Les agressions en contextos tancats de Justícia Juvenil

Aquesta recerca explora el fenomen de l'agressivitat originada en entorns tancats, com ho són els centres educatius de Justícia Juvenil de Catalunya. Aquest, però, és només un dels àmbits on la major part de les eines que s'han emprat poden ser d'utilitat. És possible estendre el camp d'aplicació a altres entorns de compliment de mesures o de tractament en règim tancat. L'ús d'eines de valoració estructurades pot ser complementat amb l'obtenció sistemàtica d'informació sobre els comportaments agressius, la qual cosa permet que els equips professionals disposin de més informació útil en termes de prevenció d'incidents. No obstant això, un aspecte rellevant en la prevenció de les agressions és la relació que un individu estableix amb la resta de persones del seu entorn. En aquest cas, s'ha incorporat l'Anàlisi de Xarxes Socials per obtenir indicadors des d'una perspectiva relacional a fi d’efectuar-ne una anàlisi conjunta amb característiques personals i de risc. Els resultats obtinguts permeten valorar aquests aspectes relacionals associats a les agressions que es van produir al Centre Educatiu durant el treball de camp. A més, la utilització d'altres eines permet caracteritzar aquestes agressions com a relativament poc greus i poc freqüents. Pel que fa als resultats de les eines de valoració de risc, s'han obtingut indicis que permeten afirmar la relació d'aquestes eines amb les agressions posteriors, motiu pel qual és factible considerar-les també com a eines vàlides per a la predicció d'incidents.

Presence of alternative lengthening of telomeres mechanism in patients with glioblastoma identifies a less aggressive tumor type with longer survival.

Patients with glioblastoma (GBM) have variable clinical courses, but the factors that underlie this heterogeneity are not understood. To determine whether the presence of the telomerase-independent alternative lengthening of telomeres (ALTs) mechanism is a significant prognostic factor for survival, we performed a retrospective analysis of 573 GBM patients. The presence of ALT was identified in paraffin sections using a combination of immunofluorescence for promyelocytic leukemia body and telomere fluorescence in situ hybridization. Alternative lengthening of telomere was present in 15% of the GBM patients. Patients with ALT had longer survival that was independent of age, surgery, and other treatments. Mutations in isocitrate dehydrogenase (IDH1mut) 1 frequently accompanied ALT, and in the presence of both molecular events, there was significantly longer overall survival. These data suggest that most ALT+ tumors may be less aggressive proneural GBMs, and the better prognosis may relate to the set of genetic changes associated with this tumor subtype. Despite improved overall survival of patients treated with the addition of chemotherapy to radiotherapy and surgery, ALT and chemotherapy independently provided a survival advantage, but these factors were not found to be additive. These results suggest a critical need for developing new therapies to target these specific GBM subtypes.

Las agresiones en contextos cerrados de Justicia Juvenil

En esta investigación se explora el fenómeno de la agresividad originada en entornos cerrados como lo son los centros educativos de justicia juvenil de Cataluña. Una correcta valoración estructurada en combinación con el análisis de las redes sociales establecidas entre los individuos de los centros permite obtener información precisa sobre los comportamientos agresivos producidos en estos entornos cerrados. Esta información puede ser utilizada por los equipos profesionales para detectar, registrar y prevenir futuros incidentes.

Visual management of sags and incidents gathered in distribution substations for power quality management

Monitor a distribution network implies working with a huge amount of data coining from the different elements that interact in the network. This paper presents a visualization tool that simplifies the task of searching the database for useful information applicable to fault management or preventive maintenance of the network

Angioinvasive lymphomatoid papulosis: a new variant simulating aggressive lymphomas.

Lymphomatoid papulosis (LyP) belongs to the spectrum of primary cutaneous CD30-positive lymphoproliferative disorders. Clinically, LyP is characterized by a variable number of self-healing papulo-nodular lesions, with the typical waxing and waning course. Histologically, 4 types (A, B, C, and D) have been delineated. Angioinvasive growth and large ulcers are rare findings in LyP and simulate aggressive lymphoma. We retrospectively analyzed the clinicopathologic and molecular features of angioinvasive LyP in a series of 16 patients. This new form of LyP is characterized by oligolesional papules that rapidly ulcerate and evolve into large necrotic eschar-like lesions with a diameter of 1 to 4 cm and an angiocentric and angiodestructive infiltrate of small-sized to medium-sized atypical lymphocytes expressing CD30 and frequently CD8. As in other forms of LyP, the lesions underwent spontaneous regression after a few weeks. Recurrences were common, but the prognosis was excellent with no extracutaneous spread or disease-related deaths. Complete remission occurred in 9 of 16 patients (56%). This LyP variant should be distinguished from aggressive forms of angiocentric and angiodestructive and cytotoxic T-cell lymphomas. We propose the term LyP type E for this clinically and histologically unusual variant.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.

INTRODUCTION: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland. METHODS: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles. RESULTS: Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources. CONCLUSIONS: Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.

