Mort des voyageurs: risques réels, risques virtuels [True and virtual risks of travellers].

Evidence-based information on travel associated mortality is scarce. Perception, intuition and the availability of interventions such as vaccinations and chemoprophylaxis often guide pre-travel advice. Important risks including accidents and cardiovascular events are not routinely included in pre-travel consultations although they cause more fatalities and costs than infectious diseases. The increased risk of sustaining a road accident in poor economy countries should always be mentioned. The general practitioner is further best placed to discuss possible problems of travellers with chronic diseases before travel.

Implementation of a medical command and control team in Switzerland.

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French-speaking part of the country.

Laboratorio virtual de software libre para bibliotecas

La elección de un programa de gestión de bibliotecas se ve afectada muchas veces por una serie de condiciones sociales, económicas y políticas que hacen que la elección no sea la más adecuada para las necesidades, características y funciones de la biblioteca. El software libre está siendo una de las soluciones más optadas, por sus libertades de copia, modificación y distribución, además de la libertad de licencias y las posibilidades de interoperación con otras aplicaciones. Esta nueva tendencia hacia el software libre en bibliotecas se refleja también en los estudios de biblioteconomía y documentación, en los que desde diferentes asignaturas se aportan conocimientos sobre programas de automatización, de gestión de repositorios, incluso del sistema operativo Linux/GNU, entre otros. Esta combinación entre las necesidades de los centros y la tendencia al uso de software libre, es la que un grupo de profesores de la Facultat de Biblioteconomia i Documentació (Universitat de Barcelona) y estudiantes, miembros del Grup de Treball sobre Programari Lliure per als Professionals de la Informació (Cobdc), han querido aportar a la comunidad profesional, creando un laboratorio virtual para el uso de software libre de aplicación en bibliotecas.

Support services for vulnerable patients by a multidisciplinary team in an emergency department

Introduction: Individuals with poor social determinants of health aremore likely to receive improper healthcare. Frequent Users (FUs) ofEmergency Departments (ED) (defined as >4 visits in the previous12 months) represent a subgroup of vulnerable patients presentingwith specific medical and social needs. They usually account for highhealthcare costs by overusing the healthcare system. In 2008-2009,FUs accounted for 4% of our ED patients but 17% of all our ED visits.Methods: We conducted a prospective cohort of patients admitted toour ED with vulnerabilities in ≥3 specific domains (somatic or mentaldiseases, risk behaviors, social determinants of health, and healthcareuse). Patients were either directly identified by a multidisciplinary team(two nurses, one social worker, one physician) or referred to that teamby the ED staff during opening hours from July 1st 2010 to April 30th2011.Results: 127 patients were included (67% males), aged 43 years (SD15); 65% were migrants. They had a median of 6 ED visits (interquartilerange (IQR) 8-1) in the previous 12 months, representing a total of 697visits. The most frequently affected domains during the index visit were:71% somatic, 61% psychiatric, 75% risk behaviors, 97% social and84% healthcare use issues. Each case required a median of 234minutes (IQR 300-90) dedicated to assess their outpatient network(99% of the patients), to set up an ambulatory medical follow-up (43%)or a meeting with social services (40%).Conclusions: Vulnerability affected ED patients in more than onedomain. Vulnerable patients have complex needs that were difficult toaddress in the time-pressured ED setting. Although ED consultationoffers immediate access to medical care, EDs are dedicated more foracute short-term somatic care. Caring for a growing number ofvulnerable patients requires a different type of management. Limitedevidence shows that multidisciplinary case-management interventionshave demonstrated positive outcomes in terms of reducing ED useand costs, and improvement of patient's medical and social outcomes.A randomized trial of case-management is underway to confirm theresults of observational studies.

A virtual exhibition of open source software for libraries

Frequently the choice of a library management program is conditioned by social, economic and/or political factors that result in the selection of a system that is not altogether suitable for the library’s needs, characteristics and functions. Open source software is quickly becoming a preferred solution, owing to the freedom to copy, modify and distribute it and the freedom from contracts, as well as for greater opportunities for interoperability with other applications. These new trends regarding open source software in libraries are also reflected in LIS studies, as evidenced by the different courses addressing automated programs, repositorymanagement, including the Linux/GNU operating system, among others. The combination of the needs of the centres and the new trends for open source software is the focus of a virtual laboratory for the use of open source software for library applications. It was the result of a project, whose aim was to make a useful contribution to the library community, that was carried out by a group of professors of the School of Library and Information Science of the University of Barcelona, together with a group of students, members of a Working Group on Open Source Software for Information Professionals, of the Professional Library Association of Catalonia.

3D virtual rendering before laparoscopic partial splenectomy in children.

