Two Italian adults arrived at the Emergency Department referring diarrhea, nausea and vomiting for 4 days; weakness, fatigue and visual hallucinations were also complained of. Patients reported the ingestion of some leaves of a plant, which they supposed to be “donkey ears”, a week before. Physical examination showed hypotension and bradycardia and ECG examination disclosed sinus rhythm and repolarization abnormalities (scooping of the ST-T complex) in both patients and a 2:1 AV block in the man.
Materials and methods:
Digoxin concentration was evaluated twice for each patient (at the admission and after 4 hours) by the automated immunoassay system ADVIA Centaur®. Digitoxin concentration was evaluated by liquid chromatography-mass spectrometry (LC-MS/MS).
Results:
Despite clinical picture was suggestive of digitalis intoxication, digoxin levels were undetectable. Due to the more severe clinical picture, the male patient was treated with anti-digoxin antibodies (Digifab®) achieving a good clinical improvement and remission of the AV block within two hours. Initial diagnosis was confirmed by LC-MS/MS showing high digitoxin concentrations, but digoxin was undetectable. Patients remained stable and 48 hours later were discharged from the hospital.
Conclusion:
Whereas digoxin determination frequently relies on monoclonal antibodies which do not cross-react to digitoxin, polyclonal antibodies constituting Digifab® recognize a large spectrum of cardiac glycosides, including digitoxin. This report emphasizes the primary role of the clinical approach to patients in the emergency setting and how an active communication and a continuous sharing of professional experiences between Laboratory and Clinicians ensure an early and correct diagnosis. 相似文献
As the scientific change problem is at the center of epistemological research, the conceptual change problem is widely discussed in didactical research. In this paper common features of both problems will be discussed. Recent ideas on the role of analogies and metaphors in the growth of scientific knowledge are analyzed in order to show their relevance for scientific education problems. These ideas are also confronted with the image of scientific learning put forward by pedagogical and epistemological constructivism. In this perspective, the analysis of Maxwell's views about metaphors and analogies seems to give a deeper insight as to the problem of scientific change and scientific abstraction which still require clarification in educational and epistemological reflection. 相似文献
‘A tribute to Dr J. Rogge’ aims to systematically review muscle activity and muscle fatigue during sustained submaximal quasi-isometric knee extension exercise (hiking) related to Olympic dinghy sailing as a tribute to Dr Rogge’s merits in the world of sports. Dr Jacques Rogge is not only the former President of the International Olympic Committee, he was also an orthopaedic surgeon and a keen sailor, competing at three Olympic Games. In 1972, in fulfilment of the requirements for the degree of Master in Sports Medicine, he was the first who studied a sailors’ muscle activity by means of invasive needle electromyography (EMG) during a specific sailing technique (hiking) on a self-constructed sailing ergometer. Hiking is a bilateral and multi-joint submaximal quasi-isometric movement which dinghy sailors use to optimize boat speed and to prevent the boat from capsizing. Large stresses are generated in the anterior muscles that cross the knee and hip joint, mainly employing the quadriceps at an intensity of 30–40% maximal voluntary contraction (MVC), sometimes exceeding 100% MVC. Better sailing level is partially determined by a lower rate of neuromuscular fatigue during hiking and for ≈60% predicted by a higher maximal isometric quadriceps strength. Although useful in exercise testing, prediction of hiking endurance capacity based on the changes in surface EMG in thigh and trunk muscles during a hiking maintenance task is not reliable. This could probably be explained by the varying exercise intensity and joint angles, and the great number of muscles and joints involved in hiking.Highlights
Dr Jacques Rogge, former president of the International Olympic Committee and Olympic Finn sailor, was the first to study muscle activity during sailing using invasive needle EMG to obtain his Master degree in Sports Medicine at the Ghent University.
Hiking is a critical bilateral and multi-joint movement during dinghy racing, accounting for >60% of the total upwind leg time. Hiking generates large stresses in the anterior muscles that cross the knee and hip joint.
Hiking is considered as a quasi-isometric bilateral knee extension exercise. Muscle activity measurements during sailing, recorded by means of EMG, show a mean contraction intensity of 30-40% maximal voluntary contraction with peaks exceeding 100%.
Hiking performance is strongly related to the development of neuromuscular fatigue in the quadriceps muscle. Since maximal strength is an important determinant of neuromuscular fatigue during hiking, combined strength and endurance training should be incorporated in the training program of dinghy sailors.
