Engaging current and potential medical students in clinical research during an elective hospital attachment: a qualitative study

Session - Curriculum Planning; International Medical EducationBACKGROUND AND PURPOSE: Exposure of medical students to research may increase the probability of their pursuing postgraduate research involvement(1,2). However, whether research exposure should ideally be mandatory (student-passive) or extra-curricular (student-proactive) is unclear(2-4). Furthermore, whether research exposure has any impact on students interested in but not yet studying medicine is also unknown. This study examines a strategy of actively offering clinical research opportunities to current and potential medical students during an …published_or_final_versio

Erythropoietin in traumatic brain injury associated acute kidney injury : A randomized controlled trial

Background Acute kidney injury (AKI) in traumatic brain injury (TBI) is poorly understood and it is unknown if it can be attenuated using erythropoietin (EPO). Methods Pre-planned analysis of patients included in the EPO-TBI (ClinicalTrials.gov NCT00987454) trial who were randomized to weekly EPO (40 000 units) or placebo (0.9% sodium chloride) subcutaneously up to three doses or until intensive care unit (ICU) discharge. Creatinine levels and urinary output (up to 7 days) were categorized according to the Kidney Disease Improving Global Outcome (KDIGO) classification. Severity of TBI was categorized with the International Mission for Prognosis and Analysis of Clinical Trials in TBI. Results Of 3348 screened patients, 606 were randomized and 603 were analyzed. Of these, 82 (14%) patients developed AKI according to KDIGO (60 [10%] with KDIGO 1, 11 [2%] patients with KDIGO 2, and 11 [2%] patients with KDIGO 3). Male gender (hazard ratio [HR] 4.0 95% confidence interval [CI] 1.4-11.2, P = 0.008) and severity of TBI (HR 1.3 95% CI 1.1-1.4, P <0.001 for each 10% increase in risk of poor 6 month outcome) predicted time to AKI. KDIGO stage 1 (HR 8.8 95% CI 4.5-17, P <0.001), KDIGO stage 2 (HR 13.2 95% CI 3.9-45.2, P <0.001) and KDIGO stage 3 (HR 11.7 95% CI 3.5-39.7, P <0.005) predicted time to mortality. EPO did not influence time to AKI (HR 1.08 95% CI 0.7-1.67, P = 0.73) or creatinine levels during ICU stay (P = 0.09). Conclusions Acute kidney injury is more common in male patients and those with severe compared to moderate TBI and appears associated with worse outcome. EPO does not prevent AKI after TBI.Peer reviewe

Rapid Detection of Leishmania infantum Infection in Dogs: Comparative Study Using an Immunochromatographic Dipstick Test, Enzyme-Linked Immunosorbent Assay, and PCR

Current zoonotic visceral leishmaniasis (ZVL) control programs in Brazil include the culling of Leishmania infantum-infected reservoir dogs, a strategy that has failed to prevent a rise of canine and human ZVL cases over the past decade. One of the main reasons this strategy has failed is because of a long delay between sample collection, sample analysis, and control implementation. A rapid, sensitive, and specific diagnostic tool would be highly desirable, because it would allow control interventions to be implemented in situ. We compared an immunochromatographic dipstick test to enzyme-linked immunosorbent assay (ELISA) and PCR for detecting L. infantum infections in dogs from an area of ZVL endemicity in Brazil. The dipstick test was shown to have 61 to 75% specificity and 72 to 77% sensitivity, compared to 100% specificity for both ELISA and PCR and 71 to 88% and 51 to 64% sensitivity for ELISA and PCR, respectively. Of the field samples tested, 92 of 175 (53%), 65 of 175 (37%), and 47 of 175 (27%) were positive by dipstick, ELISA, and PCR, respectively. The positive and negative predictive values for the tested dipstick were 58 to 77% and 75%, respectively. Efforts should be made to develop a more specific dipstick test for diagnosis of leishmaniasis, because they may ultimately prove more cost-effective than currently used diagnostic tests when used in mass-screening surveys

Diabetic Ketoacidosis

Objective: The management of children with diabetic ketoacidosis (DKA) continues to be a controversial issue with regard to amount of intravenous fluid to be given, rate of delivery of fluid, and type of fluid to be used. We aimed to analyze the results obtained by administration of rehydration fluids of two different sodium (Na) concentrations (75 mEq/L vs. 100 mEq/L) in the treatment of children with DKA. Methods: Thirty-two children with DKA were assessed for efficacy and safety of fluid treatment. After an initial rehydration time, intravenous fluids were switched to a 5 % dextrose solution with a Na content of 75 mEq/L (Group I, n=19) or 100 mEq/L (Group II, n=13). Venous blood samples were collected from all subjects at diagnosis and at the 4th, 8th, 16th and 24th hours of treatment. Results: Changes in blood glucose levels did not differ significantly between the two groups at the 4th, 8th, 16th and 24th hours of the follow-up. Nadir effective plasma osmolality (Peff osm) and Peff osm levels also did not show statistically significant differences. Plasma sodium (PNa) level did not drop lower than the level at diagnosis in both groups. The changes in PNa concentrations in the two groups were not statistically significant at diagnosis or in follow-up samples (p=0.74). pH, anion gap, pCO2 and HCO3 levels were also similar in Group I and Group II. The duration of a pH level of &lt;7.3 was shorter in Group II, but this was not statistically significant (p=0.65). None of the patients enrolled in this study developed cerebral edema. Conclusion: The efficacy and safety of rehydration fluids with Na concentrations of 75 or 100 mEq/L did not reveal any differences in children with DKA

