Impact of a Dedicated Noninvasive Ventilation Team on Intubation and Mortality Rates in Severe COPD Exacerbations.

BACKGROUND: Compared with usual care, noninvasive ventilation (NIV) lowers the risk of intubation and death for subjects with respiratory failure secondary to COPD exacerbations, but whether administration of NIV by a specialized, dedicated team improves its efficiency remains uncertain. Our aim was to test whether a dedicated team of respiratory therapists applying all acute NIV treatments would reduce the risk of intubation or death for subjects with COPD admitted for respiratory failure. METHODS: We carried out a retrospective study comparing subjects with COPD admitted to the ICU before (2001-2003) and after (2010-2012) the creation of a dedicated NIV team in a regional acute care hospital. The primary outcome was the risk of intubation or death. The secondary outcomes were the individual components of the primary outcome and ICU/hospital stay. RESULTS: A total of 126 subjects were included: 53 in the first cohort and 73 in the second. There was no significant difference in the demographic characteristics and severity of respiratory failure. Fifteen subjects (28.3%) died or had to undergo tracheal intubation in the first cohort, and only 10 subjects (13.7%) in the second cohort (odds ratio 0.40, 95% CI 0.16-0.99, P = .04). In-hospital mortality (15.1% vs 4.1%, P = .03) and median stay (ICU: 3.1 vs 1.9 d, P = .04; hospital: 11.5 vs 9.6 d, P = .04) were significantly lower in the second cohort, and a trend for a lower intubation risk was observed (20.8% vs 11% P = .13). CONCLUSIONS: The delivery of NIV by a dedicated team was associated with a lower risk of death or intubation in subjects with respiratory failure secondary to COPD exacerbations. Therefore, the implementation of a team administering all NIV treatments on a 24-h basis should be considered in institutions admitting subjects with COPD exacerbations.

Once-daily dolutegravir versus darunavir plus ritonavir for treatment-naive adults with HIV-1 infection (FLAMINGO): 96 week results from a randomised, open-label, phase 3b study.

BACKGROUND: The primary analysis of the FLAMINGO study at 48 weeks showed that patients taking dolutegravir once daily had a significantly higher virological response rate than did those taking ritonavir-boosted darunavir once daily, with similar tolerability. We present secondary efficacy and safety results analysed at 96 weeks. METHODS: FLAMINGO was a multicentre, open-label, phase 3b, non-inferiority study of HIV-1-infected treatment-naive adults. Patients were randomly assigned (1:1) to dolutegravir 50 mg or darunavir 800 mg plus ritonavir 100 mg, with investigator-selected combination tenofovir and emtricitabine or combination abacavir and lamivudine background treatment. The main endpoints were plasma HIV-1 RNA less than 50 copies per mL and safety. The non-inferiority margin was -12%. If the lower end of the 95% CI was greater than 0%, then we concluded that dolutegravir was superior to ritonavir-boosted darunavir. This trial is registered with ClinicalTrials.gov, number NCT01449929. FINDINGS: Of 595 patients screened, 488 were randomly assigned and 484 included in the analysis (242 assigned to receive dolutegravir and 242 assigned to receive ritonavir-boosted darunavir). At 96 weeks, 194 (80%) of 242 patients in the dolutegravir group and 164 (68%) of 242 in the ritonavir-boosted darunavir group had HIV-1 RNA less than 50 copies per mL (adjusted difference 12·4, 95% CI 4·7-20·2; p=0·002), with the greatest difference in patients with high viral load at baseline (50/61 [82%] vs 32/61 [52%], homogeneity test p=0·014). Six participants (three since 48 weeks) in the dolutegravir group and 13 (four) in the darunavir plus ritonavir group discontinued because of adverse events. The most common drug-related adverse events were diarrhoea (23/242 [10%] in the dolutegravir group vs 57/242 [24%] in the darunavir plus ritonavir group), nausea (31/242 [13%] vs 34/242 [14%]), and headache (17/242 [7%] vs 12/242 [5%]). INTERPRETATION: Once-daily dolutegravir is associated with a higher virological response rate than is once-daily ritonavir-boosted darunavir. Dolutegravir compares favourably in efficacy and safety to a boosted darunavir regimen with nucleoside reverse transcriptase inhibitor background treatment for HIV-1-infected treatment-naive patients. FUNDING: ViiV Healthcare and Shionogi & Co.

