El sonido de la guerra: Las trompas de la Fortaleza Medieval de Ausa (Zaldibia, Guipuzcoa)

During the fieldwork in the medieval fortification of Ausa (Gipuzkoa), a vast amount of sherds from several pottery artifacts featured by a cylindrical body has been found out. They presumably had the same function in contexts dated from the first half of xiv century. Although it has not been possible to reconstruct any of these artefacts, the study of the sherds allows us to think that they would have formed some sort of big-sized horn. This high-sounding instrument, which has been frequently reproduced in iconographic references, does not have at this moment any direct parallelism in Hispanic contexts, despite being plentiful of references to similar objects in medieval ranges from Provence and Languedoc. By introducing these artefacts from different approaches, we aim to go over the scarce knowledge of these instruments, whose evidence lets us to believe in their widespread distribution all over the landscape in several material contexts from Medieval Ages.

El sonido de la guerra: Las trompas de la Fortaleza Medieval de Ausa (Zaldibia, Guipuzcoa)

During the fieldwork in the medieval fortification of Ausa (Gipuzkoa), a vast amount of sherds from several pottery artifacts featured by a cylindrical body has been found out. They presumably had the same function in contexts dated from the first half of xiv century. Although it has not been possible to reconstruct any of these artefacts, the study of the sherds allows us to think that they would have formed some sort of big-sized horn. This high-sounding instrument, which has been frequently reproduced in iconographic references, does not have at this moment any direct parallelism in Hispanic contexts, despite being plentiful of references to similar objects in medieval ranges from Provence and Languedoc. By introducing these artefacts from different approaches, we aim to go over the scarce knowledge of these instruments, whose evidence lets us to believe in their widespread distribution all over the landscape in several material contexts from Medieval Ages.

Systems Medicine and Integrated Care to Combat Chronic Noncommunicable Diseases.

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Microscopic, chemical, and molecular-biological investigation of the decayed medieval stained window glasses of two Catalonian churches

We investigated the decayed historical church window glasses of two Catalonian churches, both under Mediterranean climate. Glass surfaces were studied by scanning electron microscopy (SEM), energy dispersive spectrometry (EDS), and X-ray diffraction (XRD). Their chemical composition was determined by avelength-dispersive spectrometry (WDS) microprobe analysis. The biodiversity was investigated by molecular methods: DNA extraction from glass, amplification by PCR targeting the16S rRNA and ITS regions, and fingerprint analyses by denaturing gradient gel electrophoresis (DGGE). Clone libraries containing either PCR fragments of the bacterial 16S rDNA or the fungal ITS regions were screened by DGGE. Clone inserts were sequenced and compared with the EMBL database.

Animals in an Urban Context. A Zooarchaeological study of the Medieval and Post-Medieval town of Turku

The aim of this study is to explore the role and importance of different animal species in Turku through an analysis of osteological data and documentary evidence. The osteological material used in this study is derived from two town plots in Turku dating from the 13th century to the 19th century. The osteological material deposited in Turku represents animals bred both in the town and in the surrounding landscape. Animal husbandry in SW-Finland can also be examined through a number of historical documents. The importance of animals in Turku and its hinterland are closely connected and therefore the roles of the animals in both urban and rural settings are examined. The study has revealed the complexity of the depositional patterns in medieval and post-medieval Turku. In the different areas of Turku, characteristic patterns in the osteological material and different deposit types were evident. These patterns are reflections of the activities and therefore of the lifestyles practiced in Turku. The results emphasise the importance of context- awareness in the study of material culture from archaeological sites. Both the zooarchaeological and historical sources indicate that cattle were important in animal husbandry in Turku from the Middle Ages up to the 19th century. Sheep were the second most common species. When taking into consideration the larger size of cattle, the dominance of these animals when it come to meat consumption seems clear even in those phases where sheep bones are more abundant. Pig is less abundant in the material than either cattle or sheep and their importance for subsistence was probably fairly modest, albeit constant. Goats were not abundant in the material. Most of the identified goat bones came from low utility body parts (e.g. skulls and lower extremities), but some amount of goat meat was also consumed. Wild species were of minor importance when it came to consumption practices in Turku. The changes in Turku’s animal husbandry patterns between the medieval and post medieval periods is reflected in the change in age of the animals slaughtered, which was part of a wider pattern seen in North- and Central Europe. More mature animals are also present in the assemblages. This pattern is related to the more pronounced importance of cattle as a manure producer and a draught animal as a result of the intensification of crop cultivation. This change seems to occur later in Finland than in the more Southerly regions, and indeed it did not necessarily take hold in all parts of the country.

