Sexual activity-related emergency department admissions: eleven years of experience at a Swiss university hospital

PRINCIPALS: Most people enjoy sexual intercourse without complications, but a significant, if small, number need to seek emergency medical help for related health problems. The true incidence of these problems is not known. We therefore assessed all admissions to our emergency department (ED) in direct relation to sexual intercourse. METHODS: All data were collected prospectively and entered into the ED's centralised electronic patient record database (Qualicare, Switzerland) and retrospectively analysed. The database was scanned for the standardised key words: 'sexual intercourse' (German 'Geschlechtsverkehr') or 'coitus' (German 'Koitus'). RESULTS: A total of 445 patients were available for further evaluation; 308 (69.0%) were male, 137 (31.0%) were female. The median age was 32 years (range 16-71) for male subjects and 30 years (range 16-70) for female subjects. Two men had cardiovascular emergencies. 46 (10.3%) of our patients suffered from trauma. Neurological emergencies occurred in 55 (12.4%) patients: the most frequent were headaches in 27 (49.0%), followed by subarachnoid haemorrhage (12, 22.0%) and transient global amnesia (11, 20.0%). 154 (97.0%) of the patients presenting with presumed infection actually had infections of the urogenital tract. The most common infection was urethritis (64, 41.0%), followed by cystitis (21, 13.0%) and epididymitis (19, 12.0%). A sexually transmitted disease (STD) was diagnosed in 43 (16.0%) of all patients presenting with a presumed infection. 118 (43.0%) of the patients with a possible infection requested testing for an STD because of unsafe sexual activity without underlying symptoms. CONCLUSIONS: Sexual activity is mechanically dangerous, potentially infectious and stressful for the cardiovascular system. Because information on ED presentation related to sexual intercourse is scarce, more efforts should be undertaken to document all such complications to improve treatment and preventative strategies.

Hoisting C Structures Into Clay In Device Drivers

This project addresses the unreliability of operating system code, in particular in device drivers. Device driver software is the interface between the operating system and the device's hardware. Device drivers are written in low level code, making them difficult to understand. Almost all device drivers are written in the programming language C which allows for direct manipulation of memory. Due to the complexity of manual movement of data, most mistakes in operating systems occur in device driver code. The programming language Clay can be used to check device driver code at compile-time. Clay does most of its error checking statically to minimize the overhead of run-time checks in order to stay competitive with C's performance time. The Clay compiler can detect a lot more types of errors than the C compiler like buffer overflows, kernel stack overflows, NULL pointer uses, freed memory uses, and aliasing errors. Clay code that successfully compiles is guaranteed to run without failing on errors that Clay can detect. Even though C is unsafe, currently most device drivers are written in it. Not only are device drivers the part of the operating system most likely to fail, they also are the largest part of the operating system. As rewriting every existing device driver in Clay by hand would be impractical, this thesis is part of a project to automate translation of existing drivers from C to Clay. Although C and Clay both allow low level manipulation of data and fill the same niche for developing low level code, they have different syntax, type systems, and paradigms. This paper explores how C can be translated into Clay. It identifies what part of C device drivers cannot be translated into Clay and what information drivers in Clay will require that C cannot provide. It also explains how these translations will occur by explaining how each C structure is represented in the compiler and how these structures are changed to represent a Clay structure.

Language, Thought, Relativism, Nationalism: An Interdisciplinary Study

Ms. Neumer and her team began their project with a critical analysis of the various theories of the relationship between language and thought. Their aim was to develop a theoretical position concerning the issue of universalism versus relativism. This issue is closely bound up with one of the main questions of the history of East and Central Europe, namely, the question of the nation, and the possibility of mutual understanding between national cultures. The team attempted to avoid falling into an all-too-common trap, that of allowing a political perspective to obscure the central theoretical issues. In a project whose outcome totalled over 1000 pages of manuscript in German, English and Hungarian, they touched on cognitive psychological, linguistic, semiotic, socio-semiotic, and other such themes. Their experience has convinced them of the fruitful heuristic possibilities of the interaction of scientific and philosophical approaches in this area of research. A preliminary analysis of the history of philosophy and inquiries into conceptual fields revealed that, in order to reach strong relativist conclusions concerning the unity of thought and language, it is required to take as a point of departure the widest possible sense of these concepts. But in fact, such an option ends up refuting itself: pursuing the premises to their final conclusion one arrives at the restriction of relativism. The team outlined a theory of the understanding of the Other which, borrowing from analytical as well as continental-hermeneutic trends, does not underestimate, on the one hand, the difficulties of understanding between various forms of life, cultures, and languages, but, on the other hand, can provide an alternative solution to the theory of incommensurabiltiy. Within the boundary of this problematic the team studied the problems of translatability, the acquisition of the mother and foreign languages, and natural or cultural determinacy of kind terms. The team regards its most original contribution to be the association of the problem of relativism-universalism and the language-thought relation with contemporary investigations into the question of orality, literacy, and secondary orality. Their conclusion was that, although certain connections can be revealed both between forms of communication and the thesis of the unity of language and thought, and between periods in the history of communication and the predominance of relativistic or universalistic tendencies, forms of communication do not unequivocally determine the answers to these questions.

