Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine.

OBJECTIVES: To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy. METHODS: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors based on clinical examination, electrophysiology, biomarkers and imaging were included. RESULTS AND CONCLUSIONS: Evidence from a total of 73 studies was reviewed. The quality of evidence was low or very low for almost all studies. In patients who are comatose with absent or extensor motor response at ?72h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron specific enolase at 48-72h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.

Défis et opportunités liés a la création d'une société unique de spécialistes en médecine interne générale en 2015 [Challenges and opportunities related to the creation of a unique society of specialists in general internal medicine in 2015].

A common training plan in general internal medicine was a brave enterprise started in 2011 in accordance with the common objectives of the Swiss Society of General Medicine and the Swiss Society of Internal Medicine. The next challenge will be the dissolution of the two Societies and therefore the creation of an unique new association in 2015. This is an extraordinary opportunity to bring together the specific qualities of each association and to create a new society. Issues, objectives and secondary benefits expected from the creation of the largest national society of a medical discipline are explored as a joint discussion in this article.

Diagnòstic en profunditat sobre la integració dels i les joves de 14 a 18 anys migrats a Catalunya

[cat] La finalitat d’aquest projecte és aprofundir en el procés d’integració socioeducativa de la joventut migrada a Catalunya, específicament, dels i les joves entre 14 i 18 anys. Entre els resultats destaquem que els joves tenen un concepte força tancat i excloent del concepte de ciutadania com a estatus, i un baix grau de coneixement de la diversitat cultural, especialment els joves autòctons; tot i que tenen una actitud de reconeixement i acceptació, favorable a la convivència intercultural, tant al centre educatiu com al seu barri. No obstant, tenen una visió de la diversitat cultural i del fet migratori en clau de coexistència, sense el reconeixement que suposaria un pas més per a la convivència. La immigració és vista com un col·lectiu vulnerable, amb un baix nivell econòmic i cultural i que també és percebut com un problema i, fins i tot, com a causant de les dificultats que actualment pateix i travessa el conjunt de la societat. Els joves tendeixen a relacionar-se amb el seu grup cultural, i responen de forma passiva en la comprensió i actuació davant dels problemes i assumptes públics. Entre els elements que valoren per sentir-se ciutadà té una especial importància la llengua. Els joves que fa més de 10 anys que viuen a Catalunya són els que tendeixen a tenir un sentiment de pertinença cívica amb el lloc de residència. De fet, com més temps porten els joves estrangers vivint al lloc d’acollida, perden importància elements d’identificació cultural del país d’origen, però la religió, les celebracions populars, l’art i la tendència a formar parella són elements identitaris del lloc d’origen, més estables. Es demana una intervenció urgent en diversos nivells i destinades a diferents agents. Destaquem: -La importància d’una acollida afectiva i efectiva, -Potenciar espais de trobada, -Treballar els prejudicis, -Transversalitzar l’educació intercultural, - Potenciació de l’aprenentatge de la llengua catalana, -Formació del professorat en competències interculturals.

OCP effects in catalan cliticization

In Catalan, sequences of sibilants are never pronounced as such. In most contexts all varieties coincide in the «strategies» used to avoid these sequences, namely epenthesis or deletion. Variation is only found in the domain of pronominal clitics (but not with other types of clitics). One source of variation is accounted for by decomposing a general constraint into two specific ones, which implies partial constraint reranking. The other source of variation, which involves a case of apparent opacity, is explained through an Output-Output constraint that makes reference to paradigmatic relations.

Velar verbs and verbal classes in catalan

There is in Catalan a set of verbs, the so-called «velar verbs», whose differential characteristic consists in presenting a velar segment between the root and the inflectional suffixes in certain morphosyntactic contexts. This velar segment has traditionally been considered as being part of the root in the contexts where it occurs, and has been made responsible for the typical allomorphic character of velar verbs. Under the assumption that regular verbs are only one-root verbs, velar verbs have been treated as irregular verbs. Nevertheless, neither the phonic character of the velar segment nor the marginal character of velar verbs is clear. The aim of this paper is to present a different account of velar verbs on the basis of the inflectional morphological character of the velar segment. The work is split into two parts. The first one focuses on standard Catalan, and tries to show that in this variety velar verbs are better treated as regular verbs. The second one focuses on other Catalan varieties, and aims to exhibit the incoherence implied in the traditional treatment of velar verbs in the context of the Catalan language as a whole. The discussion is mainly developed on morphological grounds, halfway between theory and description.

Prosody and pragmatics in parenthetical insertions in catalan

This paper analyses the role of prosody in parenthetical insertions, a type of structure that is extremely common in both speech and writing. The materials under study come from a corpus of spontaneous speech acts in Central Catalan (with varying degrees of spontaneity) from which a corpus of oral parenthetical insertions has been compiled. The prototypical prosodic features of a parenthetical insertion in Catalan are: prosodic autonomy, limited extension, production in between pauses or final pause, tendency towards acceleration, fall in intensity, lower pitch range and, finally, falling or rising melodic pattern. While the final fall is the most frequent pattern in spontaneous conversations with a high degree of confidence between interlocutors, a final rising structure is found in interviews in which the degree of confidence between participants is smaller, their roles are unequal, and the interviewed constructs a narrative discourse. We thus suggest that the pitch contour of parenthetical insertions is related to formality and discourse typology (in this case, narrative vs. dialogue). Bearing in mind the discursive functions performed by these insertions, we propose a typology which classifies them with regards to two main functions: completion of information, and modalisation.

Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC).

An increasing number of patients suffering from cardiovascular disease, especially coronary artery disease (CAD), are treated with aspirin and/or clopidogrel for the prevention of major adverse events. Unfortunately, there are no specific, widely accepted recommendations for the perioperative management of patients receiving antiplatelet therapy. Therefore, members of the Perioperative Haemostasis Group of the Society on Thrombosis and Haemostasis Research (GTH), the Perioperative Coagulation Group of the Austrian Society for Anesthesiology, Reanimation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society of Cardiology (ESC) have created this consensus position paper to provide clear recommendations on the perioperative use of anti-platelet agents (specifically with semi-urgent and urgent surgery), strongly supporting a multidisciplinary approach to optimize the treatment of individual patients with coronary artery disease who need major cardiac and non-cardiac surgery. With planned surgery, drug eluting stents (DES) should not be used unless surgery can be delayed for ≥12 months after DES implantation. If surgery cannot be delayed, surgical revascularisation, bare-metal stents or pure balloon angioplasty should be considered. During ongoing antiplatelet therapy, elective surgery should be delayed for the recommended duration of treatment. In patients with semi-urgent surgery, the decision to prematurely stop one or both antiplatelet agents (at least 5 days pre-operatively) has to be taken after multidisciplinary consultation, evaluating the individual thrombotic and bleeding risk. Urgently needed surgery has to take place under full antiplatelet therapy despite the increased bleeding risk. A multidisciplinary approach for optimal antithrombotic and haemostatic patient management is thus mandatory.

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(®)) Society Recommendations.

BACKGROUND: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. METHODS: An international working group constructed within the Enhanced Recovery After Surgery (ERAS(®)) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated "high", "moderate", "low" or "very low". Recommendations were graded as "strong" or "weak". RESULTS: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. CONCLUSIONS: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.

Compliance with the Swiss Society for Nutrition's dietary recommendations in the population of Geneva, Switzerland: a 10-year trend study (1999-2009).

The trends in compliance with the dietary recommendations of the Swiss Society for Nutrition in the Geneva population were assessed for the period from 1999 to 2009 using 10 cross-sectional, population-based surveys (Bus Santé study) with a total of 9,320 participants aged 35 to 75 years (50% women). Dietary intake was assessed using a self-administered, validated, semi-quantitative food frequency questionnaire. Trends were assessed by logistic regression adjusting for age, smoking status, education, and nationality using survey year as the independent variable. After excluding participants with extreme intakes, the percentage of participants with a cholesterol intake of <300 mg/day increased from 40.8% in 1999 to 43.6% in 2009 for men (multivariate-adjusted P for trend=0.04) and from 57.8% to 61.4% in women (multivariate-adjusted P for trend=0.06). Calcium intake >1 g/day decreased from 53.3% to 46% in men and from 47.6% to 40.7% in women (multivariate-adjusted P for trend<0.001). Adequate iron intake decreased from 68.3% to 65.3% in men and from 13.3% to 8.4% in women (multivariate-adjusted P for trend<0.001). Conversely, no significant changes were observed for carbohydrates, protein, total fat (including saturated, monounsaturated, and polyunsaturated fatty acids), fiber, and vitamins D and A. We conclude that the quality of the Swiss diet did not improve between 1999 and 2009 and that intakes deviate substantially from expert recommendations for health promotion and chronic disease risk reduction.

A guide to resources for the study of the recent history of the United States in the libraries of the University of Iowa, the State Historical Society of Iowa, and in the Herbert Hoover Presidential Library, 1977

This guide is designed as a finding aid for researchers seeking materials on a particular topic and it indicates the nature and extent of resources for the study of United States history available at the Historical Society of Iowa, the Herbert Hoover Presidential Library and the Iowa University Libraries.

Statistics in science and in society: From a state-of-the-art to a new research agenda

Statistics occupies a prominent role in science and citizens' daily life. This article provides a state-of-the-art of the problems associated with statistics in science and in society, structured along the three paradigms defined by Bauer, Allum and Miller (2007). It explores in more detail medicine and public understanding of science on the one hand, and risks and surveys on the other. Statistics has received a good deal of attention; however, very often handled in terms of deficit - either of scientists or of citizens. Many tools have been proposed to improve statistical literacy, the image of and trust in statistics, but with little understanding of their roots, with little coordination among stakeholders and with few assessments of impacts. These deficiencies represent as many new and promising directions in which the PUS research agenda could be expanded.

An overlapping generations approach to price policies in privatehealthcare insurance. The Catalan case

We analyze premium policies and price dispersion among private healthcare insurance firms from an overlapping-generations model. The model shows that firms that apply equal premium to all policyholders and firms that set premiums according to the risk of insured can coexist in the short run, whereas coexistence is unlikely in the long run because it requires the coincidence of economic growth and interest rates. We find support for the model’s results in the Catalan health insurance industry. Keywords: Economic theory, price policies, health insurance, health economics, overlapping-generations. JEL Classifications: I11 / L11 / L23