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.

Pere Puig i Adam: ahir, avui i sempre

El tema central d'aquesta Lliçó serà doncs la figura emblemàtica del gran professor i matemàtic català Pere Puig i Adam (1900-1960). Si bé el centenari del seu naixement ja justifica per si mateix l'oportunitat de l'homenatge, hi ha un valor afegit al fet de parlar d'en Pere Puig i Adam : tots nosaltres com a catalans i com a gent de Matemàtiques podem unir a l'orgull de rememorar una figura senyera del nostre passat científic, el goig de conservar avui el seu patrimoni i el deure de projectar el seu exemple vers el nostre futur. Així doncs parlarem de qui va ser i qué va fer en Pere Puig i Adam, per després analitzar, amb ulls d'avui, la vigència i possible projecció del seu llegat.

A virtual mathematics learning environment for engineering students

Teachers of the course Introduction to Mathematics for Engineers at the UOC, an online distance-learning university, have designed,developed and tested an online studymaterial. It includes basic pre-university mathematics, indications for correct follow-up of this content and recommendations for finding appropriate support and complementarymaterials. Many different resources are used,depending on the characteristics of thecontents: Flash sequences, interactive applets, WIRIS calculators and PDF files.During the last semester, the new study material has been tested with 119 students. The academic results and student satisfaction have allowed us to outline and prioritise future lines of action.

A virtual learning environment for pregraduate mathematical students

Peer-reviewed

A Virtual Mathematics Learning Environment for Engineering Students

Teachers of the course Introduction to Mathematics for Engineers at the UOC, an online distance-learning university, have designed and produced online study material which includes basic pre-university mathematics, instructions for correct follow-up of this content and recommendations for finding appropiate support and complementary materials.

Interactive Calculus in a Virtual Learning Environment

The teaching of higher level mathematics for technical students in a virtual learningenvironment poses some difficulties, but also opportunities, now specific to that virtuality.On the other hand, resources and ways to do now manly available in VLEs might soon extend to all kinds of environments.In this short presentation we will discuss anexperience carried at Universitat Oberta deCatalunya (UOC) involving (an on line university), first, the translation of LaTeX written existent materials to a web based format(specifically, a combination of XHTML andMathML), and then the integration of a symbolic calculator software (WIRIS) running as a Java applet embedded in the materials, intending to achieve an evolution from memorising concepts and repetitive algorithms to understanding and experiment concepts and the use of those algorithms.

La integración de Internet en la educación escolar española : situación actual y perspectivas de futuro

The main objectives and findings of this first research report are presented in thischapter. "The Implementation of the Internet in the Spanish Education System: State of Affairsand Future Prospects" is a large-scale research project that seeks to obtain relevant data about the introduction and dissemination of Information and Communication Technology, particularly the internet, in the practical and organizational general procedures of the Spanish schools and high schools. The project articulates the processes of ICT implementation on the primary andsecondary education levels embracing a holistic approach, propped up by an empirical and analytical research methodology. Thus, our survey does not intend to detect which is the impact of ICT on school activities but how all the agents involved in the school community incorporate ICT and what use they make of it. We are especially interested in identifying the teachers' pedagogical and professional uses of ICT, how students use it in their activities and to what extent it contributes in reinforcing teamwork andparticipation proceedings in the institutions, as well as the relations between the latter and their context. It is also of our interest to know the factors that exert the strongest influence on the way teachers, head teachers and students make use of ICT. Finally, we intend to identify the ways ICT may contribute to the improvement of educational practices.

Técnicas de estudio en estudiantes de Secundaria que asisten a clases extraescolares en la provincia de Girona

Study techniques in out of school secondary education in the province of Girona. It is important to provide students with different ways to study so they can find the most appropriate method for them. Our research focuses on the study techniques used in secondary education by those students attending classes out of school time. In order to conduct this research, we have developed a general questionnaire after reviewing the existing literature on the topic. Some of the results obtained with this study are the following: adolescents attach great importance to learn study techniques, being summaries, diagrams and underlining the most well-known strategies for them, and mind maps and teamwork the least popular ones; they prefer dynamic teaching and learning methodologies, such as making interactive discussions; tutoring is the most valued element. Based on the results obtained with the study, we have developed some proposals to facilitate the work of the teacher when teaching study techniques and helping students to improve their academic performance

Hacia la alfabetización numérica en Educación Infantil: algunos avances en Chile y España

This article reviews the main contemporary international references on numerical knowledge acquisition in the kindergarten stage. Secondly it analyzes the instructions curricular in two countries-one Spanish-speaking Latin America (Chile) and one European (Spain) - to determine the extent to assume international benchmarks while comparing the curricula of both countries. Finally, it presents a proposal for intervention in the classroom that the combination of different learning contexts and processes to investigate mathematical teaching practices and most effective in promoting and numeracy of children from the earliest ages

Formal Education, Mismatch and Wages After Transition: Assessing the Impact of Unobserved Heterogeneity using Matching Estimators

This paper studies the incidence and consequences of the mismatch between formal education and the educational requirements of jobs in Estonia during the years 1997-2003. We fi nd large wage penalties associated with the phenomenon of educational mismatch. Moreover, the incidence and wage penalty of mismatches increase with age. This suggests that structural educational mismatches can occur after fast transition periods. Our results are robust for various methodologies, and more importantly regarding departures from the exogeneity assumptions inherent in the matching estimators used in our analysis

Práctica educativa y adquisición de la lengua de la escuela

El trabajo que presentamos pretende establecer e implamentar criterios respecto la organización escolar y la práctica educativa para mejorar las competencias básicas del alumnado extranjero que participa en las aulas de Cataluña con una gran diversidad respecto el conocimiento de la lengua de la escuela. En concreto, buscamos profundizar y localizar los factores y elementos relevantes para la organización escolar y la práctica educativa en escuelas plurilingües con estas características

Evolución y retos de la educación virtual : construyendo el e-learning del siglo XXI

Las autoras y autores de este libro ofrecen una descripción de la evolución general del e-learning apuntando los elementos clave hacia los que debe ir evolucionando. Parten de la experiencia y la práctica contrastada con las investigaciones sobre el tema. A lo largo de los distintos capítulos nos muestran cómo vive un estudiante virtual, su papel y la manera en que plantea y organiza sus actividades; nos acercan al profesorado analizando su rol en el diseño de la formación y la comunicación con los estudiantes; hablan de la colaboración, analizando cómo diseñar actividades colaborativas y señalando sus ventajas y límites; describen los diferentes recursos de aprendizaje que podemos disponer en el diseño de los cursos y, por último, acompañan nuestra mirada hacia el futuro próximo analizando las tendencias y los retos a los que debemos hacer frente para construir el e-learning del siglo XXI.

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

El Uso del cine en el aula de ELE

En los últimos años existe un interés creciente en la incorporación de material audiovisual en las aulas de ELE gracias, en mayor medida, al avance de las nuevas tecnologías que facilitan su uso. Sin embargo, todavía no se saca todo su potencial como material para trabajar las destrezas interculturales que contempla el actual MECD. En el siguiente ensayo apuntaremos algunas de esas razones, sobre el cine en general y el español en particular, y las diferentes aproximaciones que pueden contemplarse según las características del alumnado