Feasibility, acceptability and effect of the Mindful Practice curriculum in postgraduate training of general practitioners.

BACKGROUND: Early career general practitioners are known to be at high risk of burnout. There is a need for widely applicable, cost-effective evidence-based interventions to develop trainees' protective skills and strategies. RESULTS: Of 120 eligible trainees, 23 (19.2%) expressed interest in participating, 17 subsequently started the course, and 15 completed at least 5 out of its 6 sessions. All psychological measures were stable for the six-week period prior to commencing the course. Following the course, there were statistically significant (p < 0.05) improvements in wellbeing, resilience, mindfulness, emotional exhaustion, disengagement, and stress scores. Participants described numerous benefits, and most stated that they would recommend it to colleagues. CONCLUSION: Including mindful practice within general practice vocational training is feasible, and in this study it benefited the psychological wellbeing of participants. Further research is needed to explore ways of increasing uptake and course completion, the sustainability of its effects, and the wider applicability of this approach.

Can a partnership between general practitioners and ambulance services reduce conveyance to emergency care?

BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) . METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED. RESULTS: Of 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72). CONCLUSION: Support of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation.

Climate variability and oceanographic settings associated with interannual variability in the initiation of Dinophysis acuminata blooms.

In 2012, there were exceptional blooms of D. acuminata in early spring in what appeared to be a mesoscale event affecting Western Iberia and the Bay of Biscay. The objective of this work was to identify common climatic patterns to explain the observed anomalies in two important aquaculture sites, the Galician Rías Baixas (NW Spain) and Arcachon Bay (SW France). Here, we examine climate variability through physical-biological couplings, Sea Surface Temperature (SST) anomalies and time of initiation of the upwelling season and its intensity over several decades. In 2012, the mesoscale features common to the two sites were positive anomalies in SST and unusual wind patterns. These led to an atypical predominance of upwelling in winter in the Galician Rías, and increased haline stratification associated with a southward advection of the Gironde plume in Arcachon Bay. Both scenarios promoted an early phytoplankton growth season and increased stability that enhanced D. acuminata growth. Therefore, a common climate anomaly caused exceptional blooms of D. acuminata in two distant regions through different triggering mechanisms. These results increase our capability to predict intense diarrhetic shellfish poisoning outbreaks in the early spring from observations in the preceding winter.

Evaluating the complexity and falsifiability of psychological models.

Understanding model complexity is important for developing useful psychological models. One way to think about model complexity is in terms of the predictions a model makes and the ability of empirical evidence to falsify those predictions. We argue that existing measures of falsifiability have important limitations and develop a new measure. KL-delta uses Kullback-Leibler divergence to compare the prior predictive distributions of models to the data prior that formalizes knowledge about the plausibility of different experimental outcomes. Using introductory conceptual examples and applications with existing models and experiments, we show that KL-delta challenges widely held scientific intuitions about model complexity and falsifiability. In a psychophysics application, we show that hierarchical models with more parameters are often more falsifiable than the original nonhierarchical model. This counters the intuition that adding parameters always makes a model more complex. In a decision-making application, we show that a choice model incorporating response determinism can be harder to falsify than its special case of probability matching. This counters the intuition that if one model is a special case of another, the special case must be less complex. In a memory recall application, we show that using informative data priors based on the serial position curve allows KL-delta to distinguish models that otherwise would be indistinguishable. This shows the value in model evaluation of extending the notion of possible falsifiability, in which all data are considered equally likely, to the more general notion of plausible falsifiability, in which some data are more likely than others. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The niche of a stress-tolerant specialist, Dinophysis acuminata, in a coastal upwelling system.

Dinophysis acuminata, the main cause of shellfish harvesting bans in Europe, blooms in the Galician Rías (NW Spain) throughout the upwelling season (ca. March to September). Here we illustrate rapid changes in vertical and across ría-shelf distributions of diatoms and dinoflagellates (including D. acuminata vegetative and small cells) in Ría de Pontevedra (RP) and Ría de Vigo (RV) during transitions from spin-down to spin-up phases of upwelling cycles. A subniche approach based on a Within Outlying Mean Index (WitOMI) showed that under the transient environmental conditions met during the cruise, both vegetative and small cells of D. acuminata colonized the Ria and Mid-shelf subniches, exhibiting good tolerance and extremely high marginality, in particular the small cells. Bottom-up (abiotic) control overwhelmed biological constraints, and shelf waters became a more favourable environment than the Rías. Contrasting higher biotic constraints inside the Rías were found for the small cells, with a subniche possibly controlled by unsuitable physiological status (notwithstanding the higher density) of the vegetative cell population. Results here on behaviour (vertical positioning) and physiological traits (high tolerance but very specialized niche) of D. acuminata give new insights into the ability of this species to remain in the upwelling circulation system. Higher shelf-ría exchanges in the Ría (RP) with more dense and persistent D. acuminata blooms reveal the relevance of transient event-scales and species- and site-specific characteristics to the fate of these blooms. Earlier statements about simple linear relationships between average upwelling intensities and the recurrence of Harmful algae bloom (HAB) events in the Galician Rías Baixas are questioned.