Representing Polar Questions

Although the linguistic properties of polar questions have been extensively studied, comparatively little is known about how polar questions are processed in real time. In this paper, we report on three eye-tracking experiments on the processing of positive and negative polar questions in English and French. Our results show that in the early stages, participants pay attention to both positive and negative states of affairs for both positive and negative questions. In the late stages, positive and certain negative polar questions were associated with a bias for the positive state, and this bias appears to be pragmatic in nature. We suggest that different biases in mental representations reflect the hearer’s reasoning about the speaker’s purposes of enquiry

Étude biomécanique du traitement de la scoliose idiopathique par orthèse: effets des paramètres de conception des corsets sur les corrections géométriques et sur les contraintes internes du rachis.

RÉSUMÉ La scoliose est une déformation tridimensionnelle évolutive de la colonne vertébrale et de la cage thoracique. Pour des déformations modérées, le principal traitement utilisé est le traitement par corset. Son objectif est, à court-terme, de réduire les déformations scoliotiques et, à long-terme, d’en empêcher la progression. Toutefois le traitement par corset tel qu’il est effectué actuellement n’est pas optimal. La conception des corsets repose encore principalement sur des principes empiriques et l’expérience variée des orthésistes. Aucune étude, clinique ou numérique, n’a étudié directement l’effet des paramètres de conception d’un corset sur son efficacité. De nombreuses controverses existent encore de ce fait sur les paramètres de conception optimaux. De même, aucune étude, expérimentale ou numérique, n’a tenté de prouver que le traitement par corset permet de modifier favorablement les contraintes agissant sur les plaques de croissance d’un sujet scoliotique, démontrant ainsi de façon théorique l’efficacité du traitement à empêcher la progression des déformations. L’objectif général de ce projet est donc d’étudier l’effet du design des corsets sur la correction immédiate des déformations scoliotiques et sur les contraintes agissant sur les plaques de croissance. L’hypothèse que nous souhaitons vérifier est que le traitement par corset peut annuler l’asymétrie des contraintes de compression s’exerçant sur les plaques de croissance à l’apex des courbures scoliotiques mais que cet effet est dépendant des paramètres de conception du corset, ce qui nécessite un ajustement optimal. Cette étude a été divisée en 5 parties. Une méthode a tout d’abord été développée pour représenter les forces de gravité sur un modèle éléments finis (MEF) du tronc d’un patient scoliotique tout en respectant sa géométrie 3D. Un processus d’optimisation a permis de déterminer les forces à soustraire au MEF, dont la géométrie a été construit à partir d’une reconstruction 3D par radiographies biplanaires du patient, afin d’obtenir suite à l’application de la gravité un modèle correspondant à la géométrie réelle du patient. La différence entre la position 3D des vertèbres issue des radiographies et la position simulée des vertèbres du modèle EF après application de la gravité s’est avéré être inférieure à 3 mm. Les contraintes de compression et les moments d’inflexion latérale agissant sur les plateaux vertébraux ont été calculés. Il a été constaté que dans le plan frontal la concavité des courbures scoliotiques était soumise à des contraintes de compression moyennes supérieures de 0.1 à 0.4 MPa à celles de la convexité.----------ABSTRACT Scoliosis is defined as a three-dimensional deformity of the spine and rib cage. For moderate deformities, bracing is the most common treatment. Its aim is to reduce the scoliotic deformities in a short-term perspective and to prevent their progression in a long-term perspective. The brace treatment is however not optimal as it is practiced today. The braces design is mostly based on empirical principles and on the experience of the orthotists. The effects of the design parameters of a brace on its efficiency have never been studied, experimentally or numerically. As a consequence, the optimal brace design parameters are still controversial. No study demonstrated that the brace treatment modifies favorably the stresses in the vertebral growth plates of a scoliotic patient, proving thus that the brace treatment is theoretically efficient in preventing the scoliotic deformities from progressing. The objective of this project was consequently to study the effect of the brace design on the immediate correction of the scoliotic deformities and on the spinal stresses. The hypothesis we want to verify is that the brace treatment is able to nullify the asymmetry of the compressive stresses exerted on the growth plates at the apex of the scoliotic curves but this effect depends on the design parameters of the brace and an optimal adjustment is thus required. This study was divided into 5 parts. A simulation process was firstly developed to represent the gravity forces in a finite element model (FEM) of the trunk of a scoliotic patient. An optimization process computed the forces to substract to the FEM, based on the 3D reconstruction of biplanar x-rays of the patient, in order to obtain after the inclusion of the gravity forces a model corresponding to the actual geometry of the patient. The difference in the vertebral positions between the geometry acquired form radiographs and the computed geometry of the model including the gravity forces was inferior to 3 mm. The forces and compressive stresses in the scoliotic spine were then computed. An asymmetrical load in the coronal plane, particularly at the apices of the scoliotic curves, was present. Difference of mean compressive stresses between concavity and convexity of the scoliotic curves ranged between 0.1 and 0.4 MPa