The COPD control panel: towards personalised medicine in COPD

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease whose assessment and management have traditionally been based on the severity of airflow limitation (forced expiratory volume in 1 s (FEV1)). Yet, it is now clear that FEV1 alone cannot describe the complexity of the disease. In fact, the recently released Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2011 revision has proposed a new combined assessment method using three variables (symptoms, airflow limitation and exacerbations). Methods Here, we go one step further and propose that in the near future physicians will need a"control panel" for the assessment and optimal management of individual patients with complex diseases, including COPD, that provides a path towards personalised medicine. Results We propose that such a"COPD control panel" should include at least three different domains of the disease: severity, activity and impact. Each of these domains presents information on different"elements" of the disease with potential prognostic value and/or with specific therapeutic requirements. All this information can be easily incorporated into an"app" for daily use in clinical practice. Conclusion We recognise that this preliminary proposal needs debate, validation and evolution (eg, including"omics" and molecular imaging information in the future), but we hope that it may stimulate debate and research in the field.

El Barceloneta I. Una embarcación medieval a tingladillo en Barcelona

El año 2008 una intervención arqueológica en un solar cercano al Port Vell de Barcelona permitió estudiar y localizar una importante área del puerto medieval de la ciudad entre el que destacaría el muelle construido en el año 1477 y un pecio de construcción de casco previo y a tingladillo. El presente artículo realiza una aproximación al pecio Barceloneta I desde diferentes enfoques como los estudios palinológicos, dendrocronológicos, además del estudio histórico y arquitectónico. El conjunto de resultados permite situar la embarcación como la evidencia material de las complejas redes de comunicación marítima entre el Atlántico y el Mediterráneo en época Bajo Medieval así como avanzar en el conocimiento de la construcción naval en este periodo.

Canvis ambientals i modelació antròpica del territori entre l'època ibèrica i l'alt medieval a Catalunya: aportacions de la palinologia

[spa] En los últimos años ha aumentado el interés arqueológico por los cambios territoriales de época histórica. Asimismo, el número de registros polínicos ha aumentado sensiblemente. A pesar de que la falta de marcos cronológicos fiables impone límites a las interpretaciones sobre antropización, el presente artículo pretende realizar una síntesis de los cambios paleoambientales documentados entre los siglos VIII aC y XII dC, haciendo especial referencia a las transformaciones humanas del entorno. Este conjunto de datos polínicos hace evidente una intervención humana al inicio del periodo ibérico, presión que se intensifica durante el iberismo Pleno con la expansión de actividades agrícolas. El mundo romano significa una explotación del espacio menos extensiva, si bien el el siglo VII dC se produce una extensión de los pastos tanto en sectores elevados del Pirineo como de litoral catalán que modifica profundamente el paisaje. [eng] The archaeological interest on the environmental changes during historical times has increased during the last decades. In accordance, a number of palynological from NE Spain records has been recently published. Despite chronological frame works are not yet enough reliable, this paper proposes a synthesis of landscape changes from VIIIth century BC to XIIth century AD. Palynological data suggest the presence of human impacts at ghe beginning of iberic times. Humans pressure, mainly farmning activities, intensified during iberian times. Roman times record a less extensive land use but at the IVth century AD, grazing expanded at regional scale. Pastures expanded again at VIIth century AD, reaching high altitudes in the Pyrenees while at littoral plains, meadows were used for grazing. This period resulted in a deep change of the Catalan lansacapes.

Pédiatrie. (2.) Consultation de médecine du sport dédiée à l'adolescent [Sport medicine consultation for adolescents].

