Targeted Temperature Management at 36°C in the treatment of out- of- hospital cardiac arrest

Introduction: Targeted temperature management (TTM) had been shown to limit neurological damage that is incurred in the post- cardiac arrest period. However, the temperature at which neurologic protection is greatest is still unknown. This review analyzes mortality rates and neurologic outcomes of groups treated with TTM at 36°C vs TTM at 32°C- 34°C. Methods: A literature search was conducted in November 2019 in the PubMed and Ovid databases. A total of six articles, randomized controlled trials and retrospective studies, were selected based on relevance to the research question, study design and population demographics. Results: An analysis of the articles revealed that there was no statistically significant difference in mortality or neurologic function between the 32°C- 34°C group and the 36°C group in all studies that investigated these outcomes. Other studies also measured adverse events that occurred during treatment and found that the 36°C groups had lower rates of shivering, fever and severe bleeding. Discussion: Most studies found no difference between the 32°C- 34°C and the 36°C groups in regard to mortality and neurologic outcomes. The majority of the studies used the Cerebral Performance Category (CPC) as the form of measurement for neurologic functioning, and this review found congruency in results across studies using this method. Other studies used different rating scales that cannot be compared but showed similar outcomes in relation to neurologic functioning. Conclusion: TTM at 36°C should be considered an equally valid treatment as it pertains to neurologic outcomes in patients experiencing OHCA when compared to TTM at 32°C- 34°C. Further research should consider the adverse events, effects on other body systems, long term outcomes and feasibility of obtaining and sustaining a temperature of 36°C

Something in Nothing: A Discussion of Madness and Wisdom in King Lear

This essay argues against Shakespeare critic David Kastan’s nihilistic reading of King Lear. While I agree that nothingness lies at the heart of the tragedy, I maintain that the recurring theme of nothing does not depict a world devoid of meaning. Rather, Shakespeare suggests that the recognition of the abyss is necessary in the quest for higher meaning. I approach this debate through various philosophical lenses, presenting a reading that equates wisdom and nothingness. Cordelia’s recognition of the limitations of human knowledge first introduces this idea. I detect elements of the divine nature of nothingness in the seemingly nonsensical speeches of Edgar and the Fool, illustrating the nature of divine truth as being something outside the realm of human understanding. Lear, dismissing this divine wisdom as false, consequently falls into a state of diseased madness as he consumed by his obsession with material reality. And so, I hold that Shakespeare ascribes meaning to nonsense, asserting that only through the recognition of nothingness can one approach divine truth

A hard nut to crack : regulatory failure shows how rating really works

Credit rating agencies such as Moody’s and Standard & Poor’s are key players in the governance of global financial markets. Given the very strong criticism the rating agencies faced in the wake of the global financial crisis 2008, how can we explain the puzzle of their survival? Market and regulatory reliance on ratings continues, despite the shift from a light-touch to a mandatory system of agency regulation and supervision. Drawing on the analysis of rating agency regulation in the US and the EU before and after the financial crisis, we argue that a pervasive, persistent and, in our view, erroneous understanding of rating has supported the never-ending story of rating agency authority. We show how treating ratings as metrics, private goods, and independent and neutral third-party opinions contributes to the ineffectiveness of rating agency regulation and supports the continuing authoritative standing of the credit rating agencies in market and regulatory practices

Musées et accessibilité: de la sélection de l'information à la médiation, quelles approches pour les publics en situation de handicap visuel ?

