Knowledge of Glasgow coma scale by air-rescue physicians.

OBJECTIVE: To assess the theoretical and practical knowledge of the Glasgow Coma Scale (GCS) by trained Air-rescue physicians in Switzerland. METHODS: Prospective anonymous observational study with a specially designed questionnaire. General knowledge of the GCS and its use in a clinical case were assessed. RESULTS: From 130 questionnaires send out, 103 were returned (response rate of 79.2%) and analyzed. Theoretical knowledge of the GCS was consistent for registrars, fellows, consultants and private practitioners active in physician-staffed helicopters. The clinical case was wrongly scored by 38 participants (36.9%). Wrong evaluation of the motor component occurred in 28 questionnaires (27.2%), and 19 errors were made for the verbal score (18.5%). Errors were made most frequently by registrars (47.5%, p = 0.09), followed by fellows (31.6%, p = 0.67) and private practitioners (18.4%, p = 1.00). Consultants made significantly less errors than the rest of the participating physicians (0%, p < 0.05). No statistically significant differences were shown between anesthetists, general practitioners, internal medicine trainees or others. CONCLUSION: Although the theoretical knowledge of the GCS by out-of-hospital physicians is correct, significant errors were made in scoring a clinical case. Less experienced physicians had a higher rate of errors. Further emphasis on teaching the GCS is mandatory.

Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia.

Methylmalonic and propionic acidemia (MMA/PA) are inborn errors of metabolism characterized by accumulation of propionic acid and/or methylmalonic acid due to deficiency of methylmalonyl-CoA mutase (MUT) or propionyl-CoA carboxylase (PCC). MMA has an estimated incidence of ~ 1: 50,000 and PA of ~ 1:100'000 -150,000. Patients present either shortly after birth with acute deterioration, metabolic acidosis and hyperammonemia or later at any age with a more heterogeneous clinical picture, leading to early death or to severe neurological handicap in many survivors. Mental outcome tends to be worse in PA and late complications include chronic kidney disease almost exclusively in MMA and cardiomyopathy mainly in PA. Except for vitamin B12 responsive forms of MMA the outcome remains poor despite the existence of apparently effective therapy with a low protein diet and carnitine. This may be related to under recognition and delayed diagnosis due to nonspecific clinical presentation and insufficient awareness of health care professionals because of disease rarity.

Entrevistant infants pre-escolars víctimes d’abús sexual i/o maltractament familiar : Eficàcia dels models d’entrevista forense