La collaboration interprofessionnelle à l'interface des institutions socio-éducative et psychiatrique. Jeux et enjeux de l'intervention auprès de personnes en situation de handicap mental et de troubles psychiques

La prise en charge et le suivi de personnes en situation de handicap mental souffrant de troubles psychiques et se trouvant donc à l'interface des domaines socio:éducatif et psychiatrique, constituent des défis complexes en matière de collaboration interprofessionnelle. Dans le canton de Vaud, les acteurs concernés par ce problème s'efforcent depuis de nombreuses années de créer des réseaux pluridisciplinaires visant un meilleur échange entre professionnels et le développement de compétences et de connaissances permettant d'améliorer le bien:être des bénéficiaires. Ce travail se propose ainsi d'étudier et de questionner ces modalités de travail dans une perspective socioculturelle (Vygotski, 1934/1997), afin d'en comprendre le fonctionnement, d'en éclairer les mécanismes et de fournir des pistes de réflexion aux professionnels. Il repose sur un travail de terrain mené auprès des membres du Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM) du Département de psychiatrie du CHUV, dont la mission principale est de faciliter la collaboration entre les institutions socio:éducatives et psychiatriques spécialisées dans le suivi des personnes en situation de handicap mental et souffrant de troubles psychiques. Le travail empirique est basé sur une approche qualitative et compréhensive des interactions sociales, et procède par une étude de terrain approfondie. Les données recueillies sont variées : notes de terrain et récolte de documentation, enregistrement de réunions d'équipe au sein du DCPHM et de réunions de réseau, et entretiens de différents types. L'analyse montre que le travail de collaboration qui incombe à l'équipe est constitué d'obstacles qui sont autant d'occasions de développement professionnel et de construction identitaire. Les résultats mettent en lumière des mécanismes discursifs de catégorisation concourant à la fois à la construction des patients comme objets d'activité, et à la construction d'une place qui légitime les interventions de l'équipe dans le paysage socio:éducatif et psychiatrique vaudois et la met au centre de l'arène professionnelle. -- Care and follow:up for people with mental disabilities suffering from psychological disorders : therefore at the interface between the socio:educational and psychiatric fields : represent complex challenges in terms of interprofessional collaboration. In the canton of Vaud, the caregivers involved in this issue have been trying for years to build multidisciplinary networks in order to better exchange between professionals and develop skills and knowledge to improve the recipients' well:being. This work thus proposes to study and question these working methods in a sociocultural perspective (Vygotski, 1934/1997) so as to understand how they operate, highlight inherent mechanisms and provide actionable insights to the professionals. It is based on fieldwork conducted among members of the Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM), of the Psychiatry Department at the CHUV University Hospital in Lausanne, whose main mission is to facilitate collaboration between the socio:educational and psychiatric institutions specialising in monitoring people presenting with both mental handicap and psychiatric disorder. The empirical work is based on a qualitative and comprehensive approach to social interactions, and conducted based on an in:depth field study. The data collected are varied - field notes and documentation collection, recordings of team meetings within the DCPHM and network meetings, and various types of interviews. The analysis shows that the collaborative work that befalls the team consists of obstacles, all of which provide opportunities for professional development and identity construction. The results highlight discursive strategies of categorisation which contribute both to the construction of the patients as objects of activity and to building a position that legitimates the team's interventions in the socio: educational and psychiatric landscape of canton Vaud and puts it in the centre of the professional arena.

Association of Hematological Variables with Team-Sport Specific Fitness Performance.

