Prevalence, incidence and indications of hypno-sedative treatments in hospitalized patients aged 75 and older

Introduction Sleep impairment is a common problem in older persons and is associated with adverse health and economic consequences. The most prescribed hypnosedatives in Switzerland are benzodiazepines, benzodiazepine-like hypnosedatives and clomethiazole. In the elderly persons, these medications have been associated with decreased cognitive performance, an increased risk of addiction and an increased risk of falls. The main aim of this study was to determine the prevalence, incidence and indications of hypnosedative prescriptions in older in-patients admitted to a Swiss university hospital. Furthermore, we planned to investigate the possible relationship between hypnosedatives' prescription and patients' falls during the hospital stay and we compared the prevalence of hypnosedative drugs' prescribing between geriatric and non-geriatric clinical wards.Materials & Methods This observational study included all patients aged 75 years or older admitted to a Swiss university hospital for 24 h or more. Prescription-related data were recorded every day for 26 consecutive days in the two geriatric wards, and twice, a week apart, in three non-geriatric wards.Results A total of 204 patients (mean age 84.7 ± 0.7 years, 66% women) were included. The prevalence of hypnosedative drugs prescription was 73% and the incidence was 28% on the two geriatric wards. The most common indications for a prescription on geriatric wards was insomnia (51%), followed by continuation of usual treatment (12%). The most frequently prescribed hypnosedative drug was clomethiazole (64% of the patients), followed by lorazepam (11%). We were not able to demonstrate any significant correlation between the number of hypnosedative drugs prescribed and the number of falls during hospital stay. The prevalence of hypnosedative drugs prescriptions was similar between geriatric and non-geriatric wards. The proportion of patients treated by at least one hypnosedative increased between hospital admission (32%) and discharge (45%).Discussions, Conclusion This study reveals a high prevalence of hypnosedative prescription in medical in-patients aged 75 years or older. Main indication was insomnia and the most frequently prescribed hypnosedative molecule was clomethiazole. Prescription incidence was also very high and the proportion of patients being prescribed a hypnosedative increased during hospital stay. Systematic interventions need to be integrated in order to reduce elderly inpatient exposure to treatments that are associated with adverse health outcomes.Conference information: ESCP 40th International Symposium on Clinical Pharmacy. Clinical Pharmacy: Connecting Care and Outcomes Dublin Ireland, 19-21 October 2011

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient"s QoL during the first postoperative week, especially due to local pain and eating discomfort.

Kernel-based Mapping of Meteorological Fields in Complex Orography

Due to the advances in sensor networks and remote sensing technologies, the acquisition and storage rates of meteorological and climatological data increases every day and ask for novel and efficient processing algorithms. A fundamental problem of data analysis and modeling is the spatial prediction of meteorological variables in complex orography, which serves among others to extended climatological analyses, for the assimilation of data into numerical weather prediction models, for preparing inputs to hydrological models and for real time monitoring and short-term forecasting of weather.In this thesis, a new framework for spatial estimation is proposed by taking advantage of a class of algorithms emerging from the statistical learning theory. Nonparametric kernel-based methods for nonlinear data classification, regression and target detection, known as support vector machines (SVM), are adapted for mapping of meteorological variables in complex orography.With the advent of high resolution digital elevation models, the field of spatial prediction met new horizons. In fact, by exploiting image processing tools along with physical heuristics, an incredible number of terrain features which account for the topographic conditions at multiple spatial scales can be extracted. Such features are highly relevant for the mapping of meteorological variables because they control a considerable part of the spatial variability of meteorological fields in the complex Alpine orography. For instance, patterns of orographic rainfall, wind speed and cold air pools are known to be correlated with particular terrain forms, e.g. convex/concave surfaces and upwind sides of mountain slopes.Kernel-based methods are employed to learn the nonlinear statistical dependence which links the multidimensional space of geographical and topographic explanatory variables to the variable of interest, that is the wind speed as measured at the weather stations or the occurrence of orographic rainfall patterns as extracted from sequences of radar images. Compared to low dimensional models integrating only the geographical coordinates, the proposed framework opens a way to regionalize meteorological variables which are multidimensional in nature and rarely show spatial auto-correlation in the original space making the use of classical geostatistics tangled.The challenges which are explored during the thesis are manifolds. First, the complexity of models is optimized to impose appropriate smoothness properties and reduce the impact of noisy measurements. Secondly, a multiple kernel extension of SVM is considered to select the multiscale features which explain most of the spatial variability of wind speed. Then, SVM target detection methods are implemented to describe the orographic conditions which cause persistent and stationary rainfall patterns. Finally, the optimal splitting of the data is studied to estimate realistic performances and confidence intervals characterizing the uncertainty of predictions.The resulting maps of average wind speeds find applications within renewable resources assessment and opens a route to decrease the temporal scale of analysis to meet hydrological requirements. Furthermore, the maps depicting the susceptibility to orographic rainfall enhancement can be used to improve current radar-based quantitative precipitation estimation and forecasting systems and to generate stochastic ensembles of precipitation fields conditioned upon the orography.

