Chronic low-frequency rTMS of primary motor cortex diminishes exercise training-induced gains in maximal voluntary force in humans.

Although there is consensus that the central nervous system mediates the increases in maximal voluntary force (maximal voluntary contraction, MVC) produced by resistance exercise, the involvement of the primary motor cortex (M1) in these processes remains controversial. We hypothesized that 1-Hz repetitive transcranial magnetic stimulation (rTMS) of M1 during resistance training would diminish strength gains. Forty subjects were divided equally into five groups. Subjects voluntarily (Vol) abducted the first dorsal interosseus (FDI) (5 bouts x 10 repetitions, 10 sessions, 4 wk) at 70-80% MVC. Another group also exercised but in the 1-min-long interbout rest intervals they received rTMS [Vol+rTMS, 1 Hz, FDI motor area, 300 pulses/session, 120% of the resting motor threshold (rMT)]. The third group also exercised and received sham rTMS (Vol+Sham). The fourth group received only rTMS (rTMS_only). The 37.5% and 33.3% gains in MVC in Vol and Vol+Sham groups, respectively, were greater (P = 0.001) than the 18.9% gain in Vol+rTMS, 1.9% in rTMS_only, and 2.6% in unexercised control subjects who received no stimulation. Acutely, within sessions 5 and 10, single-pulse TMS revealed that motor-evoked potential size and recruitment curve slopes were reduced in Vol+rTMS and rTMS_only groups and accumulated to chronic reductions by session 10. There were no changes in rMT, maximum compound action potential amplitude (M(max)), and peripherally evoked twitch forces in the trained FDI and the untrained abductor digiti minimi. Although contributions from spinal sources cannot be excluded, the data suggest that M1 may play a role in mediating neural adaptations to strength training.

ABS: a database of Annotated regulatory Binding Sites from orthologous promoters

Information about the genomic coordinates and the sequence of experimentally identified transcription factor binding sites is found scattered under a variety of diverse formats. The availability of standard collections of such high-quality data is important to design, evaluate and improve novel computational approaches to identify binding motifs on promoter sequences from related genes. ABS (http://genome.imim.es/datasets/abs2005/index.html) is a public database of known binding sites identified in promoters of orthologous vertebrate genes that have been manually curated from bibliography. We have annotated 650 experimental binding sites from 68 transcription factors and 100 orthologous target genes in human, mouse, rat or chicken genome sequences. Computational predictions and promoter alignment information are also provided for each entry. A simple and easy-to-use web interface facilitates data retrieval allowing different views of the information. In addition, the release 1.0 of ABS includes a customizable generator of artificial datasets based on the known sites contained in the collection and an evaluation tool to aid during the training and the assessment of motif-finding programs.

Interhospital aeromedical transfers: need for a specific training

Introduction: The interhospital aeromedical transfers concern mainly unstable patients presenting with multiple organ failure and among whom the intensity, as well as the difficulty of care are often underestimated. Material and method: Retrospective analysis of 2094 interhospital transfers made by the Rega helicopter of Lausanne between 2003 and 2008, with description of the pathologies, the demographic characteristics, as well as the medical and technical difficulties. Results: Male patient are overrepresented (65 vs 35%), their age being 40-80 years old. On the other hand, we note an important number (10%) of patients less than 10 years. The average time of flight is 13 minutes, with a high rate of night transfers (34%). In 73% of the cases, the transfers concern medical, especially cardiovascular and neurological situations. Trauma and surgical situations account for less than 20%. The transferred patients often require mechanical ventilation (27%), as well as invasive measure of blood pressure (11%), particularly in cases of neurological, pulmonary or cardiac diseases. In 6% of the cases, we note a haemodynamic instability, requiring the use of catecholamines. In 1% a cardiopulmonary resuscitation was initiated during the flight. The overall mortality at 48 hours is about 5%. Conclusions: In spite of relatively brief flights, the complexity and the variety of the pathologies require a specific training for the medical teams involved in the transfers, concerning the aspects of resuscitation, mechanical ventilation, and the knowledge of advanced life support in paediatrics, traumatology and cardiopulmonary intensive care.

