The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult

AIM OF THE STUDY: The Alvarado score is a validated test in clinical adult surgery practice which can be helpful in the diagnosis of acute appendicitis. This study aimed to assess the reliability and the reproducibility of this score for patients presenting in the emergency room with acute right lower quadrant abdominal pain. MATERIAL AND METHODS: A prospective monocenter study included all adults who presented in the emergency room with right lower quadrant abdominal pain. The score was calculated by assessing six symptoms and two laboratory values weighted by coefficients. The diagnosis of acute appendicitis was confirmed by the histological examination of the resected appendix. Three groups of patients with high, low, and intermediate scores were defined as described in the literature. RESULTS: Of the 233 patients studied, 174 underwent surgery: three had a normal appendix on histological exam. The statistical analysis of the results showed that a score lower than 4 was significantly associated with the absence of acute appendicitis while a score higher than 6 was significantly associated with acute appendicitis which required surgical care. But a score between 4 and 6 was not discriminant. CONCLUSION: The Alvarado score is a reliable, cheap and reproducible tool for the diagnosis of acute appendicitis in the emergency room; if the score is higher than 6 or lower than 4, there is no need for complementary exams. Patients with a score between 4 and 6, require serial reassessment of physical findings and score over 24 hours and/or complementary diagnostic exam such as ultrasound or CT scan

Relación entre capacidades físicas, Indice de Masa Corporal (IMC) y la discriminación dentro de la clase de educación física en alumnos de 10 y 11 años, en cuatro colegios de Chillan, Chile

Objetivo: verificar relación entre IMC, capacidades físicas y discriminación en clase de Educación Física, alumnos entre 10 a 11 años, 4 colegios de Chillán, Chile. Metodología: medir flexibilidad, velocidad y resistencia; calcular IMC; posteriormente contestar cuestionario de auto percepción frente a sus pares en relación a discriminación en clases de Educación Física. Población: 178 sujetos; muestra: 44 indicaron discriminación. Resultados: IMC: 72,6 por ciento de la muestra, que sienten discriminación, no presentan niveles de obesidad. Velocidad: 47,7 por ciento sujetos discriminados se encuentran sobre el promedio; demuestra que la velocidad es un factor que influye en la discriminación debido a que menos de la mitad de los alumnos discriminados se encuentran sobre el nivel de aprobación. Resistencia: 75 por ciento superior y 25 por ciento bajo el promedio lo que demuestra que la resistencia no es un factor determinante en la discriminación. Flexibilidad: 11 por ciento de los sujetos bajo el promedio y un 89 por ciento sobre el nivel de aprobación; se indica que la flexibilidad no es un factor determinarte en la discriminación. Los resultados indicaron que la relación de IMC y las capacidades físicas, en base a la discriminación en la clase de Educación Física, existe relación entre ambas, pero con resultados diferentes, ya que el índice de masa corporal en sujetos que presentan el rango de bajo peso y son discriminados, tienen mejor capacidad física que en alumnos de rango normal, riesgo de obesidad y obesida

Caracterização diamétrica de um povoamento de Araucaria angustifolia (bertol.) Kuntze sob alta competição.

Resumo

Reconceptualizing Context: A Multilevel Model of the Context of Reception and Second-Generation Educational Attainment

This paper seeks to return scholarly attention to a core intellectual divide between segmented and conventional (or neo-)assimilation approaches, doing so through a theoretical and empirical reconsideration of contextual effects on second-generation outcomes. We evaluate multiple approaches to measuring receiving country contextual effects and measuring their impact on the educational attainment of the children of immigrants. We demonstrate that our proposed measures better predict second-generation educational attainment than prevailing approaches, enabling a multilevel modeling strategy that accounts for the structure of immigrant families nested within different receiving contexts

Organizational-Social-Capital, Time and International Family SMEs:An Empirical Study from the East of England

Previous studies on family-SME internationalization have largely focused on what resources are needed to drive an incremental process rather than how resource management occurs in historical time. This paper focuses on the latter, adopting a social capital perspective (capturing both internal, i.e. among family-SME board members, and external, cross border agent dyads, relations) in order to decipher case study data from the East of England. Findings show that it is not the presence or absence of organizational-social-capital that affects family-SME internationalization success but rather its variable use over the years driven by the future pursuit of longevity, not growth. Key within this context is the variable use of the international expertise and management capability of non-family managers in the family SME intra-organizational context. Ultimately this may lead to change and learning that occurs erratically, often including reversals, without causing family-SME progression across a sequence of incremental stages

Competition index: a tool to define thinning in stands of Araucaria angustifolia.