Adaptive Design Optimization for a Mnemonic Similarity Task.

The Mnemonic Similarity Task (MST: Stark et al., 2019) is a modified recognition memory task designed to place strong demand on pattern separation. The sensitivity and reliability of the MST make it an extremely valuable tool in clinical settings, where it has been used to identify hippocampal dysfunction associated with healthy aging, dementia, schizophrenia, depression, and other disorders. As with any test used in a clinical setting, it is especially important for the MST to be administered as efficiently as possible. We apply adaptive design optimization methods (Lesmes et al., 2015; Myung et al., 2013) to optimize the presentation of test stimuli in accordance with previous responses. This optimization is based on a signal-detection model of an individual's memory capabilities and decision-making processes. We demonstrate that the adaptive design optimization approach generally reduces the number of test stimuli needed to provide these measures.

Effect of an Online Mindfulness Course for Hospital Doctors During COVID-19 Pandemic on Resilience and Coping.

INTRODUCTION: Physicians' wellbeing is a priority to prevent increasing rates of poor mental health and burnout, exacerbated by caregiving during the COVID-19 pandemic. Structured mindfulness courses have been shown to be beneficial, but face-to-face delivery is not always feasible in the context of busy health services. Remotely delivered structured mindfulness courses could enable wider participation, particularly at time when social distancing to prevent infection transmission is necessary. Our objective was to test the feasibility of a remotely delivered structured mindfulness course for hospital doctors during the COVID-19 pandemic. METHODS: This was a feasibility study run at one English hospital between January and March 2021, when COVID-19 admissions were at a high. Interested doctors participated in a 6-session remotely delivered mindfulness course. Sessions lasted 90 min and could be attended on-line or the recording watched at later time. Main outcome measures were data on interest, course attendance and engagement, together with validated psychological outcome measures at baseline and follow-up after course completion. RESULTS: 20 doctors expressed interest to participate and 16 started the course. Of these, 12 completed at least 3 sessions (median = 4); difficulty attending resulted from conflicting clinical commitments and rosters. Twelve participants completed the follow-up survey. They rated the course highly and all perceived it to have been useful, with statistically significant (P < .01) improvements in wellbeing and mindfulness scores. They all stated that they would recommend this course to their colleagues and most (10/12) were interested in follow-up mindfulness sessions. CONCLUSION: Remotely delivered structured mindfulness training for hospital doctors was feasible, but there is a need to address the difficulties that affected attendance in order to optimize accessibility and completion of such programs.

Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study.

BACKGROUND: Trainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice. AIM: To explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme. DESIGN & SETTING: A qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire. METHOD: This mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice. RESULTS: In total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training. CONCLUSION: This study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.

Bayesian methods applied to the generalized matching law.

We demonstrate the usefulness of Bayesian methods in developing, evaluating, and using psychological models in the experimental analysis of behavior. We do this through a case study, involving new experimental data that measure the response count and time allocation behavior in pigeons under concurrent random-ratio random-interval schedules of reinforcement. To analyze these data, we implement a series of behavioral models, based on the generalized matching law, as graphical models, and use computational methods to perform fully Bayesian inference. We demonstrate how Bayesian methods, implemented in this way, make inferences about parameters representing psychological variables, how they test the descriptive adequacy of models as accounts of behavior, and how they compare multiple competing models. We also demonstrate how the Bayesian graphical modeling approach allows for more complicated modeling structures, including hierarchical, common cause, and latent mixture structures, to formalize more complicated behavioral models. As part of the case study, we demonstrate how the statistical properties of Bayesian methods allow them to provide more direct and intuitive tests of theories and hypotheses, and how they support the creative and exploratory development of new theories and models.

Mesoscale Dynamics and Niche Segregation of Two Dinophysis Species in Galician-Portuguese Coastal Waters.

