Diagnostic methods in sepsis: the need of speed

OBJECTIVE: Sepsis is a common condition encountered in hospital environments. There is no effective treatment for sepsis, and it remains an important cause of death at intensive care units. This study aimed to discuss some methods that are available in clinics, and tests that have been recently developed for the diagnosis of sepsis. METHODS: A systematic review was performed through the analysis of the following descriptors: sepsis, diagnostic methods, biological markers, and cytokines. RESULTS: The deleterious effects of sepsis are caused by an imbalance between the invasiveness of the pathogen and the ability of the host to mount an effective immune response. Consequently, the host's immune surveillance fails to eliminate the pathogen, allowing it to spread. Moreover, there is a pro-inflammatory mediator release, inappropriate activation of the coagulation and complement cascades, leading to dysfunction of multiple organs and systems. The difficulty achieve total recovery of the patient is explainable. There is an increased incidence of sepsis worldwide due to factors such as aging population, larger number of surgeries, and number of microorganisms resistant to existing antibiotics. CONCLUSION: The search for new diagnostic markers associated with increased risk of sepsis development and molecules that can be correlated to certain steps of sepsis is becoming necessary. This would allow for earlier diagnosis, facilitate patient prognosis characterization, and prediction of possible evolution of each case. All other markers are regrettably constrained to research units.

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. RESULTS: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. CONCLUSION: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed.

The need of more rigorous assessments of marine species introductions: A counter example from the Brazilian coast

CAPES/PROCAD

Fatigue crack growth assessments in welded components including crack closure effects: Experiments and 3-D numerical modeling

This work provides a numerical and experimental investigation of fatigue crack growth behavior in steel weldments including crack closure effects and their coupled interaction with weld strength mismatch. A central objective of this study is to extend previously developed frameworks for evaluation of crack clo- sure effects on FCGR to steel weldments while, at the same time, gaining additional understanding of commonly adopted criteria for crack closure loads and their influence on fatigue life of structural welds. Very detailed non-linear finite element analyses using 3-D models of compact tension C ( T ) fracture spec- imens with center cracked, square groove welds provide the evolution of crack growth with cyclic stress intensity factor which is required for the estimation of the closure loads. Fatigue crack growth tests con- ducted on plane-sided, shallow-cracked C ( T ) specimens provide the necessary data against which crack closure effects on fatigue crack growth behavior can be assessed. Overall, the present investigation pro- vides additional support for estimation procedures of plasticity-induced crack closure loads in fatigue analyses of structural steels and their weldments

Forecasting the need for medical specialists in Spain: application of a system dynamics model

[EN] Background: Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods: We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results: In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions: The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.

Need certificaction in the field of sport

[EN] The need for stronger credentialing in the field of sports is recommended because of the complex issues modern sports face. A brief overview of the development of professional credentials/licensure is provided to set the rationale for the need for accreditation in the field of sports. The research reviewed supports the need for accreditation of both the individual professionals that serve sports and athletes and the schools and institutions as well. This research points to the similar developmental path that other licensed/credentialed professions have followed leading up to their regulation. Accreditation by the International association is offered as an answer to this need for certification.

Modelling the stable, nocturnal boundary layer: different approaches to turbulence closure problem

Il lavoro è dedicato all'analisi fisica e alla modellizzazione dello strato limite atmosferico in condizioni stabili. L'obiettivo principale è quello di migliorare i modelli di parametrizzazione della turbulenza attualmente utilizzati dai modelli meteorologici a grande scala. Questi modelli di parametrizzazione della turbolenza consistono nell' esprimere gli stress di Reynolds come funzioni dei campi medi (componenti orizzontali della velocità e temperatura potenziale) usando delle chiusure. La maggior parte delle chiusure sono state sviluppate per i casi quasi-neutrali, e la difficoltà è trattare l'effetto della stabilità in modo rigoroso. Studieremo in dettaglio due differenti modelli di chiusura della turbolenza per lo strato limite stabile basati su assunzioni diverse: uno schema TKE-l (Mellor-Yamada,1982), che è usato nel modello di previsione BOLAM (Bologna Limited Area Model), e uno schema sviluppato recentemente da Mauritsen et al. (2007). Le assunzioni delle chiusure dei due schemi sono analizzate con dati sperimentali provenienti dalla torre di Cabauw in Olanda e dal sito CIBA in Spagna. Questi schemi di parametrizzazione della turbolenza sono quindi inseriti all'interno di un modello colonnare dello strato limite atmosferico, per testare le loro predizioni senza influenze esterne. Il confronto tra i differenti schemi è effettuato su un caso ben documentato in letteratura, il "GABLS1". Per confermare la validità delle predizioni, un dataset tridimensionale è creato simulando lo stesso caso GABLS1 con una Large Eddy Simulation. ARPS (Advanced Regional Prediction System) è stato usato per questo scopo. La stratificazione stabile vincola il passo di griglia, poichè la LES deve essere ad una risoluzione abbastanza elevata affinchè le tipiche scale verticali di moto siano correttamente risolte. Il confronto di questo dataset tridimensionale con le predizioni degli schemi turbolenti permettono di proporre un insieme di nuove chiusure atte a migliorare il modello di turbolenza di BOLAM. Il lavoro è stato compiuto all' ISAC-CNR di Bologna e al LEGI di Grenoble.

