Fitness to drive and cannabis: Validation of two blood THCCOOH thresholds to distinguish occasional users from heavy smokers.

Many studies based on either an experimental or an epidemiological approach, have shown that the ability to drive is impaired when the driver is under the influence of cannabis. Baseline performances of heavy users remain impaired even after several weeks of abstinence. Symptoms of cannabis abuse and dependence are generally considered incompatible with safe driving. Recently, it has been shown that traffic safety can be increased by reporting the long-term unfit drivers to the driver licensing authorities and referring the cases for further medical assessment. Evaluation of the frequency of cannabis use is a prerequisite for a reliable medical assessment of the fitness to drive. In a previous paper we advocated the use of two thresholds based on 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH) concentration in whole blood to help to distinguish occasional cannabis users (≤3μg/L) from heavy regular smokers (≥40μg/L). These criteria were established on the basis of results obtained in a controlled cannabis smoking study with placebo, carried out with two groups of young male volunteers; the first group was characterized by a heavy use (≥10 joints/month) while the second group was made up of occasional users smoking at most 1 joint/week. However, to date, these cutoffs have not been adequately assessed under real conditions. Their validity can now be evaluated and confirmed with 146 traffic offenders' real cases in which the whole blood cannabinoid concentrations and the frequency of cannabis use are known. The two thresholds were not challenged by the presence of ethanol (40% of cases) and of other therapeutic and illegal drugs (24%). Thus, we propose the following procedure that can be very useful in the Swiss context but also in other countries with similar traffic policies: if the whole blood THCCOOH concentration is higher than 40μg/L, traffic offenders must be directed first and foremost toward medical assessment of their fitness to drive. This evaluation is not recommended if the THCCOOH concentration is lower than 3μg/L and if the self-rated frequency of cannabis use is less than 1 time/week. A THCCOOH level between these two thresholds cannot be reliably interpreted. In such a case, further medical assessment and follow-up of the fitness to drive are also suggested, but with lower priority.

Multi-agent contracting with countervailing incentives and limited liability

We consider a principal who deals with a privately informed agent protected by limited liability in a correlated information setting. The agent's technology is such that the fixed cost declines with the marginal cost (the type), so that countervailing incentives may arise. We show that, with high liability, the first-best outcome can be effected for any type if (1) the fixed cost is non-concave in type, under the contract that yields the smallest feasible loss to the agent; (2) the fixed cost is not very concave in type, under the contract that yields the maximum sustainable loss to the agent. We further show that, with low liability, the first-best outcome is still implemented for a non-degenerate range of types if the fixed cost is less concave in type than some given threshold, which tightens as the liability reduces. The optimal contract entails pooling otherwise.

COMUNICAEMAT: comunicant objectius matemàtics unint nombres, càlcul, algebra, espai, mesura anglès i tecnologia

S' ha realitzat una anàlisi de processos comunicatius i didàctics en un treball de matemàtiques a Primària en llengua anglesa, emmarcat dins un projecte escolar plurilingüe. El treball s' organitza en forma de recerca-acció que analitza dos objectius principals: (a) elaboració de propostes d' activitat matemàtica i de formació de professorat, i (b) anàlisi del treball realitzat en una experiència escolar. Els resultats mostren que: (1) Les dificultats generals observades, es centren més sobre el contingut de la llengua matemàtica (anomenat L4), pel damunt de les pròpies de l’ús de la llengua anglesa L3. (2) Les decisions del professorat privilegiant l’ús de L1 i L2 (català i castellà) per a treballar L4 s’han mostrat positives i adients. La proposta elaborada, que segueix el model CLIL (Content Language Integrated Learning) ha estat positiva i reproduïble (3) Ha estat possible constatar un bon treball amb els estudiants de formació inicial de mestres de llengua estrangera futurs docents dins l'assignatura de Matemàtiques i la seva Didàctica.a la Formació de professorat. Tanmateix es reconeixen dificultats degudes al poc coneixement previ dels estudiants en L3 i L4 i el fet de ser la primera experiència d’aquest tipus que realitzen. (4) L’alumnat de l’escola és capaç de tenir una bona conversa oral en anglès al final de Primària, que creix en qualitat fins dominar estructures causals pròpies del raonament deductiu. (5) L’alumnat guanya en confiança en l’ús de les quatre llengües ,(6) el professorat incorpora relativament elements didàctics nous en la seva acció pedagògica.

Factors associated with 24-hour urinary volume: the Swiss salt survey.

