Aetiologies of pulseless electrical activity in out-of-hospital cardiac arrests:A retrospective study and analysis of specific causes

Background: Pulseless electrical activity (PEA) cardiac arrest is defined as a cardiac arrest (CA) presenting with a residual organized electrical activity on the electrocardiogram. In the last decades, the incidence of PEA has regularly increased, compared to other types of CA like ventricular fibrillation or pulseless ventricular tachycardia. PEA is frequently induced by reversible conditions. The "4 (or 5) H" & "4 (or 5) T" are proposed as a mnemonic to asses for Hypoxia, Hypovolemia, Hypo- /Hyperkalaemia, Hypothermia, Thrombosis (cardiac or pulmonary), cardiac Tamponade, Toxins, and Tension pneumothorax. Other pathologies (intracranial haemorrhage, severe sepsis, myocardial contraction dysfunction) have been identified as potential causes for PEA, but their respective probability and frequencies are unclear and they are not yet included into the resuscitation guidelines. The aim of this study was to analyse the aetiologies of PEA out-of-hospital CA, in order to evaluate the relative frequencies of each cause and therefore to improve the management of patients suffering a PEA cardiac arrest. Method: This retrospective study was based on data routinely and prospectively collected for each PEMS intervention. All adult patients treated from January 1st 2002 to December 2012 31st by the PEMS for out-of-hospital cardiac arrest, with PEA as the first recorded rhythm, and admitted to the emergency department (ED) of the Lausanne University Hospital were included. The aetiologies of PEA cardiac arrest were classified into subgroups, based on the classical H&T's classification, supplemented by four other subgroups analysis: trauma, intra-cranial haemorrhage (ICH), non-ischemic cardiomyopathy (NIC) and undetermined cause. Results: 1866 OHCA were treated by the PEMS. PEA was the first recorded rhythm in 240 adult patients (13.8 %). After exclusion of 96 patients, 144 patients with a PEA cardiac arrest admitted to the ED were included in the analysis. The mean age was 63.8 ± 20.0 years, 58.3% were men and the survival rate at 48 hours was 29%. 32 different causes of OHCA PEA were established for 119 patients. For 25 patients (17.4 %), we were unable to attribute a specific cause for the PEA cardiac arrest. Hypoxia (23.6 %), acute coronary syndrome (12.5%) and trauma (12.5 %) were the three most frequent causes. Pulmonary embolism, Hypovolemia, Intoxication and Hyperkaliemia occurs in less than 10% of the cases (7.6 %, 5.6 %, 3.5%, respectively 2.1 %). Non ischemic cardiomyopathy and intra-cranial haemorrhage occur in 8.3 % and 6.9 %, respectively. Conclusions: According to our results, intra-cranial haemorrhage and non-ischemic cardiomyopathy represent noticeable causes of PEA in OHCA, with a prevalence equalling or exceeding the frequency of classical 4 H's and 4 T's aetiologies. These two pathologies are potentially accessible to simple diagnostic procedures (native CT-scan or echocardiography) and should be included into the 4 H's and 4 T's mnemonic.

Online Learning and Teaching in Higher Education, a book review

Peer-reviewed

Combining Generic Programming and Service-Oriented Architectures for the Effective and Timely Development of Complex e-Learning Systems

Peer-reviewed

An Experimental Study on Peer Selection in a P2P Network over PlanetLab

Peer-reviewed

Els Gèneres de la narrativa oral en prosa: material didàctic d’aula ordinària d’ESO amb presència d’alumat que té el català com a segona llengua

En aquest treball proposem crear materials didàctics per a l’alumnat de les aules de secundària que en molts casos és heterogeni i inclou estudiants que surten de l’aula d’acollida amb un coneixement del català informal i que tenen dificultats per a incorporar-se al ritme habitual de l’aula ordinària

Feasibility Study and Market Review of Small Scale Bioenergy Heating Plants in North-West Russia

The paper is focused on feasibility study and market review of small scale bioenergy heating plants in the Russian North-West region. The main focus is effective and competitive usage of low-grade wood for heating purposes in the region. As example of economical feasibility estimation it was chosen the project of reconstruction of small scale boiler plant in Leningrad region that Brofta Oy is planning to implement the nearest time. It includes calculation the payback time with and without interest, the estimation of probable investments, the evaluation of possible risks and research on the potential of small scale heating plants projects. Calculations show that the profitability of this kind of projects is high, but payback time is not very short, because of high level of initial investments. Though, the development of small scale bioenergy heating plants in the region is considered to be the best way to solve the problems of heat supply in small settlements using own biomass resources.

