta-amyloid-PET just recently has been added to the catalogue of procedures that have been cleared for routine use, provided that a set of appropriate use criteria (AUC) be followed. To provide guidance to dementia care practitioners, the Swiss Society of Nuclear Medicine and the Swiss Memory Clinics jointly report a mini-review on beta-amyloid-PET and discuss the AUC set into effect by the Swiss Federal Office of Public Health, as well as their application and limitations.

[Recognition of Psychiatric Symptoms in Inpatient Long-Term Care]. / Erkennung psychiatrischer Symptome in der stationären Langzeitpflege.

Recognition of Psychiatric Symptoms in Inpatient Long-Term Care Abstract. As part of the Swiss national strategy on dementia, we investigated to which extent the needs assessment instruments RAI and BESA can early detect symptoms of depression, delirium, and behavioral and psychological symptoms of dementia (BPSD) in long-term care facilities. While we decided that the RAI sufficiently detected depressive symptoms, we suggest to add the two-questions-test and the geriatric depression scale to the BESA assessment. The BESA evaluation had more targeted focused assessments, allowing for better identification of delirium. Neither RAI or BESA cover the whole spectrum of behavioral and psychological symptoms of dementia. We consider the continuous application of these assessment instruments an important step towards interdisciplinary exchange and a better treatment of residents with psychiatric symptoms.

Impact of inflammation-mediated response on pan-coronary plaque vulnerability, myocardial viability and ventricular remodeling in the postinfarction period - the VIABILITY study: Protocol for a non-randomized prospective clinical study.

INTRODUCTION: While the role of inflammation in acute coronary events is well established, the impact of inflammatory-mediated vulnerability of coronary plaques from the entire coronary tree, on the extension of ventricular remodeling and scaring, has not been clarified yet. MATERIALS AND METHODS: The present manuscript describes the procedures of the VIABILITY trial, a descriptive prospective single-center cohort study. The main purpose of this trial is to assess the link between systemic inflammation, pan-coronary plaque vulnerability (referring to the plaque vulnerability within the entire coronary tree), myocardial viability and ventricular remodeling in patients who had suffered a recent ST-segment elevation acute myocardial infarction (STEMI). One hundred patients with STEMI who underwent successful revascularization of the culprit lesion in the first 12 hours after the onset of symptoms will be enrolled in the study. The level of systemic inflammation will be evaluated based on the serum biomarker levels (hs-CRP, matrix metalloproteinases, interleukin-6) in the acute phase of the myocardial infarction (MI) and at 1 month. Pan-coronary plaque vulnerability will be assessed based on serum biomarkers known to be associated with increased plaque vulnerability (V-CAM or I-CAM) and at 1 month after infarction, based on computed tomographic angiography analysis of vulnerability features of all coronary plaques. Myocardial viability and remodeling will be assessed based on 3D speckle tracking echocardiography associated with dobutamine infusion and LGE-CMR associated with post-processing imaging methods. The study population will be categorized in 2 subgroups: subgroup 1 - subjects with STEMI and increased inflammatory response at 7 days after the acute event (hs-CRP ≥ 3 mg/dl), and subgroup 2 - subjects with STEMI and no increased inflammatory response at 7 days (hs-CRP < 3 mg/dl). Study outcomes will consist in the rate of post-infarction heart failure development and the major adverse events (MACE) rate. CONCLUSION: VIABILITY is the first prospective study designed to evaluate the influence of infarct-related inflammatory response on several major determinants of post-infarction outcomes, such as coronary plaque vulnerability, myocardial viability, and ventricular remodeling.

Profile Of Patients With Advanced Parkinson's disease Suitable For Device-Aided Therapies: Restrospective Data Of A Large Cohort Of Romanian Patients.