Blooms of Dinophysis acuminata occur every year in Galicia (northwest Spain), between spring and autumn. These blooms contaminate shellfish with lipophilic toxins and cause lengthy harvesting bans. They are often followed by short-lived blooms of Dinophysis acuta, associated with northward longshore transport, at the end of the upwelling season. During the summers of 1989 and 1990, dense blooms of D. acuta developed in situ, initially co-occurring with D.acuminata and later with the paralytic shellfish toxin-producer Gymnodiniumcatenatum. Unexplored data from three cruises carried out before, during, and following autumn blooms (13⁻14, 27⁻28 September and 11⁻12 October) in 1990 showed D. acuta distribution in shelf waters within the 50 m and 130 m isobaths, delimited by the upwelling front. A joint review of monitoring data from Galicia and Portugal provided a mesoscale view of anomalies in SST and other hydroclimatic factors associated with a northward displacement of the center of gravity of D. acuta populations. At the microscale, re-examination of the vertical segregation of cell maxima in the light of current knowledge, improved our understanding of niche differentiation between the two species of Dinophysis. Results here improve local transport models and forecast of Dinophysis events, the main cause of shellfish harvesting bans in the most important mussel production area in Europe.

The Mediterranean Overflow in the Gulf of Cadiz: A rugged journey.

The pathways and transformations of dense water overflows, which depend on small-scale interactions between flow dynamics and erosional-depositional processes, are a central piece in the ocean's large-scale circulation. A novel, high-resolution current and hydrographic data set highlights the intricate pathway travelled by the saline Mediterranean Overflow as it enters the Atlantic. Interaction with the topography constraints its spreading. Over the initial 200 km west of the Gibraltar gateway, distinct channels separate the initial gravity current into several plunging branches depth-sorted by density. Shallow branches follow the upper slope and eventually detach as buoyant plumes. Deeper branches occupy mid slope channels and coalesce upon reaching a diapiric ridge. A still deeper branch, guided by a lower channel wall marked by transverse furrows, experiences small-scale overflows which travel downslope to settle at mid-depths. The Mediterranean salt flux into the Atlantic has implications for the buoyancy balance in the North Atlantic. Observations on how this flux enters at different depth levels are key to accurately measuring and understanding the role of Mediterranean Outflow in future climate scenarios.

Two new pycnidial members of the Atractiellales: Basidiopycnis hyalina and Proceropycnis pinicola.

Two new genera, Basidiopycnis and Proceropycnis, and two new species, Basidiopycnis hyalina and Proceropycnis pinicola, are described. An integrated analysis of morphological, ecological, ultrastructural and molecular data indicates that the new taxa belong to the Atractiellales. Relevant characteristics of the new genera and species are discussed and compared with those of related taxa.

[Scorpionism in children in Tucumán: descriptive analysis of cases in a second level of complexity Hospital]. / Escorpionismo en pediatría en Tucumán: análisis descriptivo de casos en un hospital de segundo nivel de complejidad.

Scorpionism in Tucumán is very frequent. The aim is to describe the clinical and epidemiological characteristics of cases of scorpionism that were seen in the Emergency Department of Eva Perón Hospital, Banda del Río Salí, Tucumán, between July 2013 and March 2015. Forty patients were assisted, 21 boys and 19 girls. The average age was 6.89 years. Thirty four (85%) resultedmild, 3 (7.5%) moderated, 3 (7.5%) moderated-severe. Hands (22.6%) and feet (20%) were the places in the body where the stings were more frequently localized. In only 3 cases the scorpion could be identified as Tityus trivittatus. Six (the moderate and moderate-severe cases) patients received specific antidote, with variable response. Although most of the cases were mild, this is an entity with severe prognosis in some patients. Epidemiological surveillance is necessary to arrange prevention measures, as we do in this Hospital.

Tucumán es una de las provincias con mayor incidencia de casos de escorpionismo. El objetivo es describir las características clínicas y epidemiológicas de los casos de escorpionismo atendidos en el Servicio de Pediatría del Hospital Eva Perón, Banda del Río Salí, Tucumán, entre julio de 2013 y marzo de 2015. El total de pacientes fue cuarenta (n= 40), 21 varones y 19 mujeres. La edad promedio fue 6,89 años. Del total de casos, 34 (85%) fueronleves; 3 (7,5%), moderados; y 3 (7,5%), moderados-graves. La picadura se localizó más frecuentemente en las manos (en 9, 22,6%) y los pies (en 8, 20%). La identificación del alacrán solo se realizó en 3 oportunidades. A 6 pacientes se les administró el antídoto (correspondían a casos moderados y moderados-graves), con respuesta variable. La mayoría de los casos resultaron leves, pero es una entidad con potencial gravedad en su evolución. La prevención es clave, actividad que lleva a cabo este nosocomio.

