General practitioner understanding of abbreviations used in hospital discharge letters

Determines the incidence of abbreviation use in electronic hospital discharge letters (eDLs) and general practitioner understanding of abbreviations used in eDLs. Abstract Objectives: To determine the incidence of abbreviation use in electronic hospital discharge letters (eDLs) and general practitioner understanding of abbreviations used in eDLs. Design, setting and participants: Retrospective audit of abbreviation use in 200 sequential eDLs was conducted at Nepean Hospital, Sydney, a tertiary referral centre, from 18 December to 31 December 2012. The 15 most commonly used abbreviations and five clinically important abbreviations were identified from the audit. A survey questionnaire using these abbreviations in context was then mailed to 240 GPs in the area covered by the Nepean Blue Mountains Local Health District to determine their understanding of these abbreviations. Main outcome measures: Number of abbreviations and frequency of their use in eDLs, and GPs’ understanding of abbreviations used in the survey. Results: 321 abbreviations were identified in the eDL audit; 48.6% were used only once. Fifty five per cent of GPs (132) responded to the survey. No individual abbreviation was correctly interpreted by all GPs. Six abbreviations were misinterpreted by more than a quarter of GPs. These were SNT (soft non-tender), TTE (transthoracic echocardiogram), EST (exercise stress test), NKDA (no known drug allergies), CTPA (computed tomography pulmonary angiogram), ORIF (open reduction and internal fixation). These abbreviations were interpreted incorrectly by 47.0% (62), 33.3% (44), 33.3% (44) 32.6% (43), 31.1% (41) and 28.0% (37) of GPs, respectively. Conclusion: Abbreviations used in hospital eDLs are not well understood by the GPs who receive them. This has potential to adversely affect patient care in the transition from hospital to community care

Probabilistic Analysis of Shallow Foundations on c-φ Soils Using 2nd Order Response Surface Methods

The HL-Reliability Index is utilized to investigate the applicability of several linear and nonlinear response surface models based on design experiments techniques to evaluate the safety under random loading, against bearing capacity failure of shallow foundations resting on c-φ soils with multivariate correlated variables. The reliability results obtained using FORM/SORM coupled with these models, are checked by Monte Carlo simulation method. It is demonstrated that the application of these models significantly reduces the execution time and memory requirements, with the central composite design scheme being the most accurate. It is also concluded, that consideration of correlation, significantly affects the reliability index for large values of soil friction angle uncertainty. The reliability index is found to be highly sensitive to uncertainties of soil friction angle more than the cohesion and the loading which have approximately the same influence, especially for the case of lognormally distributed variables. In addition, the probabilistic results show that reliability index decreases substantially with the increase of the applied pressure, and that there is significant difference between the reliability indices values computed, based on the assumption of normal distribution as compared to lognormal distribution, especially for the lower ranges of applied loading

Comparison of Cyanobacteria Phenotypes with Distinctive Photosynthetic Pigment Compositions to Simulated Lake Browning

Browning of inland waters has been noted over large parts of the Northern hemisphere and is a phenomenon with both ecological and societal consequences. The increase in water color is generally ascribed to increasing concentrations of dissolved organic matter (cDOM) of terrestrial origin. Changes in water color will have profound effects on the phytoplankton composition in freshwater systems. Here, I examined the effect of changes in water color associated with coloured DOM (cDOM) on red and green phenotypes of the cyanobacterium, Pseudanabaena, which emerged to surface blooms in Dickson Lake (Algonquin Provincial Park, Ontario) in the summer of 2014. Results presented here indicated that: (A) the increased level of cDOM had little effect on the growth and photosynthetic activity of either phenotype when grown independently, suggesting that lake browning was a benign, rather than selective, ecological driver; and (B) neither phenotype achieved a competitive advantage when the two phenotypes were grown together under defined cDOM regimes suggesting coexistence of both phenotypes. These findings temper the ideas that, with climate change, only specific bloom forming cyanobacteria will prevail, as both phenotypes of Pseudanabaena were present and showed the ability to co-exist. Cyanobacteria of this genera are likely to thrive under warmer and browner conditions due to their photosynthetic pigment composition that allows them to capture light at a variety of wavelengths

