The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study.

The first AO comprehensive pediatric long-bone fracture classification system has been proposed following a structured path of development and validation with experienced pediatric surgeons. A Web-based multicenter agreement study involving 70 surgeons in 15 clinics and 5 countries was conducted to assess the reliability and accuracy of this classification when used by a wide range of surgeons with various levels of experience. Training was provided at each clinic before the session. Using the Internet, participants could log in at any time and classify 275 supracondylar, radius, and tibia fractures at their own pace. The fracture diagnosis was made following the hierarchy of the classification system using both clinical terminology and codes. kappa coefficients for the single-surgeon diagnosis of epiphyseal, metaphyseal, or diaphyseal fracture type were 0.66, 0.80, and 0.91, respectively. Median accuracy estimates for each bone and type were all greater than 80%. Depending on their experience and specialization, surgeons greatly varied in their ability to classify fractures. Pediatric training and at least 2 years of experience were associated with significant improvement in reliability and accuracy. Kappa coefficients for diagnosis of specific child patterns were 0.51, 0.63, and 0.48 for epiphyseal, metaphyseal, and diaphyseal fractures, respectively. Identified reasons for coding discrepancies were related to different understandings of terminology and definitions, as well as poor quality radiographic images. Results supported some minor adjustments in the coding of fracture type and child patterns. This classification system received wide acceptance and support among the surgeons involved. As long as appropriate training could be performed, the system classification was reliable, especially among surgeons with a minimum of 2 years of clinical experience. We encourage broad-based consultation between surgeons' international societies and the use of this classification system in the context of clinical practice as well as prospectively for clinical studies.

Not accepted by the family: "Being difficult" or "being different"?

Using data from the Netherlands Kinship Panel Study (NKPS) and combining a quantitative approach and a qualitative approach (N = 8,148 and n = 43, respectively), this study investigates the mechanisms associated with a lack of acceptance by one's family. From the total NKPS sample, 12.1% did not feel (entirely) accepted by their family. The authors hypothesized that people may not feel accepted by their family when they are "difficult," for example, by exhibiting personal problems; another reason might be that they are "different," for instance, because they have made nontraditional life course transitions or differ from their parents in educational level or religious preference. Both quantitative and qualitative results confirm the first hypothesis rather than the second. Qualitative results revealed a gender difference in the mechanisms associated with a lack of acceptance by one's family as well as differences in the resilience of those who had had a difficult family background.

Why bystanders decline telephone cardiac resuscitation advice.

OBJECTIVES: The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol. METHODS: Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded. RESULTS: During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. CONCLUSIONS: The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages.

Recognition in ants: social origin matters.

The ability of group members to discriminate against foreigners is a keystone in the evolution of sociality. In social insects, colony social structure (number of queens) is generally thought to influence abilities of resident workers to discriminate between nestmates and non-nestmates. However, whether social origin of introduced individuals has an effect on their acceptance in conspecific colonies remains poorly explored. Using egg-acceptance bioassays, we tested the influence of social origin of queen-laid eggs on their acceptance by foreign workers in the ant Formica selysi. We showed that workers from both single- and multiple-queen colonies discriminated against foreign eggs from single-queen colonies, whereas they surprisingly accepted foreign eggs from multiple-queen colonies. Chemical analyses then demonstrated that social origins of eggs and workers could be discriminated on the basis of their chemical profiles, a signal generally involved in nestmate discrimination. These findings provide the first evidence in social insects that social origins of eggs interfere with nestmate discrimination and are encoded by chemical signatures.

Virtual Environment: assistance in nursing care for the deaf based on the protocol of Primary Care

Objective: Presenting a Virtual Environment (VE) based on the Protocol of Treatment of Hypertension and Diabetes Mellitus type 2, used in Primary Care for evaluation of dietary habits in nursing consultations. Method: An experimental study applied by two nurses and a nurse manager, in a sample of 30 deaf patients aged between 30 and 60 years. The environment was built in Visual Basic NET and offered eight screens about feeding containing food pictures, videos in Libras (Brazilian sign language) and audio. The analysis of the VE was done through questionnaires applied to patients and professionals by the Poisson statistical test. Results: The VE shows the possible diagnostics in red, yellow, green and blue colors, depending on the degree of patients’ need. Conclusion: The environment obtained excellent acceptance by patients and nurses, allowing great interaction between them, even without an interpreter. The time in consultation was reduced to 15 minutes, with the preservation of patient privacy.

