Monitoring the decreasing trend of testicular cancer mortality in Spain during 2005-2019 through a Bayesian approach

Purpose : To assess time trends of testicular cancer (TC) mortality in Spain for period 1985-2019 for age groups 15-74 years old through a Bayesian age-period-cohort (APC) analysis. Methods: A Bayesian age-drift model has been fitted to describe trends. Projections for 2005-2019 have been calculated by means of an autoregressive APC model. Prior precision for these parameters has been selected through evaluation of an adaptive precision parameter and 95% credible intervals (95% CRI) have been obtained for each model parameter. Results: A decrease of -2.41% (95% CRI: -3.65%; -1.13%) per year has been found for TC mortality rates in age groups 15-74 during 1985-2004, whereas mortality showed a lower annual decrease when data was restricted to age groups 15-54 (-1.18%; 95% CRI: -2.60%; -0.31%). During 2005-2019 is expected a decrease of TC mortality of 2.30% per year for men younger than 35, whereas a leveling off for TC mortality rates is expected for men older than 35. Conclusions: A Bayesian approach should be recommended to describe and project time trends for those diseases with low number of cases. Through this model it has been assessed that management of TC and advances in therapy led to decreasing trend of TC mortality during the period 1985-2004, whereas a leveling off for these trends can be considered during 2005-2019 among men older than 35.

La néphropathie ischémique par athérosclérose aortorénale : acquisitions thérapeutiques [Atherosclerotic renal artery disease management update]

In the case of atherosclerotic renal artery disease, the best conclusive results lie principally not in the degree of the stenosis but rather in the degree the renal parenchymal disease beyond the stenosis itself. These determining factors involve the controlling of the patients blood pressure, the improvement in the renal function and the beneficial results to the cardiovascular system. Besides the indispensable medical treatment, a revascularisation by angioplasty may be indicated. This procedure with or without vascular stent often allows satisfactory angiographic results. A treatment by surgical revascularisation is only recommended in the case of extensive atherosclerotic lesions of the aorta, complex lesions of the latter or an abdominal aortic aneurism. Although the frequency of restenosis of angioplasty with stent remains extremely low, the risk of cholesterol emboli due to the diffuse atherosclerotic lesions of the abdominal aorta, must be considered at the time of each aortic catheterization. The therapeutic approach of atherosclerotic renal artery disease must be dictated by the whole cardiovascular risk factors and by the threat of target organs. The control of the blood pressure and the maintenance of the renal function must be integrated in the decisional algorithm as well as the possible risks in carrying out an eventual revascularisation procedure. Finally, the renal angioplasty should in numerous situations be integrated in the overall assumption of responsibility of the atherosclerotic vascular diseases, and should be part of the medical treatment. Several questions still do exist; at what moment an atherosclerotic renal artery stenosis should and e considered critical, and which procedure should be considered for which patient? The purpose of this review is to propose a decisional tool for individualized treatments in the light of results from randomized and controlled studies.

Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis.

Patients undergoing spinal surgery are at risk of developing thromboembolic complications even though lower incidences have been reported as compared to joint arthroplasty surgery. Deep vein thrombosis (DVT) has been studied extensively in the context of spinal surgery but symptomatic pulmonary embolism (PE) has engaged less attention. We prospectively followed a consecutive cohort of 270 patients undergoing spinal surgery at a single institution. From these patients, only 26 were simple discectomies, while the largest proportion (226) was fusions. All patients received both low molecular weight heparin (LMWH) initiated after surgery and compressive stockings. PE was diagnosed with spiral chest CT. Six patients developed symptomatic PE, five during their hospital stay. In three of the six patients the embolic event occurred during the first 3 postoperative days. They were managed by the temporary insertion of an inferior vena cava (IVC) filter thus allowing for a delay in full-dose anticoagulation until removal of the filter. None of the PE patients suffered any bleeding complication as a result of the introduction of full anticoagulation. Two patients suffered postoperative haematomas, without development of neurological symptoms or signs, requiring emergency evacuation. The overall incidence of PE was 2.2% rising to 2.5% after exclusion of microdiscectomy cases. The incidence of PE was highest in anterior or combined thoracolumbar/lumbar procedures (4.2%). There is a large variation in the reported incidence of PE in the spinal literature. Results from the only study found in the literature specifically monitoring PE suggest an incidence of PE as high as 2.5%. Our study shows a similar incidence despite the use of LMWH. In the absence of randomized controlled trials (RCT) it is uncertain if this type of prophylaxis lowers the incidence of PE. However, other studies show that the morbidity of LMWH is very low. Since PE can be a life-threatening complication, LMWH may be a worthwhile option to consider for prophylaxis. RCTs are necessary in assessing the efficacy of DVT and PE prophylaxis in spinal patients.

