Growth arrest-specific gene 6 (GAS6) as an intra-hospital mortality predictor for patients in septic shock

Aim: Gas6 is known to be elevated in sepsis, correlating with the severity of infection and organ failure. We aimed to investigate the performance of Gas6 plasma levels at admission to predict the risk of mortality in a cohort of septic patients.Methods: We used prospectively collected data and plasma samples from the 'Sepsis Cohorte Romande'. Gas6 level was measured by ELISA at admission and expressed in percentage relative to its level in a pool of normal plasma.Results: Non-survivors (n = 19) presented higher Gas6 levels than survivors (n = 78; median 287% vs. 158%, IQR 182 and 119 respectively; P = 0.0003). Gas6 correlated positively with different cytokine and was the best mortality predictor, as shown by the ROC curves area (Fig. 1). In patients with septic shock (n = 67), using 249% as a cut-off value, Gas6 measurement had a specificity of 81% and a sensitivity of 68% for predicting mortality. ROC curve area was 0.76. Positive and negative predictive values were 59% and 87%, respectively.Conclusion: Thus, Gas6 plasma level at admission might be a useful tool to predict mortality in patients with septic shock. Nevertheless, independent association of Gas6 level with mortality still needs to be assessed. Although Gas6 hold promise as an early sepsis marker, its precise implication in sepsis remains to be elucidated.

La participation des consommateurs à la construction de l'autorité des normes internationales : vers une économie politique internationale de la traduction

Cette thèse explore les implications politiques de la montée en puissance des normes internationales sur nos sociétés contemporaines et pose la problématique des dynamiques participatives des représentants des consommateurs au sein des formes de pouvoir non étatique à l'aide du cas de l'Organisation internationale de normalisation (ISO). Le renforcement du pouvoir des normes internationales et autres spécifications techniques soulève d'importants enjeux démocratiques qui portent aussi bien sur la représentativité des acteurs qui les élaborent, sur l'articulation des prérogatives publiques et privées dans la gouvernance de la mondialisation, que sur le rôle de l'expertise dans la reconnaissance de ces nouvelles formes de pouvoir. La participation du monde associatif intervient sur ces différents enjeux de manière complexe. Cette recherche s'inscrit à la suite des études en relations internationales/économie politique internationale sur les formes d'autorité non étatique et s'inspire du concept de traduction issu de la sociologie des sciences et techniques pour mettre en lumière le rôle des spécifications techniques dans la construction d'une société de consommation centrée sur la liberté de choix et la façon dont les associations de consommateurs se saisissent des arènes de normalisation pour y faire valoir des préoccupations collectives, leur expertise et leur identité. Cette thèse défend l'idée que les consommateurs participent à la construction de l'autorité des normes internationales par leur rôle dans la traduction qui permet de relier les spécifications techniques au fonctionnement des marchés, au cadre réglementaire de la loi et aux préoccupations sociétales. L'analyse repose sur une observation ethnographique des délibérations d'un comité technique de l'ISO, une recherche-­‐action, la réalisation d'entretiens et la consultation de documents d'archives de l'ISO. -- This thesis explores the political significance of the rise of international standards on contemporary societies and questions the participatory dynamics of consumers' representatives within nonstate forms of power, using the case of the International organization for standardization (ISO). The power granted to international standards and other technical specifications raises important democratic issues regarding the representativity of standard-­‐ writers, the public-­‐private relationships involved in this form of governance or the expertise sustaining the recognition of such new forms of power. The participation of civil society associations affect such issues in complex ways. This research relies on international relations/international political economy approaches of nonstate authority and takes inspiration from the concept of translation developed by science and technology studies to highlight the crucial role played by technical specifications in building a consumer society based on the freedom of choice as well as how consumers' associations take stock of standardization arenas to promote collective issues and claim their expertise and identity. This thesis argues that consumers contribute to the construction of the authority of international standards through their role in the translation that links international standards to the market society, the regulatory state as well as to societal preoccupation. The analysis is based on an ethnographic observation of deliberations within an ISO technical committee, a research-­‐action, interviews as well as on the consultation of ISO archives.

International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.

Standardization of Stroke Perfusion CT for Reperfusion Therapy

With the advances in terms of perfusion imaging, the "time is brain" approach used for acute reperfusion therapy in ischemic stroke patients is slowly being replaced by a "penumbra is brain" or "imaging is brain" approach. But the concept of penumbra-guided reperfusion therapy has not been validated. The lack of standardization in penumbral imaging is one of the main contributing factors for this absence of validation. This article reviews the issues underlying the lack of standardization of perfusion-CT for penumbra imaging, and offers avenues to remedy this situation

Towards standardization of UV eye protection: what can be learned from photodermatology?