Sharing and Learning= Changing. A real story at the Institute of Public Security of Catalonia

The Institute has professionals with extensive experience in training, specifically with experience in the field of police and emergencies training. Moreover, it also has very talented people. But above all, our institution has public professionals with a desire to serve, who love security and emergency responders and want to provide them with the best knowledge to make them every day better professionals. In the quest for continuous training improvement, its during 2009 when e-learning begins to have a presence at the Institute. Virtual training methodology becomes a facilitator for the training of various professionals, avoiding geographical displacement and easing the class schedule.

L’Escolarització compartida: el cas de la Laia

Actualment s’està donant molt pes al fet d’incloure dins l’aula a tot aquell alumnat amb necessitats educatives especials per tal de fomentar la inclusió. Aquest fet i com a persona que visc el dia a dia amb persones amb diversitat funcional ha fet que hem plantegi molts dubtes i reptes sobre la inclusió. Així doncs, vaig pensar que seria interessant observar, descriure i analitzar com viu un infant amb diversitat funcional la seva escolarització dins una aula ordinària i dins una aula d’educació especial. La principal participant de la investigació ha estat la Laia, una nena de 10 anys la qual realitza escolarització compartida. La seva família i les tutores dels dos centres han col·laborat en la investigació aportant informació. El mètode utilitzat per a la investigació ha estat una recerca qualitativa a partir de l’anàlisi d’un estudi de cas utilitzant les entrevistes amb la família i els tutors de la Laia, l’observació de Laia dins l’horari escolar i les notes de camp com a instruments de recollida de dades. Com a conclusions pensem que la inclusió d’aquells infants amb diversitat funcional dins l’aula ordinària és molt important ja que els ajuda a viure en un àmbit amb total normalitat i fomenta el respecte de la gent que els envolta. Cal fomentar les situacions d’inclusió amb l’ús d’estratègies com poden ser el treball cooperatiu o establint bones relacions amb la gent que els envolta.

Statistically significant changes of antimüllerian hormone and inhibin levels during the physiologic menstrual cycle in reproductive age women.

OBJECTIVE: To define the dynamics of antimüllerian hormone (AMH) and inhibins during the physiologic menstrual cycle. DESIGN: Longitudinal study. SETTING: University hospital. PATIENT(S): 36 young, healthy, normal weight Caucasian women without medication. INTERVENTION(S): Normal ovulatory menstrual cycles were evaluated by regular blood sampling taken every other day and periovulatory every day. MAIN OUTCOME MEASURE(S): Serum concentrations of AMH, inhibin A and B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, progesterone, and free testosterone were measured in all blood samples. RESULT(S): Median AMH levels are statistically significantly higher in the late follicular compared with ovulation or the early luteal phase. There are statistically significant correlations between both AMH and FSH, and AMH and free testosterone in all cycle phases. Inhibin A increases strongly in the late follicular phase and peaks at day LH + 4. Inhibin B shows a broad midfollicular and a sharp early luteal peak, the difference being statistically significant between day LH + 4 and the earlier time points and between day LH + 2 and day LH. Although there is a negative association between inhibin A or B and the body mass index (BMI), there is no correlation between AMH and the BMI. CONCLUSION(S): Levels of AMH show a statistically significant change during the menstrual cycle and may influence the circulating gonadotropin and steroid hormone levels.

