Clinical reasoning: The relative contribution of identification, interpretation and hypothesis errors to misdiagnosis

The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process - identification of relevant information, interpretation or hypothesis generation - at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. Results indicate that hypothesis errors decrease as expertise increases but that identification and interpretation errors increase. This may be due to inappropriate use of pattern recognition or to failure of the knowledge base. Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.

Specular resentment : San-Antonio, Céline and the use of proletarian rhetoric in literary criticism

The charge of »Ressentiment« can in today's world – less from traditionally conservative quarters than from the neo-positivist discourses of particular forms of liberalism – be used to undermine the argumentative credibility of political opponents, dissidents and those who call for greater »justice«. The essays in this volume draw on the broad spectrum of cultural discourse on »Ressentiment«, both in historical and contemporary contexts. Starting with its conceptual genesis, the essays also show contemporary nuances of »Ressentiment« as well as its influence on aesthetic and literary discourse in the 20th century.

Análisis de la incidencia de la Teoría de la Identidad Colectiva en la posición de la Liga Árabe frente al reconocimiento de Somalilandia como Estado independiente

Esta Monografía se centra en mostrar cómo el intento por conservar la identidad colectiva de la Liga de los Estados Árabes impide ceder ante el deseo de Somalilandia de ser reconocida como Estado independiente.

Interpretation of ambiguity in children: a prospective study of associations with anxiety and parental interpretations

Interpretation of ambiguity is consistently associated with anxiety in children, however, the temporal relationship between interpretation and anxiety remains unclear as do the developmental origins of interpretative biases. This study set out to test a model of the development of interpretative biases in a prospective study of 110 children aged 5–9 years of age. Children and their parents were assessed three times, annually, on measures of anxiety and interpretation of ambiguous scenarios (including, for parents, both their own interpretations and their expectations regarding their child). Three models were constructed to assess associations between parent and child anxiety and threat and distress cognitions and expectancies. The three models were all a reasonable fit of the data, and supported conclusions that: (i) children’s threat and distress cognitions were stable over time and were significantly associated with anxiety, (ii) parents’ threat and distress cognitions and expectancies significantly predicted child threat cognitions at some time points, and (iii) parental anxiety significantly predicted parents cognitions, which predicted parental expectancies at some time points. Parental expectancies were also significantly predicted by child cognitions. The findings varied depending on assessment time point and whether threat or distress cognitions were being considered. The findings support the notion that child and parent cognitive processes, in particular parental expectations, may be a useful target in the treatment or prevention of anxiety disorders in children.

Interpretation bias in preschool children at risk for anxiety: a prospective study

A story-stem paradigm was used to assess interpretation bias in preschool children. Data were available for 131 children. Interpretation bias, behavioural inhibition (BI) and anxiety were assessed when children were aged between 3 years 2 months and 4 years 5 months. Anxiety was subsequently assessed 12-months, 2-years and 5-years later. A significant difference in interpretation bias was found between participants who met criteria for an anxiety diagnosis at baseline, with clinically anxious participants more likely to complete the ambiguous story-stems in a threat-related way. Threat interpretations significantly predicted anxiety symptoms at 12-month follow-up, after controlling for baseline symptoms, but did not predict anxiety symptoms or diagnoses at either 2-year or 5- year follow-up. There was little evidence for a relationship between BI and interpretation bias. Overall, the pattern of results was not consistent with the hypothesis that interpretation bias plays a role in the development of anxiety. Instead, some evidence for a role in the maintenance of anxiety over relatively short periods of time was found. The use of a story-stem methodology to assess interpretation bias in young children is discussed along with the theoretical and clinical implications of the findings.

Shared cognition in childhood anxiety: interpretation bias in preschool children and their parents

Although interpretation bias has been associated with the development and/or maintenance of childhood anxiety, its origins remain unclear. The present study is the first to examine intergenerational transmission of this bias from parents to their preschool-aged children via the verbal information pathway. A community sample of fifty parent–child pairs was recruited. Parents completed measures of their own trait anxiety and interpretation bias, their child’s anxiety symptoms, and a written story-stem measure, to capture the way parents tell their children stories. Interpretation bias was assessed in preschool-aged children (aged between 2 years 7 months and 5 years 8 months) using an extended story-stem paradigm. Young children’s interpretation bias was not significantly associated with their own anxiety symptoms. Neither was there evidence for a significant association between parent and child interpretation bias. However, parents who reported they would tell their child one or more threatening story endings in the written story-stem task had significantly higher anxiety than those who did not include any threatening story endings. In turn, children whose parents did not include any threatening endings in their written stories had significantly lower threat interpretations on the child story-stem paradigm, compared to those with parents who included at least one threatening story ending. The results suggest that parental verbal information could play a role in the development of interpretation bias in young children.