Methadone maintenance treatment in the Swiss Canton of Vaud: demographic and clinical data on 1,782 ambulatory patients.

Using data from the Public Health Service, we studied the demographic and clinical characteristics of 1,782 patients enrolled in methadone maintenance treatment (MMT) during 2001 in the Swiss Canton of Vaud, comparing our findings with the results of a previous study from 1976 to 1986. In 2001, most patients (76.9%) were treated in general practice. Mortality is low in this MMT population (1%/year). While patient age and sex profiles were similar to those found in the earlier study, we did observe a substantial increase in the number of patients and the number of practitioners treating MMT patients, probably reflecting the low-threshold governmental policies and the creation of specialized centers. In conclusion, easier access to MMT enhances the number of patients, but new concerns about the quality of management emerge: benzodiazepine as a concomitant prescription; low rates of screening for hepatitis B, C and HIV, and social and psychiatric preoccupations.

Ehkäisevän kunnossapidon suunnittelun työkalujen kehittäminen terästehtaassa

Imatra Steel Oy Ab:n Imatran terästehtaan tuotantonopeudet ja -määrät ovat nousseet selvästi alkuperäistä tasoa korkeammiksi toteutettujen investointien ja käytettävyyden parantamisen myötä. Lisäksi yrityson asettanut yhä tiukemmat käytettävyystavoitteet. Ehkäisevän kunnossapitojärjestelmän käyttöaste ei ole riittävä, jotta asetettuihin tavoitteisiin päästäisiin. Kunnossapidon rooli on myös muuttunut tärkeäksi kilpailutekijäksi jolla voidaan suoraan vaikuttaa yrityksen kilpailukykyyn. Työn avulla pyritään helpottamaan tulevaa systemaattista yrityksen koko laitekannan ehkäisevien kunnossapitotoimenpiteiden läpikäyntiä. Tässä työssä pyritään etsimään sopivia työkaluja ehkäisevän kunnossapidon suunnittelulle ja kehittämään ehkäisevää kunnossapitoa. Työssä on tavoitteisiin pääsemiseksi tutkittu erilaisia kunnossapitostrategioita, kunnossapitostrategioiden valintamenetelmiä, tunnuslukuja, vikaantumista ja kriittisyysanalyysejä. Yrityksen ehkäisevän kunnossapidon nykytilaa ja ongelmakohtia selvitettiin haastattelututkimuksen avulla. Työssä on kehitetty erilaisten kunnossapitostrategioiden valintamenetelmien pohjalta oma laitekannan kriittisyyden huomioiva menetelmä ehkäisevän kunnossapidon kohteiden päivittämiselle. Menetelmän helppokäyttöisyyttä on lisätty kehittämällä menetelmälle suunnittelukortti. Lisäksi työssä on esitelty muita ehkäisevään kunnossapitoon liittyviä kehityskohteita.

