The S.P.A.C.E Hypothesis: Physical Activity as Medium - Not Medicine - for Public Health Impact.

Most scientifically tested physical activity interventions end when research funding ends; interventions that last struggle to sustain benefits. We hypothesize that long-term public health impact will benefit from a shift in how interventionists conceptualize physical activity - from a form of medicine, of value for its innate health benefits, to a malleable medium, of value for the dynamic contexts it creates.

Spanish Validation of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA): Introducing the ERQ-SpA.

Research on emotion regulation is now extensive and shows the benefits of the adaptive management of emotions for social functioning and psychological well-being. Our purpose was to test the psychometric properties of the Emotion Regulation Questionnaire for Children and Adolescents with a sample of nonclinical Spanish adolescents. A total of 462 secondary education students (223 girls, mean age = 13.89 years, SD = 1.38) participated. The instrument proved to be two-factor and gender-invariant. Results revealed the temporal stability of both emotion regulation strategies, while the predictive validity study revealed that depressive symptoms were negatively related to cognitive reappraisal, and positively related to expressive suppression. Our findings support the use of the ERQ-SpA in Spanish adolescents.

Uterine lithiasis, management by hysteroscopy: Case report and literature review.

The presence of calculi inside the uterine cavity is an uncommon finding, with few cases described in the literature. Here, we present a clinical case of a 30-year-old patient with uterine lithiasis. The patient presented with 3 months of evolution, characterized by abdominal pain in the hypogastrium, with a report of transvaginal ultrasound of hematometra with suggestive images of endometrial polyps. For this reason, she was scheduled for hysteroscopy, where three lesions of hard consistency were found, with the largest 1.5 cm. Currently, due to the few cases of uterine lithiasis described, there is no explanation of how the stones are formed in the uterine cavity. The age of the patient in this case report and the absence of predisposing factors for uterine calcifications reported in the literature is striking, which leads us to propose a hypothesis of the origin of uterine lithiasis, which is related to the history of cesarean section and the presence of hematometra, such hematic retention could have predisposed to the development of calculi in this patient. Uterine lithiasis is an extremely rare entity with few published cases; therefore, further studies are necessary.

A morphology-based phylogeny of the Liolaemus alticolor-bibronii group (Iguania: Liolaemidae).

The genus Liolaemus was split in two subgenera, Liolaenus sensu stricto and Eulaemus. Inside the Liolaemus sensu stricto subgenus, many groups have been proposed. One of them is the L. alticolor-bibronii group. Here, I studied 184 morpho- logical characters of more than one thousand specimens that of the L. alticolor-bibronii group. Many of these characters are original from this study, especially the characters related to color pattern. Also, I include eight population without tax- onomic status. Using those characters and terminal taxa, I performed phylogenetic analyses using parsimony as optimality criterion, under implied weight. Two different topologies were found. The results show that the L. alticolor-bibronii group is monophyletic, and that it is sister to the L. gravenhorsti group. This finding is congruent with previous morphological and molecular phylogenies. Also, nested within the L. alticolor-bibronii group the L. lemniscatus and the L. robertmen- tensi groups are found. In contrast to previous hypotheses, Liolaemus tacnae is never recovered as a member of the L. alticolor-bibronii group.

Movement Reminders to Encourage Arm Use During Daily Life in Stroke Patients.

Stroke is a leading cause of long-term disability, such as loss of upper limb function. Active arm movement and frequent practice are essential to regain such function. Wearable sensors that trigger individualized movement reminders can promote awareness of the affected limb during periods of inactivity. This study investigated the immediate effect of vibrotactile reminders based on activity counts on affected arm use, the evolution of the effect throughout a 6-week intervention at home, and whether the time of the day influences the response to the reminder. Thirteen participants who experienced a unilateral ischemic stroke were included in the analysis. Activity counts were found to increase significantly after receiving a reminder. The immediate effect of receiving a reminder was maintained throughout the day as well as during the study duration of 6 weeks. In conclusion, wearable activity trackers with a feature to trigger individualized vibrotactile reminders could be a promising rehabilitation tool to increase arm activity of the affected side in stroke patients in their home environment.

Derived generalization of attentional bias for laboratory-induced threat: Yes but.

