High-altitude physiology and pathophysiology: implications and relevance for intensive care medicine

Cellular hypoxia is a fundamental mechanism of injury in the critically ill. The study of human responses to hypoxia occurring as a consequence of hypobaria defines the fields of high-altitude medicine and physiology. A new paradigm suggests that the physiological and pathophysiological responses to extreme environmental challenges (for example, hypobaric hypoxia, hyper-baria, microgravity, cold, heat) may be similar to responses seen in critical illness. The present review explores the idea that human responses to the hypoxia of high altitude may be used as a means of exploring elements of the pathophysiology of critical illness

A select bouquet of leadership theories advancing good governance and business ethics: a conceptual framework

How authors and scholars have approached leadership studies – in terms of their thinking, defining and studying – has changed remarkably over time. According to literature, this is predominantly due to greater optimism about the field and greater methodological diversity being employed to better understand complex, embedded phenomena. As a result, there has been a significant rise in the use of qualitative research approaches to the study of leadership. Numerous definitions, classifications, explanations and theories about leadership, exist in the contemporary literature. However, despite the vast array of literature, the challenge of failing leadership persists. Challenges, such as the speed of technological advancements, social, and economic change are ever-present, while the impact of COVID-19 is, as yet, uncertain. Despite these challenges, can companies compete successfully in the marketplaces they operate in while also remaining ethical and engaged with the challenges of the broader business and social environment? To answer this question, this study has undertaken qualitative research on the bouquet of trait, situational and value-based leadership theory, in order to re-assess both established and developing theories. The predominant aim is to describe, explain and analyse available literature in an attempt to ascertain academic guidance on how it might be possible to enable leaders and society to mitigate leadership challenges by proposing a conceptual framework that could support leadership theory and, in so doing, take an academic stance in providing better answers or guidance to the failures currently being experienced. Several authors have noted that leadership makes a difference with resulting impacts on many which implies that to make the world a better place, leadership has two contradictory elements; good and bad. These elements are reflected in today’s connected world where the media, either showers praise on leaders or writes articles deriding their incompetence and abuse of their roles at all levels The proposed conceptual framework of this study endeavours to enable society and leaders, practically and at an individual level, to evaluate leadership issues and link leadership frameworks to their everyday lives and, in so doing, aid in mitigating the challenges being faced.Business ManagementD.B.L

Institutionnalisme et évolutionnisme sont-ils complémentaires ? La transition comme mise à l’épreuve

L’objet de cet article est de dégager non pas les points communs, mais les complémentarités éventuelles entre l’évolutionnisme et l’institutionnalisme économique. Le terrain de cette confrontation est constitué par les économies européennes engagées dans le processus de transformations économiques de grande ampleur appelé « transition économique » - en particulier la Russie dans son processus d'ouverture économique. L'article propose une grille de lecture croisant deux axes situés au cœur des problématiques institutionnaliste et évolutionniste : l'alternative création/sélection dans les processus d'évolution économique d'une part, la place des institutions dans le changement d'autre part. Le résultat de l'application de cette grille aux travaux ayant traité de la transition et se réclamant des mouvances institutionnaliste et évolutionniste est probant : l'hypothèse d'une complémentarité entre les deux familles de travaux est corroborée, ce qui ouvre un programme de recherche prometteur pour une « économie institutionnelle du changement ».The aim of this article is to scrutinize the complementarities between two traditions of economic research: institutionnalism and evolutionnary economics. The empirical background of this study is the transition of eastern and central european economies, in particular the economic opening of the Russian Federation. We propose a framework for the analysis articulating two main topics of discussion for both traditions: the alternative between creation and selection in the process of evolution and the role of institutions in the economic change. As a result, we find that the complementarity hypothesis is strong enough to allow researchers interested in this field to investigate a new research program that could combine evolutionnary economics and institutional economics in an “institutional economics of change”

Combined Therapy of Orthopedic Surgery after Deep Brain Stimulation in Cerebral Palsy Mixed Type - A Case Report -

