Aetiologies of pulseless electrical activity in out-of-hospital cardiac arrests:A retrospective study and analysis of specific causes

Background: Pulseless electrical activity (PEA) cardiac arrest is defined as a cardiac arrest (CA) presenting with a residual organized electrical activity on the electrocardiogram. In the last decades, the incidence of PEA has regularly increased, compared to other types of CA like ventricular fibrillation or pulseless ventricular tachycardia. PEA is frequently induced by reversible conditions. The "4 (or 5) H" & "4 (or 5) T" are proposed as a mnemonic to asses for Hypoxia, Hypovolemia, Hypo- /Hyperkalaemia, Hypothermia, Thrombosis (cardiac or pulmonary), cardiac Tamponade, Toxins, and Tension pneumothorax. Other pathologies (intracranial haemorrhage, severe sepsis, myocardial contraction dysfunction) have been identified as potential causes for PEA, but their respective probability and frequencies are unclear and they are not yet included into the resuscitation guidelines. The aim of this study was to analyse the aetiologies of PEA out-of-hospital CA, in order to evaluate the relative frequencies of each cause and therefore to improve the management of patients suffering a PEA cardiac arrest. Method: This retrospective study was based on data routinely and prospectively collected for each PEMS intervention. All adult patients treated from January 1st 2002 to December 2012 31st by the PEMS for out-of-hospital cardiac arrest, with PEA as the first recorded rhythm, and admitted to the emergency department (ED) of the Lausanne University Hospital were included. The aetiologies of PEA cardiac arrest were classified into subgroups, based on the classical H&T's classification, supplemented by four other subgroups analysis: trauma, intra-cranial haemorrhage (ICH), non-ischemic cardiomyopathy (NIC) and undetermined cause. Results: 1866 OHCA were treated by the PEMS. PEA was the first recorded rhythm in 240 adult patients (13.8 %). After exclusion of 96 patients, 144 patients with a PEA cardiac arrest admitted to the ED were included in the analysis. The mean age was 63.8 ± 20.0 years, 58.3% were men and the survival rate at 48 hours was 29%. 32 different causes of OHCA PEA were established for 119 patients. For 25 patients (17.4 %), we were unable to attribute a specific cause for the PEA cardiac arrest. Hypoxia (23.6 %), acute coronary syndrome (12.5%) and trauma (12.5 %) were the three most frequent causes. Pulmonary embolism, Hypovolemia, Intoxication and Hyperkaliemia occurs in less than 10% of the cases (7.6 %, 5.6 %, 3.5%, respectively 2.1 %). Non ischemic cardiomyopathy and intra-cranial haemorrhage occur in 8.3 % and 6.9 %, respectively. Conclusions: According to our results, intra-cranial haemorrhage and non-ischemic cardiomyopathy represent noticeable causes of PEA in OHCA, with a prevalence equalling or exceeding the frequency of classical 4 H's and 4 T's aetiologies. These two pathologies are potentially accessible to simple diagnostic procedures (native CT-scan or echocardiography) and should be included into the 4 H's and 4 T's mnemonic.

Concerted changes in N and C primary metabolism in alfalfa (Medicago sativa) under water restriction

Although the mechanisms of nodule N2 fixation in legumes are now well documented, some uncertainty remains on the metabolic consequences of water deficit. In most cases, little consideration is given to other organs and, therefore, the coordinated changes in metabolism in leaves, roots, and nodules are not well known. Here, the effect of water restriction on exclusively N2-fixing alfalfa (Medicago sativa L.) plants was investigated, and proteomic, metabolomic, and physiological analyses were carried out. It is shown that the inhibition of nitrogenase activity caused by water restriction was accompanied by concerted alterations in metabolic pathways in nodules, leaves, and roots. The data suggest that nodule metabolism and metabolic exchange between plant organs nearly reached homeostasis in asparagine synthesis and partitioning, as well as the N demand from leaves. Typically, there was (i) a stimulation of the anaplerotic pathway to sustain the provision of C skeletons for amino acid (e.g. glutamate and proline) synthesis; (ii) re-allocation of glycolytic products to alanine and serine/glycine; and (iii) subtle changes in redox metabolites suggesting the implication of a slight oxidative stress. Furthermore, water restriction caused little change in both photosynthetic efficiency and respiratory cost of N2 fixation by nodules. In other words, the results suggest that under water stress, nodule metabolism follows a compromise between physiological imperatives (N demand, oxidative stress) and the lower input to sustain catabolism.

Online Learning and Teaching in Higher Education, a book review

Peer-reviewed

La integración de Internet en la educación escolar española : situación actual y perspectivas de futuro

The main objectives and findings of this first research report are presented in thischapter. "The Implementation of the Internet in the Spanish Education System: State of Affairsand Future Prospects" is a large-scale research project that seeks to obtain relevant data about the introduction and dissemination of Information and Communication Technology, particularly the internet, in the practical and organizational general procedures of the Spanish schools and high schools. The project articulates the processes of ICT implementation on the primary andsecondary education levels embracing a holistic approach, propped up by an empirical and analytical research methodology. Thus, our survey does not intend to detect which is the impact of ICT on school activities but how all the agents involved in the school community incorporate ICT and what use they make of it. We are especially interested in identifying the teachers' pedagogical and professional uses of ICT, how students use it in their activities and to what extent it contributes in reinforcing teamwork andparticipation proceedings in the institutions, as well as the relations between the latter and their context. It is also of our interest to know the factors that exert the strongest influence on the way teachers, head teachers and students make use of ICT. Finally, we intend to identify the ways ICT may contribute to the improvement of educational practices.

Combining Generic Programming and Service-Oriented Architectures for the Effective and Timely Development of Complex e-Learning Systems

Peer-reviewed

An Experimental Study on Peer Selection in a P2P Network over PlanetLab

Peer-reviewed

La Enseñanza de los sistemas externos de representación matemáticos y lingüísticos en la educación infantil

El objetivo de este estudio es identificar factores que contribuyen a mantener un enfoque básicamente instrumental para enseñar los sistemas externos de representación matemáticos y lingüísticos en las primeras edades de escolarización. En el estudio han participado 123 maestros de Educación Infantil de diversos centros escolares públicos de Andalucía, Asturias, Cataluña y Navarra que han asistido a cursos de formación permanente del profesorado. El análisis cualitativo realizado se basa en grupos de discusión a partir de tópicos. Los resultados evidencian la influencia de diversos factores: el currículo de Educación Infantil; las concepciones del profesorado; las presiones entre etapas educativas; y, finalmente, la presión social. La identificación de los factores asociados a una enseñanza instrumental de los sistemas externos de representación puede entenderse como un tipo de información relevante acerca de las condiciones de la enseñanza de estos sistemas que, además, pueden servir de base para reconstruir las prácticas educativas

Feasibility Study and Market Review of Small Scale Bioenergy Heating Plants in North-West Russia

The paper is focused on feasibility study and market review of small scale bioenergy heating plants in the Russian North-West region. The main focus is effective and competitive usage of low-grade wood for heating purposes in the region. As example of economical feasibility estimation it was chosen the project of reconstruction of small scale boiler plant in Leningrad region that Brofta Oy is planning to implement the nearest time. It includes calculation the payback time with and without interest, the estimation of probable investments, the evaluation of possible risks and research on the potential of small scale heating plants projects. Calculations show that the profitability of this kind of projects is high, but payback time is not very short, because of high level of initial investments. Though, the development of small scale bioenergy heating plants in the region is considered to be the best way to solve the problems of heat supply in small settlements using own biomass resources.