BACKGROUND: Low 24-hour urine volume (24 UV) may be a significant risk factor for decline in kidney function. We therefore aimed to study associated markers and possible determinants of 24 UV in a sample of the Swiss population. METHODS: The cross-sectional Swiss Salt Study included a population-based sample of 1535 (746 men and 789 women) individuals from three linguistic regions of Switzerland. Data from 1300 subjects were available for the present analysis. 24 UV was measured using 24-hour urine collection. Determinants of 24 UV were identified using multivariable linear regression models. RESULTS: In bivariate analysis, 24 UV was higher in women compared to men (2000 ml/24 h [interquartile range (IQR): 1354, 2562] versus 1780 ml/24 h [IQR: 1244, 2360], p = 0.002). In multivariable regression analyses, independent associated markers of 24 UV were female sex (β = 280, 95% confidence interval [CI]: 174, 386, p < 0.0001), fluid intake (β = 604, 95% CI: 539, 670, p < 0.0001), sodium excretion (β = 4.2, 95% CI: 3.4, 4.9, p < 0.0001) age (β = 6.6, CI: 3.4, 9.7, p < .0001), creatinine clearance (β = 2.4, CI: 0.2, 4.6, p = 0.04), living in the German-speaking part of Switzerland (β = 124, CI: 29, 219, p = 0.01), alcohol consumption (β = 41, CI: 9, 73, p = 0.01 for increasing categories of alcohol consumption), body mass index (β = -32, CI: -45, -18, p < 0.0001), current smoking (β = -146, CI: -265, -26, p = 0.02), and consumption of meat and cold cut (β = -56, CI: -108, -5, p = 0.03). CONCLUSION: In this large population-based, cross-sectional study, we found several strong and independent correlates for 24 UV. These findings may be important to improve our understanding in the development of chronic kidney disease.

Resultados de diversas alternativas a la castración quirúrgica de cerdos

El objetivo de este estudio fue evaluar el efecto de la castración quirúrgica (MC), la inmunocastración (MI), la producción de hembras (HE) y machos enteros (ME) sobre la productividad, el comportamiento y el bienestar animal. La castración quirúrgica se realizó a los siete días de edad y la inmunocastración mediante la administración a los 77 y 146 días de edad de un producto compuesto por una forma modifi cada del GnRF conjugado a una proteína capaz de inducir la formación de anticuerpos frente al GnRF. Durante el engorde, se evaluó el consumo individual, peso, espesor de grasa y lomo de 120 cerdos (36 ME, 36 MI, 24 MC y 24 hembras HE). Asimismo, se registró el comportamiento de los animales durante dos días consecutivos en las semanas 9, 11, 20, 21, 23 y 25. Los MI presentaron un crecimiento e ingestión diarias superior a los ME y un mejor índice de conversión que los MC. El espesor de lomo de los MI fue superior al de los MC, pero inferior al de los ME. La actividad se vio reducida en los MI en comparación con los ME, especialmente después de la segunda administración. Estos resultados sugieren que la inmunocastración es una alternativa a la castración quirúrgica. Result of differet alternatives to surgical castration of pigs The objective of this study was to evaluate the effect of surgical castration (MC), immunocastration (MI), keeping females (HE) and entire males (ME) on performance, behaviour and welfare. The surgical castration was carried out at 7 days of age, and the immunocastration through the administration at 77 and 146 days of age of a modifi ed form of GnRF conjugated to protein to induce the formation of antibodies against GnRF. Individual consumption, weight and fat and loin depth of 120 pigs (36 ME, 36 MI, 24MC and 24 HE) was measured. Moreover, behaviour was recorded during two consecutive days in weeks 9, 11, 20, 21, 23 and 25. MI presented a higher growth and feed intake compared to ME and a better conversion ratio than MC. Loin depth was higher for MI than for MC, but lower than for ME. Activity was reduced in MI compared to ME, especially after the second administration. These results suggest that immunocastration is an alternative to surgical castration.

An outbreak of human Leishmania (Viannia) braziliensis infection

The occurence of acute cutaneous leishmaniasis among inhabitants of 10 farms within 10 Km of the hamlet of Corte de Pedra, Bahia, Brazil was studied prospectively from 1984-l989. A mean population of 1,056 inhabitants living in 146 houses were visited every 6 months and the number of sKin ulcers recorded. A leishmanin skin test survey was done people with suggestive skin scars or active disease in l984. The incidence of skin ulcers due to Leishmania (Viannia) brasiliensis (Vlb) reached 83/1,000 inhabitants but declined sharply in the subsequent 2 years. Retrospective data shows that leishamiasis is a sporadic endemic disease. Although the reasons for this epidemic are unclear some possible aetiological factors are discussed.

