Cricotracheal resection for adult and pediatric subglottic stenoses: Similarities and differences

Since the mid-1970s thoracic surgeons have used cricotracheal resection (CTR) in the adult population. Similar positive results have from then on been reported by different investigators using this technique. In contrast, otolaryngologists have typically used an anterior midline approach to the larynx and trachea for their laryngotracheal reconstructions (LTRs), both in adults and children. The fear of injury to the recurrent laryngeal nerve (RLN), the risk of a dehiscence of the anastomosis, and the interference with normal growth of the larynx in the pediatric age group were the main reasons put forward for not using a CTR for the cure of subglottic stenosis. In this article, we describe the similarities and differences in CTRs performed for adult and pediatric cases. The high rate (>90%) of success for severe pediatric SGS using CTR compares most favorably with LTR, which is still used in most otolaryngology departments. The reasons lie in the full resection of the stenosis and the restoration of a steady cartilaginous framework of the larynx and trachea with full mucosal lining on both sides of the anastomosis. Furthermore, CTR can be associated with a Rethi procedure for the cure of combined posterior glottic and subglottic stenoses. Good results from series of two different centers suggest that CTR will become the treatment of choice for pediatric severe SGS, as is presently the case in the adult population.

Educational expansion, intergenerational mobility and over-education

[eng] There is a vast literature on intergenerational mobility in sociology and economics. Similar interest has emerged for the phenomenon of over-education in both disciplines. There are no studies, however, linking these two research lines. We study the relationship between social mobility and over-education in a context of educational expansion. Our framework allows for the evaluation of several policies, including those affecting social segregation, early intervention programs and the power of unions. Results show the evolution of social mobility, over-education, income inequality and equality of opportunity under each scenario.

Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients.

OBJECTIVES: A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients. METHODS: A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres. RESULTS: For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15-24%), aminoglycoside-resistant Gram-negatives (5-14%) and carbapenem-resistant P. aeruginosa (5-14%) were substantial, and significantly higher in South-East vs. North-West Europe. CONCLUSIONS: The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy.

Statewide Process and Comparative Outcomes Study of 2003 Iowa Adult and Juvenile Drug Courts, August 2009

A statewide evaluation of the six adult and three juvenile drug courts in operation during calendar year 2003 was conducted. Completion rates, recidivism, substance abuse treatment, and supervision and placement (juveniles only) costs were examined by model (Judge and Community Panel) and by Judicial District. In addition, adult drug court participants were compared with a group of offenders who were screened and declined or were rejected by drug court in 2003 (referred) and a sample of offenders starting probation in 2003 (probationer). The adult participant and comparison groups were tracked from their entry into drug court, or the study, through December 31, 2007. This yielded an average post-program follow-up time of almost 3 years (2.9) for drug court participants. For the juvenile portion, drug court participants were compared with a group matched on several demographic and offense variables (Matched Comparison group) and juveniles referred to drug court who did not enter the program (Referred Comparison group). The juvenile participant and comparison groups were tracked from their entry into drug court, or the study, through approximately 16 quarters after program discharge with an end date of December 31, 2007.

Re-Engineering CTE in Iowa: Aligning Career and Technical Education Reform, Workforce Development and Economic Development, August 2007

Iowa is a relatively small state and is on the rebound economically. It has an overall population that is stable, but which is shifting within the state from more rural areas to suburban and urban centers. There is a very tight labor market with high levels of employment. Iowa now has a time-sensitive opportunity to exert global leadership in renewable energy, while maintaining its leadership in other key industries like finance and agriculture.

Job accessibility, employment and job-education mismatch in the metropolitan area of Barcelona

This paper analyses the effect of job accessibility by public and private transport on labour market outcomes in the metropolitan area of Barcelona. Beyond employment, we consider the effect of job accessibility on job-education mismatch, which represents a relevant aspect of job quality. We adopt a recursive system of equations that models car availability, employment and mismatch. Public transport accessibility appears as an exogenous variable in the three equations. Even though it may reflect endogenous residential sorting, falsification proofs suggest that the estimated effect of public transport accessibility is not entirely driven by the endogenous nature of residential decisions.

Therapeutic concepts in adult and paediatric eosinophilic oesophagitis.

Eosinophilic oesophagitis (EoE) was first described in the early 1990s. Although initially reported to be a rare entity, EoE has rapidly become a regularly diagnosed disease with a prevalence of approximately 1 in 2,000 individuals in the USA and Europe. The disease is characterized by a combination of oesophageal dysfunction and predominant eosinophilic infiltration of the oesophageal tissue. At diagnosis, other diseases that can be associated with oesophageal eosinophilic infiltration must be ruled out. Children with EoE present with a wide variety of symptoms, whereas adults mostly present with dysphagia for solid food and chest pain. Histologic features of EoE resemble those of T-helper type 2 inflammation. Endoscopy should be carried out to establish the diagnosis, but endoscopic abnormalities are not pathognomonic for EoE and the examination might not show histologic abnormality. Treatment modalities for EoE include drugs (corticosteroids, PPIs, antiallergic and biologic agents), hypoallergenic diets and oesophageal dilatation for strictures that are unresponsive to medical therapy. Unresolved eosinophilic inflammation leads to the formation of oesophageal strictures, which probably increase the risk of food bolus impactions. To date, long-term strategies for the therapeutic management of this chronic inflammatory disease remain poorly defined.

