Advances in in vivo monitoring techniques based on prompt gamma rays in particle therapy / 中华放射肿瘤学杂志

Prompt gamma rays are a kind of secondary radiation produced in particle therapy, and prompt gamma information largely reflects the incidence of particles. Consequently, use of prompt gamma information to verify the range of particles is a promising verification method. In this article, the concept of prompt gamma ray in vivo range verification and the advantages of prompt gamma verification over existing methods were introduced. Secondly, the progress in developing a method for range verification using prompt gamma in recent years was reviewed, and the advantages and disadvantages of three methods including prompt gamma imaging (PGI), prompt gamma timing (PGT) and prompt gamma spectroscopy (PGS) were discussed. Finally, these three methods were summarized, and the development trend of prompt gamma rays for in vivo range monitoring was prospected.

Construction of Question Prompt List of information needs of patients with interstitial lung disease based on ERG theory / 中国实用护理杂志

Objective:To construct a Question Prompt List of information needs for patients with interstitial lung disease, providing a tool for patients with interstitial lung disease to actively obtain disease-related information.Methods:A literature study was conducted based on the three core needs (ERG) theory framework of existence,relatedness and growth. A purposive sampling method was used to select 15 patients with interstitial lung disease from Drum Tower Hospital, Medical School of Nanjing University from December 2021 to January 2022 for descriptive research. Based on literature research and qualitative research, the initial items of the Question Prompt List were determined through expert inquiry, and the items were extracted, discussed, and adjusted, and finalized the list of information needs and prompts for patients with interstitial lung disease.Results:The 19 experts participated in the consultation, with a positive coefficient of 100.0% and 94.7% for two rounds of consultation, an authoritative coefficient of 0.91 and 0.92, and the Kendall coordination coefficient of 0.31 and 0.23, respectively. Finally, a list of interstitial lung disease patients′ question prompts containing 4 primary indicators and 34 secondary indicators was formed.Conclusions:Based on the ERG theory, the research method for the Question Prompt List of information needs for patients with interstitial lung disease is scientific and reliable, and can be used in clinical practice to help patients inquire and obtain the necessary information.

Síndrome hemofagocítico secundario a infección por virus del dengue / Hemophagocytic syndrome secondary to dengue virus infection

Introducción: El síndrome hemofagocítico se presenta como un cuadro clínico grave, provocado por una respuesta inadecuada del sistema inmunológico a un desencadenante infeccioso, neoplásico, reumatológico o metabólico, que origina una reacción inflamatoria no controlada; presenta una incidencia baja pero la letalidad sin el manejo adecuado es muy elevada. Objetivo: Destacar la importancia de diagnóstico oportuno del síndrome hemofagocítico en pacientes con dengue que presentan evolución tórpida. Presentación del caso: Paciente de 7 años de edad, con dengue grave dado por shock, hepatomegalia con elevación de transaminasas, con mala evolución clínica, quien cumple criterios de Síndrome hemofagocítico. Recibió manejo con inmunomoduladores con evolución satisfactoria. Conclusiones: Es importante considerar el Síndrome hemofagocítico como causa ante enfermedades con evolución tórpida a pesar de tener un manejo médico correcto(AU)

Introduction: Hemophagocytic syndrome is a severe clinical picture with an uncontrolled inflammatory reaction caused by an inadequate immune system response to an infectious, neoplastic, rheumatological, or metabolic trigger. The syndrome has low incidence but high fatality when the management is not adequate. Objective: To highlight the importance of a prompt diagnosis of hemophagocytic syndrome in patients with dengue who present a torpid evolution. Case presentation: Seven-year-old patient with severe dengue caused by shock, hepatomegaly with elevated transaminase levels and poor clinical evolution who meets hemophagocytic syndrome criteria. The patient had satisfactory progression after receiving immunomodulatory treatment. Conclusions: Hemophagocytic syndrome must be considered as a cause of pathologies in dengue patients with torpid evolution, even when correct medical management is made(AU)

Transtorno do espectro autista: capacitação de professores para atividades escolares em grupo / Autism spectrum disorder: teacher training for group school activities / Trastorno del espectro autista: capacitación de profesores para actividades escolares en grupo