Entrevistant infants pre-escolars víctimes d’abús sexual i/o maltractament familiar: eficàcia dels models d’entrevista forense Entrevistar infants en edat preescolar que han viscut una situació traumàtica és una tasca complexa que dins l’avaluació psicològica forense necessita d’un protocol perfectament delimitat, clar i temporalitzat. Per això, s’han seleccionat 3 protocols d’entrevista: el Protocol de Menors (PM) de Bull i Birch, el model del National Institute for Children Development (NICHD) de Michel Lamb, a partir del qual es va desenvolupar l’EASI (Evaluación del Abuso Sexual Infantojuvenil) i l’Entrevista Cognitiva (EC) de Fisher i Geiselman. La hipòtesi de partida vol comprovar si els anteriors models permeten obtenir volums informatius diferents en infants preescolars. Conseqüentment, els objectius han estat determinar quin dels models d’entrevista permet obtenir un volum informatiu amb més precisions i menys errors, dissenyar un model d’entrevista propi i consensuar aquest model. En el treball s’afegeixen esquemes pràctics que facilitin l’obertura, desenvolupament i tancament de l’entrevista forense. La metodologia ha reproduït el binomi infant - esdeveniment traumàtic, mitjançant la visualització i l’explicació d’un fet emocionalment significatiu amb facilitat per identificar-se: l’accident en bicicleta d’un infant que cau, es fa mal, sagna i el seu pare el cura. A partir d’aquí, hem entrevistat 135 infants de P3, P4 i P5, mitjançant els 3 models d’entrevista referits, enfrontant-los a una demanda específica: recordar i narrar aquest esdeveniment. S’ha conclòs que el nivell de record correcte, quan s’utilitza un model d’entrevista adequat amb els infants en edat preescolar, oscil•la entre el 70-90%, fet que permet defensar la confiança en els records dels infants. Es constata que el percentatge d’emissions incorrectes dels infants en edat preescolar és mínim, al voltant d’un 5-6%. L’estudi remarca la necessitat d’establir perfectament les regles de l’entrevista i, per últim, en destaca la ineficàcia de les tècniques de memòria de l’entrevista cognitiva en els infants de P3 i P4. En els de P5 es comencen a veure beneficis gràcies a la tècnica de la reinstauració contextual (RC), estant les altres tècniques fora de la comprensió i utilització dels infants d’aquestes edats. Interviewing preschoolers victims of sexual abuse and/or domestic abuse: Effectiveness of forensic interviews models 135 preschool children were interviewed with 3 different interview models in order to remember a significant emotional event. Authors conclude that the correct recall of children ranging from 70-90% and the percentage of error messages is 5-6%. It is necessary to fully establish the rules of the interview. The present research highlights the effectiveness of the cognitive interview techniques in children from P3 and P4. Entrevistando niños preescolares víctimas de abuso sexual y/o maltrato familiar: eficacia de los modelos de entrevista forense Se han entrevistado 135 niños preescolares con 3 modelos de entrevista diferentes para recordar un hecho emocionalmente significativo. Se concluye que el recuerdo correcto de los niños oscila entre el 70-90% y el porcentaje de errores de mensajes es del 5-6%. El estudio remarca la necesidad de establecer perfectamente las reglas de la entrevista y se destaca la ineficacia de las técnicas de la entrevista cognitiva en los niños de P3 y P4.

Entrevistando a niños preescolares víctimas de abuso sexual y/o maltrato familiar : Eficacia de los modelos de entrevista forense

Entrevistando niños preescolares víctimas de abuso sexual y/o maltrato familiar: eficacia de los modelos de entrevista forense Se han entrevistado 135 niños preescolares con 3 modelos de entrevista diferentes para recordar un hecho emocionalmente significativo. Se concluye que el recuerdo correcto de los niños oscila entre el 70-90% y el porcentaje de errores de mensajes es del 5-6%. El estudio remarca la necesidad de establecer perfectamente las reglas de la entrevista y se destaca la ineficacia de las técnicas de la entrevista cognitiva en los niños de P3 y P4. Entrevistant infants pre-escolars víctimes d’abús sexual i/o maltractament familiar: eficàcia dels models d’entrevista forense Entrevistar infants en edat preescolar que han viscut una situació traumàtica és una tasca complexa que dins l’avaluació psicològica forense necessita d’un protocol perfectament delimitat, clar i temporalitzat. Per això, s’han seleccionat 3 protocols d’entrevista: el Protocol de Menors (PM) de Bull i Birch, el model del National Institute for Children Development (NICHD) de Michel Lamb, a partir del qual es va desenvolupar l’EASI (Evaluación del Abuso Sexual Infantojuvenil) i l’Entrevista Cognitiva (EC) de Fisher i Geiselman. La hipòtesi de partida vol comprovar si els anteriors models permeten obtenir volums informatius diferents en infants preescolars. Conseqüentment, els objectius han estat determinar quin dels models d’entrevista permet obtenir un volum informatiu amb més precisions i menys errors, dissenyar un model d’entrevista propi i consensuar aquest model. En el treball s’afegeixen esquemes pràctics que facilitin l’obertura, desenvolupament i tancament de l’entrevista forense. La metodologia ha reproduït el binomi infant - esdeveniment traumàtic, mitjançant la visualització i l’explicació d’un fet emocionalment significatiu amb facilitat per identificar-se: l’accident en bicicleta d’un infant que cau, es fa mal, sagna i el seu pare el cura. A partir d’aquí, hem entrevistat 135 infants de P3, P4 i P5, mitjançant els 3 models d’entrevista referits, enfrontant-los a una demanda específica: recordar i narrar aquest esdeveniment. S’ha conclòs que el nivell de record correcte, quan s’utilitza un model d’entrevista adequat amb els infants en edat preescolar, oscil•la entre el 70-90%, fet que permet defensar la confiança en els records dels infants. Es constata que el percentatge d’emissions incorrectes dels infants en edat preescolar és mínim, al voltant d’un 5-6%. L’estudi remarca la necessitat d’establir perfectament les regles de l’entrevista i, per últim, en destaca la ineficàcia de les tècniques de memòria de l’entrevista cognitiva en els infants de P3 i P4. En els de P5 es comencen a veure beneficis gràcies a la tècnica de la reinstauració contextual (RC), estant les altres tècniques fora de la comprensió i utilització dels infants d’aquestes edats. Interviewing preschoolers victims of sexual abuse and/or domestic abuse: Effectiveness of forensic interviews models 135 preschool children were interviewed with 3 different interview models in order to remember a significant emotional event. Authors conclude that the correct recall of children ranging from 70-90% and the percentage of error messages is 5-6%. It is necessary to fully establish the rules of the interview. The present research highlights the effectiveness of the cognitive interview techniques in children from P3 and P4.

