Evolution of insulin sensitivity and its variability in out-of-hospital cardiac arrest (OHCA) patients treated with hypothermia.

INTRODUCTION: Therapeutic hypothermia (TH) is often used to treat out-of-hospital cardiac arrest (OHCA) patients who also often simultaneously receive insulin for stress-induced hyperglycaemia. However, the impact of TH on systemic metabolism and insulin resistance in critical illness is unknown. This study analyses the impact of TH on metabolism, including the evolution of insulin sensitivity (SI) and its variability, in patients with coma after OHCA. METHODS: This study uses a clinically validated, model-based measure of SI. Insulin sensitivity was identified hourly using retrospective data from 200 post-cardiac arrest patients (8,522 hours) treated with TH, shortly after admission to the intensive care unit (ICU). Blood glucose and body temperature readings were taken every one to two hours. Data were divided into three periods: 1) cool (T <35°C); 2) an idle period of two hours as normothermia was re-established; and 3) warm (T >37°C). A maximum of 24 hours each for the cool and warm periods was considered. The impact of each condition on SI is analysed per cohort and per patient for both level and hour-to-hour variability, between periods and in six-hour blocks. RESULTS: Cohort and per-patient median SI levels increase consistently by 35% to 70% and 26% to 59% (P <0.001) respectively from cool to warm. Conversely, cohort and per-patient SI variability decreased by 11.1% to 33.6% (P <0.001) for the first 12 hours of treatment. However, SI variability increases between the 18th and 30th hours over the cool to warm transition, before continuing to decrease afterward. CONCLUSIONS: OCHA patients treated with TH have significantly lower and more variable SI during the cool period, compared to the later warm period. As treatment continues, SI level rises, and variability decreases consistently except for a large, significant increase during the cool to warm transition. These results demonstrate increased resistance to insulin during mild induced hypothermia. Our study might have important implications for glycaemic control during targeted temperature management.

Keeping Up with the Joneses: Who Loses Out?

This paper investigates how well-being varies with individual wage rates when individuals care about relative consumption and so there are Veblen effects – Keeping up with the Joneses – leading individuals to over-work. In the case where individuals compare themselves with their peers – those with the same wage-rate - it is shown that Keeping up with the Joneses leads some individuals to work who otherwise would have chosen not to. Moreover for these individuals well-being is a decreasing function of the wage rate - contrary to standard theory. So those who are worst-off in society are no longer those on the lowest wage.

Out of sight, out of mind? Educational outcomes of children with parents working abroad.

Impact of parental emigration on educational outcomes of children is theoretically ambiguous. Using novel data I collected on migration experience and its timing, family background and school performance of lower secondary pupils in Poland, I analyse the question empirically. Migration is mostly temporary in nature, with one parent engaging in employment abroad. As many as 63% of migrant parents have vocational qualifications, 29% graduated from high school, 4% have no qualifications and the remaining 4% graduated from university. Almost 18% of children are affected by parental migration. Perhaps surprisingly, estimates suggest that parental employment abroad has a positive immediate impact on a pupil’s grade. Parental education appears pivotal; children of high school graduates benefit most. Longer term effects appear more negative, however, suggesting that a prolonged migration significantly lowers a child’s grade. Interestingly, siblings’ foreign experiences exert a large, positive impact on pupils’ grades.

"How I Do It"-Radical Right Colectomy with Side-to-Side Stapled Ileo-Colonic Anastomosis.

BACKGROUND AND OBJECTIVE: Standardization of surgical technique helps to reproduce excellent clinical outcomes, especially in teaching institutions. We aim to describe in detail our established approach for oncological right colectomy. TECHNIQUE: The right colon is mobilized in a five-step latero-inferior approach starting off with (1) the terminal ileum, visualizing the duodenum and the head of pancreas. (2) The ascending colon is dissected from the retroperitoneum, and takedown of the hepatic flexure is completed coming retrograde from the transverse colon (3). (4) Transection of the remaining retroperitoneal attachments completes exposure of the duodenum and mobilization of the right colon. (5) Ileocolic vessels are dissected out and divided close to their origin, and the mesocolon is divided. We then establish intestinal continuity by use of a side-to-side stapled technique. (1) The arms of a linear cutting stapler are inserted via transverse incisions at the anti-mesenteric sides of the terminal ileum and the transverse colon (tenia) and fired. (2) The enterotomy site is closed by removal of the specimen using a second transverse firing of the linear cutting stapler. An important final step is the (3) reinforcement of the anastomotic ends and the crossing of the staple lines; an omental patch and closure of the mesenteric window are optional. CONCLUSION: The suggested standardized five-step lateral-to-medial dissection of the right colon and the three-step side-to-side stapled technique for ileo-colonic anastomosis are easy to learn and to reproduce. Careful adherence to pivotal technical details will help to obtain an optimal oncological outcome and a consistently low leak rate around 2 %.

