My patient is thrombocytopenic! Is (s)he? Why? And what shall I do? A practical approach to thrombocytopenia

Solving the riddle of a thrombocytopenic patient is a difficult and fascinating task. The spectrum of possible aetiologies is wide, ranging from an in vitro artefact to severe treatment-resistant thrombocytopenic bleeding conditions, or even life-threatening prothrombotic states. Moreover, thrombocytopenia by itself does not protect from thrombosis and sometimes a patient with a low platelet count requires concomitant antithrombotic treatment as well. In order to identify and treat the cause and the effects of the thrombocytopenia, you have to put together several pieces of information, solving a unique jig-jaw puzzle. The present work is not a textbook article about thrombocytopenia, rather a collection of differential diagnostic thoughts, treatment concepts, and some basic knowledge, that you can retrieve when facing your next thrombocytopenic patient. Enjoy reading it, but most importantly enjoy taking care of patients with a low platelet count. I bet the present work will assist you in this challenging and rewarding clinical task.

A practical approach to designing syndromic surveillance systems for livestock and poultry

The field of animal syndromic surveillance (SyS) is growing, with many systems being developed worldwide. Now is an appropriate time to share ideas and lessons learned from early SyS design and implementation. Based on our practical experience in animal health SyS, with additions from the public health and animal health SyS literature, we put forward for discussion a 6-step approach to designing SyS systems for livestock and poultry. The first step is to formalise policy and surveillance goals which are considerate of stakeholder expectations and reflect priority issues (1). Next, it is important to find consensus on national priority diseases and identify current surveillance gaps. The geographic, demographic, and temporal coverage of the system must be carefully assessed (2). A minimum dataset for SyS that includes the essential data to achieve all surveillance objectives while minimizing the amount of data collected should be defined. One can then compile an inventory of the data sources available and evaluate each using the criteria developed (3). A list of syndromes should then be produced for all data sources. Cases can be classified into syndrome classes and the data can be converted into time series (4). Based on the characteristics of the syndrome-time series, the length of historic data available and the type of outbreaks the system must detect, different aberration detection algorithms can be tested (5). Finally, it is essential to develop a minimally acceptable response protocol for each statistical signal produced (6). Important outcomes of this pre-operational phase should be building of a national network of experts and collective action and evaluation plans. While some of the more applied steps (4 and 5) are currently receiving consideration, more emphasis should be put on earlier conceptual steps by decision makers and surveillance developers (1-3).

Predicting the onset of psychosis in patients at clinical high risk: practical guide to probabilistic prognostic reasoning

Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychosis in, person-time rate of psychosis, Kaplan-Meier estimates of psychosis risk, measures of prognostic accuracy, sensitivity and specificity in receiver operator characteristic curves, positive and negative predictive values, Bayes’ theorem, likelihood ratios, potentials and limits of real-life applications of prognostic probabilistic reasoning in the CHR state. Understanding basic measures used for prognostic probabilistic reasoning is a prerequisite for successfully implementing the early detection and prevention of psychosis in clinical practice. Future refinement of these measures for CHR patients may actually influence risk management, especially as regards initiating or withholding treatment.

Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus

INTRODUCTION Daylight-mediated photodynamic therapy has been shown to be an effective therapy for actinic keratoses (AKs) and a simple and tolerable treatment procedure in three randomized Scandinavian studies and two recent Phase III randomized controlled studies in Australia and Europe. OBJECTIVES To establish consensus recommendations for the use of daylight photodynamic therapy (DL-PDT) using topical methyl aminolaevulinate (MAL) in European patients with AKs. METHODS The DL-PDT consensus recommendations were developed on behalf of the European Society for Photodynamic Therapy in Dermatology and comprised of 10 dermatologists from different European countries with experience in how to treat AK patients with PDT. Consensus was developed based on literature review and experience of the experts in the treatment of AK using DL-PDT. RESULTS The recommendations arising from this panel of experts provide general guidance on the use of DL-PDT as a dermatological procedure with specific guidance regarding patient selection, therapeutic indications, when to treat, pre-treatment skin preparation, MAL application and daylight exposure for patients with AK in different countries of Europe. CONCLUSIONS This consensus recommendation provides a framework for physicians to perform DL-PDT with MAL cream while ensuring efficiency and safety in the treatment of patients with AK in different European countries.

Practical guide to thorough bass

written by A. F. C. Kollmann

Aerial Remote Sensing in Agriculture: A Practical Approach to Area Coverage and Path Planning for Fleets of Mini Aerial Robots

In this paper, a system that allows applying precision agriculture techniques is described. The application is based on the deployment of a team of unmanned aerial vehicles that are able to take georeferenced pictures in order to create a full map by applying mosaicking procedures for postprocessing. The main contribution of this work is practical experimentation with an integrated tool. Contributions in different fields are also reported. Among them is a new one-phase automatic task partitioning manager, which is based on negotiation among the aerial vehicles, considering their state and capabilities. Once the individual tasks are assigned, an optimal path planning algorithm is in charge of determining the best path for each vehicle to follow. Also, a robust flight control based on the use of a control law that improves the maneuverability of the quadrotors has been designed. A set of field tests was performed in order to analyze all the capabilities of the system, from task negotiations to final performance. These experiments also allowed testing control robustness under different weather conditions.

A practical approach to the global analysis of CLP programs

This paper presents and illustrates with an example a practical approach to the dataflow analysis of programs written in constraint logic programming (CLP) languages using abstract interpretation. It is first argued that, from the framework point of view, it sufnces to propose relatively simple extensions of traditional analysis methods which have already been proved useful and practical and for which efncient fixpoint algorithms have been developed. This is shown by proposing a simple but quite general extensión of Bruynooghe's traditional framework to the analysis of CLP programs. In this extensión constraints are viewed not as "suspended goals" but rather as new information in the store, following the traditional view of CLP. Using this approach, and as an example of its use, a complete, constraint system independent, abstract analysis is presented for approximating definiteness information. The analysis is in fact of quite general applicability. It has been implemented and used in the analysis of CLP(R) and Prolog-III applications. Results from the implementation of this analysis are also presented.

A practical approach to project management in a very small company

This article shows how a very small company has tailored Scrum according to its own needs. The main additions made were the “sprint design” phase and the “sprint test” phase. Before the sprint 0, the requirements elicitation and the functional specification were made in order to meet deadlines and costs agreed with clients. Besides, the introduction of an agile project management tool has supported all the process and it is considered the main success factor for the institutionalization of the Scrum process.

Qualitative study of patients’ perceptions of doctors’ advice to quit smoking: implications for opportunistic health promotion

Objectives: To determine the effectiveness and acceptability of general practitioners’opportunistic antismoking interventions by examining detailed accounts of smokers’ experiences of these.