Sport activity is a determinant of health and well-being for adolescents' psychological and physic development. Early detection of traumatic lesions or pathological condition among sportive adolescent in the light of their developmental stage is of outmost importance and is best done by an interdisciplinary team. This clinical management also aims at preventing consequences of inappropriate training. The CHUV has set-up a specific sports medicine outpatient consultation clinic for adolescents in the order to provide the best integrative management of young athletes.

L'utilisation des anticoagulants oraux directs chez les patients âgés : les limites de la médecine fondée sur les preuves [The use of the new direct oral anticoagulants among older subjects: The limits of the evidence-based medicine?].

The growing use of direct oral anticoagulants, in particular among older subjects, raises questions about the limits of the evidence-based medicine. The phase III studies that have validated the efficacy and the safety profile of these molecules (dabigatran, rivaroxaban, apixaban, edoxaban) in their both indications, the venous thromboembolic disease and the non-valvular atrial fibrillation raise concerns in four major fields: the financial support of pharmaceutical companies, the links of interest for many authors with the industry, the study design (exclusively non-inferiority studies), and the poor representativeness of the older subjects included. All these points are discussed, using data of sub-groups studies, post-marketing studies and recent meta-analysis. The lack of data for the very old subjects, with frailty or comorbidities, remains the main concern from these phase III studies.

L'informatique: un outil remarquable pour l'enseignement de la médecine interne générale [The informatics: a remarkable tool for teaching general internal medicine].

INTERMED training implies a three week course, integrated in the "primary care module" for medical students in the first master year at the school of medicine in Lausanne. INTERMED uses an innovative teaching method based on repetitive sequences of e-learning-based individual learning followed by collaborative learning activities in teams, named Team-based learning (TBL). The e-learning takes place in a web-based virtual learning environment using a series of interactive multimedia virtual patients. By using INTERMED students go through a complete medical encounter applying clinical reasoning and choosing the diagnostic and therapeutic approach. INTERMED offers an authentic experience in an engaging and safe environment where errors are allowed and without consequences.

Dix ans de revue de la littérature en médecine interne générale--un premier bilan [Ten years of literature review in general internal medicine--a first assessment].

A group of family physicians in an outpatient clinic in Switzerland prospectively followed scientific literature for ten years. What to remember among the numerous articles retrieved and which paper really changed our practice? If many readings are quickly forgotten, some of them marked our minds and changed our habits. This article is a summary of our efforts to keep the essential tools in clinical practice.

Médecine d'urgence [Emergency medicine: updates 2014].

L'année 2014 a été marquée par de nouvelles acquisitions thérapeutiques en médecine d'urgence.L'estimation de la probabilité d'une néphrolithiase permet d'éviter une imagerie chez les patients à haut risque. L'hypothermie thérapeutique post-arrêt cardiorespiratoire n'a pas de bénéfice par rapport à une stratégie de normothermie contrôlée. Le traitement d'une bronchite aiguë sans signe de gravité par co-amoxicilline ou AINS est inutile. L'adjonction de colchicine au traitement standard de la péricardite aiguë diminue le risque de récidive. L'ajustement du seuil de D-dimères à l'âge permet de réduire le recours à l'imagerie en cas de risque non élevé d'embolie pulmonaire. Enfin, un monitorage invasif précoce n'apporte pas de bénéfice à la prise en charge initiale du choc septique. The year 2014 was marked by new therapeutic acquisitions in emergency medicine. Nephrolithiasis likelihood estimation should avoid imaging in patients at high risk. Therapeutic hypothermia post cardio-respiratory arrest has no benefit compared to a strategy of controlled normothermia. Treatment of acute bronchitis with no signs of severity by coamoxicillin or NSAIDs is useless. Adding colchicine to standard treatment of acute pericarditis reduces the rate of recurrence. The D-dimerthreshold adjustment by age reduces the number of imaging in case of low or intermediate risk of pulmonary embolism. Finally, the speed of the initial management of septic shock is crucial to the outcome of patients, but an early invasive monitoring provides no benefit.