There is laboratory evidence that fear conditioning underlies the emergence of attentional bias (AB) for threat. Our main objective was to test, for the first time, whether derived or symbolic responding contributes to the generalization of AB across non-conditioned stimuli. Participants were all university students (N = 86) with no pre-existing conditions. We first employed an exogenous cueing paradigm with two color slides (i.e., A1 or to-be CS+, and A2 or to-be CS-) serving as cues, and loud white noise serving as unconditioned stimulus during conditioning trials. We then employed a match-to-sample procedure to establish a derived equivalence relation between color A1 and arbitrary shape C1 as well as between color A2 and arbitrary shape C2. Next, we investigated the transfer of AB across non-conditioned stimuli: participants performed the same spatial cueing task with non-conditioned C1 and C2 stimuli serving as cues. Results replicated previous findings on the conditioning basis of AB, and most importantly, showed preliminary evidence of AB transfer: those participants who appraised C1 and not C2 as a signal of impending noise showed AB toward C1. This is the first laboratory demonstration that AB may generalize to stimuli physically unrelated to directly conditioned threats. Unfortunately, the small number of participants showing this effect calls for cautious considerations.

Neuroanatomy of the lumbosacral plexus in a highly diversified clade of South-American lizards. Evolution and phylogenetic implications.

Only few published studies that describe the neuroanatomy of lizards. Here, we describe the neuroanatomy of several Iguanian species belonging to three families (species of Liolaemus and Phymaturus belonging to Liolaemidae, Tropidurus and Stenocercus as representatives of Tropiduridae, and Diplolaemus as a representative of Leiosauridae). Based on Sudan Black B staining and conventional dissections, the neuroanatomy of the lumbosacral region is described. Among the most outstanding results is the existence of a neuronal pattern of the lumbosacral plexus characteristic of Liolaemidae. In addition, it was found that in the genus Liolaemus the lumbosacral plexus is composed of five pairs of spinal nerves while in Phymaturus, Tropidurus, Stenocercus and Diplolaemus is composed from five to six pairs of spinal nerves (from pre-sacral, sacral, and caudal vertebrae). We find differences in the origin of the spinal nerves that constitute the plexus. In some cases, the pattern of nerves involved includes even the caudal vertebrae. Variation among taxa related to the zeugopodial innervation is described, and the homology of these nervous branches is discussed. Sexual differences were found in some species studied. Based on our results and available literature, we found three different patterns of innervation of the zeugopodium. The major contribution of this study is to provide a detailed description of lumbosacral plexus nerves pathways from their origins at the vertebral column to the muscles that they innervate.

Variables biomecánicas del penalti en futbolistas de las categorías sub-12 y sub-17

Introducción: El estudio de los patrones del movimiento técnico deportivo implica analizar sus componentes biomecánicos, teniendo en cuenta el carácter multifactorial del rendimiento deportivo. Objetivo: Describir la mecánica del movimiento del tiro penalti en futbolistas categorías sub-12 y sub-17. Métodos: Estudio cuasi experimental de orden correlativo. Se estudiaron ocho variables biomecánicas: centro de gravedad en sus dos ejes, inclinación corporal, ángulos femorotibial antes del contacto, ángulos femorotibial luego del contacto, velocidad, aceleración y acierto. Se seleccionaron dos grupos independientes de 30 futbolistas del género masculino, se clasificaron por categorías sub-12 y sub-17, y se analizó su rendimiento mediante videoanálisis. Resultados: Hubo diferencias significativas a favor de la categoría sub-17 en las variables centro de gravedad en el eje X (p = 0,000), en inclinación corporal (p = 0,000), en velocidad (p = 0,000), y en aceleración y acierto (p = 0,000); y diferencias no significativas en el resto (centro de gravedad eje Y: p = 0,267; ángulos femorotibial antes del contacto: p = 0,459; ángulos femorotibial luego del contacto: p = 0,446; y aciertos: p = 0,226). Conclusiones: Todos los rangos promedios sobresalieron en la categoría sub-17, excepto en la variable aciertos, lo que implicó una mayor velocidad y aceleración del pie durante la ejecución del tiro a penal. Sin embargo, la precisión, como componente coordinativo, resultó fundamental en la efectividad del disparo.

Introduction: The study of the patterns of technical sports movement involves analyzing its biomechanical components, taking into account the multifactorial nature of sports performance. Objective: To describe the mechanics of the movement of the penalty kick in U-12 and U-17 football players. Methods: Quasi-experimental study of a correlative order. Eight biomechanical variables were studied: center of gravity in its two axes, body inclination, femorotibial angles before contact, femorotibial angles after contact, speed, acceleration and success. Two independent groups of 30 male footballers were selected, classified by U-12 and U-17 categories, and their performance was analysed through video analysis. Results: There were significant differences in favor of the sub-17 category in the variables center of gravity on the X axis (p = 0.000), body inclination (p = 0.000), speed (p = 0.000), and acceleration and accuracy (p = 0.000); and non-significant differences in the rest (center of gravity Y-axis: p = 0.267; femorotibial angles before contact: p = 0.459; femorotibial angles after contact: p = 0.446; and correct answers: p = 0.226). Conclusions: All the average ranges stood out in the U-17 category, except in the variable hits, which implied a greater speed and acceleration of the foot during the execution of the penalty kick. However, accuracy, as a coordinating component, was fundamental in the effectiveness of the shot.

