Nouveau programme de formation en médecine interne générale: implications pour les médecins de premier recours [The new postgraduate training program in general internal medicine: implications for the primary care physician].

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

Manual de la técnica de rejilla mediante el programa RECORD ver. 2.0: Capítulos I (introducció), II (Etapa de diseño) y III (Fase de administración)

La técnica de rejilla es un instrumento de evaluación de las dimensiones y estructura del significado personal que se deriva de la teoría de los constructos personales. Tanto en la versión original de G. A. Kelly (1955) como en sus continuas actualizaciones, esta técnica pretende captar la forma en que una persona da sentido a su experiencia en sus propios términos. No se trata, por tanto, de un test convencional, sino de una forma de entrevista estructurada orientada a explicitar y analizar los constructos con los que la persona organiza su mundo. De la entrevista se genera una matriz de datos que se somete a varios análisis para revelar su estructura implícita. El programa RECORD ofrece los resultados de una forma clara y proporciona además una serie de gráficos de fácil interpretación. Todo ello permite dibujar la estructura del mapa cognitivo del sujeto desde su propia semántica, culminando así, con rigor metodológico, una vieja aspiración fenomenológica. Se trata de un instrumento muy 'flexible que puede adaptarse a diversas áreas de aplicación: evaluación individual, grupal, familiar y de pareja, intervención psicoeducativa, asesoramiento vocacional, investigación de mercados, asesoramiento empresarial, investigación terapéutica, estudio de la estructura cognitiva de la personalidad, etc.

Statistical Analysis of Highway Needs Condition Data: Manual vs. Automated, TR-494

This project examines similarities and differences between the automated condition data collected on and off county paved roads and the manual condition data collected by Iowa Department of Transportation (DOT) staff in 2000 and 2001. Also, the researchers will provide staff support to the advisory committee in exploring other options to the highway need process. The results show that the automated condition data can be used in a converted highway needs process with no major differences between the two methods. Even though the foundation rating difference was significant, the foundation rating weighting factor in HWYNEEDS is minimal and should not have a major impact. In terms of RUTF formula based distribution, the results clearly show the superiority of the condition-based analysis compared to the non-condition based. That correlation can be further enhanced by adding more distress variables to the analysis.

Manual de la técnica de rejilla mediante el programa RECORD ver. 2.0: Capítulos I (introducció), II (Etapa de diseño) y III (Fase de administración)

La técnica de rejilla es un instrumento de evaluación de las dimensiones y estructura del significado personal que se deriva de la teoría de los constructos personales. Tanto en la versión original de G. A. Kelly (1955) como en sus continuas actualizaciones, esta técnica pretende captar la forma en que una persona da sentido a su experiencia en sus propios términos. No se trata, por tanto, de un test convencional, sino de una forma de entrevista estructurada orientada a explicitar y analizar los constructos con los que la persona organiza su mundo. De la entrevista se genera una matriz de datos que se somete a varios análisis para revelar su estructura implícita. El programa RECORD ofrece los resultados de una forma clara y proporciona además una serie de gráficos de fácil interpretación. Todo ello permite dibujar la estructura del mapa cognitivo del sujeto desde su propia semántica, culminando así, con rigor metodológico, una vieja aspiración fenomenológica. Se trata de un instrumento muy 'flexible que puede adaptarse a diversas áreas de aplicación: evaluación individual, grupal, familiar y de pareja, intervención psicoeducativa, asesoramiento vocacional, investigación de mercados, asesoramiento empresarial, investigación terapéutica, estudio de la estructura cognitiva de la personalidad, etc.

Automatic prostate segmentation in cone-beam computed tomography images using rigid registration.

We propose to evaluate automatic three-dimensional gray-value rigid registration (RR) methods for prostate localization on cone-beam computed tomography (CBCT) scans. In total, 103 CBCT scans of 9 prostate patients have been analyzed. Each one was registered to the planning CT scan using different methods: (a) global RR, (b) pelvis bone structure RR, (c) bone RR refined by local soft-tissue RR using the CT clinical target volume (CTV) expanded with a 1, 3, 5, 8, 10, 12, 15 or 20-mm margin. To evaluate results, a radiation oncologist was asked to manually delineate the CTV on the CBCT scans. The Dice coefficients between each automatic CBCT segmentation - derived from the transformation of the manual CT segmentation - and the manual CBCT segmentation were calculated. Global or bone CT/CBCT RR has been shown to yield insufficient results in average. Local RR with an 8-mm margin around the CTV after bone RR was found to be the best candidate for systematically significantly improving prostate localization.