Longer survival for patients with alternative lengthening of telomeres (ALT) glioblastoma multiforme is due to a less aggressive phenotype and not to improved response to adjuvant therapy

Introduction: The Alternative Lengthening of Telomeres (ALT) mechanism is a significant prognostic factor for longer survival in patients with GBM, irrespective of age. The reasons for this are unknown. We considered two possibilities; firstly that ALT identifies a subset of less aggressive GBMs, or alternatively, a group of tumours that respond more favourably to adjuvant therapy. Methods: ALT was determined by staining for ALT Associated PML Bodies (APBs) in archival tissue in a retrospective analysis of 573 GBM patients. IDH1 mutation was determined by immunohistochemistry in a subset of these. Results: We identified the presence of the telomerase-independent ALT in 15% of GBM patients and found that it correlated with survival (22% of ALT patients survive more than 2 years compared to 9% for non-ALT). This survival advantage was independent of surgery type (biopsy or full resection) and treatment (radiotherapy and chemotherapy). Interestingly ALT conferred a significant survival advantage for patients who only received surgery (13.3 months compared to 5.5 months) (19% vs 1% .2 year survival). This survival benefit was also observed in GBM patients who received surgery and radiotherapy (18.5% vs 2.4%. 2 year survival), but less so for chemotherapy (21% vs 17% . 2 year survival). For the ALT patients the fraction surviving more than 2 years did not improve significantly with adjuvant therapy. IDH1 mutation also associated with ALT. Conclusions: These data indicate ALT+ tumours are biologically distinct and associated with improved patient survival, probably due to less aggressive/invasive growth. However they respond poorly to current adjuvant treatment and therefore new therapies are urgently needed for this group.

Prevalence and factors associated with incidents related to medication in surgical patients

The aim of this study was to estimate the prevalence and factors associated with the occurrence of incidents related to medication, registered in the medical records of patients admitted to a Surgical Clinic, in 2010. This is a cross-sectional study, conducted at a university hospital, with a sample of 735 hospitalizations. Was performed the categorization of types of incidents, multivariate analysis of regression logistic and calculated the prevalence. The prevalence of drug-related incidents was estimated at 48.0% and were identified, as factors related to the occurrence of these incidents: length of hospitalization more than four days, prescribed three or more medications per day and realization of surgery intervention. It is expected to have contributed for the professionals and area managers can identify risky situations and rethink their actions.

Report of Task Force into Critical Incidents within the Iowa Prison System, 2004

Report #02-04 Concerns about the death of two Iowa inmates at the Anamosa State Penitentiary, asked the Ombudsman Office to review the incidents and provide an assessment of each incident. The Governor also asked the Ombudsman Office to propose a set of recommendations for improving inmate and staff safety within Anamosa State Penitentiary.

Indisciplina na escola : compreender para prevenir : um estudo com alunos do 7º e 9º anos de Cabo Verde

A indisciplina na escola é um tema educativo de atualidade e uma preocupação daqueles que estão ligados à educação, quer seja de uma forma direta ou indireta: professores, alunos, pais ou encarregados de educação. O presente estudo teve como objetivo geral conhecer as representações que os alunos do 7º e 9º anos de escolaridade têm acerca da indisciplina na escola. Com as nove questões de investigação formuladas, pretendeu-se averiguar a distribuição dos alunos pela disrupção, vitimização e agressão na escola, e, ainda, analisar as diferenças em função do género e do ano de escolaridade nos comportamentos de disrupção, vitimização e agressão na escola. A amostra foi constituída por 240 alunos do 7º e 9º anos de escolaridade de uma escola secundária de Cabo Verde. Para se proceder à avaliação dos comportamentos disruptivos foi utilizada a Escala de Disrupção Escolar Professada pelo Aluno, desenvolvida por Veiga (1996, 2012). Foi também utilizada a escala Peer Victimization Scale, adaptada para Portugal por Veiga (2008), que permitiu avaliar comportamentos de agressor e de agredido. Os resultados indicaram uma disrupção escolar não elevada. Em termos diferenciais, de uma forma geral, os alunos do 7º ano foram mais disruptivos que os do 9º ano; os alunos do sexo masculino revelaram ser mais disruptivos que os do sexo feminino. Em relação à escala de vitimização, os resultados obtidos permitiram encontrar ocorrências de vitimização, sendo a mais frequente a verbal; nesta escala os alunos do sexo masculino foram mais vítimas do que os do sexo feminino; os alunos do 7º ano revelaram ser mais vítima do que os do 9º. Relativamente à escala de agressão, os resultados permitiram observar que não houve registo elevado de ocorrências; nesta escala os alunos do sexo masculino revelaram ser mais agressores do que os alunos do sexo feminino; os alunos do 7º ano revelaram ser mais agressores do que os do 9º ano. Os resultados aproximam-se de outros estudos semelhantes e sugerem a necessidade de novas investigações com amostras mais heterogéneas, envolvendo outros anos de escolaridade.

Incidents and complications of totally implanted vascular access devices in children: a prospective study.

BACKGROUND: Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients. METHODS: From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery. RESULTS: 45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3-15.6; SD +/- 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection. CONCLUSION: Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.

Incidents occuring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.

Incidents occurring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.