The State of the Judiciary, 2015

My job today as chief justice is to inform you and all Iowans of the condition of the Iowa Judicial Branch. The judicial branch is accountable to do its work so that Iowans can see the value of its fair and impartial courts. It is accountable every day for the resources it is given and the important responsibilities with which it has been entrusted. We best meet these obligations by becoming the best court system we can be. I am honored to report the progress the judicial branch has made towards becoming the best court system in the nation and the value of this progress for all Iowans. Both my grandfathers were carpenters. Like others who build with their hands, they could look at their work at the end of the day and see progress since the beginning of the day. Building Iowa’s court system consistent with its goals may not reveal progress at the end of every day as easily as the work of a carpenter. It is a long, careful process that requires the hands of many, working every day. But, certain days do come along when progress can be seen and our goals are closer within reach. Again this year, the goals of the judicial branch are to:  Protect Iowa’s children;  Provide full-time access to justice;  Operate an efficient, full-service court system;  Provide faster and less costly resolution of legal disputes;  Remain open and transparent; and  Provide fair and impartial justice for all.

Estimating the contribution of occupational solar ultraviolet exposure to skin cancer

BACKGROUND: Exposure to solar ultraviolet (UV) light is the main causative factor for skin cancer. Outdoor workers are at particular risk because they spend long working hours outside, may have little shade available and be bound to take their lunch at their workplace. Despite epidemiological evidence of a doubling in risk of squamous cell carcinoma in outdoor workers, the recognition of skin cancer as an occupational disease remains scarce. OBJECTIVE: To assess occupational solar UV doses and its contribution to skin cancer risk. METHODS: A numerical model (SimUVEx) was used to assess occupational and lunch break exposures, characterize exposure patterns and anatomical distribution. Risk of squamous cell carcinoma (SCC) was estimated from an existing epidemiological model. RESULTS: Horizontal body locations received 2.0-2.5 times more UV than vertical locations. Dose associated to lunch outdoor every day was similar to outdoor work one day per week but only half of a seasonal worker. Outdoor workers are associated with an increased risk of SCC but also of frequent acute episodes. CONCLUSION: Occupational solar exposure contributes largely to the overall lifetime UV dose, resulting in an excess risk of SCC. The magnitude of the estimated excess in risk supports the recognition of SCC as an occupational disease.

Tietojohtaminen toiminnanohjausjärjestelmän tukena; Case: Kespro Oy

Tutkielman tarkoituksena on tutkia oppimisprosessin muodostumista ja toteutumista sekä prosessijohtamisen ja prosessien roolia SAP:in käyttöönottoprojektissa. Tutkielman case-organisaationa toimii Kespro Oy ja tutkimuskohteena on SAP:in käyttöönottoprojekti Kespron tukuissa. Tutkimus- ja tiedonkeruumenetelmänä käytetään kvantitatiivista kyselylomaketta. Tutkimuksessa saatiin selkeä kuva prosessijohtamisen ja prosessien roolista muutostilanteessa sekä oppimisprosessin muodostumisesta jatoteutumisesta. Johdon ja esimiesten tuen korostuminen sekä onnistunut strategisten linjausten tiedottaminen tulivat esille käytännön työssä prosessien toimivuuden ja oman työn merkityksen kautta. Tärkeänä haasteena osaamisen varmistamiseksi käyttöönoton yhteydessä oli varmistaa koulutuksen ja käyttäjäohjeiden riittävä taso ja sisältö. Käyttöönoton aikana ja sen jälkeen korostuivat tiedon jakamisessa pääkäyttäjien ja henkilöstön keskinäinen yhteistyö ja avunanto. Tehokas tiedon jakaminen mahdollisti käyttöönoton onnistumisen. Käyttöönottoon vaikutti oleellisesti myös tietotekninen näkökulma: käyttäjien kyky erottaa toisistaan oma osaaminen ja tietotekniset ongelmat. Näiden tekijöiden huomioiminen mahdollisti SAP-toiminnanohjausjärjestelmän sujuvan liikkeellelähdön Kespron tukuissa mahdollisimman vähillä operatiivisilla ongelmilla.

Inmigrantes musulmanes en una sociedad "laica". Procesos de creación, consolidación y retos de futuro de las mezquitas

El artículo presenta, a través de dos estudios empíricos, la dinámica seguida por algunos oratorios españoles. Constatando que se trata de un fenómeno en crecimiento, analiza los motivos por los que fueron creados y sus objetivos, enfatizando en el abandono del islam por parte de algunos y el proceso de recuperación de éste que realiza la creación de uno de estos centros.