Dentre as dificuldades encontradas para a inclusão de crianças com Transtorno do Espectro Autista (TEA) nas escolas está a falta de conhecimentos técnicos e instrumentos específicos que ofereçam suporte à prática dos profissionais da educação e às escolas. Considerando essa necessidade, foi aplicado um programa de capacitação, com base no referencial teórico da Análise do Comportamento, para 18 professores do Ensino Fundamental de uma escola de cidade do interior do Estado de São Paulo, com o objetivo de capacitá-los a aprenderem estratégias para promover a participação de alunos com TEA em atividades de grupo utilizando jogos cooperativos. Foram ministradas cinco aulas com enfoque prático, abordando os temas: jogos cooperativos, prompt e reforço. A avaliação do curso foi feita de três modos: aplicação de Pré-Teste, Pós-Teste e Follow-up. Para avaliar a aprendizagem dos professores participantes, foi solicitada aos professores uma atividade de simulação de situações e intervenções vivenciadas junto a alunos com TEA, a partir dos conteúdos aprendidos, e a aplicação da Escala de Avaliação do Ensino em Língua Oral em Contexto Escolar (EVALOE) para avaliar a atuação dos ministrantes. Os resultados indicaram que os participantes apresentaram mais acertos no pós-teste do que no pré-teste, a avaliação deles sobre o curso foi positiva e a atuação dos ministrantes satisfatória. Ressalta-se a importância de elaborar capacitações para os docentes e a necessidade de fornecer a eles mais materiais de apoio e atividades de autoaprendizagem.

Among the difficulties found for the inclusion of children with Autism Spectrum Disorder (ASD) in schools is the lack of technical knowledge and specific instruments that support the practice of education professionals and schools. Considering this need, a training program has been implemented based on the theoretical framework of behavior analysis for 18 elementary school teachers from a school in a city in the countryside of the State of São Paulo in order to enable them to learn strategies to promote the participation of students with ASD in group activities using cooperative games. Five classes have been given with a practical approach, addressing the themes: cooperative games, prompt and reinforcement. The evaluation of the course has been done in three steps: Pre-Test, Post-Test and Follow-up application. In order to evaluate the learning of the participating teachers, they performed a simulation activity of situations and interventions experienced with students with ASD based on the contents learned. In addition, the Assessment Scale of Oral Language Teaching at the School Context (EVALOE) was applied to evaluate the performance of the instructors. The results have indicated that the participants have had more correct answers in the Post-test than in the Pre-test, their evaluation of the course has been positive, and the performance of the students satisfactory. The importance of developing training for teachers and the need to provide them with more support materials and self-learning activities is emphasized.

En medio de las dificultades encontradas en la inclusión de los niños y niñas con Trastorno del Espectro Autista (TEA) en las escuelas, está la falta de conocimientos técnicos y instrumentos específicos que conceden soporte a la práctica de los profesionales de la educación y a las escuelas. Considerando esta necesidad, se aplicó un programa de capacitación a 18 maestros de la Escuela Primaria y Secundaria de una ciudad del estado de São Paulo, con el fin de capacitarles para promover la participación de alumnos con TEA en actividades en grupo utilizando los juegos cooperativos. Cinco clases fueron ministradas con un enfoque práctico, abordando los temas: juegos cooperativos, Prompt y refuerzo. Los resultados indicaron que los profesores tuvieron más éxito en el post-test que en el pre-test, aplicados para evaluar el curso, y su evaluación, en general, fue positiva. Se hace hincapié en la importancia de elaborar la capacitación de los docentes y la necesidad de proporcionarles más materiales de apoyo y actividades de autoaprendizaje.

Influence of different prompt measures on the quality of cardiopulmonary resuscitation chest compressions in the first year standardized training of residents in Chinese medicine hospitals / 中国中西医结合急救杂志