The origin of compression influences geometric instabilities in bilayers.

Geometric instabilities in bilayered structures control the surface morphology in a wide range of biological and technical systems. Depending on the application, different mechanisms induce compressive stresses in the bilayer. However, the impact of the chosen origin of compression on the critical conditions, post-buckling evolution and higher-order pattern selection remains insufficiently understood. Here, we conduct a numerical study on a finite-element set-up and systematically vary well-known factors contributing to pattern selection under the four main origins of compression: film growth, substrate shrinkage and whole-domain compression with and without pre-stretch. We find that the origin of compression determines the substrate stretch state at the primary instability point and thus significantly affects the critical buckling conditions. Similarly, it leads to different post-buckling evolutions and secondary instability patterns when the load further increases. Our results emphasize that future phase diagrams of geometric instabilities should incorporate not only the film thickness but also the origin of compression. Thoroughly understanding the influence of the origin of compression on geometric instabilities is crucial to solving real-life problems such as the engineering of smart surfaces or the diagnosis of neuronal disorders, which typically involve temporally or spatially combined origins of compression.

A new species of the Liolaemus alticolor-bibronii group (Iguania: Liolaemidae) from East-central Argentina.

We describe a new species of Liolaemus of the L. alticolor-bibronii group of the subgenus Liolaemus sensu stricto. We studied meristic, morphometric and qualitative pattern characters. Statistical tests were performed in order to evaluate morphological differences among the candidate species and the most closely geographically distributed species. Molecular analyses of Cyt-b mitochondrial gene were performed in order to estimate the position of the new species in relation to other taxa. We also recorded natural history data such as habitat, behavior, reproductive state, diet, and body temperature. Liolaemus absconditus sp. nov. differs from other species of Liolaemus in presenting a distinct combination of morphological character states of lepidosis and color pattern, being phylogenetically close to Liolaemus tandiliensis, Liolaemus gracilis and Liolaemus saxatilis. The new species is a saxicolous and endemic lizard of the Tandilia Mountain Range System of Buenos Aires Province.

Wrinkling instabilities in soft bilayered systems.

Wrinkling phenomena control the surface morphology of many technical and biological systems. While primary wrinkling has been extensively studied, experimentally, analytically and computationally, higher-order instabilities remain insufficiently understood, especially in systems with stiffness contrasts well below 100. Here, we use the model system of an elastomeric bilayer to experimentally characterize primary and secondary wrinkling at moderate stiffness contrasts. We systematically vary the film thickness and substrate prestretch to explore which parameters modulate the emergence of secondary instabilities, including period-doubling, period-tripling and wrinkle-to-fold transitions. Our experiments suggest that period-doubling is the favourable secondary instability mode and that period-tripling can emerge under disturbed boundary conditions. High substrate prestretch can suppress period-doubling and primary wrinkles immediately transform into folds. We combine analytical models with computational simulations to predict the onset of primary wrinkling, the post-buckling behaviour, secondary bifurcations and the wrinkle-to-fold transition. Understanding the mechanisms of pattern selection and identifying the critical control parameters of wrinkling will allow us to fabricate smart surfaces with tunable properties and to control undesired surface patterns like in the asthmatic airway.This article is part of the themed issue 'Patterning through instabilities in complex media: theory and applications.'

Kinetic gait analysis in English Bulldogs.

