Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

BACKGROUND & AIMS: 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.

Cuatro casos, cuatro historias de uso educativo de las TIC

[spa] Este informe presenta parte de los procesos y los resultados del proyecto de I+D+I: Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora, parcialmente financiado por Ministerio de Ciencia e Innovación. SEJ2007-67562. Recoge los cuatro estudios de caso llevados a cabo en dos Institutos de Enseñanza Secundaria Obligatoria y dos centros de educación primaria de Cataluña, que nos han posibilitado elucidar el impacto de las políticas de uso de las TIC y de otras iniciativas políticas para favorecer la innovación y la mejora en cada centro, prestando especial atención a: (a) los temas organizativos relacionados con el tiempo y el espacio; (b) el desarrollo del currículum en el centro (visiones sobre el conocimiento, el aprendizaje, el papel del alumnado y el profesorado, el lugar de las TIC, etc.); (c) las condiciones de trabajo del profesorado (acceso a formación, espacios y prácticas de colaboración; desarrollo profesional); (d) los resultados del aprendizaje (valor intelectual, social y personal de lo aprendido; capacidad de transferencia para seguir aprendiendo

Cuatro casos, cuatro historias de uso educativo de las TIC

[spa] Este informe presenta parte de los procesos y los resultados del proyecto de I+D+I: Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora, parcialmente financiado por Ministerio de Ciencia e Innovación. SEJ2007-67562. Recoge los cuatro estudios de caso llevados a cabo en dos Institutos de Enseñanza Secundaria Obligatoria y dos centros de educación primaria de Cataluña, que nos han posibilitado elucidar el impacto de las políticas de uso de las TIC y de otras iniciativas políticas para favorecer la innovación y la mejora en cada centro, prestando especial atención a: (a) los temas organizativos relacionados con el tiempo y el espacio; (b) el desarrollo del currículum en el centro (visiones sobre el conocimiento, el aprendizaje, el papel del alumnado y el profesorado, el lugar de las TIC, etc.); (c) las condiciones de trabajo del profesorado (acceso a formación, espacios y prácticas de colaboración; desarrollo profesional); (d) los resultados del aprendizaje (valor intelectual, social y personal de lo aprendido; capacidad de transferencia para seguir aprendiendo

Access Management Awareness Program Phase II Report, TR-402, 1997

This report presents the results of a number of detailed Iowa access management case studies. Case studies were selected to provide a cross-section of locations and community sizes in Iowa as well as a variety of project types. Generally, access management projects completed during the mid-1990s were chosen as case studies. Projects ranging from driveway consolidation to full raised medians were analyzed on a before and after basis in terms of traffic safety, traffic operations, and adjacent business vitality. Sources of information used for the case study analysis included: road project files; traffic accident records; state sales tax records; and personal interviews of business owners, business customers, and local officials. The case study results from Iowa essentially confirm results of previous access management research from around the nation. Recent access in Iowa had significant, positive impacts in terms of traffic safety. The average reduction of annual accidents and accident rates on improved roadways was approximately 40%. Improvements in access management also led to significantly better roadway operations for most case studies. Although a small number of individual businesses do report sales losses and/or customer complaints once projects have been completed, access management projects in Iowa have not had an adverse impact on the majority of businesses located along them. In fact, some access management projects in Iowa seem to have contributed to an improved business environment along the corridors that have been improved. The results from the Iowa case studies presented in this report will be used to develop access management education materials for Iowa transportation professionals and other audiences interested in the impacts of access management.

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.

Determinantes del progreso en los estudios de doctorado. Diferencias entre disciplinas científico-tecnológicas versus ciencias sociales y humanidades

En numerosos países, incluido España, existen problemas en relación con las tasas de éxito en los estudios de doctorado. El trabajo que aquí se presenta fue diseñado con el fin de identificar los factores asociados con el progreso durante el tercer ciclo y la elaboración de las tesis doctorales en dos grupos disciplinares: científico-tecnológico versus humanidades y ciencias sociales. El artículo presenta la información obtenida a partir de un cuestionario aplicado a 81 estudiantes de doctorado de la Universidad de Girona, en relación con tres áreas de interés: variables económicas, personales y académicas que condicionan el éxito en el tercer ciclo. Los resultados muestran diferencias substanciales entre disciplinas. Los factores responsables de estas diferencias son, principalmente: la vinculación profesional a la universidad, la planificación del proyecto de investigación y los objetivos personales.

