A Comparison Between Pulse Pressure Variation and Right End Diastolic Volume Index as Guides to Resuscitation in a Model of Hemorrhagic Shock in Pigs

Background: Different hemodynamic parameters including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally induced hemorrhagic shock. Methods: Twenty-six anesthetized and mechanically ventilated pigs were allocated into control (group I), PPV (group II), or RVEDVI (group III) group. Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40 mm Hg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, 60 minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), 1 hour and 2 hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on analysis of variance for repeated measures followed by the Bonferroni test (p < 0.05). Results: Volume and time to resuscitation were higher in group III than in group II (group III = 1,305 +/- 331 mL and group II = 965 +/- 245 mL, p < 0.05; and group III = 24.8 +/- 4.7 minutes and group II = 8.8 +/- 1.3 minutes, p < 0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups. Conclusion: In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI.

Itinéraires : les guides de voyage en Suisse de la fin du XVIIIe siècle à 1914 : contribution à une histoire culturelle du tourisme

Menée dans une approche d'histoire culturelle, cette thèse de doctorat prend pour objet un corpus de guides de voyage en Suisse entre la fin du XVIIIe et le début du XXe siècle. Centrée sur les guides, ces livres qui entretiennent plus que d'autres des liens étroits avec le monde physique, elle a deux grands axes. Le premier est une lecture interdisciplinaire des guides de voyage, qui mêle littérature, bibliographie matérielle, histoire et histoire de l'art. Elle a cherché à comprendre les raisons et logiques du genre, en s'attachant particulièrement à ses fonctions et à ses formes (tant structurelles que textuelles et iconographiques). Cette partie de l'étude est importante, car elle n'a encore jamais été menée. Elle s'articule en deux volets : un volet théorique qui s'intéresse à l'histoire et à la forme des guides de voyage ; et une étude de cas qui s'attache à la lecture plus rapprochée de 6 guides : ceux de Thomas Martyr (1788, 1790 & 1794), Heinrich August Ottokar Reichard (1793 & 1802) et Johann Gottfried Ebel (1793, 1805, 1810-11 & 1817-18) pour la fin du XVIIIe siècle et le tournant du XIXe, et ceux de John Murray (1838 & 1886), Adolphe Joanne (1841, 1865, 1874, 1882 & 1908) et Karl Baedeker (1844, 1852, 1859, 1869, 1876, 1883, 1893, 1901 & 1913) pour le XIXe et la Belle Epoque. Le second axe de cette recherche est une réflexion sur les manières de mettre en scène l'espace dans un texte. En étudiant les itinéraires de voyage en Suisse (mais jusqu'au début du XXe siècle, « la Suisse »est pour les guides de voyage indifféremment un pays et une région supranationale : «les Alpes »), quatre types de mises en forme ont pu être identifiés : le voyage en boucle (linéaire, il part d'un point A pour y revenir), le voyage en marguerite (linéaire avec excursions), le voyage éclaté de l'ordre alphabétique, et enfin le voyage par «routes », fragments d'espace que l'on combine comme les pièces d'un puzzle, créant son chemin au fur et à mesure de sa progression. Ce faisant, on peut affirmer que les guides de voyage modernes (dont la forme se fixe dans les années 1830-1840 avec les premiers Murray, Baedeker et Joanne) se sont construits -malgré tout ce que l'on a pu dire sur la normativité prescriptive du tourisme -autour d'une liberté de plus en plus grande accordée aux voyageurs. Chacune de ces formes et chacun de ces types ayant une histoire et des conditions de possibilités, c'est en s'appuyant sur celles-ci que l'on peut mieux comprendre non seulement l'évolution du voyage et de ses pratiques, mais aussi la constitution de la forme littéraire qui l'a accompagné et permis. Ce faisant, des jalons pour une histoire culturelle du tourisme ont aussi été posés, histoire culturelle que j'appelle maintenant de mes voeux : il est quand même surprenant que, dans le pays de tourisme qu'est la Suisse, quand on s'est jusqu'à présent attaché à l'histoire du tourisme, on n'ait parlé qu'économie, société, infrastructures, loisirs ou santé, voire, plus récemment, écologie et bien-être. Redonner son creuset culturel à ce phénomène, c'est aussi retrouver une part du nôtre, car ces mémoires s'entremêlent indissociablement.

Good Practice Guides

This series of Good Practice Guides is designed to share important information about health inequalities and some of the evidence-based measures that can be taken to reduce the stark differences in health and wellbeing within populations. It is recognised that leadership and coordinated, effective action at a number of levels can reduce this gap. Ensuring concerted, evidence-based action on health and wellbeing inequalities demands the efforts of government, statutory organisations and the community, voluntary and private sectors. The Good Practice Guides were developed to inform and support joined-up working across these sectors. It is known that health inequalities are closely linked with degrees of social disadvantage and with the unequal distribution of power, income, goods and services. According to the World Health Organization, there are also powerful social and psychological factors and life circumstances that can serve to compound health and wellbeing inequalities. The topics included in the Good Practice Guide series reflect the wider determinants of health and the range of approaches necessary to reduce health inequalities. This first set of three guides is designed, in part, to test their usefulness. There are many other issues and areas where evidence of what works may be needed. It is envisaged that further guides will follow on other issues. All of the guides will be kept under review and amended in light of experience.

Good Practice Guides: Reducing young people's drinking

Actions to tackle health inequalities demand the efforts of government, statutory organisations, and community, voluntary and private sectors. This Good Practice Guide to reducing young people's drinking is one of a series designed to capture information about health inequalities and highlight evidence-based interventions and key actions for improvement across sectors.This resource was contributed by The National Documentation Centre on Drug Use.