Pienten tuotekehityshankkeiden erityispiirteet konepajateollisuuden yrityksessä

Tutkimuksessa on tarkasteltu pienten tuotekehityshankkeiden tehokkuutta suuressa paperikoneita valmistavassa yrityksessä. Tutkimuksen osana on selvitetty sisäisen lanseerauksen kehitystarpeita oman myyntihenkilöstön aktivoinnissa, joka onolennainen osa uuden tuotteen onnistunutta markkinalanseerausta. Tuotekehityksen ja projektin johtamisen teoreettisen tutkimuksen esittelyn jälkeen tutkimuksessa on selvitetty liiketoimintaympäristön asettamia vaatimuksia yrityksen pienille tuotekehityshankkeille. Luodun teoreettisen viitekehikon avulla on tarkasteltu neljää tuotekehitysprojektia ja niiden onnistumiseen vaikuttaneita fundamentteja. Paras kilpailukyky case-liiketoiminnassa saavutetaan korkean teknologian tuotteilla, joiden kehittäminen yrityksen sisällä on strategisesti perusteltua. Matalan teknologian tuotteet tulisi hankkia pienemmiltä kilpailijoilta. Pienten kehitysprojektien nopeampi läpivienti tuoteyksiköissä vaatii yhtenäistä osaamista vaativien tuoteryhmien muodostamista sekä nykyistä selkeämpiä rooleja tuotteiden ja tuotekehityshenkilöstön välille. Organisaatiomuutoksesta johtuen tuoteyksiköiden tulee kehittää kontaktit Service-liiketoimintalinjan alaiseen myyntiverkostoon myynnin tukemiseksi. Sisäisen lanseerauksen laajuus tulee heijastaa uuden tuotteen monimutkaisuutta. Lisäksi tuotetietomyyntiverkostossa ei ole halutulla tasolla ja vaatii kehitystoimenpiteitä jatkossa.

Osavalmistusprosessin laadunhallinta, perustuen SFS-EN ISO 9001.1994 laatujärjestelmästandardiin

Työn tavoitteena oli luoda yritykseen soveltuva, toimiva laatujärjestelmän kirjallinen kuvaus sekä parantaa laadun hallintaa. Laatutoimintojen kehittämisessä perustana käytettiin laatujärjestelmästandardia SFS-EN ISO 9001. Työn lähtökohtana oli perusteellinen nykytilan selvitys. Saatujen tulosten perusteella voitiin kohdistaa toimenpiteet oikein, jolloin laadun parannus oli merkittävää ja mitattavissa. Lähtötilanteessa havaittiin suuria laatuongelmia niin asiakkaiden keskuudessa kuin yrityksen sisäisissä toiminnoissa, verrattaessa ISO 9001 standardiin. Prosessit pyrittiin kirjaamaan sekä aloitustilanteessaettä havaittujen puutteiden korjaamisen jälkeen. Tästä dokumentaatiosta muodostettiin pohja yrityksen laatujärjestelmän kuvaukselle - laatukäsikirjalle. Dokumentoitua työ- tai toiminto-ohjetta kehitettiin edelleen vastaamaan parasta havaittua toimintatapaa.Työ osoitti laadun hallinnan parantuneen merkittävästi, kun prosessi on onnistuttu kuvaamaan käytännönläheisesti ja yksinkertaisesti. Ratkaisevan tärkeää on prosessin suorittamiseen osallistuvan henkilöstön panos kuvattaessa ja kehitettäessä toimintoa. Ilman henkilöstön sitouttamista kuvaukset ja ohjeet jäävät vain hyödyttömiksi papereiksi, joita ei noudateta eikä päivitetä. Laadun, kuten minkään muunkaan parametrin, kehitystä on mahdoton seurata ilman selkeitä ja yksiselitteisiä mittareita. Työssä luotiin tärkeimpiinprosesseihin kehitystä ilmaisevat laatumittarit. Parhaimmillaan havaittiin maalaamossa suoritettujen toimenpiteiden seurauksena virheellisten kappaleiden osuuden pudonneen kertaluokkaa pienemmäksi. Laatujärjestelmän kehitystyö osoittautui tämänkin kokoisessa yrityksessä erittäin työlääksi ja aikaa vieväksi. Kuitenkin on selvää, että laadunhallinnan parantuessa ja todistusaineiston karttuessa onnistumisten kautta, lisääntyy koko yrityksen usko laadun parantamisen tärkeyteen ja näin nopeuttaa joskus kipeidenkin uudistusten läpivientiä.