BACKGROUND: Canine breed conformation may interfere with locomotion and may predispose to orthopedic disease. Bulldogs have a high incidence of orthopedic diseases such as hip dysplasia. Kinetic gait analysis provides an objective way to assess and analyze locomotion. The aim of this study was to study the vertical forces of English Bulldogs during walk using a pressure sensitive walkway. We hypothesize that Bulldogs affected by orthopedic diseases have decreased weight bearing and asymmetric locomotion in the limbs despite having mild to no sings during clinical examination. Thirty English Bulldogs were tested. Peak vertical force, vertical impulse, rate of loading, stance phase duration, symmetry index, goniometry and incidence of orthopedic diseases were recorded. RESULTS: Although none of the dogs showed signs of pain or discomfort upon manipulation of the hip joints, all dogs had radiographic evidences of hip dysplasia and lack of significant peak vertical force, vertical impulse and stance time differences. The dogs had a mean hind limb symmetry index of 19.8 ± 19.5% and rates of loading ranged from 1.0 to 3.1. CONCLUSIONS: Despite the lack of evident decrease in weight bearing, subclinical lameness can be inferred. The examined dogs had a mean hind limb symmetry index of 19.8 ± 19.5%. Symmetry indices reported in dogs free from orthopedic diseases range from 0.3 to 9.6%. Given non-lame dogs are expected to have a symmetry index close to 0%, data from this study suggests that Bulldogs have gait dysfunctions, which translates into hind limb asymmetries and rate of loading was consistent with severe hip dysplasia despite no visible signs of gait dysfunction. Future studies comparing lame and non-lame Bulldogs are warranted.

Continuous characters analyzed as such.

Quantitative and continuous characters have rarely been included in cladistic analyses of morphological data; when included, they have always been discretized, using a variety of ad hoc methods. As continuous characters are typically additive, they can be optimized with well known algorithms, so that with a proper implementation they could be easily analyzed without discretization. The program TNT has recently incorporated algorithms for analysis of continuous characters. One of the problems that has been pointed out with existing methods for discretization is that they can attribute different states to terminals that do not differ significantly-or vice versa. With the implementation in TNT, this problem is diminished (or avoided entirely) by simply assigning to each terminal a range that goes from the mean minus one (or two) SE to the mean plus one (or two) SE; given normal distributions, terminals that do not overlap thus differ significantly (more significantly if using more than 1 SE). Three real data sets (for scorpions, spiders and lizards) comprising both discrete and quantitative characters are analyzed to study the performance of continuous characters. One of the matrices has a reduced number of continuous characters, and thus continuous characters analyzed by themselves produce only poorly resolved trees; the support for many of the groups supported by the discrete characters alone, however, is increased when the continuous characters are added to the analysis. The other two matrices have larger numbers of continuous characters, so that the results of separate analyses for the discrete and the continuous characters can be more meaningfully compared. In both cases, the continuous characters (analyzed alone) result in trees that are relatively similar to the trees produced by the discrete characters alone. These results suggest that continuous characters carry indeed phylogenetic information, and that (if they have been observed) there is no real reason to exclude them from the analysis.

Modelo predictivo de la no unión de tibia / Tibia non union predictive model

OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,15­5,75, p » 0,022), diabetes OR » 3,29 (IC:1,37­7,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,81­3,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.

OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.15­5.75, p » 0.022), diabetes OR » 3.29(CI:1.37­7.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.81­3.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.

Los suelos del paisaje alto-andino de santa isabel (tolima, colombia) ¿son sumideros de carbono orgánico? / Soils in high-land landscapes of santa isabel (tolima, colombia), are they a carbon sink?

RESUMEN El cambio climático global es uno de los problemas más graves de la humanidad, causado, principalmente, por el aumento de CO2 y otros gases de efecto invernadero en la atmósfera. Se reconoce que las emisiones de estos gases pueden ser reducidas disminuyendo su emisión o aumentando su remoción y depósito, en sumideros terrestres. El suelo es el mayor sumidero de carbono © y mitiga su creciente concentración atmosférica. Los paisajes rurales alto-andinos retienen importantes cantidades de C orgánico del suelo (COS), teniendo un papel fundamental en su ciclo global, pero ha sido poco valorado. El objetivo de este estudio fue estimar el COS en los principales usos de la tierra y los impactos del cambio de uso en paisajes alto-andinos en Santa Isabel - Tolima, Colombia. Se evaluaron tres usos del suelo: (i) cultivos agrícolas (CA), (ii) sistemas silvo-pastoriles de pasturas con árboles dispersos (SSP) y (iii) bosques nativos (BN), estimando la densidad aparente, por el método del cilindro y la concentración de COS, a una profundidad de 0-40cm. La densidad aparente, se incrementó notablemente, al cambiar de BN a CA y SSP (0,35 a 0,61 y 0,65g/cm3, respectivamente). Contrastando, la concentración de COS, se redujo al convertir BN a usos agropecuarios (8,9 a 5,8%). Los BN almacenaron más C que los CA y SSP (122,4; 79,6 y 79,8t/ha, respectivamente), causando una emisión potencial de 157 t CO2/ha, en caso de deforestación. Procesos contrarios implican captura de C atmosférico. La conservación de BN alto-andinos debe estar altamente considerados en las políticas nacionales y regionales.

