Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs

CONTEXT Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery." EVIDENCE SYNTHESIS We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. CONCLUSIONS ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. PATIENT SUMMARY This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.

Infrastructure (Resilience-oriented) Modelling Language: I®ML A proposal for modelling infrastructures and their connections

The modelling of critical infrastructures (CIs) is an important issue that needs to be properly addressed, for several reasons. It is a basic support for making decisions about operation and risk reduction. It might help in understanding high-level states at the system-of-systems layer, which are not ready evident to the organisations that manage the lower level technical systems. Moreover, it is also indispensable for setting a common reference between operator and authorities, for agreeing on the incident scenarios that might affect those infrastructures. So far, critical infrastructures have been modelled ad-hoc, on the basis of knowledge and practice derived from less complex systems. As there is no theoretical framework, most of these efforts proceed without clear guides and goals and using informally defined schemas based mostly on boxes and arrows. Different CIs (electricity grid, telecommunications networks, emergency support, etc) have been modelled using particular schemas that were not directly translatable from one CI to another. If there is a desire to build a science of CIs it is because there are some observable commonalities that different CIs share. Up until now, however, those commonalities were not adequately compiled or categorized, so building models of CIs that are rooted on such commonalities was not possible. This report explores the issue of which elements underlie every CI and how those elements can be used to develop a modelling language that will enable CI modelling and, subsequently, analysis of CI interactions, with a special focus on resilience

Foreigner? Want to study in Spain? The integration process at universities

The student exchange programs being carried out at universities for over 50 years, have led to changes in the institutions, which had to adapt to accommodate these students. Despite those changes, the integration of foreign students not coming from the aforementioned exchange programs that come to our country to study at the University has been neglected. These students face many barriers (language, cultural and origin customs mainly), so a clear and detailed information would be highly desirable in order to facilitate the necessary arrangements This study aims to show the deficiencies in the integration process and hosting programs faced by a foreign student at University. The study is performed by means of an analysis of statistical data from the Polytechnic University of Madrid and the Civil Engineering School over the last 12 school years (1999 - 2000 to 2010 - 2011), as well as surveys and interviews with some of these students. The study is enhanced with the analysis of the measures and integration methods of the various minorities, which had been implemented by the foremost public universities in Spain, as well as other public and private universities abroad. It illustrates the existing backlog at the Spanish universities with regards to supporting the integration of diversity among foreign students, providing data concerning the growth of such population and its impact at the university, and on the institutions in particular. In an increasingly globalized world, we must understand and facilitate the integration of minorities at University, supplying them, from the first day, and before the enrollment process, the essential elements that will allow their adequate adaptation to the educational process at University. It concludes by identifying the main subjects that need to be tackled to endorse such integration.

On the dynamic adaptation of language models based on dialogue information

We present an approach to adapt dynamically the language models (LMs) used by a speech recognizer that is part of a spoken dialogue system. We have developed a grammar generation strategy that automatically adapts the LMs using the semantic information that the user provides (represented as dialogue concepts), together with the information regarding the intentions of the speaker (inferred by the dialogue manager, and represented as dialogue goals). We carry out the adaptation as a linear interpolation between a background LM, and one or more of the LMs associated to the dialogue elements (concepts or goals) addressed by the user. The interpolation weights between those models are automatically estimated on each dialogue turn, using measures such as the posterior probabilities of concepts and goals, estimated as part of the inference procedure to determine the actions to be carried out. We propose two approaches to handle the LMs related to concepts and goals. Whereas in the first one we estimate a LM for each one of them, in the second one we apply several clustering strategies to group together those elements that share some common properties, and estimate a LM for each cluster. Our evaluation shows how the system can estimate a dynamic model adapted to each dialogue turn, which helps to improve the performance of the speech recognition (up to a 14.82% of relative improvement), which leads to an improvement in both the language understanding and the dialogue management tasks.

Generating segmental foreign accent

For most of us, speaking in a non-native language involves deviating to some extent from native pronunciation norms. However, the detailed basis for foreign accent (FA) remains elusive, in part due to methodological challenges in isolating segmental from suprasegmental factors. The current study examines the role of segmental features in conveying FA through the use of a generative approach in which accent is localised to single consonantal segments. Three techniques are evaluated: the first requires a highly-proficiency bilingual to produce words with isolated accented segments; the second uses cross-splicing of context-dependent consonants from the non-native language into native words; the third employs hidden Markov model synthesis to blend voice models for both languages. Using English and Spanish as the native/non-native languages respectively, listener cohorts from both languages identified words and rated their degree of FA. All techniques were capable of generating accented words, but to differing degrees. Naturally-produced speech led to the strongest FA ratings and synthetic speech the weakest, which we interpret as the outcome of over-smoothing. Nevertheless, the flexibility offered by synthesising localised accent encourages further development of the method.