Interpretation of ambiguity: differences between children and adolescents with and without an anxiety disorder

Background: Theory and treatment of anxiety disorders in young people are commonly based on the premise that interpretation biases found in anxious adults are also found in children and adolescents. Although there is some evidence that this may be the case, studies have not typically taken age into account, which is surprising given the normative changes in cognition that occur throughout childhood. The aim of the current study was to identify whether associations between anxiety disorder status and interpretation biases differed in children and adolescents. Methods: The responses of children (7-10 years) and adolescents (13-16 years) with and without anxiety disorders (n = 120) were compared on an ambiguous scenarios task. Results: Children and adolescents with an anxiety disorder showed significantly higher levels of threat interpretation and avoidant strategies than non-anxious children and adolescents. However, age significantly moderated the effect of anxiety disorder status on interpretation of ambiguity, in that adolescents with anxiety disorders showed significantly higher levels of threat interpretation and associated negative emotion than non-anxious adolescents, but a similar relationship was not observed among children. Conclusions: The findings suggest that theoretical accounts of interpretation biases in anxiety disorders in children and adolescents should distinguish between different developmental periods. For both ages, treatment that targets behavioral avoidance appears warranted. However, while adolescents are likely to benefit from treatment that addresses interpretation biases, there may be limited benefit for children under the age of ten.

Petrology and geochemistry of the banded iron formation in the Eastern Sierras Pampeanas of San Luis (Argentina): Implications for the evolution of the Nogoli Metamorphic Complex

The metamorphosed banded iron formation from the Nogoli Metamorphic Complex of western Sierra de San Luis, Eastern Sierras Pampeanas of Argentina (Nogoli area, 32 degrees 55`S-66 degrees 15`W) is classified as an oxide facies iron formation of Algoma Type, with a tectonic setting possibly associated with an island arc or back arc, on the basis of field mapping, mineral and textural arrangements and whole rock geochemical features. The origin of banded iron formation is mainly related to chemical precipitation of hydrogenous sediments from seawater in oceanic environments. The primary chemical precipitate is a result of solutions that represent mixtures of seawater and hydrothermal fluids, with significant dilution by maficultramafic volcanic and siliciclastic materials. Multi-stage T(DM) model ages of 1670, 1854 and 1939 Ma and positive, mantle-like xi Nd((1502)) values of +3.8, +1.5 and +0.5 from the banded iron formation are around the range of those mafic to ultramafic meta-volcanic rocks of Nogoli Metamorphic Complex, which are between 1679 and 1765 Ma and +2.64 and +3.68, respectively. This Sm and Nd isotopic connection suggests a close genetic relationship between ferruginous and mafic-ultramafic meta-volcanic rocks, as part of the same island arc or back arc setting. A previous Sm-Nd whole rock isochron of similar to 1.5 Ga performed on mafic-ultramafic meta-volcanic rocks led to the interpretation that chemical sedimentation as old as Mesoproterozoic is possible for the banded iron formation. A clockwise P-T path can be inferred for the regional metamorphic evolution of the banded iron formation, with three distinctive trajectories: (1) Relict prograde M(1)-M(3) segment with gradual P and T increase from greenschist facies at M(1) to amphibolite facies at M(3). (2) Peak P-T conditions at high amphibolite-low granulite facies during M(4). (3) Retrograde counterpart of M(4), that returns from amphibolite facies and stabilizes at greenschist facies during M(5). Each trajectory may be regarded as produced by different tectonic events related to the Pampean? (1) and the Famatinian (2 and 3) orogenies, during the Early to Middle Paleozoic. The Nogoli Metamorphic Complex is interpreted as part of a greenstone belt within the large Meso- to Neoproterozoic Pampean Terrane of the Eastern Sierras Pampeanas of Argentina. (C) 2009 Elsevier Ltd. All rights reserved.