INTRODUCTION: Partial splenectomy in children is a good surgical option for hematological diseases and focal splenic tumors because it allows the preservation of the spleen's immunological function. Furthermore, it can be performed by laparoscopy in children as it is a safe procedure, offering the benefits of a minimally invasive approach. MATERIALS AND METHODS: The software VR-render LE version 0.81 is a system that enables the visualization of bidimentional 3D images with magnification of anatomical details. We have applied this system to five cases of non-parasitic splenic cysts before laparoscopic partial splenectomy. RESULTS: The images obtained with VR rendering software permitted the preoperative reconstruction of the vascularization of the splenic hilum, allowing the surgeon safe vessel control during laparoscopic procedures. All five partial splenectomies were carried out with no complications or major blood loss. CONCLUSIONS: Laparoscopic partial splenectomy should be a first choice procedure because it is feasible, reproducible, and safe for children; furthermore, it preserves enough splenic tissue thereby preventing post-splenectomy infections. Volume rendering provides high anatomical resolution and can be useful in guiding the surgical procedure.

Virtual anthropology: A comparison between the performance of conventional X-ray and MDCT in investigating the trabecular structure of long bones.

Recently, modern cross-sectional imaging techniques such as multi-detector computed tomography (MDCT) have pioneered post mortem investigations, especially in forensic medicine. Such approaches can also be used to investigate bones non-invasively for anthropological purposes. Long bones are often examined in forensic cases because they are frequently discovered and transferred to medico-legal departments for investigation. To estimate their age, the trabecular structure must be examined. This study aimed to compare the performance of MDCT with conventional X-rays to investigate the trabecular structure of long bones. Fifty-two dry bones (24 humeri and 28 femora) from anthropological collections were first examined by conventional X-ray, and then by MDCT. Trabecular structure was evaluated by seven observers (two experienced and five inexperienced in anthropology) who analyzed images obtained by radiological methods. Analyses contained the measurement of one quantitative parameter (caput diameter of humerus and femur) and staging the trabecular structure of each bone. Preciseness of each technique was indicated by describing areas of trabecular destruction and particularities of the bones, such as pathological changes. Concerning quantitative parameters, the measurements demonstrate comparable results for the MDCT and conventional X-ray techniques. In contrast, the overall inter-observer reliability of the staging was low with MDCT and conventional X-ray. Reliability increased significantly when only the results of the staging performed by the two experienced observers were compared, particularly regarding the MDCT analysis. Our results also indicate that MDCT appears to be better suited to a detailed examination of the trabecular structure. In our opinion, MDCT is an adequate tool with which to examine the trabecular structure of long bones. However, adequate methods should be developed or existing methods should be adapted to MDCT.

LEVERAGING SANDBOX IMMERSIVE 3D VIRTUAL WORLDS TO DEVELOP DO-IT- YOURSELF TEACHING GAMES: IMPLEMENTATION TO MARKETING CASE STUDY TEACHING IN SECOND LIFE

Games are powerful and engaging. On average, one billion people spend at least 1 hour a day playing computer and videogames. This is even more true with the younger generations. Our students have become the < digital natives >, the < gamers >, the < virtual generation >. Research shows that those who are most at risk for failure in the traditional classroom setting, also spend more time than their counterparts, using video games. They might strive, given a different learning environment. Educators have the responsibility to align their teaching style to these younger generation learning styles. However, many academics resist the use of computer-assisted learning that has been "created elsewhere". This can be extrapolated to game-based teaching: even if educational games were more widely authored, their adoption would still be limited to the educators who feel a match between the authored games and their own beliefs and practices. Consequently, game-based teaching would be much more widespread if teachers could develop their own games, or at least customize them. Yet, the development and customization of teaching games are complex and costly. This research uses a design science methodology, leveraging gamification techniques, active and cooperative learning theories, as well as immersive sandbox 3D virtual worlds, to develop a method which allows management instructors to transform any off-the-shelf case study into an engaging collaborative gamified experience. This method is applied to marketing case studies, and uses the sandbox virtual world of Second Life. -- Les jeux sont puissants et motivants, En moyenne, un milliard de personnes passent au moins 1 heure par jour jouer à des jeux vidéo sur ordinateur. Ceci se vérifie encore plus avec les jeunes générations, Nos étudiants sont nés à l'ère du numérique, certains les appellent des < gamers >, d'autres la < génération virtuelle >. Les études montrent que les élèves qui se trouvent en échec scolaire dans les salles de classes traditionnelles, passent aussi plus de temps que leurs homologues à jouer à des jeux vidéo. lls pourraient potentiellement briller, si on leur proposait un autre environnement d'apprentissage. Les enseignants ont la responsabilité d'adapter leur style d'enseignement aux styles d'apprentissage de ces jeunes générations. Toutefois, de nombreux professeurs résistent lorsqu'il s'agit d'utiliser des contenus d'apprentissage assisté par ordinateur, développés par d'autres. Ceci peut être extrapolé à l'enseignement par les jeux : même si un plus grand nombre de jeux éducatifs était créé, leur adoption se limiterait tout de même aux éducateurs qui perçoivent une bonne adéquation entre ces jeux et leurs propres convictions et pratiques. Par conséquent, I'enseignement par les jeux serait bien plus répandu si les enseignants pouvaient développer leurs propres jeux, ou au moins les customiser. Mais le développement de jeux pédagogiques est complexe et coûteux. Cette recherche utilise une méthodologie Design Science pour développer, en s'appuyant sur des techniques de ludification, sur les théories de pédagogie active et d'apprentissage coopératif, ainsi que sur les mondes virtuels immersifs < bac à sable > en 3D, une méthode qui permet aux enseignants et formateurs de management, de transformer n'importe quelle étude de cas, provenant par exemple d'une centrale de cas, en une expérience ludique, collaborative et motivante. Cette méthode est appliquée aux études de cas Marketing dans le monde virtuel de Second Life.