While knowledge about standardization of skin protection against ultraviolet radiation (UVR) has progressed over the past few decades, there is no uniform and generally accepted standardized measurement for UV eye protection. The literature provides solid evidence that UV can induce considerable damage to structures of the eye. As well as damaging the eyelids and periorbital skin, chronic UV exposure may also affect the conjunctiva and lens. Clinically, this damage can manifest as skin cancer and premature skin ageing as well as the development of pterygia and premature cortical cataracts. Modern eye protection, used daily, offers the opportunity to prevent these adverse sequelae of lifelong UV exposure. A standardized, reliable and comprehensive label for consumers and professionals is currently lacking. In this review we (i) summarize the existing literature about UV radiation-induced damage to the eye and surrounding skin; (ii) review the recent technological advances in UV protection by means of lenses; (iii) review the definition of the Eye-Sun Protection Factor (E-SPF®), which describes the intrinsic UV protection properties of lenses and lens coating materials based on their capacity to absorb or reflect UV radiation; and (iv) propose a strategy for establishing the biological relevance of the E-SPF.

The policy-making structure of European regulatory networks and the domestic adoption of standards

European regulatory networks (ERNs) constitute the main governance instrument for the informal co-ordination of public regulation at the European Union (EU) level. They are in charge of co-ordinating national regulators and ensuring the implementation of harmonized regulatory policies across the EU, while also offering sector-specific expertise to the Commission. To this aim, ERNs develop 'best practices' and benchmarking procedures in the form of standards, norms and guidelines to be adopted in member states. In this paper, we focus on the Committee of European Securities Regulators and examine the consequences of the policy-making structure of ERNs on the domestic adoption of standards. We find that the regulators of countries with larger financial industries tend to occupy more central positions in the network, especially among newer member states. In turn, network centrality is associated with a more prompt domestic adoption of standards.

Services standardization in the United-States and in Europe: an institutional analysis of private authority

This contribution explores the role of international standards in the rules governing the internationalisation of the service economy. It analyses on a cross-institutional basis patterns of authority in the institutional setting of service standards in the European and Amercian context. The entry into force of the World Trade Organisation (WTO) in 1995 gave international standards a major role in harmonising the technical specifications of goods and services traded on the global market Despite the careful wording of the WTO, a whole range of international bodies still have the capacity to define generic as well as detailed technical specifications affecting how swelling offshore services are expected to be traded on worldwide basis. The analysis relies on global political economy approaches to identify constitutive patterns of authority mediating between the political and the economic spheres on a transnational space. It extends to the area of service standards the assumption that the process of globalisation is not opposing states and markets, but a joint expression of both of them including new patterns and agents of structural change through formal and informal power and regulatory practices. The paper argues that service standards reflect the significant development of a form of transnational hybrid authority, that blurs the distinction between private and public actors, whose scope spread all along from physical measures to societal values, and which reinforces the deterritorialisation of regulatory practices in contemporary capitalism. It provides evidence of this argument by analysing the current European strategy regarding service standardization in response to several programming mandate of the European Commission and the American views on the future development of service standards.

How to Assess Histology in Eosinophilic Esophagitis: Standardization by the EEsAI Histopathology Questionnaire

Background and Aims: The international EEsAI study group iscurrently developing the first activity index specific forEosinophilic Esophagitis (EoE). So far histologic assessment inEoE i s not standardized but urgently needed to harmonizehistologic endpoints i n clinical trials. G oal: To develop andevaluate the EEsAI histopathology questionnaire.Methods: B ased o n multiple Delphi r ounds w ith national a ndinternational ( Europe and North America) E oE e xperthistopathologists and gastroenterologists, w e have d evelopedthe EEsAI histopathology questionnaire.Results: T he EEsAI histopathology questionnaire t akes i ntoaccount the following items: number of eosinphils per highpower field, pattern of i nflammation, eosinophil abscesses,basal l ayer e nlargement, and lamina propria f ibrosis. D istinctdefinitions a nd categories f or every item were established byagreement among experts. EoE expert pathologists had amedian of 22 minutes to complete the questionnaire and judgedit as well feasible. The histopathology questionnaire was pilotedin 20 patients and is currently evaluated in a cohort of 150 adultEoE patients.Conclusions: T he EEsAI histopathology questionnaire is thefirst tool that assesses EoE severity according to clearly definedhistologic criteria. These definitions, as well as their categories,established by i nternational E oE e xpert pathologists, w illstandardize h istologic EoE s everity assessment and therebyfacilitate the comparison of histologic outcome measures inclinical trials.

The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the neuromodulation appropriateness consensus committee.

INTRODUCTION: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. METHODS: The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. RESULTS: Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated. CONCLUSIONS: Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.

Guidelines for imaging retinoblastoma: imaging principles and MRI standardization.

Retinoblastoma is the most common intraocular tumor in children. The diagnosis is usually established by the ophthalmologist on the basis of fundoscopy and US. Together with US, high-resolution MRI has emerged as an important imaging modality for pretreatment assessment, i.e. for diagnostic confirmation, detection of local tumor extent, detection of associated developmental malformation of the brain and detection of associated intracranial primitive neuroectodermal tumor (trilateral retinoblastoma). Minimum requirements for pretreatment diagnostic evaluation of retinoblastoma or mimicking lesions are presented, based on consensus among members of the European Retinoblastoma Imaging Collaboration (ERIC). The most appropriate techniques for imaging in a child with leukocoria are reviewed. CT is no longer recommended. Implementation of a standardized MRI protocol for retinoblastoma in clinical practice may benefit children worldwide, especially those with hereditary retinoblastoma, since a decreased use of CT reduces the exposure to ionizing radiation.