The effects of laryngeal mask airway passage simulation training on the acquisition of undergraduate clinical skills: a randomised controlled trial

Background\ud Effective use of the laryngeal mask airway (LMA) requires learning proper insertion technique in normal patients undergoing routine surgical procedures. However, there is a move towards simulation training for learning practical clinical skills, such as LMA placement. The evidence linking different amounts of mannequin simulation training to the undergraduate clinical skill of LMA placement in real patients is limited. The purpose of this study was to compare the effectiveness in vivo of two LMA placement simulation courses of different durations. \ud \ud Methods\ud Medical students (n = 126) enrolled in a randomised controlled trial. Seventy-eight of these students completed the trial. The control group (n = 38) received brief mannequin training while the intervention group (n = 40) received additional more intensive mannequin training as part of which they repeated LMA insertion until they were proficient. The anaesthetists supervising LMA placements in real patients rated the participants' performance on assessment forms. Participants completed a self-assessment questionnaire. \ud \ud Results\ud Additional mannequin training was not associated with improved performance (37% of intervention participants received an overall placement rating of > 3/5 on their first patient compared to 48% of the control group, $X^2$ = 0.81, p = 0.37). The agreement between the participants and their instructors in terms of LMA placement success rates was poor to fair. Participants reported that mannequins were poor at mimicking reality. \ud \ud Conclusions\ud The results suggest that the value of extended mannequin simulation training in the case of LMA placement is limited. Educators considering simulation for the training of practical skills should reflect on the extent to which the in vitro simulation mimics the skill required and the degree of difficulty of the procedure. \ud \u

Functional renormalization group with a compactly supported smooth regulator function

The functional renormalization group equation with a compactly supported smooth (CSS) regulator function is considered. It is demonstrated that in an appropriate limit the CSS regulator recovers the optimized one and it has derivatives of all orders. The more generalized form of the CSS regulator is shown to reduce to all major type of regulator functions (exponential, power-law) in appropriate limits. The CSS regulator function is tested by studying the critical behavior of the bosonized two-dimensional quantum electrodynamics in the local potential approximation and the sine-Gordon scalar theory for d<2 dimensions beyond the local potential approximation. It is shown that a similar smoothing problem in nuclear physics has already been solved by introducing the so called Salamon-Vertse potential which can be related to the CSS regulator.Comment: JHEP style, 11 pages, 2 figures, proofs corrected, accepted for publication by JHE

Holographic Geometry of Entanglement Renormalization in Quantum Field Theories

We study a conjectured connection between the AdS/CFT and a real-space quantum renormalization group scheme, the multi-scale entanglement renormalization ansatz (MERA). By making a close contact with the holographic formula of the entanglement entropy, we propose a general definition of the metric in the MERA in the extra holographic direction, which is formulated purely in terms of quantum field theoretical data. Using the continuum version of the MERA (cMERA), we calculate this emergent holographic metric explicitly for free scalar boson and free fermions theories, and check that the metric so computed has the properties expected from AdS/CFT. We also discuss the cMERA in a time-dependent background induced by quantum quench and estimate its corresponding metric.Comment: 42pages, 9figures, reference added, minor chang

Evolución de la preparación física en el fútbol

The In the area of sport, has been being shown, one of the most important factors for the athlete to perform at its best is to have a good physical condition. Regardless of the technical improvement, medical support nutrition, new materials, etc.. physical training has in recent years experienced an extraordinary evolution in both quantity and quality. In recent decades, sports science have greatly evolved as a result of this progress are appearing in the physical preparation in football at all levels. In this article the main trends that have historically been being used to improve various physical qualities involving this sport, with the aim of achieving the best possible performance are analyzed.En el ámbito del deporte, ha venido siendo demostrado, que uno de los factores más importantes para que el deportista pueda rendir en las mejores condiciones es el de tener una buena preparación física. Independientemente del perfeccionamiento técnico, apoyo médico, nutrición, nuevos materiales, etc. la preparación física ha experimentado en los últimos años una evolución extraordinaria, tanto en cantidad como en calidad. En las últimas décadas las ciencias del deporte han evolucionado enormemente, producto de ello son los avances aparecidos en la preparación física en el fútbol a todos sus niveles. En este artículo se analizan las principales tendencias que históricamente han venido empleándose para la mejora de las diferentes cualidades físicas que implican la práctica de este deporte, con el objetivo de alcanzar el mejor rendimiento posible

The Dry Puna as an ecological megapatch and the peopling of South America: Technology, mobility, and the development of a late Pleistocene/early Holocene Andean hunter-gatherer tradition in northern Chile

