Decision making and underperformance in competitive environments: evidence from the National Hockey League

We find evidence of suboptimal decisions leading to underperformance in a policy experiment where two teams of professionals compete in a tournament (National Hockey League shootout) performing a task (penalty shot) sequentially. Before an exogenous policy change, home teams had to perform the task second in the sequence. After the policy change, home teams were given the choice to lead or to follow in the sequence. Home teams should move first only when this is optimal, and this should lead them to winning the tournament more often. We find that after given the choice, home teams most of the time choose to move first in the sequence, and this results in a lower winning frequency for them. Contrary to what economic theory would predict, we find that an expanded choice set can lead to worse outcomes for the agents

Microbial and chemical changes during the spontaneous ensilage of grape pomace

Pilot scale fermentations with grape pomace from two different wineries were investigated during the 24 weeks of the ensiling period, along with laboratory scale experiments in which the environmental temperatures were held constant at 20, 25, 30 and 35 °C. During this period, yeast and lactic acid bacteria (LAB) counts were made, after which the identity of both groups of organisms was studied, as were the major microbial metabolites present. Major microbial and chemical alterations occurred during the first 3 weeks of ensilage, leaving a more stable product differing significantly from the initial substrate. The results obtained indicated that after initial growth, yeast and LAB populations undergo progressive inactivation at environmental temperatures above 20 °C, although LAB seem to adjust better to this specific, post-fermentation environment. Homofermentative species of Lactobacillus were the dominant LAB. The initial yeast flora of non-Saccharomyces species was replaced by a typical wine yeast flora, i.e. predominantly Saccharomyces cerevisiae. At the chemical level, major alterations were due to an alcoholic fermentation and a malolactic conversion within the first 3 weeks

Atrasos Pubertários. Considerações a Propósito da Casuística de uma Consulta de Endocrinologia Pediátrica

Os autores fizeram a revisão retrospectiva de 65 processos de jovens enviados à Consulta de Endocrinologia Pediátrica por atraso pubertário durante um período de 10 anos. O diagnóstico foi confirmado em 27 jovens e em 38 a observação e a evolução permitiram demonstrar que aquele não existia. Nos doentes com atraso pubertário, a idade média de referência à consulta foi 14,6 ± 3,3 anos (média ± DP) e o tempo médio de seguimento foi 3,2 ± 3,0 anos. Os doentes com atraso pubertário comprovado dividiram-se por 3 grupos etiológicos: hipogonadismo temporário incluindo o atraso constitucional de maturação e anemias crónicas; situações hipergonadotróficas e hipogonadotróficas permanentes. Analisaram-se as características de cada grupo etiológico. Em 5 casos de hipogonadismo temporário e em 7 de condições permanentes foi feito tratamento; a idade cronológica e a idade óssea médias no início da terapêutica eram 17,4 ± 2,5 anos e 12,9 ± 1,3 anos respectivamente. Os autores concluem, de acordo com literatura recente, pela necessidade de referência e tratamento mais precoce destes doentes

O tratamento da dor oncológica e a utilização idónea de opióides

Copyright © Ordem dos Médicos 2015Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics - by a registered medical practitioner for absolute pain control - is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.O controlo da dor é fundamental no tratamento do cancro. Apesar da vasta utilização e do reconhecimento das normas de orientação clínica para o controlo da dor oncológica, o sofrimento evitável é ainda prevalente em doentes com cancro. Existe um hiato entre o co-nhecimento e a prática clínica no que concerne a uma adequada gestão da dor pelos doentes, cuidadores, profissionais e instituições de saúde. Os opióides representam o pilar do tratamento farmacológico da dor moderada a insuportável. A prescrição de analgésicos opióides - por um médico credenciado, para o controlo absoluto da dor, - é uma prática legítima. Neste artigo debruçamo-nos sobre as hesitações dos médicos e os receios dos doentes perante a morfina e similares. Examinamos os preconceitos que promovem o fracasso do uso terapêutico dos opióides e, consequentemente condicionam o controlo inadequado da dorinfo:eu-repo/semantics/publishedVersio

Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic

© 2017 Reis-Pina et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php)Background: Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy. Objectives: To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC). Methods: Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model. Results: Of 371 participants, 95 (25.6%) had PMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief ” scores were all less likely to be PMI(−). Conclusion: The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.info:eu-repo/semantics/publishedVersio

Dynamic weather effects induced from the 2017 total solar eclipse

This research project was part of a nationwide effort organized by Montana Space Grant consortium to study and film the 2017 total solar eclipse with high altitude balloons. Our mission is to measure the changes in light from the total solar eclipse and its effects on the local weather conditions in the air and on the ground. Our results showed that the effects of totality on the ambient light levels were not gradual, like we had expected from our observations of sunsets, but rather the light levels decreased sharply at totality. We measured a 5.61% decrease in light before full totality, followed by a 94.4% decrease, over 90 seconds, into totality. The dramatic decreases in light levels are the root cause for the measured weather phenomena, including a short-term pressure increase associated with totality