AbstractThe aim of this study was to compare the reliability, internal responsiveness and interchangeability of the Yo-Yo intermittent recovery test level 1 (YY1), level 2 (YY2) and submaximal YY1 (YY1-sub). Twenty-four young soccer players (age 17 ± 1 years; height 177 ± 7 cm; body mass 68 ± 6 kg) completed each test five times within pre- and in-season; distances covered and heart rates (HRs) were measured. Reliability was expressed as typical error of measurement (TEM) and intraclass correlation coefficient (ICC). Internal responsiveness was determined as effect size (ES) and signal-to-noise ratio (ESTEM). Interchangeability was determined with correlation between training-induced changes. The TEM and ICC for distances in the YY1 and YY2 and for HR in YY1-sub were 7.3% and 0.78, 7.1% and 0.93 and 2.2% and 0.78, respectively. The ESs and ESTEMs were 0.9 and 1.9 for YY1, 0.4 and 1.2 for YY2 and ?0.3 and ?0.3 for YY1-sub. Correlations between YY1 vs. YY2 and YY1-sub were 0.56 to 0.84 and ?0.36 to ?0.81, respectively. Correlations between change scores in YY1 vs. YY2 were 0.29 and ?0.21 vs. YY1-sub. Peak HR was higher in YY1 vs. YY2. The YY1 and YY2 showed similar reliability; however, they were not interchangeable. The YY1 was more responsive to training compared to YY2 and YY1-sub. 相似文献
We examined the relation of parental empathy-related characteristics and emotion-related child-rearing practices to third and sixth graders' vicarious emotional responding. Children's heart rate, skin conductance, facial, and self-reported reactions to a sympathy-inducing film were assessed, as were their dispositional sympathy, empathy, and self-monitoring. Parental sympathy was positively related to low levels of personal distress in same-sex children and, for both parents, with sons' dispositional sympathy or empathy. Parental emphasis on problem-focused coping strategies when their sons were anxious was positively correlated with indexes of sons' situational and dispositional sympathy. Same-sex parental restrictiveness in regard to the control of inappropriate, hurtful emotional displays was associated with sons' and daughters' dispositional and situational sympathy, whereas maternal restrictiveness in regard to emotions that are unlikely to hurt others was correlated with nonverbal indexes of personal distress and self reports of low distress. Parental emphasis on control of the child's own negative emotion was associated with children's self-monitoring. 相似文献
This study attempts to understand how achievement gap Discourse might be present in preservice teachers' (PSTs) Discourse about students they found challenging to teach. Using a Discourse analytic approach, the project considers: How do PSTs describe challenging students in their written reflections? Do PSTs draw on students' multiple identities? Findings reveal PSTs are taking up a Discourse prevalent in today's educational environment in which students, particularly ethnically and linguistically diverse students, are discussed in terms of inadequacy. PSTs typically describe students in terms of a single label, rather than as having multiple identities. Implications include that PSTs might enter teaching with a limited view and incomplete understanding of students and that even a teacher-education program aimed at pushing PSTs to question their assumptions about students might be reifying a systemwide Discourse that identifies students based on labels—sometimes deficit-oriented labels—rather than fuller understandings of students. 相似文献
In this study, we examined the mechanics and energetics of locomotion with a paddle-wheel boat and a water bike. Power output (Wtot) was measured directly on the water bike by means of an instrumented chain-ring. The simultaneous assessment of oxygen uptake (VO2) allowed the computation of the "overall" efficiency of locomotion (etao = Wtot/VO2). Mean etao was 0.27 (s = 0.02), which was unaffected by the speed, and was assumed to be the same for the two boats as both are semi-recumbent bicycles. For the paddle-wheel boat, Wtot was then obtained from etao and measures of VO2. The power to overcome (passive) drag was calculated as Wd = D x v (where D is the force measured by means of a load cell when towing the boats at given speeds). Propelling efficiency was calculated as etap = Wd/Wtot, which was lower with the paddle-wheel boat (mean 0.35, s = 0.01) than with the water bike (mean 0.57, s = 0.01). The observed differences in etap and Wd explain why at the highest speed tested (approximately 3 m s(-1), the energy required to cover a unit distance with the water bike is similar to that required to move the paddle-wheel boat at 1.3 m s-1). 相似文献
The Obama administration campaigned on the platform of increased transparency and access to government information after the limitations of the Bush years. As part of this focus on transparency, the Obama administration is emphasizing the use of e-government and new social media services to open up access to government. This paper explores the considerations and challenges of this approach, such as the inclusion of members of the public with limited access to the internet, the use of non-governmental channels to disseminate government information, the permanence of digital-born government information, and the design of e-government. 相似文献