Objective To investigate the influence of different prompt measures on the quality of cardiopulmonary resuscitation (CPR) chest compressions in the standardized training of residents in Chinese medicine hospitals. Methods There were 84 participants who were the first year standardized training residents recruited from Guangdong Provincial Hospital of Chinese medicine during July to August 2016, and eleven of them were excluded because of incomplete chest compression data collected from the feedback system. Finally, 73 participants being volunteers were enrolled. They were divided randomly into phone metronome group (n = 16), music metronome group (n = 15), depth display group (n = 22), and blank control group (n = 20). In phone metronome group, a mobile phone metronome was applied in the duration of CPR, with a frequency of 110 beats per minute, beat 2/4; in the music metronome group, it was accompanied by the music Staying Alive during the compression period, with frequency of 107 beats per minute, beat 4/4; in depth display group, a model electronic displayer was used in the duration of the compressions to feedback the real time compression depth and its rebound situation in CPR; there was no any intervention measure in blank control group. Each participant performed 5 cycles of CPR on a manikin. A chest compression feedback device was placed on the pressing point, on which the participants places the hand for CPR. The chest compression fraction 1 (CCF1), compression depth, compression rate, too slow frequency, too fast frequency, too shallow frequency, the total times of compressions, the correct times of compressions, correct rate, and the rate of compression retention were record as preliminary evaluation data by using the dual sensor and the pressure sensor built in the chest compression feedback device. At the same time, the correct compression ratio, correct ventilation ratio, the chest compression fraction 2 (CCF2) displayed on the human electronic displayer of the manikin were used as the review criteria. The quality of chest compression among the four groups of volunteers was compared. Results The compression rate and the too fast frequency in the depth display group were significantly higher than those in the music metronome group [compression rate (bpm): 140.59±17.90 vs. 124.27±21.43, the too fast frequency (times): 134.18±49.88 vs. 95.40±53.76, both P < 0.05], and the total compression times in depth display group were significantly higher than either in music metronome group or in blank control group (times: 152.73±27.05 vs. 135.60±10.38, 144.60±12.56, all P < 0.05), the rate of compression retention in depth display group was significantly higher than that in blank control group [37.50% (4.75%, 88.25%) vs. 12.00% (2.75%, 47.00%)]. Consistency detection of two sets of feedback systems for chest compression showed that the chest compression ratio in music metronome group evaluated by the chest compression feedback device was obviously lower than that assessed by the analog human electronic displayer [(53.60±9.87)% vs. (58.20±28.17)%], and it was suggested that the chest compression ratio in depth display group evaluated by the chest compression feedback device be markedly higher than that assessed by the analog human electronic displayer [(56.32±7.77)% vs. (43.86±27.63)%, P < 0.05], and it was shown that the correct rates of chest compression assessed by the chest compression feedback device were significantly lower than those evaluated by the analog human electronic displayer in metronome, music, depth and blank control groups [phone metronome group: 0.00% (0.00%, 60.75%) vs. 38.50% (24.25%, 92.00%), music metronome group: 0.00% (0.00%, 7.00%) vs. 60.00% (32.00%, 89.00%), depth display group: 0.00% (0.00%, 0.25%) vs. 34.00% (20.75%, 68.25%), blank control group: 0.00% (0.00%, 1.75%) vs. 61.50% (30.75%, 84.25%), all P < 0.05], suggesting that the consistency of this two feedback systems be poor and their degrees of reliability low. Conclusion The effects of intervention measures on the quality of chest compressions vary from person to person, and the quality of chest compressions can be really elevated only by systematic training and repeated practice.

Etiology and outcome of mono-articular arthritis: a follow up study

Background: Monoarthritis is a common rheumatological complaint. Inspite of investigations, many cases remain undiagnosed. Prompt investigation and treatment is important in acute arthritis especially septic arthritis else joint destruction, permanent disability or even death can result. This study was conducted to etiologically categorise patients as inflammatory, non-inflammatory and infective arthritis and to study the outcome.Methods: This observational prospective study conducted at a tertiary care hospital in Mumbai enrolled 40 patients above the age of 12 yrs presenting with first episode of mono-articular arthritis. They were treated with standard treatment guidelines and followed up every 3 monthly for one year. Outcome was assessed using ESR, CRP values and Health Assessment Questionnaire.Results: Mean age at diagnosis was 38 years with a male to female ratio of 1.4:1. Acute and chronic mono-articular arthritis cases were 16.2% and 83.7% respectively. Knee joint was most commonly involved (38%). Etiologically inflammatory, infectious and non-inflammatory cases were 59.5%, 29.7% and 10.8% respectively. In 21% cases etiology was tuberculosis. 27 % evolved into oligoarthritis over one year. The serial ESR, CRP values and Stanford Health Assessment Questionarre scores decreased significantly across all etiological groups with treatment.Conclusions: Knee is the most commonly affected joint in mono-articular arthritis. Tuberculosis is the most common etiology. Irrespective of the etiology, if patients are treated according to standard guidelines promptly mono-articular arthritis has a good response to therapy as assessed by the health assessment questionnaire (HAQ) and serial measurements of proinflammatory markers like ESR, CRP.

