Validation of the estimation of physiologic ability and surgical stress (E-PASS) score in liver surgery

BACKGROUND: The estimation of physiologic ability and surgical stress (E-PASS) has been used to produce a numerical estimate of expected mortality and morbidity after elective gastrointestinal surgery. The aim of this study was to validate E-PASS in a selected cohort of patients requiring liver resections (LR). METHODS: In this retrospective study, E-PASS predictor equations for morbidity and mortality were applied to the prospective data from 243 patients requiring LR. The observed rates were compared with predicted rates using Fisher's exact test. The discriminative capability of E-PASS was evaluated using receiver-operating characteristic (ROC) curve analysis. RESULTS: The observed and predicted overall mortality rates were both 3.3% and the morbidity rates were 31.3 and 26.9%, respectively. There was a significant difference in the comprehensive risk scores for deceased and surviving patients (p = 0.043). However, the scores for patients with or without complications were not significantly different (p = 0.120). Subsequent ROC curve analysis revealed a poor predictive accuracy for morbidity. CONCLUSIONS: The E-PASS score seems to effectively predict mortality in this specific group of patients but is a poor predictor of complications. A new modified logistic regression might be required for LR in order to better predict the postoperative outcome.

Topoclimatological case-study of Alpine pastures near the Albula Pass in the eastern Swiss Alps

Alpine grasslands are an important source of fodder for the cattle of Alpine farmers. Only during the short summer season can these pastures be used for grazing. With the anticipated climate change, it is likely that plant production – and thus the fodder basis for the cattle – will be influenced. Investigating the dependence of biomass production on topoclimatic factors will allow us to better understand how anticipated climate change may influence this traditional Alpine farming system. Because small-scale topoclimatological variations of the main meteorological variables: temperature, humidity, precipitation, shortwave incoming radiation and wind speed are not easily derived from available long-term climate stations in mountainous terrain, it was our goal to investigate the topoclimatic variations over the pastures belonging to the Alp Weissenstein research station north of the Albula Pass in the eastern Swiss Alps. We present a basic assessment of current topoclimatic conditions as a site characterization for ongoing ecological climate change studies. To be able to link short-term studies with long-term climate records, we related agrometeorological measurements with those of surrounding long-term sites run by MeteoSwiss, both on valley bottoms (Davos, Samedan), and on mountain tops (Weissfluhjoch, Piz Corvatsch). We found that the Davos climate station north of the study area is most closely correlated with the local climate of Alp Weissenstein, although a much closer site (Samedan) exists on the other side of the Albula Pass. Mountain top stations, however, did not provide a convincing approximation for the climate at Alp Weissenstein. Direct comparisons of near-surface measurements from a set of 11 small weather stations distributed over the domain where cattle and sheep are grazed indicate that nocturnal minimum air temperature and minimum vapor pressure deficit are mostly governed by the altitudinal gradient, whereas daily maxima – including also wind speed – are more strongly depending on vegetation cover and less on the altitude.

Essai sur le Judaisme, son passé et son avenir

par Israel-Michel Rabbinowicz

Les juifs algériens : leur passé, leur présent, leur avenir juridique, leur naturalisation collective

par C. Frégier

Modeling corrective experiences as motivational mountain pass

Aim: The landscape metaphor allows viewing corrective experiences (CE) as pathway to a state with relatively lower 'tension' (local minimum). However, such local minima are not easily accessible but obstructed by states with relatively high tension (local maxima) according to the landscape metaphor (Caspar & Berger, 2012). For example, an individual with spider phobia has to transiently tolerate high levels of tension during an exposure therapy to access the local minimum of habituation. To allow for more specific therapeutic guidelines and empirically testable hypotheses, we advance the landscape metaphor to a scientific model which bases on motivational processes. Specifically, we conceptualize CEs as available but unusual trajectories (=pathways) through a motivational space. The dimensions of the motivational state are set up by basic motives such as need for agency or attachment. Methods: Dynamic system theory is used to model motivational states and trajectories using mathematical equations. Fortunately, these equations have easy-to-comprehend and intuitive visual representations similar to the landscape metaphor. Thus, trajectories that represent CEs are informative and action guiding for both therapists and patients without knowledge on dynamic systems. However, the mathematical underpinnings of the model allow researchers to deduct hypotheses for empirical testing. Results: First, the results of simulations of CEs during exposure therapy in anxiety disorders are presented and compared to empirical findings. Second, hypothetical CEs in an autonomy-attachment conflict are reported from a simulation study. Discussion: Preliminary clinical implications for the evocation of CEs are drawn after a critical discussion of the proposed model.