Gènere i sexoafectivitat segons els adolescents dels usuaris dels centres oberts de la ciutat de Girona

L’objectiu d’aquest treball és conèixer la percepció que tenen els adolescents usuaris dels centres oberts de la ciutat de Girona sobre la sexualitat, l’afectivitat, quins rols de gènere se’n deriven i quines creences els sustenten. El disseny del treball ha estat qualitatiu, observacional, grups de discussió. Pel que fa als subjectes i al mètode, la població seleccionada ha estat de 33 adolescents i joves d’edats compreses entre els 12 i els 22 anys, usuaris de quatre centres oberts de Girona: el centre obert de Taialà, el Centre Obert de Font de la Pólvora (Onyar), el Centre Obert de Santa Eugènia i el Centre Obert del Barri Vell. Es van dur a terme grups de discussió d’una hora de duració sense descans amb d’entre 6 i 8 persones a partir d’un guió format per diversos mites i frases en relació a diversos temes (El festeig, la virginitat, la curiositat pel cos i per la sexualitat, els anticonceptius i les principals fonts d’informació) sobre les que havien de dir si estaven d’acord o no i qui creien que les deia (si un noi o una noia). Sobre els resultats del treball cal dir que s’ha observat la persistència d’algunes creences del model del amor romàntic en relació al rols de gènere com la definició de la dona vinculada a papers de cura i prevenció, una dona que té accés a la sexualitat però segueix estan catalogada per la vivència d’aquesta essent una persona “respectable” o una “puta”, que pren un rol més actiu en la iniciativa però no el l’assertivitat en les relacions; i un home, més impulsiu i sexual. En relació als comportaments sexuals destacar l’embaràs no desitjat com la principal preocupació de les relacions i el desconeixement/confusió entre els mètodes anticonceptius i de barrera disponibles a la xarxa de salut. Apareix la pornografia com a model emergent de relacions sexuals i models de relació entre homes i dones, en contraposició a altres fonts de informació i consulta tradicionals com els amics que segueixen essent la més significativa, la família, els serveis socials i educatius, i Internet. Com a conclusió cal dir que queda palesa la necessitat de incorporar una perspectiva de gènere en la formació curricular dels joves i el fet de seguir replantejant les millors estratègies d’intervenció per una concepció integradora de la sexualitat

Evaluation of the inhalation technique in asthmatic children visiting a specialised outpatient clinic

Background and objective: Asthma is one of the most frequent chronic diseases affecting children and adolescents. Good compliance is indispensable for effective treatment since a suboptimal use of inhalation devices can result in decreased therapeutic efficacy and increased morbidity. The objective of this work was to evaluate the inhalation technique of paediatric patients visiting a specialized consultation clinic of a university hospital. Design: Observational prospective study during a 3-month period. Setting Specialized consultation clinic of a university hospital. Main outcome measures: This study involved 40 outpatient infants, children and adolescents visiting alone or with their parent(s). Patients' data (age, sex, weight, diagnostic, reason for consulting, previous consultations) and their medicines were compiled using an ad hoc form. Filmed sequences of the inhalation procedure used by each child were reviewed independently by members of an interdisciplinary team consisting in a physician, a pharmacist, a nurse and a physiotherapist. A score of 1 was assigned to each correct step in the procedure, and a score of 0 to an incorrect step. A perfect procedure implied 12 correct steps. Results: Thirty patients were treated with a metered-dose inhaler and an inhalation chamber (Babyhaler or AeroChamber Plus); ten other patients were treated with a dry powder inhaler (Diskus or Turbuhaler). The agreement between the members of the interdisciplinary team was considered satisfactory. Nine patients (22.5%) reached an average score lower than 7, 18 patients (45%) a score between 7 and 10 and 13 (32.5%) a score equal to or better than 10. No patient reached the maximum score of 12. Users of the metered-dose inhalers (average score = 9.2) showed a better technique than users of the dry powder inhalers (average score = 7.4). Disappointingly, the score was not improved during a second consultation or following regular consultations. Conclusions: Video recording is a simple method to evaluate the degree of mastery of an inhalation procedure in paediatric patients. The method allows a convenient and efficient identification of suboptimal procedure steps by the hospital staff, and opens the way to patient-specific teaching. In two-thirds of juvenile patients, their inhalation technique was suboptimal despite initial training. This study shows conclusively that the inhalation technique in paediatric patients must be monitored during each examination, and teaching measures taken to improve it when necessary.