PURPOSE: We investigated association of hematological variables with specific fitness performance in elite team-sport players. METHODS: Hemoglobin mass (Hbmass) was measured in 25 elite field hockey players using the optimized (2 min) CO-rebreathing method. Hemoglobin concentration ([Hb]), hematocrit and mean corpuscular hemoglobin concentration (MCHC) were analyzed in venous blood. Fitness performance evaluation included a repeated-sprint ability (RSA) test (8 x 20 m sprints, 20 s of rest) and the Yo-Yo intermittent recovery level 2 (YYIR2). RESULTS: Hbmass was largely correlated (r = 0.62, P<0.01) with YYIR2 total distance covered (YYIR2TD) but not with any RSA-derived parameters (r ranging from -0.06 to -0.32; all P>0.05). [Hb] and MCHC displayed moderate correlations with both YYIR2TD (r = 0.44 and 0.41; both P<0.01) and RSA sprint decrement score (r = -0.41 and -0.44; both P<0.05). YYIR2TD correlated with RSA best and total sprint times (r = -0.46, P<0.05 and -0.60, P<0.01; respectively), but not with RSA sprint decrement score (r = -0.19, P>0.05). CONCLUSION: Hbmass is positively correlated with specific aerobic fitness, but not with RSA, in elite team-sport players. Additionally, the negative relationships between YYIR2 and RSA tests performance imply that different hematological mechanisms may be at play. Overall, these results indicate that these two fitness tests should not be used interchangeably as they reflect different hematological mechanisms.

The mediterranean diet pattern and its main components are associated with lower plasma concentrations of tumor necrosis factor receptor 60 in patients at high risk for cardiovascular disease

Adherence to aMediterranean diet (MD) is associated with a reduced risk of coronary heart disease. However, themolecular mechanisms involved are not fully understood. The aim of this studywas to compare the effects of 2MD with those of a lowfat- diet (LFD) on circulating inflammatory biomarkers related to atherogenesis. A total of 516 participants included in the PreventionwithMediterraneanDiet Studywere randomized into 3 intervention groups [MD supplementedwith virgin olive oil (MD-VOO); MD supplemented with mixed nuts (MD-Nuts); and LFD]. At baseline and after 1 y, participants completed FFQ and adherence to MD questionnaires, and plasma concentrations of inflammatory markers including intercellular adhesion molecule-1(ICAM-1), IL-6, and 2 TNF receptors (TNFR60 and TNFR80) were measured by ELISA. At 1 y, the MD groups had lower plasma concentrations of IL-6, TNFR60, and TNFR80 (P , 0.05), whereas ICAM-1, TNFR60, and TNFR80 concentrations increased in the LFD group (P , 0.002). Due to between-group differences, participants in the 2 MD groups had lower plasma concentrations of ICAM-1, IL-6, TNFR60, and TNFR80 compared to those in the LFD group (P # 0.028). When participants were categorized in tertiles of 1-y changes in the consumption of selected foods, those in the highest tertile of virgin olive oil (VOO) and vegetable consumption had a lower plasma TNFR60 concentration compared with those in tertile 1 (P,0.02).Moreover, the only changes in consumption thatwere associated with 1-y changes in the geometricmean TNFR60 concentrations were those of VOO and vegetables (P = 0.01). This study suggests that a MD reduces TNFR concentrations in patients at high cardiovascular risk.

The Transatlantic Productivity Gap : Is R&D the Main Culprit?

The literature has pointed to different causes to explain the productivity gap between Europe and United States in the last decades. This paper tests the hypothesis that the lower European productivity performance in comparison with the US can be explained not only by a lower level of corporate R&D investment, but also by a lower capacity to translate R&D investment into productivity gains. The proposed microeconometric estimates are based on a unique longitudinal database covering the period 1990-2008 and comprising 1.809 US and European companies for a total of 16.079 observations. Consistent with previous literature, we find robust evidence of a significant impact of R&D on productivity, however – using different estimation techniques - the R&D coefficients for the US firms always turn out to be significantly higher. To see to what extent these transatlantic differences may be related to the different sectoral structures in the US and the EU, we differentiated the analysis by sectors. The result is that both in manufacturing, services and high-tech sectors US firms are more efficient in translating their R&D investments into productivity increases.

