Dysarthria for diazepam use in aged adults [Disartria por el uso del diazepam en adultos mayores]

Dysarthria is a speech motor disorder of neurological origin. It is characterized by slowness, weakness, involuntary movements or alteration of the tone for speech-involved musculature and can lead to a large number of complications, including communication problems, social difficulties and depression. In the elderly, benzodiazepines are widely used in clinical practice, due to their efficacy in short-term symptomatic treatment of anxiety and insomnia; however, they may have adverse effects due to their action as muscle relaxant, especially at the level of tongue muscles. We report the clinical case of a patient with dysarthria associated with the use of diazepam, with the aim of describing some uncommon clinical manifestations associated with the dosage of this drug. The use of benzodiazepines should be avoided in elderly patients or indicate low doses instead, since, due to their advanced age, they are very susceptible to the adverse effects by drugs, due to the pharmacokinetic changes that come with aging and that can lead to benzodiazepines accumulation. © 2018, Editorial Ciencias Medicas. All rights reserved

AN ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF GENETIC COUNSELING SERVICES IN U.S. HTCs

Hemophilia is a hereditary bleeding disorder which requires lifelong specialized care. A network of Hemophilia Treatment Centers (HTCs) exists to meet the medical needs of patients affected by hemophilia. Genetic counseling services are an integral part of the HTC model of care; however, many HTCs do not have genetic counselors on staff. As a result, the duty to provide these services must fall to other healthcare providers within the HTC. To assess the knowledge and attitudes of these providers we developed a 49 question survey that was distributed electronically to hematologists and nurses at U.S. HTCs. The survey consisted of a three sections: demographic information, knowledge of hemophilia genetics, and attitudes towards genetic services. A total of 111 complete responses were received and analyzed. The average knowledge score among all participants was 74.8% with a total of 81 participants receiving a passing score of 70% or above. Thirty participants scored below 70% in the knowledge section. In general, attitude scores were high indicating that the majority of hematologists and nurses in HTCs feel confident in their ability to provide genetic counseling services. Over 90% of participants reported that they have some form of access to genetic counseling services at their center. Hematologists and nurses practicing in U.S. HTCs demonstrate sufficient knowledge of the genetics of hemophilia, and they generally feel confident in their ability to provide genetic counseling services to their patients. While their knowledge is sufficient, the average knowledge score was lower than 75%. Certain questions covering new genetic technologies and testing practices were more commonly missed than questions asking about more basic aspects of hemophilia genetics, such as inheritance and carrier testing. Finally, many clinics report having access to a counselor, but it is oftentimes a hematologist or nurse who is providing genetic counseling services to patients. Given the inconsistency in knowledge among providers coupled with the high confidence in one’s ability to counsel patients, it leaves room to question whether information about the genetics of hemophilia is being communicated to patients in the most appropriate and accurate manner

Bayesian Nonparametric Inverse Reinforcement Learning

Inverse reinforcement learning (IRL) is the task of learning the reward function of a Markov Decision Process (MDP) given the transition function and a set of observed demonstrations in the form of state-action pairs. Current IRL algorithms attempt to find a single reward function which explains the entire observation set. In practice, this leads to a computationally-costly search over a large (typically infinite) space of complex reward functions. This paper proposes the notion that if the observations can be partitioned into smaller groups, a class of much simpler reward functions can be used to explain each group. The proposed method uses a Bayesian nonparametric mixture model to automatically partition the data and find a set of simple reward functions corresponding to each partition. The simple rewards are interpreted intuitively as subgoals, which can be used to predict actions or analyze which states are important to the demonstrator. Experimental results are given for simple examples showing comparable performance to other IRL algorithms in nominal situations. Moreover, the proposed method handles cyclic tasks (where the agent begins and ends in the same state) that would break existing algorithms without modification. Finally, the new algorithm has a fundamentally different structure than previous methods, making it more computationally efficient in a real-world learning scenario where the state space is large but the demonstration set is small