Towards dynamics in flood risk assessment

As a consequence of flood impacts, communities inhabiting mountain areas are increasingly affected by considerable damage to infrastructure and property. The design of effective flood risk mitigation strategies and their subsequent implementation is crucial for a sustainable development in mountain areas. The assessment of the dynamic evolution of flood risk is the pillar of any subsequent planning process that is targeted at a reduction of the expected adverse consequences of the hazard impact. Given these premises, firstly, a comprehensive method to derive flood hazard process scenarios for well-defined areas at risk is presented. Secondly, conceptualisations of a static and dynamic flood risk assessment are provided. These are based on formal schemes to compute the risk mitigation performance of devised mitigation strategies within the framework of economic cost-benefit analysis. In this context, techniques suitable to quantify the expected losses induced by the identified flood impacts are provided.

Perioperative anaesthetic management of mediastinal mass in adults

Mediastinal mass syndrome remains an anaesthetic challenge that cannot be underestimated. Depending on the localization and the size of the mediastinal tumour, the clinical presentation is variable ranging from a complete lack of symptoms to severe cardiorespiratory problems. The administration of general anaesthesia can be associated with acute intraoperative or postoperative cardiorespiratory decompensation that may result in death due to tumour-related compression syndromes. The role of the anaesthesiologist, as a part of the interdisciplinary treatment team, is to ensure a safe perioperative period. However, there is still no structured protocol available for perioperative anaesthesiological procedure. The aim of this article is to summarize the genesis of and the diagnostic options for mediastinal mass syndrome and to provide a solid detailed methodology for its safe perioperative management based on a review of the latest literature and our own clinical experiences. Proper anaesthetic management of patients with mediastinal mass syndrome begins with an assessment of the preoperative status, directed foremost at establishing the localization of the tumour and on the basis of the clinical and radiological findings, discerning whether any vital mediastinal structures are affected. We have found it helpful to assign 'severity grade' (using a three-grade clinical classification scale: 'safe', 'uncertain', 'unsafe'), whereby each stage triggers appropriate action in terms of staffing and apparatus, such as the provision of alternatives for airway management, cardiopulmonary bypass and additional specialists. During the preoperative period, we are guided by a 12-point plan that also takes into account the special features of transportation into the operating theatre and patient monitoring. Tumour compression on the airways or the great vessels may create a critical respiratory and/or haemodynamic situation, and therefore the standard of intraoperative management includes induction of anaesthesia in the operating theatre on an adjustable surgical table, the use of short-acting anaesthetics, avoidance of muscle relaxants and maintenance of spontaneous respiration. In the case of severe clinical symptoms and large mediastinal tumours, we consider it absolutely essential to cannulate the femoral vessels preoperatively under local anaesthesia and to provide for the availability of cardiopulmonary bypass in the operating theatre, should extracorporeal circulation become necessary. The benefits of establishing vascular access under local anaesthesia clearly outweigh any associated degree of patient discomfort. In the case of patients classified as 'safe' or 'uncertain', a preoperative consensus with the surgeons should be reached as to the anaesthetic approach and the management of possible complications.

Investment Valuation with Tax-optimized Financing Decisions and a Tax-optimized Default Alternative

In this paper we evaluate an indivisible investment project that is carried out in a corporation under very simple premises. In particular, we discuss a one-period model with certainty, the pure domestic case and proportional tax rates. Surprisingly, the decision problem turns out to be rather complex if one has to make allowance for different taxation of the corporation and its owner. Altogether there are more than 10 cases that have to be distinguished if the firm's managers want to make a correct decision, depending on the relation of personal and corporate tax rates.

