Comparison of tendency-oriented perimetry and dynamic strategy in octopus perimetry as a screening tool in a clinical setting: a prospective study

OBJECTIVE: The aim of this study was to compare the results of tendency-oriented perimetry (TOP) and a dynamic strategy in octopus perimetry as screening methods in clinical practice. DESIGN: A prospective single centre observational case series was performed. PARTICIPANTS AND METHODS: In a newly opened general ophthalmologic practice 89 consecutive patients (171 eyes) with a clinical indication for octopus static perimetry testing (ocular hypertension or suspicious optic nerve cupping) were examined prospectively with TOP and a dynamic strategy. The visual fields were graded by 3 masked observers as normal, borderline or abnormal without any further clinical information. RESULTS: 83% eyes showed the same result for both strategies. In 14% there was a small difference (with one visual field being abnormal or normal, the other being borderline). In only 2.9% of the eyes (5 cases) was there a contradictory result. In 4 out of 5 cases the dynamic visual field was abnormal and TOP was normal. 4 of these cases came back for a second examination. In all 4 the follow-up examination showed a normal second dynamic visual field. CONCLUSIONS: Octopus static perimetry using a TOP strategy is a fast, patient-friendly and very reliable screening tool for the general ophthalmological practice. We found no false-negative results in our series.

Value of a novel Neisseria meningitidis--specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia

BACKGROUND: Chronic meningococcemia (CM) is a diagnostic challenge. Skin lesions are frequent but in most cases nonspecific. Polymerase chain reaction (PCR)-based diagnosis has been validated in blood and cerebrospinal fluid for acute Neisseria meningitidis infection, in patients in whom routine microbiologic tests have failed to isolate the bacteria. In 2 patients with CM, we established the diagnosis by a newly developed PCR-based approach performed on skin biopsy specimens. OBSERVATIONS: Two patients presented with fever together with systemic and cutaneous manifestations suggestive of CM. Although findings from blood cultures remained negative, we were able to identify N meningitidis in the skin lesions by a newly developed PCR assay. In 1 patient, an N meningitidis strain of the same serogroup was also isolated from a throat swab specimen. Both patients rapidly improved after appropriate antibiotherapy. CONCLUSIONS: To our knowledge, we report the first cases of CM diagnosed by PCR testing on skin biopsy specimens. It is noteworthy that, although N meningitidis-specific PCR is highly sensitive in blood and cerebrospinal fluid in acute infections, our observations underscore the usefulness of PCR performed on skin lesions for the diagnosis of chronic N meningitidis infections. Whenever possible, this approach should be systematically employed in patients for whom N meningitidis infection cannot be confirmed by routine microbiologic investigations.

Accuracy and reproducibility of aortic annulus sizing using a dedicated three-dimensional computed tomography reconstruction tool in patients evaluated for transcatheter aortic valve replacement

Aims: To evaluate the accuracy and reproducibility of aortic annulus sizing using a multislice computed tomography (MSCT) based aortic root reconstruction tool compared with conventional imaging among patients evaluated for transcatheter aortic valve replacement (TAVR). Methods and results: Patients referred for TAVR underwent standard preprocedural assessment of aortic annulus parameters using MSCT, angiography and transoesophageal echocardiography (TEE). Three-dimensional (3-D) reconstruction of MSCT images of the aortic root was performed using 3mensio (3mensio Medical Imaging BV, Bilthoven, The Netherlands), allowing for semi-automated delineation of the annular plane and assessment of annulus perimeter, area, maximum, minimum and virtual diameters derived from area and perimeter (aVD and pVD). A total of 177 patients were enrolled. We observed a good inter-observer variability of 3-D reconstruction assessments with concordance coefficients for agreement of 0.91 (95% CI: 0.87-0.93) and 0.91 (0.88-0.94) for annulus perimeter and area assessments, respectively. 3-D derived pVD and aVD correlated very closely with a concordance coefficient of 0.97 (0.96-0.98) with a mean difference of 0.5±0.3 mm (pVD-aVD). 3-D derived pVD showed the best, but moderate concordance with diameters obtained from coronal MSCT (0.67, 0.56-0.75; 0.3±1.8 mm), and the lowest concordance with diameters obtained from TEE (0.42, 0.31-0.52; 1.9±1.9 mm). Conclusions: MSCT-based 3-D reconstruction of the aortic annulus using the 3mensio software enables accurate and reproducible assessment of aortic annulus dimensions.