L’accès aux musées pour les publics en situation de handicap visuel constitue un défi considérable, que de plus en plus d’institutions s’attellent à relever. Au-delà des difficultés liées aux déplacements physiques et à l’orientation dans l’espace, la complexité réside aussi dans la transmission de l’objet muséal, de ses contenus informatifs et de son ressenti. Alors que, traditionnellement, l’exposition sollicite de manière quasi exclusive la vue, comment s’adresser à un public privé de ce sens ? Ce travail traite donc de la problématique de l’accessibilité informationnelle et émotionnelle. Il a pour objectifs de dresser un état des lieux de la théorie et de la pratique dans ce domaine en Suisse et à l’étranger, de recueillir les besoins des handicapés de la vue et d’explorer les différents moyens permettant de communiquer des informations et de générer des émotions lors d’une visite. Il s’adresse aux musées souhaitant développer l’accueil des publics aveugles et malvoyants, en leur offrant l’occasion de mieux comprendre les attentes spécifiques de cette catégorie de visiteurs et en leur fournissant un panel d’exemples de médiations, réalisées ou non. Dans la première partie de ce travail, l’état de l’art regroupe d’abord des données contextuelles sur la définition du handicap visuel, qui s’avère être fort varié suivant les déficiences et les vécus des personnes atteintes, et les aspects juridiques traitant de l’égalité d’accès à la culture. Il rassemble ensuite les éléments touchant à la médiation, allant de l’éducation à l’art à la formation du personnel, en passant par les dispositifs eux-mêmes, classés en fonction des sens qu’ils stimulent. Enfin, il présente des exemples de médiations en Suisse et dans le monde. Sur la base cette première recherche, nous avons mené une enquête qualitative sur le territoire genevois, sous la forme d’un entretien avec des médiateurs culturels et d’un focus group avec des visiteurs de musées ayant une déficience visuelle, recrutés par le biais d’associations d’aide aux aveugles. Les résultats de ces entrevues sont présentés dans la deuxième partie de ce dossier. Ils permettent de mieux cerner la nature de l’offre et de la demande en matière de médiation pour les handicapés de la vue. L’une et l’autre sont également comparées pour évaluer leur degré d’adéquation. Dans la troisième partie de cette étude, la confrontation des résultats de notre enquête avec l’état de l’art fait ressortir les similitudes et les décalages entre la théorie et les pratiques actuelles à Genève. Parmi les éléments mis en évidence, nous pouvons notamment citer la prépondérance de la médiation humaine par rapport à la médiation technologique, l’importance de la stimulation de l’ensemble des sens dans la transmission des émotions et la nécessité de développer des dispositifs adaptés à tous les types de handicaps visuels. Enfin, notre réflexion débouche sur une série de recommandations à l’attention des institutions culturelles

L'influence des programmes de formation et des codes d'éthique sur l'image de la profession de bibliothécaire

Le présent travail a comme objectif d’explorer des pistes de recherche jusqu’à maintenant un peu négligées : les codes de déontologie et les programmes de formation de bibliothécaires dans six pays différents, à savoir : Suisse, Italie, France,Belgique, Canada et Etats-Unis. Si la formation et les codes déontologiques ont déjà fait l’objet de plusieurs études, Ce travail veut aussi réfléchir autour de l’influence, des liens existants et potentiels que ces deux éléments ont sur l’image actuelle et future de la profession. Il veut également comprendre si ceux-ci sont porteurs de stéréotypes et les propagent, influençant négativement notre image professionnelle, ou s’ils pourraient être plutôt des alliés des bibliothécaires dans la lutte contre les stéréotypes associés à leur travail. Bien évidemment, il s’agit d’une démarche empirique, car cette réflexion se base sur des suppositions. Tout d’abord, un état de l’art de la littérature professionnelle a été effectué, ce qui a permis de donner le contexte actuel et de rédiger une liste des stéréotypes récurrents. Ceux-ci ont permis, dans un deuxième temps, d’analyser tant les codes déontologiques que les formations dans le détail, à l’aide de grilles. Selon les résultats de ce travail, ni les codes de déontologie ni les formations de bibliothécaires prises en considération dans cette étude ne semblent être responsables de la diffusion d’une image négative de notre profession dans l’opinion publique. Les artisans de cette perception négative sont donc à rechercher ailleurs et cette étude dresse une liste des principaux responsables qui contribuent à la diffusion d’une image négative de la profession de bibliothécaire. Les résultats de cette réflexion débouchent sur des propositions à partir desquelles les bibliothécaires pourraient s’inspirer, pour finalement modifier la mauvaise perception que la plus grande partie de la société a de notre profession

Ecotoxicological properties of ketoprofen and the S(+)‐enantiomer (dexketoprofen): Bioassays in freshwater model species and biomarkers in fish PLHC‐1 cell line

The increased use of non-steroidal anti-inflammatory drugs (NSAIDs) has resulted in their ubiquitous presence in the environment. The toxicological properties of these two widely prescribed NSAIDs, namely - racemic ketoprofen (rac-KP) and its enantiomer S(+)-ketoprofen (dexketoprofen, DKP) were evaluated. Firstly, by acute and chronic toxicity tests using three representative model organisms (Vibrio fischeri, Pseudokirchneriella subcapitata and Ceriodaphnia dubia). Secondly, by evaluating the responses of biotransformation systems and multidrug resistance associated proteins (MRP1/MRP2) using the PLHC-1 fish hepatic cell-line. Toxicity data from both acute and chronic DKP exposure indicated higher sensitivity through inhibition of bioluminescence and algal growth and through increased mortality/immobilization compared to rac-KP exposure. The growth inhibition test showed that rac-KP and DKP exhibited different values for EC50 (240.2 µg/L and 65.6 µg/L, respectively). Furthermore, rac-KP and DKP did not exert cytotoxic effects in PLHC-1 cells, and produced compound-, time- and concentration-specific differential effects on CYP1A and GST levels. For CYP1A, the effects of rac-KP and DKP differed at transcriptional and catalytic level. Exposure to rac-KP and DKP modulated MRP1 and MRP2 mRNA levels and these effects were also dependent on compound, exposure time and concentration of the individual drug. The present study revealed for the first time, the interactions between these NSAIDs and key detoxification systems, and different sensitivity to the racemic mixture compared to its enantiomer. This article is protected by copyright. All rights reserved