BACKGROUND: There is insufficient data in the literature regarding the real-life, daily clinical practice evaluation of patients with advanced Parkinson's disease (APD). We are not sure what is the upper limit of dopaminergic medication, especially the levodopa (LD) dosage, and how it is influenced by access and suitability to the various add-on and device-aided therapies (DAT). OBJECTIVE: This retrospective study explored the profile of APD patients that were considered and systematically evaluated regarding the suitability for DAT. METHODS: We analyzed the data from 311 consecutive patients with APD hospitalized between 2011 and 2017 that 1) described at least 2 hrs/day off periods divided into at least two instances/day (except early morning akinesia), 2) were in stage 3 or above on the Hoehn and Yahr scale, 3) were with or without dyskinesia, and 4) received at least four levodopa doses/day combined with adjuvant therapy. RESULTS: Of the 311 patients enrolled initially, 286 patients showed up for the second visit, of which in 125 cases we assessed that DAT would be necessary. Finally, 107 patients were tested in our clinic to confirm the efficacy of LCIG. Patients selected for DAT had significantly longer off periods, more frequent dyskinesia, early morning akinesia, and freezing despite having significantly higher LD doses than those with an improved conservative therapy. CONCLUSION: Patients with APD can have a variety of symptoms, and because symptoms and therapeutical efficacy can be manifested in many different combinations, it is not possible to decide using a single, rigid set of criteria which APD patient is eligible for DAT. Nevertheless, treating physicians should refer APD patients to a specialized movement disorder center when patients with an average daily dose of LD of at least 750-1000 mg and maximal complementary therapies present daily motor complications that significantly reduce the quality of life.

Recommendations of Swiss Memory Clinics for the Diagnosis of Dementia / Die Empfehlungen der Swiss Memory Clinics für die Diagnostik der Demenzerkrankungen.

The early diagnosis of subjectively perceived or externally anamnestically observed cognitive impairments is essential for proving neurodegenerative diseases or excluding treatable causes such as internal, neurological or psychiatric disorders. Only in this way is early treatment made possible. As part of the project 3.1 of the National Dementia Strategy 2014­2019 («Development and expansion of regional and networked centres of competence for diagnostics¼), the association Swiss Memory Clinics (SMC) set itself the goal of developing quality standards for dementia clarification and improving the community-based care in this field. In these recommendations, general guidelines of diagnostics and individual examination possibilities are presented, and standards for the related processes are suggested. Individual areas such as anamnesis, clinical examination, laboratory examination, neuropsychological testing and neuroradiological procedures are discussed in detail as part of standard diagnostics, and supplementary examination methods for differential diagnosis considerations are portrayed. The most important goals of the SMC recommendations for the diagnosis of dementia are to give all those affected access to high-quality diagnostics, if possible, to improve early diagnosis of dementia and to offer the basic service providers and the employees of Memory Clinics a useful instrument for the clarification.

Explicit solutions to correlation matrix completion problems, with an application to risk management and insurance.

We derive explicit solutions to the problem of completing a partially specified correlation matrix. Our results apply to several block structures for the unspecified entries that arise in insurance and risk management, where an insurance company with many lines of business is required to satisfy certain capital requirements but may have incomplete knowledge of the underlying correlation matrix. Among the many possible completions, we focus on the one with maximal determinant. This has attractive properties and we argue that it is suitable for use in the insurance application. Our explicit formulae enable easy solution of practical problems and are useful for testing more general algorithms for the maximal determinant correlation matrix completion problem.

[Recommendations of Swiss Memory Clinics for the Diagnosis of Dementia]. / Recommandations de Swiss Memory Clinics pour le diagnostic des démences.

