OBJECTIVE: To develop and test a clinical protocol for determining post-traumatic amnesia by retrospective questioning. To establish its limits and factors which influence reliability. DESIGN: Two ...independent assessments using the Rivermead post-traumatic amnesia protocol were undertaken by separate observers on various groups of patients at various time intervals. Analysis investigated the correlations between assessments, the percentage difference between assessments, the number of patients changing category, and the differences between these analyses in the different patient subgroups. Assessments were undertaken both in hospital and in the patients' homes. Four different patient groups were studied. These were group A: 12 inpatients with very severe head injury late after injury; Group B: 40 patients interviewed at home six months after injury; group C: 22 patients interviewed within a few weeks of injury at home; group D: 116 patients interviewed initially within a few weeks and then at six months, on both occasions at home. The Rivermead post-traumatic amnesia protocol involved clinical questioning of the patient to establish how long after injury (in hours/days/weeks) the patient regained continuous day to day memory. All periods of coma were included. Severity was categorised with standard criteria. RESULTS: Overall correlation was good (Spearman's r 0.79), but the correlation was lower for patients with post-traumatic amnesia < 24 hours and when there was a long delay between assessments. In all groups 19%-25% of patients changed categories between assessments, but only 2% changed by two categories. CONCLUSIONS: The assessment of post-traumatic amnesia with the Rivermead post-traumatic amnesia protocol is reasonably reliable. The misclassification rate however, is significant enough that some caution should be taken in individual cases. Other evidence does show post-traumatic amnesia to be valid, and it probably remains the best simple prognostic item available. In clinical practice one should avoid placing too much weight on post-traumatic amnesia alone.
Context. Exoplanet properties crucially depend on the parameters of their host stars: more accurate stellar parameters yield more accurate exoplanet characteristics. When the exoplanet host star ...shows pulsations, asteroseismology can be used for an improved description of the stellar parameters. Aims. We aim to revisit the pulsational properties of β Pic and identify its pulsation modes from normalized amplitudes in five different passbands. We also investigate the potential presence of a magnetic field. Methods. We conducted a frequency analysis using three seasons of BRITE-Constellation observations in the two BRITE filters, the about 620-day-long bRing light curve, and the nearly 8-year-long SMEI photometric time series. We calculated normalized amplitudes using all passbands and including previously published values obtained from ASTEP observations. We investigated the magnetic properties of β Pic using spectropolarimetric observations conducted with the HARPSpol instrument. Using 2D rotating models, we fit the normalized amplitudes and frequencies through Monte Carlo Markov chains. Results. We identify 15 pulsation frequencies in the range from 34 to 55 d−1, where two, F13 at 53.6917 d−1 and F11 at 50.4921 d−1, display clear amplitude variability. We use the normalized amplitudes in up to five passbands to identify the modes as three ℓ = 1, six ℓ = 2, and six ℓ = 3 modes. β Pic is shown to be non-magnetic with an upper limit of the possible undetected dipolar field of 300 Gauss. Conclusions. Multiple fits to the frequencies and normalized amplitudes are obtained, including one with a near equator-on inclination for β Pic, which corresponds to our expectations based on the orbital inclination of β Pic b and the orientation of the circumstellar disk. This solution leads to a rotation rate of 27% of the Keplerian breakup velocity, a radius of 1.497 ± 0.025 R⊙, and a mass of 1.797 ± 0.035 M⊙. The ∼2% errors in radius and mass do not account for uncertainties in the models and a potentially erroneous mode-identification.
Background If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors ...that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a ‘journey’ across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues.
Objectives In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance, define educational need and initiate educational action.
Method To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess.
Conclusions We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.
Objectives. King (1996) reported that a combination of emotional, organic and neuropsychological measures taken at 7‐10 days following mild and moderate head injury may significantly help predict ...patients most likely to suffer persisting postconcussion symptoms (PCS) at three months post‐injury. This study investigated a cross‐validation sample (N= 57) to determine whether the results would be replicated for the early prediction of longer‐term sufferers (i.e. those with persisting symptoms at 6 months post‐injury).
