The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel. METHODOLOGY: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience. RESULTS: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent. POSTINTERVENTION RESULTS: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the postintervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage. CONCLUSION: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance

Parâmetros genéticos e avaliação genética de características morfofuncionais do burro de Miranda

Apresentação oralO Burro de Miranda é uma das duas raças asininas autóctones portuguesas, que está atualmente incluída num programa de conservação e melhoramento genético. O objetivo deste estudo foi realizar a estimativa de parâmetros genéticos e a avaliação genética para as características morfofuncionais do Burro de Miranda: Altura ao Garrote (AltG), Andamentos (An), Cabeça e Pescoço (CP), Conjunto de Formas (CF), Espádua e Garrote (EG), Garupa (Ga), Membros (Me), Pelagem (Pe), Pontuação Total (PT) e Tronco (Tr). Utilizaram-se 5685 registos genealógicos e 825 a 863 dados morfofuncionais de Burros de Miranda nascidos entre 1982 e 2021, num total de 224 criadores. As estimativas dos parâmetros genéticos foram obtidas por máxima verosimilhança restrita, através do BLUP – Modelo Animal, em análises univariadas com o programa MTDFREML. O modelo animal utilizado incluiu os efeitos fixos do criador de origem, do ano de nascimento, do género, efeito linear e quadrático da idade à classificação e efeito linear da consanguinidade individual e, como efeitos aleatórios, o valor genético direto e o erro residual. As estimativas do valor da heritabilidade foram altas para a AltG (0.611 cm) e Pe (0.665 pontos), intermédias para a CP (0.216 pontos) e reduzidas para a PT, An, Tr e CF (0.027, 0.083, 0.114 e 0.153 pontos). Foram ainda estimadas as tendências genéticas da AltG, An, CP, CF, Pe, PT e Tr, por regressão do valor genético de cada característica no ano de nascimento. De um modo geral as tendências genéticas para os caracteres avaliados foram positivas, mas muito reduzidas (entre 0.0003 pontos/ano nos An e 0.0034 cm/ano na AltG). Este trabalho contribuiu para a implementação da avaliação genética nesta raça. A disponibilização dos resultados obtidos aos criadores de Burros de Miranda e poderá vir a facilitar a escolha dos futuros reprodutores e agilizar a seleção para determinadas características.info:eu-repo/semantics/publishedVersio

Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students’ Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study

Background: Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored. Objective: To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability. Methods: Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results. Results: This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students’ performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions. Conclusions: If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students’ skills in the detection of caries lesions and clinical decision-making

Bivariate genome-wide association meta-analysis of pediatric musculoskeletal traits reveals pleiotropic effects at the SREBF1/TOM1L2 locus

Bone mineral density is known to be a heritable, polygenic trait whereas genetic variants contributing to lean mass variation remain largely unknown. We estimated the shared SNP heritability and performed a bivariate GWAS meta-analysis of total-body lean mass (TB-LM) and total-body less head bone mineral density (TBLH-BMD) regions in 10,414 children. The estimated SNP heritability is 43% for TBLH-BMD, and 39% for TB-LM, with a shared genetic component of 43%. We identify variants with pleiotropic effects in eight loci, including seven established bone mineral density loci: _WNT4, GALNT3, MEPE, CPED1/WNT16, TNFSF11, RIN3, and PPP6R3/LRP5_. Variants in the _TOM1L2/SREBF1_ locus exert opposing effects TB-LM and TBLH-BMD, and have a stronger association with the former trait. We show that _SREBF1_ is expressed in murine and human osteoblasts, as well as in human muscle tissue. This is the first bivariate GWAS meta-analysis to demonstrate genetic factors with pleiotropic effects on bone mineral density and lean mass

The impact of the metabotropic glutamate receptor and other gene family interaction networks on autism

Although multiple reports show that defective genetic networks underlie the aetiology of autism, few have translated into pharmacotherapeutic opportunities. Since drugs compete with endogenous small molecules for protein binding, many successful drugs target large gene families with multiple drug binding sites. Here we search for defective gene family interaction networks (GFINs) in 6,742 patients with the ASDs relative to 12,544 neurologically normal controls, to find potentially druggable genetic targets. We find significant enrichment of structural defects (P≤2.40E-09, 1.8-fold enrichment) in the metabotropic glutamate receptor (GRM) GFIN, previously observed to impact attention deficit hyperactivity disorder (ADHD) and schizophrenia. Also, the MXD-MYC-MAX network of genes, previously implicated in cancer, is significantly enriched (P≤3.83E-23, 2.5-fold enrichment), as is the calmodulin 1 (CALM1) gene interaction network (P≤4.16E-04, 14.4-fold enrichment), which regulates voltage-independent calcium-activated action potentials at the neuronal synapse. We find that multiple defective gene family interactions underlie autism, presenting new translational opportunities to explore for therapeutic interventions

Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C: A prospective observational study

Background: Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. Methods: In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with =2 clinical signs/symptoms of NP-C were considered ''suspected NP-C'' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI =70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. Results: In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores =70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. Conclusion: This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis

Editorial: Changes and Clarifications to the Policies of the International Journal of Primatology to Promote Transparency and Open Communication.

The joint meeting of the International Primatological Society and the American Society of Primatologists in Chicago 2016 provided an opportunity to discuss and update the policies of the International Journal of Primatology, the official journal of the International Primatological Society. As a result, we have made several changes and clarifications to journal policy. Most of these are to improve transparency. Scientific progress requires transparency and open communication among scientists. However, an emphasis on innovation combined with insufficient and selective reporting of methods and results impede progress. In this editorial we clarify our policies on replication, reproducibility, null results, statistical reporting, and methods validation. We have updated the Instructions for Authors and introduced badges to acknowledge open science. We also take this opportunity to summarize other changes to the International Journal of Primatology

Local synchronization indices for rotors detection in atrial fibrillation: A simulation study

Stable rotors have been proposed as mechanisms that maintain atrial fibrillation which is the most common arrhythmia worldwide. The information of intracardiac electrograms (EGMs), recorded through multielectrode arrays, is used to characterize the electrical conduction dynamics and thus to identify rotors or reentrant propagating waves. Most of the methods of EGMs processing are based on the assessment of the individual properties of each EGM signal. Additionally, synchronization indices have been proposed to evaluate the properties of the conduction patterns by means of multivariate analysis. However, the problem of rotor detection through EGMs remains open. We evaluate the behavior of four local synchronization indices using computational simulations of different conduction patterns and the corresponding EGMs in 2D models. The results show that phase synchronization exhibits better performance than correlation, coherence, and mutual information for detecting rotors under different fibrillatory patterns. We also show that this approach outperforms a previously reported technique based on entropy analysis of individual EGM. Synchronization maps using phase-locking values calculated from adjacent EGM highlight the vicinity of the core of stable rotors, even in the presence of multiple wavefronts and wave breaks. Therefore, phase-locking maps can be a useful tool for characterizing rotors during atrial fibrillation episodes. © 202