Recommendations of Swiss Memory Clinics for the Diagnosis of Dementia Abstract. The early diagnosis of subjectively perceived or externally anamnestically observed cognitive impairments is essential for proving neurodegenerative diseases or excluding treatable causes such as internal, neurological or psychiatric disorders. Only in this way is early treatment made possible. As part of the project 3.1 of the National Dementia Strategy 2014-2019 ('Development and expansion of regional and networked centres of competence for diagnostics'), the association Swiss Memory Clinics (SMC) set itself the goal of developing quality standards for dementia clarification and improving the community-based care in this field. In these recommendations, general guidelines of diagnostics and individual examination possibilities are presented, and standards for the related processes are suggested. Individual areas such as anamnesis, clinical examination, laboratory examination, neuropsychological testing and neuroradiological procedures are discussed in detail as part of standard diagnostics, and supplementary examination methods for differential diagnosis considerations are portrayed. The most important goals of the SMC recommendations for the diagnosis of dementia are to give all those affected access to high-quality diagnostics, if possible, to improve early diagnosis of dementia and to offer the basic service providers and the employees of Memory Clinics a useful instrument for the clarification.

Résumé. Le diagnostic précoce des atteintes cognitives, ressenties subjectivement ou rapportées par un tiers, est essentiel pour détecter des maladies neurodégénératives ou exclure des causes traitables telles que des pathologies de médecine interne, neurologiques ou psychiatriques. C'est la seule façon de garantir un traitement anticipé. Dans le cadre du projet 3.1 de la stratégie nationale en matière de démences 2014­2019 («Mise en place et extension d'un réseau de centres de compétences régionaux pour le diagnostic¼), l'association Swiss Memory Clinics (SMC) s'est fixé pour objectif d'améliorer les normes de qualité en matière de diagnostic des démences et de soins de proximité dans ce domaine. Ces recommandations contiennent des directives d'ordre général sur le diagnostic et les différentes possibilités d'examens, et proposent des normes pour les procédures à appliquer. Elles expliquent en détail les différents éléments du diagnostic standard, tels que l'anamnèse, l'examen clinique, l'analyse de laboratoire, les tests neuropsychologiques et les procédures neuroradiologiques, et présentent des examens complémentaires pouvant alimenter les réflexions sur le diagnostic différentiel. Les principaux objectifs des recommandations SMC pour le diagnostic des démences sont les suivants: assurer l'accès à un diagnostic de haute qualité à un maximum de personnes atteintes, améliorer le diagnostic précoce de la démence, ainsi que proposer aux médecins de premier recours et aux collaborateurs de Memory Clinics un outil d'investigations diagnostiques utile.

Echocardiographic characteristics of pulmonary arterial hypertension in children with horizontally transmitted HIV.

BACKGROUND: The prevalence of primitive pulmonary arterial hypertension (PAH) in patients with human immunodeficiency virus infection (HIV) is estimated at approximately 0.5%, significantly higher than in the general population. OBJECTIVES: This study aimed to assess the echocardiographic modifications in HIV-associated pulmonary arterial hypertension (PAH). MATERIAL AND METHODS: A group of 117 patients, aged under 16, with horizontally transmitted HIV staged according to the U.S. Center for Disease Control and Prevention criteria, were included in this prospective study, with echocardiographic abnormalities in 79 children. The study group consisted of 27 HIV-infected patients with PAH, while the control group consisted of 38 patients with normal ultrasound features. The diagnostic criterion for PAH was the presence of a mean pulmonary artery pressure above 25 mm Hg, determined at 2 consecutive measurements having at least 6 months distance between them. All subjects underwent a complex echocardiographic assessment, including assessment of left and right ventricular hypertrophy and evaluation of left ventricular function, associated with determination of the immunological stage. RESULTS: We recorded the presence of PAH in 27 patients (23.08%), in whom an average value of 31.48 mm Hg was recorded for pulmonary artery pressure. All patients had mild forms of PAH. Age, gender and immunological stage showed no significant differences in the PAH group compared to patients in the control group. Right ventricular hypertrophy was encountered in 95.23% and left ventricular hypertrophy in 88.88% of the patients with PAH. Left ventricular dysfunction, a complication of pulmonary hypertension, was relatively rare (11.11%). CONCLUSIONS: In children with HIV infection, PAH is present in a relatively mild form and does not correlate with the clinical and immunological stage of HIV infection, evolving as a seemingly primitive condition.