Design of Multifunctional Automated External Defibrillator Based on STM32 / 中国医疗器械杂志

This paper presents a design of multifunctional portable automated external defibrillator based on STM32F103VC SCM. The defibrillator mainly realizes the defibrillation and ECG analysis function, and according to the clinical actual need, increases information storage and transmission function, query of local records, the function of synchronous LCD display and voice prompt in the defibrillation process. The device uses the defibrillating electrodes to measure body resistance, ECG and so on. We detailedly researched and achieved the discharge module of biphasic defibrillation apparatus based on the damping of two order discharge circuit, and finished the real-time LCD display and voice prompt modules of defibrillation information based on the control of PIC24FJ256DA210 chip.

Analytic simulator and image generator of multiple-scattering Compton camera for prompt gamma ray imaging

For prompt gamma ray imaging for biomedical applications and environmental radiation monitoring, we propose herein a multiple-scattering Compton camera (MSCC). MSCC consists of three or more semiconductor layers with good energy resolution, and has potential for simultaneous detection and differentiation of multiple radio-isotopes based on the measured energies, as well as three-dimensional (3D) imaging of the radio-isotope distribution. In this study, we developed an analytic simulator and a 3D image generator for a MSCC, including the physical models of the radiation source emission and detection processes that can be utilized for geometry and performance prediction prior to the construction of a real system. The analytic simulator for a MSCC records coincidence detections of successive interactions in multiple detector layers. In the successive interaction processes, the emission direction of the incident gamma ray, the scattering angle, and the changed traveling path after the Compton scattering interaction in each detector, were determined by a conical surface uniform random number generator (RNG), and by a Klein-Nishina RNG. The 3D image generator has two functions: the recovery of the initial source energy spectrum and the 3D spatial distribution of the source. We evaluated the analytic simulator and image generator with two different energetic point radiation sources (Cs-137 and Co-60) and with an MSCC comprising three detector layers. The recovered initial energies of the incident radiations were well differentiated from the generated MSCC events. Correspondingly, we could obtain a multi-tracer image that combined the two differentiated images. The developed analytic simulator in this study emulated the randomness of the detection process of a multiple-scattering Compton camera, including the inherent degradation factors of the detectors, such as the limited spatial and energy resolutions. The Doppler-broadening effect owing to the momentum distribution of electrons in Compton scattering was not considered in the detection process because most interested isotopes for biomedical and environmental applications have high energies that are less sensitive to Doppler broadening. The analytic simulator and image generator for MSCC can be utilized to determine the optimal geometrical parameters, such as the distances between detectors and detector size, thus affecting the imaging performance of the Compton camera prior to the development of a real system.

Laboratory Workup of Drug-Induced Immune Hemolytic Anemia / 대한수혈학회지

Drug-induced immune hemolytic anemia (DIIHA) is rare condition that is often very difficult to diagnose. For proper diagnosis of DIIHA, careful interpretation of laboratory findings as well as correlation between those findings with the patient's history is important. Therefore, the role of the laboratory physician is critical. DIIHA can be diagnosed using a stepwise approach, from suspicion of hemolytic anemia in the patient to confirmation of serologic tests. Prompt diagnosis is necessary since an essential part of DIIHA treatment is to cease drug administration, and many cases of hemolysis can be improved without further intervention. Furthermore, distinction between the mechanisms of DIIHA is important, as clinical manifestation, treatment options, and prognosis of the disease can differ according to the main mechanism involved in the process of hemolysis.

Exploration of regulating infusion administration sequence by an intelligent prompt system in pharmacy intravenous admixture services / 中华医院管理杂志

Eight sub-databases of pharmacological information on rational use of medicines were designed and established. These sub-databases cover dosing frequency, therapeutic drug priority to auxiliary medication, infusion shelf-life after admixture, incompatibility of two continuous infusion in the vein infusion tube, chronopharmacology, drug interaction involved in administration sequence , venous irritative drugs and preventive medicine. Once the standing order delivery to PIVAS involves any of these sub-databases, the system will prompt in turn " Auxiliary" , " Time limit" , " Taboo" , " Chronopharmacology" , " Interaction" , " Irritative" and " Preventive (therapeutic)" , starting from therapeutic drug priority to auxiliary medication. Pharmacists would make a reasonable sequence of the corresponding infusion and label the administration sequence on the infusion tag according to the prompt.Compared to the circumstance prior to this system, the wards with the infusion sequence labeling and equipped with intelligent prompt increased from 2 to 43; the percentage of such inpatients increased from 0.50% to 66.33%; the percentage of medical orders increased from 0.72% to 78.94%. The time spent by pharmacists for the same workload reduced from 73.44 h per day to 1.94 h per day. The times of flushing infusion tube reduced from 34.42 to 1.49 per ward and per day. The cost of flushing infusion tubes reduced by a big margin. PIVAS has established a method of regulating infusion administration sequence by an intelligent prompt system, based on improved safety and effectiveness of medication.