Linking landscape- and population ecology for large population management modelling: the case of Ibex (capra ibex) in Switzerland

La biologie de la conservation est communément associée à la protection de petites populations menacées d?extinction. Pourtant, il peut également être nécessaire de soumettre à gestion des populations surabondantes ou susceptibles d?une trop grande expansion, dans le but de prévenir les effets néfastes de la surpopulation. Du fait des différences tant quantitatives que qualitatives entre protection des petites populations et contrôle des grandes, il est nécessaire de disposer de modèles et de méthodes distinctes. L?objectif de ce travail a été de développer des modèles prédictifs de la dynamique des grandes populations, ainsi que des logiciels permettant de calculer les paramètres de ces modèles et de tester des scénarios de gestion. Le cas du Bouquetin des Alpes (Capra ibex ibex) - en forte expansion en Suisse depuis sa réintroduction au début du XXème siècle - servit d?exemple. Cette tâche fut accomplie en trois étapes : En premier lieu, un modèle de dynamique locale, spécifique au Bouquetin, fut développé : le modèle sous-jacent - structuré en classes d?âge et de sexe - est basé sur une matrice de Leslie à laquelle ont été ajoutées la densité-dépendance, la stochasticité environnementale et la chasse de régulation. Ce modèle fut implémenté dans un logiciel d?aide à la gestion - nommé SIM-Ibex - permettant la maintenance de données de recensements, l?estimation automatisée des paramètres, ainsi que l?ajustement et la simulation de stratégies de régulation. Mais la dynamique d?une population est influencée non seulement par des facteurs démographiques, mais aussi par la dispersion et la colonisation de nouveaux espaces. Il est donc nécessaire de pouvoir modéliser tant la qualité de l?habitat que les obstacles à la dispersion. Une collection de logiciels - nommée Biomapper - fut donc développée. Son module central est basé sur l?Analyse Factorielle de la Niche Ecologique (ENFA) dont le principe est de calculer des facteurs de marginalité et de spécialisation de la niche écologique à partir de prédicteurs environnementaux et de données d?observation de l?espèce. Tous les modules de Biomapper sont liés aux Systèmes d?Information Géographiques (SIG) ; ils couvrent toutes les opérations d?importation des données, préparation des prédicteurs, ENFA et calcul de la carte de qualité d?habitat, validation et traitement des résultats ; un module permet également de cartographier les barrières et les corridors de dispersion. Le domaine d?application de l?ENFA fut exploré par le biais d?une distribution d?espèce virtuelle. La comparaison à une méthode couramment utilisée pour construire des cartes de qualité d?habitat, le Modèle Linéaire Généralisé (GLM), montra qu?elle était particulièrement adaptée pour les espèces cryptiques ou en cours d?expansion. Les informations sur la démographie et le paysage furent finalement fusionnées en un modèle global. Une approche basée sur un automate cellulaire fut choisie, tant pour satisfaire aux contraintes du réalisme de la modélisation du paysage qu?à celles imposées par les grandes populations : la zone d?étude est modélisée par un pavage de cellules hexagonales, chacune caractérisée par des propriétés - une capacité de soutien et six taux d?imperméabilité quantifiant les échanges entre cellules adjacentes - et une variable, la densité de la population. Cette dernière varie en fonction de la reproduction et de la survie locale, ainsi que de la dispersion, sous l?influence de la densité-dépendance et de la stochasticité. Un logiciel - nommé HexaSpace - fut développé pour accomplir deux fonctions : 1° Calibrer l?automate sur la base de modèles de dynamique (par ex. calculés par SIM-Ibex) et d?une carte de qualité d?habitat (par ex. calculée par Biomapper). 2° Faire tourner des simulations. Il permet d?étudier l?expansion d?une espèce envahisseuse dans un paysage complexe composé de zones de qualité diverses et comportant des obstacles à la dispersion. Ce modèle fut appliqué à l?histoire de la réintroduction du Bouquetin dans les Alpes bernoises (Suisse). SIM-Ibex est actuellement utilisé par les gestionnaires de la faune et par les inspecteurs du gouvernement pour préparer et contrôler les plans de tir. Biomapper a été appliqué à plusieurs espèces (tant végétales qu?animales) à travers le Monde. De même, même si HexaSpace fut initialement conçu pour des espèces animales terrestres, il pourrait aisément être étndu à la propagation de plantes ou à la dispersion d?animaux volants. Ces logiciels étant conçus pour, à partir de données brutes, construire un modèle réaliste complexe, et du fait qu?ils sont dotés d?une interface d?utilisation intuitive, ils sont susceptibles de nombreuses applications en biologie de la conservation. En outre, ces approches peuvent également s?appliquer à des questions théoriques dans les domaines de l?