Educational pamphlets on health: a reception study

OBJECTIVES Identifying the socioeconomic and cultural profile of users/readers of educational pamphlets, characterizing the context of the reading material and people involved; describing the user/reader evaluation on language and style used, as well as content range or limitations, and its characterization as an educational material in assisting users for meeting homecare demands. METHOD A reception, cross-sectional, qualitative study. 27 respondents who had received five educational pamphlets were interviewed on Oncology signs and symptoms during primary care consultations. RESULTS Study participants were adults, with average schooling of more than 10 years and low income. Pamphlets were assessed as appropriate for consistent language, quantity and quality of content, and especially in relation to the capacity of helping in the homecare decision making process. The importance of receiving pamphlets at the initial stage of the disease was verified. CONCLUSION Users acceptance was positive and the study revealed aspects that should be reinforced in the creation of educational pamphlets.

Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report.

BACKGROUND: Clients of street sex workers may be at higher risk for HIV infection than the general population. Furthermore, there is a lack of knowledge regarding HIV testing of clients of sex workers in developed countries. METHOD: This pilot study assessed the feasibility and acceptance of rapid HIV testing by the clients of street-based sex workers in Lausanne, Switzerland. For 5 evenings, clients in cars were stopped by trained field staff for face-to-face interviews focusing on sex-related HIV risk behaviors and HIV testing history. The clients were then offered a free anonymous rapid HIV test in a bus parked nearby. Rapid HIV testing and counselling were performed by experienced nurse practitioners. Clients with reactive tests were offered confirmatory testing, medical evaluation, and care in our HIV clinic. RESULT: We intercepted 144 men, 112 (77.8%) agreed to be interviewed. Among them, 50 (46.6%) had never been tested for HIV. A total of 31 (27.7%) rapid HIV tests were performed, 16 (51.6%) in clients who had not previously been tested. None were reactive. Initially, 19 (16.9%) additional clients agreed to HIV testing but later declined due to the 40-minute queue for testing. CONCLUSION: This pilot study showed that rapid HIV testing in the red light district of Lausanne was feasible, and that the clients of sex workers accepted testing at an unexpectedly high rate. This setting seems particularly appropriate for targeted HIV screening, since more than 40% of the clients had not previously been tested for HIV even though they engaged in sex-related HIV risk behaviour.

Iterated local search

Iterated Local Search has many of the desirable features of a metaheuristic: it is simple, easy to implement, robust, and highly effective. The essential idea of Iterated Local Search lies in focusing the search not on the full space of solutions but on a smaller subspace defined by the solutions that are locally optimal for a given optimization engine. The success of Iterated Local Search lies in the biased sampling of this set of local optima. How effective this approach turns out to be depends mainly on the choice of the local search, the perturbations, and the acceptance criterion. So far, in spite of its conceptual simplicity, it has lead to a number of state-of-the-art results without the use of too much problem-specific knowledge. But with further work so that the different modules are well adapted to the problem at hand, Iterated Local Search can often become a competitive or even state of the artalgorithm. The purpose of this review is both to give a detailed description of this metaheuristic and to show where it stands in terms of performance.

Clinical Proton MR Spectroscopy in Central Nervous System Disorders.

A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units. © RSNA, 2014 Online supplemental material is available for this article.

Welfare of naive and sophisticated players in school choice

Two main school choice mechanisms have attracted the attention in the literature: Boston and deferred acceptance (DA). The question arises on the ex-ante welfareimplications when the game is played by participants that vary in terms of their strategicsophistication. Abdulkadiroglu, Che and Yasuda (2011) have shown that the chances ofnaive participants getting into a good school are higher under the Boston mechanism thanunder DA, and some naive participants are actually better off. In this note we show thatthese results can be extended to show that, under the veil of ignorance, i.e. students not yetknowing their utility values, all naive students may prefer to adopt the Boston mechanism.