Novel Approaches to Myocardial Perfusion: 3D First-Pass CMR Perfusion Imaging and Oxygenation-Sensitive

This article reviews technical aspects and the current status of novel cardiovascular magnetic resonance (CMR) approaches to assessing myocardial perfusion, specifically oxygenation-sensitive magnetic resonance imaging, comparing their diagnostic targets and clinical role with those of other imaging approaches. The paper includes discussions of relevant pathophysiological aspects of myocardial ischemia and the clinical context of revascularization in patients with suspected or known coronary artery disease. Research using oxygenation-sensitive CMR may play an important role for a better understanding of the interplay of coronary artery stenosis, blood flow reduction, and their impact on actual myocardial ischemia.

Chronology of Lateglacial ice flow reorganization and deglaciation in the Gotthard Pass area, Central Swiss Alps, based on cosmogenic 10Be and in situ 14C

We reconstruct the timing of ice flow reconfiguration and deglaciation of the Central Alpine Gotthard Pass, Switzerland, using cosmogenic 10Be and in situ14C surface exposure dating. Combined with mapping of glacial erosional markers, exposure ages of bedrock surfaces reveal progressive glacier downwasting from the maximum LGM ice volume and a gradual reorganization of the paleoflow pattern with a southward migration of the ice divide. Exposure ages of ∼16–14 ka (snow corrected) give evidence for continuous early Lateglacial ice cover and indicate that the first deglaciation was contemporaneous with the decay of the large Gschnitz glacier system. In agreement with published ages from other Alpine passes, these data support the concept of large transection glaciers that persisted in the high Alps after the breakdown of the LGM ice masses in the foreland and possibly decayed as late as the onset of the Bølling warming. A younger group of ages around ∼12–13 ka records the timing of deglaciation following local glacier readvance during the Egesen stadial. Glacial erosional features and the distribution of exposure ages consistently imply that Egesen glaciers were of comparatively small volume and were following a topographically controlled paleoflow pattern. Dating of a boulder close to the pass elevation gives a minimum age of 11.1 ± 0.4 ka for final deglaciation by the end of the Younger Dryas. In situ14C data are overall in good agreement with the 10Be ages and confirm continuous exposure throughout the Holocene. However, in situ14C demonstrates that partial surface shielding, e.g. by snow, has to be incorporated in the exposure age calculations and the model of deglaciation.

Vertical mobility in the Swiss Alps. The alpine pass Schnidejoch and indications of early pastoralism.

Since 2003 a melting ice field on the Schnidejoch pass (2756 a.s.l) delivered several hundred objects from the Neolithic, the Bronze and Iron Age as well as from Roman and Early Medieval times. The oldest finds date to the beginning 5th millennium BC, the youngest ones date around 1000 AD. Most of the objects stem from the Neolithic and the Bronze Age and are of organic origin. A series of more than 70 radiocarbon dates confirms that the Schnidejoch pass, linking the Bernese Highlands with the River Rhone valley, was in use at least from 4800–4500 BC on. The accessibility of the pass was easy when the glaciers descending from the nearby Wildhorn mountain range (peak on 3248 a.s.l) were in a retreating phase. In contrary glacier advances closed the way to the pass. In 2010 a palaeoecological study of sediment cores researched nearby Lake Iffig (2065 m a.s.l.). The results show clear indications of early human impact in this alpine area. Linking archaeological finds from Schnidejoch pass and River Rhone valley with the palaeoecological data can be interpreted as early indications of alpine pastoralism and transhumance. The combined archaeological and paleoecolical research allows to explain vertical mobility in the Swiss Alps.

Schnidejoch (2756 m a.s.l., Western Bernese Alps, Switzerland). Did Holocene glacier advances close the alpine pass for human transhumance?

A series of more than 70 radiocarbon dates confirms that the Schnidejoch pass, linking the Bernese Highlands with the River Rhone valley, was in use at least from 4800–4500 BC on. The pass was of easy access when the glaciers from the nearby Wildhorn mountain range (peak on 3248 a.s.l) were in a retreating phase e.g. as is the situation today. During holocene phases of advancing glaciers the pass was blocked for humans accompanied by herding animals. The presentation reviews the publication of Grosjean et al. (Ice-borne prehistoric finds in the Swiss Alps reflect Holocene glacier fluctuations, JOURNAL OF QUATERNARY SCIENCE, 200, 22.3, 203–207) on a larger basis of radiocarbon dating and discusses the position of the pass within a system of prehistoric settlements, camp sites and passes.