La actividad bancaria en entornos de alto riesgo: el caso de Palestina y los países limítrofes

Este proyecto pretende analizar la actividad bancaria en entornos de alto riesgo. En concreto, se analiza como se ve afectada la actividad transformadora de activos cuando las entidades bancarias operan en condiciones de alta complejidad. Además, se pretende evaluar el impacto sobre el riesgo que asumen y sobre la rentabilidad que obtienen. La tesis trata de cubrir una importante laguna en este ámbito de investigación puesto que son muchos los trabajos que analizar el sector bancario en países desarrollados, pero apenas hay literatura que centre su objeto de estudio en países con condiciones económicas y políticas adversas. Por este motivo, nuestro estudio ha seleccionado los bancos que tienen como ámbito geográfico los países de Palestina y limítrofes. En este sentido, consideramos que la tesis aporta evidencia inédita y contribuye a la literatura existente que servirá para identificar estrategias de éxito en dichos países y diseñar políticas que permitan mejorar la actividad de intermediación y, consiguientemente, el desarrollo económico de los países analizados

MANAGEMENT AND ASSESSMENT OF DEHYDRATION IN PEDIATRICS

The level of fluid deficit may be difficult to scientifically quantify and there is no laboratory worth that is either delicate or details to approximate the degree of dehydration in children. Rehydration may take place by means of oral, subcutaneous, or IV paths. We performed a search using electronic databases; MEDLINE, science-direct, and EMBASE, through October, 2018. Dehydration related to gastroenteritis makes up a considerable worry of disease worldwide. Most of dehydration is amenable to ORT; only the treatment of severe dehydration needs IVF. Prior pilot data on the superiority of rapid IVF administration for rehydration has actually been refuted. Nevertheless, a new research suggests that initial rehydration with glucose including IVF trends toward lowering the return visits and decreasing the admission rates. More data on the efficiency and safety and security of antiemetics has actually been produced. Antiemetics have been proven well tolerated without masking severe alternate diagnoses, efficacious in improving the success of ORT, and affordable. These brand-new data supporters highly for the consolidation of antiemetics right into the scientific guidelines. Variability in guideline conformity has been shown, with doctors mentioning troubles in evaluating dehydration and scientific judgment as factors for variation

Medical students' perceptions of complementary and alternative medicine therapies: A pre- and post-exposure survey in Majmaah University, Saudi Arabia

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health  and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and  innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia.Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item  self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or  alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities.Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies.Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation. Key words: Medical students; Complementary and Alternative Medicine; CAM course; CAM therapies; pre-post design study; Saudi Arabia

MEDICAL STUDENTS' PERCEPTIONS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES: A PRE- AND POST-EXPOSURE SURVEY IN MAJMAAH UNIVERSITY, SAUDI ARABIA

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia. Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities. Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies. Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation

Seroprevalence of SARS-CoV-2 (COVID-19) among Healthcare Workers in Saudi Arabia: Comparing Case and Control Hospitals

Healthcare workers (HCWs) stand at the frontline for fighting coronavirus disease 2019 (COVID-19) pandemic. This puts them at higher risk of acquiring the infection than other individuals in the community. Defining immunity status among health care workers is therefore of interest since it helps to mitigate the exposure risk. This study was conducted between May 20th and 30th, 2020. Eighty-five hospitals across Kingdom of Saudi Arabia were divided into 2 groups: COVID-19 referral hospitals are those to which RT-PCR-confirmed COVID-19 patients were admitted or referred for management (Case-hospitals). COVID-19 nonaffected hospitals where no COVID-19 patients had been admitted or managed and no HCW outbreak (Control hospitals). Next, seroprevalence of severe acute respiratory syndrome coronavirus 2 among HCWs was evaluated; there were 12,621 HCWs from the 85 hospitals. There were 61 case-hospitals with 9379 (74.3%) observations, and 24 control-hospitals with 3242 (25.7%) observations. The overall positivity rate by the immunoassay was 299 (2.36%) with a significant difference between the case-hospital (2.9%) and the control-group (0.8%) (P value <0.001). There was a wide variation in the positivity rate between regions and/or cities in Saudi Arabia, ranging from 0% to 6.31%. Of the serology positive samples, 100 samples were further tested using the SAS2pp neutralization assay; 92 (92%) samples showed neutralization activity. The seropositivity rate in Kingdom of Saudi Arabia is low and varies across different regions with higher positivity in case-hospitals than control-hospitals. The lack of neutralizing antibodies (NAb) in 8% of the tested samples could mean that assay is a more sensitive assay or that neutralization assay has a lower detection limits; or possibly that some samples had cross-reaction to spike protein of other coronaviruses in the assay, but these were not specific to neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Sur les observateurs des systemes non lineaires

SIGLEAvailable from INIST (FR), Document Supply Service, under shelf-number : T 82694 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

On the use of Nonlinear Receding Horizon Observers in Batch Terpolymerization Reactors

International audienceIn this paper, a nonlinear receding-horizon observer is proposed for state reconstruction in batch terpolymerization reactors. The related investigations show that the state reconstruction problem may be quite ill conditioned in the sense that different states may exist that lead to roughly the same output. It seems however that when constrained receding-horizon estimation is used together with a dedicated crossing singularity heuristic, state reconstruction is possible even in presence of measurement noise and up-to 10\% error on the r.h.s of the ODE's describing the system's dynamics. The efficiency and the real-time implementability of the overall scheme is shown through illustrative scenarios including both simulation and experimental validation