Thérapeutique et médecine interne générale [Therapy and internal medicine].

This review is based on five articles published in 2006 and dealing with therapies in general internal medicine: in case of acute non complicated rhino-sinusitis, the use of topical corticoids in mono-therapy is indicated; cross-reactivity between penicillins and cephalosporins is less frequent than established so far. In our daily practice we should be more "pro-active" in prescribing probiotics which have proved their efficacy in the prevention of antibiotic-associated diarrhoeas; an antibiotic treatment of three days is recommended in case of non complicated cystitis in women less than 65 years of age. Finally, every patient treated with bisphosphonates must be regularly followed by a dentist.

The farmer's lung disease : occupational medicine input

Background: Although there has been an abundant literature in recent years about farmer's lung disease, few addressed occupational measures able to maintain the farmer in his work. Nevertheless we know now that most of the farmers can be kept at the workplace by the way of occupational preventive measures. Methods: This matter is discussed from a case report. A farmer affected by the farmer's lung disease was sent to us by his pneumologist, in order to estimate the possibility of maintaining him in his job and to determine relevant changes at his workplace to minimize risk of exposure to dust antigen. This approach required a visit to the workplace by occupational physician and hygienist. Results: The visit of the workplace pointed out different habits and architectural particularities which were potential sources of exposure. The two main proposed measures to reduce the risk, were to wear respiratory masks while working inside the barn, such as preparing hay, feeding the cattle or sweeping the floor, and to build a direct access from the bathroom (shower and toilet) to the outside, allowing to go out of the barn after taking a shower and changing, without risk of being contaminated again. Although upgrading the shower-toilet is not yet completed to date, the already performed modifications led currently to significant clinical improvements, despite the risk of exposure was high since the animals were in the barn for more than two months. Conclusion: The treatment of the farmer's lung disease must be multidisciplinary involving general practitioner, pneumologist, occupational hygienist and occupational physician.

Iowa Drivers Manual, 2013-2014

The rules and regulations for operating a motored vehicles in Iowa.

Iowa Motorcycle Operator's Manual, 2014

The rules and regualtions for owning and operating a motorcycle in Iowa

Calibration of Highway Safety Manual Work Zone Crash Modification Factors, TPF-5(081), 2014

The Highway Safety Manual is the national safety manual that provides quantitative methods for analyzing highway safety. The HSM presents crash modification factors related to work zone characteristics such as work zone duration and length. These crash modification factors were based on high-impact work zones in California. Therefore there was a need to use work zone and safety data from the Midwest to calibrate these crash modification factors for use in the Midwest. Almost 11,000 Missouri freeway work zones were analyzed to derive a representative and stratified sample of 162 work zones. The 162 work zones was more than four times the number of work zones used in the HSM. This dataset was used for modeling and testing crash modification factors applicable to the Midwest. The dataset contained work zones ranging from 0.76 mile to 9.24 miles and with durations from 16 days to 590 days. A combined fatal/injury/non-injury model produced a R2 fit of 0.9079 and a prediction slope of 0.963. The resulting crash modification factors of 1.01 for duration and 0.58 for length were smaller than the values in the HSM. Two practical application examples illustrate the use of the crash modification factors for comparing alternate work zone setups.

Gériatrie [What's new in geriatric medicine]

Several studies clarified the role of different interventions such as vitamine D replacement, denosumab treatment, and vertebroplasty in the prevention and management of falls and fractures. A trial tested the effectiveness of pharmaceutical assistance at the time of discharge, emphasizing the potential benefits for the patients and the health care system. Syncopal episodes frequently lead to hospital admission. A retrospective study evaluated the diagnostic yield of different tests and emphasized the importance to actively seek orthostatic hypotension in older patients. Finally, advances remain modest in the field of dementias.