Current scientific evidence shows that humans colonized South America at least 15,000 years ago, but there are still many unknown aspects of this process, including the major and minor migratory routes involved, and the pattern of successive occupation of a diverse continental mosaic of ecosystems. In this context, the role of the Andean highlands (≥3400 meters above sea level) has been neglected, because of the supposedly harsh conditions for humans including hypoxia and cold climate. Nevertheless, the environmental and cultural resources available in the high Andes constitutes an important "megapatch" that should be assessed in terms of human settlement patterns. We review the evidence for late Pleistocene/early Holocene hunter-gatherer occupation of one part of this megapatch, the northern Chilean Dry Puna, in its palaeoecological context. We focus on lithic technology, faunal remains, radiocarbon dates, and other archaeological materials related to different social activities, which allow us to suggest that groups of hunter-gatherers organized and adapted their way of life to highland ecosystems through logistical mobility, and curatorial strategies for lithic tool kits that included projectile points and other formalized tools. The morphology and technological processes involved are recognized over vast territories along the high Andes. We identify this material expression as the high south central Andean Archaic hunter-gatherer tradition, which also featured long distance mobile settlement systems and communication processes over this broad and distinct megapatch. More speculatively, we outline the hypothesis that these highland ecosystems constituted a suitable migratory route that may have been key for the early peopling of the continent, and contrast it with the alternative hypothesis of the initially secondary and seasonally intermittent exploitation of this habitat by hunter-gatherers dispersing along the Pacific coastal corridor

Holographic studies of quasi-topological gravity

Quasi-topological gravity is a new gravitational theory including curvature-cubed interactions and for which exact black hole solutions were constructed. In a holographic framework, classical quasi-topological gravity can be thought to be dual to the large $N_c$ limit of some non-supersymmetric but conformal gauge theory. We establish various elements of the AdS/CFT dictionary for this duality. This allows us to infer physical constraints on the couplings in the gravitational theory. Further we use holography to investigate hydrodynamic aspects of the dual gauge theory. In particular, we find that the minimum value of the shear-viscosity-to-entropy-density ratio for this model is $\eta/s \simeq 0.4140/(4\pi)$.Comment: 45 pages, 6 figures. v2: References adde

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p

Corner contributions to holographic entanglement entropy

The entanglement entropy of three-dimensional conformal field theories contains a universal contribution coming from corners in the entangling surface. We study these contributions in a holographic framework and, in particular, we consider the effects of higher curvature interactions in the bulk gravity theory. We find that for all of our holographic models, the corner contribution is only modified by an overall factor but the functional dependence on the opening angle is not modified by the new gravitational interactions. We also compare the dependence of the corner term on the new gravitational couplings to that for a number of other physical quantities, and we show that the ratio of the corner contribution over the central charge appearing in the two-point function of the stress tensor is a universal function for all of the holographic theories studied here. Comparing this holographic result to the analogous functions for free CFT's, we find fairly good agreement across the full range of the opening angle. However, there is a precise match in the limit where the entangling surface becomes smooth, i.e., the angle approaches $\pi$, and we conjecture the corresponding ratio is a universal constant for all three-dimensional conformal field theories. In this paper, we expand on the holographic calculations in our previous letter arXiv:1505.04804, where this conjecture was first introduced.Comment: 62 pages, 6 figures, 1 table; v2: minor modifications to match published version, typos fixe

Phase Structure and Compactness

In order to study the influence of compactness on low-energy properties, we compare the phase structures of the compact and non-compact two-dimensional multi-frequency sine-Gordon models. It is shown that the high-energy scaling of the compact and non-compact models coincides, but their low-energy behaviors differ. The critical frequency $\beta^2 = 8\pi$ at which the sine-Gordon model undergoes a topological phase transition is found to be unaffected by the compactness of the field since it is determined by high-energy scaling laws. However, the compact two-frequency sine-Gordon model has first and second order phase transitions determined by the low-energy scaling: we show that these are absent in the non-compact model.Comment: 21 pages, 5 figures, minor changes, final version, accepted for publication in JHE

Variability of indication criteria in knee and hip replacement: an observational study

<p>Abstract</p> <p>Background</p> <p>Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication.</p> <p>Methods</p> <p>The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated.</p> <p>The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ_5-95), variation coefficient (CV_5-95) and weighted variation coefficient (WCV_5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV_5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity.</p> <p>Results</p> <p>The variability expressed as WCV_5-95was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate.</p> <p>Conclusions</p> <p>A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.</p