Patterns of civil society after authoritarianism: a comparison of Portugal and Spain, 1970s-2000s. CES Papers - Open Forum #17, 2013-2014

In this paper we argue that patterns of civil society in post-authoritarian democracies are the result of divergent pathways to democracy. Through a comparison of contemporary Portugal (social revolution) and Spain (reform), we show that revolutionary pathways to democracy have a positive impact on the self-organizing abilities of popular groups, thus also contributing to a higher quality of democracy. There are three mechanisms in social revolutionary processes that contribute to this. The first stems from the fact that the masses are the key actor in the revolutionary transformation process, with the power to shape (at least partially) the new rules and institutions of the emerging democratic regime. This results in greater legal recognition and institutional embeddedness between civil society organizations and the state, making it easier, in turn, for resources to be transferred to those organizations. Secondly, as a result of changes to the social and economic structure, revolutions engender more egalitarian societies. Likewise, citizens are given more resources and capacities for collective action. Finally, revolutions tend to crystalize a political culture between elites and the masses in which the principles of egalitarian participation and social change through the action of the people are accepted. This all leads to greater opportunities, resources and legitimacy for the civic action of the common people during the subsequent democratic regime.

The Catholic Question in Contemporary Portuguese Civil Society: A Case of Muted Vibrancy? CES Papers - Open Forum #14, 2012

The ‘Catholic question’ in contemporary Portugal obliges us to consider whether Catholicism will remain a force in Portuguese associational life in the next century, or whether it faces a future of slow and steady decline. On the one hand, an overall statistical drop of church membership, and the lack of religious practice by almost half of self-identified Roman Catholics, suggests that the future of the Catholic Church in Portugal will probably be very different than the past. On the other hand, the church’s support for democratic processes, the important social services it provides, and its educational establishment, have certainly been a positive factor in Portuguese associational life, and helped the larger process of democratic-regime consolidation since the Carnation Revolution of 1974. This paper suggests that social scientists need to move beyond the lens normally applied to the question of Catholicism in contemporary Europe (i.e. it is a dying, anti-modern, anti-rational, conservative institution), and instead consider the complex interplay of its demographic challenges combined with the popular sources of its theological and spiritual strength, as well as its vital societal contributions, to assess whether or not it will remain a force in Portuguese associational life in the future.

The Weakness of Post-Communist Civil Society Reassessed. CES Papers - Open Forum #11, 2012

During the last two decades, scholars from a variety of disciplines have argued that civil society is structurally deficient in post-communist countries. Yet why have the seemingly strong, active and mobilized civic movements of the transition period become so weak after democracy was established? And why have there been diverging political trajectories across the post-communist space if civil society structures were universally weak? This paper uses a wide range of data from various available sources to show that civil societies in Central and Eastern European countries are not as feeble as is commonly assumed. Some post-communist countries possess vigorous public spheres, and active civil society organizations strongly connected to transnational civic networks able to shape domestic policies. Following the calls by Anheier (2004) and Bernhard and Karakoç (2007) we adopt a multidimensional approach to the measurement of civil society. In a series of cross-section timeseries models, we show that our broader measures of civic and social institutions are able to predict the diverging transition paths among post-communist regimes, and in particular the growing gap between democratic East Central Europe and the increasingly authoritarian post-Soviet space.

Revue GRASPE/GRASPE Review. Réflexions sur l'avenir de la Service Publique Européenne/Reflections on the future of the European civil service. Cahier n° 26 Février 2016

No abstract.

Plasma Heme Oxygenase-1 in Patients Resuscitated from out-of-Hospital Cardiac Arrest