Als Marie Bonaparte sich taub stellte ...

Between 1927 and 1931 Marie Bonaparte had herself operated upon her clitoris three times. She did so against Freud's advice with whom she was in analysis. Among psychoanalysts these operations are still often regarded as "errors" or aberrations. But for Marie Bonaparte, who was in various ways familiar with physics and a somatic approach, surgery was the first choice, psychoanalysis only a possible alternative. She was not impressed by the skepticism of her colleagues, and adhered even more emphatically to her own strategy

Tienda online y gestor de stock

El objetivo de este proyecto es desarrollar una aplicación web que sirva y gestione una tienda de música, tanto para su tienda física como para su tienda online. La aplicación Web está gestionada por los usuarios "administrador" y utilizada por los dos tipos de usuarios: administradores y clientes. Sus principales funciones son: Introducción y modificación de artículos. Gestión de entradas y salidas de productos. Gestión de pedidos. Obtención de datos para la gestión de la empresa. Minimizar los errores de gestión. Mejorar la imagen de la empresa. Ampliar los ámbitos de negocio. Correcta visualización de los artículos. Facilitar la búsqueda y compra de artículos.

Improving the performance of positive selection inference by filtering unreliable alignment regions.

Errors in the inferred multiple sequence alignment may lead to false prediction of positive selection. Recently, methods for detecting unreliable alignment regions were developed and were shown to accurately identify incorrectly aligned regions. While removing unreliable alignment regions is expected to increase the accuracy of positive selection inference, such filtering may also significantly decrease the power of the test, as positively selected regions are fast evolving, and those same regions are often those that are difficult to align. Here, we used realistic simulations that mimic sequence evolution of HIV-1 genes to test the hypothesis that the performance of positive selection inference using codon models can be improved by removing unreliable alignment regions. Our study shows that the benefit of removing unreliable regions exceeds the loss of power due to the removal of some of the true positively selected sites.

Estimation of glomerular filtration rate in hospitalised patients: are we overestimating renal function?

