Accidental digitoxin intoxication: an interplay between laboratory and clinical medicine

Introduction:

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.     

Surface tension effects on submerged electrosprays

Electrosprays are a powerful technique to generate charged micro/nanodroplets. In the last century, the technique has been extensively studied, developed, and recognized with a shared Nobel price in Chemistry in 2002 for its wide spread application in mass spectrometry. However, nowadays techniques based on microfluidic devices are competing to be the next generation in atomization techniques. Therefore, an interesting development would be to integrate the electrospray technique into a microfluidic liquid-liquid device. Several works in the literature have attempted to build a microfluidic electrospray with disputable results. The main problem for its integration is the lack of knowledge of the working parameters of the liquid-liquid electrospray. The “submerged electrosprays” share similar properties as their counterparts in air. However, in the microfluidic generation of micro/nanodroplets, the liquid-liquid interfaces are normally stabilized with surface active agents, which might have critical effects on the electrospray behavior. In this work, we review the main properties of the submerged electrosprays in liquid baths with no surfactant, and we methodically study the behavior of the system for increasing surfactant concentrations. The different regimes found are then analyzed and compared with both classical and more recent experimental, theoretical and numerical studies. A very rich phenomenology is found when the surface tension is allowed to vary in the system. More concretely, the lower states of electrification achieved with the reduced surface tension regimes might be of interest in biological or biomedical applications in which excessive electrification can be hazardous for the encapsulated entities.     

Creatine kinase activity weakly correlates to volume completed following upper body resistance exercise

In the current study, we examined the relationship between serum creatine kinase (CK) activity following upper body resistance exercise with a 1- or 3-min rest between sets. Twenty men performed two sessions, each consisting of four sets with a 10-repetition maximum load. The results demonstrated significantly greater volume for the 3-min condition (M = 4156 kg, SD = 867, for 3 min; vs. M = 3503 kg SD = 759, for 1 min; p < .001), with no significant differences in delta CK activity between conditions (p = .574). Nevertheless, there was a weak correlation between the delta CK activity and total volume of exercise completed (r = .55 with a 1-min rest, and r = .45 with a 3-min rest). Therefore, the volume following upper body resistance exercise correlates weakly with serum CK levels, irrespective of rest interval length between sets.     

Design issues for human-machine platform interface in cable-based parallel manipulators for physiotherapy applications

We outline problems and potential solutions for feasible human-machine interfaces using cable-based parallel manipulators for physiotherapy applications. From an engineering perspective, we discuss the design constraints related to acceptance by patients and physiotherapist users. To date, most designs have focused on mobile platforms that are designed to be operated as an end-effector connected to human limbs for direct patient interaction. Some specific examples are illustrated from the authors＇ experience with prototypes available at Laboratory of Robotics and Mechatronics （LARM）, Italy.     

The effect of scholar collaboration on impact and quality of academic papers

We study how scholar collaboration varies across disciplines in science, social science, arts and humanities and the effects of author collaboration on impact and quality of co-authored papers. Impact is measured with the aid of citations collected by papers, while quality is determined by the judgements expressed by peer reviewers. To this end, we take advantage of the dataset provided by the first-ever national research assessment exercise of Italian universities, which involved 20 disciplinary areas, 102 research structures, 18,500 research products, and 6661 peer reviewers. Collaboration intensity neatly varies across disciplines: it is inescapable is most sciences and negligible in most humanities. We measured a general positive association between cardinality of the author set of a paper and citation count as well as peer quality of the contribution. The correlation is stronger when the affiliations of authors are heterogeneous. There exist, however, notable and interesting counter-examples.     

