Església, poder i societat als comtats catalans d'origen carolingi (877-1010)

El projecte de recerca “Església, poder i societat als comtats catalans d'origen carolingi (877-1010)” contempla l'estudi de l'Església catalana del segle X en tots els seus vessants: com a estructura formada per diferents institucions (seus episcopals, cenobis, parròquies i esglésies-oratoris); com a conjunt de persones (clergues i laics que participen de diferent manera i amb diferent implicació dels afers eclesiàstics); en relació al poder polític-administratiu dels comtats catalans (comtes, vescomtes, senyors i altres delegats del poder i la justícia); com en relació amb els aspectes socioeconòmics i d'ordenació territorial (la gran massa de camperols, l'acaparament de terres per part dels grans propietaris, l'articulació d'un sistema de rendes, els vincles entre persones de diferents rangs, la compartimentació d'un espai creixent). Observem, doncs, que l'Església catalana altmedieval resta present en tots els àmbits de la vida i que el seu estudi permet, de retruc, un coneixement més profund i rigorós de la societat. Tot això, contextualitzat durant el segle X, a cavall entre dos períodes ben estudiats i que en ocasions l'han ennuvolat. El segle X és un període privilegiat per a l'estudi d'un bon nombre de dinàmiques polítiques, socials, econòmiques i culturals que demostren que aquesta centúria tenia una personalitat pròpia i que la posen en rellevància respecte als temps anteriors i posteriors. La historiografia tradicional altmedieval catalana tendeix a buscar l'origen dels canvis socials, institucionals i polítics, de la Catalunya medieval, en dos moments concrets: el món carolingi o els anys immediatament posteriors al canvi de mil•lenni. No obstant això, l'augment de fonts històriques, el millor coneixement dels conceptes i de les institucions i l'apropament a la història mitjançant nous enfocaments i paradigmes, permet visualitzar el segle X com a moment de continuació, però també de naixement de situacions prou importants com per a no ser negligides.

El foment de la creativitat i de l’esperit emprenedor en el context dels ECTS per a les assignatures de primer curs de la Diplomatura de Turisme de la UAB

El present Projecte de millora de la qualitat docent subvencionat pel Departament d’Universitats, Recerca i Societat de la Informació de la Generalitat de Catalunya dins del programa d’ajuts MQD-2006 convocades per l’AGAUR, s’ha desenvolupat amb els alumnes de primer de la Diplomatura de Turisme de l’Escola de Turisme i Direcció Hotelera (EUTDH) de la UAB durant el curs acadèmic 2006-2007, comptant amb la participació de l’equip docent així com amb la col·laboració i implicació directa de la direcció de l’escola. Aquest projecte parteix de la base que el desenvolupament de l’esperit emprenedor entre els estudiants és un pilar fonamental en la seva educació i preparació tant personal com professional per l’entrada amb èxit al mercat laboral. Així doncs, el fet que els estudiants mostrin més iniciativa individual així com més capacitat per buscar solucions als problemes d’una manera creativa i diferent, són aspectes bàsics d’aquest Projecte que preten, a llarg termini, repercutir en la societat, tot formant persones més emprenedores que aportin valor econòmic i social al sector turístic. Amb la finalitat d’assolir els objectius esmentats anteriorment es van realitzar una sèrie d’accions adreçades tant al professorat com a l’alumnat que portessin a canviar les actituds, comportaments i maneres de fer de la “metodologia docent tradicional”. En aquest sentit, s’han revisat les fitxes de les assignatures, tot adaptant les activitats existents o creant-ne de noves per tal de treballar les competències transversals relacionades amb el foment de l’esperit emprenedor. Tot i que aquests canvis són lents i difícils de mesurar, en general, s’ha pogut constatar com l’alumnat, en finalitzar el curs, mostra una major iniciativa, autonomía i independència i més capacitat per buscar solucions alternatives als problemes d’una manera creativa així com una actitud més favorable cap a la creació d’empreses que la que tenia al començament.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease.

The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a disease), bladder neck invasion, lymphovascular invasion and the definition of pT4 were coordinated by working group 3. It was agreed that prostate cancer can be categorized as pT3a in the absence of adipose tissue involvement when cancer bulges beyond the contour of the gland or beyond the condensed smooth muscle of the prostate at posterior and posterolateral sites. Extraprostatic extension can also be identified anteriorly. It was agreed that the location of extraprostatic extension should be reported. Although there was consensus that the amount of extraprostatic extension should be quantitated, there was no agreement as to which method of quantitation should be employed. There was overwhelming consensus that microscopic urinary bladder neck invasion by carcinoma should be reported as stage pT3a and that lymphovascular invasion by carcinoma should be reported. It is recommended that these elements are considered in the development of practice guidelines and in the daily practice of urological surgical pathology.

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

A comparison of initial antiretroviral therapy in the Swiss HIV Cohort Study and the recommendations of the International AIDS Society-USA.

BACKGROUND: In order to facilitate and improve the use of antiretroviral therapy (ART), international recommendations are released and updated regularly. We aimed to study if adherence to the recommendations is associated with better treatment outcomes in the Swiss HIV Cohort Study (SHCS). METHODS: Initial ART regimens prescribed to participants between 1998 and 2007 were classified according to IAS-USA recommendations. Baseline characteristics of patients who received regimens in violation with these recommendations (violation ART) were compared to other patients. Multivariable logistic and linear regression analyses were performed to identify associations between violation ART and (i) virological suppression and (ii) CD4 cell count increase, after one year. RESULTS: Between 1998 and 2007, 4189 SHCS participants started 241 different ART regimens. A violation ART was started in 5% of patients. Female patients (adjusted odds ratio aOR 1.83, 95%CI 1.28-2.62), those with a high education level (aOR 1.49, 95%CI 1.07-2.06) or a high CD4 count (aOR 1.53, 95%CI 1.02-2.30) were more likely to receive violation ART. The proportion of patients with an undetectable viral load (<400 copies/mL) after one year was significantly lower with violation ART than with recommended regimens (aOR 0.54, 95% CI 0.37-0.80) whereas CD4 count increase after one year of treatment was similar in both groups. CONCLUSIONS: Although more than 240 different initial regimens were prescribed, violations of the IAS-USA recommendations were uncommon. Patients receiving these regimens were less likely to have an undetectable viral load after one year, which strengthens the validity of these recommendations.

IPH response to Seanad Consultation Committee on 'Changes in lifestyle can prevent approximately one third of cancers. How does Government and Society respond to this challenge?'

IPH responded to the Seanad Consultation Committee on the consultation topic ‘Changes in lifestyle can prevent approximately one third of cancers.  How does Government and Society respond to this challenge?’. Between 2010 and 2020 the total number of cancers in Ireland is projected to increase by 40% for women and by just over 50% for men (National Cancer Registry).  A focus is needed on developing social, economical and built environments that support healthy choices. IPH presented recommendations based on the international evidence-base as well as national cancer data and research.

Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.

IMPORTANCE: New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV). OBJECTIVE: To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus. RESULTS: Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency. CONCLUSIONS AND RELEVANCE: After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.