Climate variability and Dinophysis acuta blooms in an upwelling system.

Dinophysis acuta is a frequent seasonal lipophilic toxin producer in European Atlantic coastal waters associated with thermal stratification. In the Galician Rías, populations of D. acuta with their epicentre located off Aveiro (northern Portugal), typically co-occur with and follow those of Dinophysis acuminata during the upwelling transition (early autumn) as a result of longshore transport. During hotter than average summers, D. acuta blooms also occur in August in the Rías, when they replace D. acuminata. Here we examined a 30-year (1985-2014) time series of D. acuta from samples collected by the same method in the Galician Rías. Our main objective was to identify patterns of distribution and their relation with climate variability, and to explain the exceptional summer blooms of D. acuta in 1989-1990. A dome-shaped relationship was found between summer upwelling intensity and D. acuta blooms; cell maxima were associated with conditions where the balance between upwelling intensity and heating, leading to deepened thermoclines, combined with tidal phase (3 days after neap tides) created windows of opportunity for this species. The application of a generalized additive model based on biological (D. acuta inoculum) and environmental predictors (Cumulative June-August upwelling CUIJJA, average June-August SSTJJA and tidal range) explained more than 70% of the deviance for the exceptional summer blooms of D. acuta, through a combination of moderate (35,000-50,000m3s-1km-1) summer upwelling (CUIJJA), thermal stratification (SSTJJA>17°C) and moderate tidal range (∼2.5m), provided D. acuta cells (inoculum) were present in July. There was no evidence of increasing trends in D. acuta bloom frequency/intensity nor a clear relationship with NAO or other long-term climatic cycles. Instead, the exceptional summer blooms of 1989-1990 appeared linked to extreme hydroclimatic anomalies (high positive anomalies in SST and NAO index), which affected most of the European Atlantic coast.

Perfil clínico y angiográfico de las mujeres con infarto agudo al miocardio en un hospital nacional / Clinical and angiographic profile of women with acute myocardial infarction in a national hospital

Resumen Justificación: La cardiopatía isquémica es la principal causa de muerte de mujeres en Costa Rica, y su incidencia ha aumentado con los años. A pesar de esto, hay pocos estudios clínicos a este respecto en nuestro país. El objetivo del presente trabajo es presentar las principales características clínicas y angiográficas de un grupo de pacientes con infarto agudo del miocardio con la idea de establecer no solo sus particularidades sino permitir comparaciones con otras poblaciones. Métodos: Se trató de un estudio observacional, descriptivo y retrospectivo, de un periodo de cinco años, en el cual se incluyeron a las pacientes ingresadas con infarto del miocardio a la Unidad de Cuidados Intensivos. Se registraron datos demográficos, de evolución clínica, complicaciones, hallazgos angiográficos, tratamiento y desenlace. El análisis estadístico fue cuantitativo descriptivo, realizado con el programa informático SPSS v.21 (IBM Corp., EEUU) y éste consistió en cálculos de frecuencia, tendencia central, medidas de variabilidad de rango, percentiles, y chi-cuadrado. El protocolo de la investigación fue aprobado por el Comité Ético Científico del Hospital Rafael Ángel Calderón Guardia (DG-3380-2020). Resultados: De 190 pacientes se incluyeron un total de 54. La edad promedio fue de 60 años, con una mortalidad del 17,9%, la cual fue 5,4 % más alta que en los hombres. La mayor parte de las pacientes padecía de hipertensión arterial (74%), 24 (44,5%) eran taba- quistas y 23 (42,5%) tenían diabetes mellitus. Los síntomas más frecuentes fueron: dolor torácico, criodiaforesis y disnea. Se consideró que hubo dolor torácico atípico en 8 casos (15%). A 48 pacientes se le llevó a angioplastia coronaria y solo 35% la recibieron en tiempo oportuno. A 17 pacientes se les aplicó trombólisis farmacológica y solo en 3 pacientes fue exitosa. La arteria coronaria derecha y la arteria descendente anterior fueron los vasos responsables en la mayoría de los casos (19 casos (39,5%) cada uno de ellas.) Conclusión: Esta población tuvo síntomas isquémicos claros, con enfermedad coronaria severa y una mortalidad mayor que los hombres. En general la terapia farmacológica, así como la mecánica se aplicaron en forma tardía.