How Insecurity impacts on school attendance and school drop out among urban slum children in Nairobi

This paper discusses how perceptions of personal security can impact on school enrolment and attendance. It mainly focuses on threats to physical harm, crime, community and domestic violence. These security fears can include insecurity that children suffer from as they go to school, maybe through the use of unsafe routes; insecurity that children feel at school; and the insecurity they suffer from in their homes. Although poverty is an indicator of insecurity, this paper does not focus solely on poverty as it is well covered elsewhere in the literature. The paper relies on qualitative data collected in Korogocho and Viwandani slum areas in Nairobi, Kenya between October and November 2004. The paper analyses data from individual interviews and focus group interviews and focuses on the narrative of slum dwellers on how insecurity impacts on educational attainment. The conclusion in this paper is that insecure neighbourhoods may have a negative impact on schooling. As a result policies that address insecurity in slum neighbourhoods can also improve school attendance and performance.

Neighborhood Disadvantage and Birth Weight: The Role of Perceived Danger and Substance Abuse

In this analysis we connect structural neighborhood conditions to birth outcomes through their intermediate effects on mothers’ perceptions of neighborhood danger and their tendency to abuse substances during pregnancy. We hypothesize that neighborhood poverty and racial/ethnic concentration combine to produce environments that mothers perceive as unsafe, thereby increasing the likelihood of negative coping behaviors (substance abuse). We expect these behaviors, in turn, to produce lower birth weights. Using data from the Fragile Families and Child Wellbeing Study, a survey of a cohort mothers and children born between 1998 and 2000 in large cities in the United States, we find little evidence to suggest that neighborhood circumstances have strong, direct effects on birth weight. Living in a neighborhood with more foreigners had a positive effect on birth weight. To the extent that neighborhood conditions influence birth weight, the effect mainly occurs through an association with perceived neighborhood danger and subsequent negative coping behaviors. Poverty and racial/ethnic concentration increase a mother’s sense that her neighborhood is unsafe. The perception of an unsafe neighborhood, in turn, associates with a greater likelihood of smoking cigarettes and using illegal drugs, and these behaviors have strong and significant effects in reducing birth weight. However, demographic characteristics, rather than perceived danger or substance abuse, mediate the influence of neighborhood characteristics on birth weight.

Effects of an educational patient safety campaign on patients' safety behaviours and adverse events

Rationale, aims and objectives  The study aims to investigate the effects of a patient safety advisory on patients' risk perceptions, perceived behavioural control, performance of safety behaviours and experience of adverse incidents. Method  Quasi-experimental intervention study with non-equivalent group comparison was used. Patients admitted to the surgical department of a Swiss large non-university hospital were included. Patients in the intervention group received a safety advisory at their first clinical encounter. Outcomes were assessed using a questionnaire at discharge. Odds ratios for control versus intervention group were calculated. Regression analysis was used to model the effects of the intervention and safety behaviours on the experience of safety incidents. Results  Two hundred eighteen patients in the control and 202 in the intervention group completed the survey (75 and 77% response rates, respectively). Patients in the intervention group were less likely to feel poorly informed about medical errors (OR = 0.55, P = 0.043). There were 73.1% in the intervention and 84.3% in the control group who underestimated the risk for infection (OR = 0.51, CI 0.31-0.84, P = 0.009). Perceived behavioural control was lower in the control group (meanCon  = 3.2, meanInt  = 3.5, P = 0.010). Performance of safety-related behaviours was unaffected by the intervention. Patients in the intervention group were less likely to experience any safety-related incident or unsafe situation (OR for intervention group = 0.57, CI 0.38-0.87, P = 0.009). There were no differences in concerns for errors during hospitalization. There were 96% of patients (intervention) who would recommend other patients to read the advisory. Conclusions  The results suggest that the safety advisory decreases experiences of adverse events and unsafe situations. It renders awareness and perceived behavioural control without increasing concerns for safety and can thus serve as a useful instrument for communication about safety between health care workers and patients.