Dystonia is a symptom defined by involuntary and irregular contractions of the muscles, which cause movement disorders and postural problems. Deep brain stimulation (DBS) in globus pallidus interna (GPi) is a good option for controlling dystonia. DBS has already been shown to have significant effects on primary dystonia as well as Parkinson's disease. Dystonia is very difficult to manage, as seen in cerebral palsy (CP) mixed with spasticity. As CP patients grow, their musculoskeletal problems may require orthopedic surgery. However, the outcome of orthopedic surgery is not usually suitable due to dystonia. Therefore, we attempted to control dystonia through DBS initially and perform orthopedic surgery to correct musculoskeletal deformities after treatment of dystonia. Herein, we report a case that showed remarkable improvement in terms of the dystonia rating scale and gait pattern after combined therapy of DBS and orthopedic surgery

What does the Covid-19 crisis reveal about economics and the economy? Introduction to this issue

Just a year after it was announced that a new virus had been discovered in the city of Wuhan, China, the world is no longer the same. The transformations wrought by the pandemic and the collective responses to it (lockdown of populations, drastic cuts in the movement of goods and more widely in economic and social activity) will entail structural effects. However, it is difficult to get a handle on the scope and nature of those effects. The Revue de la régulation posted a call for papers to j..

Brain Processing of Emotional Scenes in Aging: Effect of Arousal and Affective Context

International audienceResearch on emotion showed an increase, with age, in prevalence of positive information relative to negative ones. This effect is called positivity effect. From the cerebral analysis of the Late Positive Potential (LPP), sensitive to attention, our study investigated to which extent the arousal level of negative scenes is differently processed between young and older adults and, to which extent the arousal level of negative scenes, depending on its value, may contextually modulate the cerebral processing of positive (and neutral) scenes and favor the observation of a positivity effect with age. With this aim, two negative scene groups characterized by two distinct arousal levels (high and low) were displayed into two separate experimental blocks in which were included positive and neutral pictures. The two blocks only differed by their negative pictures across participants, as to create two negative global contexts for the processing of the positive and neutral pictures. The results show that the relative processing of different arousal levels of negative stimuli, reflected by LPP, appears similar between the two age groups. However, a lower activity for negative stimuli is observed with the older group for both tested arousal levels. The processing of positive information seems to be preserved with age and is also not contextually impacted by negative stimuli in both younger and older adults. For neutral stimuli, a significantly reduced activity is observed for older adults in the contextual block of low-arousal negative stimuli. Globally, our study reveals that the positivity effect is mainly due to a modulation, with age, in processing of negative stimuli, regardless of their arousal level. It also suggests that processing of neutral stimuli may be modulated with age, depending on negative context in which they are presented to. These age-related effects could contribute to justify the differences in emotional preference with age

Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK

These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone-producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during the peri-operative period. Many more patients other than those with adrenal and hypothalamic-pituitary causes of adrenal failure are receiving glucocorticoids as treatment for other medical conditions. Daily doses of prednisolone of 5 mg or greater in adults and 10-15 mg.m-2 hydrocortisone equivalent or greater in children may result in hypothalamo-pituitary-adrenal axis suppression if administered for 1 month or more by oral, inhaled, intranasal, intra-articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency. A pragmatic approach to adrenal replacement during major stress is required; considering the evidence available, blanket recommendations would not be appropriate, and it is essential for the clinician to remember that adrenal replacement dosing following surgical stress or illness is in addition to usual steroid treatment. Patients with previously undiagnosed adrenal insufficiency sometimes present for the first time following the stress of surgery. Anaesthetists must be familiar with the symptoms and signs of acute adrenal insufficiency so that inadequate supplementation or undiagnosed adrenal insufficiency can be detected and treated promptly. Delays may prove fatal

A Case of Peripherally Induced Task-Specific “Lipstick Dystonic Tremor”

Background: Peripherally induced movement disorders (PIMDs) represent a rare and debated complication of peripheral trauma. Phenomenology Shown: We report a case of task-specific “lipstick” jerky dystonic tremor as a consequence of traumatic shoulder injury, successfully treated with EMG-guided botulinum toxin injections. Educational Value: This case expands the phenotypic spectrum of PIMDs, with a visual example of a task-specific dystonic tremor after peripheral trauma, and the efficacy of EMG-guided botulinum toxin treatment in the setting of posttraumatic dystonic tremor