Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM.

OBJECTIVES: Recommendations for EEG monitoring in the ICU are lacking. The Neurointensive Care Section of the ESICM assembled a multidisciplinary group to establish consensus recommendations on the use of EEG in the ICU. METHODS: A systematic review was performed and 42 studies were included. Data were extracted using the PICO approach, including: (a) population, i.e. ICU patients with at least one of the following: traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, stroke, coma after cardiac arrest, septic and metabolic encephalopathy, encephalitis, and status epilepticus; (b) intervention, i.e. EEG monitoring of at least 30 min duration; (c) control, i.e. intermittent vs. continuous EEG, as no studies compared patients with a specific clinical condition, with and without EEG monitoring; (d) outcome endpoints, i.e. seizure detection, ischemia detection, and prognostication. After selection, evidence was classified and recommendations developed using the GRADE system. RECOMMENDATIONS: The panel recommends EEG in generalized convulsive status epilepticus and to rule out nonconvulsive seizures in brain-injured patients and in comatose ICU patients without primary brain injury who have unexplained and persistent altered consciousness. We suggest EEG to detect ischemia in comatose patients with subarachnoid hemorrhage and to improve prognostication of coma after cardiac arrest. We recommend continuous over intermittent EEG for refractory status epilepticus and suggest it for patients with status epilepticus and suspected ongoing seizures and for comatose patients with unexplained and persistent altered consciousness. CONCLUSIONS: EEG monitoring is an important diagnostic tool for specific indications. Further data are necessary to understand its potential for ischemia assessment and coma prognostication.

Guignol de la mission Rockefeller [enfants assis devant le mini théâtre de Guignol], 26-11-19 : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57058

Saylor Township, Independent Auditor's Reports Financial Statement Schedule of Findings, June 30, 2003

Audit Report - Township

Perry Municipal Waterworks, Independent Auditor's Reports, Financial Statement and Supplementary Information Schedule of Findings, June 30, 2004

Other Audit Report - Utilities

Butler County Solid Waste Commission, Independent Auditor's Reports, Financial Statement, Schedule of Findings, June 30, 2004

Other Audit Reports - Butler County Solid Waste Commission

North Iowa Juvenile Detention Services Commission, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

Delware County Solid Waste Disposal Commission, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

Black Hawk County Criminal Justice Information Systems, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

Westory Fire Agency, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

Northeast Iowa Schools Insurance Trust, Independent Auditor's Reports, Finacial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

Assessing ageing of individual T lymphocytes: Mission impossible?

Effector T lymphocytes are the progeny of a limited number of antigen- specific precursor cells and it has been estimated that clonotypic human T cells may expand million fold on their way reaching high cell numbers that are sufficient for immune protection. Moreover, memory T cell responses are characterized by repetitive expansion of antigen-specific T cell clonotypes, and limitations in the proliferative capacity could lead to immune senescence. Because telomeres progressively shorten as a function of cell division, telomere length is a powerful indicator of the replicative in vivo history of human T lymphocytes. In this review, we summarize observations made over the last decade on telomere length dynamics of well-defined T cell populations derived from healthy donors and patients with infectious disease or cancer. We focus on T cell differentiation, T cell ageing, and natural and vaccine induced immune responses. We also discuss the scientific evidence for in vivo replicative senescence of antigen-specific T cells, and evaluate the available methods for measuring telomere lengths and telomerase activity, and their potential and limitations to increase our understanding of T cell physiology. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Rural Iowa Waste Management Association Independent Auditor's Reports Finanical Statement and Required Supplementary Information Schedule of Findings for the period ending June 30, 2004.

Rural Iowa Waste Management Association Independent Auditor's Reports, Financial Statement, Required Supplementary Information and Schedule of Findings for the Period Ending June 30, 2004.

Adair County Sanitary Landfill and Recycling Center, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2005

Other Audit Reports - 28E Organizations

Central Iowa Juvenile Detention Center, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2005

Other Audit Reports - 28E Organizations