Admissibility in Finitely Generated Quasivarieties

Checking the admissibility of quasiequations in a finitely generated (i.e., generated by a finite set of finite algebras) quasivariety Q amounts to checking validity in a suitable finite free algebra of the quasivariety, and is therefore decidable. However, since free algebras may be large even for small sets of small algebras and very few generators, this naive method for checking admissibility in Q is not computationally feasible. In this paper, algorithms are introduced that generate a minimal (with respect to a multiset well-ordering on their cardinalities) finite set of algebras such that the validity of a quasiequation in this set corresponds to admissibility of the quasiequation in Q. In particular, structural completeness (validity and admissibility coincide) and almost structural completeness (validity and admissibility coincide for quasiequations with unifiable premises) can be checked. The algorithms are illustrated with a selection of well-known finitely generated quasivarieties, and adapted to handle also admissibility of rules in finite-valued logics.

Evaluation of control and surveillance strategies for classical swine fever using a simulation model

Classical swine fever (CSF) outbreaks can cause enormous losses in naïve pig populations. How to best minimize the economic damage and number of culled animals caused by CSF is therefore an important research area. The baseline CSF control strategy in the European Union and Switzerland consists of culling all animals in infected herds, movement restrictions for animals, material and people within a given distance to the infected herd and epidemiological tracing of transmission contacts. Additional disease control measures such as pre-emptive culling or vaccination have been recommended based on the results from several simulation models; however, these models were parameterized for areas with high animal densities. The objective of this study was to explore whether pre-emptive culling and emergency vaccination should also be recommended in low- to moderate-density areas such as Switzerland. Additionally, we studied the influence of initial outbreak conditions on outbreak severity to improve the efficiency of disease prevention and surveillance. A spatial, stochastic, individual-animal-based simulation model using all registered Swiss pig premises in 2009 (n=9770) was implemented to quantify these relationships. The model simulates within-herd and between-herd transmission (direct and indirect contacts and local area spread). By varying the four parameters (a) control measures, (b) index herd type (breeding, fattening, weaning or mixed herd), (c) detection delay for secondary cases during an outbreak and (d) contact tracing probability, 112 distinct scenarios were simulated. To assess the impact of scenarios on outbreak severity, daily transmission rates were compared between scenarios. Compared with the baseline strategy (stamping out and movement restrictions) vaccination and pre-emptive culling neither reduced outbreak size nor duration. Outbreaks starting in a herd with weaning piglets or fattening pigs caused higher losses regarding to the number of culled premises and were longer lasting than those starting in the two other index herd types. Similarly, larger transmission rates were estimated for these index herd type outbreaks. A longer detection delay resulted in more culled premises and longer duration and better transmission tracing increased the number of short outbreaks. Based on the simulation results, baseline control strategies seem sufficient to control CSF in low-medium animal-dense areas. Early detection of outbreaks is crucial and risk-based surveillance should be focused on weaning piglet and fattening pig premises.

Evaluation of the benefit of emergency vaccination in a foot-and-mouth disease free country with low livestock density

Foot-and-mouth disease (FMD) is highly contagious and one of the most economically devastating diseases of cloven-hoofed animals. Scientific-based preparedness about how to best control the disease in a previously FMD-free country is therefore essential for veterinary services. The present study used a spatial, stochastic epidemic simulation model to compare the effectiveness of emergency vaccination with conventional (non-vaccination) control measures in Switzerland, a low-livestock density country. Model results revealed that emergency vaccination with a radius of 3 km or 10 km around infected premises (IP) did not significantly reduce either the cumulative herd incidence or epidemic duration if started in a small epidemic situation where the number of IPs is still low. However, in a situation where the epidemic has become extensive, both the cumulative herd incidence and epidemic duration are reduced significantly if vaccination were implemented with a radius of 10 km around IPs. The effect of different levels of conventional strategy measures was also explored for the non-vaccination strategy. It was found that a lower compliance level of farmers for movement restrictions and delayed culling of IPs significantly increased both the cumulative IP incidence and epidemic duration. Contingency management should therefore focus mainly on improving conventional strategies, by increasing disease awareness and communication with stakeholders and preparedness of culling teams in countries with a livestock structure similar to Switzerland; however, emergency vaccination should be considered if there are reasons to believe that the epidemic may become extensive, such as when disease detection has been delayed and many IPs are discovered at the beginning of the epidemic.

