"Lovingkindness and truth have met together: righteousness and peace have met each other" (PS 84, 11). The christian Novitas of the reconciliation

La Ley del Talión es un punto de referencia esencial, ya que se basa en el principio de “proporcionalidad” entre el crimen y el castigo. La originalidad Antiguo Testamento consiste en unir a los requisitos de la ley y la misericordia de Dios. En el Nuevo Testamento, la presencia de los pecadores no está asociado con la condena o el castigo, pero el perdón, encarnado en la práctica de la penitencia. La idea de que cada castigo debe apuntar a la mejora moral del delincuente se encuentre en las dos frases más significativas del derecho canónico, dos penales en la legislación vigente, a pesar de que, a lo largo de los siglos, tienen una profunda evolución. La novedad cristiana consiste en una persona, Cristo reconciliador. Para los cristianos, la reconciliación es el resultado de una vida fructífera y transformada por la práctica de la oración y los sacramentos, especialmente la Penitencia y de la Eucaristía, fuente de vida divina.The Talion Law is an essential reference point since it is based on the principle of “proportionality” between crime and punishment. The originality of the Old Testament is to unite the requirements of the Law and the mercy of God. In the New Testament, the presence of sinners is not associated with condemnation or punishment, but with forgiveness, which is embodied in the practice of penance. The idea that any punishment must aim at the moral improvement of the culprit is present in the two most significant penalties of canon law, two punishments present in current law, even though over the centuries they have known a profound evolution. Christian novelty consists in a person, Christ reconciling. For the Christian, reconciliation is the result of a fertilized life transformed by the practice of prayer and sacraments, especially Penance and Eucharist, source of divine life.Ciencias ReligiosasDerech

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

En guise de conclusion…

Organiser un colloque international requiert intelligence, talent, volonté, moyens économiques, relations dans le monde universitaire, mais venir à bout de la publication d’actes dignes de ce nom relève de la passion. Or, les communications données lors du colloque international consacré à « La Justice dans les cités épiscopales du Moyen Âge à la fin de l’Ancien Régime » ont été réunies en un temps record, grâce à Madame Béatrice Fourniel, qui a été la cheville ouvrière de ce colloque, en a a..

Un précurseur de la réforme catholique en Lorraine. Nicolas Psaume évêque et comte de Verdun (1548-1575)

The premonstratensian Nicolas Psaume (1518-1575), abbot of St Paul of Verdun, then bishop of Verdun (1548-1575), didn't participate only at the two last periods of the Council of Trent, but he tried to apply the decrees of the Council in his diocese during the wars of religion, using the pastoral means that the Council would advocate, and especially the diocesan synod. He dedicated his zeal to promote the teaching of the doctrine. Desirous of doing his clergy the key of vault of the catholic reform, he contributed to the establishment of the type of the " pastor of souls " according to the tridentine directives, insisting on the clergymen's intellectual and spiritual formation, helped in this task by the Company of Jesus. Tridentine prelate, Psaume must be mentioned among the pioneers of the catholic reform.Le prémontré Nicolas Psaume (1518-1575), abbé de Saint-Paul de Verdun, puis évêque de Verdun (1548-1575), n'a pas seulement participé aux deux dernières périodes du concile de Trente, il a aussi essayé d'appliquer les décrets du concile dans son diocèse pendant les Guerres de religion, à l'aide des moyens pastoraux promus par le concile, spécialement le synode diocésain. Il a cherché à développer l'enseignement de la doctrine. Désireux de faire du clergé la clef de voûte de la réforme catholique, il a contribué à l'établissement d'un type de «pasteur des âmes» selon les directives tridentines, en insistant sur la formation intellectuelle et spirituelle des clercs, avec l'aide de la Société de Jésus. Prélat tridentin, Psaume doit être placé parmi les pionniers de la réforme catholique.Ardura Bernard. Un précurseur de la réforme catholique en Lorraine. Nicolas Psaume évêque et comte de Verdun (1548-1575). In: Revue d'histoire de l'Église de France, tome 75, n°194, 1989. Les débuts de la réforme catholique dans les pays de langue française (1560-1620) pp. 35-43