Does this child have a foreign body aspiration?

Context: Foreign body aspiration (FbA) is a serious problem in children. Accurate clinical and radiographic diagnosis is important because missed or delayed diagnosis can result in respiratory difficulties ranging from life-treatening airway obstruction to chronic wheezing or recurrent pneumonia. Bronchoscopy also has risks and accurate clinical and radiographc diagnosis can support the decision of bronchoscopy. Objective: To rewiev the diagnostic accuracy of clinical presentation (CP) and pulmonary radiograph (PR) for the diagnosis of FbA. There is no previous rewievMethods: A search of Medline is conducted for articles containing data regarding CP and PR signes of FbA. Calculation of likelihood ratios (LR) and pre and post test probability using Bayes theorem were performed for all signs of CP and PR. Inclusion criteria: Articles containing prospective data regarding CP and PR of FbA. Exclusion criteria: Retrospectives studies. Articles containing incomplete data for calculation of LR. Results: Five prospectives studies are included with a total of 585 patients. Prevalence of FbA is 63% in children suspected of FbA. If CP is normal, probability of FbA is 25% and if PR is normal, probability is 14%. If CP is pathologic, probability of FbA is 69-76% with presence of cough (LR = 1.32) or dyspnea (LR = 1.84) or localized crackles (LR = 1.5). Probability is 81-88% if cyanosis (LR = 4.8) or decreased breaths sounds (LR = 4.3) or asymetric auscultation (LR = 2.9) or localized wheezing (LR = 2.5) are present. When CP is anormal and PR show mediatinal shift (LR = 100), pneumomediatin (LR = 100), radio opaque foreign body (LR = 100), lobar distention (LR = 4), atelectasis (LR = 2.5), inspiratory/expiratory abnormal (LR = 7), the probability of FbA is 96-100%. If CP is normal and PR is abnormal the probability is 40-100%. If CP is abnormal and PR is normal the probability is 55-75%. Conclusions: This rewiev of prospective studies demonstrates the importance of CP and PR and an algorithm can be proposed. When CP is abnormal with or without PR pathologic, the probability of FbA is high and bronchoscopy is indicated. When CP and PR are normal the probability of FbA is low and bronchoscopy is not necessary immediatly, observation should be proposed. This approach should be validated with prospective study.

L'essence relationnelle. Fonctionnement neurobiologique et relations humaines

Dans une perspective phénoménologique, le corps, les fonctions vitales, le mouvement déterminent un échange constant entre le sujet et le monde, entre soi et l'autre. La neurobiologie, de son côté, s'intéresse aux transformations biologiques liées à ces expériences, mais sa méthode est fort différente. Les auteurs proposent une réflexion sur la manière dont les découvertes de la neurobiologie interviennent pour mieux "comprendre" la dimension de la rencontre. La relation intersubjective est façonnée non seulement par les structures du fonctionnement mental, par le vécu du sujet, mais encore par la "danse" des postures et le mouvement des corps ; elle est enfin portée par le milieu culturel et social, par la nature de l'environnement. La construction des liens entre le patient et le thérapeute permet à chacun d'eux de cheminer vers un accomplissement de sa propre existence. In a phenomenological perspective, the body, the vital functions, the movements determine a constant exchange between the subject and the world, between self and the others. The neurobiology on its part, is interested in the biological transformations connected to these experiences but its method is quite different. The authors suggest to consider how the neurobiological discoveries help to get a better understanding of the dimension of the encounter. The intersubjective relationship is not only shaped by the structures of the mental functioning, by the subject's experiences, but also by the « dance » of the postures and movements of the body; it is nonetheless influenced by the cultural and social environment, as well as by the type of environment. The build-up of relationships between the therapist and the patient allows both of them to find a way to fulfillment of their own existence.

Report of recommendations to the Public Employment Relations Board for the year ending, June 30, 2011

Audit report of the Public Employment Relations Board for the year ended June 30, 2011

Foreign trade traps in the european periphery: Spain, 1870-1913

In this article we research into the difficulties that foreign trade imposed onSpanish process of integration into the international economy in the years priorto the First World War. We start out by examining some features of the foreigntrade structure of the country. By means of an econometric analysis of importand export series, it is possible to observe the presence of a trend towards tradedeficit, which was in force when Spain grew at a rate similar to that of itstrading partners. We also check that, in the absence of these compensatorymechanisms, adjustment in foreign payments could be reached by means ofprotective measures and the exchange rate.

A two-level analysis of the determinants of direct democratic choices in European, immigration and foreign policy in Switzerland

This article employs a unique data set - covering 25 popular votes on foreign, European and immigration/asylum policy held between 1992 and 2006 in Switzerland - in order to examine the conditional impact of context upon utilitarian, cultural, political and cognitive determinants of individual attitudes toward international openness. Our results reveal clear patterns of cross-level interactions between individual determinants and the project-related context of the vote. Thus, although party cues and political competence have a strong impact on individuals' support for international openness, this impact is substantially mediated by the type of coalition that is operating within the party elite. Similarly, subjective utilitarian and cultural considerations influence the voters' decision in interaction with the content of the proposal submitted to the voters as well as with the framing of the voting campaign.

Foreign migrations and new couples in Spain. Nuptiality and Gender Imbalance in the new century

Nuptiality is not a central item in Migration Research now. In the past, especially for American countries, many scholars were really interested in marriages of immigrants, specially knowing the exchanges between different communities; that is, mixed marriages. Here is the Spanish case in nuptiality between foreign and local people.