Concept de first responders en Suisse romande: état des lieux et perspectives [Concept of first responders in Western Switzerland: current situation and future perspectives].

The notion of "First Responder" (FR) refers to the system of first-aid volunteers who act to initiate the first-aid care before the classical emergency help arrives. In 2011, the French-speaking Switzerland counts 19 groups, divided up between four cantons (Fribourg, Vaud, Neuchâtel, Valais). The geographical distribution of those FR shows the stakes of these peripherical areas, with the accessibility difficulties for the emergency services, and a low demography of ambulances and doctors. The number of interventions carried out by the FR has significantly increased during the last years. The association of a quality formation, an excellent knowledge of the ground and a quick intervention has a positive impact on the survival of the patients with vital emergency or traumatic conditions.

Brain metastasis: opportunity for drug development?

PURPOSE OF REVIEW: Brain metastases are a common clinical problem, and only limited treatment options exist. We review recent advances in medical brain metastasis research with a focus on the most common tumor types associated with secondary brain colonization: melanoma, breast cancer and lung cancer. We speculate on opportunities for drug development in patients with brain metastases, both as a treatment of established disease and as an adjuvant and prophylactic strategy. RECENT FINDINGS: BRAF inhibitors and the immunomodulatory anticytotoxic T-lymphocyte-associated antigen 4 antibody ipilimumab have shown clinically meaningful activity in melanoma patients with brain metastases. In breast cancer, current studies on drug treatment of brain metastases are mainly focusing on human epidermal growth factor receptor 2 targeting agents such as lapatinib. Emerging data seem to implicate a potential role of targeted agents including antiangiogenic compounds, pazopanib, and epithelial growth factor receptor inhibitors for prevention of brain metastasis formation in breast cancer or nonsmall cell lung cancer. SUMMARY: Novel drugs are beginning to enter clinical practice for selected patients with brain metastases. The promising findings from recent studies may fuel more research on brain metastases and their optimal drug treatment.

Projecting the self to past and future in mental time

Introduction: Human experience takes place in the line of mental-time (MT) created through imagination of oneself in different time-points in past or future (self-projection in time). Here we manipulated self-projection in MT not only with respect to one's life-events but also with respect to one's faces from different past and future time-points. Methods: We here compared MTT with respect to one's facial images from different time points in past and future (study 1: MT-faces) as well as with respect to different past and future life events (study 2: MT-events). Participants were asked to make judgments about past and future face images and past and future events from three different time-points: the present (Now), eight years earlier (Past) or eight years later (Future). In addition, as a control task participants were asked to make recognition judgments with respect to faces and memory-related judgments with respect to events without changing their habitual self-location in time. Behavioral measures and functional magnetic resonance imaging (fMRI) activity after subtraction of recognition and memory related activities show both absolute MT and relative MT effects for faces and events, signifying a fundamental brain mechanism of MT, disentangled from episodic memory functions. Results: Behavioural and event-related fMRI activity showed three independent effects characterized by (1) similarity between past recollection and future imagination, (2) facilitation of judgments related to the future as compared to the past, and (3) facilitation of judgments related to time-points distant from the present. These effects were found with respect to faces and events suggesting that the brain mechanisms of MT are independent of whether actual life episodes have to be re-/pre-experienced and recruited a common cerebral network including the medial-temporal, precuneus, inferior-frontal, temporo-parietal, and insular cortices. Conclusions: These behavioural and neural data suggest that self-projection in time is a crucial aspect of MT, relying on neural structures encoding memory, mental imagery, and self. Furthermore our results emphasize the idea that mental temporal processing is more strongly directed to future prediction than to past recollection.

The 5th anniversary of "Patient Safety in Surgery" - from the Journal's origin to its future vision.

A prospective study was undertaken to determine prognostic markers for patients with obstructive jaundice. Along with routine liver function tests, antipyrine clearance was determined in 20 patients. Four patients died after basal investigations. Five patients underwent definitive surgery. The remaining 11 patients were subjected to percutaneous transhepatic biliary decompression. Four patients died during the drainage period, while surgery was carried out for seven patients within 1-3 weeks of drainage. Of 20 patients, only six patients survived. Basal liver function tests were comparable in survivors and nonsurvivors. Discriminant analysis of the basal data revealed that plasma bilirubin, proteins and antipyrine half-life taken together had a strong association with mortality. A mathematical equation was derived using these variables and a score was computed for each patient. It was observed that a score value greater than or equal to 0.84 indicated survival. Omission of antipyrine half-life from the data, however, resulted in prediction of false security in 55% of patients. This study highlights the importance of addition of antipyrine elimination test to the routine liver function tests for precise identification of high risk patients.

The past, present and future of renin-angiotensin aldosterone system inhibition.

The renin-angiotensin aldosterone system (RAAS) is central to the pathogenesis of cardiovascular disease. RAAS inhibition can reduce blood pressure, prevent target organ damage in hypertension and diabetes, and improve outcomes in patients with heart failure and/or myocardial infarction. This review presents the history of RAAS inhibition including a summary of key heart failure, myocardial infarction, hypertension and atrial fibrillation trials. Recent developments in RAAS inhibition are discussed including implementation and optimization of current drug therapies. Finally, ongoing clinical trials, opportunities for future trials and issues related to the barriers and approvability of novel RAAS inhibitors are highlighted.

Strategic Enterprise Architecture Management - Challenges, Best Practices, and Future Developments

The discipline of Enterprise Architecture Management (EAM) deals with the alignment of business and information systems architectures. While EAM has long been regarded as a discipline for IT managers this book takes a different stance: It explains how top executives can use EAM for leveraging their strategic planning and controlling processes and how EAM can contribute to sustainable competitive advantage. Based on the analysis of best practices from eight leading European companies from various industries the book presents crucial elements of successful EAM. It outlines what executives need to do in terms of governance, processes, methodologies and culture in order to bring their management to the next level. Beyond this, the book points how EAM might develop in the next decade allowing today's managers to prepare for the future of architecture management.