Mesura de la força i de la potència en l'esport. Aplicació del chronojump boscosystem

El propòsit del Treball de Fi de Grau és dissenyar un document que serveixi als usuaris del Chronojump Boscosystem per aprendre a utilitzar-lo i treure’n el màxim rendiment. Previ a l’elaboració d’aquest, s’ha requerit un treball de documentació teòrica, fet a través de la revisió bibliogràfica i entrevistes a experts en preparació física dintre del món de l’entrenament esportiu, procés que ha servit per a establir les bases i els fonaments del dossier didàctic. Aquest últim està compost per deu pràctiques on, en cadascuna d’elles, es treballen aspectes concrets del programa Chronojump. Cada una d’aquestes consta d’una primera part més teòrica on es defineixen els aspectes a tractar, seguit de la seqüència de passos a fer per a portar a terme la pràctica i, finalment, deu preguntes tipus test per a saber si s’ha comprès la informació donada i el funcionament del programa. En les pràctiques on s’ha de passar algun test, s’afegeix també un suport audiovisual per tal de deixar clar l’execució i la tècnica correcta de la prova en qüestió.

Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series.

OBJECTIVES: The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland. METHODS: A retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability. RESULTS: Highly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4). CONCLUSION: Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.

Open source software in translator training

La formació de traductors implica l´ús de procediments i eines que permetin els estudiants familiaritzar-se amb contextos professionals. El software lliure especialitzat inclou eines de qualitat professional i procediments accessibles per a les institucions acadèmiques i els estudiants a distància que treballen a casa seva. Els projectes reals que utilitzen software lliure i traducció col·laborativa (crowdsourcing) constitueixen recursos indispensables en la formació de traductors.

Training Aids to Reduce Potential County Liability, HR-289, Draft, 1987

Iowans who travel secondary roads regard these roads as a very important part of their lives. These highways provide a means of transporting products to market and children to school. They are also links to nearby cities and towns. Nearly 3.8 billion vehicle miles of travel occur each year on Iowa's nearly 90,000 mile secondary road system. Accidents do happen. However, improvements in highways, in vehicles, in driver education, in legislation, and in enforcement have combined to make driving in Iowa very safe. If our highways are to remain safe, these efforts need to be continued. This presentation was developed to help county highway department personnel in their effort to maintain and improve highway safety. The presentation is not a standard, specification or regulation.

Maximal lipid oxidation during exercise: a target for individualizing endurance training in obesity and diabetes?

This review summarizes the rationale for personalized exercise training in obesity and diabetes, targeted at the level of maximal lipid oxidation as can be determined by exercise calorimetry. This measurement is reproducible and reflects muscles' ability to oxidize lipids. Targeted training at this level is well tolerated, increases the ability to oxidize lipids during exercise and improves body composition, lipid and inflammatory status, and glycated hemoglobin, thus representing a possible future strategy for exercise prescription in patients suffering from obesity and diabetes.

Typing less common ovarian tumors: A training tool based on a pattern-based algorithm applied to a set of 20 virtual slides.

Context: Ovarian tumors (OT) typing is a competency expected from pathologists, with significant clinical implications. OT however come in numerous different types, some rather rare, with the consequence of few opportunities for practice in some departments. Aim: Our aim was to design a tool for pathologists to train in less common OT typing. Method and Results: Representative slides of 20 less common OT were scanned (Nano Zoomer Digital Hamamatsu®) and the diagnostic algorithm proposed by Young and Scully applied to each case (Young RH and Scully RE, Seminars in Diagnostic Pathology 2001, 18: 161-235) to include: recognition of morphological pattern(s); shortlisting of differential diagnosis; proposition of relevant immunohistochemical markers. The next steps of this project will be: evaluation of the tool in several post-graduate training centers in Europe and Québec; improvement of its design based on evaluation results; diffusion to a larger public. Discussion: In clinical medicine, solving many cases is recognized as of utmost importance for a novice to become an expert. This project relies on the virtual slides technology to provide pathologists with a learning tool aimed at increasing their skills in OT typing. After due evaluation, this model might be extended to other uncommon tumors.

Pulse oximetry for hypoxemia: a warning to users and manufacturers.

Pulse oximetry represents a major advance in patient monitoring, but measurement below 70 to 80% saturation has important limitations. Several authors have tested pulse oximetry at low saturations with conflicting results. A review of these data indicates that every patient with a pulse oximeter value below 75 to 80% SaO2 should have one or more invasive measurements of the arterial SaO2 in order to avoid undetected severe hypoxemia.