The Transformation of Practical Teaching Focusing on Dialogic Learning

This study investigates the transformation of practical teaching in a Catalan school, connected to the design, implementation and development of project-based learning, and focusing on dialogic learning to investigate its limits and possibilities. Qualitative and design-based research (DBR) methods are applied. These methods are based on empirical educational research with the theory-driven of learning environments. DBR is proposed and applied using practical guidance for the teachers of the school. It can be associated with the current proposals for Embedding Social Sciences and Humanities in the Horizon 2020 Societal Challenges. This position statement defends the social sciences and the humanities as the most fundamental and important ideas to face all societal challenges. The results of this study show that before the training process, teachers apply dialogic learning in specific moments (for example, when they speak about the weekend); however, during the process and after the process, they work systematically with dialogic learning through the PEPT: they start and finish every activity with a individual and group reflection about their own processes, favouring motivation, reasoning and the implication of all the participants. These results prove that progressive transformations of teaching practice benefit cooperative work in class

Study and modeling of the desintegration kinetics of coated paper

The disintegration of recovered paper is the first operation in the preparation of recycled pulp. It is known that the defibering process follows a first order kinetics from which it is possible to obtain the disintegration kinetic constant (KD) by means of different ways. The disintegration constant can be obtained from the Somerville index results (%lsv and from the dissipated energy per volume unit (Ss). The %slv is related to the quantity of non-defibrated paper, as a measure of the non-disintegrated fiber residual (percentage of flakes), which is expressed in disintegration time units. In this work, disintegration kinetics from recycled coated paper has been evaluated, working at 20 revise rotor speed and for different fiber consistency (6, 8, 10, 12 and 14%). The results showed that the values of experimental disintegration kinetic constant, Ko, through the analysis of Somerville index, as function of time. Increased, the disintegration time was drastically reduced. The calculation of the disintegration kinetic constant (modelled Ko), extracted from the Rayleigh’s dissipation function, showed a good correlation with the experimental values using the evolution of the Somerville index or with the dissipated energy

Early Childhood Mathematics Education: Research, Curriculum and Educational Practice

This article reviews data obtained through research into early childhood mathematics education in Spain. It analyses the current curricular directions in mathematics education with early learners. It also provides an overview of mathematical practices in early childhood education classrooms to analyse the commonalities and differences between research, curriculum and educational practice. A review of the research presented at SEIEM symposia from 1997 until 2012 demonstrates: a) very little research has been done, a trend that is repeated in other areas, such as the JCR-Social Sciences Edition or the PME; b) the first steps have been taken to create a more and more cohesive body of research, although until now there has not been enough data to outline the curricular directions; and c) some discrepancies still exist between the mathematical practices in early childhood education classrooms and the official guidelines

Otra mirada al tema del cambio de escala: los nuevos espacios de comercio, ocio y turismo = Another look at the theme of the change of scale: new spaces in commerce, leisure and tourism

The technological advances and new organisation of the economy together with a change in ideas in consumer habits andlifestyle that have happened in the last 25 years have placed us in a new state of capitalism. The spatial translation of thisnew state has been immediate and implies among other changes the overcoming of the concept of scale. Commercialspaces and those of leisure and tourism offer us an unbeatable opportunity of exemplifying these changes because they arethe most effected by the new postmodern tendencies

Matemáticas y juego = Mathematics and games

In this article we try to look at the learning of mathematics through games in the first years of schooling. The use of game resources in the class should not be carried out in a uniquely intuitive way but rather in a manner that contains some preliminary reflections such as, what do we understand by games? Why use games as a resource in the Mathematics classroom? And what does its use imply?

Una visión actualizada de la didáctica de la matemática en educación infantil = An up-to-date vision of pre-school mathematics teaching

This article aims to investigate pre-school mathematics teaching from an uptodate perspective. To pursue this contemporary vision we focus on four key questions: what kind of maths is being worked on, who is doing it, how it is being done, and why it is being done

El juego y su estructura interna en relación con el trabajo de la condición física en primaria = Games and their internal structure in relation to the work of physical condition in Primary Education

One of the methodological resources that teachers use in a generalised way in Physical Education classes is the game. Inthis article we define the concept of game and analyse the characteristics of their internal structure. On the other hand welook at the concepts of physical condition and conditional skills and describe the objectives of its work in Primary Education.Finally, we relate these concepts and propose two practical examples of modifying the internal structure of the game so asto produce variations in the implied conditional skills

Polarographic study and electrode kinetics of [Zn(II) - antibiotics - cephaloglycin] system vis a vis kinetics of electrode reactions

Electrode kinetics and complex formation of Zn(II) using doxycycline, chlortetracycline, oxytetracycline, tetracycline, minocycline, amoxicillin, chloramphenicol and cephaloglycin were reported at pH = 7.30 ± 0.01 in = 1.0 molL-1 NaClO4 used as supporting electrolyte at 25.0°C. Kinetic parameters viz. transfer coefficient (α), degree of irreversibility (λ) and rate constant (k) were determined. The study showed that 'Transition state' behaves between reactant (O) and product (R) response to applied potential. The stability constants varied from 2.14 to 10.31 showing that these drugs or their complexes could be used against Zn toxicity.

Thermoanalytical study and characterization of native starches of Paraná pine seeds (Araucaria angustiofolia, Bert O. Ktze) and European chestnut seeds (Castanea sativa, Mill)

Starch is the most important carbohydrate storage in plants. It is a raw material with diverse botanical origins, and is used by the food, paper, chemical, pharmaceutical, textile and other industries. In this work, native starches of Paraná pine seeds (pinhão) (Araucária angustiofolia, Bert O. Ktze) and european chestnut seeds (Castanea sativa, Mill) were studied by thermoanalytical techniques: thermo-gravimetry (TG), differential thermal analysis (DTA) and differential scanning calorimetry (DSC), as well as X-ray powder patterns diffractometry. Apparent and total amylose content was also determined.