Relationships between anthropometric measures and athletic performance, with special reference to repeated-sprint ability, in the Qatar national soccer team.

The aim of this study was to determine potential relationships between anthropometric parameters and athletic performance with special consideration to repeated-sprint ability (RSA). Sixteen players of the senior male Qatar national soccer team performed a series of anthropometric and physical tests including countermovement jumps without (CMJ) and with free arms (CMJwA), straight-line 20 m sprint, RSA (6 × 35 m with 10 s recovery) and incremental field test. Significant (P < 0.05) relationships occurred between muscle-to-bone ratio and both CMJs height (r ranging from 0.56 to 0.69) as well as with all RSA-related variables (r < -0.53 for sprinting times and r = 0.54 for maximal sprinting speed) with the exception of the sprint decrement score (Sdec). The sum of six skinfolds and adipose mass index were largely correlated with Sdec (r = 0.68, P < 0.01 and r = 0.55, P < 0.05, respectively) but not with total time (TT, r = 0.44 and 0.33, P > 0.05, respectively) or any standard athletic tests. Multiple regression analyses indicated that muscular cross-sectional area for mid-thigh, adipose index, straight-line 20 m time, maximal sprinting speed and CMJwA are the strongest predictors of Sdec (r(2) = 0.89) and TT (r(2) = 0.95) during our RSA test. In the Qatar national soccer team, players' power-related qualities and RSA are associated with a high muscular profile and a low adiposity. This supports the relevance of explosive power for the soccer players and the larger importance of neuromuscular qualities determining the RSA.

Evolving team compositions by agent swapping

Optimizing collective behavior in multiagent systems requires algorithms to find not only appropriate individual behaviors but also a suitable composition of agents within a team. Over the last two decades, evolutionary methods have emerged as a promising approach for the design of agents and their compositions into teams. The choice of a crossover operator that facilitates the evolution of optimal team composition is recognized to be crucial, but so far, it has never been thoroughly quantified. Here, we highlight the limitations of two different crossover operators that exchange entire agents between teams: restricted agent swapping (RAS) that exchanges only corresponding agents between teams and free agent swapping (FAS) that allows an arbitrary exchange of agents. Our results show that RAS suffers from premature convergence, whereas FAS entails insufficient convergence. Consequently, in both cases, the exploration and exploitation aspects of the evolutionary algorithm are not well balanced resulting in the evolution of suboptimal team compositions. To overcome this problem, we propose combining the two methods. Our approach first applies FAS to explore the search space and then RAS to exploit it. This mixed approach is a much more efficient strategy for the evolution of team compositions compared to either strategy on its own. Our results suggest that such a mixed agent-swapping algorithm should always be preferred whenever the optimal composition of individuals in a multiagent system is unknown.

Une équipe mobile en psychiatrie de l'âge avancé [A crisis team in the field of old age psychiatry]

In the context of demographic evolution, psychiatric care needs increase steadily in most western countries. Given the financial limitations, it is mandatory to establish appropriate care priorities in order to avoid psychiatric hospitalisations by assisting care providers, general practionners and nurses, at home or in the nursing homes. A crisis team has been established 18 months ago within the Division of old age psychiatry in Lausanne. The care program included immediate assistance in the community, assessement, crisis counseling, medication consultation and referral for psychiatric services providing an alternative to hospitalization. The first results indicate that this intervention is well accepted by the users and correspond to a real need.