The Transformation of Practical Teaching Focusing on Dialogic Learning

This study investigates the transformation of practical teaching in a Catalan school, connected to the design, implementation and development of project-based learning, and focusing on dialogic learning to investigate its limits and possibilities. Qualitative and design-based research (DBR) methods are applied. These methods are based on empirical educational research with the theory-driven of learning environments. DBR is proposed and applied using practical guidance for the teachers of the school. It can be associated with the current proposals for Embedding Social Sciences and Humanities in the Horizon 2020 Societal Challenges. This position statement defends the social sciences and the humanities as the most fundamental and important ideas to face all societal challenges. The results of this study show that before the training process, teachers apply dialogic learning in specific moments (for example, when they speak about the weekend); however, during the process and after the process, they work systematically with dialogic learning through the PEPT: they start and finish every activity with a individual and group reflection about their own processes, favouring motivation, reasoning and the implication of all the participants. These results prove that progressive transformations of teaching practice benefit cooperative work in class

Study and modeling of the desintegration kinetics of coated paper

The disintegration of recovered paper is the first operation in the preparation of recycled pulp. It is known that the defibering process follows a first order kinetics from which it is possible to obtain the disintegration kinetic constant (KD) by means of different ways. The disintegration constant can be obtained from the Somerville index results (%lsv and from the dissipated energy per volume unit (Ss). The %slv is related to the quantity of non-defibrated paper, as a measure of the non-disintegrated fiber residual (percentage of flakes), which is expressed in disintegration time units. In this work, disintegration kinetics from recycled coated paper has been evaluated, working at 20 revise rotor speed and for different fiber consistency (6, 8, 10, 12 and 14%). The results showed that the values of experimental disintegration kinetic constant, Ko, through the analysis of Somerville index, as function of time. Increased, the disintegration time was drastically reduced. The calculation of the disintegration kinetic constant (modelled Ko), extracted from the Rayleigh’s dissipation function, showed a good correlation with the experimental values using the evolution of the Somerville index or with the dissipated energy

'L’escriptura del jo', una proposta d’educació intercultural i tractament de la diversitat per a l’ensenyament secundari obligatori = The writing of I, an intercultural educational proposal and treatment of diversity for Compulsory Secondary Education

The writing of I is a project that starts an itinerary through past, present and future experiences of each of our students based on following research activities. Reading, creation and recreation of text and other items that turn essentially around autobiographical writing and culminate with the elaboration of a free autobiography

La incorporación y enseñanza de la lengua extranjera

Tradicionalment, el sistema educatiu espanyol ha presentat carències importants respecte al desenvolupament de competències lingüístiques en una o més llengües estrangeres

Otra mirada al tema del cambio de escala: los nuevos espacios de comercio, ocio y turismo = Another look at the theme of the change of scale: new spaces in commerce, leisure and tourism

The technological advances and new organisation of the economy together with a change in ideas in consumer habits andlifestyle that have happened in the last 25 years have placed us in a new state of capitalism. The spatial translation of thisnew state has been immediate and implies among other changes the overcoming of the concept of scale. Commercialspaces and those of leisure and tourism offer us an unbeatable opportunity of exemplifying these changes because they arethe most effected by the new postmodern tendencies

Del papel a la pantalla y del aula a la nube: ideas para dinamizar la expresión escrita en secundaria = From paper to the screen and from the classroom to the cloud: ideas to energise written expression at secondary level

The spread of sociocultural focuses and critical literacy studies, which offer an holistic perspective on communicative skills, has reached our country at a time when the commonest environment for writing is the internet, and information technologies have transformed writing with new channels, genres, forms of preparation and languages. Thanks to these changes, educational programmes now include new concepts of literacy related to knowledge and the use of digital environments. This paper explores the impact of introducing these new communicative environments to teaching written expression at secondary level and puts forward some ideas to link learning how to write to present communicative contexts and established practices. Without forgetting the achievements of recent decades, we need to bring about a series of changes to bring new learned writing practices to class and leave behind others we had championed as necessary when the goal was to move beyond exclusively linguistic or grammatical approaches