Contemporary approach to neurologic prognostication of coma after cardiac arrest.

Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.

[Voyage en Italie : 1824-1830]. , [Vue présumée de la Punta Nera, port et] rue en pente à Porto Ferrajo : [deux vues perspectives, un plan d'ensemble] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 106

[Voyage en Italie : 1825-1830]. , Fontaine sur la place de S. Spirito ; fontaine adossée à la prison : [deux vues perspectives, un petit plan] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 153

[Voyage en Italie : 1824-1830]. , [Modèles de claustrats et de bâtiments dans une chartreuse] : [détails de huit claustras en briques, vues perspectives de deux petits bâtiments agrémentés de deux desdits modèles de claustras] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 163

[Voyage en Italie : 1824-1830]. , Chiesa di S. Giacomo : [vues perspectives de la façade et de la nef] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 37

[Voyage en Italie : 1824-1830]. , Pont antique en pépérin [...] ; [Tombeaux en ruines de] Castel d'Asso : [deux vues perspectives] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 464

[Voyage en Italie : 1824-1830]. , Fontaines à la Villa Medicis : [vues perspectives] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 635

[Voyage en Italie : 1824-1830]. , [Chapiteau] à la Villa Poniatowski à Rome : [deux vues perspectives d'un même chapiteau ionique, profil d'une volute] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 645

[Voyage en Italie : 1824-1830]. , [Six motifs de bâtiments du] IX[e] Siècle [et] d'une peinture de la chapelle Sixtine XV[e] Siècle : [vues perspectives] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 615

New perspectives in the use of ink evidence in forensic science : part III : operational applications and evaluation

The research reported in this series of article aimed at (1) automating the search of questioned ink specimens in ink reference collections and (2) at evaluating the strength of ink evidence in a transparent and balanced manner. These aims require that ink samples are analysed in an accurate and reproducible way and that they are compared in an objective and automated way. This latter requirement is due to the large number of comparisons that are necessary in both scenarios. A research programme was designed to (a) develop a standard methodology for analysing ink samples in a reproducible way, (b) comparing automatically and objectively ink samples and (c) evaluate the proposed methodology in forensic contexts. This report focuses on the last of the three stages of the research programme. The calibration and acquisition process and the mathematical comparison algorithms were described in previous papers [C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part I: Development of a quality assurance process for forensic ink analysis by HPTLC, Forensic Sci. Int. 185 (2009) 29-37; C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part II: Development and testing of mathematical algorithms for the automatic comparison of ink samples analysed by HPTLC, Forensic Sci. Int. 185 (2009) 38-50]. In this paper, the benefits and challenges of the proposed concepts are tested in two forensic contexts: (1) ink identification and (2) ink evidential value assessment. The results show that different algorithms are better suited for different tasks. This research shows that it is possible to build digital ink libraries using the most commonly used ink analytical technique, i.e. high-performance thin layer chromatography, despite its reputation of lacking reproducibility. More importantly, it is possible to assign evidential value to ink evidence in a transparent way using a probabilistic model. It is therefore possible to move away from the traditional subjective approach, which is entirely based on experts' opinion, and which is usually not very informative. While there is room for the improvement, this report demonstrates the significant gains obtained over the traditional subjective approach for the search of ink specimens in ink databases, and the interpretation of their evidential value.

La cultura obrera: perspectives per al seu estudi

This "Introduction" underlines the multi-explanatory causes that explain the incorporation of the cultural approaches and methodologies to today's Catalan Social History.

La cultura obrera: perspectives per al seu estudi

This "Introduction" underlines the multi-explanatory causes that explain the incorporation of the cultural approaches and methodologies to today's Catalan Social History.