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Abstract We present a case of a 21-year-old Caucasian woman at 27 weeks of pregnancy who was admitted to the obstetric department for pre-term labor. She received 10 mg of nifedipine 4 times in 1 h, according to the internal protocol. Shortly after, she brutally deteriorated with pulmonary edema and hypoxemia requiring transfer to the intensive care unit (ICU) for mechanical ventilation. She finally improved and was successfully extubated after undergoing a percutaneous valvuloplasty of the mitral valve. This case illustrates a severe cardiogenic shock after administration of nifedipine for premature labor in a context of unknown rheumatic mitral stenosis. Nifedipine induces a reflex tachycardia that reduces the diastolic period and thereby precipitates pulmonary edema in case of mitral stenosis. This case emphasizes the fact that this drug may be severely harmful and should never be used before a careful physical examination and echocardiography if valvular heart disease is suspected.

Este caso de estudo tem como objetivo demonstrar a utilidade da utilização de imagens de satélite de alta resolução para a produção de cartografia temática em áreas urbanas, bem como, experimentar a extracção de elementos de uma imagem de alta resolução a partir de protocolos de segmentação, aplicando uma abordagem orientada por regiões, e recorrendo a dados de uma cena do satélite WorldView2 com as suas novas 4 bandas adicionais. Definiu-se uma nomenclatura de ocupação de solo com base na fotointerpretação da imagem, criou-se uma legenda hierarquizada por 3 níveis de desagregação. No primeiro nível incluiu-se sete classes, no segundo nível as classes foram classificadas pelo nome dos objetos identificados na fotointerpretação, e o terceiro nível foram classificados pelas características dos objetos definidos no nível anterior. Foram criados segmentos de treino através do algoritmo da segmentação, que tem como função criar segmentos vetoriais com base na similaridade espectral e no valor espectral dos conjuntos dos pixéis vizinhos, testou-se varios parâmetros de segmentação de modo a obter o nível de segmentação que visivelmente na imagem se aproximasse mais aos objetos reconhecidos, para assim se gerar as assinaturas espectrais dos objetos representados pela segmentação, procedendo-se à classificação de ocupação de solo baseada nos segmentos.

Background: Nursing homes are among the most common places of death in many countries. Aim: To determine the quality of dying and end-of-life care of nursing home residents in six European countries. Design: Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales – Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality. Setting/participants: Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident’s care. Results: Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales – Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14–42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11–55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales – Comfort Assessment while Dying score was associated with country ( p = 0.027), older age ( p = 0.012), length of stay ⩾1 year ( p = 0.034), higher functional status ( p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country ( p < 0.001), older age ( p < 0.001), length of stay ⩾1 year ( p < 0.001), higher functional status ( p = 0.002), absence of dementia ( p = 0.001), death in nursing home ( p = 0.033). Conclusion: The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.

Miller's famous pyramid of competence starts with knowledge at the bottom level, when the clinician “knows” the facts.1 Superior competence is achieved when the clinician can use knowledge in a particular context, “knows how.” Better still, “shows how” indicates that when tested, the clinician can show practical application of the knowledge. The peak level of “does” refers to actual performance in practice. But is there not a missing concept here—that of “knows about”? I was struck by a rapid response to Mrs Patel's case from a doctor who had previously shown his competence around the thyroid issue in the first week. …

Invånarna har blivit mindre nöjda med stadsdelsnämndernas service efter SDN-reformen i Göteborg, västsvenskar med funktionshinder exkluderas i sociala aktiviteter och unga nyhetskonsumenter tror att den lokala papperstidningen går mot sin död. Beställ bäcker från SOM-institutet:http://som.gu.se/publicerat/B%C3%B6cker/bokbestallning//bestall-bocker.cid895360 Pris: 290 kronor.

AbstractIn everyday life, our behavior varies on a continuum from automatic and habitual to deliberate and goal-directed. Recent evidence suggests that habit formation and relearning of habits operate in a context-dependent manner: Habit formation is promoted when actions are performed in a specific context, while breaking off habits is facilitated after a context change. It is an open question how one can computationally model the brain’s balancing between context-specific habits and goal-directed actions. Here, we propose a hierarchical Bayesian approach for control of a partially observable Markov decision process that enables conjoint learning of habits and reward structure in a context-specific manner. In this model, habit learning corresponds to an updating of priors over policies and interacts with the learning of the outcome contingencies. Importantly, the model is solely built on probabilistic inference, which effectively provides a simple explanation of how the brain may balance contributions of habitual and goal-directed control. We illustrated the resulting behavior using agent-based simulated experiments, where we replicated several findings of devaluation, extinction, and renewal experiments, as well as the so-called two-step task which is typically used with human participants. In addition, we show how a single parameter, the habitual tendency, can explain individual differences in habit learning and the balancing between habitual and goal-directed control. Finally, we discuss the link of the proposed model to other habit learning models and implications for understanding specific phenomena in substance use disorder.