HyPaLib: a database of RNAs and RNA structural elements defined by hybrid patterns

The database, called HyPaLib (for Hybrid Pattern Library), contains annotated structural elements characteristic for certain classes of structural and/or functional RNAs. These elements are described in a language specifically designed for this purpose. The language allows convenient specification of hybrid patterns, i.e. motifs consisting of sequence features and structural elements together with sequence similarity and thermodynamic constraints. We are currently developing software tools that allow a user to search sequence databases for any pattern in HyPaLib, thus providing functionality which is similar to PROSITE, but dedicated to the more complex patterns in RNA sequences. HyPaLib is available at http://bibiserv.techfak.uni-bielefeld.de/HyPa/.

Gut-specific transcriptional regulatory elements of the carboxypeptidase gene are conserved between black flies and Drosophila.

Millions of people die every year in the tropical world from diseases transmitted by hematophagous insects. Failure of conventional containment measures emphasizes the need for additional approaches, such as transformation of vector insects with genes that restrict vectorial capacity. The availability of an efficient promoter to drive foreign genes in transgenic insects is a necessary tool to test the feasibility of such approach. Here we characterize the putative promoter region of a black fly midgut carboxypeptidase gene and show that these sequences correctly direct the expression of a beta-glucuronidase reporter in Drosophila melanogaster. By histochemical staining and mRNA analysis, we found that the gene is expressed strongly and gut-specifically in the transgenic Drosophila. This gut-specific black fly carboxypeptidase promoter provides a valuable tool for the study of disease vectors.

Análisis traductológico de la obra paremiográfica de Charles Cahier, (francés-español)

This thesis contains a translatological analysis of the Spanish proverbs collected by Charles Cahier in Quelque six mille proverbes et aphorismes usuels empruntés à notre âge et aux siècles derniers. Proverbs and other sententious sayings are part of our day-to-day life, and are more or less intensely used according to cultures and their types of speech. They have always existed in every single civilisation. There is, indeed, no denying that the purpose of proverbs is to convey an old experience. They are quoted by major philosophers and writers of all times. As a result of the interest they have raised, books of proverbs have been published for many centuries in a high number of countries. Proverbs can be found everywhere, both in professional and personal settings, or in a conversation between friends. In France, these sayings are more commonly used in literature than in spoken language, whereas in Spain proverbs can be found at all levels of communication. In this regard, it is interesting to compare the translations of international works to detect a number of misunderstandings regarding the interpretation of paremiological elements. This is why translating proverbs is a genuine, complex issue. This thesis, which is aimed at Spanish and French speakers (including native and foreign speakers), has a double application (translatological and linguistic) and falls within the context of translatological and comparative paremiology...

Do first-year university students understand the language of mathematics?

The aim of the project is to determine if the understanding of the language of Mathematics of students starting university is propitious to the development of an appropriate cognitive structure. The objective of this current work was to analyse the ability of first-year university students to translate the registers of verbal or written expressions and their representations to the registers of algebraic language. Results indicate that students do not understand the basic elements of the language of Mathematics and this causes them to make numerous errors of construction and interpretation. The students were not able to associate concepts with definitions and were unable to offer examples.

La fraseología en la clase de lengua extranjera: ¿misión imposible?

En este artículo ofrecemos una perspectiva diferente del aprendizaje y la enseñanza de la fraseología en clase de lengua extranjera (LE). Partiendo de la premisa sobre el carácter eminentemente holístico del lenguaje, concebimos las unidades fraseológicas (UF) como elementos habituales e inherentes en la comunicación verbal, por lo que no pueden excluirse del proceso de adquisición de la competencia comunicativa en una LE. Nuestra propuesta consiste en partir de la fraseología para optimizar el desarrollo de diversas subcompetencias de la competencia comunicativa. Para ello, resulta imprescindible indagar en la configuración y el funcionamiento del significado fraseológico, que, según defendemos en este trabajo, conforma un conjunto de informaciones de diversa índole que se articulan en dos niveles, el semántico y el pragmático. Tal indagación permite desarrollar una serie de consideraciones con interesantes implicaciones didácticas.