Synthèse, études physico-chimiques et biologiques de conjugués oestradiol- rose bengale pour la thérapie photodynamique anticancéreuse

La photothérapie dynamique (PDT) est un traitement thérapeutique anticancéreux basé sur la libération d'espèces oxygénées réactives par un photosensibilisateur en présence de lumière et d'oxygène. Pour augmenter l'activité photocytotoxique des photosensibilisateurs, la vectorisation active du Rose Bengale par le ciblage du récepteur nucléaire de l'oestradiol a été réalisée. Pour parvenir à cet objectif, la dérivatisation de l'oestradiol en position 17 bêta à l'aide d'anhydride succinique a été optimisée en un premier temps, en fonction des solvants et de la température. En un second temps, la fixation du Rose Bengale au 17 hémisuccinate d'oestradiol par l'intermédiaire d'un bras espaceur , le dioxadodécanodiamine, via la formation de liaisons amides, a été effectuée en comparant l'efficacité des activateurs de fonction acide, benzotriazolyl-N-oxytris-(diméthylamino)phosphonium (BOP), dicyclocarbodiimide (DCC), N-(3-diméthylaminopropyl)-N'-éthylcarbodiimide (EDC) et 1-hydroxybenzotriazole (HOBT). En un troisième temps le bras espaceur, dioxadodécanodiamine (16 Angstrom) a été substitué par quatre bras de longueurs différentes ; 7,4; 30; 38 et 76 Angstrom. Les propriétés physicochimiques (absorbtion UV-visible, fluorescence, génération d'oxygène singulet) des 5 conjugués ont été caractérisés, l'activité photocytotoxique, ainsi que la pénétration cellulaire vis à vis de cellules cancéreuses mammaire (MCF-7) ont été étudiées. La longueur et la lipophilie du bras espaceur sont des facteurs limitant à l'activité photocytotoxique. Le conjugué E-RB (16 Angstrom) présente une activité photocytotoxique 13 fois supérieur à celle du Rose Bengale seul, le conjugué E-RB (7,4 Angstrom) est 6 fois supérieur au Rose Bengale seul en terme d'activité photocytotoxique, les conjugués E-RB (30 Angstrom) et E-RB (38 Angstrom) sont 2,5 fois supérieur au Rose Bengale seul, le conjugué E-RB (70 Angstrom) a une activité photocytotoxique similaire au Rose Bengale. Les images réalisées en microscopie confocale ont montré que le conjugués E-RB (16 Angstrom) se trouve a l'intérieur du noyau des cellules MCF-7. Les autres conjugués, tout comme le Rose Bengale sont exclus très rapidement des cellules cancéreuses.Photodynamic therapy (PDT) is an anti-cancer therapeutic treatment based on the release of reactive species oxygenated by a photosensitizer in the presence of light and oxygen. To increase the photocytotoxic activity of the photosensitizer, the active vectorization of the Rose Bengal by targeting the nuclear receptor of estradiol was carried out. To achieve this objective, the derivatisation of the estradiol in position 17 beta using succinic anhydride was optimized in the first time according to solvents and temperature. In the second time, the fixing of the Rose Bengal to the 17 estradiol hémisuccinate via an arm spacer, the dioxadodécanodiamine, via the formation of bonds amides, was carried out by comparing the effectiveness of the activators of acid function benzotriazolyl-N-oxytris-(diméthylamino) phosphonium (BOP), dicyclocarbodiimide (DCC), N (3-diméthylaminopropyl)-éthylcarbodiimide (EDC) and 1-hydroxybenzotriazole (HOBT). In the third time the arm spacer, dioxadodécanodiamine which measures 16 Angstrom was substituted by four different arms length, 7.4; 30; 38 and 76 Angstrom, the physicochemical properties (UV-visible absorbtion, fluorescence, generation of singulet oxygen) of the 5 conjugates were characterized. The photocytotoxic activity, as well as the cellular penetration towards human breast cancer cells (MCF-7) of the different conjugates were studied. The length and the lipophilicity of the arm spacer are limiting factors to the photocytotoxic activity. The E-RB (16 Angstrom) conjugate show a photocytotoxic activity 13 times superior to that of the Rose Bengal, the E-RB (7,4 Angstrom) conjugate is 6 times superior to the Rose Bengal in term of photocytotoxic activity, the E-RB (30 Angstrom) and E-RB (38 Angstrom) conjugates are 2.5 times superior to the Rose Bengal, the E-RB (70 Angstrom) conjugates has a photocytotoxic activity similar to Rose Bengal. The images carried out in confocal microscopy showed that the E-RB (16 Angstrom) conjugate targets the nucleus of the human breast cancer cells (MCF-7). The others conjugates, just like Rose Bengal are excluded very quickly from the cancer cells

