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Road traffic accidents are a public health epidemic, causing significant morbidity and mortality in low- and middle-income countries. The Dominican Republic (DR) ranks among the highest road traffic fatality rates in the world. There is no formalized trauma curriculum in the DR. A short trauma course was implemented at a San Pedro de Macoris, DR hospital with pre-, post- and retention evaluation of the knowledge, skills and confidence of the providers.

A 4-day trauma course was developed for medical students and residents. On days 1 and 4, providers completed pre- and post-training assessments consisting of a 40-question written exam, 1 simulation case and a trauma confidence questionnaire. Simulation cases were evaluated using a critical actions checklist and a non-technical skills scale (TNOTECHS). Assessments were repeated in 2 months to evaluate for knowledge, skill and confidence retention. A repeated measures ANOVA model was used to evaluate pre-, post- and retention training differences in the writ0.05). Provider opinion that their ED patients received best care possible and patients’ needs were identified and addressed showed statistically significant increases.

A short trauma course can improve trauma specific knowledge, skills and confidence with significant retention at two months. A longitudinal trauma curriculum may bolster retention.

A short trauma course can improve trauma specific knowledge, skills and confidence with significant retention at two months. A longitudinal trauma curriculum may bolster retention.

A stable fixation of highly unstable proximal humerus fractures remains challenging and complication rates, especially secondary varus dislocation, remains high. Different techniques of double plate osteosynthesis have been suggested for the treatment of complex proximal humeral fractures as they are well established for other fractures. The aim of this study was to evaluate an operative technique using an angular stable lateral plate supported by a one-third tubular plate positioned anteriorly at the lesser tuberosity for unstable proximal humeral fractures.

Retrospectively, patients treated with a double plate osteosynthesis were included between January 2014 and December 2017. Out of 31, 25 patients (80.6%) with an average age of 53.1 years ± 12.5 were available for follow-up. 60% of the patients were male. The clinical evaluation consisted of a physical examination and standardised questionnaire including subjective and objective shoulder scores like the Constant-Murley Shoulder Score, Simple Shouldertability and shows good clinical results despite a higher rate of avascular necrosis and high primary stability with comparable complication-rates to single plate osteosynthesis. CGS 21680 clinical trial It seems to be a valid alternative to primary fracture arthroplasty and can prevent secondary varus displacement.