IUFROLAT 2013. Disponibilizado online. Resumen

Negotiating networks of self-employed work: strategies of minority ethnic contractors

Within the increased flexible, contracted work in cities, employment is negotiated through network arrangements characterised by multiplicity, mobility and fluidity. For black and minority ethnic group members, this network labour becomes fraught as they negotiate both their own communities, which can be complex systems of conflicting networks, as well as non-BME networks which can be exclusionary. This discussion explores the networking experiences of BME individuals who are self-employed in portfolio work arrangements in Canada. The analysis draws from a theoretical frame of ‘racialisation’ (Mirchandani and Chan, 2007) to examine the social processes of continually constructing and positioning the Other as well as the self through representations in these networks. These positions and concomitant identities enroll BME workers in particular modes of social production, which order their roles and movement in the changing dynamics of material production in networked employment

Live Imaging at the Onset of Cortical Neurogenesis Reveals Differential Appearance of the Neuronal Phenotype in Apical versus Basal Progenitor Progeny

The neurons of the mammalian brain are generated by progenitors dividing either at the apical surface of the ventricular zone (neuroepithelial and radial glial cells, collectively referred to as apical progenitors) or at its basal side (basal progenitors, also called intermediate progenitors). For apical progenitors, the orientation of the cleavage plane relative to their apical-basal axis is thought to be of critical importance for the fate of the daughter cells. For basal progenitors, the relationship between cell polarity, cleavage plane orientation and the fate of daughter cells is unknown. Here, we have investigated these issues at the very onset of cortical neurogenesis. To directly observe the generation of neurons from apical and basal progenitors, we established a novel transgenic mouse line in which membrane GFP is expressed from the beta-III-tubulin promoter, an early pan-neuronal marker, and crossed this line with a previously described knock-in line in which nuclear GFP is expressed from the Tis21 promoter, a pan-neurogenic progenitor marker. Mitotic Tis21-positive basal progenitors nearly always divided symmetrically, generating two neurons, but, in contrast to symmetrically dividing apical progenitors, lacked apical-basal polarity and showed a nearly randomized cleavage plane orientation. Moreover, the appearance of beta-III-tubulin–driven GFP fluorescence in basal progenitor-derived neurons, in contrast to that in apical progenitor-derived neurons, was so rapid that it suggested the initiation of the neuronal phenotype already in the progenitor. Our observations imply that (i) the loss of apical-basal polarity restricts neuronal progenitors to the symmetric mode of cell division, and that (ii) basal progenitors initiate the expression of neuronal phenotype already before mitosis, in contrast to apical progenitors

The association between family and community social capital and health risk behaviours in young people: an integrative review

Background: Health risk behaviours known to result in poorer outcomes in adulthood are generally established in late childhood and adolescence. These ‘risky’ behaviours include smoking, alcohol and illicit drug use and sexual risk taking. While the role of social capital in the establishment of health risk behaviours in young people has been explored, to date, no attempt has been made to consolidate the evidence in the form of a review. Thus, this integrative review was undertaken to identify and synthesise research findings on the role and impact of family and community social capital on health risk behaviours in young people and provide a consolidated evidence base to inform multi-sectorial policy and practice.<p></p> Methods: Key electronic databases were searched (i.e. ASSIA, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Embase, Medline, PsycINFO, Sociological Abstracts) for relevant studies and this was complemented by hand searching. Inclusion/exclusion criteria were applied and data was extracted from the included studies. Heterogeneity in study design and the outcomes assessed precluded meta-analysis/meta-synthesis; the results are therefore presented in narrative form.<p></p> Results: Thirty-four papers satisfied the review inclusion criteria; most were cross-sectional surveys. The majority of the studies were conducted in North America (n=25), with three being conducted in the UK. Sample sizes ranged from 61 to 98,340. The synthesised evidence demonstrates that social capital is an important construct for understanding the establishment of health risk behaviours in young people. The different elements of family and community social capital varied in terms of their saliency within each behavioural domain, with positive parent–child relations, parental monitoring, religiosity and school quality being particularly important in reducing risk.<p></p> Conclusions: This review is the first to systematically synthesise research findings about the association between social capital and health risk behaviours in young people. While providing evidence that may inform the development of interventions framed around social capital, the review also highlights key areas where further research is required to provide a fuller account of the nature and role of social capital in influencing the uptake of health risk behaviours.<p></p&gt

Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

<b>Background</b> In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.<p></p> <b>Discussion</b> As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.<p></p> <b>Summary</b> Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts