Is fast track management after elective cranial surgery safe and can it replace routine early postoperative computed tomography?

Aims: Patient management following elective cranial surgery varies between different neurosurgical institutions. Early routine postoperative cranial computed tomography (CT) is often performed while keeping patients sedated and ventilated for several hours. We hypothesize that fast track management without routine CT scanning, i.e., early extubation within one hour allowing neurological monitoring, is safe and does not increase the rate of return to OR compared with published data. Methods: We prospectively screened 1118 patients with cranial procedures performed at our department over a period of two years. 420 patients with elective brain surgery older than 18 years with no history of prior cranial surgery were included. Routine neurosurgical practice as it is performed at our department was not altered for this observational study. Fast track management was aimed for all cases, extubated and awake patients were further monitored. CT scanning within 48 hours after surgery was not performed except for unexpected neurological deterioration. This study was registered at ClinicalTrials.gov (NCT01987648). Results: 420 elective craniotomies were performed for 310 supra- and 110 infratentorial lesions. 398 patients (94.8%) were able to be extubated within 1 hour, 21 (5%) within 6 hours, and 1 patient (0.2%) was extubated 9 hours after surgery. Emergency CT within 48 hours was performed for 36 patients (8.6%, 26 supra- and 10 infratentorial cases) due to unexpected neurological worsening. Of these 36 patients 5 had to return to the OR (hemorrhage in 3, swelling in 2 cases). Return to OR rate of all included cases was 1.2%. This rate compares favorably with 1-4% as quoted in the current literature. No patient returned to the OR without prior CT imaging. Of 398 patients extubated within one hour 2 (0.5%) returned to the OR. Patients who couldn’t be extubated within the first hour had a higher risk of returning to the OR (3 of 22, i.e., 14%). Overall 30-day mortality was 0.2% (1 patient). Conclusions: Early extubation and CT imaging performed only for patients with unexpected neurological worsening after elective craniotomy procedures is safe and does not increase patient mortality or the return to OR rate. With this fast track approach early postoperative cranial CT for detection of postoperative complications in the absence of an unexpected neurological finding is not justified. Acknowledgments The authors thank Nicole Söll, study nurse, Department of Neurosurgery, Bern University Hospital, Switzerland for crucial support in data collection and managing the database.

Forest regeneration capacity and its enhancement by forest management and silviculture in Cabo Delgado

SDC has been involved in rural development in Cabo Delgado for more than 30 years. Shortly after the independence of Mozambique, projects in water supply and integrated rural development were initiated. The silvoagropastoral project FO9 based in Mueda was a very early experience in forestry in Cabo Delgado. Andreas Kläy was responsible for the forestry sector in FO9 for 3 years in the early 1980s and had an opportunity to initiate an exchange of ideas and experience in rural development theory and approaches with Yussuf Adam, who was doing research in human anthropology and history in the province. 25 years later, the current situation of forest management in Cabo Delgado was reassessed, with a specific focus on concessions in the North. The opportunity for a partnership between the MITI SA, the University of Eduardo Mondlane, and CDE was created on the basis of this preliminary study1. The aim of this partnership is to generate knowledge and develop capacity for sustainable forest management. The preliminary study showed that “…we have to face weaknesses and would like to start a learning process with the main institutions, organisations, and stakeholder groups active in forest management and research in the North of Cabo Delgado. This learning process will involve studies supported by competent research institutions and workshops …” The specific objectives of ESAPP project Q804 are the following: 1. Contribute to understanding of the forestry sector; 2. Capacity development for professionals and academics; 3. Support for the private sector and the local forest service; 4. Support data generation at Cabo Delgado's Provincial Service; 5. Capacity development for Swiss academic institutions (CDE and ETHZ). A conceptual planning platform was elaborated as a basis for cooperation and research in the partnership (cf. Annex 1). The partners agreed to work on two lines of research: biophysical and socio-economic. In order to ensure a transdisciplinary approach, disciplinary research is anchored in common understanding in workshops based on the LforS methods. These workshops integrate the main stakeholders in the local context of the COMADEL concession in Nangade District managed by MITI SA, and take place in the village of Namiune. The research team observed that current management schemes consist mainly of strategies of nature mining by most stakeholders involved. Institutional settings - formal and informal - have little impact due to weak capacity at the local level and corruption. Local difficulties in a remote rural area facilitate external access to resources and are perpetuated by the loss of benefits. The benefits of logging remain at the top level (economic and political elites). The interests of the owners of the concession in stopping the loss of resources caused by this regime offers a unique opportunity to intervene in the logic of resource degradation and agony in rural development and forest management.

Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

The palaeoecological history of the Praz-Rodet bog (Swiss Jura) based on pollen, plant macrofossils and testate amoebae (Protozoa)

Stratigraphy, radiocarbon dating and analyses of pollen, plant macrofossils and testate amoebae were used to reconstruct the development and ecology of a small raised bog in a karst-dominated landscape in the Swiss Jura Mountains. Special focus was on past vegetation and on the history of Pinus rotundata in relation to anthropogenic and climatic influences. Testate amoebae were used to reconstruc-t past local soil pH and water-table depth. The inferred development of the Praz-Rodet bog typifies a classic hydroseral tefrestrialization of a small basin. Two features are specific for this site. First, the bog was much wetter than today for a long period; according to our hypothesis, this only changed as a consequence of human activities. Second, two hiatuses are present at the coring location (Younger Dryas--early Preboreal, and 4700-2800 cal. yr BP), the former probably caused by low lake productivity due to cold temperatures and the latter by the erosional activity of the adjacent small river. The date of 2800 cal. yr BP for renewed peat accumulation may be related to climatic change (Subboreal-Subatlantic transition). Pollen indicators failed to show one hiatus: an apparently complete pollen sequence is therefore no guarantee of an uninterrupted sediment accumulation. Evidence of early minor human impact on the vegetation in the Joux Valley dates back to c. 6850 calendar years, congruous with the early Neolithic in the Jura Mountains. The history of Pinuis rotindata appears to be more complex than previously believed. Human activity is clearly responsible for the present abundance of this species, but the tree was naturally present on the bog long before the first evidence of important human disturbance of the site (1500 cal. yr BP). It is suggested that, in karst-dominated landscapes, dense forests growing on mineral soils around raised bogs may significantly reduce summer evapotranspiration by acting as windbreaks. Forest clearance results in increased evapotranspiration, causing a lowering of the water table on the bog and a modification of the vegetation cover. This hypothesis has implications for the management of similar small raised bogs in karst-dominated landscape.

Dr. William Gorgas and his style of management against yellow fever during the construction of the Panama Canal: A historical case study

This study describes the style of management of Dr. William Gorgas as he led the public health effort to reduce diseases to a level that permitted the completion of the Panama Canal construction. Initially, Gorgas was skeptical of the mosquito vector theory. He fully accepted this theory after participating in Walter Reed’s massive cleanup of Havana, Cuba during the Spanish American War of 1898. During 1905 to 1914, Gorgas was selected to lead the sanitary effort during the construction of the Panama Canal. The lessons learned from this historical case study provide public health administrators with guidance to effectively lead current and future infectious diseases threats. Understanding styles of management within the context of disease control is essential in tackling epidemics like yellow fever and other infectious diseases. ^