FPGA-Based Interface of Digital DAQ System for Double-Scattering Compton Camera / 대한핵의학회잡지

PURPOSE: The double-scattering Compton camera (DSCC) is a radiation imaging system that can provide both unknown source energy spectra and 3D spatial source distributions. The energies and detection locations measured in coincidence with three CdZnTe (CZT) detectors contribute to reconstructing emission energies and a spatial image based on conical surface integrals. In this study, we developed a digital data acquisition (DAQ) board to support our research into coincidence detection in the DSCC.METHODS: The main components of the digital DAQ board were 12 ADCs and one field programmable gate array (FPGA). The ADCs digitized the analog 96-channel CZTsignals at a sampling rate of 50MHz and transferred the serialized ADC samples and the bit and frame clocks to the FPGA. In order to correctly capture the ADC sample bits in the FPGA, we conducted individual sync calibrations for all the ADC channels to align the bit and frame clocks to the right positions of the ADC sample bits. The FPGA logic design was composed of IDELAYand IDDR components, six shift registers, and bit slip buffer resources.RESULTS: Using a Deskew test pattern, the delay value of the IDELAY component was determined to align the bit clock to the center of each sample bit.We determined the bit slip in the 12-bit ADC sample using an MSB test pattern by checking where the MSB value of one is located in the captured parallel data.CONCLUSION: After sync calibration, we tested the interface between the ADCs and the FPGA with a synthetic analog Gaussian signal. The 96 ADC channels yielded a mean R2 goodness-of-fit value of 0.95 between the Gaussian curve and the captured 12-bit parallel data.

Evaluación de tres métodos de tamizaje para detección de Enterobacteriaceae productoras de carbapenemasas en hisopados rectales / Evaluation of three screening methods for detection of carbapenemase-producing Enterobacteriaceae in rectal swabs

Resumen Introducción: Las Enterobacteriaceae productoras de carbapenemasas (EPC) han tomado gran importancia en salud pública a una escala global, haciendo necesario implementar test rápidos para su detección oportuna. Objetivo: Evaluar tres metodologías para el tamizaje de EPC en hisopados rectales. Materiales y Métodos: Estudio prospectivo transversal. Se evaluaron 73 hisopados rectales por tres metodologías. Se realizó identificación y evaluación de susceptibilidad por sistemas automatizados y la producción de carbapenemasas se confirmó por test de Hodge modificado, sinergia con ácido borónico y EDTA. Resultados: Método 1 (ChromID CARBA®): detectó 20 muestras positivas (27,4%), 5 falsos positivos (6,9%), con índice de concordancia de 93,2%, sensibilidad 100% y especificidad de 90%. Método 2 (HB&L Carbapenemase®): detectó 17 muestras positivas (23,3%) y 3 falsos negativos (4,1%). La sensibilidad y especificidad fue 85 y 100% respectivamente, con concordancia de 95,9%. Método 3 (Xpert Carba-R®): detectó 19 muestras positivas (57,5 %) y 1 falso negativo (3,1%), sensibilidad 95%, especificidad 100% e índice de concordancia de 97%. Discusión: Existe amplia variedad de metodologías para búsqueda y detección rápida de microorganismos productores de carbapenemasas. La elección del método debe tener como requisito una buena sensibilidad y especificidad, rapidez y costo efectividad.