Modified Team-based Learning (TBL) as a tool in Problem-based learning (PBL); Observations and Lessons from Year One

Both TBL and PBL attempt to maximally engage the learner and both are designed to encourage interactive teaching / learning. PBL is student centered. TBL, in contrast, is typically instructor centered. The PBL Executive Committee of the UTHSC-Houston Medical School, in an attempt to capture the pedagogical advantages of PBL and of TBL, implemented a unique PBL experience into the ICE/PBL course during the final block of PBL instruction in year 2. PBL cases provided the content knowledge for focused learning. The subsequent, related TBL exercises fostered integration / critical thinking about each of these cases. [See PDF for complete abstract]

Evaluating an e-mental health program (“deprexis”) as adjunctive treatment tool in psychotherapy for depression: design of a pragmatic randomized controlled trial

Background Major depressive disorder (MDD) places a significant disease burden on individuals as well as on societies. Several web-based interventions for MDD have shown to be effective in reducing depressive symptoms. However, it is not known whether web-based interventions, when used as adjunctive treatment tools to regular psychotherapy, have an additional effect compared to regular psychotherapy for depression. Methods/design This study is a currently recruiting pragmatic randomized controlled trial (RCT) that compares regular psychotherapy plus a web-based depression program (¿deprexis¿) with a control condition exclusively receiving regular psychotherapy. Adults with a depressive disorder (N?=?800) will be recruited in routine secondary care from therapists over the course of their initial sessions and will then be randomized within therapists to one of the two conditions. The primary outcome is depressive symptoms measured with the Beck Depression Inventory (BDI-II) at three months post randomization. Secondary outcomes include changes on various indicators such as anxiety, somatic symptoms and quality of life. All outcomes are again assessed at the secondary endpoint six months post randomization. In addition, the working alliance and feasibility/acceptability of the treatment condition will be explored. Discussion This is the first randomized controlled trial to examine the feasibility/acceptability and the effectiveness of a combination of traditional face-to-face psychotherapy and web-based depression program compared to regular psychotherapeutic treatment in depressed outpatients in routine care.

A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance

PURPOSES Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems. BASIC PROCEDURES The EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period. MAIN FINDINGS Emergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; P<.001). Emergency geriatric screening predicted nursing home admission after the in-hospital stay (odds ratio for ≥3 vs <3 abnormal domains 12.13; 95% confidence interval, 2.79-52.72; P=.001). PRINCIPAL CONCLUSIONS The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.

A Case Study on Using the Via Christi Breastfeeding Assessment Tool in a Clinical Setting

Aims- The goal of this study is to obtain a subjective point of view of the use, benefits, and shortcomings of the Via Christi breastfeeding Assessment Tool in a clinical setting. Methods- This case study is based on a single yet detailed interview with a lactation consultant who has utilized the Via Christi Breastfeeding Tool in a clinical setting. Findings- Advantages of the Via Christi Breastfeeding Assessment Tool include that the tool is practical and concrete, encompassing both a subjective dimension and the basic elements of breastfeeding. Shortcomings of the tool include its non-specificity in focus on the feeding technique only and excluding other factors involved with the birth and mother- baby couplet. Conclusion- The Via Christi Breastfeeding Tool serves as a good initial screening of breastfeeding, which in result leads to the recommendation of further and more extensive study of a specific mother-baby couplet breastfeeding measures if needed.

Propuesta metodológica para la identificación de medidas de adaptación al cambio climático en sistemas de recursos hídricos

