Tailored polities in the shadow of the state's hierarchy. The CLLD implementation and a future research agenda

The paper provides a theoretical contribution to the multi-level governance debate, discussing the role of the policy instruments in tailoring polities for local development strategies. To this purpose, it examines the Community-Led Local Development (CLLD), a policy tool of the EU Cohesion Policy 2014–2020, which has generated more than 3000 local initiatives across the EU. An institutionalist perspective enables a reflection on the multi-level normative dimensions of these local initiatives. A combination of the post-functionalist governance theory, the soft space debate, state-theory and strategic-relational approach provides an interpretative framework to be deployed for a dedicated research agenda. The interpretative challenge is about whether the CLLD enables spatial-temporal fixes in which a deliberative polity pursues a spatial imaginary for an ad-hoc territory. The consequent analytical dimensions can be found in (a) the relationship between attendant ad-hoc polity, policy agenda, territorial design and societal processes; and (b) the meta-governance dimensions that locate the bottom-up constituency of this institutional technology in the shadow of state’s hierarchy. An overview of the CLLD implementation across the EU provides evidence on the latter

Performances of cpap devices with an oronasal mask

BACKGROUND: The aim of this bench study was to investigate the performances of 8 devices for noninvasive CPAP. METHODS: Eight devices for noninvasive CPAP with an orofacial mask were studied: Ventumask, Ventumask 30, EasyVent, EasyVent Emergency, Compact Model II, Flowone, Superflow, Boussignac CPAP valve. Each device was tested at oxygen input flows from 5 to 20 L/min, and the output gas flow was measured in static conditions. Each device was evaluated during a eupneic and a tachypneic simulated breathing test. RESULTS: The gas output flow generated by each device increased with higher oxygen input flow; EasyVent and Flowone produced the highest output flow (P < .001). At the simulated eupneic breathing test, Superflow and EasyVent showed a more stable pressure swing at different PEEP levels, whereas the other masks had a greater swing, between 10 and 15 cm H2O PEEP (P = .002 for all pairwise comparisons). During the tachypneic breathing test, the pressure swing was stable with Flowone and EasyVent (P = .055), whereas it had increased with other masks (P = .002 for all pairwise comparisons). CONCLUSIONS: We found a significant variation in the performances of the 8 CPAP devices examined in this study. The technical characteristics and limitations of different CPAP devices should be considered when using in patients with hypoxemic acute respiratory failure. Key words: CPAP; mechanical ventilation; respiratory failure; hypoxemia; orofacial mask; effectiveness; efficacy

ESPON TOWN spin-off Denmark. Small and medium sized towns in Denmark

This study “ESPON TOWN spin-off Denmark” provides supporting knowledge and evidence on the state and development of SMSTs in Denmark by using detailed datasets and by conducting an in-depth analysis of the local context . Based on a quantitative data-driven analysis, it describes the main characteristics of SMSTs in Denmark, how they differ from each other and what role various aspects including tourism and services play. Furthermore, it presents a short update of SMST research as well as a recap of recent Danish policies related to SMSTs. Finally, it provides perspectives on Denmark’s SMSTs within a European policy context

Ergothioneine Biosynthesis and Functionality in the Opportunistic Fungal Pathogen, Aspergillus fumigatus.

Ergothioneine (EGT; 2-mercaptohistidine trimethylbetaine) is a trimethylated and sulphurised histidine derivative which exhibits antioxidant properties. Here we report that deletion of Aspergillus fumigatus egtA (AFUA_2G15650), which encodes a trimodular enzyme, abrogated EGT biosynthesis in this opportunistic pathogen. EGT biosynthetic deficiency in A. fumigatus significantly reduced resistance to elevated H2O2 and menadione, respectively, impaired gliotoxin production and resulted in attenuated conidiation. Quantitative proteomic analysis revealed substantial proteomic remodelling in ΔegtA compared to wild-type under both basal and ROS conditions, whereby the abundance of 290 proteins was altered. Specifically, the reciprocal differential abundance of cystathionine γ-synthase and β-lyase, respectively, influenced cystathionine availability to effect EGT biosynthesis. A combined deficiency in EGT biosynthesis and the oxidative stress response regulator Yap1, which led to extreme oxidative stress susceptibility, decreased resistance to heavy metals and production of the extracellular siderophore triacetylfusarinine C and increased accumulation of the intracellular siderophore ferricrocin. EGT dissipated H2O2 in vitro, and elevated intracellular GSH levels accompanied abrogation of EGT biosynthesis. EGT deficiency only decreased resistance to high H2O2 levels which suggests functionality as an auxiliary antioxidant, required for growth at elevated oxidative stress conditions. Combined, these data reveal new interactions between cellular redox homeostasis, secondary metabolism and metal ion homeostasis