SUMMARY Global climate change is one of the most serious problems of mankind, caused mainly by the increase of CO2 and other greenhouse gases in the atmosphere. It is recognized that net emissions of these gases can be reduced either by reducing their emission or by increasing their removal by depositing in terrestrial sinks. The soil is the largest carbon I sink and mitigates its increase in atmospheric concentration. The rural landscapes in high-land ndean zones retain significant amounts of organic soil C (SOC), playing a key role in its global cycle. The objective of this study was to estimate the SOC stocks in the main land uses, and the impacts of land use change in high-land ndean landscapes in Santa Isabel, Tolima, Colombia. Three land uses were evaluated: (i) agricultural crops (AC), (ii) silvopastoral systems of pastures with dispersed trees (SPS), and (iii) native forests (NF), estimating bulk density (BD) by cylinder method and the concentration of SOC to a depth of 0-40cm. The BD notably increased by changing from NF to AC and SPS (0.35 to 0.61 and 0.65g/ cm3, respectively). Contrasting, the concentration of SOC was reduced when NF change to agricultural and livestock uses (8.9 to 5.8%). The NF stocked more C than AC and SPS (122.4, 79.6 and 79.8t/ha, respectively), causing a potential emission of 157t CO2/ha in case of deforestation. Opposite processes imply capture of atmospheric carbon. The conservation of NF in high-land Andean zones must be highly considered in national and regional policies.

Perfil demográfico y epidemiológico de la sepsis en la Unidad de Cuidados Intensivos del Hospital de Especialidades Carlos Andrade Marín / Epidemiologic and demographic profile of sepsis in the Intensive Care Unit of Carlos Andrade Marin Specialties Hospital

Introducción. La sepsis y el choque séptico representan la principal causa de muerte en las unidades de cuidados intensivos de todo el mundo; además, se encuentran entre las condiciones que conllevan alto costo en cuanto a su manejo y tratamiento, a pesar del progreso que se ha realizado en esta área. Objetivo. Establecer los principales aspectos epidemiológicos y demográficos de los pacientes diagnosticados de sepsis, la progresión y mortalidad de los mismos en el Área de Terapia Intensiva del Hospital Carlos Andrade Marín de Quito. Material y métodos. Se realizó un análisis descriptivo retrospectivo. El número total de pacientes ingresados en la unidad fue de 3 164. Se incluyó únicamente a aquellos mayores de 18 años, se excluyeron aquellos pacientes que murieron antes de las 24 horas independiente de la causa y en quienes el motivo de ingreso a la unidad se debió a traumatismo craneoencefálico. El número final de pacientes correspondió a 2 835. Resultados. De los 2 835 pacientes se identificaron: 15,1% con sepsis, 10% con sepsis grave y 64% con choque séptico. A los 28 días la mortalidad de los pacientes sépticos fue del 42,4% y a los 90 días del 47,5%. Conclusiones. El estudio evidenció que la mortalidad a los 28 y 90 días, según la progresión de gravedad de la sepsis, es comparable con algunas series de estudios realizados a nivel mundial; así como aspectos epidemiológicos y demográficos de la población de nuestra unidad.

Introduction. Sepsis and septic shock are the leading causes of death in intensive care units around the world. In addition, they are among the conditions that entail a high cost in terms of handling and treatment, despite the progress in this area. Objective. To establish the main epidemiological and demographic aspects of patients diagnosed with sepsis, their progression and mortality in the Intensive Care Unit, "Carlos Andrade Marín". Specialties Hospital in Quito. Materials and methods. A retrospective descriptive analysis was carried out, with a total number of 3164 patients; the only inclusion criteria corresponded to all admissions of patients older than 18 years old. Patients who died within 24 hours after admission, independently of the cause, were excluded, as well as those who had traumatic brain injury. The final number of patients was 2835. Results. 15.1% of the 2 835 patients were diagnosed with sepsis, 10% with severe sepsis and 64% with septic shock. Mortality of septic patients at 28 day was 42.4% and 47.5% at 90 days. Conclusions. Mortality rates at 28 and at 90 days, according to the progression of severity were comparable with other studies published in the medical literature, as well as epidemiological and demographic aspects of the population of our unit.

Sospecha de sumisión química en urgencias: procedimiento de actuación y análisis toxicológico en una serie de casos / Suspicion of chemical submission in a hospital emergency department: procedures followed and toxicological analyses in a case series

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