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External validation of the MiGUTS nomogram for the prediction of bleeding control intervention after renal trauma
No full textINTRODUCTION
The American Association for the Surgery of Trauma (AAST) renal trauma grading leads to a variable management of patients with high-grade renal injuries. For a better prediction of the risk for bleeding interventions, Keihani et al. introduced the multi-institutional genito-urinary trauma study (MiGUTS) renal trauma nomogram in 2019. The aim of this study was to conduct an external validation and generalization for all kidney trauma cases of the nomogram with a European cohort of a Swiss level 1 trauma center.
METHODS
We collected data from the clinical information system of the Kantonsspital Graubünden, Chur, Switzerland. All patients ≥ 18 years of age from 01.01.2008 to 01.12.2020 with a renal trauma who underwent computed tomography imaging of the abdomen were included. The descriptive analysis was performed by a t-test/Wilcoxon signed-rank test and a Chi-square test. The predictions of the nomogram were analysed by the Pearson correlation coefficient. The threshold of prediction of a bleeding intervention was optimized by a ROC analysis.
RESULTS
Overall, 166 patients were included. Most patients were male (80.7%) with a median age of 44 years. Using the prediction from the MiGUTS nomogram developed by Keihani et al. we were able to identify a threshold with a sensitivity of 1.00, specificity of 0.87, positive predictive value of 0.44, negative predictive value of 1.00 and accuracy of 0.88.
CONCLUSION
The MiGUTS nomogram by Keihani et al. demonstrated to be reliable in the prediction of an intervention for bleeding control in our validation study in a European cohort
From seeing to knowing: the case of propositional perception
No full textThis paper examines the question as to whether propositional seeing is best thought of as a way of knowing a proposition to be true. After showing how Pritchard’s distinction between objective and subjective goodness motivates a negative answer to this question, I examine a challenge raised by Ghijsen for Pritchard’s construal of that distinction. I then turn to the connection between propositional seeing and belief. I argue that doxasticism about propositional seeing – the claim that propositional seeing involves belief – ultimately lacks independent motivation and I offer a model of propositional seeing that explains how propositional perception can provide one with a rational basis for forming a perceptual belief. Finally, I discuss in what way the proposed model of propositional seeing may remain compatible with the claim that propositional seeing is a way of knowing a proposition to be true
Novel Well-Balanced Continuous Interior Penalty Stabilizations
No full textIn this work, the high order accuracy and the well-balanced (WB) properties of some novel continuous interior penalty (CIP) stabilizations for the Shallow Water (SW) equations are investigated. The underlying arbitrary high order numerical framework is given by a Residual Distribution (RD)/continuous Galerkin (CG) finite element method (FEM) setting for the space discretization coupled with a Deferred Correction (DeC) time integration, to have a fully-explicit scheme. If, on the one hand, the introduced CIP stabilizations are all specifically designed to guarantee the exact preservation of the lake at rest steady state, on the other hand, some of them make use of general structures to tackle the preservation of general steady states, whose explicit analytical expression is not known. Several basis functions have been considered in the numerical experiments and, in all cases, the numerical results confirm the high order accuracy and the ability of the novel stabilizations to exactly preserve the lake at rest steady state and to capture small perturbations of such equilibrium. Moreover, some of them, based on the notions of space residual and global flux, have shown very good performances and superconvergences in the context of general steady solutions not known in closed-form. Many elements introduced here can be extended to other hyperbolic systems, e.g., to the Euler equations with gravity
Nuclear medicine practice for the assessment of cardiac sarcoidosis and amyloidosis. A survey endorsed by the EANM and EACVI
No full textGenital Wounding in Chimpanzees (Pan troglodytes): Targeted Attacks or Happenstance?