écologie des populations et du paysage.<br/><br/>Conservation biology is commonly associated to small and endangered population protection. Nevertheless, large or potentially large populations may also need human management to prevent negative effects of overpopulation. As there are both qualitative and quantitative differences between small population protection and large population controlling, distinct methods and models are needed. The aim of this work was to develop theoretical models to predict large population dynamics, as well as computer tools to assess the parameters of these models and to test management scenarios. The alpine Ibex (Capra ibex ibex) - which experienced a spectacular increase since its reintroduction in Switzerland at the beginning of the 20th century - was used as paradigm species. This task was achieved in three steps: A local population dynamics model was first developed specifically for Ibex: the underlying age- and sex-structured model is based on a Leslie matrix approach with addition of density-dependence, environmental stochasticity and culling. This model was implemented into a management-support software - named SIM-Ibex - allowing census data maintenance, parameter automated assessment and culling strategies tuning and simulating. However population dynamics is driven not only by demographic factors, but also by dispersal and colonisation of new areas. Habitat suitability and obstacles modelling had therefore to be addressed. Thus, a software package - named Biomapper - was developed. Its central module is based on the Ecological Niche Factor Analysis (ENFA) whose principle is to compute niche marginality and specialisation factors from a set of environmental predictors and species presence data. All Biomapper modules are linked to Geographic Information Systems (GIS); they cover all operations of data importation, predictor preparation, ENFA and habitat suitability map computation, results validation and further processing; a module also allows mapping of dispersal barriers and corridors. ENFA application domain was then explored by means of a simulated species distribution. It was compared to a common habitat suitability assessing method, the Generalised Linear Model (GLM), and was proven better suited for spreading or cryptic species. Demography and landscape informations were finally merged into a global model. To cope with landscape realism and technical constraints of large population modelling, a cellular automaton approach was chosen: the study area is modelled by a lattice of hexagonal cells, each one characterised by a few fixed properties - a carrying capacity and six impermeability rates quantifying exchanges between adjacent cells - and one variable, population density. The later varies according to local reproduction/survival and dispersal dynamics, modified by density-dependence and stochasticity. A software - named HexaSpace - was developed, which achieves two functions: 1° Calibrating the automaton on the base of local population dynamics models (e.g., computed by SIM-Ibex) and a habitat suitability map (e.g. computed by Biomapper). 2° Running simulations. It allows studying the spreading of an invading species across a complex landscape made of variously suitable areas and dispersal barriers. This model was applied to the history of Ibex reintroduction in Bernese Alps (Switzerland). SIM-Ibex is now used by governmental wildlife managers to prepare and verify culling plans. Biomapper has been applied to several species (both plants and animals) all around the World. In the same way, whilst HexaSpace was originally designed for terrestrial animal species, it could be easily extended to model plant propagation or flying animals dispersal. As these softwares were designed to proceed from low-level data to build a complex realistic model and as they benefit from an intuitive user-interface, they may have many conservation applications. Moreover, theoretical questions in the fields of population and landscape ecology might also be addressed by these approaches.

Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management.

PURPOSE: To identify risk factors associated with mortality in patients with severe community-acquired pneumonia (CAP) caused by S. pneumoniae who require intensive care unit (ICU) management, and to assess the prognostic values of these risk factors at the time of admission. METHODS: Retrospective analysis of all consecutive patients with CAP caused by S. pneumoniae who were admitted to the 32-bed medico-surgical ICU of a community and referral university hospital between 2002 and 2011. Univariate and multivariate analyses were performed on variables available at admission. RESULTS: Among the 77 adult patients with severe CAP caused by S. pneumoniae who required ICU management, 12 patients died (observed mortality rate 15.6 %). Univariate analysis indicated that septic shock and low C-reactive protein (CRP) values at admission were associated with an increased risk of death. In a multivariate model, after adjustment for age and gender, septic shock [odds ratio (OR), confidence interval 95 %; 4.96, 1.11-22.25; p = 0.036], and CRP (OR 0.99, 0.98-0.99 p = 0.034) remained significantly associated with death. Finally, we assessed the discriminative ability of CRP to predict mortality by computing its receiver operating characteristic curve. The CRP value cut-off for the best sensitivity and specificity was 169.5 mg/L to predict hospital mortality with an area under the curve of 0.72 (0.55-0.89). CONCLUSIONS: The mortality of patients with S. pneumoniae CAP requiring ICU management was much lower than predicted by severity scores. The presence of septic shock and a CRP value at admission <169.5 mg/L predicted a fatal outcome.

Recommendations for the use of multimodal monitoring in the neurointensive care unit.

PURPOSE OF REVIEW: Multimodal monitoring (MMM) is routinely applied in neurointensive care. Unfortunately, there is no robust evidence on which MMM-derived physiologic variables are the most clinically relevant, how and when they should be monitored, and whether MMM impacts outcome. The complexity is even higher because once the data are continuously collected, interpretation and integration of these complex physiologic events into targeted individualized care is still embryonic. RECENT FINDINGS: Recent clinical investigation mainly focused on intracranial pressure, perfusion of the brain, and oxygen availability along with electrophysiology. Moreover, a series of articles reviewing the available evidence on all the MMM tools, giving practical recommendations for bedside MMM, has been published, along with other consensus documents on the role of neuromonitoring and electroencephalography in this setting. SUMMARY: MMM allows comprehensive exploration of the complex pathophysiology of acute brain damage and, depending on the different configuration of the pathological condition we are treating, the application of targeted individualized care. Unfortunately, we still lack robust evidence on how to better integrate MMM-derived information at the bedside to improve patient management. Advanced informatics is promising and may provide us a supportive tool to interpret physiologic events and guide pathophysiological-based therapeutic decisions.

Strategic supply lead time management. Case Nokia Networks, Hardware Services

Teollisuuden palveluiden on huomattu olevan potentiaalinen lisätulojen lähde. Teollisuuden palveluiden dynaamisessa maailmassa räätälöinti ja kyky toimia nopeasti ovat kriittisiä asiakastyytyväisyyden ja kilpailuedun luomisprosessin osia. Toimitusketjussa käytetyn ajan lyhentämisellä voidaan saavuttaa sekä paremmat vasteajat, että alhaisemmat kokonaiskustannukset. Tutkielman tavoitteena on kuvata teollisuuden palveluiden dynaamista ympäristöä: asiakastarvetta, sekä mahdollisuuksia kaventaa pyydetyn ja saavutetun toimitusajan välistä eroa. Tämä toteutetaan pääosin strategisen toimitusajan hallinnan keinoin. Langattomien tietoliikenneverkkojen operaattorit haluavat vähentää ydinosaamiseensa kuulumatomiin toimintoihin, kuten ylläpitoon sitoutuneita pääomia. Tutkielman case osiossa varaosapalvelujen toimitusketjun kysyntä-, materiaali- ja informaatiovirtoja analysoidaan niin kvalitatiivisten haastatteluiden, sisäisten dokumenttien, kuin kvantitatiivisten tilastollisten menetelmienkin avulla. Löydöksiä peilataan vallitsevaa toimitusketjun ja ajanhallinnan paradigmaa vasten. Tulokset osoittavat, että vahvan palvelukulttuurin omaksuminen ja kokonaisvaltainen toimitusketjun tehokkuuden mittaaminen ovat ajanhallinnan lähtökohtia teollisuuden palveluissa.