Arthroplasty is the less favourable treatment for a younger, active cohort of patients with highly unstable proximal humeral fractures as results are not as good and options for revision are limited. Double plate osteosynthesis can be used in addition to calcar screws, bone graft augmentation, cement augmentation and additional free screws for more multidirectional stability and shows good clinical results despite a higher rate of avascular necrosis and high primary stability with comparable complication-rates to single plate osteosynthesis. It seems to be a valid alternative to primary fracture arthroplasty and can prevent secondary varus displacement.Reinforcement learning methods are being applied to control problems in robotics domain. These algorithms are well suited for dealing with the continuous large scale state spaces in robotics field. Even though policy search methods related to stochastic gradient optimization algorithms have become a successful candidate for coping with challenging robotics and control problems in recent years, they may become unstable when abrupt variations occur in gradient computations. Moreover, they may end up with a locally optimal solution. To avoid these disadvantages, a Markov chain Monte Carlo (MCMC) algorithm for policy learning under the RL configuration is proposed. The policy space is explored in a non-contiguous manner such that higher reward regions have a higher probability of being visited. The proposed algorithm is applied in a risk-sensitive setting where the reward structure is multiplicative. Our method has the advantages of being model-free and gradient-free, as well as being suitable for real-world implementation. link2 The merits of the proposed algorithm are shown with experimental evaluations on a 2-Degree of Freedom robot arm. The experiments demonstrate that it can perform a thorough policy space search while maintaining adequate control performance and can learn a complex trajectory control task within a small finite number of iteration steps.This work focuses on the extended dissipative synchronization problem for chaotic neural networks with time delay under quantized control. The discretized Lyapunov-Krasovskii functional method, in combination with the free-weighting matrix approach, is employed to obtain an analysis result of the extended dissipativity with low conservatism. Then, with the help of several decoupling methods, a computationally tractable design approach is proposed for the needed quantized controller. Finally, two examples are provided to illustrate the usefulness of the present analysis and design methods, respectively.Jacques Mehler and I started Cognition, to break the grip of empiricist associationist behaviorism and stultifying style requirements on scientific discourse, and to liberate Cognitive Psychology’s contributions to social issues. The journal provided opportunities for upcoming generations to expand Cognitive Psychology, publishing new concepts unhindered by established topics and standard formats. As the journal matured, Jacques kept. it fresh for 4 decades, seeking young scientists, novel ideas, and elegant writing, as it midwifed the emergence from Reductionist Behaviorism through Cognitive Psychology to rationalist Cognitive Science. The journal now has opportunities to nurture further progress in the future of Cognitive Science. I speculate that the field will keep associationist processes but integrate them with a new kind of non-reductionist theory that eschews detailed predictions, and which which interprets the brain as an enactor of thought, but not its structural cause. Ideally it will provide a set of constraints on the action of brain and mind that subsume and explain behavioral regularities, the role of frequency, how the brain externalizes those constraints and how the externalization processes emerge developmentally as a function of innate factors, structures unique to the mind and brain, experience and natural law.Mental illness affects 48.9 % of the Moroccan population. Despite this significant figure, mental illness remains unrecognized. The patients suffering from mental disorders are therefore subject to stigma and social rejection. A descriptive study was conducted at the consultation service of the psychiatric Ibn Nafiss hospital of the CHU of Marrakech. We chose as a sample 100 stabilized patients, followed on an outpatient basis. The study included the three mental disorders depressive disorder, bipolar disorder, and schizophrenia. The number of patients in each group had been fixed beforehand; and we tried to get a fairly even distribution between the two genders. The questionnaire had three main axes (1) Sociodemographic data of the patient. (2) Knowledge of the disease. (3) Evaluation of the experience of stigma. The results of our sample were as follows For both sexes the age extremes were 19 to 68 years with an average of 38.5 with a clear predominance of women. For the entire population, most patients were single with a percentage of 60 %. Two thirds of the patients, i.e. link3 59 %, did not exceed primary school. For personal medical history, endocrine pathologies were the most prevalent, at 18 % of cases, while depression was the most common family psychiatric history in our study. We noticed that our population suffered more discrimination and disclosure from those around them regardless of family, social and professional with less appreciation of the positive aspects.Bipolar disorder is a chronic and disabling mental illness affecting approximately 1-2% of the general population, characterized by the occurrence of manic episodes alone or alternating with depressive episodes. Bipolar disorder is associated with significant morbidity, mortality and personal suffering. The mechanisms underlying the onset and progression of bipolar disease are still poorly understood. Recently, immunological dysfunctions have been suggested in the pathogenesis of bipolar disorder, and many studies have focused on the interaction between bipolar disorder and immunity. Immunological changes have been widely studied during depressive episodes but less explored during manic episodes. The objective of our study was to explore changes in serum proteins and autoantibodies after treatment for a manic episode of bipolar I disorder. This study was carried out over a 30-month period from January 2017 to June 2019, in collaboration between the psychiatry department B of the Hédi Chaker CHU and the immunoer with sodium valproate. On atypical antipsychotic medication, the mean plasma level of fraction C3 was statistically lower, whereas on conventional antipsychotic medication it was statistically higher. This is in line with the data in the literature which support the immunomodulatory role of thymoregulators and antipsychotics. Serum proteins have been more sensitive than autoantibodies to the effect of psychotropic therapy during manic relapse.

Psychiatric disorders are common in peripartum and are associated with adverse outcomes for mother and fetus. Electroconvulsive therapy (ECT) is one of the most effective and safe options to treat severe mental illness, including during the perinatal period. Nevertheless, it remains underutilized during this period, possibly due to negative representations. Research has been carried out on the representations and attitudes of caregivers towards ECT, but the specificities of these attitudes during peripartum have not been explored.

We aimed to assess the attitudes towards ECT during the peripartum among psychiatrists, nurses, social workers and psychologists. The primary objective was to compare the score of favorability for ECT during peripartum according to the profession. The secondary objective was to highlight other factors involved in the favorability for ECT in peripartum.

We investigated mental health professionals’ attitudes sending by e-mail an anonymous questionnaire in five hospitals in Francn the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.

In this study, we have found that profession, training and experience in ECT are linked to the attitudes towards ECT, including in the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.