Incidència de les lesions en el futbol. Primera divisió. Temporada 1999-2000

El futbol constitueix al nostre país, igual com en d’altres Estats del nostre entorn, un fenomen que transcendeix allò merament esportiu per esdevenir un referent social que desperta passions i que té el seu consegüent reflex als mitjans de comunicació social. No és, doncs, estrany, que de forma diària la premsa esportiva d’àmbit nacional proporcioni informació constant sobre la matèria, incloent-hi allò que concerneix a les lesions que afecten els jugadors, car consideren que és un fet noticiable en la mesura en què això pugui influir en les expectatives dels diferents equips. La informació esmentada, adequadament recollida, sistematitzada i analitzada és susceptible de proporcionar valuoses dades sobre la incidència de les lesions en aquesta modalitat esportiva. Aquest és, precisament, l’objectiu del nostre estudi, sense una altra pretensió que la de proporcionar unes pautes a prendre en consideració per part dels professionals, perquè el seu esforç se centri en l’optimització del rendiment, la planificació de la temporada, l’establiment de programes de prevenció i, al capdavall, en la minimització del risc de lesions.

La enseñanza de estrategias de resolución de problemas matemáticos en la ESO: un ejemplo concreto

Within this article is included a description and justification of a didactical sequence to improve the learning of problem solving strategies of Secondary Education students. The design of the didactical sequence is guided by four principles: a) to context the activities and problems to solve in students’ every day practices; b) to use teaching methods that show the problem solving processes; c) to design didactical materials in order to guide strategies such as selection, organisation and control; d) to facilitate the co-operative learning of problem solving strategies.

Percepción por los expertos de la función de densidad de probabilidad de los rendimientos de cultivos

En la literatura sobre determinación subjetiva de funciones de densidad de probabilidad (f.d.p.) de rendimientos de cultivos, se ha señalado que los agricultores tienden a percibir f.d.p. muy «estrechas» (con varianza baja), un resultado que coincide con el señalado en otros contextos experimentales. En este trabajo se ha constatado que investigadores y expertos en producción vegetal tienen también una pobre percepción de la forma de la f.d.p. Este sesgo en la percepción de la f.d.p. sería compartido por agricultores y expertos, estos últimos con una buena formación estadística. Sin embargo ambos grupos realizan un trabajo diario exitoso que implica frecuentemente discriminar entre f.d.p. de rendimientos de cultivos.

Incidencia lesional en el fútbol. Primera división. Temporada 1999-2000

El fútbol constituye en nuestro país, al igual que en otros Estados de nuestro entorno, un fenómeno que trasciende de lo meramente deportivo para convertirse en un referente social que despierta pasiones y que tiene su consiguiente reflejo en los medios de comunicación social. No es pues de extrañar que de forma diaria la prensa deportiva de ámbito nacional proporcione información constante sobre la materia, incluyendo lo concerniente a las lesiones que aquejan a los jugadores considerándolo hecho noticiable en la medida que ello pueda afectar a las expectativas de los diferentes equipos. Dicha información, debidamente recogida, sistematizada y analizada, es susceptible de proporcionar valiosos datos sobre la incidencia lesional en esta modalidad deportiva. Éste es precisamente el objetivo de nuestro estudio, sin otra pretensión que la de proporcionar unas pautas a tomar en consideración por los profesionales cuyo esfuerzo se centre en la optimización del rendimiento, en la planificación de la temporada, en el establecimiento de programas de prevención y, en definitiva, en la minimización del riesgo lesional.

Use and availability of scholarly journals in Catalan academic libraries

This paper presents the results of a survey of academics affiliated to the universities that are members of the Consortium of Academic Libraries of Catalonia (CBUC) and an analysis of the availability in the libraries of these universities of the references cited in a sample of articles published by these academics. The results reflect the major importance that researchers assign to scholarly journals as the main source of scientific information. Most state that they use electronic journals either exclusively or in any case more than print journals, a preference that is higher among younger scholars. With regard to frequency of reading, four out of ten researchers state that they read journals virtually every day, while nine out of ten report that they do so at least once a week. Scholars claim that the obstacles they face when trying to download an article are related to the lack of subscriptions. However, the availability study showed that most of the articles cited in their publications are available at least at one of the CBUC libraries. Though most researchers keep a copy of the articles they consult, just over a third of them use some kind of reference management software.