Assessing Value-based Health Care Delivery for Hemodialysis

Rationale, aims and objectives Disparities in haemodialysis outcomes among centres have been well-documented. Besides, attempts to assess haemodialysis results have been based on non-comprehensive methodologies. This study aimed to develop a comprehensive methodology for assessing haemodialysis centres, based on the value of health care. The value of health care is defined as the patient benefit from a specific medical intervention per monetary unit invested (Value = Patient Benefit/Cost). This study assessed the value of health care and ranked different haemodialysis centres. Method A nephrology quality management group identified the criteria for the assess- ment. An expert group composed of stakeholders (patients, clinicians and managers) agreed on the weighting of each variable, considering values and preferences. Multi-criteria methodology was used to analyse the data. Four criteria and their weights were identified: evidence-based clinical performance measures = 43 points; yearly mortality = 27 points; patient satisfaction = 13 points; and health-related quality of life = 17 points (100-point scale). Evidence-based clinical performance measures included five sub-criteria, with respective weights, including: dialysis adequacy; haemoglobin concentration; mineral and bone disorders; type of vascular access; and hospitalization rate. The patient benefit was determined from co-morbidity–adjusted results and corresponding weights. The cost of each centre was calculated as the average amount expended per patient per year. Results The study was conducted in five centres (1–5). After adjusting for co-morbidity, value of health care was calculated, and the centres were ranked. A multi-way sensitivity analysis that considered different weights (10–60% changes) and costs (changes of 10% in direct and 30% in allocated costs) showed that the methodology was robust. The rankings: 4-5-3-2-1 and 4-3-5-2-1 were observed in 62.21% and 21.55%, respectively, of simula- tions, when weights were varied by 60%. Conclusions Value assessments may integrate divergent stakeholder perceptions, create a context for improvement and aid in policy-making decisions

Efecto del tipo de lactancia sobre la calidad de la canal y de la carne en cabritos

En el trabajo se han tomado 40 cabritos pertenecientes a las razas autóctonas Florida Sevillana y Payoya, 20 animales de lactancia natural y 20 de lactancia artificial con el objeto de comparar los parámetros de la calidad de la canal y de la carne. Los resultados nos muestran que aunque existen diferencias en el algunas medidas de la canal, el resto de los parámetros estudiados no presentaron diferencias significativas entre los dos tipos de lactancia.Diputación de BadajozJunta de Extremadur

Search for the Rare Decay KL --> pi0 ee

The KTeV/E799 experiment at Fermilab has searched for the rare kaon decay KL--> pi0ee. This mode is expected to have a significant CP violating component. The measurement of its branching ratio could support the Standard Model or could indicate the existence of new physics. This letter reports new results from the 1999-2000 data set. One event is observed with an expected background at 0.99 +/- 0.35 events. We set a limit on the branching ratio of 3.5 x 10^(-10) at the 90% confidence level. Combining the results with the dataset taken in 1997 yields the final KTeV result: BR(KL --> pi0 ee) < 2.8 x 10^(-10) at 90% CL.Comment: 4 pages, three figure

Background subtraction with Dirichlet processes

Abstract. Background subtraction is an important first step for video analysis, where it is used to discover the objects of interest for fur-ther processing. Such an algorithm often consists of a background model and a regularisation scheme. The background model determines a per-pixel measure of if a pixel belongs to the background or the foreground, whilst the regularisation brings in information from adjacent pixels. A new method is presented that uses a Dirichlet process Gaussian mixture model to estimate a per-pixel background distribution, which is followed by probabilistic regularisation. Key advantages include inferring the per-pixel mode count, such that it accurately models dynamic backgrounds, and that it updates its model continuously in a principled way.