Survey of Biobanks at a Swiss University Hospital

Human biobanks are a valuable source of biospecimens and personal data to be used for research. Little is known of how many biobanks exist at a given Swiss University Hospital. The purpose of this survey conducted at the CHUV hospital ( >40'000 patients hospitalized per year) and the faculty of biology and medicine (FBM) at the University in Lausanne, Switzerland was a) to provide an overview of the number of biobanks, b) to assess their purpose and size, c) to determine the kinds of biospecimens collected and d) to analyse the extent to which the biobanks follow the Swiss Academy of Medical Sciences (SAMS) guidelines on biobanks

Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses

Objectives: Assess the main problems referred by the patients and observed by the professionals after the bucodental rehabilitation with an implant-supported hybrid prothesis. Patients and Methods: A retrospective study was carried out in which there were 43 patients included who were visited in the Department of Oral Surgery and Orofacial Implantology of University of Barcelona Dental School for one year. An oral rehabilitation with an implant-supported hybrid prosthesis was made to those patients. The following variables were registered: age, gender, number of inserted implants, type of implant and principal problems produced by the hybrid prosthesis. Results: The rehabilitation with an implant supported hybrid prosthesis was only performed in 43 of 116 cases treated in one year (January, 2006 to January, 2007). They were 26 men and 17 women of ages between 37 and 74 years, being the rate age of 56,5 years. The main complication recorded was the mucositis, associated frequently with a difficulty to carry a correct oral hygiene and to an overextention of the tail of resin of the prosthesis. Other observed problems were the peri-implantitis, the break of the acrylic teeth and the loss of some of the prosthetic screws. Conclusions: The most frequent complication after the laying of an implant supported hybrid prosthesis was the mucositis, associated mainly with a prosthetic tail too long and to the consequent difficulty of carrying a correct oral hygiene. In spite of the high prevalence of observed complications, most of them were mild and resolved on subsequent visits.

L’Educació en valors a les classe d'educació física als instituts

l’educació física esdevé un excel·lent camp d’actuació per educar en valors a l’alumnat, sent aquesta una necessitat social existent segons els experts. El propòsit d’aquesta investigació és saber com i de quina manera s’educa en valors a les classes d’educació física, si és que es fa, i des d’un punt de vista del professorat. A través d’una recerca teòrica en l’àmbit, complementada amb 4 entrevistes a professorat d’educació física en actiu i amb més de 20 anys d’experiència, s’analitza qualitativament l’estat actual de l’educació en valors als instituts. L’anàlisi del marc teòric ressalta la importància que per desenvolupar aquests valors personals i socials, cal seguir un procés adequat, planificat i conscient per part del professorat. La part aplicada de l’estudi suggereix que en general es tenen en compte valors com el respecte i la cooperació durant el transcurs de les classes d’educació física, però que no es desenvolupen de forma eficient per manca de recursos i per infravalorar la seva importància. La investigació conclou que l’educació en valors als instituts, ha de ser una tasca transversal i coordinada amb d’altres agents fora d’aquest àmbit escolar, com són els entrenadors/es de clubs esportius, els pares i les mares i d’altres institucions implicades en el procés educatiu de l’alumnat. A partir d’aquesta anàlisi es vol promoure l’educació física com a eina per desenvolupar els valors en l’alumnat.

Com influencia la pràctica Dalcroze en l'estimulacio de les diferents capacitats dels infants

Aquest treball consta d’un procés d’investigació en el qual hi podem trobar la corroboració de la pregunta inicial sobre com influencia la pràctica Dalcroze en l’estimulació de les diferents capacitats dels infants. Aquest mètode consisteix en estimular la coordinació i la maduresa personal de l’infant i està basat en el moviment i la percepció del ritme. Basant-me en el què diuen alguns autors i pedagogs s’han comprovat les hipòtesis a partir d’una investigació. Per poder investigar aquest fet s’han realitzat una sèrie d’observacions de diferents sessions de música amb infants de tres a set anys de dues escoles diferents. En una de les escoles, en la qual s’ha estat investigant, els alumnes fan música a partir del mètode Dalcroze i a l’altre escola no. A partir de les observacions de totes les sessions de música s’ha analitzat i comparat les dues maneres de treballar la música i les capacitats que es poden desenvolupar treballant la música d’una manera vivencial i dinàmica. Per fer la part pràctica s’ha utilitzant una metodologia qualitativa la qual investiga si a partir de la rítmica Dalcroze es poden estimular les diferents capacitats dels infants. Les dades han estat recollides en una graella d’observació on hi ha transcrita cada una de les sessions de música de les dues escoles, també han estat recollides a partir de les gravacions de totes les sessions i dues entrevistes realitzades a les professores de música. A partir d’aquí ha començat el procés d’investigació i anàlisi.

