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.     

On functional observers for linear systems with unknown inputs and HOSM differentiators

The problem of constructing functional observers for linear systems with unknown inputs is considered. Necessary and sufficient conditions for the existence of a proper observer (without differentiations) are revisited. A simple and explicit form of a functional observer is presented. It is shown that when such observer is not proper, it is still possible to use the High-Order Sliding Mode differentiator to implement it. Nevertheless, in such case, additional conditions on the system and the unknown input are required.     

The Role of Historical-Philosophical Controversies in Teaching Sciences: The Debate Between Biot and Ampère

This paper evaluates the viability of using controversies in teaching. An educational project has been elaborated in which some historical-philosophical clashes were introduced into the classical syllabus of physics. The historical-philosophical controversy dealt with here, took place between the French physicists Biot and Ampère in the 19th century and referred to distinct interpretations of the Oersted experiment. This controversy was inserted into the syllabus of the 12th grade of a Brazilian secondary school.     

What drives teacher engagement: a study of different age cohorts

Despite the growing body of research on work engagement, little is known about what drives work engagement among different age cohorts. This study aims to investigate whether engagement varies across age cohorts and examine the job resources that foster teacher engagement. A questionnaire was distributed to 537 teachers who were employed in elementary, lower and upper secondary school. Findings show that work engagement did indeed vary across the diverse age group and is influenced by different resources. In line with previous studies, data revealed that the engagement of younger teachers is driven by the opportunity for development and interaction with colleagues, while older employees appreciate the opportunity to see their competencies acknowledged. What is most noteworthy is the opportunity to design practices and to provide every age group with the appropriate set of motivators.     

Do field position and playing standard influence athlete performance in wheelchair basketball?

Improved understanding of mobility performance in wheelchair basketball is required to increase game performance. The aim of this study was to quantify the wheelchair-athlete activities of players in different field positions and of different playing standard during wheelchair basketball matches. From video analysis, absolute and relative duration and frequency of wheelchair movements and athlete control options were examined in 27 national standard and 29 international standard players during entire wheelchair basketball matches. Between-group factorial analysis of variances identified that national players drove more forward (42.6 ± 6.8 vs. 35.4 ± 3.7%; effect size Cohen’s d (ES) = 1.48) and started more often driving forward (33.9 ± 2.6 vs. 31.8 ± 2.8; ES = 0.77) during a match while the mean activity duration for a single driving forward activity was longer (4.3 ± 0.9 vs. 3.7 ± 0.6 s; ES = 0.75) than for international players. Furthermore, national players performed fewer rotational movements (21.8 ± 4.0 vs. 28.9 ± 7.8%; ES = –1.30) and started less often with the rotational movements (35.0 ± 3.6 vs. 40.5 ± 5.5; ES = –1.21) while the mean activity duration for a single rotation activity was shorter (2.1 ± 0.3 vs. 2.3 ± 0.3 s; ES = –0.67) than for international players. Differences in mobility performance among guard, forward and centre players were minimal. The results should help wheelchair basketball coaches specify wheelchair-handling training techniques and means to optimise wheelchair-athlete configurations.     

Quantifying external focus of attention in sailing by means of action sport cameras

The aim of the current study was twofold: (1) to validate the use of action sport cameras for quantifying focus of visual attention in sailing and (2) to apply this method to examine whether an external focus of attention is associated with better performance in upwind sailing. To test the validity of this novel quantification method, we first calculated the agreement between gaze location measures and head orientation measures in 13 sailors sailing upwind during training regattas using a head mounted eye tracker. The results confirmed that for measuring visual focus of attention in upwind sailing, the agreement for the two measures was high (intraclass correlation coefficient (ICC) = 0.97) and the 95% limits of agreement were acceptable (between ?8.0% and 14.6%). In a next step, we quantified the focus of visual attention in sailing upwind as fast as possible by means of an action sport camera. We captured sailing performance, operationalised as boat speed in the direction of the wind, and environmental conditions using a GPS, compass and wind meter. Four trials, each lasting 1 min, were analysed for 15 sailors each, resulting in a total of 30 upwind speed trials on port tack and 30 upwind speed trials on starboard tack. The results revealed that in sailing – within constantly changing environments – the focus of attention is not a significant predictor for better upwind sailing performances. This implicates that neither external nor internal foci of attention was per se correlated with better performances. Rather, relatively large interindividual differences seem to indicate that different visual attention strategies can lead to similar performance outcomes.     

Leading higher education professionals: local,connected, and artful

In this paper, we explore the work life of a scholar new to academia in her methods of leading informally. We discuss five vignettes that offer moments of learning and reflection, including reducing performance anxiety, privileging financial accountability, the rise of the virtual world, the impact of silence, and the potential for confrontation to strengthen working relationships. We offer suggestions as to how contemporary leaders may adapt to the freedom that artful action offers.     

Visual search,movement behaviour and boat control during the windward mark rounding in sailing

In search of key-performance predictors in sailing, we examined to what degree visual search, movement behaviour and boat control contribute to skilled performance while rounding the windward mark. To this end, we analysed 62 windward mark roundings sailed without opponents and 40 windward mark roundings sailed with opponents while competing in small regattas. Across conditions, results revealed that better performances were related to gazing more to the tangent point during the actual rounding. More specifically, in the condition without opponents, skilled performance was associated with gazing more outside the dinghy during the actual rounding, while in the condition with opponents, superior performance was related to gazing less outside the dinghy. With respect to movement behaviour, superior performance was associated with the release of the trimming lines close to rounding the mark. In addition, better performances were related to approaching the mark with little heel, yet heeling the boat more to the windward side when being close to the mark. Potential implications for practice are suggested for each phase of the windward mark rounding.     

NEET: A Phenomenom Yet to Be Explored

Who are the NEET? How much do we know about this? What do institutions and the media know about them? How different definitions could get to shared policies? This paper tries to provide an initial overview of the situation regarding the NEET, through an analysis of the emerging international literature on the subject. Different definitions across nations are analyzed in order to reflect on the cultural differences and economics-work policies, in order to then analyze more in deep the Italian situation. In Italy, the phenomenon is still little known in society and, often, not recognized by the acronym NEET, with the many variables that define it, despite statistics showing a rise in numbers (26 % of the total population for the age group considered).     

Seeking sustainability competence and capability in the ESD and HESD literature: an international philosophical hermeneutic analysis

Education for sustainable development (ESD) and higher education for sustainable development (HESD) are complex, multidisciplinary fields of enquiry, drawing on concepts and terms from different disciplines and languages. Although the fields are advancing in their acceptability within educational systems worldwide, they are currently struggling to achieve sought-after graduate and societal outcomes such as environmentally-responsible or sustainability-focussed-citizenship. The research described in this article explores the possibility that miscommunication or misunderstanding of basic concepts within these fields is contributing to slow progress towards their objectives. We used a philosophical hermeneutic analysis to explore how the terms ‘competence’ and ‘capability’ are used within selected ESD/HESD papers. We identify substantial internal contradictions and inconsistencies with respect to differences between learners’ abilities and their willingness to perform these abilities, and to the educational context in which these outcomes are sought. We emphasise the importance of linking educational objectives with pedagogical approaches to teaching and assessment.