Regional Science trends through the analysis of the main facts of the 51st ERSA Conference

The 51st ERSA Conference held in Barcelona in 2011 was one of the largest ever. By examining the characteristics of the conference, this paper identifies the main trends in Regional Science and draws on a broad array of sources of information: the delegates" demographic details, the conference program itself, a satisfaction survey conducted among delegates, a quality survey addressed to those chairing the sessions and, finally, a bibliometric database including each author signing a paper presented at the conference. We finally run a regression analysis from which we show that for ERSA delegates what matters most is quality, and this must be the direction that future conferences should move toward. Ultimately, ERSA conferences are comprehensive, all-embracing occasions, representing an ideal opportunity for regional scientists to present their work to each other and to network.

Anàlisi de la incidència del sistema de joc en la creació de situacions de superioritat numèrica en el futbol amb el juvenil “A” del Futbol Club Barcelona

El present treball es centra en l’estudi de les situacions de superioritat numèrica generades al llarg de la temporada 2013-2014 de l’equip Juvenil A del Futbol Club Barcelona. L’objectiu principal d’aquest treball és esbrinar quina incidència té el sistema de joc 1-4-3-3 en la creació d’aquestes situacions ofensives en el joc de l’equip. Per tal d’enregistrar múltiples situacions de joc i diferenciar la seva complexitat, s’han establert tres variables d’estudi: la zona del camp on es crea la superioritat numèrica (dividint el camp en 12 zones), el tipus de superioritat produïda (2 contra 1, 3 contra 1, 3 contra 2, 4 contra 2 i 4 contra 3), i la freqüència d’interacció dels jugadors en les situacions de superioritat en relació al networking (jugadors que intervenen en les situacions de superioritat per tal de poder establir relacions entre posicions del sistema de joc 1-4-3-3). El mètode utilitzat és notacional (ja que s’enregistra la freqüència en què succeeix un fenomen a partir d’unes taules creades especialment per l’enregistrament de dades), on fent ús de la proposta de Gréhaigne (2001) s’analitzen 8 partits al llarg de la temporada 2013-2014. Els resultats obtinguts mostren que es produeixen més superioritats a les zones 4 i 6 (20,37% respectivament), seguides de les zones 7 (14,81%) i 5 (13,89%). El major tipus de superioritat ha estat el 2 contra 1 (48,15%) seguit del 3 contra 2 (39,81%). La interacció més freqüent entre jugadors en les situacions de 2 contra 1 ha estat: lateral dret i central dret (26,92%) i lateral esquerre i central esquerre (21,15%). En les situacions de tres jugadors (3 contra 1) ha estat: entre el central dret, central esquerre i el pivot (28,57%) i entre el central dret, el lateral dret i el pivot (28,75%). En les situacions de 3 contra 2: lateral dret, l’interior dret i l’extrem dret (18,60%) i entre el central esquerre, el lateral esquerre i l’interior esquerre (18,60%). Pel que fa a les situacions de 4 contra 2 no se n’ha produït cap, i les de 4 contra 3 hi ha una igualtat entre diverses posicions(16,67%), però no s’observen dades molt significatives en quan a la intervenció, excepte la posició del pivot que intervé en gairebé totes. Aquestes dades, s’assimilen al que diuen Sans i Frattarola (2009) sobre el fet que en la zona d’inici es creen més situacions de superioritat que en la zona de progressió i finalització. També Castelo (1999) aporta un estudi sobre els percentatges d’aportacions ofensives dels jugadors en funció de l’espai i la demarcació, però tot i que en aquest cas no ho compara amb situacions de superioritat numèrica, les dades extretes son interessants per la comparativa amb l’estudi que es presenta.