Heme oxygenase-1 (HO-1) is an enzyme induced by hypoxia and reperfusion injury, and is associated with organ dysfunction in critically ill patients. Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are subjected to hypoxemia, brain injury, and organ dysfunction. Accordingly, we studied HO-1 among these patients. A total of 143 OHCA patients resuscitated from a shockable initial rhythm and admitted to an ICU were included, with plasma HO-1 measured at ICU admission and at 24 h. We analyzed the associations between plasma HO-1 and time to return of spontaneous circulation (ROSC), 90-day mortality, and 12-month Cerebral Performance Category (CPC). HO-1 plasma concentrations were higher after OHCA compared with controls. HO-1 concentrations at admission and on day 1 associated with ROSC (P = 0.002 to P = 0.003). Admission and day 1 HO-1 plasma concentrations were higher in 90-day non-survivors than in survivors (P = 0.017, 0.026). In addition, poor neurological outcome (CPC 3-5) was associated with higher HO-1 plasma levels at admission (P = 0.024). Admission plasma HO-1 levels had an AUC of 0.623 to predict 90-day mortality and an AUC of 0.611 to predict CPC 3 to 5. In conclusion, we found that higher HO-1 plasma levels are associated with longer ROSC and poor long-term outcome.

NT-proBNP in patients with out-of-hospital cardiac arrest: Results from the FINNRESUSCI Study

AIM To assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF). METHODS We measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6h of OHCA-VT/VF and later after 24h, 48h, and 96h. The end-points were mortality and neurological outcome classified according to Cerebral Performance Category (CPC) after one year. NT-proBNP levels were compared to high-sensitivity troponin T (hs-TnT) levels and established risk scores. RESULTS NT-proBNP levels were higher in non-survivors compared to survivors on study inclusion (median 1003 [quartile (Q) 1-3 502-2457] vs. 527 [179-1284]ng/L, p=0.001) and after 24h (1913 [1012-4573] vs. 1080 [519-2210]ng/L, p<0.001). NT-proBNP levels increased from baseline to 96h after ICU admission (p<0.001). NT-proBNP levels were significantly correlated to hs-TnT levels after 24h (rho=0.27, p=0.001), but not to hs-TnT levels on study inclusion (rho=0.05, p=0.67). NT-proBNP levels at all time points were associated with clinical outcome, but only NT-proBNP levels after 24h predicted mortality and poor neurological outcome, defined as CPC 3-5, in models that adjusted for SAPS II and SOFA scores. hs-TnT levels did not add prognostic information to NT-proBNP measurements alone. CONCLUSION NT-proBNP levels at 24h improved risk assessment for poor outcome after one year on top of established risk indices, while hs-TnT measurements did not further add to risk prediction.

Time-differentiated target temperature management after out-of-hospital cardiac arrest: a multicentre, randomised, parallel-group, assessor-blinded clinical trial (the TTH48 trial): study protocol for a randomised controlled trial

BACKGROUND The application of therapeutic hypothermia (TH) for 12 to 24 hours following out-of-hospital cardiac arrest (OHCA) has been associated with decreased mortality and improved neurological function. However, the optimal duration of cooling is not known. We aimed to investigate whether targeted temperature management (TTM) at 33 ± 1 °C for 48 hours compared to 24 hours results in a better long-term neurological outcome. METHODS The TTH48 trial is an investigator-initiated pragmatic international trial in which patients resuscitated from OHCA are randomised to TTM at 33 ± 1 °C for either 24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to treatment allocation and dichotomised to good (CPC 1-2) or poor (CPC 3-5) outcome. Secondary outcomes are: 6-month mortality, incidence of infection, bleeding and organ failure and CPC at hospital discharge, at day 28 and at day 90 following OHCA. Assuming that 50 % of the patients treated for 24 hours will have a poor outcome at 6 months, a study including 350 patients (175/arm) will have 80 % power (with a significance level of 5 %) to detect an absolute 15 % difference in primary outcome between treatment groups. A safety interim analysis was performed after the inclusion of 175 patients. DISCUSSION This is the first randomised trial to investigate the effect of the duration of TTM at 33 ± 1 °C in adult OHCA patients. We anticipate that the results of this trial will add significant knowledge regarding the management of cooling procedures in OHCA patients. TRIAL REGISTRATION NCT01689077.

Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome

THE AIM OF THE STUDY There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). METHODS We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. RESULTS Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p<0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p=0.03). During the first 48h the median (IQR) of the TW mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. CONCLUSIONS Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients.

Minorities and women as government contractors : a report of the United States Commission on Civil Rights.

Cover title.

The state of civil rights; a report of the United States Commission on Civil Rights.

Mode of access: Internet.

Consultations on the affirmative action statement of the U.S. Commission on Civil Rights.

Item 288-A