Family health history discussion in patient-provider encounters

Ascertaining the family health history (FHH) may provide insight into genetic and environmental susceptibilities specific to a variety of chronic diseases, including type II diabetes mellitus. However, discussion of FHH during patient-provider encounters has been limited and uncharacterized. A longitudinal, observational study was conducted in order to compare the content of FHH topics in a convenience sample of 37 patients, 13 new and 24 established. Each patient had an average of three follow-up encounters involving 6 staff physicians at the Audie L. Murphy Memorial Veterans Hospital (VHA) in San Antonio, TX from 2003 to 2005. A total of 131 encounters were analyzed in this study. The average age of the selected population was 68 years and included 35 males and two females. Transcriptions of encounters were obtained, coded and analyzed, in NVIVO 8. Of the 131 total encounters transcribed among the 37 patients, only 24 encounters (18.3%) included discussion of FHH. Additionally, the relationship between FHH discussion and discussion of self-care management (SCM) topics were assessed. In this study, providers were more likely to initiate discussion on family health history among new patients in the first encounter (ORnew = 8.55, 95% CI: 1.49–52.90). The discussion of FHH occurred sporadically in established patients throughout the longitudinal study with no apparent pattern. Provider-initiated FHH discussion most frequently had satisfactory level(s) of discussion while patient-initiated FHH discussion most frequently had minimal level(s) of discussion. FHH discussion most oftentimes involved topics of cancer and cardiovascular disease among primary-degree familial relationships. Overall, family health histories are largely, an underutilized tool in personalized preventive care.^

Customer Relationship Management-PeopleSoft CRM

1 RESUMEN 1.1 Resumen (español) El intercambio y comercio tanto de bienes como servicios se remonta a tiempos inmemoriales dentro de la historia de la humanidad. Desde sus inicios tempranos con el intercambio o trueque de productos en el Neolítico hasta nuestra época híper globalizada, en la que existen clientes potenciales en el otro extremo del mundo, podemos decir que se ha recorrido un largo camino. Con el paso del tiempo y la evolución de la sociedad y la tecnología, así como la evolución empresarial, se ha visto necesario la implementación de estrategias para lograr la fidelización y satisfacción de los clientes. De esta forma entendimos que ya no valía simplemente con vender un producto a un cliente, si no que si queríamos establecer una relación continúa con el mismo, debíamos lograr su satisfacción y por tanto su fidelización. Como forma de extender la relación más allá de una simple venta, las empresas modernas empezaron a implementar diversas estrategias. De esta forma aparecieron los primeros centros de atención al cliente, las primeras aplicaciones hechas a medida para dar soporte a los clientes y por fin los sistemas CRM tal y como los concebimos hoy día. El presente proyecto fin de carrera da una explicación de dichos sistemas indicando cuáles son sus objetos fundamentales y cómo implementan la estrategia CRM y profundiza en uno de los sistemas CRM más utilizados: PeopleSoft CRM, dando una explicación detallada de dicho sistemas así como de los conceptos y lenguaje de programación de dicho sistema CRM. 1.2 SUMMARY (ENGLISH) The exchange and trade of goods as well and services goes back to ancient times in the history of mankind. Since its early beginning with the bartering of products in the Neolithic to our globalized hyper era, in which there are potential customers on the other side of the world, we can say that it has come a long way. After a certain length of time, the society and technology evolution, and also the enterprise development, has been necessary to implement strategies to achieve customer loyalty and satisfaction. We understood in this way that it no longer simply worth to sell a product to a customer, otherwise if we wanted to establish a relationship continues with the same, we should ensure their satisfaction and thus their loyalty. As a way to extend the relationship beyond a simple sale, modern enterprises began to implement several strategies. Therefore appeared the first customer service centers, the first applications tailored to support customers and finally the CRM systems as we know it today. This final project gives an explanation of such systems by indicating what the core objects are and how to implement the CRM strategy, deeping into one of the most widely used CRM systems: PeopleSoft CRM, and also giving a detailed explanation of this system and its programming language.