Background: Carbapenemase-producing Enterobacteriaceae (CPE) have taken great importance on public health at global scale, which makes it necessary to implement rapid test for its prompt detection. Aim: To evaluate three screening methods to detect CPE in rectal swabs. Material and Methods: Transverse study, prospective. Seventy three rectal swabs were evaluated by three methodologies. Microorganism identification and susceptibility testing were made using automated systems. Carbapenemase production was confirmed by modified Hodge test and synergy tests using boronic acid and EDTA. Results: The method 1 (ChromID CARBA®) detected 20 positive samples (27.4%), 5 false positives (6.9 %), with concordance index of 93.2%, sensitivity 100% and specificity of 90%. Method 2 (HB&L Carbapenemase®) detected 17 positive samples (23.3%) and 3 false negatives (4.1%). The sensitivity and specificity of the assay were 85% and 100%, with concordance index of 95.9%. Method 3 (Xpert Carba-R®) detected 19 positive samples (57.5%) and 1 false negatives (3.1%), sensitivity 95%, specificity 100% and concordance index of 97%. Discussion: There is a wide variety of methodologies for rapid detection of carbapenemase-producing microorganisms. Choosing the best method must have as requirement a good sensitivity, specificity, and cost-effectiveness.

Ensino de Relações Espaciais de Esquerda e Direita a Participantes com Autismo e Deficiência Intelectual / Teaching Left-right Spatial Relations to Individuals with Autism and Intellectual Disability

RESUMO O reconhecimento dos conceitos de direita-esquerda é uma evidência do desenvolvimento da noção do corpo e faz parte de um processo de lateralização simbólica. Nesse sentido, o objetivo foi ensinar respostas de ouvinte para relações espaciais de direita-esquerda envolvendo partes do corpo e verificar o uso dessas relações em um contexto diferente. Foram conduzidos dois experimentos, que se diferenciaram em função da idade e repertório de entrada dos participantes e do delineamento experimental. No primeiro, foi utilizado um delineamento do tipo A-B e os participantes foram um menino com autismo e dois jovens com deficiência intelectual. No segundo, foi utilizado o delineamento de linha de base múltipla entre participantes, que foram quatro meninos com autismo. O ensino envolveu o uso de um procedimento de instrução com múltiplos exemplares e esvanecimento de dicas (imitação, dicas gestuais, verbais e físicas). Os resultados indicaram aprendizagem das relações ensinadas e uso dessas relações em um contexto diferente (generalização). O uso de múltiplos exemplares e de esvanecimento mostraram-se promissores no ensino de relações espaciais a participantes com pouco repertório verbal.

ABSTRACT The recognition of the left-right concept is an evidence of the body notion development and is part of a process of symbolic lateralization. In this sense, the goal of the present study was to teach listener responses to left-right spatial relations involving body parts and to verify the use of these relations in a different context. Two experiments were conducted, which differed in terms of the age and the input repertoire of the participants and and in terms of experimental design. In the first, an A-B design was used and the participants were a boy with autism and two adolescents with intellectual disabilities. In the second, a concurrent multiple baseline design across participants was used and the participants were four boys with autism. The teaching phase involved the use of a multiple exemplar instruction (MEI) and prompt fading (imitation, gestural, verbal and physical prompts) procedure. The results indicated that the participants learned the taught relations and used those relations in a different context (generalization). The use of MEI and fading showed to be promising in teaching left-right spatial relations to participants with a small verbal repertoire.

Plantão psicológico em unidade básica de saúde: atendimento em abordagem humanista-fenomenológica / Prompt psychological attention in basic health unit: care in humanistic-phenomenological approach / Servicio de emergencia psicológica en la unidad básica de salud: atención en el enfoque humanista-fenomenológico

Analisando o psicólogo na Atenção Primária entendemos que, este profissional tem muito a contribuir, seja integrando a equipe ou atuando em parceria com ela. E que este trabalho seria mais abrangente no formato de Plantão Psicológico (PP), que acolhe a pessoa no exato momento de sua necessidade. Este estudo é do tipo qualitativo-fenomenológico e buscou descrever atendimentos psicológicos realizados em uma Unidade Básica de Saúde (UBS). Participaram da pesquisa 13 pessoas, com idades entre 10 e 80 anos, 12 pessoas eram do sexo feminino e 1 do sexo masculino, a maioria eram de baixa escolaridade e de baixa renda. Foram atendidos, primeiramente no formato de PP e, quando necessário, os clientes foram convidados a seguirem em psicoterapia. Os atendimentos foram orientados teoricamente pela abordagem Fenomenológico-Existencial. A maioria dos participantes apresentou queixa de depressão, mostrando vincular-se a problemas familiares. Houve outras queixas como luto, ansiedade, gravidez, e um caso da patologia de transtorno obsessivo compulsivo. Uma grande parcela dos clientes preferiu buscar outro plantão se sentissem necessidade a seguir um processo psicoterapêutico. Conclui-se que o Plantão Psicológico é um instrumento viável e pertinente na prevenção e promoção de saúde.