Turbulence models in the atmospheric boundary layer under convective conditions

In this work a modelization of the turbulence in the atmospheric boundary layer, under convective condition, is made. For this aim, the equations that describe the atmospheric motion are expressed through Reynolds averages and, then, they need closures. This work consists in modifying the TKE-l closure used in the BOLAM (Bologna Limited Area Model) forecast model. In particular, the single column model extracted from BOLAM is used, which is modified to obtain other three different closure schemes: a non-local term is added to the flux- gradient relations used to close the second order moments present in the evolution equation of the turbulent kinetic energy, so that the flux-gradient relations become more suitable for simulating an unstable boundary layer. Furthermore, a comparison among the results obtained from the single column model, the ones obtained from the three new schemes and the observations provided by the known case in literature ”GABLS2” is made.

Il trattamento ortodontico nei bambini con particolari necessità sanitarie (SHCN): una valutazione della durata e del risultato clinico utilizzando l'indice PAR (Peer Assessment Rating), la componente DHC (Dental Health Component) e la componente AC (Aesthetic Component) dell'indice IOTN (Orthodontic Treatment Need Index)

Obbiettivo: Valutazione delle eventuali differenze nel trattamento ortodontico di un gruppo di bambini con particolari necessità sanitarie (SHCN) rispetto ad un gruppo di bambini non diagnosticati con SHCN. Materiali e Metodi: Il gruppo campione (SHCN) è costituito da 50 bambini con SHCN. Il gruppo di controllo (NO SHCN) è costituito da 50 bambini non diagnosticati con SHCN pienamente corrispondenti per età, genere e tipo di apparecchio ortodontico utilizzato con i pazienti del gruppo di studio. I dati riguardanti i gruppi SHCN e NO SHCN sono stati analizzati in modo retrospettivo, valutando: - il punteggio pre- e post-trattamento e la riduzione finale dei valori dell'indice PAR (Peer Assessment Rating), della componente DHC (Dental Health Component) e della componente AC (Aesthetic Component) dell'indice IOTN (Orthodontic Treatment Need Index), - il numero di appuntamenti, - il numero di sedute semplici e complesse, - la durata complessiva del trattamento, - l'età all’inizio ed alla fine della terapia. Risultati: Non sono state rilevate differenze statisticamente significative tra i due gruppi per quanto concerne il numero di appuntamenti, la durata complessiva del trattamento, l'età all’inizio ed alla fine della terapia ortodontica (valori del p-value:0.682, 0.458, 0.535, 0.675). Sono state rilevate differenze statisticamente significative tra i due gruppi per quanto riguarda i punteggi dell’indice PAR, delle componenti DHC e AC dello IOTN pre- e post-trattamento, il numero di sedute semplici e complesse (valori del p-value:0.030, 0.000, 0.020, 0.023, 0.000, 0.000, 0.043, 0.037). Per quanto concerne la riduzione finale del valore dell’indice PAR, della componente DHC e di quella AC dello IOTN non sono state riscontrate differenze statisticamente significative tra i due gruppi (valori del p-value:0.060, 0.765, 0.825). Conclusioni: Lo studio incoraggia gli ortodontisti a trattare i bambini con SHCN nell'obiettivo di migliorarne la qualità di vita, pur evidenziando la necessità di un maggior numero di sedute complesse.

I fumetti e la glottodidattica: Proposte di insegnamento per l'italiano ls.

This study explores comics as an educational tool in teaching Italian as a foreign language, and shows that, in this perspective, the potential of this medium goes beyond the idea that pictures can help to understand words. Comics has to be understood as a unified text, where it is precisely the combination of pictures and words that promotes the development of the students' linguistic and communicative competences. The general educational potential of comics is analyzed in Chapter 1, with a focus on the notions of closure, cartooning and here and now, which are in harmony with the application of ludic teaching theories; an analysis then follows on the features of comics that can be exploited in the field of language teaching; finally a description is provided of the linguistic competences whose development can be favored by comics. Emphasis was placed only on those competences that are most affected by the context of use, i.e, lexical, textual, pragmatic and (inter-)cultural competences. In Chapter 2, three Italian comic books are analyzed with an eye to their use as teaching material in three ideally homogeneous classes, respectively belonging to the Common European Framework of Reference for Language A2, B2 and C2 levels. The cognitive processes carried out by students to achieve a global understanding of each book are postulated both for picture-to-picure and picture-to-word relations. After an overview of the main planning phases of a language-learning pathway, the educational approach adopted in Chapter 3 places the students at the core of the learning process, and emphasizes the need for a cooperative and interactional relationship between learners and teachers. In Chapter 4, three hypothetical learning pathways are described. Their main goal is to develop the linguistic and communicative competences of the students, who would then be able to understand and produce text not merely as learners, but rather as readers, hence users of an Italian cultural product.

Do we really need 24-h observation for patients with minimal brain injury and small intracranial bleeding? The Bernese Trauma Unit Protocol

Traumatic brain injury is one of the most common reasons for admission to hospital emergency departments. However, optimal diagnosis and treatment protocols remain controversial. The aim of this study is to assess whether a specific group of patients can be discharged from the hospital without 24-h neurological observation.