Appropriate maintenance treatment for Crohn's disease: results of a multidisciplinary international expert panel - EPACT II

Introduction: Biological. therapy has dramatically changed management of Crohn's disease (CD). New data have confirmed the benefit and relative long-term safety of anti-TNF alpha inhibition as part of a regular scheduled administration programme. The EPACT appropriateness criteria for maintenance treatment after medically-induced remission (MIR) or surgically-induced remission (SIR) of CD thus required updating. Methods: A multidisciplinary international expert panel (EPACT II, Geneva, Switzerland) discussed and anonymously rated detailed, explicit clinical indications based on evidence in the literature and personal expertise. Median ratings (on a 9-point scale) were stratified into three assessment categories: appropriate (7-9), uncertain (4-6 and/or disagreement) and inappropriate (1-3). Experts ranked appropriate medication according to their own clinical practice, without any consideration of cost. Results: Three hundred and ninety-two specific indications for maintenance treatment of CD were rated (200 for MIR and 192 for SIR). Azathioprine, methotrexate and/or anti-TNF alpha antibodies were considered appropriate in 42 indications, corresponding to 68% of all appropriate interventions (97% of MIR and 39% of SIR). The remaining appropriate interventions consisted of mesalazine and a "wait-and-see" strategy. Factors that influenced the panel's voting were patient characteristics and outcome of previous treatment. Results favour use of anti-TNF alpha agents after failure of any immunosuppressive therapy, while earlier primary use remains controversial. Conclusion: Detailed explicit appropriateness criteria (EPACT) have been updated for maintenance treatment of CD. New expert recommendations for use of the classic immunosuppressors as well as anti-TNF alpha agents are now freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

1010-005 Bloody Run Creek Watershed Final Report

The City of Marquette lies in the 65,000 acre Mississippi River watershed, and is surrounded by steep bluffs. Though scenic, controlling water runoff during storm events presents significant challenges. Flash-flooding from the local watershed has plagued the city for decades. The people of Marquette have committed to preserve the water quality of key natural resources in the area including the Bloody Run Creek and associated wetlands by undertaking projects to control the spread of debris and sediment caused by excess runoff during area storm events. Following a July 2007 storm (over 8” of rain in 24 hours) which caused unprecedented flood damage, the City retained an engineering firm to study the area and provide recommendations to eliminate or greatly reduce uncontrolled runoff into the Bloody Run Creek wetland, infrastructure damage and personal property loss. Marquette has received Iowa Great Places designation, and has demonstrated its commitment to wetland preservation with the construction of Phase I of this water quality project. The Bench Area Storm Water Management Plan prepared by the City in 2008 made a number of recommendations to mitigate flash flooding by improving storm water conveyance paths, detention, and infrastructure within the Bench area. Due to steep slopes and rocky geography, infiltration based systems, though desirable, would not be an option over surface based systems. Runoff from the 240 acre watershed comes primarily from large, steep drainage areas to the south and west, flowing to the Bench area down three hillside routes; designated as South East, South Central and South West. Completion of Phase I, which included an increased storage capacity of the upper pond, addressed the South East and South Central areas. The increased upper pond capacity will now allow Phase II to proceed. Phase II will address runoff from the South West drainage area; which engineers have estimated to produce as much water volume as the South Central and South East areas combined. Total costs for Phase I are $1.45 million, of which Marquette has invested $775,000, and IJOBS funding contributed $677,000. Phase II costs are estimated at $617,000. WIRB funding support of $200,000 would expedite project completion, lessen the long term debt impact to the community and aid in the preservation of the Bloody Run Creek and adjoining wetlands more quickly than Marquette could accomplish on its own.