Sorting out measures and definitions of screening participation to improve comparability: The example of colorectal cancer.

Participation is a key indicator of the potential effectiveness of any population-based intervention. Defining, measuring and reporting participation in cancer screening programmes has become more heterogeneous as the number and diversity of interventions have increased, and the purposes of this benchmarking parameter have broadened. This study, centred on colorectal cancer, addresses current issues that affect the increasingly complex task of comparing screening participation across settings. Reports from programmes with a defined target population and active invitation scheme, published between 2005 and 2012, were reviewed. Differences in defining and measuring participation were identified and quantified, and participation indicators were grouped by aims of measure and temporal dimensions. We found that consistent terminology, clear and complete reporting of participation definition and systematic documentation of coverage by invitation were lacking. Further, adherence to definitions proposed in the 2010 European Guidelines for Quality Assurance in Colorectal Cancer Screening was suboptimal. Ineligible individuals represented 1% to 15% of invitations, and variable criteria for ineligibility yielded differences in participation estimates that could obscure the interpretation of colorectal cancer screening participation internationally. Excluding ineligible individuals from the reference population enhances comparability of participation measures. Standardised measures of cumulative participation to compare screening protocols with different intervals and inclusion of time since invitation in definitions are urgently needed to improve international comparability of colorectal cancer screening participation. Recommendations to improve comparability of participation indicators in cancer screening interventions are made.

Emissions distribution in post-Kyoto international negotiations: a policy

An abundant scientific literature about climate change economics points out that the future participation of developing countries in international environmental policies will depend on their amount of pay offs inside and outside specific agreements. These studies are aimed at analyzing coalitions stability typically through a game theoretical approach. Though these contributions represent a corner stone in the research field investigating future plausible international coalitions and the reasons behind the difficulties incurred over time to implement emissions stabilizing actions, they cannot disentangle satisfactorily the role that equality play in inducing poor regions to tackle global warming. If we focus on the Stern Review findings stressing that climate change will generate heavy damages and policy actions will be costly in a finite time horizon, we understand why there is a great incentive to free ride in order to exploit benefits from emissions reduction efforts of others. The reluctance of poor countries in joining international agreements is mainly supported by historical responsibility of rich regions in generating atmospheric carbon concentration, whereas rich countries claim that emissions stabilizing policies will be effective only when developing countries will join them.Scholars recently outline that a perceived fairness in the distribution of emissions would facilitate a wide spread participation in international agreements. In this paper we overview the literature about distributional aspects of emissions by focusing on those contributions investigating past trends of emissions distribution through empirical data and future trajectories through simulations obtained by integrated assessment models. We will explain methodologies used to elaborate data and the link between real data and those coming from simulations. Results from this strand of research will be interpreted in order to discuss future negotiations for post Kyoto agreements that will be the focus of the next. Conference of the Parties in Copenhagen at the end of 2009. A particular attention will be devoted to the role that technological change will play in affecting the distribution of emissions over time and to how spillovers and experience diffusion could influence equality issues and future outcomes of policy negotiations.

Tintín: El reporter del segle XX

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. L’objectiu d’aquest treball és veure de quina manera les historietes de Tintín reflecteixen l’època en què van ser elaborades i establir una relació entre la història i el còmic. La metodologia que s’ha emprat ha estat centrada principalment en dues tasques paral•leles i complementàries. D’una banda, l’estudi de la història del segle XX a partir de l’obra d’Eric Hobsbawm del mateix nom i d’altres fonts bibliogràfiques per tal d’adquirir una idea general sobre l’anterior segle. D’altra banda, l’anàlisi d’uns determinats aspectes dels còmics de Tintín. Aquests són: l’època en què va ser elaborat, una síntesi de l’argument, el recorregut geogràfic que fa Tintín, els conflictes i esdeveniments històrics - paral•lels a la realitat del moment- que hi apareixen, les problemàtiques contemporànies, i un comentari entorn de la documentació i les fonts d’inspiració usades per Hergé. Aquesta anàlisi es va dur a terme a partir d’una selecció de sis còmics del mateix període. En conclusió, veiem que realment existeix una relació entre els esdeveniments dels còmics i l’època en què van ser elaborats. Això ens permet també apropar-nos-hi i conèixer l’autor, Hergé, de qui podem dir que es basa en la realitat que l’envolta i en els esdeveniments del seu moment per elaborar els còmics.