Tower of Martín González or castle of La Raya (Soria): territory, history, defense and construction / La torre de Martín González o castillo de La Raya (Soria): territorio, historia, defensa y construcción

Abstract The Tower of Martín González, also known as castle of La Raya, is placed in the actual border between the Spanish provinces of Soria and Zaragoza and in the historical limit between the Crowns of Castile and Aragon: this is the reason for its name. The castle dominates the hedge of the plain-moors that surround the Valley of Nágima River. It is a castle with courtyard and a high tower in the western flank. The paper analyzes the castle in four main levels. All references about the castle are studied to draw a historical narration and to relate with the territory and other fortifications, both Castilian and Aragonese. Despite its advanced state of ruin, it preserves many rests that allow making an analysis of its defensive elements and constructive aspects. Resumen La torre de Martín González, también conocida como el castillo de La Raya, se sitúa en el límite actual entre las provincias de Soria y Zaragoza y en el límite histórico entre las coronas de Castilla y Aragón. Domina el extremo de los páramos que circundan el río Nágima. Es un castillo de tipo torrejón con patio de armas y una torre del homenaje adosada a su flanco occidental. El análisis contempla cuatro niveles fundamentales para el entendimiento de la arquitectura fortificada. La comunicación revisa la documentación existente sobre los elementos históricos que se ponen en relación, mediante el análisis territorial, con el sistema fortificado de frontera. A pesar de su avanzado estado de ruina, conserva restos que permiten realizar una lectura interpretativa de sus elementos defensivos y de sus aspectos constructivos.

Application of low cost technology for the management of irrigation in organic orchards

Throughout history, humans have cyclically return to their old traditions such as the organic orchards. Nowadays, these have been integrated into the modern cities and could supply fresh vegetables to the daily food improving human health. Organic orchards grow crops without pesticides and artificial fertilizers thus, they are respectful with the environment and guarantee the food's safety . In modern society, the application of new technology is a must, in this case to obtain an efficient irrigation. In order to monitor a proper irrigation and save water and energy, soil water content probes are used to measure soil water content. Among them, capacitive probes ,monitored with a specific data logger, are typically used. Most of them, specially the data loggers, are expensive and in many cases are not used. In this work, we have applied the open hardware Arduino to build and program a low cost datalogger for the programming of irrigation in an experimental organic orchard. Results showed that the application of such as low cost technology, which is easily available in the market and easy to understand, everyone can built and program its own device helping in managing water resources in organic orchards .

Clinical presentation, allergens, and management of wheat allergy

IgE-mediated allergy to wheat proteins can be caused by exposure through ingestion, inhalation, or skin/mucosal contact, and can affect various populations and age groups. Respiratory allergy to wheat proteins is commonly observed in adult patients occupationally exposed to flour, whereas wheat food allergy is more common in children. Wheat allergy is of growing importance for patients with recurrent anaphylaxis, especially when exercise related. The diagnosis of wheat allergy relies on a consistent clinical history, skin prick testing with well-characterized extracts and specific IgE tests. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several wheat components. However, a high degree of heterogeneity has been found in the recognition pattern of allergens among patient groups with different clinical profiles, as well as within each group. Thus, oral provocation with wheat or the implicated cereal is the reference test for the definitive diagnosis of ingested wheat/cereal allergy.

Agua, derecho de uso y utilidad en el regadío de tradición andalusí del Reino de Valencia

El origen de la normativa escrita sobre el uso de las aguas en el territorio peninsular levantino plantea diversas incógnitas. Las primera de ellas sobre los quienes fueron los protagonistas en la redacción y determinación de ese derecho. La segunda sobre el papel que la costumbre de los sarracenos desempeñó en la preservación de tradiciones jurídicas, mantenimiento de infraestructuras y gestión del agua. La tercera tiene que ver con el modo de aunar intereses de comunidades distintas desde el punto de vista religioso y jurídico sobre el derecho de uso de forma equitativa y proporcional a necesidades no necesariamente coincidentes. Lo cierto es que las fuentes conservadas sobre el proceso de reconquista y población siguen siendo una de las mejores referencias para despejar incógnitas y justificar la tradición y pervivencia de un derecho inmemorial y vigente en algunas de sus formas y manifestaciones, no solo en el marco levantino sino en otros muchos espacios de la cuenca mediterránea con idénticas características medioambientales y geo-climáticas.

Where no man has gone before [microform] : a history of Apollo lunar exploration missions /

Mode of access: Internet.

Management of out-apiaries.

Mode of access: Internet.