Tracks of immigrant political incorporation

Models of Immigrant Political Incorporation brings together a multidisciplinary group of scholars to consider pathways by which immigrants may be incorporated into the political processes of western democracies. It builds on a rich tradition of studying immigrant incorporation, but each chapter innovates by moving beyond singular accounts of particular groups and locations toward a general causal model with the scope and breadth to apply across groups, places, and time. Models of Immigrant Political Incorporation addresses three key analytic questions: what, if anything, are the distinctive features of immigrants or immigrant groups? How broadly should one define and study politics? What are the initial premises for analyzing pathways toward incorporation; does one learn more by starting from an assumption of racialization and exclusion or from an assumption of engagement and inclusion? While all models engage with all three key analytic questions, chapters vary in their relative focus on one or another, and in the answers they provide. Most include graphical illustrations of the model, as well as extended examples applying the model to one or more immigrant populations. At a time when research on immigrant political incorporation is rapidly accumulating - and when immigrants are increasingly significant political actors in many democratic polities — this volume makes a timely and valuable intervention by pushing researchers to articulate causal dynamics, provide clear definitions and measurable concepts, and develop testable hypotheses. Furthermore, the wide array of frameworks examining how immigrants become part of a polity or are shunted aside ensure that activists and analysts alike will find useful insights. By including historians, sociologists, and political scientists, by ranging across North America and Western Europe, by addressing successful and failed incorporative efforts, this handbook offers guides for anyone seeking to develop a dynamic, unified, and supple model of immigrant political incorporation.

An examination of the Gonorrhea Cases & Places Study: An analysis of the Theory of Gender and Power, Situational/Environmental Variables Theory, and Sexual Script Theory as it relates to risky sexual behavior in African American adults

Objective. The purpose of the study is to provide a holistic depiction of behavioral & environmental factors contributing to risky sexual behaviors among predominantly high school educated, low-income African Americans residing in urban areas of Houston, TX utilizing the Theory of Gender and Power, Situational/Environmental Variables Theory, and Sexual Script Theory. Methods. A cross-sectional study was conducted via questionnaires among 215 Houston area residents, 149 were women and 66 were male. Measures used to assess behaviors of the population included a history of homelessness, use of crack/cocaine among several other illicit drugs, the type of sexual partner, age of participant, age of most recent sex partner, whether or not participants sought health care in the last 12 months, knowledge of partner's other sexual activities, symptoms of depression, and places where partner's were met. In an effort to determine risk of sexual encounters, a risk index employing the variables used to assess condom use was created categorizing sexual encounters as unsafe or safe. Results. Variables meeting the significance level of p<.15 for the bivariate analysis of each theory were entered into a binary logistic regression analysis. The block for each theory was significant, suggesting that the grouping assignments of each variable by theory were significantly associated with unsafe sexual behaviors. Within the regression analysis, variables such as sex for drugs/money, low income, and crack use demonstrated an effect size of ≥ ± 1, indicating that these variables had a significant effect on unsafe sexual behavioral practices. Conclusions. Variables assessing behavior and environment demonstrated a significant effect when categorized by relation to designated theories.

A novel computer test to assess driving-relevant cognitive functions - a pilot study

BACKGROUND: The assessment of driving-relevant cognitive functions in older drivers is a difficult challenge as there is no clear-cut dividing line between normal cognition and impaired cognition and not all cognitive functions are equally important for driving. METHODS: To support decision makers, the Bern Cognitive Screening Test (BCST) for older drivers was designed. It is a computer-assisted test battery assessing visuo-spatial attention, executive functions, eye-hand coordination, distance judgment, and speed regulation. Here we compare the performance in BCST with the performance in paper and pencil cognitive screening tests and the performance in the driving simulator testing of 41 safe drivers (without crash history) and 14 unsafe drivers (with crash history). RESULTS: Safe drivers performed better than unsafe drivers in BCST (Mann-Whitney U test: U = 125.5; p = 0.001) and in the driving simulator (Student's t-test: t(44) = -2.64, p = 0.006). No clear group differences were found in paper and pencil screening tests (p > 0.05; ns). BCST was best at identifying older unsafe drivers (sensitivity 86%; specificity 61%) and was also better tolerated than the driving simulator test with fewer dropouts. CONCLUSIONS: BCST is more accurate than paper and pencil screening tests, and better tolerated than driving simulator testing when assessing driving-relevant cognition in older drivers.