De l'avantage du scanner par rapport à l'autopsie pour la détection des fractures de la face

La radiologie post-­‐mortem a suivi les développements de la radiologie conventionnelle depuis ses débuts. De nos jours, ce sont les dernières techniques de radiologie qui prennent de plus en plus de place en médecine légale, avec les nouveaux outils que sont le scanner et l'imagerie par résonance magnétique. Le centre universitaire romand de médecine légal (CURML) à Lausanne réalise ainsi de façon systématique un examen tomodensitométrique (TDM) complet de chaque corps avant l'autopsie depuis 2008. Cette étude cherche à éprouver l'utilité de la nouvelle méthode de l'imagerie tomodensitométrique dans la détection des fractures de la face par rapport à l'autopsie, méthode traditionnelle. Pour ce faire, les constatations des rapports d'autopsie ont été comparées à celles des rapports de radiologie tomodensitométrique si ces derniers existaient. Ces rapports d'autopsie ont d'abord été sélectionnés s'ils présentaient une forte suspicion de traumatisme facial. Les causes de décès non traumatiques pour la face ont d'abord été exclues (noyade, strangulation volontaire, intoxication, etc.). Les causes les plus traumatiques (accidents de la voie publique, arme à feu, hétéro-­‐agression, etc.) ont été retenues dans un premier temps. Par la suite, les dossiers n'ont pas été retenus si l'autopsie faisait état de lésions traumatiques ne concernant pas la face ou de lésions bénignes de la face. Les constatations des rapports d'autopsie ont finalement été comparées avec ces rapports de radiologie tomodensitométriques s'ils existaient, soit 69 dossiers. Dans un deuxième temps, une seconde lecture des images radiologiques a été effectuée par un radiologue formé. Sur les 146 fractures répertoriées parmi les 69 dossiers restant, 62 (42,4%) ont été décrites à l'autopsie et à la radiologie. 42 (28,8%) ont été décrites dans le rapport d'autopsie uniquement et 42 (28,8%) par la radiologie uniquement. Parmi toutes les fractures de la face détectées uniquement à l'autopsie, toutes sauf une seule ont été retrouvées sur les images d'archive par un radiologue formé. La contribution dans le processus diagnostique de chacune de ces fractures, notée sur une échelle de 1 à 6 par deux médecins-­‐légistes expérimentés, est légère (notes de 1 à 2 dans 98% des cas) concernant la cause du décès. En revanche, concernant les circonstances du décès, on observe une différence entre les deux examinateurs avec des notes de 5 à 6 dans 77% des cas chez l'un, et 19% chez l'autre examinateur. Les deux examinateurs ne sont pas d'accord au sujet de l'importance des fractures dans les cas de traumatismes à haute énergie, l'un jugeant qu'elles sont alors évidentes et l'autre qu'elles permettent d'en savoir plus sur la force exacte de l'impact considéré. Cependant, bien que les fractures de la face ne contribuent que modestement au processus judiciaire suivant un décès, notre étude permet de démontrer la performance de la méthode de l'imagerie tomodensitométrique dans la détection desdites fractures par rapport à l'autopsie avec un taux de détection supérieur.

A collaborative approach for incorporating forensic case data into crime investigation using criminal intelligence analysis and visualisation

There is an increasing awareness that the articulation of forensic science and criminal investigation is critical to the resolution of crimes. However, models and methods to support an effective collaboration between these partners are still poorly expressed or even lacking. Three propositions are borrowed from crime intelligence methods in order to bridge this gap: (a) the general intelligence process, (b) the analyses of investigative problems along principal perspectives: entities and their relationships, time and space, quantitative aspects and (c) visualisation methods as a mode of expression of a problem in these dimensions. Indeed, in a collaborative framework, different kinds of visualisations integrating forensic case data can play a central role for supporting decisions. Among them, link-charts are scrutinised for their abilities to structure and ease the analysis of a case by describing how relevant entities are connected. However, designing an informative chart that does not bias the reasoning process is not straightforward. Using visualisation as a catalyser for a collaborative approach integrating forensic data thus calls for better specifications.