Esta tesis realiza una contribución metodológica en el estudio de medidas de adaptación potencialmente adecuadas a largo plazo, donde los sistemas de recursos hídricos experimentan fuertes presiones debido a los efectos del cambio climático. Esta metodología integra el análisis físico del sistema, basándose en el uso de indicadores que valoran el comportamiento de éste, y el análisis económico mediante el uso del valor del agua. El procedimiento metodológico inicia con la construcción de un conjunto de escenarios futuros, que capturan por un lado las características de variabilidad de las aportaciones de diversos modelos climáticos y, por otro, las características hidrológicas de la zona de estudio. Las zonas de estudio seleccionadas fueron las cuencas del Guadalquivir, Duero y Ebro y se utilizaron como datos observados las series de escorrentía en régimen natural estimadas por el modelo SIMPA que está calibrado en la totalidad del territorio español. Estas series observadas corresponden al periodo 1961-1990. Los escenarios futuros construidos representan el periodo 2071-2100. La identificación de medidas de adaptación se apoyó en el uso de indicadores que sean capaces de caracterizar el comportamiento de un sistema de recursos hídricos frente a los efectos del cambio climático. Para ello se seleccionaron los indicadores de calidad de servicio (I1) y de confiabilidad de la demanda (I2) propuestos por Martin-Carrasco et al. (2012). Estos indicadores valoran el comportamiento de un sistema mediante la identificación de los problemas de escasez de agua que presente, y requieren para su cuantificación el uso de un modelo de optimización. Para este estudio se ha trabajado con el modelo de optimización OPTIGES. La determinación de estos indicadores fue realizada para análisis a corto plazo donde los efectos del cambio climático no son de relevancia, por lo que fue necesario analizar su capacidad para ser usados en sistemas afectados por dichos efectos. Para este análisis se seleccionaron tres cuencas españolas: Guadalquivir, Duero y Ebro, determinándose que I2 no es adecuado para este tipo de escenarios. Por ello se propuso un nuevo indicador “Indicador de calidad de servicio bajo cambio climático” (I2p) que mantiene los mismos criterios de valoración que I2 pero que responde mejor bajo fuertes reducciones de aportaciones producto del cambio climático. La metodología propuesta para la identificación de medidas de adaptación se basa en un proceso iterativo en el cual se van afectando diversos elementos que conforman el esquema del sistema bajo acciones de gestión previamente identificadas, hasta llegar a un comportamiento óptimo dado por el gestor. Las mejoras de estas afectaciones son cuantificadas mediante los indicadores I1 e I2p, y de este conjunto de valores se selecciona la que se acerca más al comportamiento óptimo. Debido a la extensa cantidad de información manejada en este análisis, se desarrolló una herramienta de cálculo automatizada en Matlab. El proceso seguido por esta herramienta es: (i) Ejecución del modelo OPTIGES para las diferentes modificaciones por acciones de gestión; (ii) Cálculo de los valores de I1 e I2p para cada una de estas afectaciones; y (iii) Selección de la mejor opción. Este proceso se repite hasta llegar al comportamiento óptimo buscado, permitiendo la identificación de las medidas de adaptación mas adecuadas. La aplicación de la metodología para la identificación de medidas de adaptación se realizó en la cuenca del Guadalquivir, por ser de las tres cuencas analizadas bajo los indicadores I1 e I2p la que presenta los problemas más serios de escasez de agua. Para la identificación de medidas de adaptación se analizaron dos acciones de gestión: 1) incremento de los volúmenes de regulación y 2) reducción de las demandas de riego, primero bajo la valoración del comportamiento físico del sistema (análisis de sensibilidad) permitiendo identificar que la primera acción de gestión no genera cambios importantes en el comportamiento del sistema, que si se presentan bajo la segunda acción. Posteriormente, con la acción que genera cambios importantes en el comportamiento del sistema (segunda acción) se identificaron las medidas de adaptación más adecuadas, mediante el análisis físico y económico del sistema. Se concluyó que en la cuenca del Guadalquivir, la acción de reducción de las demandas de riego permite minimizar e incluso eliminar los problemas de escasez de agua que se presentarían a futuro bajo diferentes proyecciones hidrológicas, aunque estas mejoras implicarían fuertes reducciones en dichas demandas. Siendo las demandas más afectadas aquellas ubicadas en cabecera de cuenca. Los criterios para la reducción de las demandas se encuentran en función de las productividades y garantías con las que son atendidas dichas demandas. This thesis makes a methodological contribution to the study of potentially suitable adaptation measures in the long term, where water resource systems undergo strong pressure due to the effects of climate change. This methodology integrates the physical analysis of the system, by the use of indicators which assess its behavior, and the economic analysis by the use of the value of water. The methodological procedure begins with the building of a set of future scenarios that capture, by one hand, the characteristics and variability of the streamflow of various climate models and, on the other hand, the hydrological characteristics of the study area. The study areas chosen were the Guadalquivir, Ebro and Duero basins, and as observed data where used runoff series in natural regimen estimated by the SIMPA model, which is calibrated in the whole Spanish territory. The observed series are for the 1961-1990 period. The future scenarios built represent the 2071-2100 periods. The identification of adaptation measures relied on the use of indicators that were able of characterize the behavior of one water resource system facing the effects of climate change. Because of that, the Demand Satisfaction Index (I1) and the Demand Reliability Index (I2) proposed by Martin-Carrasco et al. (2012) were selected. These indicators assess the behavior of a system by identifying the water scarcity problems that it presents, and require in order to be quantified the use of one optimization model. For this study the OPTIGES optimization model has been used. The determination of the indicators was made for the short-term analysis where the climates change effect are not relevant, so it was necessary to analyze their capability to be used in systems affected by those these. For this analysis three Spanish basins were selected: Guadalquivir, Duero and Ebro. It was determined that the indicator I2 is not suitable for this type of scenario. It was proposed a new indicator called “Demand Reliability Index under climate change” (I2p), which keeps the same assessment criteria than I2, but responsive under heavy reductions of streamflow due to climate change. The proposed methodology for identifying adaptation measures is based on an iterative process, in which the different elements of the system´s schema are affected by previously defined management actions, until reach an optimal behavior given by the manager. The improvements of affectations are measured by indicators I1 e I2p, and from this set of values it is selected the affectation that is closer to the optimal behavior. Due to the large amount of information managed in this analysis, it was developed an automatic calculation tool in Matlab. The process followed by this tool is: Firstly, it executes the OPTIGES model for the different modifications by management actions; secondly, it calculates the values of I1 e I2p for each of these affectations; and finally it chooses the best option. This process is performed for the different iterations that are required until reach the optimal behavior, allowing to identify the most appropriate adaptation measured. The application of the methodology for the identification of adaptation measures was conducted in the Guadalquivir basin, due to this was from the three basins analyzed under the indicators I1 e I2p, which presents the most serious problems of water scarcity. For the identification of adaptation measures there were analyzed two management actions: 1) To increase the regulation volumes, and 2) to reduce the irrigation demands, first under the assessment of the physical behavior of the system (sensibility analysis), allowing to identify that the first management action does not generate significant changes in the system´s behavior, which there are present under the second management action. Afterwards, with the management action that generates significant changes in the system´s behavior (second management action), there were identified the most adequate adaptation measures, through the physical and economic analysis of the system. It was concluded that in the Guadalquivir basin, the action of reduction of irrigation demands allows to minimize or even eliminate the water scarcity problems that could exist in the future under different hydrologic projections, although this improvements should involve strong reductions of the irrigation demands. Being the most affected demands those located in basins head. The criteria for reducing the demands are based on the productivities and reliabilities with which such demands are meet.