Mating disruption with low density diffusers for the management of oriental fruit moths (Lepidoptera: Tortricidae) in apple orchards under subtropical climate in southern Brazil

The oriental fruit moth, Grapholita molesta Busck, and fruit flies, Anastrepha fraterculus L., are the important apple pests under Subtropical climate in Southern Brazil, and control is normally accomplished with insecticides. An alternative strategy for the control of G. molesta is mating disruption, through the use of pheromones. Mating disruption strategies using a low density of dispensers (20) per hectare were tested in comparison with conventional pesticides for control of G. molesta in commercial Gala apple orchards in Fraiburgo, SC, for a period of five years. The average field efficiency period of mating disruption formulation over five years was 113 days. In this period the mating interruption index on mating disruption plots was 84.8% over five years. Damage to Gala apples by oriental moth larvae was low (<0.1%) in mating disruption plots but did not differ from conventional plots, except in the third year. The use of mating disruption allowed for an average reduction of 5.2 insecticide treatments per year in Gala orchards during field efficiency period. It was necessary to apply 1.0 and 1.2 applications of insecticide to control of G. molesta and A. fraterculus, respectively. Mating disruption with a low density of diffusers proved to be an effective alternative to conventional methods for control of G. molesta in Gala apple orchards in subtropical climate in southern Brazil.

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.

Updates in the perioperative and emergency management of non-vitamin K antagonist oral anticoagulants.

Perioperative management of patients treated with the non-vitamin K antagonist oral anticoagulants is an ongoing challenge. Due to the lack of good clinical studies involving adequate monitoring and reversal therapies, management requires knowledge and understanding of pharmacokinetics, renal function, drug interactions, and evaluation of the surgical bleeding risk. Consideration of the benefit of reversal of anticoagulation is important and, for some low risk bleeding procedures, it may be in the patient's interest to continue anticoagulation. In case of major intra-operative bleeding in patients likely to have therapeutic or supra-therapeutic levels of anticoagulation, specific reversal agents/antidotes would be of value but are currently lacking. As a consequence, a multimodal approach should be taken which includes the administration of 25 to 50 U/kg 4-factor prothrombin complex concentrates or 30 to 50 U/kg activated prothrombin complex concentrate (FEIBA®) in some life-threatening situations. Finally, further studies are needed to clarify the ideal therapeutic intervention.

The environmental effects of changing speed limits: a quantile regression approach

Two speed management policies were implemented in the metropolitan area of Barcelona aimed at reducing air pollution concentration levels. In 2008, the maximum speed limit was reduced to 80 km/h and, in 2009, a variable speed system was introduced on some metropolitan motorways. This paper evaluates whether such policies have been successful in promoting cleaner air, not only in terms of mean pollutant levels but also during high and low pollution episodes. We use a quantile regression approach for fixed effect panel data. We find that the variable speed system improves air quality with regard to the two pollutants considered here, being most effective when nitrogen oxide levels are not too low and when particulate matter concentrations are below extremely high levels. However, reducing the maximum speed limit from 120/100 km/h to 80 km/h has no effect – or even a slightly increasing effect –on the two pollutants, depending on the pollution scenario. Length: 32 pages