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials

The aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients

Insulin-like growth factor-1 as predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma: A pilot study

Background: Growth hormone (GH)-producing pituitary tumors account for 10 to 15% of pituitary tumors. The hypersecretion of GH may induce changes in the airway anatomy through the activation of Insulin-like Growth factor 1(IGF-1) pathway. We sought investigate the role IGF-1 as a potential predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma. Methods: This study was a single center retrospective study. We included 33 patients undergoing transsphenoidal resection of GH-producing pituitary. We recorded demographic data, el-Ganzouri risk index (EGRI) and modified Look-Evaluate-Mallampati-Obstruction-Neck mobility (mLEMON) score, and pituitary hormone plasma levels. We performed ordinal logistic regression to analyze the relationship between IGF-1 and EGRI, mLEMON, and Cormack-Lehane Grade score and a multiple logistic regression to test the capability of EGRI, mLEMON and IGF-1 levels to predict Cormack-Lehane score. Receiver operating curve (ROC), area under the curve (AUC), and cut-off value of IGF-1 were calculated. Results: Only 14 (42.8%) and 12 (36.36%) patients showed predictive factors of difficult intubation according to EGRI and mLEMON score, respectively. IGF-1 significantly correlated with Cormack-Lehane (p = 0.005879) but not with mLEMON and EGRI (p = 0.3080 and 0.4146, respectively). In multiple regression model IGF-1 correlated only with Cormack-Lehane grade (p = 0.0089). Area under ROC was 0.8571 and cut-off value of IGF-1 was 186.15 ng/ml. Conclusion: Higher IGF-1 levels correlate with the probability of having a higher Cormack-Lehane score; classical bedside scores, such as mLEMON and EGRI, were not able to predict difficult laryngoscopy in our population

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

‘Left behind places’: a geographical etymology

‘Left behind places’ has become the leitmotif of geographical inequalities since the 2008 crisis. Yet, the term’s origins, definition and implications are poorly specified and risk obscuring the differentiated problems and pathways of different kinds of areas. This paper explicates the geographical etymology and spatial imaginary of ‘left behind places’. It argues that the appellation and its spatial expression have modified how geographical inequalities are understood and addressed by recovering a more relational understanding of multiple ‘left behind’ conditions, widening the analytical frame beyond only economic concerns, and opening up interpretations of the ‘development’ of ‘left behind places’ and their predicaments and prospects. While renewing interest in fundamental urban and regional concerns, what needs to endure from the ascendance of the ‘left behind places’ label is the terminology and spatial imaginary of reducing geographical inequalities and enhancing social and spatial justice

'Left behind places': a geographical etymology

'Left behind places' has become the leitmotif of geographical inequalities since the 2008 crisis. Yet, the term's origins, definition and implications are poorly specified and risk obscuring the differentiated problems and pathways of different kinds of areas. This paper explicates the geographical etymology and spatial imaginary of 'left behind places'. It argues that the appellation and its spatial expression have modified how geographical inequalities are understood and addressed by recovering a more relational understanding of multiple 'left behind' conditions, widening the analytical frame beyond only economic concerns, and opening up interpretations of the 'development' of 'left behind places' and their predicaments and prospects. While renewing interest in fundamental urban and regional concerns, what needs to endure from the ascendance of the 'left behind places' label is the terminology and spatial imaginary of reducing geographical inequalities and enhancing social and spatial justice