U.S. National Parks and "The Tragedy of the Commons" : A contribution to the characterization of U.S. mountain guides' professional practice

This paper aims at presenting the stakes related to the access to protected land in the United States and to its conservation, through the analysis of the professional practice of U.S. mountain guides. From a methodological standpoint, this research is based both on a theoretical analysis grounded in the field of environmental economics and on an empirical study. The authors' starting point is Garrett Hardin's paper, "The Tragedy of the Commons" (Science, 1968), even if it introduces some confusion on the notion of common goods. So as to avoid this confusion, the authors use two theoretical tools pertaining to a typology of common goods and the different property rights that can be applied in National Parks. Finally, they apply this framework to the observations made on the field in Colorado in July 2009.

Good Practice Guides

This series of Good Practice Guides is designed to share important information about health inequalities and some of the evidence-based measures that can be taken to reduce the stark differences in health and wellbeing within populations.

Thyroid hormone in biodegradable nerve guides stimulates sciatic nerve regeneration: a potential therapeutic approach for human peripheral nerve injuries.

It has been already demonstrated that thyroid hormone (T3) is one of the most important stimulating factors in peripheral nerve regeneration. We have recently shown that local administration of T3 in silicon tubes at the level of the transected rat sciatic nerve enhanced axonal regeneration and improved functional recovery. Silicon, however, cannot be used in humans because it causes a chronic inflammatory reaction. Therefore, in order to provide future clinical applications of thyroid hormone in human peripheral nerve lesions, we carried out comparative studies on the regeneration of transected rat sciatic nerve bridged either by biodegradable P(DLLA-(-CL) or by silicon nerve guides, both guides filled with either T3 or phosphate buffer. Our macroscopic observation revealed that 85% of the biodegradable guides allowed the expected regeneration of the transected sciatic nerve. The morphological, morphometric and electrophysiological analysis showed that T3 in biodegradable guides induces a significant increase in the number of myelinated regenerated axons (6862 +/- 1831 in control vs. 11799 +/- 1163 in T3-treated). Also, T3 skewed the diameter of myelinated axons toward larger values than in controls. Moreover, T3 increases the compound muscle action potential amplitude of the flexor and extensor muscles of the treated rats. This T3 stimulation in biodegradable guides was equally well to that obtained by using silicone guides. In conclusion, the administration of T3 in biodegradable guides significantly improves sciatic nerve regeneration, confirming the feasibility of our technique to provide a serious step towards future clinical application of T3 in human peripheral nerve injuries.

Evaluation de la campagne de lutte contre le SIDA de l'Office fédéral de la santé publique (OFSP) : 1987-1988 : questionnaires et guides d'interviews : annexe au Cahier no 16 s.1

[Table des matières] Comportements à risque et usage des préservatifs (enquête représentative auprès des jeunes Suisses de 17-30 ans): questionnaire. - Comportements à risque et usage de préservatifs (enquête auprès des médecins Sentinelles): questionnaires. - Attitudes des leaders d'opinion informels: questionnaires. - Enquête "Adolescents": questionnaire et guide d'entretien. - Enquête "Dragueurs": projet de grille-questionnaire. - Enquête "Sex-tourisme tropical": guide d'interview. - Enquête "Homosexuels": questionnaire et guide d'interview. - Enquête "Toxicomanes": questionnaire.

L'Indicateur des locations : guides des locataires : publication spéciale des annonces de ventes d'immeubles, renseignements et avis divers ...

1862/07/15 (N1)-1862/07/30.

L'Indicateur des locations : guides des locataires : publication spéciale des annonces de ventes d'immeubles, renseignements et avis divers ...

1862/08/01 (N2)-1862/08/15.

L'Indicateur des locations : guides des locataires : publication spéciale des annonces de ventes d'immeubles, renseignements et avis divers ...

Etat de collection : juillet 1862 (n° 1-30). août 1862 (n° 2-15)

“Who is steering the ship and which constellation guides the way? Exploring transparency in the European Central Bank during the time of crisis”

This paper explores transparency in the decision-making of the European Central Bank (ECB). According to ECB´s definition, transparency means that the central bank provides the general public with all relevant information on its strategy, assessments and policy decisions as well as its procedures in an open, clear and timely manner. In this paper, however, the interpretation of transparency is somewhat broader: Information is freely available and directly accessible to those who will be affected by the decisions. Moreover, the individuals shall be able to master this material. ECB´s negative attitude towards publication of documents has demonstrated central bank´s reluctance to strive towards more extensive transparency. By virtue of the definition adopted by the ECB the bank itself is responsible for determining what is considered as relevant information. On the grounds of EU treaties, this paper assesses ECB`s accountability concentrating especially on transparency by employing principal-agent theory and constitutional approach. Traditionally, the definite mandate and the tenet of central bank independence have been used to justify the limited accountability. The de facto competence of the ECB has, however, considerably expanded as the central bank has decisively resorted to non-standard measures in order to combat the economic turbulences facing Europe. It is alleged that non-standard monetary policy constitutes a grey zone occasionally resembling economic policy or fiscal policy. Notwithstanding, the European Court of Justice has repeatedly approved these measures. This dynamic interpretation of the treaties seems to allow temporarily exceptions from the central bank´s primary objective during extraordinary times. Regardless, the paper suggests that the accountability nexus defined in the treaties is not sufficient in order to guarantee the accountability of the ECB after the adoption of the new, more active role. Enhanced transparency would help the ECB to maintain its credibility. Investing in the quality of monetary dialogue between the Parliament and the ECB appears to constitute the most adequate and practicable method to accomplish this intention. As a result of upgraded transparency the legitimacy of the central bank would not solely rest on its policy outputs.