Traumatic mitral valve injury after blunt chest trauma: a case report and review of the literature.

Mitral valve injury after blunt chest trauma is a rare occurrence. We recently admitted a patient with severe traumatic mitral regurgitation who was successfully treated with surgery. Review of the literature aimed at taking an inventory of cases of traumatic nonpenetrating mitral insufficiency that were operated on, since the earliest report in 1964. Eighty-two cases were found and analyzed allowing for a better understanding of the epidemiology, etiology, natural history, pathology, and treatment of this rare condition. The most common lesions reach the papillary muscles (PM), followed by the chordae and then the mitral valve leaflets. Among the 82 cases reported that have been treated with surgery, 57% required a valve replacement. More than half of the patients had a PM injury with a complete or partial rupture. When the rupture is complete, and especially when it involves the anterior PM, the clinical picture is most always acute with clinically important hemodynamic repercussions, often necessitating emergency surgery, most of the time with mitral valve replacement. One must always suspect traumatic mitral injury after blunt chest trauma. The most common mitral lesions affect the PM. The clinical course can be indolent or devastating, and most often requires urgent or delayed surgical treatment, either with mitral valve repair or replacement.

Der 11. September aus der Sicht eines Schweizer Trauma Fellows in New York [September 11 from the viewpoint of a Swiss trauma fellow in New York]

This is the report of the events of September 11th seen through the eyes of a Swiss Trauma Fellow. This ill-fated day is described by someone who went down to ground zero with other doctors to help and save lives and came back frustrated because there was so little to be done.

Wolves in sheep's clothing: SDO asymmetrically predicts perceived ethnic victimization among White and Latino students across three years

Dominant groups have claimed to be the targets of discrimination on several historical occasions during violent intergroup conflict and genocide.The authors argue that perceptions of ethnic victimization among members of dominant groups express social dominance motives and thus may be recruited for the enforcement of group hierarchy. They examine the antecedents of perceived ethnic victimization among dominants, following 561 college students over 3 years from freshman year to graduation year. Using longitudinal, cross-lagged structural equation modeling, the authors show that social dominance orientation (SDO) positively predicts perceived ethnic victimization among Whites but not among Latinos, whereas victimization does not predict SDO over time. In contrast, ethnic identity and victimization reciprocally predicted each other longitudinally with equal strength among White and Latino students. SDO is not merely a reflection of contextualized social identity concerns but a psychological, relational motivation that undergirds intergroup attitudes across extended periods of time and interacts with the context of group dominance.

Cumulative risk factors for adolescent alcohol misuse and its perceived consequences among 16 to 20 year old adolescents in Switzerland

Rapport de synthèse : OBJECTIF: évaluer l'impact cumulatif des facteurs individuels et environnementaux associés au mésusage d'alcool chez les adolescents et leurs corrélations avec ses conséquences perçues. METHODE : enquête scolaire transversale d'un échantillon représentatif de la population nationale, incluant 7548 apprentis et élèves ayant terminé l'école obligatoire âgés de 16 à 20 ans, en Suisse, en 2002. Le mésusage de l'alcool est fondé sur les réponses aux questions portant sur la fréquence 1) de sa consommation, 2) des épisodes d'ivresse et 3) de la conduite d'un véhicule sous son emprise. RÉSULTATS : quinze facteurs de risque significatifs ont été identifiés pour les adolescents des deux sexes. Un score individuel de facteurs de risques cumulés a été calculé en les additionnant. L'association entre ce score et la probabilité d'être engagé dans le mésusage d'alcool s'est révélée hautement significative et dose dépendante (p<0.001). Une proportion importante des adolescents rapporte des conséquences subjectives néfastes liées à leur consommation d'alcool. Il existe une corrélation linéaire (p<0.001) entre le score de facteurs de risque et la proportion d'adolescents rapportant des problèmes liés à la consommation d'alcool tels que mauvaises performances scolaires, comportements à risque, problèmes relationnels et comportements sexuels à risques. CONCLUSION : les facteurs de risque du mésusage d'alcool chez les adolescents sont cumulatifs et peuvent être synthétisés par un score individuel corrélé à la tendance à ce mésusage. La relation linéaire de ce score avec des problèmes subjectifs consécutifs à ce mésusage est un indicateur supplémentaire de sa validité.

Determinants of the educational use of digital learning materials: The mediating role of self-efficacy, perceived norm and attitude

Initiatives to stimulate the development and propagation of open educational resources (OER) need a sufficiently large community that can be mobilized to participate in this endeavour. Failure to achieve this could lead to underuse of OER. In the context of the Wikiwijs initiative a large scale survey was undertaken amongst primary and secondary school teachers to explore possible determinants of the educational use of digital learning materials (DLMs). Basing on the Integrative Model of Behaviour Prediction it was conjectured that self-efficacy, attitude and perceived norm would take a central role in explaining the intention to use DLMs. Several other predictors were added to the model as well whose effects were hypothesized to be mediated by the three central variables.All conjectured relationships were found using path analysis on survey data from 1484 teachers. Intention to DLMs was most strongly determined by self-efficacy, followed by attitude. ICT proficiency was in its turn the strongest predictor of self-efficacy. Perceived norm played only a limited role in the intention to use DLMs. Concluding, it seems paramount for the success of projects such as Wikiwijs to train teachers in the use of digital learning materials and ICT (e.g. the digital blackboard) and to impact on their attitude.