Consumer interpretation of ready to drink orange juice and nectar labelling

The aim of this study was to evaluate consumers' use and interpretation of ready to drink orange juice and nectar label information and its influence on the purchase decision. One hundred and sixty-seven consumers of ready to drink orange juice and nectar were interviewed. The labels were analysed to evaluate their conformance to Brazilian legislation. The manufacturing and shelf life date were the information most often checked, followed by health related issues. Brand, price and flavour were the most important factors for purchase decision. Brand and flavour showed significant association with consumer age. For most interviewed, 'nectar', 'whole' and 'natural' or '100% natural' were not well understood; they were not in accordance with the Brazilian legislation. 'Nectar', 'whole' and 'natural' or '100% natural' received a positive interpretation, whereas 'reconstituted juice' was considered a negative expression. Nevertheless, none of the labels completely conformed to the specific nutritional labelling legislation. © 2013 Institute of Food Science and Technology.

MicroRNA expression profile in head and neck cancer: HOX-cluster embedded microRNA-196a and microRNA-10b dysregulation implicated in cell proliferation

Abstract Background Current evidence implicates aberrant microRNA expression patterns in human malignancies; measurement of microRNA expression may have diagnostic and prognostic applications. Roles for microRNAs in head and neck squamous cell carcinomas (HNSCC) are largely unknown. HNSCC, a smoking-related cancer, is one of the most common malignancies worldwide but reliable diagnostic and prognostic markers have not been discovered so far. Some studies have evaluated the potential use of microRNA as biomarkers with clinical application in HNSCC. Methods MicroRNA expression profile of oral squamous cell carcinoma samples was determined by means of DNA microarrays. We also performed gain-of-function assays for two differentially expressed microRNA using two squamous cell carcinoma cell lines and normal oral keratinocytes. The effect of the over-expression of these molecules was evaluated by means of global gene expression profiling and cell proliferation assessment. Results Altered microRNA expression was detected for a total of 72 microRNAs. Among these we found well studied molecules, such as the miR-17-92 cluster, comprising potent oncogenic microRNA, and miR-34, recently found to interact with p53. HOX-cluster embedded miR-196a/b and miR-10b were up- and down-regulated, respectively, in tumor samples. Since validated HOX gene targets for these microRNAs are not consistently deregulated in HNSCC, we performed gain-of-function experiments, in an attempt to outline their possible role. Our results suggest that both molecules interfere in cell proliferation through distinct processes, possibly targeting a small set of genes involved in cell cycle progression. Conclusions Functional data on miRNAs in HNSCC is still scarce. Our data corroborate current literature and brings new insights into the role of microRNAs in HNSCC. We also show that miR-196a and miR-10b, not previously associated with HNSCC, may play an oncogenic role in this disease through the deregulation of cell proliferation. The study of microRNA alterations in HNSCC is an essential step to the mechanistic understanding of tumor formation and could lead to the discovery of clinically relevant biomarkers.

Place for video games : a theoretical and pedagogical framework for multiliteracies learning in English studies

Students are now involved in a vastly different textual landscape than many English scholars, one that relies on the “reading” and interpretation of multiple channels of simultaneous information. As a response to these new kinds of literate practices, my dissertation adds to the growing body of research on multimodal literacies, narratology in new media, and rhetoric through an examination of the place of video games in English teaching and research. I describe in this dissertation a hybridized theoretical basis for incorporating video games in English classrooms. This framework for textual analysis includes elements from narrative theory in literary study, rhetorical theory, and literacy theory, and when combined to account for the multiple modalities and complexities of gaming, can provide new insights about those theories and practices across all kinds of media, whether in written texts, films, or video games. In creating this framework, I hope to encourage students to view texts from a meta-level perspective, encompassing textual construction, use, and interpretation. In order to foster meta-level learning in an English course, I use specific theoretical frameworks from the fields of literary studies, narratology, film theory, aural theory, reader-response criticism, game studies, and multiliteracies theory to analyze a particular video game: World of Goo. These theoretical frameworks inform pedagogical practices used in the classroom for textual analysis of multiple media. Examining a video game from these perspectives, I use analytical methods from each, including close reading, explication, textual analysis, and individual elements of multiliteracies theory and pedagogy. In undertaking an in-depth analysis of World of Goo, I demonstrate the possibilities for classroom instruction with a complex blend of theories and pedagogies in English courses. This blend of theories and practices is meant to foster literacy learning across media, helping students develop metaknowledge of their own literate practices in multiple modes. Finally, I outline a design for a multiliteracies course that would allow English scholars to use video games along with other texts to interrogate texts as systems of information. In doing so, students can hopefully view and transform systems in their own lives as audiences, citizens, and workers.