Design. Multiple regression analyses were used in which scores on the Hospital Anxiety and Depression Scale, Impact of Event Scale, Short Orientation Memory and Concentration Test, Rivermead Post‐Concussion Symptoms Questionnaire and Post‐Traumatic Amnesia taken at 7‐10 days post‐injury were the independent measures. Scoring on the Rivermead Post‐Concussion Symptoms Questionnaire taken at 6 months post‐injury was the dependent measure.
Methods. Sixty‐six consecutive patients admitted to any trauma ward in Oxfordshire with a mild or moderate head injury were recruited from a largescale randomized controlled sample. The assessment measures were administered at 7‐10 days post‐injury and the Rivermead Post‐Concussion Symptoms Questionnaire at 6 months post‐injury. Nine patients were unable to be followed up, leaving an active sample of 57.
Results. The cross‐validation data confirmed that a similar combination of measures to that found in the original study best predicted persisting PCS but that the strength of prediction diminished for the longer term prediction (i.e. 6 months post‐injury).
Conclusions. The Hospital Anxiety and Depression Scale, Impact of Event Scale and Post‐Traumatic Amnesia in combination are recommended as useful prognostic screening instruments for predicting persisting PCS, but great caution is required if they are used to aid predictions beyond 3 months post‐injury.
Boaventura de Sousa Santos De la Fuente, Alejandro; Reid Andrews, George; Ferreira, Roquinaldo ...
11/2019
eBook
Open access
Este livro procura apresentar aos leitores o dinâmico e crescente campo dos estudos afro-latino-americanos. Definimos esse campo, primeiro, como o estudo dos povos de ascendência africana na América ...Latina e, segundo, como o estudo das sociedades mais amplas das quais esses povos fazem parte. No primeiro tópico, os acadêmicos estudam histórias, culturas, estratégias e lutas do negro na região. No segundo, estudam negritude e raça de modo geral, como uma categoria de diferença, como motor de estratificação e desigualdade e como uma variável-chave nos processos de formação nacional.
Abstract During the transformation from larval tadpole to juvenile frog, there are critical periods of metamorphic development and sex differentiation that may be particularly sensitive to endocrine ...disruption. The aim of the present study was to identify sensitive developmental periods for estrogenic endocrine disruption in the northern leopard frog ( Rana pipiens ) using short, targeted exposures to the synthetic estrogen, ethinylestradiol (EE2). Post-hatch tadpoles (Gosner stage 27) were exposed over five distinct periods of metamorphosis: early (stage 27–30), mid (stage 30–36), early and mid (stage 27–36), late (stage 36–42), and the entire metamorphic period (chronic; stage 27–42). For each period, animals were sampled immediately following the EE2 exposure and at metamorphic climax (stage 42). The effects of EE2 on metamorphic development and sex differentiation were assessed through measures of length, weight, developmental stage, days to metamorphosis, sex ratios and incidence of gonadal intersex. Our results show that tadpoles exposed to EE2 during mid-metamorphosis were developmentally delayed immediately following exposure and took 2 weeks longer to reach metamorphic climax. In the unexposed groups, there was low proportion (0.15) of intersex tadpoles at stage 30 and gonads appeared to be morphologically distinct (male and female) in all individuals by stage 36. Tadpoles exposed early in development displayed a strong female-biased sex ratio compared to the controls. Moreover, these effects were also seen at metamorphic climax, approximately 2–3 months after the exposure period, demonstrating that transient early life-stage exposure to estrogen can induce effects on the reproductive organs that persist into the beginning of adult life-stages.
BACKGROUND:Limited data exist in the United States on the prevalence of HIV among women who exchange sex.
SETTING:We estimate HIV prevalence of women who exchange sex from a 2016 survey in Chicago, ...Detroit, Houston, and Seattle and compare it with the prevalence of HIV among women of low socioeconomic status (SES), who did not exchange sex, and women in the general population.
METHODS:Women who exchange sex were recruited via respondent-driven sampling among some cities participating in National HIV Behavioral Surveillance, interviewed, and offered HIV testing. We estimate HIV prevalence and, using prevalence ratios, compare it with the prevalence among women of low SES who did not exchange sex in the 2013 National HIV Behavioral Surveillance cycle, and to women in the general population estimated using 2015 National HIV Surveillance data.