Uvod: Zaradi napredka na področju zdravljenja hiva osebe s hivom živijo bolje in dlje. S tem pa se povečuje število oseb s hivom, ki potrebujejo strokovno in sočutno zobozdravstveno obravnavo. Zobozdravstvena oskrba je za osebe s hivom pomembna zaradi odkrivanja okužbe, saj se prvi znaki bolezni navadno pojavijo v ustni votlini. Pomembna je tudi pri spremljanju napredovanja bolezni. Kljub pomenu zobozdravstvene oskrbe pa osebam s hivom veliko težavo povzroča stigma, ki je prisotna tudi med zdravstvenimi delavci, zlasti v zobozdravstvu. Zaradi družbenega strahu pred nalezljivo okužbo, neinformiranosti in nesprejemanja drugačnosti so osebe s hivom pogosto tarča stereotipov, predsodkov in diskriminatornega ravnanja. Namen: Namen diplomskega dela je izpostaviti kršitve, s katerimi se pri zobozdravstveni obravnavi soočajo osebe s hivom, predstaviti vzroke zanje in opisati, katere aktivnosti so potrebne za zmanjševanje stigme in diskriminacije oseb s hivom v zobozdravstvu. Metode dela: Diplomsko delo temelji na deskriptivni metodi pregleda domače in tuje strokovne in znanstvene literature. Literaturo smo časovno omejili na obdobje od leta 2009 do leta 2019, pozneje pa smo obdobje razširili od leta 1992 do izdelave diplomskega dela. Uporabili smo oddaljen dostop do podatkovnih baz Medline, PubMed, Cinahl. Uporabili smo tudi spletna brskalnika Google in Google Scholar. Ključne besede, ki smo jih uporabili pri iskanju literature, so: hiv, stigma, dentistry, oral care, discrimination. Rezultati: Osebe s hivom pri zobozdravstveni obravnavi kljub jasni zakonodaji pogosto doživljajo odpor in zavračanje zdravstvenih delavcev. Zobozdravniki zaradi pretiranega strahu pred okužbo, pomanjkanja znanja in negativnih stališč neradi obravnavajo osebe s hivom. Razprava in zaključek: Osebe s hivom pri zobozdravstveni obravnavi doživljajo različne kršitve, kot so zavrnitev zobozdravstvene oskrbe, nadlegovanje in nespoštovanje zasebnosti. Za etično obravnavo oseb s hivom ne zadostujejo le strokovno znanje in praktične sposobnosti zobozdravnika, potrebna je celovita podpora. Potrebna je humana obravnava, ki vključuje tudi oblikovanje varnega okolja in ustrezno komunikacijo. Z izobraževanjem in ozaveščanjem je potrebno oblikovati pozitivna stališča zdravstvenih delavcev do oseb s hivom. Introduction: Due to advances in HIV treatment, people diagnosed with HIV live better and longer. Hence the number of HIV-positive patients in need of professional and compassionate dental care is increasing. Dental care is important for detecting HIV infection. The first signs of HIV infection usually appear in the oral cavity. Furthermore, dental care is very important for monitoring the progression of the disease. Despite the importance of dental care, people living with HIV face a major problem due to the stigma which exists among health professionals, especially in dentistry. Due to societal fear of contagious infection, lack of information, and lack of acceptance of difference, they are often the target of stereotyping, prejudice and discriminatory treatment. Purpose: The aim of this thesis is to highlight the violations which people with HIV face in dental treatment, to present the causes of these violations, and to describe the activities needed to reduce stigma and discrimination against them in dentistry. Methods: The diploma thesis is based on a descriptive method of reviewing domestic and foreign professional and scientific literature. The literature was limited to the period from 2009 to 2019, and later the period was increased from 1992 until the time when the thesis was completed. Remote access to Medline, PubMed, Cinahl databases was used for the research. Furthermore, Google web browser and Google Scholar were used. Keywords used in the literature search: hiv, stigma, dentistry, oral care, discrimination. Results: Despite clear legislation, people with HIV often experience resistance and rejection by health professionals in dental treatment. Dentists are reluctant to treat them due to excessive fear of infection, lack of knowledge and negative attitudes. Discussion and conclusion: People with HIV experience various violations in dental treatment, such as denial of dental care, harassment, and disrespect of privacy. Ethical treatment requires more than the expertise and practical skills of the dentist it requires comprehensive support. Humane treatment is needed, including the creation of a safe environment and appropriate communication. In conclusion, it is necessary to form positive attitudes of health professionals towards people with HIV through education and awareness-raising.