Analyzing the psychologist's role in primary health care we understand this occupation can contribute complementing or being partner of the medical staff. We understand this work could be wider in a prompt psychological attention (PP), in which we can attend the patients in the moment of their needs. This study is qualitative-descriptive and tries to analyze psychological assistances made in a medical center (MC). This research comprehends 13 people between 10 and 80 years old; 12 people are female and 01 male. Most of them have low income and low education level. Firstly, these assistances happened as PP and, when necessary, the patients were invited to continue their assistance in psychotherapy. These assistances had as theoretical background existential-phenomenological. Most patients presented complaints of depression linked to their families. There were others complaints linked to mourning, anxiety, pregnancy, and one case of obsessive-compulsive disorder. Many patients preferred to seek PP again whenever they felt the need instead of starting a psychotherapy. We conclude that prompt psychological attention (PP) is a viable and pertinent instrument for health care and prevention.

Al analizar el psicólogo en la Atención Primaria hemos entendido que esto profesional tiene mucho que cooperar, sea añadido al equipo, sea actuando junto a ella. Además, que esto trabajo sería más abarcador en el formato de Plantón Psicológico (PP), el cual acoge a la persona en el exacto momento de su necesidad. Esta investigación es cualitativo descriptivo y buscó hacer un análisis de las atenciones psicológicas realizadas en un puesto médico. Cooperaron en la investigación 13 personas, con edades entre 10 a 80 años, 12 personas eran del sexo femenino y 1 del masculino, en que la mayoría era de baja escolaridad y de baja renta. Han sido atendidos, en primer momento, en el formato de PP y, cuando fuera necesario, los clientes fueron invitados a seguir en la psicoterapia. Las atenciones han sido orientadas teóricamente por el abordaje fenomenológico existencial. La mayoría de los participantes presentaron la queja de depresión atadas a problemas familiares. Además, otras quejas como luto, ansiedad, embarazo y un caso de la patología de trastorno obsesivo compulsivo. Una gran parcela de los clientes ha preferido buscar otro plantón si tuviera necesidad para seguir un proceso psicoterapéutico. Así, se concluye que el Plantón Psicológico es un instrumento viable e pertinente a prevención y promoción de salud.

Ensino sem erro e aprendizagem de discriminação / Errorless learning and discrimination learning / Aprendizaje sin error y la discriminación aprendizaje

O termo aprendizagem sem erro tem sido utilizado para se referir, de maneira ampla, à programação de contingências de ensino que resultam em desempenhos precisos ou com pouco erro. A ocorrência de erros durante a aprendizagem tem sido considerada uma parte importante e necessária à aprendizagem na cultura e no meio acadêmico. Na Análise do Comportamento os erros e suas implicações para a aprendizagem são investigados em estudos sobre controle de estímulos e os resultados indicam que erros podem interferir na precisão de desempenhos já aprendidos, gerar comportamentos emocionais, esquiva da tarefa e/ou do professor. Neste estudo, são apresentados diferentes procedimentos de modificação gradual de estímulos para ensinar discriminações, que podem gerar aprendizagem sem erro, e os fatores que afetam a eficácia dessas contingências de ensino. Esses procedimentos necessitam ser mais amplamente divulgados, por serem contribuições importantes da Análise do Comportamento para contextos aplicados, especialmente para o desenvolvimento de tecnologias de ensino quando métodos tradicionais fracassam.

The term errorless learning is largely used to refer to programming teaching contingencies which result in accurate performances or learning without errors. The occurrence of errors during learning has been considered an important and necessary part of learning in cultural and academic contexts. Errors and their implications for learning are investigated in behavioral analytic studies on stimuli control and their results indicate that errors can affect the accuracy of an already established performance, generate emotional behaviors, and avoidance of the task or teacher. The present study describes different procedures with gradual stimulus change, to teach discrimination skills with none or few errors, and the factors that affect the efficacy of those discriminative training. Such procedures are a relevant contribution from behavior analysis to applied contexts, especially for the development of educational technologies when traditional methods fail.

