Analysis of the inappropriate utilization of the emergency service of a third-level hospital

OBJECTIVE: a) To find the reasons for inadequate use of Hospital Casualty Departments (HCDs); b) to discover the general population's levels of information concerning non-hospital Emergency Services (NESs); c) to analyse the relationship between the type of Primary Care Centre (PCC), i.e. whether reformed or not, and inadequate use of HCDs. DESIGN: A crossover study. SETTING: The Germans Trias i Pujol Hospital Casualty Department, Badalona. PATIENTS: A random sample of 321 patients over 14 years old, who were attended for pathologies considered emergencies not requiring hospital treatment. MEASUREMENTS AND MAIN RESULTS: The variables gathered were: age, gender, where the patient came from, reason for hospital use, knowledge of NESs and subsequent referral. 83.2% of patients attended on their own initiative. The main reasons given were "advantages of a hospital" and "the persistence of symptoms." 49% of the patients stated they knew of the NESs. 80% of the patients proceeded from PCCs which had not been reformed. There were no statistically significant differences (p > 0.05) when the variables "reason for use" and "knowledge of NESs" were compared in relation to where the patient came from (i.e. reformed or non-reformed PCC). CONCLUSIONS: General practitioners in reformed PCCs are less likely to refer to HCDs. Knowledge and use of NESs should be actively supported.     

Trends in psychotherapy process research: Samples, measures, researchers, and classic publications.

Psychotherapy studies published in the Journal of Counseling Psychology (JCP) and the Journal of Consulting and Clinical Psychology (JCCP) between 1978 and 1992 were examined. Differences were found between the 2 journals. JCP published mostly process, outcome, and analog research, whereas JCCP published mostly outcome research. Most process and process-outcome studies across journals were of individual, brief therapy. Across the years, more diversity was evident in samples used in process research in terms of student status, gender, and race of clients and therapists. Three content areas were prominent in the process measures and classic studies: therapist techniques, therapist influence, and facilitative conditions. Lists are provided of the frequently used measures, most productive authors, and classic studies in process research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synthesis, Structure and Antitumour Properties of a New 1,2-Propylenediaminetetraacetate-Ruthenium(III) Compound

A novel complex formed by ruthenium (III) and the sequestering ligand 1,2-propylenediaminetetraacetic acid (PDTA) has been synthetized and characterized. The structure of the monomeric compound, studied by X-ray diffraction , shows an almost symmetric octahedral geometry around the metal ion, with two chlorine atoms in a cis conformation. The antitumour activity against a variety of murine and human cancers is reported.     

Homopolymer Nanolithography

Future progress in nanoscience and nanotechnology necessitates further development of versatile, labor‐, and cost‐efficient surface patterning strategies. A new approach to nanopatterning is reported, which utilizes surface segregation of a smooth layer of an end‐grafted homopolymer in a poor solvent. The variation in polymer grafting density yields a range of surface nanostructures, including randomly organized pinned spherical micelles, worm‐like structures, networks, and porous films. The capability to use the polymer patterns for site‐specific deposition of small molecules, polymers, or nanoparticles is shown. This versatile strategy enables patterning of curved surfaces with direct access to the substrate and no need in changing polymer composition to realize different surface patterns.     

Excess volumes and excess viscosities of binary mixtures of some cyclic ethers + bromocyclohexane at 298.15 and 313.15 K

Excess Volumes,V ^E, and excess viscosities, ^E, at 293.15 and 313.15 K are reported for binary mixtures of some cyclic ethers (tetrahydrofuran, tetrahydropyran, 2-methyltetrahydrofuran and 2,5-dimethyltetrahydrofuran) + bromocyclohexane. These properties were obtained from density and viscosity measurements. ^E and ^E show negatives values for all the mixtures.     

The urologic work of Doctor Alejandro Settier (1858-1915). (V). Specialist Alejandro Settier

In spite of the names and works of practically all the early 19th Century Spanish specialists in urinary tract being widely known, there are still in my opinion several names and writings, either forgotten or misplaced in newspaper libraries, archives and general libraries, awaiting to be discovered. The second half of the 19th Century was a prolific age in every aspect of Spanish life, most particularly literature. In Medicine, apart from the well known professional writings, the number of scientific journals and publications, whether in the form of brochures or divulgative articles, that came to light was countless. Computer management of collections currently under implementation in many registers, will allow their location and the finding of new texts. One of these long forgotten pioneers, is Doctor Alejandro Settier (1858-1915), a Valencian practitioner who describes himself as a "disciple of the Paris hospitals and specialist in genitourinary tract disorders", who practised in Madrid between 1883 and 1890. Surprisingly, and in spite of him being the most prolific author in urological issues during the last century (my investigations show he is the author of 2 books, 3 brochures and 40 articles in journals), neither his name nor his work, as far as we know, are mentioned by none of the historians consulted, which is nothing but highly surprising if we also take into consideration that Alejandro Settier was the founder of the first Spanish monographic journal for urinary disorders: "Gaceta de enfermedades de los órganos génito-urinarios" (Gazette of genitourinary organs disorders), Madrid 1887, which in spite of its short existence, can be considered as the first scientific periodical publication in our specialty.     

PAK-104P, a pyridine analogue, reverses paclitaxel and doxorubicin resistance in cell lines and nude mice bearing xenografts that overexpress the multidrug resistance protein

For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.     

Acetylcholine-induced potassium current of guinea pig outer hair cells: its dependence on a calcium influx through nicotinic-like receptors

The cholinergic efferent inhibition of mammalian outer hair cells (OHCs) is mediated by a hyperpolarizing K+ current. We have made whole-cell tight-seal recordings from single OHCs isolated from the guinea pig cochlea to characterize the mechanism by which acetylcholine (ACh) activates K+ channels. After ACh application, OHCs exhibited a biphasic response: an early depolarizing current preceding the predominant hyperpolarizing K+ current. The current-voltage (I-V) relationship of the ACh-induced response displayed an N-shape, suggesting the involvement of Ca2+ influx. When whole-cell recording was combined with confocal calcium imaging, we simultaneously observed the ACh-induced K+ current (IK(ACh)) and a Ca2+ response restricted to the synaptic area of the cell. This IK(ACh) could be prevented by loading OHCs with 10 mM of the fast Ca2+ buffer bis(2-aminophenoxy)ethane-N,N,N',N'-tetra-acetic acid (or BAPTA), therefore allowing the observation of the ACh-induced early current in isolation. This early current revealed nicotinic features because it activated with an intrinsic delay in the millisecond range, reversed nearly in between potassium and sodium equilibrium potentials, and was blocked by curare. However, it was strongly reduced in the absence of external Ca2+, and its I-V relationship displayed an unusual outward rectification at positive membrane potentials and an inward rectification below -60 mV. The results indicate that the cholinergic response of mammalian OHCs involves a "nicotinic-like" nonspecific cation channel through which Ca2+ enters and triggers activation of nearby Ca2+-dependent K+ channels.     

Turk-2, a multi-modal chess player

In this paper we present Turk-2, a hybrid multi-modal chess player with a robot arm and a screen-based talking head. Turk-2 can not only play chess, but can see and hear the opponent, can talk to him and display emotions. We were interested to find out if a simple embodiment with human-like communication capabilities enhances the experience of playing chess against a computer. First, give an overview of the development road to multi-modal communication with computers. Then we motivate our research with a hybrid system, we introduce the architecture of Turk-2, we describe the human experiments and its evaluation. The results justify that multi-modal interaction makes game playing more engaging, enjoyable – and even more effective. These findings for a specific game situation provide yet another evidence of the power of human-like interaction in turning computer systems more attractive and easier to use.