Once Upon A Time: Teaching Preservice Educators Dialogic Reading Strategies

This study investigated the effects of instruction on the retention and application of dialogic reading (DR) strategies by undergraduate students in a Child Studies program. Thirty-eight participants, enrolled in the same field placement course, were assigned to one of three groups. The first group received only in-class instruction on DR strategies. The other two groups received the same in-class instruction and additionally engaged in observation and reflection; one group observed and reflected on a teacher’s use of DR in a video, while the second group observed and reflected on their own use of DR practices, after having recorded themselves reading to a child. The pretest and posttest measures were participants' responses to a hypothetical bookreading scenario. These responses were transcribed and scored for the number of different DR strategies mentioned (diversity of DR strategies), the number of examples given (frequency of DR strategies), and a ratio of the two variables (i.e., examples/diversity). Mixed ANOVA analyses showed a significant effect of group and time for each of these variables. Post hoc tests indicated that the group receiving only in-class instruction scored significantly lower than the two observation groups on all three dependent variables. However, there was no significant difference between the self-observation group and the teacher-observation group on all three variables. The implications of the findings for teaching DR are discussed

Design of a robust Controller/Observer for TCP/AQM network: First application to intrusion detection systems for drone fleet

International audienceThis paper proposes a robust controller/observer for UAVs network anomaly estimation which is based on both Lyapunov Krasovkii functional and dynamic behavior of TCP (Transmission Control Protocol). Several research works on network anomaly estimation have been led using automatic control techniques and provide methods for designing both observer and command laws dedicated to time delay problem while estimating the anomaly or intrusion in the system. The observer design is based on a linearized fluid-flow model of the TCP behavior and must be associated to an AQM (Active Queue Management) to perform its diagnosis. The developed robust controller/observer in this paper has to be tuned by considering the time delay linear state-space representation of TCP model. As a first result, the designed controller/observer system has been successfully applied to some relevant practical problems such as topology network for aerial vehicles and the effectiveness is illustrated by using real traffic traces including Denial of Service attacks. Our first results show promising perspectives for Intrusion Detection System (IDS) in a fleet of UAVs

Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study

Background: In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations. Methods: A ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS. Results: The most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%),and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 - 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 - 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS. Conclusions: Patients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency

Efecto de la extracción de premolares por ortodoncia en la erupción de los terceros molares

Certain orthodontic treatments may need as a complement the extraction of dental pieces, and depending on the treatment these pieces may be the first or second premolars, superior and / or inferior. In some cases, the extraction of premolars promotes an increase in the size of the retromolar space, and with this the probability of eruption of the third molars increases. To analyze if such eruption is possible, after the extraction of the premolars in case the orthodontic treatment indicates its necessity, the radiographs and especially the panoramic ones are studied...Ciertos tratamientos de Ortodoncia pueden llegar a necesitar como complemento la extracción de piezas dentarias, y dependiendo del tratamiento adecuado estas piezas pueden ser los primeros o segundos premolares, superiores y/o inferiores. En algunos casos la extracción de premolares induce a un aumento del tamaño del espacio retromolar, con lo cual la probabilidad de erupción de los terceros molares aumenta. Para analizar si dicha erupción es posible, posteriormente a la extracción de los premolares en caso de que el tratamiento de ortodoncia indique su necesidad, se estudian las radiografías y en especial las panorámicas..