The Soil and Water Assessment Tool:Historical Development, Applications, and Future Research Directions, 2007

The Soil and Water Assessment Tool (SWAT) model is a continuation of nearly 30 years of modeling efforts conducted by the U.S. Department of Agriculture (USDA), Agricultural Research Service. SWAT has gained international acceptance as a robust interdisciplinary watershed modeling tool, as evidenced by international SWAT conferences, hundreds of SWAT-related papers presented at numerous scientific meetings, and dozens of articles published in peer-reviewed journals. The model has also been adopted as part of the U.S. Environmental Protection Agency’s BASINS (Better Assessment Science Integrating Point & Nonpoint Sources) software package and is being used by many U.S. federal and state agencies, including the USDA within the Conservation Effects Assessment Project. At present, over 250 peer-reviewed, published articles have been identified that report SWAT applications, reviews of SWAT components, or other research that includes SWAT. Many of these peer-reviewed articles are summarized here according to relevant application categories such as streamflow calibration and related hydrologic analyses, climate change impacts on hydrology, pollutant load assessments, comparisons with other models, and sensitivity analyses and calibration techniques. Strengths and weaknesses of the model are presented, and recommended research needs for SWAT are provided.

Nature, evolution and characterisation of rhizospheric chemical exudates affecting root herbivores

Similar to aboveground herbivores, root-feeding insects must locate and identify suitable resources. In the darkness of soil, they mainly rely on root chemical exudations and, therefore, have evolved specific behaviours. Because of their impact on crop yield, most of our knowledge in belowground chemical ecology is biased towards soil-dwelling insect pests. Yet the increasing literature on volatile-mediated interactions in the ground underpins the great importance of chemical signalling in this ecosystem and its potential in pest control. Here, we explore the ecology and physiology of these chemically based interactions. An evolutionary approach reveals interesting patterns in the response of insects to particular classes of volatile or water-soluble organic compounds commonly emitted by roots. Food web analyses reasonably support that volatiles are used as long-range cues whereas water-soluble molecules serve in host acceptance/rejection by the insect; however, data are still scarce. As a case study, the chemical ecology of Diabrotica virgifera virgifera is discussed and applications of belowground signalling in pest management are examined. Soil chemical ecology is an expanding field of research and will certainly be a hub of our understanding of soil communities and subsequently of the management of belowground ecosystem services.

Entre a Terra e o Mar - Grau de Satisfação dos Cruzeiristas na Ilha de São Vicente

Este trabalho apresenta os resultados de um estudo realizado em São Vicente, de Março a Abril de 2012 a turistas de cruzeiro. Este estudo teve como objectivo analisar o perfile a satisfação dos visitantes durante a sua estadia na ilha, para ajudar a indústria do turismo na melhoria do produto e infra-estrutura turística, e ao fazê-lo melhorar aexperiência para os cruzeiristas. O estudo foi conduzido através da revisão da literaturasobre turismo de cruzeiro, imagem do destino, elementos da oferta turística, qualidade esatisfação e sua relação com o turismo. Para a avaliação do perfil e satisfação do turistade cruzeiro, aplicou-se um questionário a uma amostra de 131 cruzeiristas, no fim dasua visita à ilha. Os resultados do questionário aplicado aos cruzeiristas evidenciaram maior satisfação com aspectos como paisagem natural, clima, simpatia da população local, oportunidadepara conhecer pessoas e limpeza urbana. Os atributos que demonstraram valores maisaltos de insatisfação são: museus, sanitários, gastronomia, sinalização, serviços derestauração e de informação turística. O perfil do cruzeirista é caracterizado pela disponibilidade em viajar, nível académico eprofissional médio alto, poder de compra médio alto e de média idade. Verificou-se que os vários sectores não estão bem organizados e integrados entre si paraatender às necessidades e desejos dos visitantes. Assim, recomenda-se uma série deactividades, tendo em vista, minimizar os aspectos negativos identificados peloscruzeiristas e integrar a oferta turística entre os vários elementos que a compõem. This research is based on the results acquired from tourists who traveled to the island of Sao Vicente on cruise ships during the months of March and April of 2012. The object of this study was to analyze the characteristics and level of satisfaction of those visiting the island of Sao Vicente, in order to help improve the tourism industry, and its infrastructure in hopes of bettering the overall experience for cruise tourists. The study emerged from a profound revision of cruise ship literature, now detailing destination images, available touristic elements, as well as quality and satisfaction ratings in relationship to tourism. In order to measure the satisfaction of the tourists we implemented a questionnaire where a sample of 131 people was surveyed at the end of their visit to the island. The questionnaire resulted in evidence detailing higher satisfaction regarding natural landscape, climate, local acceptance, ability to meet others and urban cleanliness. However, elements such as museums, sanitation, gastronomy, signage, restaurant services and travel information demonstrated higher levels of dissatisfaction. Cruise tourists are characterized as middle aged, frequent travelers with high academic and professional levels, and by their ability to consume heavily. This study verifies that various elements within the tourism sector are not well organized to satisfy the necessities and desires of cruise tourists. Therefore, an implementation of more activities is recommended for those visiting the island of Sao Vicente on cruise ships. While considering the need to minimize the negative aspects identified by the surveyed cruise tourists it is also important to integrate the offered tourist attractions within the various elements that embody tourism.