From splendid isolation to crossed boundaries? The futures of teacher education in the light of activity theory

Many policy documents addressing the future of teacher education do not take into account the fundamental unpredictability of the future, nor the opposing forces that will try to influence that future. Through the analysis of 48 scenario documents on the future of education or teacher education, we identified a set of unpredictable key factors that have to be taken into account when addressing the future of teacher education. We also identified four main futures that may lie ahead for teacher education. We analyzed these four scenarios using the concepts of activity systems, boundary objects, and boundary crossing. This revealed that the extent to which activity systems are open to boundary crossing and are willing to remove institutional boundaries will largely define the future that lies ahead for teacher education. Future scenarios in themselves can play a role as boundary objects that facilitate the dialogue and boundary crossing between these activity systems.     

Telematics for Teacher Education: issues from a European conference

ABSTRACT

The world Information Superhighway is under discussion in many countries. Within Europe the discussion is also very active as is the promotion of the use of telematics for trans‐European communication and co‐operation in various areas. For education and training, representatives of European teacher trainers, teachers, students, parents, policy and decision makers discussed their needs and views on a trans‐European network at a conference held in May 1994 in Luxembourg. This paper presents a selection of various issues raised at the conference regarding the use of telematics for teacher education and illustrates the discussion and the method of discussion. It also describes and discusses the conference programme model, as it offered innovative on‐line activities to facilitate appreciation of telematics. The case is argued that teacher education can benefit greatly from telematics and some points are put forward for further discussion.     

Exploring the Lived Experiences and Intersectionalities of Mexican Community College Transfer Students: Qualitative Insights Toward Expanding a Transfer Receptive Culture

ABSTRACT

This qualitative study examines the experiences of six Mexican community college transfer students attending a research-intensive institution in the Pacific Northwest. Using semi-structured interviews, the objectives of this study were to 1) understand how Mexican students made meaning of their transfer experiences and 2) how those experiences could inform conceptual and practical thinking toward building a transfer receptive culture at the receiving institution. We use intersectionality as a site of material and discursive possibility to encourage predominantly White receiving institutions to recognize how they position Mexican community college transfer students on campus. Concluding are conceptual and practical recommendations that emphasize institutional and organizational responsibility in creating equitable environments for Mexican community college transfer students.     

CFD application to optimise the ventilation strategy of Senate Room at Palazzo Madama in Turin (Italy)

Over the last years, there was an increasing interest in keeping suitable microclimatic conditions for the preservation of artefacts: the artefacts preservation requirements may diverge from those of the museums visitors, willing to enjoy the works of art in a situation of psycho-physical wellness. The HVAC designers and engineers will have then to cooperate closely with the curator, in order to define a compromise between conflicting environmental performance requirements. In particular at the stage of air-conditioning system design or retrofit, it is extremely important to carry out a series of preliminary analysis to evaluate and monitor the existing environmental conditions and to anticipatory simulate and predict the post-intervention conditions. To this aim, advanced fluid-dynamic investigation tools (Computational Fluid Dynamic [CFD] techniques) enable to deal with the specificity of such topics and provide a useful decision-making support.     

Conservation of stained glass windows with protective glazing: Main results from the European VIDRIO research programme

The methodology of protecting the European stained glass windows against environmental risk (e.g. meteorological factors, air pollution, microorganisms) by means of an external glazing is not new. In spite of many scientific studies carried out in the last 20 years, some questions were still up for discussion. The European VIDRIO (2002–2005) project gave an answer to these questions. The research carried out by the different project partners established a new multidisciplinary approach aimed at evaluating the efficiency of the protective glazing systems and their effects on stained glass windows conservation, and finally at assessing the most appropriate strategy to preserve stained glass windows. Scientific results showed that the so-called isothermal glazing (i.e. ventilation by the air coming from the inside of the building) protected efficiently the ancient stained glass window from environmental attack (i.e. rain, pollutants, condensation, thermal shocks) with very limited secondary effects. The scientific research highlighted that its efficiency was strongly related to the technical design of the protective system. In particular, the ventilation and the size of the interspace had to be carefully considered. The research developed within the VIDRIO project was turned into general recommendations to the owners and practitioners on the best practice for the stained glass windows future conservation.