Influence of silver content on the tribomechanical behavior on Ag-TiCN bioactive coatings

Surface modification of bulk materials used in biomedical applications has become an important prerequisite for better biocompatibility. In particular, to overcome the particle generation, low-wear coatings based on carbon (nitrogen) and containing antimicrobial elements such as silver are promising candidates. Thus, the present work explores the potentialities of silver-containing carbonitride-based (Ag-TiCN) thin films prepared by direct current unbalanced reactive magnetron sputtering. The silver content in the coatings was varied from 0 to 26.7 at.% by changing the targets and the fraction of C2H2 and N2 in the gas mixture with Ar. The obtained Ag-TiCN based coatings were characterized in terms of composition and microstructure. Mechanical and tribological properties of the films were studied by nanoindentation and reciprocating pin-on disk testing in a fetal bovine serum solution, respectively. Raman, scanning electron microscope and energy dispersive X-ray analysis was carried out in the contact region after tribological tests to obtain information about the friction mechanism. The cytotoxicity of the coatings was assessed by in vitro tests using fibroblast cells. The coatings comprised a mixture of TiCxN1−x, Ag and a-C(N)x phases whose relative proportion varied depending on the Ag/Ti ratio. The mechanical, tribological and cytotoxicity properties were correlated with the chemical and phase composition. When the Ag/Ti ratios were below 0.20 (Ag contents b6.3 at.%) the films resulted harder (~18 GPa) with higher wear resistance (~10−6 mm3/Nm), showing similar friction coefficient (~0.3) and good biocompatibility.The authors are grateful to the financial support of the CRUP Institution by the project "Accao No E-1007/08", the Spanish Ministry of Science and Innovation (projects FUNCOAT CSD2008-00023 and HP2007-0116), Junta de Andalucia (project TEP 06782) and CSIC-FCT institutions (2007PT0043). The work was financially supported by Portuguese national funds through the FCT-Fundacao para a Ciencia e a Tecnologia, (project PTDC/CTM/102853/2008) and partially sponsored by FEDER funds through the program COMPETE - Programa Operacional Factores de Competitividade

Evaluation of Cavitation Erosion Behavior of Commercial Steel Grades Used in the Design of Fluid Machinery

The erosion response under cavitation of different steel grades was assessed by studying the erosion rate, the volume removal, the roughness evolution, and the accumulated strain energy. A 20 kHz ltrasonic transducer with a probe diameter of 5 mm and peak-to-peak amplitude of 50 lm was deployed in distilled water to induce damage on the surface of commercial chromium and carbon steel samples. After a relatively short incubation period, cavitation induced the formation of pits, cracks, and craters whose features strongly depended on the hardness and composition of the tested steel. AISI 52100 chromium steel showed the best performance and is, therefore, a promising design candidate for replacing the existing fluid machinery materials that operate within potential cavitating environments

Update on the correlation of the highest energy cosmic rays with nearby extragalactic matter

Data collected by the Pierre Auger Observatory through 31 August 2007 showed evidence for anisotropy in the arrival directions of cosmic rays above the Greisen-Zatsepin-Kuz'min energy threshold, \nobreak{$6\times 10^{19}$eV}. The anisotropy was measured by the fraction of arrival directions that are less than $3.1^\circ$ from the position of an active galactic nucleus within 75 Mpc (using the V\'eron-Cetty and V\'eron $12^{\rm th}$ catalog). An updated measurement of this fraction is reported here using the arrival directions of cosmic rays recorded above the same energy threshold through 31 December 2009. The number of arrival directions has increased from 27 to 69, allowing a more precise measurement. The correlating fraction is $(38^{+7}_{-6})$, compared with $21$ expected for isotropic cosmic rays. This is down from the early estimate of $(69^{+11}_{-13})$. The enlarged set of arrival directions is examined also in relation to other populations of nearby extragalactic objects: galaxies in the 2 Microns All Sky Survey and active galactic nuclei detected in hard X-rays by the Swift Burst Alert Telescope. A celestial region around the position of the radiogalaxy Cen A has the largest excess of arrival directions relative to isotropic expectations. The 2-point autocorrelation function is shown for the enlarged set of arrival directions and compared to the isotropic expectation.Comment: Accepted for publication in Astroparticle Physics on 31 August 201