Delinquência Juvenil, Violência no Namoro e Aceitação-Rejeição do Parceiro Íntimo: um Estudo com Jovens Internados em Centros Educativos Portugueses

A delinquência juvenil e a violência no namoro configuram-se como problemas sociais vivenciados por milhares de jovens e adolescentes. A delinquência, a violência na intimidade, a rejeição por parte do par amoroso na adolescência é uma experiencia que pode ter um impacto devastador em várias áreas da vida. Esta dissertação tem como principal objetivo perceber a relação entre a prática de comportamentos antissociais e delitivos, as crenças e as práticas de violência no namoro e a perceção de aceitação-rejeição do par amoroso junto de jovens portugueses descendentes de estrangeiros e de estrangeiros que se encontram internados em centros educativos portugueses. A amostra foi constituída por 22 jovens, doze da nacionalidade portuguesa com ascendência estrangeira, com idades compreendidas entre os 14 e os 18 anos de idade, e dez jovens da nacionalidade estrangeira, com idades compreendidas entre os 15 e 18 anos, sendo que apenas dez dos 22 jovens participaram nas entrevistas. Os instrumentos utilizados na recolha de dados foram a entrevista semiestruturada, o questionário sociodemográfico, o Questionário de Condutas Antissociais e Delitivas (CAD), o Intimate Partner Acceptance-Rejection/Control Questionnaire (IPARQ/CQ), a Escala de Crenças sobre Violência Conjugal (ECVC) e o Inventário de Violência Conjugal (IVC). Os resultados confirmam a prática de comportamentos antissociais e delitivos tanto pelos jovens estrangeiros como pelos jovens portugueses com ascendência estrangeira internados em Centros Educativos Portugueses. Verificou-se que a prática da violência no namoro (física e emocional), quer nas relações atuais, quer nas relações passadas é também uma evidência nesta amostra. As crenças favoráveis que legitimam e banalizam a pequena violência estão presentes tanto nos jovens estrangeiros como nos portugueses, contudo são os estrangeiros que mais banalizam e legitimam a pequena violência. Verifica-se que a hostilidade é a dimensão da rejeição mais presente nas relações; verifica-se também que a rejeição total é a dimensão da rejeição mais frequente no grupo dos jovens portugueses do que no grupo de jovens estrangeiros.

Comunidade política, imigração e coesão social: o caso português

This work contributes to an understanding of how the existence of multiple ethnic- cultural belongings in the political community concurs with the maintenance of a socially cohesive and politically united community. Considering the immigration reality in Portugal, we tried to identify the bonds that link immigrants to the political community and how those bonds can be mobilized to integrate immigrants in a common living project inside the national territory. Methodologically, this investigation is based in a qualitative and quantitative analysis of the policies and measures applied in Portugal in the immigration sphere, as well as the results of the empirical work we carried out with two immigration groups (Brazilians and Cape Verdeans) living in Lisbon’s metropolitan area, and the answers to a survey we sent to immigrant associations. The results of this research revealed the existence of a certain political ambivalence concerning the immigrant integration process, which expresses itself to a certain degree in the way national citizens and immigrants appraise the immigrant contribution to Portuguese society. The prevailing and blurred idea states that immigration expenses don’t make up for the benefits, and that is likely to influence the mutual relationship established between the two. Despite the existence of objective situations of social and economic disparity and despite a feeling of discrimination shared between immigrants, it is possible to identify a progressive citizenship universalization and the formal acceptance of immigrant religious and cultural traditions, even though the Portuguese parliament does not reflect such diversity. Thus, we perceive the possibility of warranting specific ethnic and cultural minority rights without the ethnicization or culturalization of political representation, and the general standards that serve as a backbone to the national political community might be enough to warrant that protection. Notwithstanding, some signs suggest that immigrant access to public sphere might not be easy, and this might have repercussions in the visibility and in the public discussion of demands, with outcomes on the type of integration policies Portugal applies.