No full textReports of primate violence frequently note wounds to the genital region, raising the possibility that attackers target genitals to eliminate the reproductive capacity of rivals. Alternatively, in chimpanzees (Pan troglodytes) and other species with prominent genitals, injuries may occur simply because large size makes genitals easy targets. To test these hypotheses, we compiled records of wounds suffered by chimpanzees in four communities at three long-term study sites (Gombe, Tanzania; Kibale, Uganda; Fongoli, Senegal), including both nonlethal (N = 1,268 wounds; N = 891 male wounds; N = 377 female wounds) and lethal attacks (N = 258 wounds), to determine whether genital wounding occurred more frequently than expected by chance. In nonfatal cases, wounds occurred in the genital region more often than expected for females (Kasekela: N = 9/80 wounds, Mitumba: N = 8/61 wounds, Fongoli: N = 11/84 wounds, Kanyawara: N = 31/152 wounds), but only in Kasekela did males suffer genital wounds more often than expected by chance (Kasekela: N = 3/80 wounds, Mitumba: N = 2/48 wounds, Fongoli: N = 6/413 wounds, Kanyawara: N = 4/350 wounds). In contrast, killings of males involved genital wounds more often than expected (N = 12/258 wounds). Increased genital wounding may occur when genitals are more accessible, such as when females flee from male aggression, exposing their hindquarters, or when victims are immobilized during fatal attacks
Wochenbett, Nachuntersuchungen
No full textIm Wochenbett finden Uterusrückbildung mit Wundheilung und Laktationsbeginn statt. Die Subinvolutio uteri kann über eine Endometritis/Endomyometritis zur Puerperalsepsis und zum Toxic-shock-Syndrom (TTS) durch z. B. Strepto- oder Staphylokokken führen. Jedes Fieber, eine plötzlich auftretende Verschlechterung des Allgemeinzustands oder eine Organdysfunktion müssen abgeklärt und behandelt werden, um nicht zum septischen Schock zu führen. Bei Fieber muss auch an die Mastitis, Pyelonephritis und an eine septische Ovarialvenenthrombose gedacht werden. Bei Sepsismanifestationen sollten eine hochdosierte antibiotische Kombinationstherapie, großzügig die operative Entfernung des Infektionsherdes und intensivmedizinische Maßnahmen erfolgen. Auch Harnverhalt, Urininkontinenz oder Hämorrhoidalbeschwerden kommen im Wochenbett vor. Es ist wichtig, den auftretenden häufig „maternity blues“ von der postpartalen-Depression und der Puerperalpsychose abzugrenzen. Bei der Nachuntersuchung gewinnen neben der gynäkologischen Kontrolle mit Besprechung der postpartalen Kontrazeption, die Erkennung der postpartalen Depression und die Vorsorgeuntersuchungen nach Schwangerschaftserkrankungen wie z. B. der Präeklampsie und dem Gestationsdiabetes zunehmend an Bedeutung
Opinion dynamics in communities with major influencers and implicit social influence via mean-field approximation
Full text linkWe study binary opinion formation in a large population where individuals are influenced by the opinions of other individuals. The population is characterised by the existence of (i) communities where individuals share some similar features, (ii) opinion leaders that may trigger unpredictable opinion shifts in the short term (iii) some degree of incomplete information in the observation of the individual or public opinion processes. In this setting, we study three different approximate mechanisms: common sampling approximation, independent sampling approximation, and, what will be our main focus in this paper, McKean–Vlasov (or mean-field) approximation. We show that all three approximations perform well in terms of different metrics that we introduce for measuring population level and individual level errors. In the presence of a common noise represented by the major influencers opinions processes, and despite the absence of idiosyncratic noises, we derive a propagation of chaos type result. For the particular case of a linear model and particular specifications of the major influencers opinion dynamics, we provide additional analysis, including long term behavior and fluctuations of the public opinion. The theoretical results are complemented by some concrete examples and numerical analysis, illustrating the formation of echo-chambers, the propagation of chaos, and phenomena such as snowball effect and social inertia
Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
No full textAssociation of Prenatally Diagnosed Isolated Single Left Superior Vena Cava and Postnatal Development of Coarctation of the Aorta
No full textTo report the prevalence of coarctation of the aorta (CoA) in fetuses with single left superior vena cava (SL-SVC) and to evaluate changes in echocardiographic measurements. Additionally, to report the prevalence of associated malformations. Retrospective observational study of fetuses diagnosed with SL-SVC between 2012 and 2021 at a tertiary fetal cardiology unit. In fetuses without intracardiac abnormalities, Z-scores of the ventricles, great arteries, and Doppler flow patterns are reported. We identified 47 fetuses with SL-SVC of which 8/47 (17%) had abnormal intracardiac anatomy. One fetus was lost to follow-up. Of those with normal intracardiac anatomy and postnatal follow-up (38), karyotype abnormalities were confirmed in 2/38 (5%) and ECA in 8/38 (21%). 33/38 were live-born. None developed CoA postnatally. Paired analysis of Z-scores between early and late scans of 24 fetuses showed that diameters of the right heart structures and Doppler flows of tricuspid valve increased significantly during pregnancy, while the left heart structures and flow patterns did not change. The median risk of CoA did not change between the early and the late scan. We did not observe CoA in this cohort. A degree of ventricular asymmetry was present, but this was due to right heart dominance rather than hypoplasia of left heart structures. This likely reflects redistribution of blood and does not appear to confer increased risk of CoA. Predictive models of the postnatal development of CoA which set the dimensions of right and left heart structures in relation might not be applicable in this situation