La censura del tema deportivo en la prensa durante la posguerra española (1939-1945)

La presente tesis doctoral pretende arrojar nueva luz sobre la utilización de la prensa durante los primeros años del franquismo. En concreto, el objetivo ha sido estudiar la censura del tema deportivo dentro del sistema censorio de los primeros años de posguerra civil en España, una área no estudiada hasta hoy y que entendemos fundamental para entender el desarrollo del deporte durante el llamado primer franquismo. Para ello, se estudiaron de manera pormenorizada los actores principales y los pasos básicos del proceso de censura; los métodos utilizados, tanto materiales como personales, para hacer efectiva ésta; y, por último, sus manifestaciones reales en el ámbito de la información deportiva: qué se censuró, por parte de quién, de qué forma y por qué motivos. De este modo, pretendemos llenar una de las lagunas de investigación que aún quedan dentro del estudio de la censura de prensa durante el franquismo. La metodología utilizada es la técnica historiográfica. Basado en el análisis crítico y en la interpretación de fuentes primarias, dicho método trata de establecer marcos históricos de referencia a través del estudio pormenorizado de las circunstancias del pasado. Ello implica una estructura algo distinta a la de las tesis doctorales de otras áreas de estudio puesto que, exceptuando la introducción, toda la tesis es la exposición de los resultados de la investigación llevada a cabo. Se ha utilizado cuantiosa documentación de los archivos General de la Administracion (Alcalá de Henares) y Centrale dello Stato (Roma) no manejada anteriormente por ningún investigador. La prensa periódica de la época y la legislación que afecta a nuestro tema de estudio también han sido ampliamente investigadas, tanto en el contexto español como en el italiano. Nuestra investigación arroja los siguientes resultados. Efectivamente, existió censura de prensa en el tema deportivo en las siguientes temáticas fundamentales: cuestiones económicas, autoridades y jerarquías, uso del lenguaje y comportamiento de los deportistas. En la mayor parte de los casos, la censura se ejerce en la información deportiva por razones ajenas al propio deporte. No se puede afirmar que existan diferencias en el tratamiento general entre medios de la Prensa del Movimiento y otros de titularidad privada o eclesiástica, si bien la aplicación de la censura no fue homogénea sino arbitraria en muchos casos. El sistema de censura de prensa español del primer franquismo toma la mayoría de sus rasgos del modelo fascista italiano, aunque tiene alguna característica propia como la censura previa y el catolicismo imperante. ABSTRACT This doctoral thesis aims to shed light on the use of press during the first years of francoism. The particular objective was to study the censorship of the sport topic into the general system of censorship carried out after the Spanish Civil War. It is a subject comparatively understudied to date but a key aspect to understand the development of sport during the so called early francoism. To this end, an in-depth study was made on key actors, main steps of censorship process, human and material methods used to ensure its effectiveness, and the actual manifestations in sports information area: what was censored, by whom, how and why. This should ensure us to fill the historiographical gap within the research on Francoʼs press censorship. Methodology used was historiographic research. It is based on critical analysis and interpretation of primary sources and seeks to establish historical reference frameworks tracing back the past in detail. It determines a different doctoral thesis structure in some aspects. Except the introduction, the whole document is the report and explanation of the results of research. A large amount of unexplored documents from the Archivo General de la Administración (Alcalá de Henares, Spain) and the Archivio Centrale dello Stato (Rome, Italy) has been used. The press of the period and legislation about our topic have also been analysed in detail both in Spain and Italy. Our research states these results. We can affirm that press censorship actually existed on sports topic in these thematic priorities: economical issues, authorities and hierarchies, use of language and sportsmen behaviours. In most cases, the censorship of sports information is exercised for reasons unconnected to sport. It cannot be concluded that general differences were applied in press censorship between State-owned media and private or church media although its implementation was non-uniform and arbitrary in many cases. The system of press censorship in Spain during the early francoism is clearly inspired by fascist Italy system copying most of its features although Spain had a few specific characteristics like prior censorship and catholicism.

Mistletoe and holly / by Sophia Prior.

no.24(1939)

Comparative education, an outline summary and study guide for students and teachers,

Reproduced from type-written copy.