RESULTS:One thousand four hundred forty women reported exchange sex in 2016. Aggregated HIV prevalence was 4.9% 95% confidence interval (CI)2.7 to 7.1 among women who exchanged sex, 1.6% (95% CI0.3 to 2.8) among women of low SES who did not exchange sex, and 0.6% (95% CI0.5% to 0.6%) among women in the general population. HIV prevalence among women who exchanged sex was 3.1 times (95% CI1.6 to 5.9) as high as among women of low SES who did not exchange sex, and 8.8 times (95% CI7.0 to 11.1) as high as among women in the general population.
CONCLUSION:HIV prevalence was significantly higher among women who exchanged sex compared with women in the general population and women of low SES who did not exchange sex.
We examined roles of loading and inflammation on forearm bones in a rat model of upper extremity overuse. Trabecular structure in distal radius and ulna was examined in three groups of young adult ...rats: 1) 5% food-restricted that underwent an initial training period of 10 min/day for 5 weeks to learn the repetitive task (TRHF); 2) rats that underwent the same training before performing a high repetition high force task, 2 hours/day for 12 weeks (HRHF); and 3) food-restricted only (FRC). Subsets were treated with oral ibuprofen (IBU). TRHF rats had increased trabecular bone volume and numbers, osteoblasts, and serum osteocalcin, indicative of bone adaptation. HRHF rats had constant muscle pulling forces, showed limited signs of bone adaptation, but many signs of bone resorption, including decreased trabecular bone volume and bone mineral density, increased osteoclasts and bone inflammatory cytokines, and reduced median nerve conduction velocity (15%). HRHF+IBU rats showed no trabecular resorptive changes, no increased osteoclasts or bone inflammatory cytokines, no nerve inflammation, preserved nerve conduction, and increased muscle voluntary pulling forces. Ibuprofen treatment preserved trabecular bone quality by reducing osteoclasts and bone inflammatory cytokines, and improving muscle pulling forces on bones as a result of reduced nerve inflammation.
To describe the interventions given by the Oxford Head Injury Service (OXHIS) to patients seen after head injury, predominantly mild or moderate, over the first six months after their injuries.
...Descriptive data of the amounts of early intervention provided by OXHIS in relation to severity of head injury and the amount of service need identified at six month follow-up.
OXHIS aimed to register all patients aged 16-65 with a head injury of any severity, resident in Oxfordshire. It contacted and provided interventions for a random half of those registered at 7-10 days post-injury as part of a randomized controlled trial to investigate the effectiveness of early follow-up. At six months post-injury, independent assessment of all those registered was undertaken to evaluate outcome and identify continuing service needs.
The data come from the 579 patients (of the 1156 registered), randomized to receive the new service at 7-10 days post-injury. All but eight of these received some form of service, and 252 of the randomized patients were available for interview at six months post-injury to assess their continuing service need.
In the first five months after head injury: 240 patients received postal information alone and were not otherwise in contact with the service; 127 had telephone contact, advice and information; 93 were seen in person, assessed and given advice and information; 78 needed more help and support from the OXHIS team over the telephone; and 33 required further face-to-face contact either from OXHIS or other services. Extensive use was made of standardized leaflets but only accompanied by individualized assessment and advice. At six months 252 of the 579 patients were interviewed: 101 had no problems; 136 needed further reassurance; and 15 required further intervention. Patients with longer periods of post-traumatic amnesia (PTA) were more likely to receive a higher level of service, but the majority of patients who received the more extensive services were those with 'mild' and 'moderate' head injuries.
Although the amount of service provided at 7-10 days post-injury increased with severity of head injury, most service was in fact given to patients with milder head injuries which were much more common. The majority of patients seen at six months post-injury needed reassurance, advice or other services, and monitoring of patients for some time after their head injuries does seem warranted. A population of 560,000 people could receive service from three whole-time equivalent (WTE) staff using these assessment and management protocols.
This paper presents real time test results arising from the application of a case based reasoning technique for voltage control of a section of existing UK 11kV network. The test network includes two ...distributed generation schemes. The objective of the case based reasoning technique is to maintain voltages within statutory limits while also maximizing the DG access to the network. The control algorithm is embedded on a commercially available hardware platform designed for installation in power system substations. The case based reasoning technique employs the following control actions to achieve its objectives: DG real power control, DG reactive power control and transformer tap change control. The voltage control technique is tested during over-voltage conditions and for situations where only partial sensor data is available.
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