Integration of Virtual Map Rooms as a support tool in historical and social research

At the present time almost all map libraries on the Internet are image collections generated by the digitization of early maps. This type of graphics files provides researchers with the possibility of accessing and visualizing historical cartographic information keeping in mind that this information has a degree of quality that depends upon elements such as the accuracy of the digitization process and proprietary constraints (e.g. visualization, resolution downloading options, copyright, use constraints). In most cases, access to these map libraries is useful only as a first approach and it is not possible to use those maps for scientific work due to the sparse tools available to measure, match, analyze and/or combine those resources with different kinds of cartography. This paper presents a method to enrich virtual map rooms and provide historians and other professional with a tool that let them to make the most of libraries in the digital era.

Benchmarking of calculation schemes in Apollo2 and COBAYA3 for VVER lattices

This paper presents solutions of the NURISP VVER lattice benchmark using APOLLO2, TRIPOLI4 and COBAYA3 pin-by-pin. The main objective is to validate MOC based calculation schemes for pin-by-pin cross-section generation with APOLLO2 against TRIPOLI4 reference results. A specific objective is to test the APOLLO2 generated cross-sections and interface discontinuity factors in COBAYA3 pin-by-pin calculations with unstructured mesh. The VVER-1000 core consists of large hexagonal assemblies with 2mm inter-assembly water gaps which require the use of unstructured meshes in the pin-by-pin core simulators. The considered 2D benchmark problems include 19-pin clusters, fuel assemblies and 7-assembly clusters. APOLLO2 calculation schemes with the step characteristic method (MOC) and the higher-order Linear Surface MOC have been tested. The comparison of APOLLO2 vs.TRIPOLI4 results shows a very close agreement. The 3D lattice solver in COBAYA3 uses transport corrected multi-group diffusion approximation with interface discontinuity factors of GET or Black Box Homogenization type. The COBAYA3 pin-by-pin results in 2, 4 and 8 energy groups are close to the reference solutions when using side-dependent interface discontinuity factors.

History of health, a valuable tool in public health

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called “re-emerging diseases” and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.