La literatura popular del nord del Marroc

Treball de recerca realitzat per una alumna d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit cientí¬fic del Jovent l'any 2009. L’objectiu d’aquest treball és fer un recull de literatura de transmissió oral i reunir d’aquesta manera les històries, els contes, les llegendes. etc. que els avis de l’autora li contaven. Un dels objectius era que servís alhora de mitjà de coneixement per a tots els nens i nenes que, tenint un origen marroquí o berber, han nascut a Catalunya, per la qual cosa no han tingut accés a aquest tipus de literatura. Ja que, per una banda han estat sempre escolaritzats en català, i per l altra la font de coneixement que suposen els avis s ha quedat al Marroc. Aquests nens tenen poc coneixement sobre la seva cultura d’origen i més si aquesta gaudeix de poc valor.

A stepwise protocol to coat aAPC beads prevents out-competition of anti-CD3 mAb and consequent experimental artefacts.

Artificial antigen-presenting cells (aAPC) are widely used for both clinical and basic research applications, as cell-based or bead-based scaffolds, combining immune synapse components of interest. Adequate and controlled preparation of aAPCs is crucial for subsequent immunoassays. We reveal that certain proteins such as activatory anti-CD3 antibody can be out-competed by other proteins (e.g. inhibitory receptor ligands such as PDL1:Fc) during the coating of aAPC beads, under the usually performed coating procedures. This may be misleading, as we found that decreased CD8 T cell activity was not due to inhibitory receptor triggering but rather because of unexpectedly low anti-CD3 antibody density on the beads upon co-incubation with inhibitory receptor ligands. We propose an optimized protocol, and emphasize the need to quality-control the coating of proteins on aAPC beads prior to their use in immunoassays.

Del Noguerola al Segre: els problemes de la qualitat ambiental de l'aigua

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. Els principals objectius del treball són intentar demostrar, cinc anys més tard, si el riu Noguerola és encara fruit d'abocaments residuals en el seu pas subterrani per la ciutat de Lleida, i observar i analitzar com el riu Segre sofreix múltiples impactes ambientals provinents, especialment, de les activitats agrícoles i ramaderes. Es van fer dos campanyes de mostrejos en les confluències de 10 afluents dels marges dret i esquerre del riu Segre, i en 5 punts al llarg d'aquest. Per a cada mostra es van analitzar: conductivitat, temperatura, ph, nitrats, nitrits, amoni, fosfats, duresa i microorganismes. A més a més, es van delimitar i determinar les superfícies de les conques i es van fer balanços hidrometeorològics per determinar les aportacions naturals de l’aigua de pluja, i es van estimar els excedents de reg de totes les conques, per així calcular les masses totals de cada paràmetre, aportades per cada afluent. Les principals conclusions a què s’ha arribat són: que el riu Noguerola continua sent fruit d'abocaments residuals en el seu pas subterrani per la ciutat de Lleida. I que, tant les activitats agrícoles i ramaderes, com les captacions d'aigua dels canals de Balaguer i de Seròs per a l’obtenció d’energia hidroelèctrica, provoquen greus impactes ambientals al riu Segre.

Síntesi i control de qualitat de biodièsel

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. Aquest treball té com a base donar les pautes necessàries per a l'obtenció de biodièsel i determinar-ne la seva acceptabilitat. Per tal de que això sigui possible, s'han sintetitzat biodièsels provinents d'oli de girasol refinat, d'oli d'oliva refinat, i d'aquests mateixos fregits al emprar-los al cuinar. Un cop sintetitzats se'ls hi ha realitzat una sèrie d'anàlisis fisicoquímics per tal de determinar-ne la seva acceptabilitat mitjançant una comparativa amb els resultats obtinguts amb un dièsel comercial, així com amb els límits que marca la unió europea en l'esborrany final de la norma prEN 14214.

How to Read Bible stories

A welcome supplement to the bestselling How to Read the OT and How to Read the NT, indicating more recent developments in biblical studies especially in the area of narrative criticism.

Mujer y trabajo: el opting-out (abandono de la carrera profesional)

L’objectiu d’aquest treball és definir el nou fenomen de l’opting out i la situació de la dona davant el mateix; així com, descriure la relació que hi ha entre la societat, la dona, la família i el mercat laboral. En primer lloc, es desenvolupa el context de la dona dins la nostra societat i el mercat laboral. Seguidament, es defineix l’opting out o abandonament professional i es revela el que està succeint entorn d’aquest tema, mitjançant l’ús d’alguns estudis que s’han dut a terme. En tercer lloc, s’assenyalen les causes més rellevants d’aquest abandonament professional de les dones i, per últim, es descriuen les repercussions més significatives que pateixen degut a aquest fenomen.