Novel organ-specific effects of Ketoprofen and its enantiomer, dexketoprofen on toxicological response transcripts and their functional products in salmon

Racemic ketoprofen (RS-KP) and its enantiomer, dexketoprofen (S(+)-KP) are widely used non-steroidal anti-inflammatory drugs (NSAIDs), and commonly detected in the aquatic environment. The present study has evaluated the toxicological effects of RS-KP and S(+)-KP on biotransformation and oxidative stress responses in gills and liver of Atlantic salmon. Fish were exposed for 10 days using different concentrations of RS-KP (1, 10 and 100 μg/L) and S(+)-KP (0.5, 5 and 50 μg/L). Biotransformation and oxidative stress responses were analysed at both transcript and functional levels. In the gills, significant inhibitory effect at transcriptional and enzymatic levels were observed for biotransformation and oxidative stress responses. On the contrary, biotransformation responses were significantly increased at transcriptional and translational levels in the liver, while the associated enzymatic activities did not parallel this trend and were inhibited and further demonstrated by principal component analysis (PCA). Our findings showed that both compounds produced comparable toxicological effects, by producing organ-specific effect differences. RS-KP and S(+)-KP did not bioaccumulate in fish muscle, either due to rapid metabolism or excretion as a result of their hydrophobic properties. Interestingly, the inhibitory effects observed in the gills suggest that these drugs may not undergo first pass metabolism, that might result to downstream differences in toxicological outcomes

The near-death experience of the celtic tiger: A Model-Driven Narrative from the European Sovereign Debt Crisis

This article narrates Ireland's recent odyssey from the pride and envy of Europe to kneeling supplicant through the eyes of an econometric model of the government bond market. The exercise suggests that, in essence, two developments triggered and propelled Ireland's drift towards sovereign default: first, the global financial crisis that drove Ireland into a severe recession with collapsing tax revenues and increasing unemployment; second, a gap between the post-2007 increase in sovereign default risk that can actually be linked to macroeconomic fundamentals and the much bigger increase in perceived risk reflected by high interest rates and communicated by the massive downgrades of Ireland's sovereign debt ratin

Novel organ-specific effects of Ketoprofen and its enantiomer, dexketoprofen on toxicological response transcripts and their functional products in salmon.

Racemic ketoprofen (RS-KP) and its enantiomer, dexketoprofen (S(+)-KP) are widely used non-steroidal anti-inflammatory drugs (NSAIDs), and commonly detected in the aquatic environment. The present study has evaluated the toxicological effects of RS-KP and S(+)-KP on biotransformation and oxidative stress responses in gills and liver of Atlantic salmon. Fish were exposed for 10 days using different concentrations of RS-KP (1, 10 and 100 μg/L) and S(+)-KP (0.5, 5 and 50 μg/L). Biotransformation and oxidative stress responses were analysed at both transcript and functional levels. In the gills, significant inhibitory effect at transcriptional and enzymatic levels were observed for biotransformation and oxidative stress responses. On the contrary, biotransformation responses were significantly increased at transcriptional and translational levels in the liver, while the associated enzymatic activities did not parallel this trend and were inhibited and further demonstrated by principal component analysis (PCA). Our findings showed that both compounds produced comparable toxicological effects, by producing organ-specific effect differences. RS-KP and S(+)-KP did not bioaccumulate in fish muscle, either due to rapid metabolism or excretion as a result of their hydrophobic properties. Interestingly, the inhibitory effects observed in the gills suggest that these drugs may not undergo first pass metabolism, that might result to downstream differences in toxicological outcomes

The near-death experience of the celtic tiger

This article narrates Ireland's recent odyssey from the pride and envy of Europe to kneeling supplicant through the eyes of an econometric model of the government bond market. The exercise suggests that, in essence, two developments triggered and propelled Ireland's drift towards sovereign default: first, the global financial crisis that drove Ireland into a severe recession with collapsing tax revenues and increasing unemployment; second, a gap between the post-2007 increase in sovereign default risk that can actually be linked to macroeconomic fundamentals and the much bigger increase in perceived risk reflected by high interest rates and communicated by the massive downgrades of Ireland's sovereign debt rating