Implementing evidence-based patient and family education on oral anticoagulation therapy: a community-based participatory project.

AIMS AND OBJECTIVES: This study aimed at developing and implementing evidence-based patient and family education on oral anticoagulation therapy. BACKGROUND: The number of persons with chronic diseases who live at home is increasing. They have to manage multiple diseases and complex treatments. One such treatment is oral anticoagulation therapy, a high risk variable dose medication. Adherence to oral anticoagulation therapy is jeopardised by limited information about the medications, their risk and complications, the impact of individual daily routine and the limited inclusion of family members in education. Hence, improved and tailored education is essential for patients and families to manage oral anticoagulation therapy at home. DESIGN AND METHODS: A community-based participatory research design combined with the Precede-Proceed model was used including a systematic literature review, posteducation analysis, an online nurse survey, a documentation analysis and patient/family interviews. The study was conducted between April 2010-December 2012 at a department of general internal medicine in a teaching hospital in Switzerland. Participants were the department's nursing and medical professionals including the patients and their families. RESULTS: The evidence-based patient and family education on oral anticoagulation therapy emerged comprising a learning assessment, teaching units, clarification of responsibilities of nurse professionals and documentation guidelines. CONCLUSION AND CLINICAL RELEVANCE: The inclusion of the whole department has contributed to the development and implementation of this evidence-based patient family education on oral anticoagulation therapy, which encompasses local characteristics and patient preferences. This education is now being used throughout the department.

Entrepreneurial skills and over-education five years later. A comparison between Spain and the Netherlands

[cat] El fenòmen de la sobre-educació és freqüent i persistent a molts països. En aquest article estudiem el paper de les habilitats emprenedores en evitar la sobre-educació a la primera feina, i en sortir d’una situació de sobre-educació cinc anys després. Comparem els resultats d’Espanya i Holanda, dos països que difereixen en el seu sistema educatiu i mercat de treball. Els resultats mostren que les habilitats emprenedores ajuden a evitar i/o sortir de la sobre-educació només a Espanya, on el sistema educatiu és més flexible i menys vinculat amb el mercat de treball. En general, els nostres resultats recolzen les polítiques que promocionen el desenvolupament d’habilitats emprenedores al sistema educatiu espanyol.

Entrepreneurial skills and over-education five years later. A comparison between Spain and the Netherlands

[cat] El fenòmen de la sobre-educació és freqüent i persistent a molts països. En aquest article estudiem el paper de les habilitats emprenedores en evitar la sobre-educació a la primera feina, i en sortir d’una situació de sobre-educació cinc anys després. Comparem els resultats d’Espanya i Holanda, dos països que difereixen en el seu sistema educatiu i mercat de treball. Els resultats mostren que les habilitats emprenedores ajuden a evitar i/o sortir de la sobre-educació només a Espanya, on el sistema educatiu és més flexible i menys vinculat amb el mercat de treball. En general, els nostres resultats recolzen les polítiques que promocionen el desenvolupament d’habilitats emprenedores al sistema educatiu espanyol.

CRM and higher education : developing a monitoring system to improve relationships in e-learning environments

Peer-reviewed

John Dewey i l’educació democràtica = John Dewey and democratic education

In Dewey, philosophy and education are inseparable. It is often forgotten that Dewey’s conception of school and education has only been possible because he conceived thought in terms of lived experience, of constantly tested experience, of incessant research; in other words, of 'continuous search' of 'effective means of action'. In addition, according to Dewey, true education is an education in democracy, and that means investing in an education that deals with thought. The service to democratic progress is done precisely through an education in reasonability and taking into account the experience

Salir de la escuela: entre la tradición y la educación ambiental para la sostenibilidad = Excursions from school: between tradition and environmental education for sustainability

Las actividades escolares fuera del centro constituyen una marca de calidad del pasado y del presente educativo, y tienen que seguir siéndolo en el futuro. A partir de una investigación cualitativa se identifican las razones aducidas por enseñantes para salir del aula y, con ejemplos concretos, quedan plasmados algunos de los objetivos perseguidos, así como otros que se añaden a la propia actividad. Se identifican salidas vivenciales y otras más experimentales, se reconocen valores positivos, pero también se echa en falta un trabajo más coherente con los principios actuales de la educación ambiental. Precisamente esta educación es la propuesta como el camino a seguir para renovar objetivos, técnicas y procedimientos para salir del aula

Epistemological anarchism of Paul Karl Feyerabend and medical education

The thoughts of the philosopher Paul Karl Feyerabend brought important contributions to the debate on Science in the 20th century. Most recently his views about non-existence of a single method for doing science have been employed to rethink science education and propose the use of multiple methods for effective teaching-learning process. This article employs the theoretical framework of the author expressed in the book Against Method, 1977, about the epistemological anarchism and the methodological pluralism and uses it in the contemporary discussion of medical education.