Abstrac Justification: The ischemic heart disease is the main cause of death of women in Costa Rica, and its incidence has increased with the years. In spite of this, there are few clinical studies in this respect in our country. The aim of this paper is to present the main clinical and angiographic characteristics of a group of patients with acute myocardial infarction in order to establish not only their particularities but also to allow comparisons with other populations. Methods: An observational, descriptive and retrospective study was carried out over a period of five years, in which patients admitted with myocardial infarction to the Intensive Care Unit were included. Demographic data, clinical evolution, complications, angiographic findings, treatment, and outcome were recorded. Statistical analysis was quantitative and descriptive, performed with SPSS v.21 software (IBM Corp., USA) and consisted of calculations of frequency, central tendency, measures of variability, percentiles, and chi-square. The Ethical Committee of the Hospital Rafael Angel Calderon Guardia approved the research protocol (DG-3380-2020). Results: A total of 54 out of 190 patients were included. The average age was 60 years, with a mortality rate of 17.9%, which was 5.4% higher than in men. Most of the patients suffered from arterial hypertension (74%), 24 (44.5%) were smokers and 23 (42.5%) had diabetes mellitus. The most frequent symptoms were chest pain, cryodiaphoresis and dyspnea. It was considered that there was atypical chest pain in 8 cases (15%). Forty-eight patients were taken for coronary angioplasty and only 35% received it in time. Pharmacological thrombolysis was applied to 17 patients, and it was successful in only 3 patients. The right coronary artery and the anterior descending artery were the vessels responsible in most cases (19 cases (39.5%) each). Conclusión: This population had clear ischemic symptoms, with severe coronary disease and higher mortality than men. In general, pharmacological as well as mechanical therapy was applied late.

Applied simulations and integrated modelling for the understanding of toxic and harmful algal blooms (ASIMUTH): Integrated HAB forecast systems for Europe's Atlantic Arc.

Reasons for the emergent interest in HABs are abundant, including concerns associated with human health, adverse effects on biological resources, economic losses attributed to recreation, tourism and seafood related industries, and the cost of maintaining public advisory services and monitoring programs for shellfish toxins and water quality. The impact of HABs can potentially be mitigated by early warning of their development. In this regard the project ASIMUTH (Applied Simulations and Integrated Modelling for the Understanding of Toxic and Harmful algal blooms) was borne in order to develop short term HAB alert systems for Atlantic Europe. This was achieved using information on the most current marine conditions (weather, water characteristics, toxicity, harmful algal presence etc.) combined with high resolution local numerical predictions. This integrated, multidisciplinary, trans-boundary approach to the study of HABs developed during ASIMUTH led to a better understanding of the physical, chemical and ecological factors controlling these blooms, as well as their impact on human activities. The outcome was an appropriate alert system for an effective management of areas that are usually associated with HAB events and where these episodes may have a more significant negative impact on human activities. Specifically for the aquaculture industry, the information provided enabled farmers to adapt their working practices in time to prevent mortalities in finfish farms and/or manage their shellfish harvest more effectively. This paper summarises the modelling and alert developments generated by the ASIMUTH project.

Modelling the hydrodynamic conditions associated with Dinophysis blooms in Galicia (NW Spain).

The northwestern Iberian coast (Galician Rías and shelf) is frequently affected by toxic harmful algal blooms (HABs) (mainly Dinophysis spp.), leading to lengthy harvesting closures in a region where aquaculture has a strong socioeconomic impact. The project ASIMUTH (http://www.asimuth.eu) aimed to develop forecasting capabilities to warn of impending HABs along the European Atlantic coast. Simulations with the ROMS model (hydrodynamical and ecological simulations complemented with Lagrangian particle tracking simulations) of the Galician coastal circulation have been performed in the framework of the ASIMUTH project to characterize and forecast oceanographic conditions before and during HAB periods. In this work, we present the Galician ASIMUTH forecast system and demonstrate its skill in predicting HAB transport and its usefulness to provide assessment for the management of the areas affected by toxic outbreaks. Experience gained during DSP events in 2005 and 2013 is shown. We also describe the Galician pilot HAB bulletins, aimed at distributing forecasts of HAB events that might induce closures of harvesting areas or, when the areas are already closed, at giving information on forthcoming oceanographic conditions that could favour or hamper the opening of an area. Our results show that the model forecasts and the bulletins can provide early warning of the risk of Dinophysis spp. events and the risk of closures linked to the presence of DSP toxins above regulatory levels in harvesting areas.