El término aprendizaje sin error se ha utilizado para referirse, en general, la programación de contingencias de enseñanza que se traducen en rendimientos precisos o con poco errores. La ocurrencia de errores durante el aprendizaje se ha considerado importante y necesario para el aprendizaje en la cultura y en la academia. En el Análisis de la Conducta errores y sus implicaciones para el aprendizaje son investigados en los estudios sobre control de estímulos y los resultados indican que errores puede afectar la precisión de rendimiento ya aprendido, generar comportamientos emocionales, evitación de la tarea o del maestro. En este texto, se presentarán diferentes procedimientos de modificación gradual de estímulos para enseñar la discriminación, que puede generar el aprendizaje sin error y los factores que afectan la efectividad de estas contingencias. Estos procedimientos deben difundirse más ampliamente, constituyen importantes contribuciones para contextos de análisis aplicado del comportamiento, especialmente para el desarrollo de tecnologías educativas cuando fallan los métodos tradicionales.

Ipsilateral fracture dislocations of the hip and knee joints with fracture of acetabulum : a rare case and its management principles.

Simultaneous ipsilateral hip and knee dislocations can be a devastating injury rendering the limb useless if not treated for time. Long term results also vary because these two types of injuries are associated with complications like avascular necrosis of the femoral head, knee instability, and stiffness at both the joints. Early diagnosis and prompt reduction is must to prevent the complications. Here we report a case with such an injury with description regarding its management difficulties. The prompt reduction of dislocations was carried out to achieve good results. Our case report add to this existing literature.

Evaluation on the effect of Point of Decision Prompt to increase the use of stairs / 中华流行病学杂志

Objective To evaluate whether Point of Decision Prompt (PDP) could effectively increase the use of stairs in the Chinese university dormitory buildings.Methods Number and certain features of students who used stairs and lifts were respectively recorded through observation in both buildings A (intervened) and building B (not intervened) simultaneously one week before the intervention (stage Ⅰ),the first week after the intervention (stage Ⅱ) and the fourth week after the intervention (stage Ⅲ).Self-questionnaires were also used to evaluate the effect of the intervention program in building A.Results According to the observation,the overall stair-use in building A increased from 34.3% in stage Ⅰ to 37.5% (P＜0.05,compared with stage Ⅰ) in stage Ⅱ and dropped to 35.4% (P＜0.05,compared with stage Ⅰ) in stage Ⅲ.In contrast,the change in the overall stair-use in building B between these three stages was not statistically significant.The change of the stair-use varied with different sexes,different directions (up or down) and different days (weekday or weekend).Data from the questionnaires showed that 97.3% of the students being surveyed reported that they had noticed the PDPs and 26.4% of whom reported that they had increased the frequency of stair-use.Results from the logistic analysis of the questionnaire showed that girls (OR=8.78,95% CI:3.23-23.87,deff= 1.24) and those who lived under the fifth floor (OR=2.78,95%CI:1.28-6.06,deff= 1.38) were more inclined to increase the stair-use.Conclusion PDP could effectively increase the frequency of stair-use in the Chinese university dormitory buildings.

Acute fatty liver of pregnancy: A case report / 대한산부인과학회지

Acute fatty liver of pregnancy are relatively rare but extremely dangerous, because they may quickly develop into a fulminant disease and become a serious life-threatening disorder for mother and fetus in the third trimester. Therefore, early diagnosis, prompt delivery and intensive supportive care the cornerstones in the management of acute fatty liver of pregnancy. Clinical findings in acute fatty liver of pregnancy vary because it may occur with varying degrees of clinical severity and in conjunction with other third trimester symptoms, making early diagnosis difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We have experienced a case of acute fatty liver of pregnancy presenting as early hepatic encephalopathy, renal failure which developed during the third trimester. We diagnosed acute fatty liver of pregnancy based on clinical presentation and laboratory abnormalities. Despite of prompt delivery and adequate supportive care management, this severe complication of pregnancy has had an adverse outcome for mother.

Clinical and Radiological Analysis of Carotid Cavernous Fistula and Detachable Balloon Occlusion: Case Report

Carotid-cavernous fistula is a serious complication of head trauma. We have experienced 5 cases of carotid-cavernous fistula(four cases were traumatic and one was spontaneous) recently and have successfully managed them by detachable balloon occlusion. We have found that while some cases had typical manifestations, the others had atypical features. We therefore concluded that clinical suspicion and early imaging studies are essential steps in the management of carotid-cavernous fistula. Careful monitoring and prompt treatment are important because of its dismal progression and poor outcome. Detachable balloon occlusion is a method of choice in management of carotid-cavernous fistula, because it can be used under local anesthesia. It provides a chance of early detection of neurological deterioration during the procedure and it can be, if necessary performed during diagnostic procedures.