Parental occupational exposure to organic solvents and anencephaly in Mexico

Objective: To assess the relationship between parental occupational exposure to organic solvents, and the risk of anencephaly in Mexico. Methods: A case-control study was conducted based on the registers of the Epidemiological Surveillance System for Neural Tube Defects in Mexico; 151 cases of anencephaly of ≥20 weeks’ gestation were included. A control, born alive and without any apparent congenital malformations at birth, was selected for each case in the same maternity service in which the case was born. Information on occupational exposures, lifestyle habits, reproductive history, use of medicines, supplementation with multivitamins and folic acid, was obtained by a general questionnaire; a food frequency questionnaire was also applied to obtain information of daily intake of folate and other B vitamins. Occupational exposure to organic solvents was based on job title as a proxy for exposure and analysed considering two critical periods around conception. Results: In logistic regression analysis, the odds of having a child with anencephaly was higher if the mother or the father was occupationally exposed to organic solvents during the periconceptional period, or when both parents or at least one of them were occupationally exposed during this period with an adjusted odds ratio of 2.97 (95% CI 1.36 to 6.52). Conclusions: The results support the hypothesis that both maternal and paternal occupational exposure to organic solvents can increase the probability of having a child with anencephaly.

Management of bleeding following major trauma: a European guideline

INTRODUCTION Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.

Parental influences on pathogen resistance in brown trout embryos and effects of outcrossing within a river network.

Phenotypic plasticity can increase tolerance to heterogeneous environments but the elevations and slopes of reaction norms are often population specific. Disruption of locally adapted reaction norms through outcrossing can lower individual viability. Here, we sampled five genetically distinct populations of brown trout (Salmo trutta) from within a river network, crossed them in a full-factorial design, and challenged the embryos with the opportunistic pathogen Pseudomonas fluorescens. By virtue of our design, we were able to disentangle effects of genetic crossing distance from sire and dam effects on early life-history traits. While pathogen infection did not increase mortality, it was associated with delayed hatching of smaller larvae with reduced yolk sac reserves. We found no evidence of a relationship between genetic distance (W, FST) and the expression of early-life history traits. Moreover, hybrids did not differ in phenotypic means or reaction norms in comparison to offspring from within-population crosses. Heritable variation in early life-history traits was found to remain stable across the control and pathogen environments. Our findings show that outcrossing within a rather narrow geographical scale can have neutral effects on F1 hybrid viability at the embryonic stage, i.e. at a stage when environmental and genetic effects on phenotypes are usually large.

Management of bleeding and coagulopathy following major trauma: an updated European guideline.

INTRODUCTION: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved. METHODS: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS: A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.

Quand référer aux urgences un patient présentant un trauma de l'appareil locomoteur [When should a patient with musculoskeletal trauma be referred to emergency ward?].

Standardized clinical examination can obviate the need for osteoarticular radiographs for trauma. This paper summarizes a number of decision rules that allow clinical exclusion of significant fracture of the cervical spine, elbow, knee or ankle, making radiographs unnecessary. These criteria were all derived from large cohort studies (Nexus, Ottawa, CCS, etc..., and have been prospectively validated. The rigorous use of these criteria in daily practice improves treatment times and costs with no adverse effect on treatment quality.

Associations between parental and child attachment representations.

In the present article on intergenerational transmission of attachment representations, we use mothers' and fathers' Adult Attachment Interview classifications to predict a 3-year-old's responses to the Attachment Story Completion Task (ASCT). We present a Q-sort coding procedure for the ASCT, which was developed for children as young as three. The Q-sort yields scores on four attachment dimensions (security, deactivation, hyperactivation, and disorganization). One-way ANOVAs revealed significant mother-child associations for each dimension, although results for the hyperactivation and disorganization dimensions were significant only according to contrast tests. Conversely, no father-child association was found, regardless of the dimension considered. Findings are discussed in terms of the respective part played by each parent in their children's emotional development.

Perceived competition explains regional differences in stereotype content of immigrant groups

This research investigates differences in the stereotype content of immigrant groups between linguistic regions. We expected that immigrant groups who speak the local language of a specific linguistic region would be perceived as more competitive within this region than in another linguistic region. Further, we expected these differences would underlie regional differences in stereotype content, albeit only for the warmth dimension. Predictions were tested in the two largest linguistic regions of Switzerland. As expected, in the German-speaking region, locals perceived German immigrants as more competitive and thus as less warm, whereas in the French-speaking region, locals perceived French immigrants as more competitive and, consequently, as less warm. So, paradoxically, immigrants with strong integration potential are particularly disliked because they are regarded as direct competitors.