La formación competencial del niño/a: Bases para una propuesta articulada entre familia y escuela

El present treball vol constatar un fet, que alhora ha resultat motor d'aquest. La realitat tal com se'ns planteja és la següent: sembla que no existeix un model organitzat i globalizador de competències, a manera de paradigma integrat, que relacioni els processos educatius que s'esdevenen en el si de la família i de l'escola. La definició d'aquesta problemàtica tan estretament relacionada amb la tasca docent ens ha conduït a plantejar una hipòtesi d'investigació, que pot formular-se d'aquesta manera. El nostre sistema educatiu preveu la implicació de la institució familiar en la formació competencial dels escolars?, i si és així, ens plantegem la segona qüestió: és possible elaborar un model de formació competencial que articuli els processos educatius que s'esdevenen en el si de la família i de l'escola de forma operativa i integrada? Per aconseguir respondre a aquestes qüestions s'inicia el treball amb l'estudi i posterior exposició dels següents punts: el marc legislatiu més recent, (des de la primera norma postconstitucional que va regular la participació dels pares a l'escola fins als nostres dies), les propostes formulades pels Consells Escolars Autonòmics i de l'Estat en les seves trobades anuals i les dades obtingudes de diversos informes realitzats pel INCE sobre la participació dels pares a l'escola. Tenint en compte que el nucli de la recerca gira al voltant de la relació família-escola a nivell competencial, s’exposa -més endavant- el marc legal i institucional, que actualment sembla favorable a la viabilitat d'un desenvolupament competencial comú entre família i escola . A continuació, es mostren unes taules amb indicadors que facilitaran l'estudi de la potencial relació entre les competències que es desenvolupen a l'escola i les que es donen en la família. Els aspectes relacionats amb la família els obtindrem de les aportacions trobades en obres i documents de pedagogs rellevants com Pestalozzi, Froebel, Montessori i Decroly. Al final del treball podem trobar -mitjançant l'assignació d'indicadors o descriptors- la relació que s'estableix entre les accions familiars i les competències escolars. Aquest treball permet postular que no només és possible articular una formació competencial del nen / a en la família i l'escola, sinó que les dues institucions educatives són articulables i sinèrgiques en aquest desenvolupament, optimitzant la formació competencial.

Rhumatologie. Polyarthrite rhumatoide et spondylarthrite ankylosante [Rheumatoid arthritis and ankylosing spondylitis: rheumatologic highlights 2007]

L'utilisation des traitements biologiques est maintenant solidement ancrée dans la prise en charge des rhumatismes inflammatoires. Les anti-TNFa sont à juste titre devenus des agents de choix ces dix dernières années, et la littérature récente nous rappelle leurs places et indications dans la spondylarthrite ankylosante. Toutefois, tous les patients n'y répondent pas et la disponibilité de nouveaux traitements est certainement une addition bienvenue. L'abatacept est un nouveau traitement de la polyarthrite rhumatoïde avec un mode d’action innovateur, qui paraît efficace et adéquatement sûr et pour lequel quelques données et aspects pratiques d'utilisation sont présentés. Nous devons néanmoins encore apprendre à l'intégrer dans des stratégies thérapeutiques, comme nous sommes en train de le faire avec le rituximab. The use of biological therapy is now firmly established in the management of inflammatory rheumatism. The anti-TNFalpha have rightly become agents of choice over the last 10 years, and the recent literature reminds us of their places and indications in ankylosing spondylitis. However, not all patients respond, and the availability of new treatments is certainly a welcome addition. Abatacept is a new treatment for rheumatoid arthritis with an innovative mode of action. It appears effective and safe, and some data as well as practical aspects on its use are presented. Nevertheless, we must still learn to integrate it into our therapeutic strategies, as we are presently doing with rituximab

Evolution of anaesthesia care and related events between 1996 and 2010 in a developed country

Background: Anaesthesia Databank Switzerland (ADS) is a voluntary data registry introduced in 1996. The goal was to promote quality in anaesthesiology. Methods: Analysis of routinely recorded adverse events. Internal and external benchmark comparisons between anaesthesia departments. Results: In 2010, the database included 2'158'735 anaesthetic procedures. Forty-four anaesthesia departments were participating to the data collection in 2010. Over time, the number of patients in older age groups increased, the largest group being patients aged 50 to 64 years. Over time, the percentage of patients with ASA physical status score 1 decreased while the number of ASA 2 or 3 patients increased. The most frequent co-morbidities were hypertension (21%), smoking (16%), allergy (15%), and obesity (12%). Between 1996 and 2010, 146'459 adverse events were recorded, of which 34% were cardiovascular, 7% respiratory, 39% specific to anaesthesia and 17% nonspecific. The overall proportion of adverse events decreased over time, whatever their severity. Conclusion: The ADS routine data collection contributes to monitoring the trends of anaesthesia care in Switzerland.