Fraseodidáctica: a fraseoloxía para a didáctica

In this article it is offered a different view of the role of phraseology in the foreign language class. Considering the holistic nature of language, phraseological units are conceived as inherent elements in the verbal communication, which confirms its importance in the formation process of the communicative competence in a foreign language. With attention to the modular conceptions of the communicative competence (Canale 1983) and of the phraseological meaning (Timofeeva 2012), it is proposed conceiving the phraseology as a starting point for developing the different parts of communicative competence. As it is explained, phraseological meaning is conformed by several informational chunks articulated in two levels, the semantic and the pragmatic. The connexions between these chunks and the parts of communicative competence allow to use more effectively the phraseological contents for the foreign language learning and teaching.

Diversity for Texts Builds in Language L(MT): Indexes Based in Theory of Information

If one has a distribution of words (SLUNs or CLUNS) in a text written in language L(MT), and is adjusted one of the mathematical expressions of distribution that exists in the mathematical literature, some parameter of the elected expression it can be considered as a measure of the diversity. But because the adjustment is not always perfect as usual measure; it is preferable to select an index that doesn't postulate a regularity of distribution expressible for a simple formula. The problem can be approachable statistically, without having special interest for the organization of the text. It can serve as index any monotonous function that has a minimum value when all their elements belong to the same class, that is to say, all the individuals belong to oneself symbol, and a maximum value when each element belongs to a different class, that is to say, each individual is of a different symbol. It should also gather certain conditions like they are: to be not very sensitive to the extension of the text and being invariant to certain number of operations of selection in the text. These operations can be theoretically random. The expressions that offer more advantages are those coming from the theory of the information of Shannon-Weaver. Based on them, the authors develop a theoretical study for indexes of diversity to be applied in texts built in modeling language L(MT), although anything impedes that they can be applied to texts written in natural languages.

Foreign words in the English of textiles

All references and quotations to be made to the original, i.e. Balteiro Fernández, M. Isabel. 2009. “Foreign Words in the English of Textiles”. In Linde, A. and Crespo, R. Ed. Professional English in the European Context: The EHEA Challenge. Bern: Peter Lang. Pp. 127-150

En estil de fictes paraules que tenen sentits no fictes: anàlisi de locucions i col·locacions en Joan Roís de Corella en el context del llenguatge literari de la Corona d’Aragó en el segle XV

Aquest article presenta una mostra dels resultats de l’anàlisi detallada de locucions, col·locacions i altres elements fraseològics i d’ordre de mots significatius quant a la caracterització del cabal de llenguatge literari de Joan Roís de Corella. Aquesta anàlisi es fa amb metodologia interdisciplinar de base de lingüistica de corpus i de diacronia lingüistica, i amb el concurs de les tecnologies de la informació i la comunicació (humanitats digitals), que s’apliquen a l’anàlisi de l’aportació lèxica i estilística d’un autor clau com és Roís de Corella a fide calibrar el grau de sintonia i, alhora, d’especificitat del seu llenguatge literari; en quin grau coincideix el seu llenguatge literari amb el d’altres grans clàssics culturals de la Corona d’Aragó, i en què basa, alhora, Roís de Corella la clau de la seua mestria estilística.

Semantic change and intersubjectification: The origin of reprise evidential conditional in Old Catalan

The reprise evidential conditional (REC) is nowadays not very usual in Catalan: it is restricted to journalistic language and to some very formal genres (such as academic or legal language), it is not present in spontaneous discourse. On the one hand, it has been described among the rather new modality values of the conditional. On the other, the normative tradition tended to reject it for being a gallicism, or to describe it as an unsuitable neologism. Thanks to the extraction from text corpora, we surprisingly find this REC in Catalan from the beginning of the fourteenth century to the contemporary age, with semantic and pragmatic nuances and different evidence of grammaticalization. Due to the current interest in evidentiality, the REC has been widely studied in French, Italian and Portuguese, focusing mainly on its contemporary uses and not so intensively on the diachronic process that could explain the origin of this value. In line with this research, that we initiated studying the epistemic and evidential future in Catalan, our aim is to describe: a) the pragmatic context that could have been the initial point of the REC in the thirteenth century, before we find indisputable attestations of this use; b) the path of semantic change followed by the conditional from a ‘future in the past’ tense to the acquisition of epistemic and evidential values; and c) the role played by invited inferences, subjectification and intersubjectification in this change.