Life designing: A paradigm for career construction in the 21st century

At the beginning of the 21st century, a new social arrangement of work poses a series of questions and challenges to scholars who aim to help people develop their working lives. Given the globalization of career counseling, we decided to address these issues and then to formulate potentially innovative responses in an international forum. We used this approach to avoid the difficulties of creating models and methods in one country and then trying to export them to other countries where they would be adapted for use. This article presents the initial outcome of this collaboration, a counseling model and methods. The life-designing model for career intervention endorses five presuppositions about people and their work lives: contextual possibilities, dynamic processes, non-linear progression, multiple perspectives, and personal patterns. Thinking from these five presuppositions, we have crafted a contextualized model based on the epistemology of social constructionism, particularly recognizing that an individual's knowledge and identity are the product of social interaction and that meaning is co-constructed through discourse. The life-design framework for counseling implements the theories of self-constructing [Guichard, J. (2005). Life-long self-construction. International Journal for Educational and Vocational Guidance, 5, 111-124] and career construction [Savickas, M. L. (2005). The theory and practice of career construction. In S. D. Brown & R. W. Lent (Eds.), Career development and counselling: putting theory and research to work (pp. 42-70). Hoboken, NJ: Wiley] that describe vocational behavior and its development. Thus, the framework is structured to be life-long, holistic, contextual, and preventive.

Prévalence des maladies infectieuses au Centre hospitalier universitaire vaudois [Prevalence of infectious diseases at the Vaud University Hospital Center].

The prevalence of infectious diseases at our hospital (Centre hospitalier universitaire vaudois, Lausanne [CHUV], 900 beds) was studied retrospectively over a two years period (1980-1981). The medical diagnosis of 30203 patients recorded in the computerized medical archives, representing 93% of the patients admitted during the period of observation, was reviewed. To assess the reliability of the computerized data, quality control was carried out through detailed analysis of all the histologically proven appendicitis recorded during 1981. 88% of the histologically proven appendicitis were registered in the computer and the diagnosis was specific in 87% of cases. An infectious disease was the primary reason for admission in 12.8% of the patients (3873) during the study period. Altogether, 20.2% of patients presented with an infection during their hospital stay. Because of the retrospective nature of the study it was not possible to determine whether these additional infections were nosocomially acquired. The organ systems most frequently infected were the respiratory tract (28.5% of all infections), the digestive tract (20.5%), the skin and osteoarticular system (16%) and the urogenital tract (11.6%). An infection was the primary reason for admission of 40.2% of the patients hospitalized in the dermatology service, of 19.7% of patients admitted in internal medicine, of 15-17% of the patients admitted in pediatrics, ENT and general surgery, and of 1-2% of the patients admitted in neurosurgery and radiotherapy. These observations highlight the continuing importance of infectious diseases in a modern hospital, in spite of high socio-economic levels, stringent hygiene and epidemiologic measures, and modern antibiotic availability.

Katalysaattorin valmistuksen benchmarking

Työn tarkoituksena oli selvittää kilpailullisen benchmarkingin avulla Ecocat Oy:n käyttämien katalysaattoreiden valmistusmenetelmien suhdetta kilpailijoiden käyttämiin valmistusmenetelmiin, sekä tehdä benchmarking-tiedon pohjalta johtopäätöksiä ja ehdotuksia valmistusmenetelmien kehittämisestä. Tutkimuksen runkonatoimi benchmarking-prosessimalli, joka oli yhdistelmä kolmesta työn teoriaosassa esitellystä benchmarking-prosessimallista. Tiedon keruu benchmarkingia varten tapahtui käyttämällä hyväksi julkisten lähteiden lisäksi yrityksen sisäisiä tietolähteitä ja yrityksen ulkopuolisia kontakteja. Kerätyn tiedon pohjalta laadittiin kuvaukset Ecocatin ja sen kilpailijoiden käyttämistä valmistusmenetelmistä, tuotteista ja kustannuksista. Laadittujen kuvausten pohjalta suoritettiin vertailua menetelmien, tuotteiden ja kustannusten kesken. Tutkimuksessa havaittiin että Ecocatin käyttämät valmistusmenetelmät ovat kilpailukykyisiäja hyvin samankaltaisia kuin kilpailijoilla. Valmistusmenetelmien kehitysehdotusten tekemiseen kilpailullinen benchmarking antoi niukasti tietoa. Menetelmien kehittämiseen soveltuisikin paremmin jokin toinen benchmarking-tekniikka ja avoimempi benchmarking-yhteistyö.