Efficient tools for marine operational forecast and oil spill tracking.

Ocean forecasting and oil spill modelling and tracking are complex activities requiring specialised institutions. In this work we present a lighter solution based on the Operational Ocean Forecast Python Engine (OOFε) and the oil spill model General NOAA Operational Modelling Environment (GNOME). These two are robust relocatable and simple to implement and maintain. Implementations of the operational engine in three different regions with distinct oceanic systems, using the ocean model Regional Ocean Modelling System (ROMS), are described, namely the Galician region, the southeastern Brazilian waters and the Texas-Louisiana shelf. GNOME was able to simulate the fate of the Prestige oil spill (Galicia) and compared well with observations of the Krimsk accident (Texas). Scenarios of hypothetical spills in Campos Basin (Brazil) are illustrated, evidencing the sensitiveness to the dynamical system. OOFε and GNOME are proved to be valuable, efficient and low cost tools and can be seen as an intermediate stage towards more complex operational implementations of ocean forecasting and oil spill modelling strategies.

Towards operational modeling and forecasting of the Iberian shelves ecosystem.

There is a growing interest on physical and biogeochemical oceanic hindcasts and forecasts from a wide range of users and businesses. In this contribution we present an operational biogeochemical forecast system for the Portuguese and Galician oceanographic regions, where atmospheric, hydrodynamic and biogeochemical variables are integrated. The ocean model ROMS, with a horizontal resolution of 3 km, is forced by the atmospheric model WRF and includes a Nutrients-Phytoplankton-Zooplankton-Detritus biogeochemical module (NPZD). In addition to oceanographic variables, the system predicts the concentration of nitrate, phytoplankton, zooplankton and detritus (mmol N m(-3)). Model results are compared against radar currents and remote sensed SST and chlorophyll. Quantitative skill assessment during a summer upwelling period shows that our modelling system adequately represents the surface circulation over the shelf including the observed spatial variability and trends of temperature and chlorophyll concentration. Additionally, the skill assessment also shows some deficiencies like the overestimation of upwelling circulation and consequently, of the duration and intensity of the phytoplankton blooms. These and other departures from the observations are discussed, their origins identified and future improvements suggested. The forecast system is the first of its kind in the region and provides free online distribution of model input and output, as well as comparisons of model results with satellite imagery for qualitative operational assessment of model skill.

Escorpionismo en pediatría en Tucumán: análisis descriptivo de casos en un hospital de segundo nivel de complejidad / Scorpionism in children in Tucumán: descriptive analysis of cases in a second level of complexity Hospital

Tucumán es una de las provincias con mayor incidencia de casos de escorpionismo. El objetivo es describir las características clínicas y epidemiológicas de los casos de escorpionismo atendidos en el Servicio de Pediatría del Hospital Eva Perón, Banda del Río Salí, Tucumán, entre julio de 2013 y marzo de 2015. El total de pacientes fue cuarenta (n= 40), 21 varones y 19 mujeres. La edad promedio fue 6,89 años. Del total de casos, 34 (85%) fueronleves; 3 (7,5%), moderados; y 3 (7,5%), moderados-graves. La picadura se localizó más frecuentemente en las manos (en 9, 22,6%) y los pies (en 8, 20%). La identificación del alacrán solo se realizó en 3 oportunidades. A 6 pacientes se les administró el antídoto (correspondían a casos moderados y moderados-graves), con respuesta variable. La mayoría de los casos resultaron leves, pero es una entidad con potencial gravedad en su evolución. La prevención es clave, actividad que lleva a cabo este nosocomio.

Scorpionism in Tucumán is very frequent. The aim is to describe the clinical and epidemiological characteristics of cases of scorpionism that were seen in the Emergency Department of Eva Perón Hospital, Banda del Río Salí, Tucumán, between July 2013 and March 2015. Forty patients were assisted, 21 boys and 19 girls. The average age was 6.89 years. Thirty four (85%) resultedmild, 3 (7.5%) moderated, 3 (7.5%) moderated-severe. Hands (22.6%) and feet (20%) were the places in the body where the stings were more frequently localized. In only 3 cases the scorpion could be identified as Tityus trivittatus. Six (the moderate and moderate-severe cases) patients received specific antidote, with variable response. Although most of the cases were mild, this is an entity with severe prognosis in some patients. Epidemiological surveillance is necessary to arrange prevention measures, as we do in this Hospital.