Anàlisi del bloc de fonaments individuals per demarcació (fid) corresponent a la defensa de l'espai per la posició dels laterals en el futbol: comparació entre categories amateur i semi-professional

L’objectiu d’aquest estudi va ser analitzar un element del component tàctic com a factor determinant en el rendiment del futbol, és a dir, comprovar si hi ha diferències en l’execució del bloc de Fonaments Individuals per Demarcació (FID) corresponent a la defensa de l’espai per la posició dels laterals en el futbol, entre les categories amateur i semi-professional. Es van enregistrar un total de 18 partits, on 9 dels quals feien referència a l’equip de l’Arbúcies Club de Futbol i la resta a l’equip de la Unió Esportiva Llagostera. Les variables estudiades van ser les següents: cobertures al central que defensa al possessor de la pilota, evitar passades interiors que guanyin l’esquena, defensa individual dels jugadors que intenten passar per l’esquena del segon central (entrar-sortir) i eliminar l’espai de desmarcada en profunditat, mantenint la línia amb el central. Per analitzar-les es va utilitzar el programa Longomatch i el Excel on hi vam configurar un instrument d’avaluació. Els principals resultats del treball van ser que l’equip de la Unió Esportiva Llagostera va fer menys errors en l’execució dels FID, tot i que va seguir tenint errors en el compliment d’aquests fonaments.

Passion for Ski Mountaineering and Relationship Quality: The Mediating Role of Team Cohesion

Vallerand and colleagues (2003) developed a dualistic model of passion, wherein two types of passion are proposed: harmonious and obsessive passions that predict adaptive and less adaptive interpersonal outcomes, respectively. The present study examined the mediating role of team cohesion between passion and relationship satisfaction and interpersonal conflict with teammates. We hypothesized that harmonious and obsessive passions would be positively and negatively related to team cohesion, respectively, which, in turn should be associated with high relationship satisfaction and low interpersonal conflict with teammates. Ski mountaineers (N = 559) participating in the "Patrouille des Glaciers" completed an initial questionnaire assessing harmonious and obsessive passions for ski mountaineering and team cohesion before the race. After the race, a second questionnaire was completed and assessed participants' relationship quality with teammates and team conflict during the race. Results from path analyses supported the hypothesized model. Future research directions are discussed in light of the dualistic model of passion and team cohesion literature.

Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

Abstract Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications.

Cultural Diffusion Was the Main Driving Mechanism of the Neolithic Transition in Southern Africa

It is well known that the Neolithic transition spread across Europe at a speed of about 1 km/yr. This result has been previously interpreted as a range expansion of the Neolithic driven mainly by demic diffusion (whereas cultural diffusion played a secondary role). However, a long-standing problem is whether this value (1 km/yr) and its interpretation (mainly demic diffusion) are characteristic only of Europe or universal (i.e. intrinsic features of Neolithic transitions all over the world). So far Neolithic spread rates outside Europe have been barely measured, and Neolithic spread rates substantially faster than 1 km/yr have not been previously reported. Here we show that the transition from hunting and gathering into herding in southern Africa spread at a rate of about 2.4 km/yr, i.e. about twice faster than the European Neolithic transition. Thus the value 1 km/yr is not a universal feature of Neolithic transitions in the world. Resorting to a recent demic-cultural wave-of-advance model, we also find that the main mechanism at work in the southern African Neolithic spread was cultural diffusion (whereas demic diffusion played a secondary role). This is in sharp contrast to the European Neolithic. Our results further suggest that Neolithic spread rates could be mainly driven by cultural diffusion in cases where the final state of this transition is herding/pastoralism (such as in southern Africa) rather than farming and stockbreeding (as in Europe)

Building a Social Education curriculum based on Professional Competences : the experience of University of Girona

This article describes the process of adapting Social Education studies to the European Higher Education Area undertaken by a team of the teaching staff at the University of Girona (Spain). The aim of the experience is to build a curriculum based on thecompetencies recognized as such by professionals in the field of social education in our region. The article specifies the development of the various phases, each involving the active participation of professionals and teaching staff from the universities. To conclude, main characteristics of the curriculum are highlighted