QUESTIONS UNDER STUDY AND PRINCIPLES: Estimating glomerular filtration rate (GFR) in hospitalised patients with chronic kidney disease (CKD) is important for drug prescription but it remains a difficult task. The purpose of this study was to investigate the reliability of selected algorithms based on serum creatinine, cystatin C and beta-trace protein to estimate GFR and the potential added advantage of measuring muscle mass by bioimpedance. In a prospective unselected group of patients hospitalised in a general internal medicine ward with CKD, GFR was evaluated using inulin clearance as the gold standard and the algorithms of Cockcroft, MDRD, Larsson (cystatin C), White (beta-trace) and MacDonald (creatinine and muscle mass by bioimpedance). 69 patients were included in the study. Median age (interquartile range) was 80 years (73-83); weight 74.7 kg (67.0-85.6), appendicular lean mass 19.1 kg (14.9-22.3), serum creatinine 126 μmol/l (100-149), cystatin C 1.45 mg/l (1.19-1.90), beta-trace protein 1.17 mg/l (0.99-1.53) and GFR measured by inulin 30.9 ml/min (22.0-43.3). The errors in the estimation of GFR and the area under the ROC curves (95% confidence interval) relative to inulin were respectively: Cockcroft 14.3 ml/min (5.55-23.2) and 0.68 (0.55-0.81), MDRD 16.3 ml/min (6.4-27.5) and 0.76 (0.64-0.87), Larsson 12.8 ml/min (4.50-25.3) and 0.82 (0.72-0.92), White 17.6 ml/min (11.5-31.5) and 0.75 (0.63-0.87), MacDonald 32.2 ml/min (13.9-45.4) and 0.65 (0.52-0.78). Currently used algorithms overestimate GFR in hospitalised patients with CKD. As a consequence eGFR targeted prescriptions of renal-cleared drugs, might expose patients to overdosing. The best results were obtained with the Larsson algorithm. The determination of muscle mass by bioimpedance did not provide significant contributions.

Extreme Precipitation Modelling Using Geostatistics and Machine Learning Algorithms

The paper presents an approach for mapping of precipitation data. The main goal is to perform spatial predictions and simulations of precipitation fields using geostatistical methods (ordinary kriging, kriging with external drift) as well as machine learning algorithms (neural networks). More practically, the objective is to reproduce simultaneously both the spatial patterns and the extreme values. This objective is best reached by models integrating geostatistics and machine learning algorithms. To demonstrate how such models work, two case studies have been considered: first, a 2-day accumulation of heavy precipitation and second, a 6-day accumulation of extreme orographic precipitation. The first example is used to compare the performance of two optimization algorithms (conjugate gradients and Levenberg-Marquardt) of a neural network for the reproduction of extreme values. Hybrid models, which combine geostatistical and machine learning algorithms, are also treated in this context. The second dataset is used to analyze the contribution of radar Doppler imagery when used as external drift or as input in the models (kriging with external drift and neural networks). Model assessment is carried out by comparing independent validation errors as well as analyzing data patterns.

Simultaneous B(0)- and B(1)+-map acquisition for fast localized shim, frequency, and RF power determination in the heart at 3 T.

High-field (>or=3 T) cardiac MRI is challenged by inhomogeneities of both the static magnetic field (B(0)) and the transmit radiofrequency field (B(1)+). The inhomogeneous B fields not only demand improved shimming methods but also impede the correct determination of the zero-order terms, i.e., the local resonance frequency f(0) and the radiofrequency power to generate the intended local B(1)+ field. In this work, dual echo time B(0)-map and dual flip angle B(1)+-map acquisition methods are combined to acquire multislice B(0)- and B(1)+-maps simultaneously covering the entire heart in a single breath hold of 18 heartbeats. A previously proposed excitation pulse shape dependent slice profile correction is tested and applied to reduce systematic errors of the multislice B(1)+-map. Localized higher-order shim correction values including the zero-order terms for frequency f(0) and radiofrequency power can be determined based on the acquired B(0)- and B(1)+-maps. This method has been tested in 7 healthy adult human subjects at 3 T and improved the B(0) field homogeneity (standard deviation) from 60 Hz to 35 Hz and the average B(1)+ field from 77% to 100% of the desired B(1)+ field when compared to more commonly used preparation methods.